Occupational Therapy for Autism – Assessment and Intervention

What is the Role of Occupational therapy in Autism and Autism Spectrum Disorders?

Occupational therapy plays important role in early intervention of autistic child, occupational therapy is a noble profession which works to promote, maintain, and develop the skills needed by the autistic kid to be functional in their respective home setting, community and beyond.

Pediatric occupational therapists use a holistic approach in planning treatment for each individual case of autism.

In a case of autism, the child finds it difficult to process and act upon information received through the sensory input creates challenges in performing everyday tasks. This can result in motor coordination difficulties, behavioral issues, cognitive impairment, anxiety, learning difficulty and more.

Before we go further, it’s better to understand the disorder and its features.

What is Autism?

Autism is a Neuro-developmental disorder by which we mean an impairment that occurs due to interference in the development and functioning of the brain during its formative phase. It mainly manifests as difficulties in three major areas of functioning of a child. These are social, communication, imaginative play areas in the child’s development.

Autism is a lifelong condition like cerebral palsy and mental retardation with varying degrees of severity and prognosis. It is also a disorder diagnosed by clinical observation and not by any lab tests.

Autism is a very complex, puzzling disorder to understand both parents and professionals working with these children.

Autism is not a single entity which is due to a single cause but represents a comprehensive diagnosis of the set of symptoms which varies from mild to severe. Hence, it is called as Autistic spectrum disorder (ASD).

Clinical features of Autism –

Autism is characterized by deficits in 4 areas of normal function-

1. Impairment in the development of social skills –

These children do not relate themselves to others, to objects and events around meaningfully. They have poor eye contact, they live in their own world, and they have difficulty in interacting with others.

2. Delayed and deviant language development and communication-

They have delayed speech, generally monosyllable or disyllable. Echolalia (repetition of sentences) is also common in these kids.

3. Stereotyped repetitive behavior and actions-

They are obsessed with their routine schedule. They show narrow range of interests. They lack imagination and pretend play, which makes learning difficult.

4. Abnormal response to sensory inputs-

Abnormal responses to sight, hearing, touch, pain, smell, and other sensory perceptions.

These features are spread over a wide spectrum and may vary with the child.

Whom should you approach for help?

Autism can be diagnosed as early as 9-14 months by a trained developmental pediatrician, developmental neurologist or child psychiatrist. It is diagnosed by a detailed history and clinical examination, which checks on certain criteria laid down by diagnostic manuals. Contact your child specialist, or psychologist or an occupational therapist for referral and help.

How autism or ASD child treated?-

Autism is not a disease which can be cured, but with early diagnosis and intervention, many of problematic symptoms can be controlled. The child can be helped to achieve functional ability and independence as per his ability so as to have an acceptable quality of life.

What does an occupational therapist do with Autism and autism spectrum disorder?

A pediatric occupational therapist provides their services to the autistic kids. The occupational therapist uses different functional approaches to control the behavior and inappropriate action.

Occupational therapist helps the autistic kids to participate in the activities of daily living (e.g. Feeding, dressing, toileting), educational activities, playing activities and social activities.

Occupational therapy services for the autistic child include assessment, intervention, and follow-up.

Read More… what does an occupational therapist do?

Occupational therapy assessment for autism-

The occupational therapy evaluation and assessment process are designed to gain an understanding of the individual’s skill, his/her abilities, and disabilities.

Occupational therapist performs many standardized and non-standardized scale to assess the areas of dysfunction. Autistic kids don’t always cooperate and help the therapist to assess. More often, the therapist must rely on informal play observation, parent/teacher questionnaires to obtain information about the child’s developmental maturity, sensorimotor responses, and functional capabilities

Some screening tools can be used by the therapist –

• Autism checklist
• Childhood autism rating scale (CARS)
• Sensory Profile
• Diagnostic criteria for autism spectrum disorder- DSM-IV

In short, Occupational therapist evaluate autistic kids in these areas-

1. Social skills-

Eye to eye contact, peer relationship, interaction with others etc.

2. Communication-

Inadequate speech, Echolalia, non verbal communication etc.

3. Sensory Processing-

Sensory seeking, sensory defensiveness, balancing issues etc.

4. Behavior-

Stereotypical behavior (hand flapping), avoid changes in schedules, commands following, etc.

Occupational therapy interventions for autism –

the occupational therapist provides interventions to help an individual respond to the information coming through the senses. Intervention plan may include sensory integration, motor developmental activities, and play activities to boost cognition and perception skills.

The two approaches most frequently used by occupational therapists are Sensory integration and Behavioral therapy.

Sensory Integration Therapy for autism-

Children with autism demonstrate a variety of sensory processing impairments and often show patterns of dysfunction similar to those of dyspraxic children. The therapist may use different activities so the child is able to register, modulate, and act on a sensory input.

