OCCUPATIONAL THERAPY PRACTICE FOR CHILDREN WITH ADHD IN EAST JERUSALEM: PROFESSIONAL VALUES, INSTITUTIONAL CONSTRAINTS, AND THE POLITICS OF CARE

Reem Maloukh

Abstract


This study explores the description of practice by occupational therapists (OTs) in East Jerusalem working with children with attention deficit hyperactivity disorder (ADHD) and how their practice is influenced by professional values, expectations of change and institutional context. The rationale for this study is primarily based on observational evidence and gaps in the empirical literature in the field of occupational therapy for ADHD in politically contested, resource-limited, and culturally specific contexts, such as East Jerusalem, where Palestinian children experience the compounded burden of structural, geographic, and political barriers to care. Methodology: This study was conducted using a qualitative methodology, composed of semi-structured interviews of 29 occupational therapists working in school, clinic and early childhood services in East Jerusalem. Data were analysed using reflexive thematic analysis (Braun & Clarke, 2006). The results yielded six themes: session as negotiated space; aspirations and institutional reality; competing change agendas; professional values as practice driver; East Jerusalem as practice context; and navigating resistance and accommodation. The results disclose that the nature of the practice of OT in East Jerusalem is first and foremost a milieu of chronic under-resourcing, institutional discrepancy, political insecurity, and an almost-conspicuous absence of a collective professional infrastructure, instead of principally formal, theoretical or evidence-based protocols .Therapists routinely drew from sensory regulation (the intervention of choice), improvised given insufficient equipment and space, and balanced clashing mandates from parents, schools, and institutions. Cultural responsiveness, therapeutic relationship and individualization emerged as de facto core values underpinning structural constraint treatment practice. This study is the first empirical insight into occupational therapy in a community with ADHD in East Jerusalem and has important implications for education, service provision and policy change.

Keywords


occupational therapy, ADHD, East Jerusalem, qualitative research, thematic analysis, professional practice, Palestine, structural barriers, sensory integration, cultural competency

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References


Aas, M. H., & Bonsaksen, T. (2023). Exploring occupation-based practice among occupational therapists in hospitals and rehabilitation institutions. Scandinavian Journal of Occupational Therapy, 30, 1074–1084. https://doi.org/10.1080/11038128.2022.2059564

Aloshi, J., & Majadley, E. (2024). Attention deficit hyperactivity disorder and its relationship to risk-taking behavior among adolescents with ADHD during the COVID-19 pandemic. Educational Administration: Theory and Practice, 30(4), 8320–8333. https://doi.org/10.53555/kuey.v30i4.970

Ayano, G., Demelash, S., Gizachew, Y., Tsegay, L., & Alati, R. (2023). The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. Journal of Affective Disorders, 339, 860–866. https://doi.org/10.1016/j.jad.2023.07.071

Ayres, A. J. (1972). Sensory integration and learning disorders. Western Psychological Services. Retrieved from https://archive.org/details/sensoryintegrati00ayre

Barlev, L., Rivkin, D., & Milstein, E. (2020). Children with ADHD: Identification, diagnosis, and treatment — A follow-up study. Myers-JDC-Brookdale Institute. Retrieved from https://brookdale-web.s3.amazonaws.com/uploads/2020/03/Eng_Summary_819_20.pdf

Ornoy, A., Ovadia, M., Rivkin, D., Milshtein, E., & Barlev, L. (2016). Prevalence of ADHD among 7–9-year-old children in Israel: A comparison between Jewish and Arab populations. Israel Journal of Psychiatry and Related Sciences, 53(2), 3–9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28079031/

Bass, J. D., de Sam Lazaro, S. L., Baum, C. M., & Marchant, J. K. (2024a). Editorial: The Person-Environment-Occupation-Performance (PEOP) model—An OTJR focused issue. OTJR: Occupation, Participation and Health, 44(3), 449–454. https://doi.org/10.1177/15394492241252578

Bass, J. D., Marchant, J. K., de Sam Lazaro, S. L., & Baum, C. M. (2024b). Application of the Person–Environment–Occupation–Performance model: A scoping review. OTJR: Occupation, Participation and Health, 44(3), 521–540. https://doi.org/10.1177/15394492241238951

