I expect that most listeners are familiar with the Alert Programme or How Does your Engine Rune? I think was the first self-regulation programme developed by occupational therapists, many years before Zones of Regulation and the Interoceptive Curriculum. Whilst this intervention is widely used in clinical practice to date there’s been no standardised way to verify whether practitioners are delivering the programme as intended by its developers. This study addresses this need by developing the first comprehensive fidelity measure for the Alert Program®. Their objective was to create an instrument that could effectively assess the fidelity and adherence of occupational therapists when delivering the programme.

For those who are not familiar with the Alert Programme I’ll give you a brief summary. The programme uses a car engine metaphor to help children recognise, modify, and regulate their arousal states. It consists of three progressive stages: Stage 1 focuses on helping children learn the language and labelling associated with their engine levels; Stage 2 encourages children to employ various sensorimotor strategies to modulate their engine levels; and Stage 3 supports children in developing personalised strategies to facilitate engagement in meaningful occupations and reflecting on their progress. I’ve included the link to programme in the show notes on EBPOT.com.

Methods

The researchers utilised a three-step implementation framework outlined by Mowbray and colleagues to develop the measure. This included identification and specification of fidelity criteria, development of methods to quantify the fidelity criteria, and assessment of the reliability and validity of the fidelity criteria.

Following development, the therapists tested reliability of the fidelity measure. To do this, two independent raters with Alert Program® training assessed 15 randomly selected intervention videos from a larger study. Each rater independently evaluated whether core structural, process, and content elements were present in each session. Percent agreement was calculated to assess inter-rater reliability.

The Results

The authors reviewed the literature to develop an initial list of the structural, process, and content elements they might include in the fidelity measure.

The preliminary fidelity measure was then reviewed by four experts. There was an agreement rate of 93.4% that the measure contained the core elements of the Alert Program®. Comments from the experts were used to refine the measure. Refinements included eight specific language and terminology adjustments to align with established Alert Program® standards, refinement of scoring criteria specifications, and adaptations to enhance applicability across diverse clinical settings.

The final version was then tested for inter-rater reliability. The observed agreement between the two independent raters indicated 91% agreement on the preliminary fidelity measure, suggesting the measure offers clear, observable criteria that can be consistently identified by different raters.

Practical Takeaways

So what are our practice take aways? Essentially, the authors have provided us with a fidelity measure we can used to assess Alert Program® implementation. The reason I have reviewed the article is because the measure is in at the end of the article and the article is open access so everyone can view it. So, if you are delivering the Alert Programme, or recommending to schools it’s there for you to use. It provides a very clear list of elements that should be included during programme delivery, and these are scored as yes or no. You can use the measure to audit whether you or your education colleagues are implementing all elements of the programme and identify if any elements are missing. It’s simple way to check and identify relevant changes that might be required to deliver the programme with fidelity.

This systematic review by Cabezas-Durán and colleagues examined physical activity-based interventions and their impact on emotional regulation in individuals with autism spectrum disorder. The review synthesised evidence from six randomized controlled trials on how structured physical activity programmes can support emotional regulation capabilities in autistic individuals. The findings highlight the potential of movement-based approaches as part of comprehensive intervention strategies for supporting emotional regulation in autism, but like most research we review there were methodological concerns that mean we need to interpret the results with some caution. However, we also know that there is other research which shows positive outcomes of physical activity on mental health in other areas and minimal to no side effects as such, so it’s a good tool to have in our arsenal.

This study by Adornetti and colleagues explored the associations between sensory processing sensitivity and psychological well-being and sleep health in 145 adolescent girls. The research examined how heightened sensory sensitivity relates to mental health outcomes and sleep patterns during adolescence. Those with the highest reported sensitivity had more stress, anxiety and depressive symptoms and that they had later sleep times compared to those with moderate sensitivity and low sensitivity. The authors suggested that understanding these associations is important for therapists working with adolescents who experience sensory processing sensitivity, as it highlights the broader impact of sensory differences on overall well-being and mental health

This study by Bibb and colleagues investigated how childhood family conflict impacts adolescents’ startle reactivity to threat, with a particular focus on the moderating role of sensory processing sensitivity. They used the Highly Sensitive Person Scale. The research found that sensory processing sensitivity influenced how adolescents responded to threatening stimuli in the context of prior family conflict exposure. These findings contribute to our understanding of how sensory processing differences interact with environmental factors to shape stress responses in adolescence.

The final study by Ender and colleagues examined the discriminative validity of the Evaluation in Ayres Sensory Integration (EASI). For those who are not familiar with it, the EASI is a assessment tool for evaluating sensory integration and praxis in children. The research demonstrated the tool’s ability to discriminate between children with and without sensory integration difficulties, providing important psychometric evidence. If you are using the EASI, I would suggest that you review the article as it adds to the evidence base for the assessment. I know they have also recently removed some of the subtests, so I assume this research helped to support that decision making.