Occupational Therapy for Autism

Occupational therapy improves the functioning of individuals with Autism Spectrum Disorder (ASD), behavioral, and sensory processing challenges. Inclusion of sensory symptoms (e.g., over or under-responsive to or atypical interest in sensory stimuli) in the new DSM-5 ASD diagnosis has the potential to further promote the use of occupational therapy (OT) interventions for Autism. Research currently supports the relationship between sensory symptoms and functional behavior problems affecting individuals with ASD. However, the contribution of occupational therapists has been limited by a lack of attention to the interrelated sensory, behavioral, and developmental challenges of many individuals with ASD.

OT uses the sensory integration and behavioral frames of reference to improve functioning in daily activities. The Sensory Profile www.sensoryprofile.com ; PaganoFABTriggerCopingForms ,activity analysis, and clinical observations can be useful components of an OT Evaluation. The OT Evaluation helps determine the most important functional goals related to sensory and behavioral challenges.

Functional goals for clients with ASD can include increasing seated behavior, attention, and keeping safe hands (e.g., eliminating physical aggression towards ones self and others). Objective baseline data is used in developing the functional goal and monitoring progress. Examples of baseline data may include: client currently sits a maximum of 10 consecutive minutes, attends to teacher selected tasks for an average of 5 minutes, or keeps safe hands (e.g., does not hit others) for ten consecutive minutes.

Occupational therapy sensory interventions related to functional goals in ASD include psycho-education, environmental adaptations, sensory diet activities, and direct therapeutic intervention. Psycho-education involves teaching clients with ASD how their sensory processing, emotion regulation, and behavior challenges affect their functioning. A related intervention is coaching clients, families and professionals to develop environmental adaptations that enhance participation in daily activities.

Environmental adaptations include the use of adaptive equipment and techniques that enhance daily functioning. Commonly used adaptive equipment for ASD include noise canceling headphones, fidget toys, chewey tubes, and theraputty. Frequently used adaptive sensory strategies for clients with ASD include initially reducing then if needed incrementally increasing sensory input in a socially acceptable manner, choosing one activity and doing it for a set period of time beginning another task, and using a sensory coping area to improve self-control.

Clients with ASD, sensory processing, behavior, and social skill challenges may receive direct occupational therapy services including sensory and behavioral interventions. Given the strong relationship between tactile sensory processing and behavioral problems in ASD, touch intervention appears important. Examples of direct intervention activities for clients with ASD include massage, scrub brushing, vibration, mindfulness, yoga, and movement planning tasks.

By combining sensory and behavioral strategies as part of a transdisciplinary team, OTs can achieve functional goals that enhance the daily life of individuals with ASD (e.g., increased attention, improved social interactions, decreased self-injurious behaviors). Pivotal Response Therapy (PRT) http://education.ucsb.edu/autism is an evidence-based behavioral strategy that can be used in conjunction with sensory strategies. PRT provides developmental transdisciplinary interventions addressing effort, communication, and social interactions. Developed by a psychologist with expertise in Applied Behavioral Analysis and a Speech/Language Pathologist, PRT is a practical intervention that is useful for teachers, parents, as well as occupational, speech, and physical therapists.

For example, a behaviorist and I provided services to a kindergarten girl who had ASD, sensory seeking, and behavior challenges. Her repeated hand mouthing was interfering with learning and damaging the skin on her fingers. Our transdisciplinary assessments included a FAB Sensory Functional Behavioral Analysis (FBA), Sensory Profile, and observations.  The FAB Sensory FBA adds sensory environment antecedents (e.g., loudness, crowding, transitions) to traditional FBA data for greater focus on antecedents (what happens before problematic behavior that could be changed to improve functioning).

The evaluation suggested she was sucking her hands to receive sensory input in her mouth and wetness on her hands. Using a Preference Assessment and Activity Analysis, her favorite activities matching the sensory input she got from hand sucking were mouthing a chewey tube and playing in a water table. Intervention involved allowing use of the chewey tube and water table as well as rewarding her for going progressively longer periods with out sucking her hands.

 

cheweyuseWaterTable

This example shows how sensory and behavioral strategies can be combined to improve functioning in individuals with ASD.  Transdisciplinary use of sensory and behavioral strategies is especially helpful for improving functioning in individuals with ASD, sensory processing, and behavior challenges. It is time for the conflicts to end so all professionals are working together to help our clients. Hopefully, recognition of sensory challenges in the new ASD diagnosis will encourage transdisciplinary sensory and functional behavioral interventions.

References:

Dunn, W., Cox, J., Foster, L., Mische-Lawson, L. & Tanquary, J. (2012). Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest-posttest repeated-measure design. American Journal of Occupational Therapy, 66(5), 520-528.

Foss-Feig, J. H., Heacock, J. L., & Cascio, C. J. (2012). Tactile responsiveness patterns and their association with core features in autism spectrum disorders. Research in autism spectrum disorders, 6(1), 337-344.

Silva, L., & Schalock, M. (2013). Treatment of tactile impairment in young children with Autism: Results with qigong massage. International Journal of Therapeutic Massage & Bodywork, 6(4), 12-20.

Stahmer, A., Suhrheinrich, J., Reed, S., Schreibman, L., Bolduc, C. (2011). Classroom Pivotal Response Teaching for children with Autism. New York, NY: Guilford Press.

Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L.& White, S. W. (2013). The role of emotion regulation in Autism Spectrum Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679-688.

 

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