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| Division of Occupational Therapy - OT Connect Autism in Adolescence and Adulthood
Autism is a pervasive developmental disorder characterized by a distinctive pattern of deficits in social dysfunction, communicative deviance, and restrictive and repetitive behaviors and interests. Because Autism is a spectrum disorder the symptoms and other manifestations of autism affect each person differently. (APA, 1994) Comorbid Conditions:
Several mental disorders including ADHD, psychoses, depressive disorders, obsessive-compulsive disorder, and other anxiety disorders often occur with autism due to a common underlying problem in brain functioning (NIMH,1997). Common Symptoms/Course of disease
Age of onset: Symptoms of autism typically appear during the first three years of life. However, autism cannot be “outgrown” and the progression from childhood to adulthood is an intensive and complex course resulting in diverse aspects of life needing attention. However, the ability to learn and develop new skills is within every individual. Although many remain severely disabled, roughly 1/3 of persons with autism are able to attain some level of personal and occupational independence. Early identification of individuals with autism is a positive prognostic factor for their future development. Other important predictors of adult outcome are communication skills and level of intelligence. The availability of vocational and residential community resources are also influential factors. (APA, 1994; Cohen, S., 1998; Florey, 1998; Huebner, R., 2001; Moshlem, 2004; NIMH, 1997; Paradox, P., 2001; Paris, B., 2000; Sarracino, Dell, & Milchick, 200). Sexual Bias: Autism is four times more prevalent in boys than girls. It occurs in families of all racial, ethnic, and social backgrounds. Family income, lifestyle, and educational levels do not affect the chance of autism's occurrence ( American Psychiatry Association, 1994; Paris, B., 2000; Huebner, R., 2001, Paradox, P., 2001; Cohen, S., 1998). Cultural Bias: Although there is no known cultural or ethnical bias for autism, research is currently investigating the possibility of a genetic base for the disorder (American Psychiatry Association, 1994; Paris, B., 2000; Huebner, R. ,2001; Paradox, P. ,2001; Cohen, S., 1998). Current Medical Treatment: To date, there are no medical tests like x-rays or blood tests that detect autism. The disorder affects each person differently and symptoms change with age. Therefore, periodic reevaluations are necessary to respond to changing needs (NIMH, 1997). Antidepressant medications such as clomipramine and fluoxetine. Antipsychotics, such as Haloperidol, help to control the aggressive behaviors. Antiepileptics help to stabilize brain activity and therefore control seizures and assist in the control of the aggressive behaviors. Depakote and Tegretol are just two examples of this class of medication. Vitamin B6, taken with magnesium to stimulate brain activity. Behavior Therapy (NIMH, 1997) Autism Transfer Factor is an alternative treatment being developed as a “cure for autism." Leukocytes or lymphocytes from human blood cells are taken from a family member in order to transfer immunity to autism. Occupational Therapy Involvement Occupational Therapy (OT) is prescribed to help the individual become as independent as possible. OT Evaluation: Assessing the adult with autism will reveal strengths and weak areas that may need to be addressed to improve the individuals functioning and level of independence. Two possible evaluation tools are the:
Assessments such as the AMPS and KELS help to guide OTs develop goals and treatment plans that are customized to address the needs of the client. Areas of intervention may include developing skills in housekeeping, self-care tasks, clothing care, shopping, money management, communication, telephone use, and leisure activities. Social dysfunction is one of the significant features of autism and is apparent in difficulties in give-and-take social interaction and the ability to form and maintain relationships. Also making sense of nonverbal communication and subtle social situations continue to be problematic for people with autism. Using group therapy, clients may improve and expand their social interaction skills, learn to recognize other's feelings in addition to their own, and build coping abilities (Sarracino, Dell, & Milchick, 2001). Sensory problems, such as tactile defensiveness, and fine and gross motor skills are also problem areas that may need to be addressed by OT. References
How OT Makes a Difference: Evidence-Based Practice Van Bourgondien, Mary E.; Schopler, Eric (1996). Intervention for adults with autism. Journal of Rehabilitation, Jan-Mar 96, Vol. 62 Issue 1, p65, 7p This article presents information on the major components of the application of the Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH) system, to programs for adolescents and adults with autism. This study considers four primary treatment components - structured teaching, communication training, leisure and social skill development. The authors of this paper report that these four treatment area impact the adaptation of adults in vocational, residential, and recreational settings. Many of the intervention strategies recommended in this paper are interventions in which occupational therapists have specialized training. The establishment of functional routines for daily living and self care, exploration of healthy social and leisure behaviors, and the enhancement of interpersonal interactions are identified as important focii for intervention in adults with autism. OT Evaluation: Assessing the adult with autism will reveal strengths and weak areas that may need to be addressed to improve the individuals functioning and level of independence. Two possible evaluation tools are the:
Assessments such as the AMPS and KELS help to guide OTs develop goals and treatment plans that are customized to address the needs of the client. Areas of intervention may include developing skills in housekeeping, self-care tasks, clothing care, shopping, money management, communication, telephone use, and leisure activities. Social dysfunction is one of the significant features of autism and is apparent in difficulties in give-and-take social interaction and the ability to form and maintain relationships. Also making sense of nonverbal communication and subtle social situations continue to be problematic for people with autism. Using group therapy, clients may improve and expand their social interaction skills, learn to recognize other's feelings in addition to their own, and build coping abilities (Sarracino, Dell, & Milchick, 2001). Sensory problems, such as tactile defensiveness, and fine and gross motor skills are also problem areas that may need to be addressed by OT. F. was diagnosed as having autism at about 2 1/2 years of age. F. benefited from early intervention and services received while in school. At 22 years of age and having graduated high school F. was having trouble maintaining her apartment and holding down a job due to difficulties with planning and executing daily activities. F said that her occupational therapist taught her different strategies that would help her to maintain her independence. Some of these tactics include developing and following a routine, break tasks down to manageable sections (clean one room instead of four), use checklists as reminders of what needs done, write down and stick to a budget, and rotate clothes in the closet so that the same one aren’t worn all the time. With these techniques F. was more in control of her life and was less anxious. Writing down reminders for herself at work helped her productivity in that area too. After three weeks of skilled OT services F. reported that she was already more successful in tasks of cleaning her apartment or remembering her medication. After two months she had achieved all her goals and was able to return to work full time and be discharged from OT. Books written from the perspective of adults with autism:
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