Understanding AUTISM

Autism is a developmental disability that affects how the brain functions, specifically those areas of the brain that control social ability and communication skills and likely to have restricted interests and repetitive behavior. Boys are more likely to develop Autism, and most children are diagnosed before the age of 3.

Children and adults with autism typically have difficulty in both verbal and nonverbal communication. People with autism may have a difficult time relating to the outside world and may have unusual reactions to the people around them. People with autism may demonstrate aggressive behavior that may cause injury to themselves or others. The disorder also may cause sensitivity to the senses of sight, hearing, touch, smell, and taste.

It has long been presumed that there is a common cause at the genetic, cognitive, and neural levels for autism’s characteristic triad of symptoms However; there is increasing suspicion that autism is instead a complex disorder whose core aspects have distinct causes that often co-occur. Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear.

About half of parents of children with Autism notice their child’s unusual behaviors by age 18 months, and about four-fifths notice by age 24 months. As postponing treatment may affect long-term outcome, any of the following signs is reason to have a child evaluated by a specialist without delay:

• No babbling by 12 months.
• No gesturing (pointing, waving goodbye, etc.) by 12 months.
• No single words by 16 months.
• No two-word spontaneous phrases (other than instances of echolalia) by 24 months.
• Any loss of any language or social skills, at any age.

What Does an Occupational Therapist Do for People with Autism?

Children are assessed in terms of age-appropriate life tasks. Occupational Therapy addresses areas that interfere with the child’s ability to function in such life tasks. O.T. may be provided to children in the form of play activities which are used to enhance or maintain play, self-help and school-readiness skills. O.T. consultation is warranted when functioning in these areas is significantly compromised.

Since people with autism often lack some of the basic social and personal skills required for independent living, occupational therapists have developed techniques for working on all of these needs. For example:

• Provide interventions to help a child appropriately respond to information coming through the senses. Intervention may include swinging, brushing, playing in a ball pit and a whole gamut of other activities aimed at helping a child better manage his body in space.
• Facilitate play activities that instruct as well as aid a child in interacting and communicating with others. For the OT specializing in autism, this can translate specifically into structured play therapies, such as Floortime, which were developed to build intellectual and emotional skills as well as physical skills.
• Devise strategies to help the individual transition from one setting to another, from one person to another, and from one life phase to another. For a child with autism, this may involve soothing strategies for managing transition from home to school; for adults with autism it may involve vocational skills, cooking skills and more.
• Develop adaptive techniques and strategies to get around apparent disabilities (for example, teaching keyboarding when handwriting is simply impossible; selecting a weighted vest to enhance focus; etc.)
• Occupational Therapists use a variety of theories and treatment approaches when providing services. Such approaches may include: developmental theories, learning theory, model of occupational performance, sensory integration, play theories and others. The choice of therapeutic methods depends upon the specific needs of the individual child and the Occupational Therapist’s background. Many O.T.’s choose to employ a combination of approaches to meet those specific needs

There is no known cure. Children recover occasionally, so that they lose their diagnosis of Autism. This occurs sometimes after intensive treatment and sometimes not. It is not known how often recovery happens, reported rates in unselected samples of children with Autism have ranged from 3% to 25%. Most children with autism lack social support, meaningful relationships, future employment opportunities or self-determination. Although core difficulties tend to persist, symptoms often become less severe with age

References:

Abrahams BS, Geschwind DH (2008). “Advances in autism genetics: on the threshold of a new neurobiology”. Nat Rev Genet 9 (5): 341-55. doi:10.1038/nrg2346 PMID 18414403 and ot

I would like here to talk shortly about Sensory Integration Dysfunction, its classification and about some treatment methods by Occupational Therapists. And later on I’ll be talking about Autism in another article.

Sensory Integration Dysfunction (SID, also called sensory processing disorder (SPD) is a neurological disorder causing difficulties with processing information from the five classic senses (vision, auditory, touch, olfaction, and taste), the sense of movement (vestibular system), and/or the positional sense (proprioception). For those with SID, sensory information is sensed normally, but perceived abnormally. Unlike blindness or deafness, sensory information is received by people with SID; the difference is that information is processed by the brain in an unusual way that may cause distress or confusion.

Classifications

Sensory Processing Dysfunction is being used as a global umbrella term that includes all forms of this disorder, including three primary diagnostic groups:

• Type I - Sensory Modulation Disorder
• Type II - Sensory Based Motor Disorder
• Type III - Sensory Discrimination Disorder

Type I - Sensory Modulation Disorder (SMD). Over, or under responding to sensory stimuli or seeking sensory stimulation. This group may include a fearful and/or anxious pattern, negative and/or stubborn behaviors, self-absorbed behaviors that are difficult to engage or creative or actively seeking sensation.

