Supporting Parents of Children with Autism The Role of by zaaaaa4


									Supporting Parents of Children with Autism: The Role of Occupational
Autism is a complicated neurodevelopment disorder in which the brain does not seem to function properly.
Children with autism typically have social interaction and communication impairments as well as restricted
interests, activities, and play skills. Raising a child with autism is an enormous and often overwhelming
task, but occupational therapy can help.

Occupational therapy can help children with autism perform better in school and home environments.
Parents who are referred to occupational therapy practitioners often have concerns about the behavioral and
social development problems their children with autism display in these environments, and practitioners
can assist with these issues.

Understanding Sensory Issues

Although the behavioral and social difficulties that children with autism have are overtly displayed, many
children also have sensory issues that are trickier to detect. “Some of the issues in social interaction and
communication, as well as some of the behaviors, are occurring because the child often has sensory
processing issues,” says Jane Case-Smith, EdD, OTR/L, FAOTA, professor and director of the
Occupational Therapy Division of the School of Allied Medical Professions at Ohio State University. It is
estimated that 80% of children with autism have sensory processing problems. This means that they can’t
filter out extraneous sensory stimulation nor doesn’t process sensory stimulation in the same way typically
developing children do. Occupational therapy practitioners can address sensory issues and equip parents to
manage their child’s behavior more successfully.

Problems with sensory processing can explain why children with autism may not like noise, being touched,
or the feel of certain clothing. “Sometimes [parents] are very aware of these behaviors—that the child is
rigid, that they won’t eat certain foods or don’t like certain odors—but nobody’s really put it all together
for them,” says Case-Smith. Occupational therapy practitioners can clarify the role of sensory processing
and provide advice on practical things parents can do, such as placing a weighted vest on a child if he or
she needs calming. Occupational therapy practitioners also support positive behavior, aimed to help the
child’s social engagement, by imitating the child’s actions, waiting for his or her response, positively
responding to the child, and cuing appropriate social interaction to improve social play skills.

Accessing Occupational Therapy

Children with autism can access occupational therapy most easily through schools because public law
mandates its availability to students with disabilities who need it. In addition, many insurance plans cover
private occupational therapy for children with autism, and because of the severity of the disability, many
states offer a waiver that qualifies families with higher incomes to access occupational therapy using
Medicaid dollars.

Children with autism usually receive occupational therapy in their schools as part of their educational
program. Many also receive private occupational therapy, which may be covered by insurance or paid for
independently. Often sensory-based, this “active type of intervention focuses specifically on helping
[children] integrate their sensory systems and initiate and sustain purposeful play,” says Case-Smith.
Therapy can involve swings, deep touch, massage, and numerous other methods. Therapy sessions always
center on the child, incorporate play, are interactive, and provide activities that require the child to problem
Creating the Intervention Plan

When creating an intervention plan, occupational therapy practitioners evaluate children with autism using
observation and parent and teacher reports and also interview parents about their child’s relationships and
eating, self-care, and daily living skills.

In setting goals, occupational therapy practitioners work with families and teachers as a team to address the
most immediate and important issues. “Autism is so pervasive and it’s so complex that it’s critical that the
entire team is focused on one or two or three priorities. [These are] typically social interaction, behavior,
and performance within a classroom,” says Case-Smith. Whether practitioners modify the environment or
engage in one-on-one therapy, their efforts serve the goals of the teacher and family. By collaborating with
families, teachers, and other service providers, the occupational therapy practitioner strives to support
academic success.

An important and often overlooked part of this team is siblings. When it comes to reinforcing goals,
“There’s quite a lot of evidence that using siblings and typical peers is pretty effective with children with
autism,” says Case-Smith. Siblings can take leadership roles where they initiate and direct interactions.

However, adults must address the potential effect such interaction will have on the sibling. “You have to
help them understand that, ‘your brother isn’t going to respond to you. It doesn’t mean he doesn’t want to
play with you; he needs you to show him how to play,’” says Case-Smith. “For some siblings, it’s
overwhelming and they can’t manage it, but if you have a little bit older sibling who can understand and
wants to help, it can be effective.” Inviting the participation of sibling also fits well into sensory integration
therapy, which is playful and often involves activities done in groups or pairs.

