Why Occupational Therapy Works for Kids on the Spectrum

Occupational Therapy is one of the treatments for kids on the Autism Spectrum.  The main reason for occupational therapy is that children can work on fine and gross motor skills, as well as overcome some of their sensory processing difficulties.

A developmental delay in gross motor skills might mean the child can't ride a bike, may run in an awkward manner, or may have difficulty kicking a ball.  Therapists use organized play to work on these gross motor skills.  If a child has severe delay with gross motor skills, then physical therapy would work better.

A developmental delay in fine motor skills might mean the child has trouble feeding themselves, getting dressed, or writing.

Occupational Therapy can help with self care issues and academic skills.  They may work on writing, cutting with scissors, as well as developing the muscles required for those skills by playing with play dough, stringing beads, and squeezing sponges. 

The goal of Sensory Integration Occupational Therapy is not to teach behaviors or skills, but to help with neurological processing deficits, teaching them to adapt to the environment around them. This could include teaching tolerance to different textures, loud noises, and bright lights.  It involves determining what kind of sensory issues a child has and helping him/her get the sensory input they seek in a controlled environment.

With Sensory Integration, the therapist will be helping the child manage his/her body in space.  An OT can also help the child with communication and interaction with others through therapy known as Floortime, where the therapist gets down on the floor and Plays with the child.  The therapist works on transitions from one activity to another if transitioning is an issue with the child. Determining strategies that work can help outside of the therapy session when the child is at home, at school, and in the community.

Occupational Therapy

I am often asked what Occupational Therapy is, so I thought I'd go into detail in today's blog post.

Occupational Therapy, also known as OT, (according to Wikipedia) incorporates meaningful and purposeful occupation to enable people with limitations or impairments to participate in everyday life.

According to About.com, Occupational Therapy actually deals with strengthening fine motor skills, like writing, cutting, shoe-tying and using utensils. For adults recovering from an accident or stroke, that may include work-related skills; for children, whose "occupation" is school and play, it will focus more sharply on developmental milestones and skills required for playground and academic activities. Occupational therapists working with children typically use techniques and routines that may seem like play, but are designed to target areas of delay and difficulty. Some occupational therapists are also trained in therapy with a sensory integration approach (SI), which uses play-like activities to help children better process and tolerate the information they get through their senses.

John would spend his hour of OT swinging on different types of swings, climbing, working through obstacle courses, hanging on a trapeze bar, jumping in ball pit, jumping on trampoline, walking on different textures, riding a tricycle, throwing balls, working on fine motor skills, and sometimes, working on eating issues.

John's Services Updated

I have lots of news today and it may take more than one topic to cover all the news on John. I'll start with the IEP.

Today, we had John's IEP (Individualized Educational Plan) with the school district. It was a bittersweet moment as we learned that John no longer will qualify for services. This is a very good thing because it means that the progress John has made since May has been so overwhelming that he does not need Special Education. The school district determined through their assessments that, although John has showed developmental delays in the past, his scores in all areas of development fall within the average range. He doesn't show a need for continued service, whether it be special ed pre-school, speech, or occupational therapy.

Hopefully, the early intervention will serve as a deep enough foundation for John to integrate into regular pre-school and naturally develop alongside other children/peers. I am disappointed that occupational therapy and speech could not be continued. I learned today that to qualify for occupational therapy, he would have had to meet the requirement for special education. Then, it would be determined if it was necessary for OT. However, speech is a little bit different. It is a standalone service, meaning that if he meets certain criteria, he could qualify for speech, even if he did not for special education preschool.

Hopefully, John will continue to develop his attention so he can engage in a classroom setting without too much re-direction. As far as skill levels, he has caught up in every catergory, which I will get into in the next blog topic with regards to his latest Casa Colina evaluation. His largest problem area that his current educators see is his willingness to participate, along with his attention and engagement with little re-direction.

Occupational Therapy

It's been a crazy week, but I found some time to write. I'm going to talk more about Occupational Therapy today. I am using a handout from John's START program orientation packet as a reference.

Occupational Therapy (OT) for children is play based and goal oriented therapy designed to enable a child to do his/her job (occupation). Some of these occupations include play, being a member of a family, making friends, performing in school, completing self care activities, and reach developmental milestones.

Occupational Therapy using a Sensory Integration Framework

The tacktile, proprioceptive, and vestibular systems (discussed in previous blogs) develop and function prior to birth, and together play a part in the development of skills. We need to register, interpret, and respond to stimuli. The organization of the senses is called sensory integration. The ability to successfully meet an environmental challenge is termed adaptive response. OTSI therapy provides the child with controlled sensory input in order to facilitate a n increasingly complex ability to create an adaptive response.

5 senses - touch, taste, smell, sight, & sound
2 others - movement and body position

Using OTSI (Occupational Therapy with a Sensory Integration framework), expected outcomes:
- increase frequency & duration of adaptive responses
- development of more complex adaptive responses
- increase self-confidence & self-esteem
- Improvement of gross and fine motor skills
-improvement in daily living and personal-social skills
-improvement in cognitive, language and academic performance

Obstacle Course

Tonight before bath time, we had a little "occupational therapy" of our own.

First we created an obstacle course in the living room.

Puzzle pieces were laid out on the coffee table beside the couch. Each kid chose a puzzle piece, bounced off the couch, and into the "mud" (pillow crash pad on the floor). They had to crawl through the "mud", climb up the "bridge" (ottoman), jump off the bridge, run to the "mountain" (the chaise lounge), climb the "mountain", and go over the top of the "mountain", feet first, landing on the ground, where the puzzle was hiding. They had to place their puzzle piece into the puzzle and make their way back to get another piece.