Type II - Sensory Based Motor Disorder (SBMD). Shows disorganized motor output as a result of incorrect processing of sensory information.

Type III - Sensory Discrimination Disorder (SDD). Sensory discrimination or postural control challenges and/or dyspraxia seen in inattentiveness, disorganization, poor school performance.

This information is adapted from research and publications by: Lucy, J. Miller, Ph.D., OTR, Marie Anzalone, Sc.D., OTR, Sharon A. Cermak, Ed.D., OTR/L, Shelly J. ,Lane, Ph.D, OTR, Beth Osten, M.S,m OTR/L, Serena Wieder, Ph.D., Stanley I. Greenspan, M.D..

Sensory modulation

Sensory modulation refers to a complex central nervous system process by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted.

Behaviorally, this is manifested in the tendency to generate responses that are appropriately graded in relation to incoming sensations, neither under reacting nor overreacting to them.

Sensory Modulation Problems

• Sensory registration problems - This refers to the process by which the central nervous system attends to stimuli. This usually involves an orienting response. Sensory registration problems are characterized by failure to notice stimuli that ordinarily are salient to most people.
• Sensory defensiveness - A condition characterized by over-responsivity in one or more systems.
• Gravitational insecurity - A sensory modulation condition in which there is a tendency to react negatively and fearfully to movement experiences, particularly those involving a change in head position and movement backward or upward through space.

(Case-Smith, (2005)

Hyposensitivity and hypersensitivity

Sensory integration disorders vary between individuals in their characteristics and intensity. Some people are so mildly afflicted, the disorder is barely noticeable, while others are so impaired they have trouble with daily functioning.

Children can be born hypersensitive or hyposensitive to varying degrees and may have trouble in one sensory modality, a few, or all of them. Hypersensitivity is also known as sensory defensiveness. Examples of hypersensitivity include feeling pain from clothing rubbing against skin, an inability to tolerate normal lighting in a room, a dislike of being touched (especially light touch) and discomfort when one looks directly into the eyes of another person.

Hyposensitivity is characterized by an unusually high tolerance for environmental stimuli. A child with hyposensitivity might appear restless and seek sensory stimulation..

The main form of sensory integration therapy is a type of occupational therapy that places a child in a room specifically designed to stimulate and challenge all of the senses.

During the session, the therapist works closely with the child to provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles:

• Just Right Challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
• Adaptive Response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
• Active Engagement (the child will want to participate because the activities are fun)
• Child Directed (the child’s preferences are used to initiate therapeutic experiences within the session).

The sensory diet is a schedule of daily activities that gives the child the sensory fuel his body needs to get into an organized state and stay there. According to SI theory, rather than just relying on individual treatment sessions, ensuring that a carefully designed program of sensory input throughout the day is implemented at home and at school can create profound, lasting changes in the child’s nervous system.

Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations such as stroking with a brush, vibrations or rubbing. Play may involve a range of materials to stimulate the senses such as play dough or finger painting.

Children with heightened sensitivity (hypersensitivity) may be exposed to peaceful activities including quiet music and gentle rocking in a softly lit room. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid.

While occupational therapists using a sensory integration frame of reference work on increasing a child’s ability to tolerate and integrate sensory input, other OTs may focus on environmental accommodations that parents and school staff can use to enhance the child’s function at home, school, and in the community (Biel and Peske, 2005). These may include selecting soft, tag-free clothing, avoiding fluorescent lighting, and providing ear plugs for “emergency” use (such as for fire drills).

This information above has been taken from research and publications by: Lucy, J. Miller, Ph.D., OTR, Marie Anzalone, Sc.D., OTR, Sharon A. Cermak, Ed.D., OTR/L, Shelly J. ,Lane, Ph.D, OTR, Beth Osten, M.S,m OTR/L, Serena Wieder, Ph.D., Stanley I. Greenspan, M.D..

First I’ll talk about the Motor system and I’ll divide it into two parts the first as the gross motor which will be about the general motor activities and the other part is about the fine motor which talks about the special motor activities of the baby.

First Gross Motor:

You should first test the vision of your baby because if there is any vision impairment there will be delay in the motor activities, so first make your face move in front of your baby as he will be able to fixate at human face since birth and make sure he is following.

