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Full-Text Articles in Occupational Therapy
Effectiveness Of Occupational Therapy Services On Quality Of Life Among Chronically Homeless Mothers With Children, Stephanie Dullum, Caitlyn Fussy, Cierra Jacobson
Effectiveness Of Occupational Therapy Services On Quality Of Life Among Chronically Homeless Mothers With Children, Stephanie Dullum, Caitlyn Fussy, Cierra Jacobson
Critically Appraised Topics
Chronically homeless mothers face many challenges with their quality of life due to trauma, mental illness, substance abuse, and stress that impacts the person, their environment, and occupations. Currently there is a lack of occupational therapy interventions for improving the quality of life for this population. The purpose of this critically appraised topic is to address the role of occupational therapy within the population of chronically homeless mothers and how it can improve their quality of life.
Family-Centered Care For Preschool Children With Disabilities, Kaylee Athmann, Ashley Freund, Rachel Koenig
Family-Centered Care For Preschool Children With Disabilities, Kaylee Athmann, Ashley Freund, Rachel Koenig
Critically Appraised Topics
The purpose of this critically appraised topic paper was to define family-centered care, to look at family-centered care through the model of EHP, and to show the unique role occupational therapy plays in family-centered care. More specifically, we aimed to find the effects of family-centered care on health management. While family-centered care has been cited as beneficial by occupational therapists, there is a gap in these services being provided to preschoolers with disabilities.
Intervention Strategies To Combat The Impacts Of Covid-19 On Adolescents Mental Health: A Critically Appraised Topic, Rylie Garner, Lauryne Griego, Kailey Squier, Jamie Steinhoff
Intervention Strategies To Combat The Impacts Of Covid-19 On Adolescents Mental Health: A Critically Appraised Topic, Rylie Garner, Lauryne Griego, Kailey Squier, Jamie Steinhoff
Critically Appraised Topics
Does sensory modulation and physical activity as an occupational therapy intervention improve mental health outcomes in adolescents resulting from the COVID-19 pandemic?
The Benefits Of Habituation Altering Occupational Therapy Interventions To Improve Engagement In Adls And Iadls For Adults With Chronic Pain, Alexis Brolsma, Aleece Durbin, Casidi Pullar
The Benefits Of Habituation Altering Occupational Therapy Interventions To Improve Engagement In Adls And Iadls For Adults With Chronic Pain, Alexis Brolsma, Aleece Durbin, Casidi Pullar
Critically Appraised Topics
Adults experiencing chronic pain have difficulties performing ADLs and IADLs, consequently lowering their quality of life. Current research supports multiple interventions used by occupational therapists when working with adults with chronic pain, however, there is no primary intervention identified (Andrews et al., 2018; Guy et al., 2019; Guy et al., 2020; Nielsen et al., 2021; Schmid et al., 2019; Simon & Collins, 2017). The purpose of this CAT paper is to determine how beneficial occupational therapy interventions are at changing habits and routines (habituation) of adults (18+ years of age) with chronic pain in improving engagement in ADLs and IADLs.
Occupational Therapy In Palliative Care: Incorporating Meaningful Occupations And Education Programs For Occupational Therapists, Emily Geissler, Mariah Herring, Katya Kivi
Occupational Therapy In Palliative Care: Incorporating Meaningful Occupations And Education Programs For Occupational Therapists, Emily Geissler, Mariah Herring, Katya Kivi
Critically Appraised Topics
Based on the literature reviewed for this critically appraised topic (CAT), end-of-life care has become a more popular setting, and healthcare workers are beginning to see the need for occupational therapists. Due to the undefined role of an OT in this setting, it is difficult for the client to be provided with the best care that increases their quality of life near death, as well as inadequate training for how to address intervention. The issue found within palliative care is that clients are not provided the opportunity to engage in the meaningful activities that bring them joy. The purpose of …
Interventions For Adults With Rheumatoid Arthritis To Increase Quality Of Life And Motivation In Activities Of Daily Living And Instrumental Activities Of Daily Living: A Critically Appraised Topic, Erin Ferebee, Makenzie Kroupa, Makayla Tucker
Interventions For Adults With Rheumatoid Arthritis To Increase Quality Of Life And Motivation In Activities Of Daily Living And Instrumental Activities Of Daily Living: A Critically Appraised Topic, Erin Ferebee, Makenzie Kroupa, Makayla Tucker
Critically Appraised Topics
PICO:
P: Adults with a chronic condition of Rheumatoid Arthritis
I: Programs and interventions most effective to improve participation in ADL & IADL
C: Motivation levels & QOL
O: Increased participation in ADL & IADLS
Focused Question - What occupational therapy (OT) intervention approaches are best for Rheumatoid arthritis (RA) patients struggling with motivation, quality of life, as evidenced by the ability to participate in ADLs and IADLs?
