Australian Occupational Therapy Journal (2009) 56, 51–62 doi: 10.1111/j.1440-1630.2007.00712.x Blackwell Publishing Asia Research Article Occupational therapists prefer combining multiple intervention approaches for children with learning difficulties Alison Nelson, Jodie Copley, Kerry Flanigan and Katherine Underwood Division of Occupational Therapy, The University of Queensland, St. Lucia, Queensland, Australia Background/aim: Research to date has not fully explored how occupational therapists provide intervention for children with learning difficulties in their day-to-day practice. The purpose of this study was to provide an in-depth description of the approaches and techniques used and how they are applied and combined to meet the complex and multifaceted needs of these children. Methods: In-depth interviews and short questionnaires were completed by seven occupational therapists who had provided intervention to children with learning difficulties. Observa- tions of therapy sessions were also conducted. Thematic analysis gained insight into the approaches and techniques therapists used and how these were applied in practice. Results: Therapists use a wide range of approaches in various combinations because they feel that these best meet the needs of individual children. Sensory-based and cognitive approaches were most frequently drawn from and combined with other approaches such as visual information analysis, biomechanical and psychosocial approaches added for particular purposes. Approaches were usually combined simultaneously within an activity or session. Conclusions: Therapists create their own ‘multimodel’ approach in order to best meet the needs of their clients. They are able to articulate the theoretical basis behind these choices, although lack of clarity exists about the frames of reference being used. KEY WORDS child, learning difficulties, occupational therapy. Introduction Occupational therapists play an integral role in address- ing the difficulties experienced by children with learning difficulties (LD) by assisting them to participate in their daily occupational roles. Various terms have been used to describe children with LD in the literature, such as developmental coordination disorder (DCD), minimal cerebral dysfunction (MCD), developmental dyspraxia and perceptual motor dysfunction and these terms are sometimes used interchangeably with LD (Mandich, Polatajko & Rodger, 2003). Children with LD may struggle to achieve educational skills, coordinate their movement, maintain attention, remember information or interact appropriately with others (Clark, Getchell, Smiley-Owen & Whitall, 2005; Humphries, Wright, Snider & McDou- gall, 1992; Rogers, Gordon & Schanzenbacker, 2001; Skinner & Piek, 2001; Wallen & Walker, 1995). These children are referred to occupational therapy in order to address handwriting, coordination, learning and self- management concerns, along with associated social, behavioural and self-esteem issues. This client group is not homogenous and each child may present with a unique combination of difficulties (Wallen & Walker). It has therefore been challenging for researchers and practitioners to identify how to draw from existing frames of reference in a way that best meets the complex needs of this group (Wallen & Walker). Adding to this challenge is the apparent lack of clarity and consistency in the terms used to describe practice such as frames of reference, models of practice and inter- vention approaches. A frame of reference has long been an accepted way for therapists to organise their knowledge for use in intervention planning (Mosey, 1970). Greber, Ziviani and Rodger (in press) have suggested that therapists select an intervention approach that reflects the theoretical assumptions of their chosen frame of reference. This intervention approach comprises a collec- tion of ideas and actions that results in the application of specific treatment techniques (Greber et al., in press; Hagedorn, 2001). However, there is little knowledge about the ways in which therapists implement their chosen Alison Nelson MOccThy, BOccThy; Clinical Educator. Jodie Copley PhD, BOccThy (Hons); Lecturer and Clinic Manager. Kerry Flanigan MOccThy Studies; Graduate Entry Masters Student. Katherine Underwood MOccThy Studies; Grad- uate Entry Masters Student. Correspondence: Alison Nelson, Division of Occupational Therapy, The University of Queensland, St. Lucia, Qld 4072, Australia. Email: Alison.Nelson@uq.edu.au Accepted for publication 1 August 2007. © 2008 The Authors Journal compilation © 2008 Australian Association of Occupational Therapists