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| Division of Occupational Therapy - OT Connect Autism
Autism is a developmental disability, of unknown origin, that affects approximately 1 to 2 per 1,000 children. It is a spectrum disorder of which impairments are extremely diverse among individuals; therefore, levels of functioning vary greatly. The diagnosis of autism is behaviorally based. Common Symptoms/Course of disease Social deficits which may present in the following forms:
Communication and language deficits:
Other characteristics associated with autism:
Rapin, I. (1991). Autistic children: Diagnosis and clinical features. Pediatrics, 87 (Suppl.), 751-760. Age of Onset: There is no specified age of onset; however, for a diagnosis of autism to be warranted, delays in specified areas (social interaction, language as used in social communication, and symbolic or imaginative play) must be present before the age of 3. American Psychiaty Association. (1994). Diagnostic Statistical Manual of Mental Disorders, 4th edition. (pp.70-75). Sex Bias: Autism is 3 to 4 times more prevalent in males than in females. A genetic link is suspected in the cause for autism due to the increased number of males compared to females, as well and the high incidence of occurrence among siblings (thought to be between 3 and 7%) Prater, CD, & Zylstra, RG. (2002). Autism: A medical primer. American Family Physician, 66, 1667-1674. Rapin, I. (1991). Autistic children: Diagnosis and clinical features. Pediatrics, 87(Suppl.), 751-760. Cultural Bias: There is no known cultural, ethnical or socioeconomic bias. Current Medical Treatment:
Autism Society of America. Retrieved on January 25, 2004 from: What You Need to Know About. Autism/Pervasive Developmental Disorders. Retrieved on January 27, 2004 from: Occupational Therapy Involvement Occupational Therapy addresses areas that interfere with the individual's ability to function in such life tasks. Occupational Therapy benefits a child with autism by attempting to improve the quality of life for the individual through successful and meaningful experiences. This may be accomplished through the maintenance, improvement, or introduction of skills necessary for the child to participate as independently as possible in meaningful life activities. Such skills include coping skills (teaching the child to regulate own behavior), fine motor skills (ie. handwriting, fasting clothing), self-help skills, socialization and play skills. OT treatment begins with an evaluation of the child’s functioning in various age-appropriate performance areas or life tasks and is followed by intervention targeted toward the interfering areas. Areas frequently addressed include sensory processing, attention, play, coordination, and fine motor skills. The occupational therapist also typically works closely with the speech language pathologist in supporting communication skills and with the behavioral psychologist in developing and maintaining behavioral support schedules. One emphasis of occupational therapy is to promote the individual’s ability to process sensory input (input from the environment), and to respond in a developmentally and socially appropriate way to environmental stimulation. Sensory defensiveness, is a condition that occurs when ordinary environmental sensations, such as touch and sound, are perceived as distressing by the individual. This condition is not unique to autism, but is very commonly associated with the condition. If the differences in the persons processing of sensory information results in distress or interferes with the learning of important developmental tasks, the occupational therapist may be able to offer strategies and routines to help the child better interact with the environment. A common treatment approach used in this case is Sensory Integration Therapy (SI) (Case-Smith & Miller, 1999). Activities consistent with the SI approach include providing graded tactile, proprioceptive, and vestibular input to the child to influence arousal and attention (Case-Smith & Bryan,1999). Behavioral interventions are also widely used by occupational therapists. Behavioral analysis is a successful strategy for changing functional behavior and supporting the acquisition of new skills ( exhausting undesired behavior and replacing it with a new desired behavior). The OT has the expertise to combine information about behavior patterns, sensory needs, and environmental resources and limitations to select activities that will be fun and minimize stress (Scott, 2001). Intervention is often in the form of play activities designed to promote the child’s self-help, play and learning skills. Case-Smith, J., & Bryan, T. (1999). The effectiveness of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy, 53,489-497. Case-Smith, J. & Miller, H. (1999). Occupational therapy with children with pervasive developmental disorders. American Journal of Occupational Therapy, 53, 506-513. Prater, CD, & Zylstra, RG. (2002). Autism: A medical primer. American Family Physician, 66, 1667-1674. Scott, J. (2001). Occupational Therapy for Adolescents With Autism. Developmental Disabilities Special Interest Section Quarterly, 24(2), 1-3. Resources Books for Parents and Professionals:
