April 2, 2012 is World Autism Awareness Day and marks the “Light It Up Blue” initiative aimed to shine light on the growing public health concern of Autism. Iconic landmarks around the world will be lit in blue light to show support. In light of this, today’s post in the Milestones Blog aims to shine light at the intersection of autism and occupational therapy.
If you have read my previous posts “Demystifying Sensory Integration, Parts 1 & 2”, great! This post builds on topics discussed there. If you haven’t, please take a moment to read those posts below as this will help you put this post into perspective.
Keeping with the Milestones Blog style, my aim is to make the content accessible to as many people as possible. This post is therefore tailored to those seeking an understanding of how Occupational Therapists working with a Sensory Integration frame of reference approach children with autism or traits on the autism spectrum. You may be a parent of a child who has recently had a diagnosis of autism, an educator or other health care professional looking for information on how occupational therapy can help children you work with. Regardless, I am glad you are here!
How does Autism Fit?
Consistent with the popular media coverage of Autism in the recent past, Occupational Therapists are seeing increasing numbers of children with autism for assessment and treatment. A recent study released by the Centers For Disease Control and Prevention showed a striking increase in the prevalence of Autism (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6103a1.htm?s_cid=ss6103a1_w).
This new data suggests that in the U.S., 1 in 88 children are now diagnosed with Autism (by 8 years of age). When broken down by sex, the prevalence is 1 in 54 for males and 1 in 252 for females making males almost four times more likely to have a diagnosis of autism than females.
In addition to the usual observations of difficulty with social interaction, language development, and behavior, children with autism quite commonly show a very high level of sensory integration dysfunction. From a sensory integration perspective, children with autism show difficulties with sensory processing, commonly in three areas:
- Sensory Registration (the brain’s ability to recognize sensory stimuli)
- Sensory Modulation (the brain’s ability to pay attention or ignore the stimuli)
- Wanting to do things (the “I Want To Do It” part of the brain).
In “normal” brains, information from our senses is filtered automatically depending on what you need to do in your environment. The start point of sensory integration is registration. In autism, the part of the brain that decides what information to register and what to do with it does not function properly. For example, you may walk to work taking the same route everyday for years, but one day notice a house on the corner that you think you have never seen before only to discover that it has been there all along. Your brain has always filtered out that information, but for whatever reason (maybe the sun was hitting the door just right etc.) decided to recognize it. With autism, this function is often very inconsistent. A child with autism may be able to recognize a stimuli one day but not the next. The same inconsistency can appear across all the senses as well. The child may have difficulty with a visual stimuli in one instance followed by not being able to recognize a touch or sound in another. Simply put, the child with autism just doesn’t have the brain wiring that allows it to be consistent with sensory registration from one day to another or from one task to another.
Again, a “normal” brain “modulates” the sensory “input”. This means it automatically chooses to use incoming information and act on it, or ignores it and does not act on it. Not surprisingly in autism this function often struggles. Specifically, the child with autism has great difficulty with vestibular sensation (our body’s sense of recognizing gravity, head movement, and balance) as well as touch sensation. A high percentage of children with autism are resistant to movement and do not like even small heights above the ground because they struggle to make sense of input from the vestibular system. They may not like rough play where they may get turned upside down both because the vestibular input is too great combined with the touch input of being grabbed assertively.
The difficulty with both registration and modulation contributes to the overall sensory integration dysfunction. Very simple but unfamiliar inputs can be greatly alarming to the child with autism. For example, when brought into a new classroom, the child may react with a high level of resistance for the first several times until he/she has recognized this as a familiar and safe environment. Then after feeling safe, become alarmed again when something has changed in the classroom several days later.
Wanting to Do Things
Motivation. We can all identify with times in our week where we simply don’t feel like doing something…getting out of bed to go to work, getting in our daily run etc. Other times, we feel very driven to accomplish these things. In the book “Sensory Integration and the Child” this is described as the “I Want To Do It” function. There is a part of the brain that is responsible for this function and again not surprisingly, often does not work very well. Occupational Therapists understand that the situation is not that the child does not do anything; it is that the child cannot get him/herself to do something with purpose. This helps to understand common behaviors with autism such as playing in simple, repetitive actions. If one tries to show the child a more complex task, the child usually won’t want to do it. More puzzling and frustrating to parents and educators (and even O.T’s sometimes!) is that this behavior can easily be interpreted as the child being purposely difficult or defiant. How else can you explain that when you try to get your child to put on a pair of mitts to get out the door the child behaves indignantly. But then four hours later, you see your child independently putting on the mitts! The alternative explanation is that the child simply struggled to “turn on” the “I Want To Do It” part of the brain at that time. Finally, it is important to recognize that the child very often has the physical capacity to perform a basic task, but just can’t seem to fire up the part of the brain like you or I could most of the time.
Autism and Occupational Therapy Treatment
Given all of the above, the question now is how do occupational therapists treat children with autism. OTs that work with children with autism are often assessing and treating using the Sensory Integration Frame of Reference (see my previous blog posts).
The objective of occupational therapy using this approach with autism is “…to improve sensory processing so that more sensations will be more effectively “registered” and modulated, and to encourage the child to form simple adaptive responses as a means of helping him to learn to organize behavior” (from Sensory Integration and The Child, p. 135).
Relating this to the previous discussion, the child with autism can often be motivated to register sensory input if given an appropriate incentive. So one of the basic underlying goals of treatment is to help the child with autism “turn on” the “I Want To Do It” part of the brain through skillfully graded activity to assist in the registration of sensation. The pleasure of motion during therapy helps to motivate the child and allows the brain to process other sensory inputs over time.
What does treatment look like? Well, it looks like playing. Take a look at this video which is a great introduction.
Stephan Bourassa BMR(OT), OT Reg. (Sask)
Milestones Occupational Therapy for Children