Autistic children tend to lack the “inner drive” to master their environment. So, the therapist has to more imposing than is normally recommended for sensory integration therapy.

The occupational therapist uses different sensory strategies to promote self-regulation and motor planning.

Occupational therapy strategies based on sensory integration theory can help an autistic child to –

• Regulate arousal level
• Increase ability to attend and decrease distractibility
• Decrease anxiety
• Decrease stereotypic behavior
• Improve performance of a variety of skills.

Read more… Sensory Integration

Behavioral Therapy for Autism –

Behavior therapy also referred to as Behavior Modification. It is concerned with improving specific behaviors or skills through the structured manipulation of reinforcement. If the desired patterns of behavior are rewarded and undesired patterns of behavior are punished or ignored, behavior can be gradually modified by the therapist.

For better implication, the therapist identifies the reinforcers that are meaningful to the child and use it while correcting the undesired behavior. There are considerable pieces of evidence that behavioral therapy approaches can be effective in increasing communication and social competence in autistic kids (Werry, 1989; Howlin, 1987).

This formal explanation of therapy intervention is may be difficult to understand. Let’s have an example of an autistic kid and occupational therapy intervention.

Read more… Behavioral Therapy

Case Study-

Ryan, age 4 years, a boy with a diagnosis of Autism, referred to the occupational therapist for improvement in the functional motor, sensory problem, and self-care skills.

After evaluation, the problem areas were – an average intelligence, poor attention span, perseveration, resistance to transitions, lack of social interaction, delayed speech and tactile defensiveness.

Occupational therapist plan out the intervention after discussing the parents and their prime concerns.

Therapy session includes-

First, Ryan is welcomed to therapy by shaking hands or saying “hello”. Provide an attractive puzzle to him and promote its completion by using verbal behavioral strategies like clapping or saying “good job”.

Second, engaged him in an activity that provides firm touch or strong proprioceptive input in an effort to inhibit tactile defensiveness. For example, put him in between the two mats and squeeze it.

Third, engaged him in a play that promotes bilateral integration or mid-line crossing. Use positive reinforcement to avoid the repetitiveness of any activity.

Possible Outcomes- After 2 months of regular therapy, Ryan may show improvement in sensory defensiveness. He may cooperate with others; respond to welcome gestures, improved attention span during play.

Occupational therapy activities for autism-

Occupational therapist uses many activities to promote function and avoid the undesired behavior. These activities are endless and depend upon the creativity of the therapist.

Some proprioceptive and vestibular Sensory integration activities are-

• Push, pull games like tug of war.
• Wheelbarrow walking
• Play dough/ theraputty that offer high resistance.
• Ropes or dynamic ladder climbing.
• Theraband activity
• Sand play for tactile sensitivity.

Activities for ADL –

• Buttoning-unbuttoning
• Zipping-unzipping.
• Shoe lacing

Group Activity to promote social interactions are-

• Musical chairs
• Dance

Occupational therapy at home for autism-

Occupational therapy for the special kids always works with the parents or caretaker for better and effective treatment strategies. If the kid is having sensory processing issues, occupational therapist teaches parents about sensory diet (a planned and scheduled activity program).

Occupational therapist teaches parents how to initiate the therapy at home or how to conclude it. The OT also guides them which activities are preferable, and what types of toys should be brought.

Occupational therapist can also visit home for therapy. Therapy at home has its own importance, early intervention services may include home visits. An autistic child can better cooperate in the known environment instead of some new place. Because these kids are reluctant to break their routine.

The occupational therapist can also guide the parents to make home child proof because sometimes autistic kids may get hyper. Plus, the therapist can use basic materials for activities available in our houses. For example, dough & plastic clips-  for fine motor activities, jump rope – for gross motor and coordination, coat and blazer – for ADL buttoning/unbuttoning. A therapist can use these materials as a therapeutic medium to enhance function.

Therapeutic activities which can be performed at home are endless. What I would like to suggest (as an OT) to the parents of an autistic child is,  gain the knowledge about the purpose of activities, discuss it with your therapist, and ask him/her why he/she is using some specific games or activities. If the parents understand the reason behind it, so, they can apply it anywhere and with the available resources at home.

Summary-

The role of occupational therapy in autism is to provide early therapeutic services to them. So, they can learn the concept of self, self-esteem, constructive play, and acceptable social behavior. The occupational therapist uses sensory integration, behavior techniques, group therapy to bring autistic kids in the mainstream.

References-

American Occupational Therapy Association. (2010). The scope of occupational therapy services for individuals with an autism spectrum disorder across the life course. AJOT,64.

Ellen Yack, Shirley Sutton. Building bridges through sensory integration. 2^nd Ed., Sensory resources LLC.

Bloomer, M. and Rose. Frames of Reference: guiding treatment for children with autism. Developmental Disabilities: A handbook for occupational therapists. The Haworth press.