Optimizing Function

Report
Autism and
Occupational Therapy –
Optimizing Function
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
Environments
 Home: increasing
independence through
structuring tasks.
 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 and Marr D, 2010
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)
Productivity: Play and School
 Home: getting ready for
preschool, cleaning up toys.
 Daycare/Preschool:
following instructions,
participating in activities.
 School: starting,
maintaining, and
completing tasks, paying
attention.
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
Motor Development
 50-75% of children with Autism experience substantial motor
coordination deficits across a wide range of behaviours.
Fournier et al. 2010, J. Autism Dev. Disorders
 Treatment of identified sensory-motor delays assessed by
OT’s or PT’s.
Cox DJ, 2012
 Specific motor skill research includes delays in both fine and
gross motor skills:
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Clumsiness
Gait disturbance, arm movements
Lack of hand dominance
Motor stereotypies
Poor balance, postural stability deficits
Toe walking
Gross Motor Control
• Balance: active and standing
• Ball skills: catch, throw, aim,
bounce, hit
• Postural stability: pelvic and
shoulder girdle
• Gait: walk, run, jump
Kimberley 2010
• Developmentally, gross
motor development
precedes fine motor control
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
Social
 Talk and listen.
 Appropriate topics.
 Initiate communication or
play with other children.
 Allowing turn taking.
 Participating in group play.
Greenspan S, 2006
Self Regulation
Being in control of energy states
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Soothes self when upset
Waits turn
Transitions from task to task
Listens
Accepts challenges
Pays attention and learns
Greenspan 2006, Russo 2010
Sensory Processing Incidence 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, J. Child Psychology and
Psychiatry.
 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 Integration Intervention
• OT-SI is one model of
practice OT’s use in the
treatment of ASDs.
• OT-SI is a ‘specialist
intervention’ requiring
post-graduate training.
(USC, Certification Program in SI)
• OT-SI Theory and
principles – developed by
Jean Ayres (1972, 1979)
• To classify as OT-SI, the
intervention must meet
the fidelity requirements.
Sensory Integration Intervention
• Child lead play.
• Supervised by a trained SI
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.
Sensory Integration IS NOT:
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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 SI theory to support
improved self-regulation. Research on effectiveness of sensory
strategies is mixed and should be considered on a case by case
basis by the OT.
Evidence Based Research
• OT-SI effectiveness
questioned from both
inside and outside the
profession. Shaw 2002, Pollack 2007
• Fidelity study: Parham 2007 (AJOT)
• OT-SI Research started
afresh in 2007 and began to
focus on ASDs as well as
other diagnoses.
• New research studies since
2007, which meet fidelity
requirements for OT-SI,
show promise.
Pollack 2007
Current OT-SI Research
• Research lags behind
clinical evidence.
• Starts with case reports,
group studies then
retrospective studies.
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Miller, LJ (2007)
May-Benson et al (2010)
Pfeiffer,B. A et al (2011)
Schaaf, RC et al (2012)
POTC – Autism Group
Includes:
Diane Graham, Jane Remocker, Cris Rowan,
Jenny Sexton, Les Smith, and Susan Stacey
and
Giovanna Boniface, CAOT BC
Thank You!!!

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