Effectiveness Of Early Intervention Programs Addressing Mental Health Issues Caused By Long-Haul Covid-19 In Older Adults, Grace Kleinvachter, Lauren Fischer, Kelsey Rajewsky
Effectiveness Of Early Intervention Programs Addressing Mental Health Issues Caused By Long-Haul Covid-19 In Older Adults, Grace Kleinvachter, Lauren Fischer, Kelsey Rajewsky
Critically Appraised Topics
Lannigan & Tyminski (2021) shared that occupational therapy practitioners are ready to address the many complications that COVID-19 has caused, including emotional issues, by encouraging engagement in healthy occupations in their day-to-day lives. Occupational therapists have specific skills to combat these issues, help others reclaim their occupational identity, and improve quality of life (Lannigan & Tyminski, 2021; Wilcox & Frank, 2021). Symptoms of long-haul COVID-19 have greatly impacted the valued occupations of those over 50 years old, leading to an occupational justice need for further investigation. Occupational therapists should then use that knowledge to understand the degree of impact the …
Critically Appraised Topic: The Use Of Occupation-Based Sensory Intervention And Environmental Modification With School-Aged Children Who Have Experienced Trauma, Josie Huot, Abigail Kasper, Erin Siebenaler, Jessica Wetzel
Critically Appraised Topic: The Use Of Occupation-Based Sensory Intervention And Environmental Modification With School-Aged Children Who Have Experienced Trauma, Josie Huot, Abigail Kasper, Erin Siebenaler, Jessica Wetzel
Critically Appraised Topics
Children who have been exposed to trauma may develop sensory impairments, such as inadequate sensory processing and regulation when engaging in occupations within the school setting. Currently, there is a lack of evidence demonstrating the efficacy of sensory-based occupational therapy intervention with children who have experienced trauma. The purpose of this critically appraised topic paper is to describe the current evidence for utilizing sensory-based interventions, in combination with environmental modifications, to influence occupational engagement among school-aged children who have experienced adverse childhood experiences.
Effectiveness Of Occupational Therapy Self-Management Interventions Among Chronically Homeless Veterans With Mental Health And Substance Abuse Disorders, Jace Allard, Hannah Leisenheimer, Adeyinka Omotunde
Effectiveness Of Occupational Therapy Self-Management Interventions Among Chronically Homeless Veterans With Mental Health And Substance Abuse Disorders, Jace Allard, Hannah Leisenheimer, Adeyinka Omotunde
Critically Appraised Topics
Homeless veterans are challenged with chronic mental health and substance abuse disorders that affect their abilities to carry out their daily functions. There is a paucity of focused literature to address the extent to which occupational therapy interventions help chronically homeless veterans that struggle with substance abuse and mental health issues. The purpose of this critically appraised topic paper was to investigate and demonstrate the extent to which substance abuse and mental health occupational therapy programs may help to increase the performance range of self-management skills of chronically homeless veterans.
Efficacy Of Educational Programs For Homeless Adults With Mental Illness, Madison Herbeck, Samantha Proctor, Bailee Scheer
Efficacy Of Educational Programs For Homeless Adults With Mental Illness, Madison Herbeck, Samantha Proctor, Bailee Scheer
Critically Appraised Topics
Homeless adults continually face occupational deprivation. There is a lack of reimbursement for occupational therapy community-based interventions (Gutman, 2021). This critically appraised topic aims to explore how educational programs will impact and influence positive occupational engagement and quality of life for homeless adults with mental illness.
