Why I get excited talking about CO-OP: An intervention approach that improves occupational performance AND promotes self-regulated learning!

Claire Sangster Jokić, Ph.D., M.Phil., B.Sc. (OT) is a Lecturer in the Occupational Therapy Department at the University

I was first introduced to CO-OP as an occupational therapy student, when I had the opportunity to complete my final thesis under the mentorship of Helene Polatajko and explore the influence of the CO-OP program on cognitive strategy generation among children with developmental coordination disorder (DCD). This work, which demonstrated that children with DCD were able to identify a greater number of effective cognitive strategies for solving task performance problems after participating in CO-OP, was a catalyst that has influenced both my practice as an occupational therapist and my scientific work as a researcher for over 20 years.

As an occupational therapist, I was impressed by the manner in which CO-OP successfully enabled performance in child-chosen, functional tasks and also promoted the development of skills for improving performance and participation in tasks and occupations beyond the therapy session. 

As a researcher, I was curious to learn more about why and how this happened (and why this was particularly important for children with DCD). Based on the findings of that first piece of undergraduate research, I was prompted to explore the role of self-regulated learning in improving task performance among children with DCD participating in CO-OP. Self-regulated learning is a complex, multi-faceted construct that includes actions and thought processes that allow us to control, regulate or direct our own cognitive activity or motor performance. It is made up of (meta)cognitive knowledge about the factors that impact learning and performance, self-regulatory skills for effectively setting goals, planning, using strategies and self-monitoring during the learning process, and motivational regulation, or the awareness and regulation of motivation and emotional states. 

Previous research has indicated that children with DCD have a number of difficulties in the area of self-regulated learning. First, they often possess less detailed knowledge about motor tasks or focus on irrelevant information when identifying problems in task performance. Therapists working with children with DCD will be familiar with the most common response when a child with DCD is asked to describe how to do something or what is happening when they struggle with a task: 

I don’t know.  

This inability to verbalize the way a task is carried out (procedural knowledge) or ideas about why a problem is arising reflects the limited and poorly integrated knowledge children with DCD have about task performance. This is similarly reflected in responses to the question ‘What do you think you need to do to get better at (the task)?’:

I just need to get the hang of it. (Blake)* 

I would need a lot of practice. (Wally)

Here, children’s lack of knowledge makes it difficult for them to identify specific strategies for solving problems in task performance. In fact, children with DCD often select inappropriate strategies and are less likely to spontaneously plan, monitor or evaluate their performance when attempting to acquire a skill or perform a task. When prompted to engage in these self-regulatory skills during task practice, children will often exhibit inaccurate, irrelevant, or ineffective learning strategies:

OT: What’s your plan to get the football into the target?

Riley: I just need to throw it! 

OT: How do you think you could keep the basketball from getting away from you when you’re dribbling? 

Daniel: I could put a string on the ball…or a spring on the bottom so it bounces back higher.  

OT: (after child failed to catch a ball tossed to him) What happened that time?

Riley: The ball fell when I tried to get it. 

Furthermore, children with DCD often have difficulties with motivational regulation during skill acquisition and task performance. This is often a direct consequence of the motor difficulties they experience during performance and is reflected in behaviours indicating frustration, task avoidance/resistance, fatigue, or limited interest. With prolonged experience of performance failure, children with DCD often develop a low sense of self-efficacy and what psychologist Carol Dweck has called a fixed mind-set: the belief that our abilities cannot be changed and that any success or failure can be attributed to our inherent intelligence or abilities (or lack thereof). When adopting a fixed mind-set, children become more likely to view challenges as obstacles that cannot be overcome, effort as fruitless and feedback as criticism of an inherent trait. As a result, children with a fixed mind-set are often resistant to accepting new learning situations, do not persist in the face of challenges or do not readily learn from feedback. In the long term, this often contributes to difficulties with self-esteem, isolation and participation: 

