Autism and Occupational Therapy Optimizing Function. January 2015 POTC, AAC

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1 Autism and Occupational Therapy Optimizing Function

2 Occupational Therapy Enhancing function in activities of daily living: dressing, bathing, toileting, eating Promoting participation in play and social activities. Optimizing sensory processing and motor development. Facilitating self-regulation. Ensuring safety. Law, M (2005)

3 Home: increasing independence through structuring tasks. Environments Daycare and preschool: selfregulation for transitions; pre-literacy skill building. School: paying attention for learning, printing. Clinic: improve sensory and motor development. Luthman, MR (2010), Marr, D (2010)

4 Self Care: Activities of Daily Living Dressing: sequencing, over/under dressing, taking clothes off. Bathing: hygiene, refusal, fear of water. Toileting: bowel or bladder incontinence. Eating: choking, sensory sensitivities, fine motor skills. Cox DJ (2012)

5 Productivity: Play and School Home: getting ready for preschool, cleaning up toys. Daycare: following instructions, participating in activities. School: starting, maintaining, and completing tasks, paying attention.

6 Leisure: Fun, Fitness and Friends Requires creativity and imagination Play is a critical factor in development. Play teaches children physical, social and language skills, as well as an understanding of others emotions. Rosenbaum, P (2013, 2012) Potvin MC (2011)

7 Motor Development 50-75% of children with Autism experience substantial motor coordination deficits across a wide range of behaviors. Fournier et al. (2010) Treatment of identified sensory-motor delays performed by OT s or PT s. Cox DJ (2012) Specific motor skill research includes delays in both fine and gross motor areas: Clumsiness Gait disturbance, arm movements Lack of hand dominance Motor stereotypies Poor balance, postural stability deficits Toe walking

8 Gross Motor Control Balance: active and standing Ball skills: catch, throw, aim, bounce, hit Postural stability: maintain centre of gravity for R/L and upper/lower body coordination Gaits: walk, run, jump Kimberley (2010) Gross motor development precedes fine motor control

9 Fine Motor Control The ability to control the trunk, arms, hands, mouth, fingers and eyes to accomplish a task: dress, eat, build, paint, draw, cut printing legibility and output speed, reading computer keyboarding

10 Sensory Development Occurs in the Reticular Activating System Brain integrates incoming information and assigns meaning Output is determined by quality of input and throughput

11 Sensory and Autism 94.4% of adults with ASD reported extreme levels of sensory processing on at least one sensory quadrant of the Adult/Adolescent Sensory Profile. Crane et. al. (2009) 69% of children with Autism demonstrated sensory symptoms on the Sensory Experiences Questionnaire. Baranek et. al. (2006) 95% of children with Autism demonstrated some degree of sensory processing dysfunction on the Short Sensory Profile Total Score, with the greatest differences reported on the Underresponsive/Seeks Sensation, Auditory Filtering and Tactile Sensitivity sections. Tomchek & Dunn (2007) New research supports decades of clinical and anecdotal evidence that individuals with ASD process sensory information such as sound, touch, and vision differently than typically developing children. Russo et al. (2010) Sensory Hypo/Hyper-Reactivity has been added to the Diagnostic and Statistical Manual for Psychiatry Fifth Edition. DSM V, (2013)

12 Sensory Interventions Sensory interventions are one model of practice OT s use in the treatment of ASD, and are used in conjunction with a variety of other interventions. Sensory treatments are a specialist intervention requiring post-graduate training (USC, Certification Program in SI). Sensory theory and principles were developed by Jean Ayres (1972, 1979). Sensory interventions must meet January 2015 POTC, specific AAC fidelity requirements.

13 Sensory Intervention Specifics Child lead play Supervised by a trained sensory professional Uses equipment that is enticing, invites creativity and is safe. Promotes therapist-child relationship Provides the Just right challenge Promotes adaptive responses, self-organization, exploration and pleasure

14 Sensory Intervention IS NOT Applying deep pressure to a child Wearing a weighted vest while seated in class Using a Therapy cushion during circle time (Umeda 2012) Wearing headphones to block ambient noise Sitting in a quiet corner to recover after a meltdown Chewing gum to calm and improve focus Taking a walk in the hallway These are sensory strategies based on theory to support improved self-regulation. Research on effectiveness of sensory stimulation strategies is mixed, and should consequently be considered on a case by case basis by a trained OT.

15 Sensory Intervention Research Research lags behind clinical evidence. Starts with case reports, group studies then retrospective studies. Sensory intervention effectiveness questioned from both inside and outside the profession. Shaw, (2002) Sensory intervention research started afresh in 2007 and began to focus on ASDs as well as other diagnoses Miller, LJ (2007), May-Benson et al (2010), Pfeiffer,B. A et al (2011), Schaaf, RC et al (2012)

16 Self Regulation Being in control of energy states Soothes self when upset Waits turn Transitions from task to task Listens Accepts challenges Pays attention and learns Greenspan 2006, Russo 2010

17 Social Participation Talk and listen. Appropriate topics. Initiate communication or play with other children. Allowing turn taking. Participating in group play. Greenspan:2006

18 BC Pediatric Occupational Therapy Council Autism Advisory Committee Members: Diane Graham, OT - Kids Can Therapy, Kelowna Jane Remocker, OT - Vancouver Pediatric Occupational Therapists, Vancouver Cris Rowan, OT - Zone in Programs & Sunshine Coast Occupational Therapy, Sechelt Les Smith, OT Director, Prince George Child Development Centre, Prince George Susan Stacey, OT Chair, Paediatric OT Council of BC, Duncan, BC Giovanna Boniface, OT - Managing Director, Canadian Association of Occupational Therapists - British Columbia Chapter Additional Information and Research References can be obtained upon request to caotbc@caot.ca.