Self-regulation practice in occupational therapy: a conceptual analysis

Child mental health is an area of clinical and research importance, particularly for occupational therapists who work with children with self-regulation difficulties. Self-regulation involves the ability to adapt cognitive, emotion or behaviour responses to match the demands of a specific task or environmental context. Self-regulation difficulties increase the risk for mental health issues, difficulties with relationships and poor academic and behaviour outcomes. As an emerging area of practice it is imperative that occupational therapists align theory with practice. Therefore, the aim of this thesis was to examine the theory of self-regulation and determine its alignment with contemporary occupational therapy practice. Firstly, a scoping review of the literature was conducted to identify and characterise self-regulation measurement for school-aged children. Sixty-seven studies were included in this review, which found a range of measures that did not appear to align with how the construct was defined. A second scoping review aimed to identify and map how self-regulation is defined and conceptualised in occupational therapy literature. Fifty-seven studies were included, which highlighted key theoretical and practical discrepancies associated with defining self-regulation and other related constructs including executive function, interoception, emotion regulation and social-emotional learning. Finally, a qualitative study aimed to understand the experiences of nine occupational therapists working with children with self-regulation difficulties. This study was conducted according to the principles of constructivist theory. Data was generated through in-depth semi-structured interviews and focus groups. Four themes were generated that encapsulate the experiences of the participants, which revolve around 1) working in an evolving practice context, 2) normalising self-regulation as a complex process, 3) intervening on the systems surrounding the child and 4) bringing the occupational therapy perspective to the self-regulation puzzle. Overall, this thesis provides evidence for the importance of understanding the theory of self-regulation and aligning this with the philosophy of occupational therapy in practice.