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(Week 4 IRAT) Autism Spectrum Disorder - Coggle Diagram
(Week 4 IRAT) Autism Spectrum Disorder
Terminology of "Autism Spectrum Disorder"
Changes made in DSM5
High functioning autism used as an informal term (rather than medical diagnosis)
In practice, diagnosis of high functioning autism and Asperger's still frequently given
DSM-5 contains a new diagnosis:
Social Communication Disorder
Characteristics of
Social communication disorder
Persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability [Often marked by difficulties with interacting with others]
Symptoms
Difficulty in acquisition and use of spoken and written languages
Problems with inappropriate responses in conversation
Impact of this disorder
Limits effective communication, social relationships, academic achievement, or occupational performance
When must symptoms start to present in order to be diagnosed under this condition
Symptoms present in early childhood even if they are not recognized until later when speech, language, or communication demands exceed abilities
Other disorders that fall under "Autism Spectrum Disorder"
Asperger's/ High Functioning Autism
Characteristics of Asperger's disorder
Marked by difficulties interacting with others, along with abnormal behaviors and abnormally intense interests in topics (e.g dinosaurs, trains, astronomy)
Usually socially awkward in a manner that is not easily understood
Difference in Classic Autism VS Children with Asperger's Syndrome/HFA
Children with Asperger's Syndrome has IQs that fall in the normal or even superior range
Why it takes longer for them to diagnose children with Asperger's disorder?
It is harder for teachers and peers to understand the difficulties they face as they seem much like the other children
Main Features of Autism
(1) Social "Cluelessness"
Hard for them to understand figure or speech or in nuances in meanings of things
e.g "Hug" as a civic greeting VS a sign of romantic interest
This social cluelessness can persists into middle childoood --> adolescence
Social Cognitive Challenges
Characteristics
Difficulty with nonverbal behaviours e.g maintaining eye contact, recognizing gestures, and interpreting other's facial expression
Struggle with establishing and maintaining peer relationships, engaging in social and emotional reciprocity, and spontaneously participating in social activities
Difficulty reading other's social cues - violated social boundaries and blurted out socially inappropriate comments
Those who interacted with others only focused on common and circumscribed interests but interacted minimally
Impact of these challenges
Diminishes their social experiences and lead to isolation and loneliness
Social Isolation
Precipating factors
slower learning social competency skills necessary for experience-sharing relationships with siblings and peers
Although some children on AS with limited to no verbal skills use simple gestures or augmentative communication systems to communicate basic needs and feelings, intentionality of actions may not be apparent to their families and caregivers
May have expansive vocab but struggle with pragmatics and nuances of social exchange
May become more aware of limitations --> deliberatly avoid interacting with others at home school and community
Limited engagement imapct
feelings of lonliness, depression and isolation
May also restrict opportunities to develop communication and social skills for successful engagement
Struggle with social anxiety and stress
Experiencing poorer quality friendship sand grater feelings of lonliness
Feel that their friendship are less close, helpful, intimate and fun
However research found that t is somewhat similar with patterns of leader and follower roles
(2) Anxiety
e.g Anxious over routine. over changes, new environment, different social situation etc
(3) Lack of executive planning skills
Finds it difficult to organize and plan their lives (e.g face trouble with trying to manage households or trying to cope with minor schedule changes at school/work/group work
(4) Difficulty with transitions and change
Once a pattern is established and they are comfortable with the plan, Persons with HFA will want to continue their time use fixed with the routine
If someone would to suggest a different activity to do on that day, it might result them to become anxious and angry
(5) Emotional Dysregulation
Persons with Autism could become far too emotion in the wrong situation (e.g bursting into tears because of change in routine, or melting down because his car won't start)
But often when things are predictable and when obstacles arise --> can be very hard for them to regulate their emotion when they are stressed beyond their ability
(6) Difficulty with following verbal communication
May be unable to follow spoken instructions provided with two actions required
e.g policeman says "stay in your car and give me your license" --> person may only be able to process either "stay in your car" or "give me your license" --> processing is affected
(7) Sensory Issues
Often continues to persist from childhood to school going age/adolescence.
Some may be overwhelmed with sensory input e.g touch, sound, specially when coupled with strained situation/changes of sensory issues
Challenges experienced
Sensory over-or under responsiveness and restricted food and tactile preferences
Unusual posturing, touch aversion, restricted gestures and expressive postures, hypoactivity and difficulty orienting to social and nonsocial sensory stimuli affect interactions with parents and siblings
Positive correlation
between sensory modulation difficulties and communication and social difficulties between tactile, movement and auditory sensitivities and oppositional behavior and academic underachievement
between sensory processing and anxiety, antisocial behavior and communication and social challenges
(8) Motor Skills deficit
Motor coordination - issues with fine motor skills, hand movement, (in particular bimanual coordination)
In relation to occupation: Much look out of children with Autism are performing in Physical Education OR handwriting
Prognosis of Autism
(1) Attending Regular Education Classes VS Special Education Services
Although may attend regular education classes, some children with high functioning autism may require special education services
Reasoning: due to social and behavioural difficulties
E.g difficulties coping with anxiety/stress
School in Singapore
Pathlight School
Designed for children with HFA
Children with cognitive ability and language wise they are of a certain level and able to cope with main stream syllabus
Question: If they start studying in a special education school, will they be able to move back into mainstream school?
