Autism Spectrum Disorder (ASD)

__: incorporate visual support strategies Framework to support achievement on therapeutic & educational goals - heavy on using visual support strategies

Treatment & Education of Autistic and related Communication Handicapped children (TEACCH)

Performance Skills & Client Factors: Oral motor -Poor oral control for sucking, chewing, blowing -Poor __ support for speech -Poor __ in breath support for eating, drinking, swallowing and conversing Ocular-motor -Decreased use of eyes for guidance of body or hands in action

breath coordination

__ = most common procedure used for children with ASD - positive reinforcement of desired behavior (give child praise for eating) and removal of reinforcement for undesired behavior (ignore child when they are not eating)

differential reinforcement

Play Intervention: Need to incorporate __, preferred interests, sensory properties of toys and activities to promote improved behavior and motivation, reduce need for adult guidance or redirection, and increase interaction Floortime (DIR) OT-SI Video modeling Peer mediated interventions

choice

Increase fiber, water intake, give stool softener if recommended by doctor - __ issues - do opposite for kids with loose stool

constipation

Data & Stats: About 1 in 68 children has ASD ASD is almost 5 times more common among __ than __ is it genetic?

boys, girls yes - there is a genetic component

Red Flags: If the child is not doing this by the age of __ lack of response to name - want to make sure the child can hear, rule out a hearing issue Lack of pointing Lack of play with a variety of toys - want to play with the same thing all the time, lining toys up Lack of appropriate eye gaze - don't watch other kids play Lack of sharing in interests or enjoyment - only care about what they like/what they are doing Lack of warm/joyful expressions Lack of communication Repetitive movements or body posturing Repetetive moments with objects

2

which intervention approach? __ - looks at how learning takes place & what is the likelihood that a behavior will be repeated - look at the antecedents - what comes before behavior, what's the environment when the child is completing the behavior & what happens afterwards - functional behavior analysis - look for routines regarding the child's behavior & look at what happens immediately after the behavior - negative & positive enforcement are used in ABA - discrete trial training is used in ABA - reward the child for doing what you want them to do

Applied Behavior Analysis

which toileting method? Use doll that wets to imitate process of toileting and teach specific actions When doll urinates in potty, teach child to remove pot, empty it into toilet, flush, and return pot to chair. Once learned, begin training child Teach child to differentiate dry from wet pants. Give reward/praise for dry pants. Perform every 3-5 minutes Give child as much to drink (8oz/hr) Instruct child to walk to potty, lower pants, sit, stand up, raise pants. Watch to see if urination begins, praise if it does

Azrin and Foxx Rapid Method

Assessments Tools for ASD

Bayley Scales of Infant Development** Bruininks-Osteretsky Test of Motor Proficiency Peabody Developmental Motor Scales Pediatric Evaluation of disability Inventory** School Function Assessment** Sensory Integration and Praxis Tests Sensory processing Measure Sensory Profile ** means there's a social component

which intervention approach? goal, plan, do, check Using cognitive hehavior and motivation to guide intervention - found to be very affective for kids with ASD - skills learned transfer & generalize - problem solving approach

CO-OP

which toilet training method? At 18 months, introduce potty chair Daily, have child sit on chair fully clothed when parent uses toilet After 1-2 weeks, remove diaper and have him/her sit on potty. Make no demands When child is comfortable with potty and eliminates in diaper, take child to potty and empty diaper's content, explain that's where bowel movt goes If child understands, take child to potty several times a day As interest grows, remove diaper and pants for short periods and place potty nearby. Encourage child to use it and give reminders Training pants can be introduced

Child-Oriented Toilet-Training Method-Brazelton

__: focus on joint attention and shared interaction using naturalistic applied behavior approach Has documented effectiveness & is an established model (preschool children) - involves play - engage them in 20 hrs a week of guided instruction/targeted intervention - combines ABA & developmental & relationship oriented approaches

Early Start Denver Model

which intervention approach? Family centered approach, can be incorporated in a natural setting (home, playground, play session), you follow the child's lead, you try to expand interaction addressing motor skills & emotions ^ is a specific, child directed playful approach that is part of the larger DIR (Developmental Individual Differences Relationship) model

