Occupational therapy

Occupational therapy is a kind of therapy which helps people to function in daily life activities and occupations. Autistic children often get occupational therapy to help them with tasks related to self-care, school, play, social interaction and independent living.

Occupational therapy focuses on developing skills and is highly tailored to the individual. The therapist will discuss what needs to be addressed with the autistic person and/or their parents/caregivers. The therapist will then help the autistic person improve skills and find ways to work around difficult tasks (for example, faking eye contact in a way that minimizes discomfort).

For children, occupational therapy is mostly based upon play and discussion. It has not been found to have ethical issues, and is generally enjoyable.

Background
Approximately 80% of children with AS receive services from an occupational therapist (OT) in some form. OTs work collaboratively with the client, family, educators, clinicians, and community to enable participation in meaningful occupations. OT services for AS include assessment, intervention, and evaluation. OT focuses on achieving outcomes such as engagement in activities, adaptation, individual satisfaction, role competence, and quality of life. Occupational therapy interventions for AS often address “areas of attention, behaviour, social skills, sensory processing, motor function, play, and self-care skills.” OT services may also be solicited when impairments in social interaction (such as restricted or repetitive patterns of behaviour, interests, and activities) interfere with function.

Methodology
Two methods are typically used to deliver occupational therapy services: consultative and direct delivery. Consultative delivery for individuals with AS does not involve direct therapist intervention. Instead, the therapist spends time discussing the child's needs with parents, and/or teachers – the therapist designs, monitors and evaluates an intervention that will be implemented by others. For example, the OT may teach a parent strategies for managing behaviours to promote occupational performance, such as ways to encourage alternative behaviours, or ways to modify the environment to change negative patterns. Consultative service delivery has been found to be an effective method for facilitating the achievement of goals. When providing direct service, the OT will spend the majority of their time directly interacting with the client to solve occupational performance issues.

Individuals with AS often have difficulty understanding social norms and establishing satisfying relationships with family and peers. As individuals with AS do not 'outgrow' these difficulties, they may experience difficulties securing employment and relational difficulties in adulthood. A variety of social skills interventions may be facilitated by OTs, either directly or on a consultative basis. Social skills interventions may be administered in school classrooms as a part of the curriculum, in mixed groups with typically developing peers, or in groups consisting of only individuals with AS. Social skills programs aim to teach children and adolescents the skills necessary to navigate their social environment – to interact with peers, familiar and unfamiliar adults - through interventions such as role play, direct instruction, providing feedback on interactions, practicing learning during free play, social scripts and social stories, and systems of rewards, and teaching Theory of Mind. Topics covered include: greetings, eye contact, initiating, responding to, and maintaining social interactions, turn taking, sharing, giving and receiving compliments, awareness and expression of feelings, non-verbal communication, politeness, conversational skills, negotiation, dealing with bullying, and hygiene. Research suggests promising teaching strategies include involving parents, using 'homework,' providing people to practice with, making teaching predictable and structured, modeling, reinforcing attempts, making social rules concrete, developing a fun and nurturing environment, and starting with simple skills.

Social Skills
An array of different social skills programs, which demonstrate varying levels of success, are offered by occupational therapists. In a systematic review, seven of ten studies reported some positive results, but because social skills are both difficult to define and measure objectively, it is difficult to isolate what part of the interventions was successful. Further, generalization of skills beyond the therapeutic milieu, especially in more complex areas of social interaction, appears to be somewhat limited (based on the available measures). That being said, interventions where skill generalization was facilitated resulted in wider application of learned skills. Though social skills training programs are common clinical interventions, more research is necessary to design and evaluate programs that are specifically targeted at subgroups within the Autism Spectrum, as programs that are targeted toward children's levels of functioning are more successful.

Social Stories
Social Stories™ is a specific type of social skills intervention used by occupational therapists that aims to improve social interaction. This intervention involves short stories that are written for a child, and provide a description of a social situation with accurate information about the event, a description of how others may react, and instruction for appropriate action or response in that social situation. These stories are typically formatted as short books, written from the child's perspective. Social Stories are a common intervention used with children with ASD. There is evidence that using Social Stories may decrease disruptive behaviour, enhance greetings, and teach appropriate play. There is also evidence that social stories increase eye contact and smiling behaviours. Overall, the evidence indicates that Social Stories are a promising practice, however further research is required to increase evidence supporting this intervention for children with AS.

Sensory Issues
Like other ASDs, some individuals with AS experience difficulties with processing and coping with sensory stimuli. Two general categories of OT interventions have been developed that seek to improve activity and participation issues resulting from impairments related to sensation: impairment-oriented therapies focus on body function and structure, while performance-oriented therapies focus on performance of specific tasks. Sensory Integration and sensory based approaches aim to reduce impairment by targeting an impaired body system, in this case sensory integration and processing systems, to remediate impairments to increase performance in other areas. Sensory based approaches are widely used, but supported with limited evidence. For example, one survey found that more than fifty percent of therapists who responded used weighted vests for clients with autism and other disorders. Though this sensory based intervention claims many positive outcomes, including remediation of inattentiveness, stereotypic behaviour, clumsiness, and hyperactivity, these positive effects have not been demonstrated in reliable research studies. Other sensory based interventions include sound therapy, therapeutic riding, using therapy balls or other equipment, and movement therapy. The later four therapies are aimed at improving motor coordination, based on the assumption that motor systems cannot operate successfully without processing and integrating sensory information.

Sensory gyms are a common aspect of occupational therapy, particularly for motor skills and sensory integration issues. The autistic person plays in a colorful gym with various play equipment (exercise balls, textured ropes, swings, balls, etc). The occupational therapist will introduce them to various games that are designed to strengthen certain skills, and then the autistic person and the therapist play the games together.

They may share the gym with other children and therapists, which can also help with turn-taking and similar social skills.

CO-OP
Cognitive Orientation to Occupational Performance (CO-OP) is a performance-oriented approach to intervention that utilizes the power of cognition to drive successful performance, and to solve daily occupational performance problems. CO-OP is an individualized, client-centred approach, focused on strategy-based skill acquisition. CO-OP interventions enable the child to select a skill that will be the focus of treatment. Depending on the skill that is selected, OT intervention addresses issues in the areas of self care, productivity, or leisure. An OT would then help the child with his/her selected occupations by guiding them in the use of global problem solving strategies, as well as the identification of domain-specific strategies that will enable new and effective ways to achieve their goals.

The CO-OP approach was designed by OTs for use with children who have occupational performance deficits, specifically Developmental Coordination Disorder (DCD). However, evidence that supports the use of the CO-OP approach for children with AS is accumulating. OTs can use the CO-OP approach to assist children with AS in the acquisition of social and organizational skills. Some OTs use the CO-OP approach to assist children in acquiring new skills, and, theoretically, to enable them to generalize and transfer learned strategies to new materials, contexts, and situations. As the use of the CO-OP approach with children with AS is still a fairly new area of practice, further research is required to assess the effectiveness of the CO-OP with this population.

Assistance Animals
Animal assisted therapy for children with AS is an emerging OT intervention. Animal assisted therapy integrates animals, in a goal oriented setting, while treatment is implemented. Animal assisted therapy has significant benefits in terms of increasing cognitive, psychological, and social function. Evidence also suggests that animal assisted therapy influences physiological factors, and can lower blood pressure, heart rate, and decrease levels of anxiety. There is evidence that OT treatment for children with ASD that incorporates animals can promotes a greater use of language and increased social interaction, when compared to standard techniques.

External link

 * Occupational Therapy and Autistic Children