Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder which affects engagement and participation in everyday life. Occupational therapy is a pivotal service for increasing participation in “occupations” such as activities of daily living, play and social participation. Occupational therapy strives to increase occupational performance in order to promote health, life participation and an overall sense of well-being of the individual (O’Toole, 2011).
OT is frequently chosen by families to translate goals they have for their child into occupation-based outcomes (Schaaf, et al., 2015)
For the occupational therapist who chooses to work with children with ASD and their families, they need to have a good understanding of the social, communication, stereotyped and sensory behaviours which contribute to the ASD diagnosis or work under an experienced clinician’s supervision. In some cases, the OT may play a role in early identification and contributing to early intervention services. The sooner necessary services are in place, the better the outcome is for the child.
The OT needs to have advanced knowledge of other conditions that may co-occur with Autism such as Developmental Coordination Disorder (DCD), Attention Deficit Disorder (ADD) and mental health issues such as Anxiety Disorder. In the case of DCD, limitations in physical occupational performance skills can have lifelong implications, including social isolation because they are unable to engage in sporting activities. Promoting functional skills needed to participate in using sporting equipment is a strong role for an OT. Task analysis helps to match a child’s interests, strengths with leisure and sports options. For the child who wants to ride a bike, developing balance and bilateral coordination through riding a razor scooter is a good starting point and builds prerequisite cycling skills. From the razor scooter, the child may ride a balance bike with no pedals or a regular bike with the seat low and no pedals.
Mastering cycling may lead to participating in community cycling groups. It gives the individual with Autism a lifelong form of exercise and regular friends to join on bike rides. Research has shown that exercise can have a positive effect on self-regulation and mental health issues.
What do occupational therapists do?
The OT Domain and Practice Framework identifies eight (8) occupations that an OT may address in intervention. Activities of daily living (ADL) include personal care tasks (e.g. showering, dressing, eating) and Instrumental ADL that involves domestic tasks (e.g. cooking, laundry, shopping). (AOTA, 2014). Sleep is so vital to how a person functions and is a main concern of parents as suggested by a recent study by Chang (2018). Between 40% – 90% of parents of children with ASD report sleep issues.
It uses the International Classification of Functioning (ICF), developed by the World Health Organisation (WHO). The ICF measures health and disability of individuals and populations and considers the interaction between health, the environment and personal factors of the individual. The National DisabilityInsurance Scheme (NDIS) has adopted the WHO Disability Assessment Schedule (WHODAS 2.0). The ICF model fits with how an OT uses occupational analysis to look at all factors that may influence functioning within the context of where a person engages in occupations.
How does a child get referred for OT?
Problems with independence and participation in daily routines such as mealtime, personal care, play, social participation, self-regulation and motor skills (both fine motor and gross motor) are common reasons for referral. OT’s also provide positive behaviour support and write intervention plans.
What is the OT Assessment Process?
The occupational therapist gathers information to develop an occupational profile through checklists, questionnaires and interview. Assessment information obtained also includes the family‘s values, needs, hopes and aspiration for their child.
The OT synthesises preliminary information to determine the child and family’s strengths and what body functions/impairments might be limiting the child’s participation. In keeping with the ICF, environmental factors (e.g. support from others, attitudes, the environment and objects in the environment) are the focus.
The assessment varies according to the child, family situation and the perceived limitations for functioning. The occupational therapist favours the use of the natural environment for skilled OT observation of the child doing everyday tasks, e.g. the child playing on equipment in the playground with peers, classroom observation of manipulating learning tools, or handwriting during a creative writing session. The use of a standardised test occurs when there is a specific need for more information or to support the level of service intervention needed.
A comprehensive report provided to parents and teachers aims to clearly explain the limitations and barriers to independence and participation related to the initial goals identified. The occupational therapist may use outcome measures such as the Canadian Occupational Therapy Performance Measure (COPM), Goal Attainment Scaling (GAS) or a combination of these (Doig et al., 2010). The GAS is useful for measuring changes following OT run social group interventions (Charney et al., 2018). These specific outcome measures have the benefit of being specific to what is important to the family and the GAS sets a graded benchmark for when the family will be satisfied with the outcome for the area of concern.
What does OCCUPATIONAL THERAPY intervention involve?
The OT professional guidelines require the use of best practice and intervention that is based on evidence where possible and also the experience of the OT. Intervention is family-centred, child-centred, strengths-based and capacity building so that families will learn what they can do to improve the child’s life and theirs.
As much as possible, OT intervention is in the natural environment, e.g. school, home in the early years. The development of a trusting and collaborative relationship with the child and family within the context of the OT intervention is seen to be critical for good outcomes. The OT also works collaboratively with other therapists, educators and support workers.
