April is OT Month and Autism Awareness Month!

Another apology is in order for the neglect of my blog. I’ve had several blog entries “in the works” for a long time, but have failed to finish developing them and getting them up here. I’ve made a promise to myself to get back into this, and my goal is to try to publish at least once a week! So if you’ve abandoned my blog because I haven’t updated in a long time, please come back!!! It seemed appropriate to come out of hibernation to blog during April, as April is the celebration of both Occupational Therapy, and Autism Awareness! I work with, and have worked with, many children and adolescents on the autism spectrum (about 1/3 of my current caseload has a diagnosis on the spectrum), so Autism Awareness is something that is important to me. In honor of both April celebrations, here is a general overview of autism and how occupational therapists work with individuals on the autism spectrum.

First, for those unfamiliar with autism, allow me to explain what I mean by “autism spectrum.”  This is an umbrella term that refers to a group of developmental disabilities that may cause significant challenges in the areas of social skills, communication, sensory processing and behavior.  The general term Autism Spectrum Disorder (ASD) [which can also be referred to as Pervasive Developmental Disorder (PDD)], refers to the following three disorders: Autistic Disorder (also called “classic autism” or just “autism”), Asperger’s Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).

Someone diagnosed with Autistic Disorder generally has significant language delays, social and communication challenges, [unusual]* and/or stereotypic behaviors and interests, and atypical processing of sensory experiences. Often people with autism also have intellectual disability, but low IQ is not a diagnostic criteria. Within the classification of Autistic Disorder, there is variation in severity and functionality, though there is no “official” distinction, many people will often refer to different levels in terms such as “high functioning autism” or “severe autism.” Asperger’s Syndrome shares some symptoms with Autistic Disorder, such as social challenges and [unusual]* behaviors or interests, but symptoms exist in a more mild form, and there is no language delay. Typically those with Asperger’s Syndrome do not have intellectual disability and generally have average to above average intelligence. A diagnosis of PDD-NOS is given when an individual meets some criteria for Autistic Disorder but not all criteria. Signs of ASD in young children may include lack of, or delay in, spoken language; repetitive use of language and/or motor movements (example: echoing or scripting what another says instead of speaking spontaneously, hand-flapping , or twirling objects); little or no eye contact; lack of interest in peer relationships; lack of make-believe play; and persistent fixation on parts of objects.

*Author’s note: I bracketed [unusual] because these words are included in literature about diagnostic criteria for autism, however, I do not like these words. I do not feel as a “neurotypical” (the term that people on the autistic spectrum often use to describe those who are not) that I have the right to pass judgment on behaviors and interests of those on the spectrum, or anyone for that matter. To the person, it not unusual, so what right do I have to say it is?! Also, in my opinion often these interests aren't even necessarily so "unusual," often people with ASD just have very specific interests that can be quite intense (often referred to as obsessions or perseverations), such as Jason and his interest in the subway. Also, interests may seem "unusual" because people with ASD are often very detail oriented. The way one little girl I treat "plays" with toys is to line them up in various categories, such as organizing them by color, size and shape. To her, this is more interesting than using toys for their intended purpose. I suppose this may seem "unusual" but for her lining toys up into organized categories is meaningful and makes sense to her. It is the propensity for specific, intense, and often detail-oriented interests that can allow people with ASD to make important contributions to society. Temple Grandin (a woman with autism well-known for her work both in the autism community and her accomplishments in the field of animal husbandry), jokes that NASA is the largest sheltered workshop in the world! We should be thankful for these "unusual" interests!

What do occupational therapists do to treat individuals with ASD?  As discussed in previous blog entries, OTs assist when a person is experiencing barriers to successful participation in his or her daily occupations. OTs will work with clients diagnosed with ASD in many different areas of occupation. Interventions may target regulating emotion and behavior; processing sensory information that is needed for participation in occupation; developing social abilities, interpersonal skills and peer relationships; self-care skills such as dressing, feeding, hygiene, and sleep; skills for school success such as organization of task materials, independent work skills, group process abilities; using assistive technology to accomplish communication or other occupational needs; and developing motor skills that may be delayed.

I mentioned in previous blog entries that in December I attended the 2010 American Occupational Therapy Association (AOTA) Autism Specialty Conference in Baltimore, MD, which was an amazing opportunity to hear from the experts in the field, as well as convene with other occupational therapists who treat clients on the autism spectrum. At the conference, a point that was emphasized throughout the two days of presentations was that people with ASD are people first and a diagnosis second. They may have difficulty expressing and understanding feelings, but they certainly have them. Just because they lack social awareness and social skills does not mean they don’t long to be included. Research shows that children and adults on the autism spectrum want to have meaningful relationships, they just don’t know how. Additionally, people with ASD can contribute wonderful things to society. Sometimes, however, they just need to make their own way.  The norms of a society that is mainly made up of “neurotypicals” may not be how individuals with ASD find their path to success, and that is okay! As OTs, we have the ability to help individuals carve their own paths in the world and be able to make unique and important societal contributions. Occupational therapists are equipped with the skill set to look at a person’s strengths as well as challenges, analyze the tasks the person wants or needs to do, take into account the environment and extraneous factors that may support or inhibit participation, and collaborate with the individual to find a unique solution that allows for success!

At the conference, I had the privilege to attend presentations given by adults on the spectrum, and something they taught me that really made an impact on me was that many people with ASD do NOT consider themselves to have a disability!! They just accept that they are “wired differently” from neurotypicals. Most of these individuals have no desire to be neurotypical. They do not need to be “fixed.” They just want to be accepted, and assisted in order to be successful functioning in neurotypical society. Many adults on the spectrum have found the ability to celebrate their uniqueness and accept and embrace autism as a diversity. Now, if only neurotypicals would see it that way!