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Brown, T. E. (2006). Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views. International Journal of Disability, Development and Education, 53(1), 35–46. https://doi.org/10.1080/10349120500510024

Conrad, P., & Bergey, M. R. (2014). The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Social Science & Medicine, 122, 31–43. https://doi.org/10.1016/j.socscimed.2014.10.019

Dancza, K., & Rodger, S. (2018). Implementing occupation-centred practice. Routledge. https://doi.org/10.4324/9781315297415

Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4. Retrieved from https://www.researchgate.net/publication/359634247_Comparison_of_Convenience_Sampling_and_Purposive_Sampling

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., & Wang, Y. (2021). The World Federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

Filipe, A. M. (2016). Making ADHD evident: Data, practices, and diagnostic protocols in Portugal. Medical Anthropology, 35(5), 390–403. https://doi.org/10.1080/01459740.2015.1101102

Frisch, C., Tirosh, E., & Rosenblum, S. (2020). Parental Occupation Executive Training (POET): An efficient innovative intervention for young children with attention deficit hyperactive disorder. Physical & Occupational Therapy in Pediatrics, 40, 85–95. https://doi.org/10.1080/01942638.2019.1640336

Imam, A., & Hamdan, M. (2021). Study of East Jerusalem: Healthcare sector. Union of Charitable Societies–Jerusalem. Retrieved from https://alquds.info/wp-content/uploads/2022/03/East-Jerusalem-Health-care-sector_en.pdf

Israeli Journal of Occupational Therapy. (2017). OT intervention for ADHD across the lifespan: Position paper. Israeli Journal of Occupational Therapy, 26(3).

Jaber, L., Hamed, N., Grossman, E. S., & Berger, I. (2020). Epidemiology and diagnosis of attention deficit hyperactivity disorder in the Arab and Jewish populations in Israel. Archives of Community Medicine and Public Health, 6(2), 152–158. https://doi.org/10.17352/2455-5479.000096

Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing, 72(12), 2954–2965. https://doi.org/10.1111/jan.13031

Kelsch, K., & Miller, K. (2016). Occupational therapy interventions for children with attention deficit hyperactivity disorder: A systematic review. Occupational Therapy in Mental Health, 33(1), 1–14. https://doi.org/10.1080/0164212X.2016.1211060

Ledesma, J. (2014). Conceptual frameworks and research models on resilience in leadership. SAGE Open, 4(3). https://doi.org/10.1177/2158244014545464

Oliver, M. (1990). The politics of disablement. Macmillan. Retrieved from https://link.springer.com/book/10.1007/978-1-349-20895-1

Palestinian Vision Organization & Diakonia. (2017). Rights and services for children with ADHD in East Jerusalem. Jerusalem.

Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and meta-regression analysis. American Journal of Psychiatry, 164(6), 942–948. https://doi.org/10.1176/ajp.2007.164.6.942

Qamhawi, N. (2024). Education and health services in East Jerusalem: Policy roundtable background paper. MAS Economic Policy Research Institute.

Shehadeh-Sheeny, A., & Baron-Epel, O. (2023). Prevalence, diagnosis and treatment of ADHD in Arab and Jewish children in Israel, where are the gaps? BMC Psychiatry, 23(1), Article 586. https://doi.org/10.1186/s12888-023-05090-3

Shehadeh-Sheeny, A., Goldblatt, H., & Baron-Epel, O. (2023). Arab and Jewish mothers' decisions regarding treatment of their children with attention-deficit/hyperactivity disorder: A qualitative study. International Journal of Social Psychiatry, 69(5), 1230–1240. https://doi.org/10.1177/01430343221149697

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135(4), e994–e1001. https://doi.org/10.1542/peds.2014-3482

War Child Netherlands. (2025). Mental health and psychosocial impact of occupation on Palestinian children in the West Bank and East Jerusalem: A desk review. War Child. Retrieved from https://www.warchild.net/documents/345/Effects_of_Israeli_Occupation_on_Mental_Health_Wellbeing_in_East_Jerusalem__West_Bank.pdf

Zimmerman, M. A. (2013). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40(4), 381–383. https://doi.org/10.1177/1090198113493782




DOI: http://dx.doi.org/10.46827/ejphs.v9i2.268

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