Medicine and Health

Critical Review Form- Qualitative Studies




Bagby, M. S., Dickie, V. A., Baranek, G. T. (2012). How sensory experiences of children with and without autism affect family occupations. The American Journal of Occupational Therapy, 66, 78-86. doi: 10.5014/ajot.2012.000604











Was the purpose and/or research question stated clearly?






Outline the purpose of the study and/or research question.

The goal of this study was to use a grounded theory approach, one in which inductive reasoning is used to develop a theory from the collected data, to generate a theory to differentiate the family occupations and routines of those families with autistic children from those families with only typically developing children.




Was relevant background literature reviewed?






Describe the justification of the need for this study. Was it clear and compelling?

The rationale for this study was quite compelling. The authors noted that little literature has attempted to understand how sensory experiences impact family occupations, and to understand the similarities between families with autistic children and those with only typically developing children.  This study addresses both of those gaps in the literature.  The importance of understanding family occupations rests on the grounds that previous studies have shown that parents of autistic children have to restructure family life to cope with dailiy life experiences, particularly sensory experiences.




How does the study apply to your practice and/or to your research question? Is it worth continuing this review?[1]

The epidemic level growth in autism means that encountering this condition on a reasonably regular basis is a near-certainty.  This study presents important theoretical basis for developing appropriate interventions for such patients. Thus, it is important to continue with this paper.






What was the design?



grounded theory

participatory action research


_     _____________



Was the design appropriate for the study question? (i.e., rationale) Explain.

The study design was very appropriate for the study question.  The author used semi-structured interviews of parents of children with autism as well as parents of typically developing children; the two groups were aga- and gender-matched.  Open-ended questions combined with pre-scripted prompts and probes were used to understand how the children’s sensory experiences impacted family routines and occupations.  From the data collected, a theory was constructed in the analysis section of the paper.


Was a theoretical perspective identified?




Describe the theoretical or philosophical perspective for this study e.g., researcher’s perspective.

A grounded theoretical study such as described in this paper, does not start from a pre-established theory, but instead uses the data collection to define a new theory based on the evidence collected. The researchers noted that there was little in the literature that compared family occupations of those families with an autistic child compared to those families with only typically developing children. They were attempting to close that gap. Thus, the purpose of this paper was to construct a theory addressing this issue.  Thus, the theoretical basis was in the conclusion of the paper, rather than an a priori theory  used to design the study.





Method(s) used:

participant observation


 document review

focus groups


_     _____________



Describe the method(s) used to answer the research question. Are the methods congruent with the philosophical underpinnings and purpose?

The methodology was one of semi-structured interviews.  All interviews were conducted by a single researcher for consistency.  These interview transcripts were then encoded into a set of 110 codes representing concepts and categories.  The codes were grouped into causal conditions, phenomena; context; interviewing conditions; action-interaction strategies; and consequences.  Further, three core categories were developed along with defining potential emerging themes.  This methodology is well defined as appropriate in a grounded theoretical approach.  The methods chosen were congruent with their intentions to define a theory a posteriori rather than a priori.




Was the process of purposeful selection described?




Describe sampling methods used. Was the sampling method appropriate to the study purpose or research question?

The samples were chosen via a variety of methods, starting from participants in a much larger prior study.  The reseearchers noted that the recruitment was done via e-mail lists and word of mouth.  The researchers also noted the exclusion and inclusion criteria for the  two groups.

This is generally appropriate, however, the sample used in this study is extremely small (only 6 in each group) and the selection is a convenience sample of those meeting the criteria.  No information is provided regarding how many other potential participants, also meeting the appropriate criteria, were excluded from this study orwhether the first 6 were simply the ones chosen for participation.






Was sampling done until redundancy in data was reached?[2]



not addressed


Are the participants described in adequate detail? How is the sample applicable to your practice or research question? Is it worth continuing?