Occupational Therapy’S Ability To Address Perceived Stress Levels In Caregivers Of Individuals With Dementia, Kjerstin Drugan, Molly Van Drehle, Jadalyn Wagner
Occupational Therapy’S Ability To Address Perceived Stress Levels In Caregivers Of Individuals With Dementia, Kjerstin Drugan, Molly Van Drehle, Jadalyn Wagner
Critically Appraised Topics
Caregivers of individuals with dementia face unique challenges that affect their ability to participate in their occupations and maintain low-stress levels (Armstrong et al., 2019; Chiao et al., 2015; Cooper et al., 2010; Delgarno et al., 2021; Franzosa et al., 2019; Gleason & Miller, 2021; Lloyd et al., 2019; Madruga et al., 2020; Piersol et al., 2017; Sterling et al., 2021; Yong et al., 2020). Evidence has supported the benefits of occupational therapy intervention for caregiver well-being (Burgess et al., 2021; Lloyd et al., 2019; Raj et al., 2021; Sztramko et al., 2021; Yong et al., 2020). In this critically …
How The Physical Long-Haul Symptoms Of Covid-19 Influence Occupational Performance From A Person-Environment-Occupation Perspective: A Critically Appraised Topic, Emmalee Burtsfield, Amber Matlock, Alyssia Pucel
How The Physical Long-Haul Symptoms Of Covid-19 Influence Occupational Performance From A Person-Environment-Occupation Perspective: A Critically Appraised Topic, Emmalee Burtsfield, Amber Matlock, Alyssia Pucel
Critically Appraised Topics
An increasing number of adults continue to experience the long-term physical effects of COVID-19. Currently, there is uncertainty regarding the best practices in occupational therapy to address long-haul COVID-19 symptomology and its effects on people as research on the topic continues to emerge (Robinson et al., 2021). The purpose of this critically appraised paper is to identify prominent areas on which occupational therapists should focus during evaluation and intervention planning while considering the person, environment, and occupation to encompass the ideals of best practice when working with adult clients who are facing disruptions as a result of long-haul COVID-19 symptoms.
Effective Occupational Therapy Interventions For Reducing Parental Stress In The Neonatal Intensive Care Unit, Ann Landreville, Annah Greenmyer, Makayla Murden
Effective Occupational Therapy Interventions For Reducing Parental Stress In The Neonatal Intensive Care Unit, Ann Landreville, Annah Greenmyer, Makayla Murden
Critically Appraised Topics
John et al.’s (2018) study found that over half of the mothers in the NICU suffer from moderate to severe anxiety. This anxiety negatively impacts parents’ abilities to engage in the occupation of caring for their child, which can have long-term consequences. Currently, there is a lack of research on occupational therapy-specific interventions that focus on reducing parental stress in the NICU setting. The purpose of this critically appraised topic (CAT) is to discover which stress-reducing occupational therapy interventions have a positive impact on the abilities of parents to successfully care for their infants in the NICU.
Interventions Addressing Social And Leisure Participation For Adults With Musculoskeletal Chronic Pain, Kady Locke, Emily Ray, Josie Sylte
Interventions Addressing Social And Leisure Participation For Adults With Musculoskeletal Chronic Pain, Kady Locke, Emily Ray, Josie Sylte
Critically Appraised Topics
FOCUS QUESTION:
P - Adults 18-90 years of age
I - Exploration of most effective OT programs and interventions
C - Musculoskeletal chronic pain
O - Improved participation in social and leisure activities
What are the most effective occupational therapy interventions to improve social and leisure participation in adults aged 18 to 90 who experience chronic musculoskeletal pain?
Critically Appraised Topic Paper: What Is Motor Learning Theory? How Can It Be Implemented Into Occupational Therapy Interventions For Individuals With Cerebrovascular Accidents?, Allyson Bourque, Alison O'Sadnick, Alexis Skogen, Callie Vold
Critically Appraised Topic Paper: What Is Motor Learning Theory? How Can It Be Implemented Into Occupational Therapy Interventions For Individuals With Cerebrovascular Accidents?, Allyson Bourque, Alison O'Sadnick, Alexis Skogen, Callie Vold
Critically Appraised Topics
Purpose Statement
The purpose of this critically appraised topic (CAT) paper was to determine if motor learning theory guides interventions that are considered to be best practice for individuals with CVAs. We want to determine what is best practice for this population to provide practitioners with synthesized research allowing practitioners to implement the most effective, client-centered, evidence-based interventions possible.