Floortime and the Developmental, Individual Differences, Relationship-Based Model (DIR)

__: provide choice, use task variation, reward attempts, and use natural reinforces in play-based sessions. Teaches responsivity to multiple cues Intensive behavior intervention - naturalistic - derives from the principles of ABA - targets pivotal areas in a child's development (ex: motivation, self management, social initiations)

Pivotal Response Training

__: strategies to increase body awareness, motor planning, social-emotional contact, transitions & attention When children maneuver around obstacles & perform activities about 2-4 inches off the ground on an elevated square

Miller Method

which intervention approach? OTs use sensory strategies all the time (roll ball on child's back, weighted vest, hang on bars etc.) - bandaid When do you true SI you are altering the neurological processing through brain plasticity - this is not a quick fix

OT-SI & sensory approaches

which intervention approach? Behavioral approach based on ABA - proactive rather than reactive in terms of problem behaviors - try to understand purpose of behavior - in order for this to be successful, home, school and community must have buy in and be on the same page - teach the child rules that are always around them and reinforced - when you catch a child doing the right thing, you let them know that you saw it and give them a small reward

Positive Behavior Support

__: use imitation to increase engagement and interaction Goal is to teach the child to imitate as a means of social interaction

Reciprocal Imitation Training (RIT)

__ focuses on coping with change, flexibility, and integrating info from multiple sources Cognitive developmental intervention that hopes to build on cognitive, emotional, communicative & social skills

Relationship Development Intervention (RDI)

__: comprehensive model used with a team. OTs involved in emotional regulation portion of intervention. Provides a framework in which you can use strategies from other approaches

Social Communication, Emotional Regulation and Transactional Support (SCERTS)

__: use child's inherent motivations to engage and interact and help parents be optimistic and hopeful while helping child learn and achieve. Playful approach Help kids improve learning, development, communication & skill acquisition - you join in the child's play and their ritualistic behaviors (ex: tapping pen) to facilitate eye contact & social development

Son-Rise Program

which social skills intervention? gives a child a template for their emotions (stress/anger) level - can use actual pictures - color code it (go from very calm to angry)

Stress Thermometer

__: they have to try the little amount of food before they are able to leave the table

escape prevention

__: use sauce to mask new food (ketchup, ranch, etc.) - allow preferred condiment to be used & then decrease amount

flavor masking

__: take identified preferred food item, identify a target food - new food items are offered in between accepted food - each new food has one property that is similar to the previous food (taste) & one that is different (texture) - French fries - waffle fries - tots - hash - potato wedges dipped in cheese - baked potato with cheese - mashed potatoes & gravy - mashed potatoes, gravy & meat - chicken pot pie (target)

food chaining

__: A technique for evaluating program effectiveness on the basis of the extent to which individualized goals, established at intake, have been achieved upon termination or follow up

goal attainment scaling

Improve comfort -Carefully __ introduction of novelty into session -Attend to __ environment and child's response to it -Alter lighting, noise, smells -Provide opportunities for deep pressure and __ through active play

grade sensory proprioception

-Almost __ of children with ASD have average to above average intellectual ability -Children born to __ parents are at a higher risk for having ASD -A small percentage of children who are born prematurely or with low birth weight are at greater risk for having ASD -ASD commonly co-occurs with other developmental, psychiatric, neurologic, chromosomal, and genetic diagnoses

half older

Improve engagement and interaction -__ child and wait for child to initiate interaction via eye contact, touch, or moving into closer physical proximity -__ use of direct eye contact -Alter therapist's pace both motorically & verbally -Alter voice volume or intonation -Use __ or sing song vocalizations -Use preferred objects, colors, or movts -Interact playfully -Create fun problems to be solved