The participants were described in reasonable detail.  Note that the participants in the study were actually the parents of the autistic children (and the parents of the typically developing children). The ideintifying information used to describe the participants included the age of the chid, the gender of the child, and the mother’s level of education.  Children’sages ranged from 2 yr 4 mo. to 8 yr 6 mo.  Of the 12 participating mothers, 7 had graduate degrees, 1 had a bachelor’s degree, and 2 had associate degrees. Only 2 had only a high school diploma and none were high school dropouts.  This very high level of education most likely reflects the university-town context in which the study was conducted.

The families of this study are not directly similar to families that are likely to occur in my future practice, which are unlikely to have so much advanced education as these participants. As noted in the study, the degree to which the study’s conclusions generalize to other populations cannot be determined by this research.  However, it is unclear if that socio-economic difference makes a serious impact on the relevance of the study.  Thus, it is worth continuing to consider this paper.  This also provides an opportunity for me to consider for future reasearch to determine if similar results would be obtained from more demographically common participants, i.e., those from a lower educational and/or socioeconomic group.





Was informed consent obtained?



not addressed


The study clearly states both that parents received informed consent and that the study was approved by the institutional review board of the researchers’ university.






Descriptive Clarity

Clear & complete description of

site:                         yes   no

participants:          yes   no


Role of researcher & relationship with participants:

yes  no


Identification of assumptions and biases of researcher:

yes  no



Describe the context of the study. Was it sufficient for understanding of the “whole” picture?

The context of the study was briefly described as “telephone or face-to-face interviews.”  No indication was given regarding which participants were interviewed in person and which over the phone. Furthermore, the parents were only interviewed once, and only the mothers were interviewed.  Participants were paid either $25-$75 for parents of autistic children or $5 for parents of typically developing children.  The children received a toy. It is difficult to determine if the data collected is sufficient to understand the whole picture since the raw data was not made available in the study. The answer to that has to be “indeterminate” based solely on the information available in the study.






What was missing and how does that influence your understanding of the research?

One key missing piece would be the perspectives of other family members, such as fathers, or older siblings.  This study did not address those at all.  Also the high level of education of the participants in the study makes it hard to know how well the authors’ results generalize to other populations.


Procedural Rigour

Procedural rigor was used in data collection strategies?



not addressed




Do the researchers provide adequate information about data collection procedures e.g., gaining access to the site, field notes, training data gatherers? Describe any flexibility in the design & data collection methods.

The researchers explain their data collection process with some degree of rigor, but it could be improved. For example, only “example” questions used in the interviews were provided rather than a list of all the open-ended questions used.









Analytical Rigour

Data analyses were inductive?

yes    no   not addressed


Findings were consistent with & reflective of data?

yes   no


Describe method(s) of data analysis. Were the methods appropriate? What were the findings?

The data analysis, as noted earlier, used grounded theoretical approaches to encoding the interview transcripts. Care was taken by the researchers to confirm the encoding using a variety of self-check schemes.

The authors describe their results under three themes of ‘what families choose to do”, “how families prepare” and “extent to which experiences, meanings, and feelings are shared.”  In each theme, they describe the differences and commonalities between the two groups, citing occasional specifics from one interview or another.   In the first theme, they noted all families modified their activities based on their child’s developmental level.  In the second theme they noted that the degree of preparation varied based on the degree of sensory-intensity of the activities, with families with autistic children having to do more detailed and broader preparation.  In the third theme, the researchers noted that feelings, meaning, and experiences were shared less often in families with autistic children.












Decision trail developed?

yes   no   not addressed


Process of analyzing the data was described adequately?

yes   no   not addressed


Describe the decisions of the researcher re: transformation of data to codes/themes. Outline the rationale given for development of themes.

The authors described the encoding process with a fair degree of detail, including providing detail on the software used to identify the themes and categories.  While the authors detailed their process, they were less clear on the specificsof their data analysis in terms of listing the categories and themes that emergedin the encoding process.  What is stated in the paper is that their creation of three “core categories” attempted to cature the central phenomenon of the interview.  They also noted that Bagby (the interviewing researcher) used Charmaz’s memo technique to define potential emerging themes, to label interesting quotes, and to determine the most salient elements of the interviews. Since the core categories and groupings are not clearly stated in the paper, it is difficult to be specific about the authors’  rationale beyond stating that they complied with accepted interview analysis techniques.