I’m not good at sports so I never get picked (for the baseball team). (Lucas)

So empirical findings and clinical experience have demonstrated that children with DCD have difficulty implementing the knowledge, monitoring, planning and motivational elements of self-regulated learning. But what can be done about it? In fact, emerging understanding of these difficulties was a key factor that prompted the developers of CO-OP to apply a learning paradigm in the approach and create key features (e.g., global strategy, guided discovery, enabling principles) based on principles of learning. What’s more, the evidence suggests that CO-OP supports children with DCD to develop the self-regulatory skills and knowledge needed for more effectively acquiring skills and performing tasks. Firstly, children with DCD who learn to apply the global strategy to solve occupational performance problems in CO-OP are more able to verbalize specific task knowledge relevant to successful performance:

I used to hold the basketball like this when I was shooting (demonstrates), but now I know it’s better to have your shooting hand under the ball and your helping hand like this, on the side. (Thomas)

In this quote, Thomas not only verbalizes new knowledge about how to shoot a basketball, but also demonstrates an understanding that this is knowledge he has acquired during the learning process. This metacognitive awareness of his own understanding is a critical ingredient to ensuring that Thomas will continue to apply his new knowledge to new and different learning situations!

Children with DCD who have participated in CO-OP have also been found to demonstrate more effective goal-setting, planning and evaluation (checking) skills:

That was an OK one, but I forgot to get my bike ready before I pushed off, so I didn’t start off so straight. (Alan)

Now the ball is going to come high, so I will need to keep my hands up and jump as I watch it go through the air. (Blake)

Oops, that one (basketball shot) went right off the rim! I wasn’t lined up on the net…and maybe I could focus on the arc of the ball, like if it goes like this (demonstrates ball flight), it will go straight down into the net. (Thomas)

Interestingly, findings from research have also illustrated the manner in which these self-regulatory behaviours emerge during the interaction between the child and the therapist (using guided discovery and enabling principles) when applying the global strategy during task practice:

OT: OK, so what’s your plan for catching the Frisbee? 

Wally: Get ready! 

OT: OK, but how do we know if we’re ready? 

Wally: Um, I’m looking at you and my hands are out…so I can make the Frisbee sandwich! 

In this quote, when Wally is initially not able to identify a specific strategy (plan), the OT asks a more specific question and in doing so guides Wally to verbalize a strategy that he had previously discovered to be effective for reaching his goal (catching the Frisbee by ‘sandwiching’ it between his outstretched palms). 

Finally, children participating in CO-OP demonstrate an improved sense of self-efficacy and more positive motivational regulation, where negative motivational behaviours and self-statements are gradually reduced and replaced by self-encouragement, celebration of successes, and recognizing errors as an opportunity to revise the plan and try a new strategy:

Oh no! It (ball) rolled under the benches. I’ll try again, but this time I’ll keep my knees more bent so I stay low. (Daniel) 

Arguably, the knowledge and self-regulatory skills gained during CO-OP have enabled children to develop a more positive motivational framework in which they recognize how using the global strategy to set goals, discover strategies and evaluate performance enables improved performance on important and meaningful tasks.  To apply Dweck’s model, the skills acquired during CO-OP have enabled the development of a growth mind-set: the recognition that growth and mastery is the result of effort and that errors are opportunities for learning and discovery rather than a reflection of inherent inabilities. 

For me, this shift from a learned helplessness and the belief that failure is a reflection of fixed incapacity towards a sense of empowerment and confidence in resolving challenges is perhaps the greatest success of the CO-OP program. By providing children with the tools to analyse and discover solutions to their problems in performing tasks, CO-OP is a program that enables children to move from feeling like I can’t! to believing that I can’t…yet!


*All quotes included in this blog come from the author’s research and represent verbalizations made by 7- and 8-year-old children with DCD while participating in the CO-OP program with an occupational therapist. All identifying details (including names) have been removed or altered. 

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