· The first motor activity of the baby is the ability of moving his head from side to side while he is sleeping on his belly (face to the ground) and that begins at 2 weeks of age. (2 weeks)

· Baby start to hold his head up momentarily also while he is laying on his belly (face to the ground) at 1 month of age. (1 month)

· Baby can hold his head up and keep it up while laying on his belly at 2 months (2 months)

· Baby can hold his head and chest up while laying on his belly at 3 months (3 months)

· Baby will roll from front to back at 4 months, also if you pulled the baby while on his back to sit his head is not supposed to lag behind his body. (4 months)

· Baby will sit with only cushions around his butt at 6 months of age. (6 months)

· Baby will sit by his own at 9 months of age. And will help u when pulling to stand. (9 months)

· Baby is supposed to walk at 12 months. Also he should be able to stand by himself. (12 months)

· Baby walks backward by 15 months of age. (15 months)

· Baby will run by 18 months. (18 months)

· Baby will walk up and down stairs by 2 years of age. (24 months)

Now I’ll be talking about the Fine Motor

Second Fine Motor:

· The baby will be opening his hands spontaneously on 3 months of age. (3 months)

· The baby will reach for objects and catch them by the age of 4 months. (4 months)

· The baby will transfer anything from one hand to the other by the age of 6 months (6 months)

· The baby will hold the pen with two fingers as if in the writing position by 9 months of age also the baby will can bang two blocks by each other. (9 months)

· The baby will release the object he is holding when you ask him to by 12 months of age also he will be able to put the cubes in a cup. (12 months)

· The baby will feed with spoon by his own when he is 18 moths of age also he will be able to stack 6 cubes. (18 months)

· The baby will make a tower of 6 cubes at 2 years of age.(24 months)

The second part is about the social and language development of the baby as following.

First the social:

· The baby usually develops the social smile at 3 months of age. (3 months)

· The baby will start trying to play with toys and react to them by 4 months of age. (4 months)

· The baby will can hold the milk bottle by the age of 6 months. (6 months)

· The baby will wave bye by the age of 9 months, he will also understand the game peak a boo (bat-a-cake) (9 months)

· By the age of 12 months the baby will come when his name is called, he will be also able to drink from a cup.

· The baby will start imitating others action by the age of 15 months, he will also help in house work. (15 months)

· The baby will be able to put his clothes on and play with others by the age of 2 years.

Second the language:

The baby will be alert to bell by the age of 2 weeks and that is important to test the hearing of the baby because if there is hearing problem the baby will develop language problem.

· The baby will be able to coos at the age of 2 months. (2 months)

· The baby will be able to say pa and ma (babbling) at age of 6 months. (6 months)

· He will be able to say dada and mama but not specifically (2 syllable sounds, not meaning them) at age of 9 months (9 months).

· By the age of 12 months the baby will say mama and dada specifically with 1-2 other words.

· By the age of 15 months he will say 3-6 words. (15 months)

· By the age of 18 months he will say at least 6 words. (18 months)

· By the age of 2 years he will be able to make a sentence combining two words. (2 years)

Reference: Nelson essentials of pediatrics (Fifth edition).

Occupational therapists help patients improve their ability to perform tasks in living and working environments. They work with individuals who suffer from a mentally, physically, developmentally, or emotionally disabling condition. Occupational therapists use treatments to develop, recover, or maintain the daily living and work skills of their patients. The therapist helps clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, productive, and satisfying lives.

Occupational therapists help clients to perform all types of activities, from using a computer to caring for daily needs such as dressing, cooking, and eating. Physical exercises may be used to increase strength and dexterity, while other activities may be chosen to improve visual acuity or the ability to discern patterns. For example, a client with short-term memory loss might be encouraged to make lists to aid recall, and a person with coordination problems might be assigned exercises to improve hand-eye coordination. Occupational therapists also use computer programs to help clients improve decision-making, abstract-reasoning, problem-solving, and perceptual skills, as well as memory, sequencing, and coordination—all of which are important for independent living.

Patients with permanent disabilities, such as spinal cord injuries, cerebral palsy, or muscular dystrophy, often need special instruction to master certain daily tasks. For these individuals, therapists demonstrate the use of adaptive equipment, including wheelchairs, orthoses, eating aids, and dressing aids. They also design or build special equipment needed at home or at work, including computer-aided adaptive equipment. They teach clients how to use the equipment to improve communication and control various situations in their environment.

Some occupational therapists treat individuals whose ability to function in a work environment has been impaired. These practitioners might arrange employment, evaluate the work space, plan work activities, and assess the client’s progress. Therapists also may collaborate with the client and the employer to modify the work environment so that the client can successfully complete the work.

Assessing and recording a client’s activities and progress is an important part of an occupational therapist’s job. Accurate records are essential for evaluating clients, for billing, and for reporting to physicians and other health care providers.