Families that include a child with autism often get to a point at which their lives revolve around that child.
“The whole family’s schedule and activities are pretty much determined by this one child and what he
needs,” says Case-Smith. When talking to parents, “We try and make recommendations that are helpful
rather than more work,” she says. Parents of children with autism have enough anxiety about whether they
do enough for their child. Occupational therapy supports the parents and helps them to be more effective,
reinforcing the already good work that they do.

Ashley Opp Hofmann is AOTA’s senior staff writer.

Effects of a weighted vest on attention to task and self-stimulatory behaviors in
preschoolers with pervasive developmental disorders.

       Fertel-Daly D, Bedell G, Hinojosa J.

       Challenge Infant Developmental Center, Brooklyn, New York, USA.

       OBJECTIVE: This study examined the effectiveness of using a weighted vest for
       increasing attention to a fine motor task and decreasing self-stimulatory behaviors
       in preschool children with pervasive developmental disorders (PDD). METHOD:
       Using an ABA single-subject design, the duration of attention to task and self-
       stimulatory behaviors and the number of distractions were measured in five
       preschool children with PDD over a period of 6 weeks. RESULTS: During the
       intervention phase, all participants displayed a decrease in the number of
       distractions and an increase in the duration of focused attention while wearing the
       weighted vest. All but 1 participant demonstrated a decrease in the duration of
       self-stimulatory behaviors while wearing a weighted vest; however, the type of
       self-stimulatory behaviors changed and became less self-abusive for this child
       while she wore the vest. During the intervention withdrawal phase, 3 participants
       experienced an increase in the duration of self-stimulatory behaviors, and all
       participants experienced an increase in the number of distractions and a decrease
       in the duration of focused attention. The increase or decrease, however, never
       returned to baseline levels for these behaviors. CONCLUSION: The findings
       suggest that for these 5 children with PDD, the use of a weighted vest resulted in
       an increase in attention to task and decrease in self-stimulatory behaviors. The
       most consistent improvement observed was the decreased number of distractions.
       Additional research is necessary to build consensus about the effectiveness of
       wearing a weighted vest to increase attention to task and decrease self-stimulatory
       behaviors for children with PDD.

      Sensory integrative-based occupational therapy and functional
      outcomes in young children with pervasive developmental
      disorders: a single-subject study.

      Linderman TM, Stewart KB.

      Mighty Oaks Children's Therapy Center, Albany, Oregon 97321, USA.

      OBJECTIVE: This single-subject study explored the effects of sensory
      integrative-based occupational therapy provided in an outpatient clinic on the
      functional behaviors of two young children with pervasive developmental
      disorder (PDD) at home. METHOD: The participants were two 3-year-old boys
      with PDD. Before the study, the participants had not received a consistent
      program of sensory integrative-based occupational therapy. Before the baseline
      phase, three target behaviors were identified for each child, using an adapted
      version of Cook's revised Functional Behavior Assessment for Children with
      Sensory Integrative Dysfunction. These target behaviors were operationalized and
      used as repeated measures taken in the home during both the 2-week baseline and
      treatment phases. The treatment phase was 11 weeks for Participant 1 and 7
      weeks for Participant 2. RESULTS: Both participants displayed significant
      improvements in the areas of social interaction, approach to new activities,
      response to holding or hugging, and response to movement. Decreases were noted
      in the frequency and duration of disruptive behaviors (e.g., high activity levels,
      aggressive behaviors), with an increase in functional behaviors, such as
      spontaneous speech, purposeful play, and attention to activities and conversation.
      Concurrent interventions that were not part of this study (e.g., initiation of speech
      therapy, preschool, vitamins) may have confounded these results.
      CONCLUSIONS: These findings support the application of sensory integrative-
      based occupational therapy as a part of the services provided to some children
      with PDD. Further research is needed to replicate these findings and to isolate the
      effects of sensory integrative-based occupational therapy because both
      participants were receiving other interventions at the time of this study.

      PMID: 10200844 [PubMed - indexed for MEDLINE]

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