Autism, part of a group of disorders known as Autism Spectrum Disorders (ASD), is a complex neurodevelopmental disorder that typically lasts throughout a person’s lifetime. The disorder is characterized by varying degrees of impairment in communication skills, social abilities and also by repetitive behaviors.
According to the Centers for Disease Control, of the approximately 4 million babies born every year, 24,000 of them will eventually be identified as autistic. Also, recent studies suggest boys are more susceptible than girls to developing autism. In the United States alone, 1 out of 70 boys are suspected of being on the spectrum, with perhaps more going undiagnosed to this day. Studies have revealed that girls appear to manifest a more severe form of the disorder than their male counterparts.
No one knows for sure. Research says that there is a strong genetic base for this. Recent studies suggest a strong genetic basis for autism — up to 20 sets of genes may play a part in its development. Scientists also believe that environmental factors play a role in developing autism.
Each child with autism differs, but there are some signs that many of them share. Children on the spectrum generally have difficulty relating to others; they may hardly speak, and if they do, they may not communicate in ways that other people can easily understand (for example, they may scream loudly when they’re upset, instead of crying). They don’t usually sustain eye contact. It’s too intense and has trouble reading social cues. They’re also prone to repetitive behaviors, flapping their hands constantly or uttering the same phrase over and over again. Further, they may be more sensitive than typically developing children, or dramatically less so, to sights, sounds and touch.
The theory of Sensory Integration (SI) was developed in the 1960s by Dr. A. Jean Ayres, an occupational therapist who was a pioneer in the field of learning disabilities. She defined SI as the body’s capacity to organize sensory input, information and stimulation a person receives from his/her own body and the environment through the different sensory systems:
• tactile (touch)
• proprioceptive (joint and muscle impulses)
• vestibular (movement, visual, auditory)
• hearing and listening/auditory
This sensory information is then processed by the central nervous system and is used to help our body develop spatial awareness, muscle tone, postural stability and self-regulation. SI gives us the awareness of our body and the ability to use it as a tool to interact with others in our world. For those with Sensory Integration Dysfunction, the brain is not processing organizing the flow of sensory impulses properly. This can impact on a person’s functional, developmental and learning processes.
Signs of Sensory Integration Dysfunction include:
• Overly sensitive to touch, movement, sights or sounds
• Easily distractible
• Decreased awareness of surroundings
• Activity level that is unusually high or unusually low
• Impulsive, lacking in self-control
• Inability to unwind or calm self
• Poor self-concept
• Social and/or emotional problems
• Physical clumsiness or apparent carelessness
• Difficulty making transitions from one situation to another
• Delays in speech, language, or motor skills
• Delays in academic achievement
• Slow reaction to touch, movements, sights, or sounds
A Typical SI/OT Session A typical SI/OT session providing the right kinds of sensory stimulation helps in the normalization of sensory systems – tactile, vestibular, proprioceptive, auditory and visual as well as to provide the optimal state of alertness and attention. In addition, it helps to develop an adaptive response for daily functioning.
The goal of occupational therapy interventions is to enable individuals to participate in everyday occupations. This may be achieved through a range of therapy approaches such as modification of tasks and/or the environment to match individuals’ abilities, to develop skills such as posture and coordination, or for the development of daily routines and to facilitate adaptive behaviours (National Institute of Child Health and Development, 2005). Occupational therapists work with children in their natural settings; in the home with their families, in the school and in the community. Occupational therapy treatment has focused on two main areas: Sensory Motor Integration In the past, one of the more frequent sensory motor interventions in occupational therapy was sensory motor integration. However, there is evidence that children with autism do process sensory information differently from other developing children (National Institute of Child Health and Development, 2005).
Therefore, the focus in Occupational therapy has shifted to understanding how and when a child is reacting poorly to a sensory experience and structuring the environment to accommodate or minimize such reactions. Occupational therapists can use a mediator or consultation approach to work with parents and teachers providing strategies to prevent reactions to sensory experiences from limiting daily activities. For example, if a child with autism is upset by excess noise that may occur at end of a school day, they could get ready to go home before others leave. If a child is bothered by a specific clothing material (e.g. wool), this type of material could be avoided in their clothing. By adapting the tasks and environments as well as working with the families on how to teach new skills and build calming or alerting activities into their everyday routines, Occupational therapists can make a difference in the family’s day to day life.
In particular, occupational therapy focuses on self care issues, feeding, bathing, hygiene and sleep which are significant issues for children and enormous stressors for the family. In the school setting, a student’s occupational performance may be impaired by sensory, developmental, inattention and/or learning challenges .Occupational therapists may adapt classroom tasks and the school environment to promote a child’s participation. Occupational therapists can assist teaching caregivers and teachers with understanding the impact of sensory processing difficulties on daily functioning and how they can modify what they need do to maximize the child’s participation and reduce behavioural difficulties. There are 4 types of supports that could potentially have a positive impact on the lives of children with autism. The environmental supports suggested are: temporal supports (events over time – this would allow a child to prepare themselves in advance for a change in activity), procedural supports (including instructions for activities or relating people to events), spatial supports (allowing the child to organize themselves within the environment), and assertion support (aiding the child in social interactions).
Occupational therapists work with children with autism and their families to provide intervention that improves the child’s ability to participate in activities of daily living, play and school. In occupational therapy, the focus is on task analysis, breaking down a task into manageable steps for the child, teaching those steps to the key people in the child’s environment and structuring task and/or environment to support successful completion. For example, if a child with autism is having difficulty dressing himself, the occupational therapist could use a backward chaining behavioural approach which teaches skills by breaking the tasks down into manageable steps which are always performed in the exact same order.