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?”