imitate reduce musical

Impact on Occupational Performance: Social participation -Difficulty with __ -Communication -Sharing similar interests/forming friendships Play -Beginning in infancy, both extreme preoccupation with and unusual use of objects are noted (unusual visual exploration, preoccupation with object features, limited flexibility and creativity in use of objects, and repetitive use of objects) -Spend less time in __ play (car around racetrack, pretending to feed a baby, pushing a train on the tracks) & less likely to engage in __ play Sleep Difficulty falling asleep, staying asleep and waking early 40-73% have difficulty with sleep

imitation functional, pretend

Performance Skills & Client Factors: Gross motor (GM) -__ of GM skills -Difficulties in developmental positions/early sequential movt patterns -FM & GM delays notable by __ months --Lying, sitting, rolling, walking Ideation -Poor ability to manage __ - this can account for their deficits in pretend play or playing with a new toy

immaturity 14 novelty

Goal Attainment Scaling: -Measures change __-criterion referenced -Can measure wide variety of behaviors or skills -Expected outcomes are predicted and possible outcomes __ around that point -Goals can reflect changes that are meaningful to the family -Score can be standardized despite individual nature of goals

individually scaled

ASD & __ disability often co-occur - social communication would have to be below the expected level of developmental in order to receive the ASD diagnosis PDD, AOS, Asperbergs - all fall under ASD now

intellectual

Performance Skills & Client Factors: Fine motor/lateralization -Impoverished __ finger movts -Poor in-hand manipulation; __ manual dexterity -Late onset __ or lack of lateralization (establishing dominant hand use - more left handed kids with ASD than right) -Little difference in skills between preferred/nonpreferred hand

isolated slow lateralization

which social intervention? __: using drawings of faces for kids to identify emotions

mind reading

Second Type of ASD Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following: -Stereotyped or repetitive __ movements, use of objects, or speech - lining up toys or objects, flipping toys, repeating what they just heard over & over again -Insistence on __, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior - even smallest change in routine will set child off, rigid thinking patterns, need to take the same route places, eat the same food in the same place with the same utensils -Highly restricted, fixated __ that are abnormal in intensity or focus -Hyper or hypo reactivity to __ input or unusual interest in sensory aspects of environment - indifference to pain or temperature (hypo), can be adverse response to sounds & textures, can have excessive smelling & touching, visual fixation

motor sameness interests senbsory

Diagnostic Criteria: -Symptoms __ be present in the early developmental period, however they may not become fully apparent until social demands exceed their social abilities -Symptoms cause clinically significant __ in social, occupational, or other important areas of current functioning -These disturbances are not better explained by intellectual disability or global developmental delay

must impairment

ASD is a __ disorder. There are 2 categories: 1. __ interaction 2. __ & stereotypic behaviors

neurodevelopmental/neurological social repetitive

Improve motor skills/praxis -Create fun __ course -Climb, walk, or crawl on __ surfaces to increase attention to motion -Gradually increase motoric sequences that are completed before a desired event or object is provided -Alternate preferred sensory activities with more challenging motor tasks -__ about motor activity you are doing, using familiar tune

obstacle raised sing

Intervention for Feeding/Eating Problems: -Establish safe, positive, predictable, and nurturing mealtime environment -Setting in which each meal or snack will take place -__ support -Develop __ guidelines -Amount and type of food to be served -Important for child to help __ & __ meals -Motor & sensory needs of child addressed -Discuss taste, texture & smell of food __ the day -Participate in shopping and preparing food as available -Transition to table (timer, Social Story, picture schedule)

postural behavioral shop & cook throughout

__: Cards have a picture of someone who is influential to the child - could be Spongebob - figure describes actions that they want them to perform - quotes telling the child what to do

power cards

Diagnosis can be made in the __ years

preschool - 3 or 4 years old

Teach specific skills using following techniques -__ - use prompts early & systematically, then reduce in frequency over time (verbal are the hardest to fade so use sparingly) -__ - most effective for teaching dressing skills - you can use a peer, sibling, or even child - want them to perform the task & have them watch it over & over again -__ - link behaviors to complete a task - requires task analysis - backward chaining (all steps completed by you or parent & child completes final step) forward chaining (child does first step & you do the rest - increase # of steps)

