Peer-reviewed article
A qualitative study of child participation in decision-making: Exploring rights-based approaches in pediatric occupational therapy
Deirdre O’Connor, Helen Lynch, Bryan Boyle ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how children experience decision-making in occupational therapy sessions in Ireland. Researchers interviewed six children, five parents, and six therapists using semi-structured interviews. The findings show that decision-making in these settings is mostly controlled by adults, and children's voices are often not heard. The study calls for occupational therapy services and training to better embed children's rights and ensure services are truly child-centred.
Key points
- Decision-making in pediatric occupational therapy is mostly adult-directed
- Children's voices are often overridden by adult-led services, priorities and agendas
- Three main themes identified: goal-setting experiences, adults as rights gatekeepers or defenders, and decision-making in context
- There is a gap between therapists' stated commitment to collaborative, client-centred practice and actual implementation of children's participation rights
- Children's rights need to be embedded as standard practice in occupational therapy
Limitations
This qualitative study with a small sample (six children) in Ireland cannot tell us how widespread these barriers to child participation are across different countries or occupational therapy settings, nor can it measure the scale of impact on child outcomes or wellbeing.
Abstract
BACKGROUND: According to Article 12 of the United Nations Convention on the Rights of the Child, therapists are duty-bound to include children in decisions that impact them. Although occupational therapists champion client-centred, collaborative practice, there remains a paucity of studies detailing children's rights and experiences of decision-making in pediatric occupational therapy. PURPOSE: This qualitative study described the decision-making experiences of children, parents and therapists in occupational therapy. METHODS: Semi-structured interviews were conducted with 17 participants (six children, five parents and six occupational therapists), and data analysed using thematic analysis. FINDINGS: Three themes emerged: 1) Goal-setting experiences; 2) Adults: child-rights gatekeepers or defenders? and 3) Decision-making in context. Findings suggest that decision-making is mostly adult directed, and children's voices are subsumed by adult-led services, priorities, and agendas. IMPLICATIONS: Children's rights need to be embedded as an aspect of best practice in providing services that are child-centred in occupational therapy practices and education.