By Ashley Opp Hofmann
Autism is a complicated neurodevelopmental disorder in which the brain does not seem to function properly. Children with autism typically have social interaction and communication impairments as well as restricted interests, activities, and play skills. Raising a child with autism is an enormous and often overwhelming task, but occupational therapy can help.
Occupational therapy can help children with autism perform better in school and home environments. Parents who are referred to occupational therapy practitioners often have concerns about the behavioral and social development problems their children with autism display in these environments, and practitioners can assist with these issues.
Understanding Sensory Issues
Although the behavioral and social difficulties that children with autism have are overtly displayed, many children also have sensory issues that are trickier to detect. “Some of the issues in social interaction and communication, as well as some of the behaviors, are occurring because the child often has sensory processing issues,” says Jane Case-Smith, EdD, OTR/L, FAOTA, professor and director of the Occupational Therapy Division of the School of Allied Medical Professions at Ohio State University. It is estimated that 80% of children with autism have sensory processing problems. This means that they can’t filter out extraneous sensory stimulation or don’t process sensory stimulation in the same way typically developing children do. Occupational therapy practitioners can address sensory issues and equip parents to manage their child’s behavior more successfully.
Problems with sensory processing can explain why children with autism may not like noise, being touched, or the feel of certain clothing. “Sometimes [parents] are very aware of these behaviors—that the child is rigid, that they won’t eat certain foods or don’t like certain odors—but nobody’s really put it all together for them,” says Case-Smith. Occupational therapy practitioners can clarify the role of sensory processing and provide advice on practical things parents can do, such as placing a weighted vest on a child if he or she needs calming. Occupational therapy practitioners also support positive behavior, aimed to help the child’s social engagement, by imitating the child’s actions, waiting for his or her response, positively responding to the child, and cuing appropriate social interaction to improve social play skills.
Accessing Occupational Therapy
Children with autism can access occupational therapy most easily through schools because public law mandates its availability to students with disabilities who need it. In addition, many insurance plans cover private occupational therapy for children with autism, and because of the severity of the disability, many states offer a waiver that qualifies families with higher incomes to access occupational therapy using Medicaid dollars.
Children with autism usually receive occupational therapy in their schools as part of their educational program. Many also receive private occupational therapy, which may be covered by insurance or paid for independently. Often sensory-based, this “active type of intervention focuses specifically on helping [children] integrate their sensory systems and initiate and sustain purposeful play,” says Case-Smith. Therapy can involve swings, deep touch, massage, and numerous other methods. Therapy sessions always center on the child, incorporate play, are interactive, and provide activities that require the child to problem solve.
Creating the Intervention Plan
When creating an intervention plan, occupational therapy practitioners evaluate children with autism using observation and parent and teacher reports and also interview parents about their child’s relationships and eating, self-care, and daily living skills.
In setting goals, occupational therapy practitioners work with families and teachers as a team to address the most immediate and important issues. “Autism is so pervasive and it’s so complex that it’s critical that the entire team is focused on one or two or three priorities. [These are] typically social interaction, behavior, and performance within a classroom,” says Case-Smith. Whether practitioners modify the environment or engage in one-on-one therapy, their efforts serve the goals of the teacher and family. By collaborating with families, teachers, and other service providers, the occupational therapy practitioner strives to support academic success.
An important and often overlooked part of this team is siblings. When it comes to reinforcing goals, “There’s quite a lot of evidence that using siblings and typical peers is pretty effective with children with autism,” says Case-Smith. Siblings can take leadership roles where they initiate and direct interactions.
However, adults must address the potential effect such interaction will have on the sibling. “You have to help them understand that, ‘your brother isn’t going to respond to you. It doesn’t mean he doesn’t want to play with you; he needs you to show him how to play,’” says Case-Smith. “For some siblings, it’s overwhelming and they can’t manage it, but if you have a little bit older sibling who can understand and wants to help, it can be effective.” Inviting the participation of sibling also fits well into sensory integration therapy, which is playful and often involves activities done in groups or pairs.
Families that include a child with autism often get to a point at which their lives revolve around that child. “The whole family’s schedule and activities are pretty much determined by this one child and what he needs,” says Case-Smith. When talking to parents, “We try and make recommendations that are helpful rather than more work,” she says. Parents of children with autism have enough anxiety about whether they do enough for their child. Occupational therapy supports the parents and helps them to be more effective, reinforcing the already good work that they do.
Ashley Opp Hofmann is AOTA’s senior staff writer.
Find an Occupational Therapy Practitioner
Your pediatrician or other health professional can refer you to occupational therapy practitioners in your area.
For More Information
Occupational Therapy’s Role for Children With Autism
Autism Tip Sheet
Autism Society of America