Autism Spectrum Disorder (ASD)

Summary

-ASD is complex. -Symptoms can impact all aspects of occupational performance. -Entire family is affected. -Requires a strengths based focus AND evidence-based practice. -Interventions commonly include behavioral, sensory, cognitive and social supports, specific strategies to motivate and improve behavior, skill, and engagement.

History

-ASD, as a diagnosis, first discussed in 1943 in scientific literature but symptoms have been described in earlier writings. -Early ideas about causation blamed parents. -Many changes in diagnostic criteria over time. -Creates difficulties in determining prevalence.

Interventions Used in ASD

-Applied behavioral analysis: Learning begins through a change in behavior brought by external experiences using reinforcers. -Floortime: naturalistic or play based. 1. Follow the child's lead 2. Challenging creativity 3. expanding interactions to sensory motor skills and emotions Developmental, Individual Differences, Relationship Based Model (DIR): considers the child's emotional development level, strengths, and preferences. Child goes through six developmental stages of self-regulation and interest in the world with the help of a parent. intimacy, engagement, falling in love, two way communication, complex communication, emotional ideas, and emotionally and logical thinking. OTs can increase engagement using playful blocking and using one's own playfulness. -Reciprocal imitation training (RTI): parent or professional imitating the child through toys -TEACCH: visual support strategies helps with motor skills and cognition -Early start Denver: Focus on joint attention and shared interaction using a naturalistic applied behavioral approach -Relationship development intervention (RDI): focuses on change and being more flexible -Pivotal response training: providing choices to the child -SCERTS model: used with a team. OTs are in charge of emotional regulation -Miller method: OT uses many strategies to help with engagement -Son-rise program: inherits motivations to the child for engagement -Animal-assisted therapy: help in calming individuals

The Role of the OT

-Broad in scope because the needs of these families are wide ranging. -OT is commonly requested intervention to manage ADLs and family routines. to deal with sensory concerns and the impact on occupations and behavior. to improve child's ability to participate in the community and in daily family life.

Occupational Performance Impacts: Sleep

-Difficulty falling asleep. -Difficulty staying asleep. -These difficulties are very common in ASD and impact parental sleep as well.

Impact on Family

-Families of a child with ASD are often quite stressed. -They have difficulty finding appropriate services. managing problem behaviors. maintaining employment for both parents. being involved in the community with their child. knowing how to best parent multiple children with different needs, fairly.

Prevalence

-Has risen over time. -Cause is still unclear. -Currently reported as 1 in 59 (but 1 in 37 boys). -1 in 6 children have a developmental disability (mild to severe (CP). -Large public health burden as ASD is now quite common and an expensive disorder for the country.

Interventions for Families

-Improving coping and self efficacy through supports and coaching -Parental education and sharing of expertise -Cognitive-behavioral interventions: to support parental optimism and provide positive behavioral supports -Optimistic parenting: managing early behavioral difficulties and keeping them from growing into bigger problems

Occupational Performance Impacts: Social

-In all areas but most consistently in social participation as social issues are a part of the diagnostic criteria -Difficulty with social interaction and friendships -Difficulty with nonverbal communication in particular -Social isolation and limited romantic relationships

Autism Spectrum Disorder (ASD)

-Is a neurologic disorder. -can cause social, communication, and behavioral challenges -Most common in males. -Symptoms cluster in Social interaction Repetitive and restrictive behaviors -There is a wide range of performance in individuals with ASD.

Performance Patterns

-Many children with ASD struggle with changes to routines. -Prefer structure and predictability. -Often hinders family flexibility. -Families often revolve their activities around the needs of the child with ASD.

Occupational Performance Impacts: ADLs and IADLs

-May have difficulties in all areas of ADLs or these may be relative strengths. -Common issues include limited diets, fear of toileting, distress over hygiene or dressing tasks, difficulties with dental care. -Safety concerns and escapism common.

Types of Interventions

-Modeling and teaching of skills -Social supports -Environmental and task modifications -Sensory supports -Behavioral supports and strategies -Visual, auditory, and technology supports -Use of structure and routine -Altering preferred and nonpreferred tasks -Using highly motivating objects or activities

Interventions

-Multiple interventions may be appropriate for those with ASD. -Many have been designed specifically for this population. -Evidence based practice is CRITICAL. -Consider the focus of the intervention Adult directed and structured Child directed, playful, and naturalistic

Evaluation

-Must be comprehensive, strengths based, and family focused -Must include education about the role of OT and what we are able to help with -Must include consideration of social interaction, friendships, and engagement -Must ask about unusual behaviors, safety concerns, and escapism -Should consider the sensory environments the child is in and how they impact performance

Occupational Performance Impacts: Play

-Play is atypical in type, quality, and complexity. -Often pretense is lacking. -Uncommon use of objects. -Sensory seeking. -Limited ideation and creativity.

Performance Skills and Client Factors

-Sensory—Motor difficulties common but highly variable across individuals Sensory over responsiveness Sensory under responsiveness Sensory seeking Difficulties with praxis Linked with difficulties in many occupations

Occupational Performance Impacts: Education

-Wide ranges of educational performance -Some children are fully included and perform well academically but may struggle socially. -Others have difficulty with behavior in the classroom and have difficulty learning academic content. -Some children are placed in special educational placements. -Determining the proper educational placement can be difficult for parents.

DSM V Criteria

Persistent deficits in social communication such as social emotional: not being able to hold a conversation, nonverbal communication such as eye contact or lack of understanding gestures, no facial expressions, and difficult time with maintaining relationships (friendships) such as imaginative play or making friends Restricted, repetitive patterns of behavior, interests, or behaviors (at least 2 areas) such as stereotyped or repetitive motor movements, inflexible to routines, highly fixated such as strong attachments, and hyper or hypo reactivity to sensory input such as sounds or textures Severity based on social communication and restricted, repetitive patterns of behavior -symptoms must be present in the early developmental period -symptoms cause impairments in social, occupational, or other important areas concerning functioning -these disturbances are not related to intellectual disability or global development delay. ASD is a combination of intellectual disability, social deficits, and below than expected for general development. *All merged into ASD: Autistic Disorder, Pervasive Developmental Disorder not otherwise specified (PDD-NOS), Asperger Syndrome

Objectives

●Describe how autism spectrum disorder (ASD) impacts occupational performance. ●Explain how ASD in one family member affects the entire family. ●Compare the occupational therapist's role in assessment and intervention in ASD to other professionals on the intervention team. ●Describe how occupational therapists assist families to improve the occupational performance of children with ASD as well as overall family functioning.