Critically Appraised Topic: The Use Of Interprofessional Practice In Occupational Therapy, Rachel Cheatley, Jaecy Giegerich, Paige Mann
Critically Appraised Topic: The Use Of Interprofessional Practice In Occupational Therapy, Rachel Cheatley, Jaecy Giegerich, Paige Mann
Critically Appraised Topics
The theoretical lens of the Ecological of Human Performance model (EHP) (Dunn et al., 1994) was used to understand why interprofessional collaborative practice is essential to occupational therapists and other health sciences across various settings. The EHP model is an occupational therapy theory model that emphasizes the importance of context on an individual’s occupational performance and their range to perform in (Dunn et al., 1994). EHP is used to describe the environmental effects on performance range, in this case, effective interprofessional practice used by occupational therapists and other healthcare stakeholders, to identify the factors that limit and support quality care. …
The Use Of Sensory Processing Interventions To Improve Academics And Social Participation For Adolescents With Trauma, Michayla Burckhard, Austin Ellis, Michael Helgeson
The Use Of Sensory Processing Interventions To Improve Academics And Social Participation For Adolescents With Trauma, Michayla Burckhard, Austin Ellis, Michael Helgeson
Critically Appraised Topics
Childhood and adolescent trauma are defined as psychological, physical, and sexual abuse, as well as household dysfunctions that include substance abuse, criminal history, mental illness, and witnessing violence or abuse against a parent (Felitti et al., 1998; Noel-London et al., 2021). Adverse childhood experiences (ACEs) are a form of trauma for those under the age of 18 involving neglect and abuse (Elmore & Crouch, 2020). ACEs have been shown to have a lasting impact on an individual’s life, including violence, behavioral disorders, and mental health disorders (Noel-London et al., 2021; Sigurvinsdottir et al., 2021). ACEs and trauma can impact all …
Prevention Of Falls In Adults Older Than 60 Years Through Therapeutic Riding: A Critically Appraised Topic, Isabella Johannes, Dominique Menard, Alicia Young
Prevention Of Falls In Adults Older Than 60 Years Through Therapeutic Riding: A Critically Appraised Topic, Isabella Johannes, Dominique Menard, Alicia Young
Critically Appraised Topics
This critically appraised topic paper will address the focus question relating to the intervention of therapeutic riding. A critically appraised topic (CAT) is an overview of scientific literature about an intervention or practical issue and how it relates to practice (Barends et al., 2017). The use of the Ecological Human Performance (EHP) model is to guide this CAT research with a theoretical basis. EHP was chosen for its emphasis on the person, environment, and tasks. The person is described in EHP as including their experiences, sensorimotor, cognition, and psychosocial abilities (Dunn et al., 1994). The use of EHP provides a …
Integrating Assistive Technology Into Outpatient Rehabilitation Programs To Increase Independent Living In Older Adults: A Critically Appraised Topic (Cat), Josie Anhorn, Kenadee Eyre, Tiana Griffith
Integrating Assistive Technology Into Outpatient Rehabilitation Programs To Increase Independent Living In Older Adults: A Critically Appraised Topic (Cat), Josie Anhorn, Kenadee Eyre, Tiana Griffith
Critically Appraised Topics
In the United States, older adults account for about “16% of the population” (Administration on Aging, 2020, p.5). Older adults are defined as anyone aged 60 and older. There has been a steady increase in the number of older adults living in the United States, and that number is expected to continue growing at a rapid rate as it is predicted that by 2040, older adults will make up approximately “21.6% of the population” (Administration on Aging, 2020, p. 5-6). The majority of this population does not reside in assisted living facilities or nursing homes but instead lives in the …
Effectiveness Of Kind Behavior Promotion In Bullying Prevention Among School-Aged Adolescents, Isabell Fetsch, Megan Fuka, Lexi Zahn
Effectiveness Of Kind Behavior Promotion In Bullying Prevention Among School-Aged Adolescents, Isabell Fetsch, Megan Fuka, Lexi Zahn
Critically Appraised Topics
Bullying is an important and prevalent issue among school-aged adolescents and adolescents. The highest rates of bullying were reported in middle schools, followed by high schools, combined schools, and primary schools, respectively. Approximately 1 in 5 high school students experience bullying at school and about 1 in 6 experience cyberbullying. The rates of bullying also differ between groups of individuals. LGBTQ+ students are more likely to be bullied than their heterosexual counterparts, females are more likely to be bullied than males, and White students reported higher rates of bullying than Hispanic and Black students (Centers for Disease Control and Prevention …
Evidence For Planning As An Intervention Approach For Adults Transitioning Into Retirement, Emily Knust, Olivia Myers, Bridget Reuss
Evidence For Planning As An Intervention Approach For Adults Transitioning Into Retirement, Emily Knust, Olivia Myers, Bridget Reuss
Critically Appraised Topics
