CHAPTER 3 78 present in the study of Costa et al. (2017), who state that children choose their goals due to social motives, their independence and the ease, competence and joy they experience when engaging in a certain activity. These reasons can be seen as the values of children, and they can be used in designing treatments, specifically occupational therapies. Occupational therapists use everyday activities to achieve goals, also called occupation as ends, but also as a means for therapeutic power (Duncan 2013; Gray 1998). Actually, this factor comprises part of the unique realm of occupational therapy’s expertise (Golledge 1998; Gray 1998). Using occupation as a means refers to the use of therapeutic occupations as the treatment modality to advance someone towards an occupational outcome (Gray 1998). To use occupation as a means, the therapist selects activities related to the client’s occupations and interests that can be modified and structured to improve functions or skills relevant for functional goals, which are everyday activities (Gray 1998). Therefore, the current findings can be utilised for occupation as means and ends. Although therapeutic power of everyday activities is personalised and based on the values of the individual child, the findings support potential values for which activities can be used as a means. Besides, the findings demonstrate the large scope of potential activities in therapy goals for school functioning. Therefore, the study results are useful for parents, teachers and health professionals to focus on the entire scope of potential relevant activities, and to determine the values in activities. Moreover, the results can especially be used by occupational therapists to use occupation as a means or as ends. Activities were divided into eight activity categories (self-care, house chores, therapy, school, work, play/game/hobby, sports and mobility/transport) and three occupational performance areas (personal maintenance, productivity, and leisure; (Reed and Sanderson 1999). Although there are some criticisms concerning the use of three occupational performance areas (Hammell 2009), the findings provided a good overview of the activities performed by this group of children. As suggested by Hammell (2009), we could use an occupational experience-based categorisation. However, experience is very much individually determined (Wilcock 2006), a phenomenon confirmed by the children’s perspectives in this study. Therefore, distinguishing the type of activities and the experiences of the child has added value. Additionally, the Person-Environment-Occupation-Performance (PEOP)-model interaction perspective provides another perspective on the findings. When used within occupational therapy, this model defines the level of participation as the result of an interaction between person, occupations and environment (Baum et al. 2015). This interaction was clearly present in what the children expressed about their way (means) of performing activities. They could participate due to adaptations of the activity or physical context. Further, it was clear from their stories that in the
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