Theoretical Connections

Did a meaningful picture of the phenomenon under study emerge?






How were concepts under study clarified & refined, and relationships made clear? Describe any conceptual frameworks that emerged.

The authors came to three key conclusions about how  children’s sensory experiences affected family occupations.  These were: (1) decisions about what the family did or did not do; (2) how the family prepared for activities and events; and (3) the extent of sharing of experiences, feelings, and meanings.  The focus was on the children under study and their parents, but there may be additional (or alternative) impacts on siblings that were not studied.

The authors do not clearly state their new theoretical framework in this paper, unfortunately. They do say that they have developed one, but as described in the paper it is somewhat vague and difficult to explain simply. In essence, the authors concluded that having a child with autism (1) restricted the types and number of activities the family participates in; (2) reduces the sharing of experiences within the family; (3) significantly increases the degree of preparation required to perform an occupation; (4) dramatically increases the sensory experiences the autisitc child has.  In addition, the authors concluded that a typically developing child having a “bad” day modified the family’s responses to be more similar to those of a family with autistic children, thus partly bridging the gap between the occupations of the two types of families.









Was there evidence of the four components of trustworthiness?

Credibility              yes  no Transferability       yes  no

Dependability        yes  no

Comfirmability      yes  no




For each of the components of trustworthiness, identify what the researcher used to ensure each.

For credibility, the authors carefully delineated their methodology and the care taken to properly analyze the data.  For transferability, which is the weakest link in this study, the authors noted that their sample is quite small and that it derived from an atypically educated segment of the general population.  For dependability, the authors noted their efforts to ccheck and cross-check their coding of the interviews to ensure that it was correctly performed.  Confirmability was not directly addressed by this study.






What meaning and relevance does this study have for your practice or research question?

The study provides some guides for developing strategies that address a child’s sensory processing as an important factor in determining family activities and occupations.  In particular, the authors noted the many similarities between typically developing children and autistic children. Thus there is relevance both for families of autistic children and typically developing children.







Conclusions were appropriate given the study findings?

yes  no


The findings contributed to theory development & future OT practice/ research?

yes  no




What did the study conclude? What were the implications of the findings for occupational therapy (practice & research)? What were the main limitations in the study?

This study provided insight into how families cope with children’s sensory experiences, whether the children are autistic or not.  Unfortunately, the conclusions are fairly general rather than specific.  It is less clear that the conclusions are non-obvious.  For example, one conclusion is that family routines are important in all families.  A second is that parents with autistic children limit family activities and locations while families with typically developing children tended to expand their children’s sensory experiences. The third conclusion was that family occupations were affected to the extent to which they were shared.  These conclusions seem fairly self-evident rather ones that are novel or that break new ground.  On the other hand, the authors also present some excellent suggestions for OT practice that are worth taking into consideration when dealing with families with children, autistic or not.

The implications for OT practice are clearly defined by the authors and can be summarized as: (1) consider both positive & negative impacts of the child’s sensory experiences on the family; (2) educate parents on these impacts and offer coaching to help them optimize their strategies to cope with the child’s responses; (3) provide strategies to plan and prepare for activities, while being sensitive to the parents’ stress levels; (4) help parents understand their child’s sensory experiences and help them minimize confusion, worry, and feelins of inadequacy, particularly with an autistic child; (5) beware of using clinical jargon with parents or or pathologizing the child; (6) provide management strategies rather than attempt to change the child; (7) identify occupations that can overcome uncomfortable sensory experiences for the child; and (8) establish positive sensory routines that promote shared experiences.

The key limitations of this study were the extremely small sample size, the high educational level of participants (which limits its generalizability), and the lack of inclusion of family members other than mothers in the interviews.


[1] When doing critical reviews, there are strategic points in the process at which you may decide the research is not applicable to your practice and question. You may decide then that it is not worthwhile to continue with the review.

[2] Throughout the form, “no” means the authors explicitly state reasons for not doing it; “not addressed” should be ticked if there is no mention of the issue.