The retirement age in America is continuing to become older. Seven in ten working adults in the Baby Boomer generation said that they expect to work past age 65 or are already past that age and are still working. Of this generation, 42% would prefer to transition into their retirement by lessening their hours at their current career (Edlerson, 2019). Those who are choosing to retire later in their life are prolonging this transition to delay the loss of a meaningful occupation that they have held for several decades. For this critically appraised topic, the authors have operationally defined retirement …
Efficacy Of Cognitive Behavioral Therapy On Adults Experiencing Chronic Musculoskeletal Pain, Emma Lehman, Abbigail Smith, Krista Weiland
Efficacy Of Cognitive Behavioral Therapy On Adults Experiencing Chronic Musculoskeletal Pain, Emma Lehman, Abbigail Smith, Krista Weiland
Critically Appraised Topics
The purpose of this critically appraised topic (CAT) paper is to explore the effectiveness of pain reduction through cognitive behavioral therapy (CBT) in assisting men and women who have chronic musculoskeletal pain with instrumental activities of daily living. There is a gap in the literature regarding the effect of cognitive behavioral therapy when managing and perceiving chronic musculoskeletal pain. There is also a gap in long-term research in the performance and satisfaction of instrumental activities of daily living (IADLs) when living with chronic pain. Aegler and Satink (2009), Cheng et al. (2017) and Ehde et al. (2014) discussed the impact …
Impact Of Stress Management Strategies And Intervention On The Mental Health Of Farmers: A Critically Appraised Topic, Logan Anderson, Zach Gascho, Nicole Gentry, Ashley Vannelli
Impact Of Stress Management Strategies And Intervention On The Mental Health Of Farmers: A Critically Appraised Topic, Logan Anderson, Zach Gascho, Nicole Gentry, Ashley Vannelli
Critically Appraised Topics
The dynamic transactions between the environment, person, and occupation play a role in the success of the farmer, their access to healthcare, and their willingness to seek support with their stressors or difficulties. Depression, stress, and other mental health conditions are highly prevalent within the farming community. This population is less likely to seek out and utilize available mental health resources and services, and in many cases, mental health resources are not available in rural areas (Gunn et al., 2021; Kennedy et al., 2020).
Best Interventions For Working Adults Experiencing Chronic Musculoskeletal Pain, Hailey Koep, Samantha Larson, Michelle Mcnamee
Best Interventions For Working Adults Experiencing Chronic Musculoskeletal Pain, Hailey Koep, Samantha Larson, Michelle Mcnamee
Critically Appraised Topics
Chronic musculoskeletal pain is defined as ongoing pain felt in the bones, joints, and tissue of the body that persists for longer than three months (Booth et al., 2017; Joelsson et al., 2017). Worldwide, 30% of the population has experienced some form of chronic pain in their lifetime (Guy et al., 2020). When living with chronic pain, it can become difficult for working adults to engage in their everyday occupations such as activities of daily living (ADL), instrumental activities of daily living (IADL), health management, social participation, and leisure (American Occupational Therapy Association [AOTA], 2020). These troubles can affect an …
Interventions That Reduce Anxiety And Depression To Support Mediation Of Lifestyle Balance In Middle School Students, Briana M. Kent, Aleksander R. Kohn, Cammy C. Robertson
Interventions That Reduce Anxiety And Depression To Support Mediation Of Lifestyle Balance In Middle School Students, Briana M. Kent, Aleksander R. Kohn, Cammy C. Robertson
Critically Appraised Topics
Mental health disorders are internationally known as a leading cause of disability throughout almost 20% of the adolescent population experiencing devastating mental health problems. Current statistics note that the prevalence of impaired mental health within this population has increased by 21% from 2001 to 2011, indicating a continuation of severe effects from poor mental health on this vulnerable population (Danielson et al., 2020). Allison et al. (2014) estimated that at the time the article was written, 14 million children in the United States had a mental health disorder that interfered with their daily life. Research from the Centers for Disease …
Occupation-Based Intervention With Evaluation Of The Home Environment For Older Adults In A Long-Term Care Facility, Teo Faulkner, Autumn Hopkin, Anna Logan
Occupation-Based Intervention With Evaluation Of The Home Environment For Older Adults In A Long-Term Care Facility, Teo Faulkner, Autumn Hopkin, Anna Logan
Critically Appraised Topics
The purpose of this critically appraised topic (CAT) is to recommend education of longterm care staff on the residents and the residents’ previous experiences and preferred occupations and how home evaluation within the long-term care facility with recommendations for the environment could indicate where there is occupational deprivation, and lack of occupational based/client-centered interventions for adults 65 and older in long-term care facilities.