Sources for this blog entry include presentations from the 2010 AOTA Autism Specialty Conference, and “The American Occupational Therapy Association Frequently Asked Questions: What is Occupational Therapy’s Role in Supporting Persons With an Autism Spectrum Disorder?”

FAQs: "What is an occupational therapist anyway???"

I do sincerely apologize to my blog readers for the very long break in blog entries. First came the holidays, then when the new year began I became very busy because I began a new job. I still am working full-time at the job I’ve had, but I’ve taken on an additional part-time job. In addition to my work at a pediatric therapy center (through which I work at a clinic every weekday afternoon/evening and am contracted out to a public secondary school two mornings per week), I am now also working two mornings per week at a special needs school. There, I work primarily with children in the school's preschool program. It has been a great experience so far, but it has taken a few weeks to acclimate to my new much busier schedule. So, once again, apologies for neglecting my blog.

I realize that a lot of my blog readers are not occupational therapists themselves. A lot you readers are people who do know me in real life, and kind of sort of know what it is I do, and have heard me try to explain it, but as readers who ARE fellow OTs know, summarizing what we do in any kind of concise way that can lead to any real understanding of our profession is almost impossible! I’ve been told many of my blog entries so far has contributed to my non-OT readers’ understanding of what OT is and what pediatric OTs do. So I decided to expand on that and write a blog entry giving my best description of my profession to help with my readers' understanding. I’ve decided to do it as a “FAQ”. These are real questions I’ve been asked when I’ve said to someone that I’m an occupational therapist. Most of these questions I’ve heard several times, as has basically every OT I know! Here are my answers.

The OT Slogan

Question: Is an occupational therapist someone who helps people find jobs?

This is one all OTs hear rather often, and always produces a collective groan from the OT community. A very common misconception is the meaning of the word “occupation.” In colloquial language an "occupation" refers to someone’s job, but an “occupation” refers to more than just a job. Occupations are what people do to occupy their time that is meaningful to them, and/or required of them. For you, your occupations likely include: activities of daily living (ADLs) (ex: dressing, eating, bathing and toileting), instrumental activities of daily living (IADLs) (ex: cooking, cleaning, pet care, and child care), your job, driving and/or navigating public transportation, and what you do for fun (such as participating in hobbies or meaningful leisure activities). Occupational therapists assist when people are unable to participate in, or have difficulty successfully participating in any of their occupations because of various barriers (including disability, disease, injury or mental health issues).

Question: What is an occupational therapist? What does an OT do?

Occupational therapists are professionals that assist their clients to overcome barriers to performing their daily occupations. This may involve assisting clients to: develop or improve necessary component skills for successful performance in their occupations; develop compensatory methods in the process of developing the component skills, or when these skills cannot improve (such as in the case of a permanent disability affecting the ability to develop the skill); adapt the task to accommodate for the client's current abilities; adapt the environment to promote the client's success; and most commonly occupational therapist use a combination of some or all of these methods for each client. An OT's overall goal with a client is to help him or her to become as independent and functional as possible, participate in meaningful occupations, and experience a high quality of life.

Question: What does an OT do with kids? Kids don’t have jobs!?

Children don’t have jobs, but children DO have occupations, For children, common occupations are: participating in ADLs (dressing, eating, bathing, toileting); being a family member and functioning within his or her family environment; playing/engaging in leisure; and being a student. Barriers to being successful in childhood occupations that pediatric occupational therapists treat include:

• Sensory integration/processing issues
• Developmental delay or disability
• Gross motor delays
• Fine motor delays
• Muscle tone abnormality
• Poor endurance
• Retained primitive reflexes
• Learning disabilities
• Cognitive impairment
• Physical disabilities
• Acquired injuries
• Behavioral issues
• Attention/focus difficulties
• Motor planning or praxis difficulties
• Visual perception and/or visual-motor integration difficulties
• Psychosocial issues

Question: Occupational therapy? Is that like physical therapy?

This is a question OTs get all of the time, likely because physical therapy has more mainstream recognition and most people understand the basics of what PTs do, but many people have no idea what OTs do. For those that can recognize a difference in the professions there is a stereotype that PTs rehabilitate from the waist down, and OTs from the waist up. Another stereotype that is out there is that PTs address gross motor skills, and OTs address fine motor skills. While these stereotypes aren’t entirely unfounded, they’re not entirely true either. Occupational therapy (OT) and physical therapy (PT) are both considered “related services” and often work in similar settings and with similar populations, but we are very different professions with different theoretical bases. Physical therapy rehabilitates a client when there is a physical problem that exists. Although OTs do that too, our treatment is always directly related to daily life functioning and ability to participate in daily occupations. OTs never have clients perform non-function based exercises merely for the sake of making a body part stronger or more flexible. We may do similar exercises as PTs if there is a physical problem limiting the client’s participation in their occupations, but the exercise will always only be a “warm-up” to working on a specific activity or developing or rehabilitating a specific skill required for the occupation. While both our professions help clients function, OTs treat all aspects of the person we are treating, not just the physical. Often we have overlapping caseloads (such as people who have had strokes or children and adults with physical disabilities). However, there are many settings where there is rarely overlap in cliental, for example OTs don’t often have a role a lot of strictly orthopedic situations where overall daily life functioning is not affected (such as a sprained ankle), and PTs don’t generally have a role in mental health or other barriers to occupation that don’t require physical rehabilitation.

The Occupational Therapy Domain

There, in summary are my answers to “OT FAQs”. Hopefully this contributed to my non-OT readers’ understanding a bit!