What is ASD and why is occupational therapy appropriate?

Autism spectrum disorder (ASD):

*Autism spectrum disorder is an umbrella term for developmental disabilities that include:

http://parenting4tomorrow.blogspot.co.nz/2011/07/autism-spectrum-disorders.htm

The disorders range in severity and individuals may have difficultly in all areas of function but are particularly challenged with:  

        *social interaction

        *communication

        *restricted behaviour or repetitive/stereotyped behaviour.

        *sensory processing

        *motor difficulties and delay

        (Dubois, 2011)

Autism Spectrum disorders cannot be 'cured' - instead intervention is available for individuals with ASD that targets behavioral language, cognitive, social, and sensory concerns (Atchison & Dirette, 2007).

Occupational therapy (OT) for ASD:
Occupational therapy services are provided for children with an ASD in order to assist them in engaging in daily life activities that are meaningful and purposeful (Case-Smith & Arbesman, 2008).
Occupational therapists who work with children diagnosed with an ASD use various environments such as school, home and community and different interventions to focus on building skills in all areas of life such as daily living skills, education, play, self-cares, motor skills and social communication (Autism Speaks, 2009).

OT's look at the individual holistically by focusing not only on the person and how they are behaving, but also how they are performing occupations and how the environment effects their performance in everyday functioning (Tomchek, LaVesser & Watling, 2010).
Currently, occupational therapists working with children who have an ASD are expanding the use of aquatic-therapy as a treatment approach.

References:

Atchison, B, J. & Dirette, D, K. (Eds.). (2007). Conditions in Occupational Therapy: Effects on Occupational Performance (3 ed) USA: Lippencott Williams & Wilkins.

Autism Speaks. (2009). Occupational therapy: How does it help children with ASD? Current News. Retrieved from:http://www.autismspeaks.org/inthenews/ian_findings_occupational_therapy.php 

Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. American Journal of Occupational Therapy, 62, 416-429.

Dubois, M. (2011). Aquatic Therapy for Children with an Autism Spectrum Disorder: Occupational Therapists' Perspectives. Australia. 

Tomchek, S., LaVesser, P., & Watling, R. (2010). The scope of occupational therapy services for individuals with an autism spectrum disorder across the life course. American Journal of Occupational Therapy, 64(Suppl.), S125-S136. 

            

What is aqua-therapy?

Aqua therapy is still a developing intervention, therapists use the water and specifically designed activities to enhance, restore, and maintain a person's overall functioning.

The warm water provides a safe and supported environment, but also provides them with hydrostatic pressure that surrounds their body in the water helping to relax and calm the children, providing the necessary sensory input they crave (Jake, 2003).  

 

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Occupational therapy and aquatic-therapy for  ASD:

For children with ASD occupational therapists can use the aquatic environment to focus on improving:

  *sensory processing and integration

*social interaction and behaviour

*self-cares and activities of daily living

*communication and cognitive improvements

 


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*motor skills and improved body awareness

*increasing muscle tone

*participation in play                                       

*having FUN!

(Dubois)

Occupational therapists can use visual cues such a laminated cards with pictures of self-cares, activities of daily living and play for the child to acknowlege what each is, objects can then be incorporated for the child to practice using, in an environment that enables them to feel safe and supported. Mirrors both under and above the water can also be used as a way of increasing the childs body awareness and encourages the child to push their limits and go beneath the water.  

Activities in the water can be applied across a wide variety of contexts in an individual or group setting that provide for the different needs of the children and activity demands.

Studies have displayed an increase in physical or behavioral skills, strength, endurance, and opportunity for life skills practice; increased self-confidence and social participation and reports that the water calmed children and improved body awareness (Jordan, 2009). Through improving these aspects of the child they then have the potential ability to participate in everyday life as desired.

Therapists need to constantly supervise the child during the session and take into consideration the water temperature and reduce any lighting and noise that may have a negative effect on the child.

References:

Dubois, M. (2011). Aquatic Therapy for Children with an Autism Spectrum Disorder: Occupational Therapists' Perspectives. Australia. 

Jake, L. (2003). Autism and the role of Aquatic Therapy in Recreational Therapy Treatment Services. Retrieved from: http://www.recreationtherapy.com/articles/autismandquatictherapy.htm

Jordan, A. (2009). Autistic students making progress at aquatics centre. The Metro West Daily News. Retrieved from http://www.metrowestdailynews.com

My experience of Aquatic Therapy

During my paediatrics placement I participated in aqua-therapy with children suffering from a variety of conditions.

One child that I will never forget and is a reason why will always support aqua therapy is:

An 8year old boy Sam* (fictious name) with autism who experienced problems with self-cares (showering, dressing and feeding), sensory issues, a lack of social interaction and presented with self-injurious behaviour (biting himself and pinching or slapping other). He attended 5 sessions during my placement, luckily I was able to see him from the start and the progress he made was amazing to witness!

First aquatic session Sam* entered the pool area with apprehension and would only put his toes in, refusing to go further.

Second session with persuading and his mother having to join us in the water, Sam* finally came in. The relief on his face was priceless when he realized how safe and supported he felt! Sam* slowly adjusted to the feel of the water noticing him relaxing the more time passed. We used a small watering can to sprinkle water over different parts of his body.... he clearly enjoyed the sensory stimulation that it provided! Something Sam’s* mother said he would never have let happen prior to the session.

Third session Sam* came bounding into the pool area ready for action! He allowed us to hold him this time as in the previous session he only let his mother. The trust Sam* was showing was already a sign he was improving! He was given a plastic spoon and encouraged to hold onto it, his mothers face light up when she saw her son acknowledge what is was used for and put it in his mouth! His mother had been having difficulty for years trying to feed him let alone him put the spoon in his mouth himself! For the rest of the session games were played with various pool toys (focusing on sharing) and the watering can was used once again with success.

Forth session Sam* arrived again with the same enthusiasm as the last session and immediately allowed us to hold him in the water.

His mother reported that there had been a significant decrease in his self-injurious behaviour and violence towards others. He was allowing her to feed him without a fuss, and had fed himself a few times. He had also taken his first shower and enjoyed it!

This session we included 3 other children to work on his social interaction skills. He was very apprehensive at first and would not make eye contact with any of them, but after a while he started to relax as the therapist swished him around in the water to calm him. Sam* made eye contact with the children a few times and eventually getting more comfortable as time went on, he even asked one of them for a toy they were playing with. We also had a ‘getting dressed’ relay on the side of the pool, which to his mothers surprise/delight Sam* won!

Fifth session Sam’s* mother informed us once again on more improvement he was making in particular he was frequently feeding himself, was showering regularly and his self-injurious behaviour and violence towards others was remaining at a minimum. His teacher had reported an increase in social interaction and also improved attention span during class. This session was also a group one but with different children. Sam* adapted to the group setting a lot better than before and was interacting well with the other children after 15mins. He even shared his toys with one of them, which was a big achievement! We worked more on feeding strategies and Sam* even let us put his head under the water.

I was disappointed to leave at this point in Sam’s* treatment and would have loved to have kept seeing the results he was achieving in such a short amount of time, I’m sure there have been many more since!

Reflection

Through having the opportunity to praticipate in aqua-therapy with children with autism and researching the topic further, my personal view is that aquatic-therapy is a highly effective intervention that can be ustilised by occupational therapists to enhance a childs ability to perform everyday occupations and achieve not only their own but also their parents desired goals.
I am passionate about working with individuals with autism and would love to develop my skills further within this area further. If I am lucky enough to gain an opportunity to work in this setting I hope to have the resources to perform aqua therapy with clients, so they can gain the benefits and amazing results that it promises!!