Post-Breast Cancer Related Lymphedema Interventions And Their Relationship To Social Involvement And Quality Of Life For Middle-Aged Women, Abby Bauman, Jenna Holm, Sarah Zuelzke
Post-Breast Cancer Related Lymphedema Interventions And Their Relationship To Social Involvement And Quality Of Life For Middle-Aged Women, Abby Bauman, Jenna Holm, Sarah Zuelzke
Critically Appraised Topics
In the United States, statistics have shown that there is a one in eight percent chance that a woman will develop breast cancer sometime throughout their life, and it is estimated that there will be 281,550 new cases of invasive breast cancer diagnosed in women in the year 2021 (American Cancer Society, 2021). One in five of the women who survive breast cancer will develop lymphedema within the initial three years following their breast cancer treatment (American College of Surgeons, 2013; DiSipio et al., 2013). Lymphedema is a chronic and progressive condition that is defined by the abnormal swelling caused …
Utilizing A Community-Based Core Approach To Foster Occupational Engagement In Individuals With Mental Health Conditions Within Rural Communities, Anne Domanus, Melanie Martinez, Sheena Miller
Utilizing A Community-Based Core Approach To Foster Occupational Engagement In Individuals With Mental Health Conditions Within Rural Communities, Anne Domanus, Melanie Martinez, Sheena Miller
Critically Appraised Topics
“Nearly 1 in 5 U.S. adults live with a mental illness,” which was approximately 51.1 million people in 2019 (National Institute of Mental Health, 2021, para. 1). This is an important issue within the country; however, it is not widely talked about, especially in rural areas. Research has shown that the prevalence of mental health conditions is consistent across urban and rural areas, but the stigma that surrounds mental health conditions is worse within rural communities (Thorne & Ebener, 2020). This has been attributed to the lack of access to resources, lack of knowledge about resources and mental health conditions …
The Effectiveness Of Intervention Facilitating Return To Work Through Improving Cognition For Those With Mild Traumatic Brain Injury, Madison Ertelt, Abbey Marinucci, Jaden Pikarski
The Effectiveness Of Intervention Facilitating Return To Work Through Improving Cognition For Those With Mild Traumatic Brain Injury, Madison Ertelt, Abbey Marinucci, Jaden Pikarski
Critically Appraised Topics
According to the Centers for Disease Control and Prevention (CDC) (2019), about 2.87 million traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States in 2019. It is estimated that around 1.5 million Americans suffer a traumatic brain injury every year. Approximately 2.5 to 6.3 million people currently live with a TBI-related disability (Centers for Disease Control and Prevention, 2019; Faul & Coronado, 2015, as cited in Powell et al., 2016). Specific populations are at a higher risk for sustaining a TBI. High-risk age groups include children aged four years or younger, young adults …
Impact Of Social Skills Groups On School Aged Children With Emotional Disturbance, Stephanie Coauette, Kaitlyn Ekre, Benjamin Stagg
Impact Of Social Skills Groups On School Aged Children With Emotional Disturbance, Stephanie Coauette, Kaitlyn Ekre, Benjamin Stagg
Critically Appraised Topics
According to the Individuals with Disabilities Education Act (U.S. Department of Education, 2017, Sec. 300.8), emotional disturbance is defined as a condition in which there are one or more of the following symptoms that interferes with a child’s ability perform successfully in their education: “An inability to learn that cannot be explained by intellectual, sensory, or health factors, an inability to build or maintain satisfactory interpersonal relationships with peers and teachers, inappropriate types of behavior or feelings under normal circumstances, a general pervasive mood of unhappiness or depression, and a tendency to develop physical symptoms or fears associated with personal …