Occupational therapists may work exclusively with individuals in a particular age group or with a particular disability. In schools, for example, they evaluate children’s capabilities, recommend and provide therapy, modify classroom equipment, and help children participate in school activities. A therapist may work with children individually, lead small groups in the classroom, consult with a teacher, or serve on an administrative committee. Some therapists provide early intervention therapy to infants and toddlers who have, or are at risk of having, developmental delays. Therapies may include facilitating the use of the hands and promoting skills for listening, following directions, social play, dressing, or grooming.

Other occupational therapists work with elderly patients. These therapists help the elderly lead more productive, active, and independent lives through a variety of methods. Therapists with specialized training in driver rehabilitation assess an individual’s ability to drive using both clinical and on-the-road tests. The evaluations allow the therapist to make recommendations for adaptive equipment, training to prolong driving independence, and alternative transportation options. Occupational therapists also work with clients to assess their homes for hazards and to identify environmental factors that contribute to falls.

Occupational therapists in mental health settings treat individuals who are mentally ill, developmentally challenged, or emotionally disturbed. To treat these problems, therapists choose activities that help people learn to engage in and cope with daily life. Activities might include time management skills, budgeting, shopping, homemaking, and the use of public transportation. Occupational therapists also work with individuals who are dealing with alcoholism, drug abuse, depression, eating disorders, or stress-related disorders.

 In large rehabilitation centers, therapists may work in spacious rooms equipped with machines, tools, and other devices generating noise. The work can be tiring because therapists are on their feet much of the time. Those providing home health care services may spend time driving from appointment to appointment. Therapists also face hazards such as back strain from lifting and moving clients and equipment.

Occupational therapists in hospitals and other health care and community settings usually work a 40-hour week. Those in schools may participate in meetings and other activities during and after the school day. In 2006, more than a quarter of occupational therapists worked part time.

Some people may think that occupational therapy is only for adults; children, after all, do not have occupations. But a child’s main job is playing and learning, and an occupational therapist can evaluate a child’s skills for play activities, school performance, and activities of daily living and compare them with what is developmentally appropriate for that age group.

 In addition to dealing with an individual’s physical well-being, OT practitioners address psychological, social, and environmental factors that may hinder an individual’s functioning in different ways. This unique approach makes occupational therapy a vital part of health care for some kids.

So who might use an occupational therapy practitioner? 

 kids with the following medical problems may benefit from OT:

• birth injuries or birth defects
• sensory processing/integrative disorders
• traumatic injuries (brain or spinal cord)
• learning problems
• autism
• pervasive developmental disorders
• juvenile rheumatoid arthritis
• mental health or behavioral problems
• broken bones or other orthopedic injuries
• developmental delays
• post-surgical conditions
• burns
• spina bifida
• traumatic amputations
• cancer
• severe hand injuries
• multiple sclerosis, cerebral palsy, and other chronic illnesses

One of the activities that occupational therapists can address to meet children’s needs is working on fine motor skills so that kids can grasp and release toys and develop good handwriting skills. Occupational therapists also address hand–eye coordination to improve play skills, such as hitting a target, batting a ball, or copying from a blackboard.

An occupational therapist can also:

• help kids with severe developmental delays learn some basic tasks, such as bathing, getting dressed, brushing their teeth, and feeding themselves
• help kids with behavioral disorders learn anger-management techniques (i.e., instead of hitting others or acting out, the children would learn positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
• teach kids with physical disabilities the coordination skills required to feed themselves, use a computer, or increase the speed and legibility of their handwriting
• evaluate each child’s needs for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
• work with kids who have sensory and attentional issues to improve focus and social skills

Occupational therapists work in a variety of settings, including:

• hospitals
• schools
• rehabilitation centers
• mental health facilities
• private practices
• children’s clinics
• nursing homes

1. A tailored scrotal support designed specifically for male patients with lymph edematous genitals and lower extremities resulting from various forms of cancer and cancer-related treatments. These patients often have difficulty with functional mobility due to increased genital swelling and discomfort. Each patient is measured and then fit with individually fabricated supports that function as a jock strap, providing compression and elevation to the genital area.

2. A pediatric chest guard designed for children who have had surgery in the thoracic region or who have had a med port placed in their upper chest wall. As these children resume school and play activities, they require protection to prevent trauma to their chest, trunk, or med port site, and

3. Four-quarter amputation prosthesis designed for patients following the surgical removal of an upper extremity that may include the humerus and portions of the clavicle. This type of surgery alters a patient’s physical appearance, symmetry, and body image.