Occupational Therapy for Children with Autism
Occupational Therapy is a health care profession. Occupational therapy provides treatment by using different types of purposeful activities, therapeutic exercises, special equipment, and skills training and by environmental modification. An Occupational Therapist help individual to reach their maxium level of function and independence that are physically and mentally ill.
Occupational therapist always focus an individuals performance area (That are self-care, work and leisure) to increase performance component (that are motor, sensory, cognitive, intrapersonal and inter-personal) by using purposeful activities. For these reason Occupational Therapy has a great role in the children Autism.
What is Autism?
Autism is most commonly evidence by impairment of social and communication skills (karner, Sigman; 1994). Another definition is - Autism is a chronic developmental disability with combination of sensory motor and behaviour characteristics along with cognitive disabilities.
Causes of Autism
40 years ago Dr. Leo Karner is the person who first identified this problem in 11 children with autism. First it was hypothesized that parents' inability to provide appropriate nurturing that caused social withdrawal.
Then it was thought as a result of some biological factor and genetic factor. Now a day most people are agreed on that it is organic brain pathology. Recent research announcement is - A French team of scientists has identified to mutated genes that appear to cause autism. Both genes are located on the X-chromosome, which makes sense.
It can occur either of two times
- At birth
- Up to the age of 30 month.
SWAC (Society for the Welfare of Autistic Children) reports that 1 child per 500 children is affected by autism.
Characteristics of Autism :
Ornitz (1973) Categorised The Characteristics in Five Types. These are :
- Disturbance in relating to person and objects.
- Disturbance in communication
- Disturbance in mortality.
- Disturbance of sensory processing and perception.
- Disturbance in developmental rate.
Clinical Features of Autism :
- Repetitive behaviour.
- Flapping hands.
- Walking on tiptoes.
- Lock of eye contact.
- Self-injurious behaviour.
- Lack of interest in toys.
- Dislike of being touched.
- Extreme dislike of certain food.
- Extreme dislike of certain sounds.
- Extreme dislike of touching certain textures.
- Problem in sensory integration.
- Poor communication skill.
Occupational Therapy Assessment :
Actually assessment is ongoing process. Once a diagnosis has been reached, this process should be repeated periodically.
Occupational Therapist Use Various Techniques to Assess The Child
- Direct observation, interactions and interviews.
- Play-based assessment
- Functional assessment.
Some Examples of Standardised Instructions :
- Sensory Integration and Praxis Test (SIPT).
- DSM : Diagnostic and Statistical Manual.
- Rating Scales and developmental inventories.
- Autism Rating Scale
- Intelligence Tests (IQ).
Occupational Therapy Treatment Approaches to Treat The Child With Autism :
- Sensory Integrative approach.
- Behavioural approach.
- Conductive education.
- Cognitive approach.
- Perceptual approach.
- Adaptation approach.
- Compensatory approach.
- Rehabilitation approach.
- Motor learning theory.
- Montessori approach.
- Mukti synergistic reflexology (MSR) techniques.
- Some time physical approaches - like- NDT [Neuro Developmental (Bobath) Treatment]
- Rood approach.
- Propriceptive Neuronuscular Facilitation (PNF) approach.
Occupational Therapy Management :
Sensory, Integrative Treatment - In sensory, Integrations (SI) treatment therapist uses Individual approach, Balance between structure and freedom, Emphasis on Innerdrive, Active participation and then setting. Some sensory integrative management strategies are
- Firm pressure/touch.
- Matress squeeze game.
- Swining on bolster, tire, hommock, blanket.
- Scooter board.
- Vestibular ball.
- Telting board.
- Joint compression.
- Rocking swing.
- Horse riding
- Vibrational toys, electric tooth brush.
Behavioural Therapy :
Behavioural Therapy focuses on the child's actions, the parents are also required to learn different methods of coping with their children. Behavioural in approach to enable the child to learn different methods of reacting to situations, role play, video filming and task setting may all be used.
Thrapist try to change the problematic behaviour of the child by rewarding positive behaviour, eg. social skills training etc. Also enable the parents and children to define realistic goal, eg., anxiety management.
Discrete Trial Instruction (DTI) is one of the core elements of applied behavioural analysis. In the DTI method takes and broken down into individual steps follows the ABC formula
- A = Antecedents
- B = Behaviours
- C = Consequence
Therapists Use Dti in Several Treatment are
- Positive reinforcement
- Negative reinforcement
Prompt fading gradually less physical verbal cues, until the student is more independent.
Daily Life Therapy
In daily life therapy (as practised at the Higashi Schools in Japan and in US), group activities are emphasised, and with the guidance of trained teachers, children with autism are put through intensive physical activities and functional activities (dressing, feeding etc) under a heighly regimented schedule.
Social Skills Training
Social Skills Training is the name given to a broad range of techniques used to help teach children and adults with autism how to interact socially. Since each social situation is unique, and has its own set of 'rules', this is painstaking work for the therapist. Examples of social skills training would be - How to make phone call, how to go shopping, how to count money, how to behave on the bus etc.
Music therapy is used in most special schools for autism, with good results. It has been found, for example, that with a skilled therapist, turn taking can be developed, and this may be useful for social skills. Music therapy helps to encourage communication in this way. It also helps to control anxiety, depression and relax the body the children ... autism.
Group Work with Autistic Children
This techniques used need to be appropriate to the developmental level of the child. So that young children will require media and action-based therapy, whereas adolescents have the ability for verbal psychotherapy groups. Art and drama therapy group are appropriate for all age groups.
Groups may be behaviour in approach to enable the child to learn different methods of reacting situation. Role play, video filming etc.
Group work with adolescents may enable them to share their difficulties in negotiation of an independent identity, exploring sexuality and making decisions about possible careers.
Psychotherapy groups enable children and adolescents to express their feeling about traumatic events in their lives, such as groups for survivors of sexual abuse.
Therapist uses different techniques and approach to treat the children and autism, whose present physical disability (Poor Oral-motor Skills, Difficulty in seating, standing, walking, etc.)
Vocational training refers to the actual training programme that the worker will undergo to learn the trade or profession that he has decided on. Occupational therapist would have at this stage of V.R. is to evaluate the client's need for or design (environmental modification) the necessary reasonable accommodations that the person will need to have to do, the job for which he is training. n
Md. Nazmul Hassan
The author is an Occupational Therapist.
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