Books on Occupational Therapy and Sensory Integration:
How OT Makes a Difference: Evidence-Based Practice Current Practice of Occupational Therapy for Children With Autism This study examined the current practice patterns used by occupational therapists in treating children with autistic spectrum disorders. Survey respondents provided information relating to current practice and evaluation and intervention tools used by occupational therapist, as well as training and experience obtained in treating children with autism. Respondents reported frequently or always using sensory integration, developmental, and behavioral theories in treating children with autism. The types of training listed as most helpful in preparing therapists to work with children with autism were sensory integration treatment, occupational therapy intervention and sensory integration theory. Watling, R., Deitz, J., Kanny, E.M., & McLaughlin, J.F. (1999). Current practice of occupational therapy for children with autism. American Journal of Occupational Therapy, 53, 498-505. The Effects of Occupational Therapy With Sensory Integration Emphasis on Pre-school Age Children With Autism This study researched the effects of sensory integrative techniques on five children with autism. Following a 3-week baseline period, occupational therapy was provided for 10 weeks, with an emphasis on sensory integrative techniques, such as swinging and brushing. Results indicated that 4 of the 5 children demonstrated a decreased frequency in nonengaged behavior, and 3 of the 5 demonstrated increased frequency of goal-directed play. Minimal improvements in frequency of interaction were noted. Case-Smith, J., & Bryan, T. (1999). The effectiveness of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy, 53, 489-497. Occupational Therapy With Children with Pervasive Developmental Disorders This study investigated occupational therapy practice with children with pervasive developmental disorder (PDD), of which they describe autism being the most severe form. A survey respondents indicated that a sensory integration approach, environmental modification and child-centered play were frequently used with children with PDD. This study further investigated the level of competence the providers felt in administering such approaches. The respondents indicated the greatest competence in sensory integration and environmental modification. Case-Smith, J. & Miller, H. (1999). Occupational therapy with children with pervasive developmental disorders. American Journal of Occupational Therapy, 53, 506-513. Ashley* is an eight year old girl diagnosed with autism. Her mother reports that she developed normally with the exception of language delays. At around the age of 18 months, she lost all the words she had developed to that point. Ashley received the diagnosis of autism at the age of 4. She does not demonstrate some of the social deficits associated with autism. She interacts with other children, and is often very loving toward her family. She does, however, demonstrate a very restricted repertoire of activities. She tends to manipulate objects rather than play with them appropriately. She displays self-stimulatory behaviors, and has displayed self-injurious behaviors in the past, although these behaviors are now rarely evident. These behaviors are what warranted OT services for Ashley. Ashley currently receives occupational therapy (OT) services in the school system and through an external agency. OT in the school system is required to provide services that are education related. Ashley has difficulties with handwriting, although she does not display any other fine motor delays. The school OT addresses Ashley’s handwriting difficulties through a program called Handwriting Without Tears. External OT services focus on Ashley’s stereotyped/self-stimulatory behaviors (arm flailing, ripping pages out of books, manipulating strings) through a sensory integration approach. The approach that works most effectively is implementing “calming activities,” such as swinging, deep pressure, heavy work activities, and brushing. The OT has developed a “sensory diet” for Ashley, and has assisted the parent in developing an “SI room” within the child’s home. The mother reports that the OT was very helpful in assisting the family in obtaining resources to help pay for equipment, such as mats and a swing. The mother attributes the child’s status to the occupational therapist, stating the child’s “self-stimulatory behaviors have been reduced to half since working with the OT,” and that this reduction in behaviors allows the child to focus on other, more appropriate activities. *Ashley is not the child’s real name
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