prompting video modeling chaining

Improve behavior and task completion -Use objects, visual cues, or schedules -Use __ that are familiar to child -Know and use child's preferred reinforces -Provide clear boundaries regarding __ -Provide choices -Provide __ instructions for child who can read

prompts space written

Performance Skills and client factors Posture -Poor __ postural stability - rely on support surfaces Gait & balance Lack of __ gait and toe walking (tandem walking) Coordination/praxis -Difficulties with initiation, sequencing and timing of actions -__ use of two or more body parts together

proximal heel-toe poor

Improve play and ideational praxis -Use __ props to begin to introduce role play -Use movie characters and stories to begin to introduce pretend play -Promote imagination -Have child help you create a __ out of unusual materials -Have child help build an obstacle course or sensorimotor activity -Discuss ways you can use certain objects based on their properties (affordances) -Try to add to current ideas with prompting -Take turns between __ the child and having child attempt to imitate you

realistic game imitating

One Type of ASD Persistent deficits in social communication and social interaction across multiple settings -Deficits in social-emotional __ - lack the ability to hold a conversation - hi how are you? How is your day going? What are you doing? -Deficits in __ communicative behaviors used for social interaction - decreased eye contact, lack of use of gestures, inability to read gestures, lack of facial expressions -Deficits in developing, maintaining, and understanding __ - sharing & imaginative play with another child, making friends, lack of interest in peers - but likes to talk about their own interests a lot

reciprocity non-verbal relationships

__: Introduce new foods to kids with selective - can take 12 or more times before the child actually gets used to the food

repeated exposure

Sleep Establish consistent bedtime __ __ strategies to help regulate sleep routines - consider __ Behavioral strategies -__: put child to bed - ignore until the morning except for safety -__: parent ignores behaviors at bedtime for a certain amount of time (10-15 minutes) before checking on the child - goal is for child to learn how to self-soothe -__: teach child to fall asleep in bedroom - you can rub their back, rock, sing, read story - parent reinforces appropriate bedtime behaviors, parent starts to remove themselves with statements such as excuse me I need to go... but I'll be back to check on you - parent leaves & comes back quickly - praise the child for not crying & staying in bed - gradually increase time until child can fall asleep on their own

routines sensory - environment (Auditory environment Visual environment Tactile environment - Softer sheets - Weighted blankets or weighted pillows - proprioceptive input Vestibular system - Linear horizontal movement - rocking baby to sleep unmodified extinction graduated extinction excuse me drill

Impact on Occupational Performance (cont.) Activities of Daily Living -Delayed __ performance particularly with feeding and toileting Education -Accommodations required to educational program __ patterns (habits, roles & routines) -Specific needs for routine and predictability -Stressful for the family because they have to be highly scheduled & structured - family may avoid social events because of child with ASD

self-care performance

__: Regular exposure to sensory events throughout the day - best type of sensory event = deep __ or __ input - you want to incorporate ^ input (heavy work) about every 90 minutes throughout the day

sensory diet proprioceptive linear vestibular

__: Child is required to accept not desired food before they can have their desired food (eat broccoli before you get dessert)

sequential presentation

Teaching Specific Feeding or Eating Skill -Begin with a __ time expectation -If stays seated, __ efforts and allow him/her to leave table -__ build up expected time at table -If goal is to increase time at table, use preferred foods

short praise gradually

__: offer a bite of lettuce & tomato together - more effective than sequential presentation

simultaneous presentation

__ issues are a hallmark of ASD

social

__: food that is significantly different from core diet - child should not be pressured to try it but should help preparing it

surprise foods

what is the most established approach?

the Early Start Denver Approach/Model

__: old foods used to try new foods - bite of fav food will be offered in between bites of new food

transitional flavors

which social skills intervention? turn down volume & ask child what is going on in the video

video detective

Education Intervention -Academic alterations -__ supports (clock, watch, checklist, picture, app on phone) -Technologic supports -Social supports -Social stories -__ supports (positiv support - v effective) -Sensory supports -Motivational supports

visual behavioral