The second obstacle course was in our family room. Inside the bounce house, we placed a jar of vehicles (planes, trains, cars, buses, etc). Each kid chose one vehicle and held it in their hand. They jumped across the bounce house, landing into the ball pit, making sure they held onto the (rubber) vehicle. Hidden in the ball pit was a mini-basketball. They had to find it, keeping hold to the vehicle. Then, the basketball needed to be thrown into a basket outside of the ball pit. They climbed out, and walked across the foot path (2 small kid size ottmans) and jump off onto the ground, where on the other side was a tub of water. They dropped their vehicles into the water and then started over.

Then, it was bath time. The kids finger painted with "soap paint" during bath time. After bath and brushing teeth, we had circle time with our new puppet friends. I found some great puppets (folkmannis puppets) at HodgePodge Games. I got a cute little lamb that Katie fell in love with for "Mary Had a Little Lamb". I got an Itsy Bitsy Spider finger puppet, a large Duck for "3 Little Ducks", and an awesome turtle for "Tim the turtle". The kids love the puppets and love learning through song.

Sensory Integration Disorder

Through an Occupation Therapy screening, I have learned John needs an evaluation for Sensory Integration. Sensory integration is an innate neurobiological process and refers to the integration and interpretation of sensory stimulation from the environment by the brain. In contrast, sensory integrative dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behavior

I was told to read a book called, "The Out-of-Sync Child" by Carol Stock Kranowitz. I can't put it down. Right now, I'm about 150 pages into the book. I feel like I am reading a book that was written about my son.

The book has checklists that parents can use to determine if their child has a Sensory Integration dysfunction and what kind it may be. I have learned that John is a Sensory Seeker. He craves movement, loves being upside down, bumps into couches for sensory stimulation, loves spinning, oftentimes not getting dizzy, can't get enough of tactile stimulation (through the hands), etc.

John has always wanted his hands in my armpits. He would put them there when trying to fall asleep, when I'd carry him in the grocery store, standing in church---everywhere and any time. I thought it was weird and annoying, but didn't think much more of it. He touches to a point of annoyance, even when the touch isn't wanted. He always has his hands on my face or trying to put them in my mouth. If I'm talking to other people and my attention is diverted away from him, he often grabs at the collars of my shirt, trying to put his hands down the front of my blouse or up the sleeves.

John is always mouthing/teething objects. He doesn't put play dough or glue in his mouth, but he does chew on shirt collars, toys, blocks, bottles, the car seatbelt ---anything that can be chewed on. His shirt is often wet and if he can't find anything else, his fingers go in his mouth. He never was a thumb sucker and his pacifier was given up at 6 months old. But, he has always chewed on toys and clothes.

He loves his teeth brushed. He has always been obsessed with toothbrushes and helping my husband and I brush our teeth. We used to joke that he was going to be a dentist. Recently, we bought him an electric toothbrush, which has helped him with his poor muscle tone in his mouth.

Low muscle tone is one of John's problems. I never realized this, as I always thought of him as strong. But, muscle tone is not a measure of strength. It is the amount of tension our muscles have at rest. Normal muscle tone would reflect muscles that are "ready to move" or react when we need them to. Low muscle tone means that they are more at rest than they should be.

John's low muscle tone in his mouth accounts for his speech delay and inability to make his mouth move in certain ways to make certain sounds. It makes it difficult to blow bubbles. Ways of increasing muscle tone of the mouth includes sucking a milkshake through a straw, blowing bubbles, etc.

Low muscle tone would also account for the inability to stack blocks. Stacking blocks in a high tower requires the hand to 'release' the block. The muscle used to release is different than the muscle used to grasp. Ways of increasing muscle tone of the hands is to squeeze a wet sponge and release it. Different size sponges increase the level of difficulty of squeezing to help build the squeeze and release muscles.

John loves tactile sensations. Many kids do, but children who are sensory seekers can't get enough of it. The brain doesn't recognize that it has received enough stimulation because the nervous system is "out of whack". These kind of children want "more more more". The opposite, but still sensory dysfunctional on the other extreme, would be the child who can't stand touch, who withdraws from it (or any other sense for that matter --- covers ears during fireworks, high pitch noises, doesn't like crowds). Each sense has sensory seekers and avoiders, as well as those that don't show one way or another. A "normal" sensory integration child would be able to adapt to the environment as different senses pick up different things. It's what tells us that there is danger or fun in what is around us. Kids with this dysfunction don't know how to interpret this sensory information and it throws their whole day off.

For John, he needs "more more more". His brain is using its energy inefficiently, which accounts for his lack of attention. Everything is full force and outside the level his brain should function at. Calming him down is difficult. When he sleeps, he's not at full rest. He inefficiently does everything around him.

I tested this theory, doing a sensory activity for the tactile sense. I put both my kids in a bathtub with shaving cream. I told them we were going to finger paint in shaving cream. I squirted it all over the bathtub and let them at it. Katie rubbed her hands and arms in it for a few minutes and then washed it off, proceeding to draw letters and pictures around the tub. John, on the other hand, took huge clumps of it, clapped it together, watched it fly around the bathroom and giggled. He then sat in the tub and put his feet up on the sides, rubbing them in the shaving cream, giggling. After that, he stood up and grabbed a bunch and began lathering himself in it. He rubbed it on his stomach and then continued to put more and more on. He then slapped it and watched it float and fly off his body. Once it was gone, he wanted more. I obliged and it started all over again. When it was all over, he transitioned fine to the next activity, but talked about the 'shvn crm' all night long. Now, every time he sees the bathtub, he wants the 'shvn crm'. I'm just happy he's saying "shvn crm"!