The intervention follows the OT Framework and ICF guidelines by looking at the environment and what might be modified to support increased participation. Key people in the child’s life receive coaching, advice, and training as appropriate to know what they might do within the context of the typical day to support the child.
The use of assistive devices or technology may be part of the intervention. For example, for an older child with ongoing handwriting problems, the OT may suggest classroom modifications such as more time to write, the teacher accepting less neat work for drafts. For older students, modifications may include the use of an alternative to handwriting such as a tablet and apps to support writing or using apps that convert handwriting to text.
Common intervention for children with ASD includes assessment of sensory processing as it affects attention, learning and behaviour. For example, environments with lots of people and high ceilings are often challenging for the individual with ASD. The receives information about what they can do before, and during the activity to reduce the stress related to sensory processing problems. The family learns what they can do in their interactions with their child to reduce sensory overload such as modulating the tone and volume of their voice. Families identify sensory activities to do before going into a challenging environment such as a gym with a high ceiling. A picture schedule can reduce stress and by adding predictability.
The OT may implement sensory-based strategies for predictability and calming including visuals for routine tasks, visual schedules, specific activities that meet sensory needs for movement/deep pressure such as swinging, climbing, breathing/yoga and other strategies according to the assessment findings.
Emotional Regulation skills teaching, either through group or individual intervention, helps the child learn what emotions are and the feeling that goes with them. The child learns about thinking strategies to stay calm and focused throughout the school day. Social skills groups have strong evidence as an OT intervention method (Charney et al., 2018)
Occupational therapists, with advanced training, address mental health issues such as Anxiety, Depression and Obsessive Compulsive Disorder. The OT may assist with identifying early warning signs, triggers, motivators and explore sensory tools. Therapy intervention may include cognitive behaviour therapy (CBT) as well as activity scheduling, relaxation and yoga techniques.
How do OT’s monitor progress and outcomes?
The OT adjusts the intervention by measuring the effect of intervention routinely against the outcome measure and adjusting the intervention as necessary.
Well written, objective goals help with outcome measurement as well as other measures that are occupation-related such as The Goal-Oriented Assessment of Lifeskills or the Vineland Adaptive Behaviour Scales.
What AIM Occupational therapy offers?
AIM’s vision is that all individuals will live satisfying, enjoyable and meaningful lives and reach their full potential. AIM’s mission is to support individuals to reach their goals and improve their participation in all their occupations.
To achieve this, AIM provides a collaborative centre-based and community-based service that puts family/child goals first. AIM therapists work with the key people involved with the child to ensure the best outcomes from OT intervention. They work across clinic, school and community settings as needed. AIM is eligible to provide services under all funding bodies and has an occupational therapist who has Mental Health accreditation.
AIM partners with speech pathologists so children may have access to both centre-based interventions in one location. AIM also has resources available for purchase to assist with intervention programs.
AIM OT’s have strong professional skills in the way they relate to all stakeholders. They readily engage in peer mentoring and a peer review process and receive supervision to review current practice and address new areas of practice.
AIM strives to provide the service that will truly help your child with life occupations that they need to have a fulfilling life.
Chang, M., Burr, A., Staffaroni, G., Adams, M., Gines, C., and Crawford, J. (2018) Stress, Sleep, and Sensory Processing Among Parents of Children With Autism Spectrum Disorder American Journal of Occupational Therapy, November 2018, Vol. 72, 7211510198p1. doi:10.5014/ajot.2018.72S1-PO6019
Charney, L., Aimes, J, Apgar, L., Buday. A., Calverly, N., Kearney, C., Redmond, A., & Spires, T. (2018) Using Single–Subject Design and Goal Attainment Scaling to Measure Improvement in Social Participation in Children With Autism Spectrum Disorder American Journal of Occupational Therapy, November 2018, Vol. 72, 7211505149p1. doi:10.5014/ajot.2018.72S1-PO7013
Doig, E., Fleming, J., Kuipers, P., and Cornwell. P. (2010) Clinical Utility
of the Combined Use of the Canadian Occupational Performance Measure and Goal Attainment Scaling American Journal of Occupational Therapy, November/December 2010, Vol. 64, 904-914. doi:10.5014/ajot.2010.08156
O’Toole, G (2011) in MacKenzie, L and O’Toole, G (2011) Occupational Analysis in Practice. Pp 3-23.
Schaaf, R. (2015) Cohn ETC Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder American Journal of Occupational Therapy, September 2015, Vol. 69, 6905185005p1-6905185005p8. doi:10.5014/ajot.2015.018036