Section 3.1

What is a Top-down Approach?

The top-down approach is a term which has been used in psychological and educational literature for many years. Within occupational therapy it describes a reasoned, outcomes-based approach to working with clients rather than a bottom-up remedial approach (Missiuna, Malloy-Miller, & Mandich, 1997 ).

It is an approach to therapeutic problem-solving which is in keeping with the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) (2001) (Rodger, 2010). It is an approach which aims to enable the individual to participate in his/her chosen life tasks, through development of the child’s skills, adapting tasks or activities, and ensuring barriers to access posed by the environment (social and physical) or the task are addressed as part of the intervention.

The top-down approach is congruent with a family-centred focus and is also client-centred. It ensures information gathering, planning and interventions are grounded in life activities which are relevant and important to the child and his/her family.

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