Occupational Therapy and Autism Spectrum Disorders (ASD)
Leslie Michaud, Occupational Therapist
“Occupational” in the title Occupational Therapy speaks to a focus on occupation. What occupy us every day are the activities we do and the roles will fill in our lives. This is a broad range that spans from our personal hygiene activities, to our work activities in our homes and at our jobs, to our play and social activities. When we complete these activities, depending on the setting, we fulfill roles in our lives-perhaps as member of a family, as a friend, as a student… Throughout our life span, we may face events that interrupt our ability to complete these activities and fulfill these roles.
By definition, an individual with an Autism Spectrum Disorder (ASD) has social interaction challenges, verbal and nonverbal communication challenges, and stereotypic behaviors and interests. These difficulties affect the individual’s ability to perform personal hygiene, work, play, and social activities at home, school, and in the community. They also impact the individual’s role fulfillment within these settings. Because of this disruption, occupational therapy has a place in 1) indentifying how the ASD impacts function in daily occupations and 2) providing support to maximize daily activity performance. These two components of identification and services, take place through two different systems with the state of Maine: the educational system and the medical system.
Within the educational system an occupational therapist or assistant works inside educational settings such as schools, regional programs, and in the case of children under age 3, within homes and child care environments. Identification and intervention targets role fulfillment and daily activities within these settings. Within the medical system, the occupational therapist or assistant works for the benefit of any age individual where identification and intervention focus on role fulfillment and daily activity within the home, community, and places of employment. In either system, the clinician may work directly with the individual or for the individual by collaborating with others (family members, caregivers, other professionals and paraprofessionals)
When an occupational therapist is assessing how the characteristics of ASD are impacting the daily activities of an individual, patterns of challenges often emerge. The individual or his /her family often describes unique occupation interests. The interest may be a repetitive, physical activity like rocking back and forth, or chewing on a shirt sleeve, or watching a fast paced light flicker. The unique interest has the effect of interrupting a functional daily task. Further assessment may show that the unique interest may be a way the individual avoids challenging functional occupations or situations that are or that overwhelm his/her senses. The intervention, to maximize daily functional performance, may include specially designed experiences to help the individual manage or process sounds, touch, and movement information. It may also involve modification of the individual’s environment or some alteration of the desired functional activity.
Once the occupational therapist has completed an assessment that yields a need for intervention, there are different service delivery options. Most commonly, the therapist will suggest a 1) direct service, where a therapist or assistant works with the individual; or 2) a consultation service where the therapist or assistant collaborates with caregivers. Depending on the setting, the therapist may also suggest a combination of service delivery options. When considering service delivery options of how, where, what, and with whom, an occupational therapist will have a preference toward desired outcomes that benefit the individual’s daily routines. An example might be for the individual to safely and successfully participate in a family meal at home or a group lesson at school. There may be times when leaving a typical setting to complete a therapeutic experience is a necessary way to start services. However, a therapist will usually prefer that the individual can ultimately practice new skills or modifications within the daily routine and typical setting (often with the support of others.) Therefore, the dynamic collaboration between a therapist/assistant and caregivers (family or staff) often becomes the most essential element toward achieving desired outcomes. Because of this viewpoint, a therapist may begin in a direct service option with a plan to shift toward consultation.
Ultimately, the effectiveness of occupational therapy intervention hinges on this link between the clinician and the important people in the individual’s life. A common and effective intervention, known as a ‘sensory diet’ or ‘sensory buffet’ solidly depends on this collaboration. Sensory diets alter the frequency, intensity, and duration of environmental information with 1) modifications to current activities and 2) additional experiences within an individual’s day. The desired outcome is to promote the individual’s readiness to participate in the goal activity, here defined as the family meal or the school lesson. Because the therapist/assistant cannot always be with the individual in these contexts, the work between the clinician and the caregivers is essential to the outcome.
Once a system of support for an individual with ASD maximizes his/her daily occupational performance, the benefit of occupational therapy will be complete and it will become time for the clinician to excuse him/herself from serving the individual. However, ASD can impact an individual throughout his/her life. As we all develop, so do our occupations and our roles. Therefore, the needs of an individual with ASD can change as well so it may become appropriate to start the occupational therapy assessment process all over again…
Leslie Michaud, Occupational Therapist
Eastern Maine Medical Center
October 25, 2011