Occupational Therapy for Autism

Occupational therapists work with autistic children and adults to help them better perform activities of daily living. Occupational therapy is one of the three most commonly offered therapies in the school setting (along with speech therapy and behavioral therapy); occupational therapists may work toward a huge range of goals, from better handwriting to play skills to sensory integration.

What Is an Occupational Therapist?

Occupational therapists are individuals who have completed a master's degree and received a license to practice. They have a wide range of skills and may work in any setting—from a hospital or clinic to a school, home, or community setting.

Their general focus is on improving the client's ability to participate in activities of daily living, but those activities may include anything from schoolwork to play to toothbrushing.

Why Occupational Therapists Work With Autistic Children

Occupational therapists often work with children who have physical challenges resulting from disorders such as cerebral palsy or traumatic brain injury. Autistic children may not have major physical disabilities, but many are struggling with specific challenges including:

• Low motor tone (weak muscles)
• Sensory dysfunction (too much or too little response to touch, sound, light, smell, or taste)
• Difficulty with motor planning (lack of coordination)
• Lack of imitative skills that help neurotypical children learn play skills and skills of daily living
• Lack of social skills that help neurotypical children learn how to engage in physical activities in a group setting

All of these challenges can be addressed (though rarely cured) through different forms of occupational therapy. Occupational therapists who work with autistic children may specialize in (for example) play therapy, handwriting therapy, sensory integration therapy, social skills therapy, or even behavioral therapy.

How Occupational Therapists Develop Treatment Plans

Because every child is different, occupational therapists who work with autistic children develop individualized plans to meet each child's needs. It's important to note that occupational therapists who work in schools must focus on needs identified through a child's Individualized Educational Plan while therapists who work in the home or community have a broader range of options.

Typically, occupational therapists use well-established tests and evaluations to determine a child's support needs. One such test is the Modified Checklist for Autism in Toddlers (M-CHAT); others include:

• School Function Assessment (SFA)
• Children’s Assessment of Participation and Enjoyment/Preference for Activities of Children (CAPE/PAC)
• Assessment of Life Habits (Life-H)— Children
• Movement Assessment Battery for Children— Second Edition (Movement ABC2)
• Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
• Sensory Processing Measure
• Sensory Profile School Companion
• Sensory Integration and Praxis Test (SIPT)

In addition to testing, occupational therapists often observe children in a range of settings to see how well they are able to complete tasks of daily life. For example, they may watch to see if a child is able to put on and button a jacket, write in a notebook, play appropriately on the playground, cut with scissors, or participate in a group activity. They may also watch to see whether specific sensory inputs such as florescent lights, buzzers, or strong smells create difficulties for the child.

Once tests and observations are complete, therapists develop a set of individualized goals for the child. These are very personal and depend on the child's support level and specific needs. Some are likely to relate to personal hygiene and life skills, others to academics and still others to functioning in the social environment. For example:

How Occupational Therapists Work with Autistic Children

Typically, occupational therapists work with autistic children in school. They may work in the classroom or pull the child out to work with them one on one. In some cases, schools have "sensory rooms" where children can interact with indoor swings, balls, trampolines, and other equipment. In other cases, the therapist may bring along exercise balls, jump ropes, and other equipment. In addition, therapists may:

• Use techniques to help strengthen the child's hands, legs, or core
• Provide tools such as a weighted vest or large pencil to improve focus and make certain tasks easier
• Work with the child in typical school settings such as recess, gym, art class, or music class

In some cases, particularly with very young children, therapists come to the child's home. They may even work directly with parents, showing parents how to continue therapeutic intervention even when the therapist is not present.

The Role of Sensory Integration Therapy

Before 2013, occupational therapy was commonly offered to autistic children but sensory dysfunction was not part of the criteria for autism spectrum disorder (ASD). In 2013, with the publication of the DSM-5, new criteria were created and sensory issues were added to the list of autism traits.

The list of sensory issues now includes hyper- or hypo-reactivity to stimuli (lights, sounds, tastes, touch, etc.) or unusual interests in stimuli (staring at lights, spinning objects, etc.). This change was because most autistic people, including those with low support needs, have and/or crave strong reactions to sensory input.

Until the change in criteria, the field of Sensory Integration Therapy (a form of occupational therapy) was struggling for general acceptance by the larger clinical community. Today, it is a more widely accepted form of therapy and may be offered even by occupational therapists who are not specifically trained as sensory integration specialists.

Sensory integration therapy uses a range of techniques such as swinging, brushing, jumping, pushing, squeezing, rolling, and exposure to selected sounds to help children (and adults) with sensory processing issues to lessen their over-reaction to (or need for) intense physical sensation.

The Role of Occupational Therapy in Social Settings

Occupational therapists are not necessarily trained in social skills therapy, but many occupational therapists use a multi-disciplinary approach that combines occupational therapy with other traditional and innovative social teaching tools. For example:

• Occupational therapists may work on spatial awareness and coordination in the context of a playground activity such as swinging, playing catch, or climbing. This makes it possible for the occupational therapist to work on both physical and emotional/cognitive skills at the same time.
• Occupational therapists have long sought training in Floortime, a social/emotional therapeutic technique devised by psychologist Stanley Greenspan. Floortime incorporates sensory techniques that are closely allied to traditional occupational therapy.
• Occupational therapists may use some of the same techniques as recreational therapists, working with their clients to participate in activities such as summer camp programs, swimming, team sports, and bicycle riding.

Occupational Therapy for Autistic Adults

Many autistic adults receive occupational therapy. For some, occupational therapy is a tool for building skills of daily living such as cooking, cleaning, dressing, folding, etc. For others, it's a means for managing stress, building physical stamina, or increasing recreational skills.

Finding an Occupational Therapist

Most autistic children qualify for free occupational therapy through early intervention or school. The therapists and therapy provided may or may not be at the level and/or quantity that parents prefer; if that's the case, insurance will often support at least some level of private therapy.

To find a private occupational therapist, it's helpful to start with recommendations from your local school, other parents of autistic children, or your local chapter of the Autism Society. You can also search through a database of licensed occupational therapists through the American Occupational Therapy Association website.

Summary

When searching for or evaluating occupational therapists, it's important to determine whether the therapist has experience and training in working with autistic people. Autism is quite different from other developmental disorders, and it is critical that your child's therapist understands and can communicate well with your child.

In many cases, a trained and licensed therapist will set up an occupational therapy program and then turn over the day-to-day work to a paraprofessional. While a licensed therapist can and should set goals and select appropriate therapeutic approaches, many paraprofessionals are more than capable of working well with autistic children.