Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a group of developmental disorders that challenges a child’s skills in social interaction, communication, and behavior. ASD’s collective signs and symptoms may include: making little eye contact, repetitive behaviors, parallel play, unexplainable temper tantrums, misunderstanding of nonverbal cues, focused interests, and/or sensory overload. Positive symptoms of ASD may reflect above-average intelligence, excellence in math, science, or art, and the ability to learn things in detail.

A question that many parent has is whAlthough an individual can be diagnosed at any age, ASD is commonly diagnosed by the age of two. In order to be diagnosed, a child will have to go through a two-stage process. A pediatrician addresses the first stage. They will screen for developmental delays at the well-child visits. Red flags for the child could be limited facial expression, very few words, or little to no eye contact. If there is concern for the child, an in-depth evaluation may be given by a specialized team of doctors. They focus on the assessment of language, cognitive, and age appropriate developmental skills of the child (National Institution of Mental Health, n.d.). Diagnoses can be made on school-aged children through recommended screenings by their parents or teachers.

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The symptoms of ASD limit a child to fully participate in their learning environment. After an evaluation, the role of an occupational therapy practioner would be to identify the child’s educational needs and address them through purposeful activities. The purpose of this paper will be centered on treatment through sensory integration for school-aged children with ASD. The application of this treatment will be investigated, along with effective ways to communicate information about the disorder to both colleagues and family members. Future research is still needed to establish the validity of sensory integration treatment.

Application to Practice

A child with ASD can have several different educational goals. To meet some of these behavioral and social challenges, sensory integration can be applied to treat the child. The basis of sensory integration therapy is to address sensory processing difficulties in a child through controlled sensory experiences. Treatment will stimulate visual, auditory, tactile, proprioceptive, or vestibular senses depending on a child’s needs. Activities will have to be adjusted to fit their response (hypersensitive/hyposensitive/sensory seeking) to sensory stimulation in their environment. Sensory integration treatment could include physical exercise, swings, or fidget toys. The goal of treatment is to help a child focus or relax depending on their response to sensory stimulation, which will result in better participation in occupations.

In 2014, a study was conducted to show the efficacy of sensory integration therapy on children with autism. The researchers individually personalized sensory motor activities to address proprioceptive sensations, tactile discrimination, and improve praxis (Schaaf, 2014). One of their treatment sessions included a carpeted scooter and a cushioned area of mats. The child had to pull themselves up a ramp on a scooter board and then roll back down the ramp into multi-textured pillows. This stimulated total body tactile and proprioceptive sensations in order to increase body awareness. More research is needed to validate their findings for positive outcomes of sensory integration therapy.

Presentation to Colleagues

A child with autism can experience difficulties learning due to sensory processing difficulties. They may be caused by hyper/ hypo response to sensory stimulation in their environment. In the classroom, this might cause the inability to listen to directions, trouble writing, or problems sitting/standing for a period of time. An occupational therapy practioner can intervene by giving the teacher suggestions for adaptations for the student in the classroom.

In a school-based setting, collaboration between an occupational therapy practioner and the teacher is essential. The first thing to do is establish rapport with the teacher. Spending time in the classroom, communicating in short emails, or asking the teacher for his/her own opinion can accomplish this. Building this relationship is important because it allows the teacher and the therapist to trust each other, share observations, and be open to suggestions from one another.

In order to educate the teacher on effective interventions, it will be helpful for the occupational therapy practioner to first explain what sensory processing disorder is and how it has been affecting the student’s classroom behavior. It may be as simple as providing an explanation that overstimulation of the senses requires the student to have to pick which sense they can focus on. For instance, a child that has turned away from the teacher while he/she is giving directions is an applicable example. The student cannot handle both the visual input of the teacher and the auditory input of the directions. They may be choosing to listen rather than to make eye contact in order to focus on what is being asked of them. After contextual information is given, the practioner can act as a resource and provide different options that the teacher can use in their classroom. It is important to reiterate that each child is different, meaning that one suggestion may work well for one student but not another. Suggestions that can be given may include earplugs, a fidget, a weighted vest, a stress ball, or seating the child away from the door/windows to limit distractions. These sensory accommodations can allow the student to focus on a classroom task.

Education of Families

An important part of helping a student with ASD succeed in the classroom is educating the caregivers. The role of occupational practioner would be to update the caregiver on child’s progress level and contact the parents to offer support through home-based suggestions and community resources. Contact can be made through an in-person discussion, IEP meetings, email, or written recommendations sent home with the child. When speaking to a caregiver, it is important to speak in laymen’s terms and listen to their concerns.

Schedules at home will have to be modified to benefit the child. Ignoring their needs can add stress and lead to a child’s meltdown. Instead, establishing routines would be beneficial because it promotes motivation and stability. For a child with autism and sensory processing dysfunction, a therapist could recommend visual schedules for the parents to go over with the child at home. This type of schedule allows the child to organize their day, aids in the completion of tasks, and helps the child transition easier between tasks. Other sensory input ideas parents can potentially incorporate into their child’s daily routine includes crab walk for proprioceptive input, an auditory timer and sensory breaks to complete homework tasks, and/or deep pressure massages or weighted blankets to calm child before bedtime (Jones, 2014). Using therapeutic suggestions in the home will increase a child’s ability to participate and focus in school.

Future Research

According to Thompson-Hodgetts and Magill-Evans (2018), 98% of occupational therapist used sensory- based approaches on children with ASD and would recommend the approaches for 57% of the children they treated. However, there still is not sufficient evidence that supports the efficacy of sensory integration therapy for children with autism. Research that addresses the effectiveness of sensory integration therapy lacks consistency because the sample sizes are too small and the outcomes are mixed. This is due to client-centered treatment necessary to address a child’s unique developmental needs. Studies are still being conducted to establish the evidence-based practice on the use of sensory integration in treatment sessions.

Summary

ASD is a developmental disorder that’s symptoms affect a person’s ability to participate in activities of daily living, to socialize with peers, and to self-regulate behaviors. Problems with sensory integration can contribute to the negative outcomes of symptoms. In a school-based setting, the role of the occupational therapist is to support and enhance a student’s participation in their educational learning process. Sensory integration therapy can accomplish this goal by addressing symptoms through visual, tactile, auditory, vestibular, or proprioceptive input. The occupational therapist should also involve the student’s teachers and caregivers with sensory-based adaptations in order to help the child succeed in multiple settings. Trust and rapport should be established in these relationships before suggestions are given. Although sensory integration therapy is a common method of treatment, research is still needed to provide evidence-based practice.    

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