Yes! While some children benefit from special education from beginning stages of education (e.g where they learn to cope with anxiety stressors) etc. they will still e able to thrive quite well in other settings e.g secondary schools
(2) Being Reliant on occupations e.g self-care and ogranisation VS Being able to be independent
Adolescents with HFA may exhibit ongoing difficulty with self-care, organization and disturbances in social and romantic relationships --> may result them to spend most time at home
However some do marry and work independently
Especially challenging for adolesents undergoing puberty
Have craving like many other adolescents in terms of relationships
Factors to take note when working with adolescents
Alcohol usage
They may find alcohol to help reduce anxiety, changes her sensory experiences, causing her to be not as aware of the information and noise around her
Chances of alcohol abuse --> risk that person with HFA may continue taking alcohol to reduce feelings of anxiousness and for socializing
May fall into peer pressure or trying to please people to maintain relationship --> very vulnerable of being abused or taken advantage of
(3) Co-occurrence of autism and other mental health diagnoses
Increased prevalence of comorbid issues such as depression, mood disorders, and obsessive compulsive disorders
many of those secondary conditions emerged later on as they approach adolescence
E.g Depression
Studies suggested certain group of people with ASD are more likely to have lower perceived social competence and increased incidence of depression
Examples of groups of people
Higher cognitive and communicative capacities
Have higher rates of obsessions, compulsions and anxiety
Experience peer victimization
Reasons why so:
Many of them have been identified to have other co-morbidities OR depression --> it is because they are able to tell how they feel about their anxiety/how they feel
Youth with more verbal skills also able to verbalize feeling better
Leading to them having lower levels of self-perceived social competence and increased incidence of de[ressioin
Things to note when diagnosing depression for persons with ASD
Attend to changes in nonverbal behaviours
Loss if interest in preferred acrucurues
Flattened facial expressions
Increased episodes of crying
Irritability
Aggresiveness
Self-abuse
Social withdrawal
Appetite or sleep disturbances
Importance of understanding co-occurence of mental health challenges
Designing effective prevention, early intervening, and individualised intensive intervention programmes
Positive mental health attributes of child and youth is equally important as it help shift perspective on autism from focus on disability
People on ASD diagnosed with affective disorders, anxiety disorders, bipolar disorders and ADHD
about 40% people referred for an evaluation of Asperger syndrome manifest additional psychiatric symptoms e.g ADHD and depression
e.g Anxiety Disorders
43% of a sample of 171 children on the autism spectrum exhibited one or more anxiety disorders - a rate twice than that in general population
Found that adolescents on autism spectrum experience anxiety at a rate similar to that of adolescents with diagnoses of anxiety disorders --> but those on autism spectrum had significantly higher rates of automatic negative thoughts, behavioral problems, obsessive-compulsiveness and social phobias
Reported high levels of peer victimization - suggesting that environmental influences affect clinically significant levels of anxiety
e.g Bipolar Disorders
Still under investigation (standardized assessment tools do not exist for measuring bipolar disorders)
e.g Obsessive-Compulsive Disorders
Ritualistic behaviors exhibited during childhood can be diagnosed as obsessive-compulsive disorder in adulthood
Part of the focus on ritualistic behaviors associated with intense interest as to how objects work and for a desire for predictable routine
Subjective feelings of stress and concern for how people work differentiate obsessive compulsions from ritualistic behaviors of youth on autism spectrum
e.g Attention Deficit Hyperactivity Disorder
Quality of attention and hyperactivity symptoms may differ in youth with and without autism
Studies have found that ADHD occurs simultaneously to pervasive developmental disorder
e.g Corbett and Constantine (2006)
Found that children on autism spectrum and those with ADHD demonstrated similar difficulties with visual and auditory attention as typically developing peers
However those on ASD exhibited greater difficulty with behavioural inhibition and sustained effort
Those with dual diagnosis have more difficulty with divided attention VS
Those with only ADHD have more difficulty with sustained attention
Working with children with HFA
Encouraging to fam members and parents with children with HFA and Aspergers
Very important to work with their strengths and interests
because individuals thrive very well in situations where they can be working on their strength and interests because of their commitment to area of work
Every child is different and they excel in diff areas
Important to find out how they are supported as well
e.g finding out their social environment (family members) etc
Working using a strength based approach to focus on their ability to think of ways to help build on their strengths
Occupations for individuals with ASD
Play
May have difficulty with imgination
e.g faces difficulty when playing with others using imaginative play, doing role play of getting them to take role of doctor, lwayer etc
Due to lack of social skills
Often struggle to learn how to play in groups, using turn-taking skills, sharing
E.g use of pragmatics, turn taking or sharing of toys
Influences their play in e.g playground
Interact with fewer peers, less often and for shorter duration
More time unengaged or observing others
Gets upset when lost in games
Not uncommon, but even more common in children with Autism
Reason: they may be spending a lot of effort and have so much anxiety when playing the game
If they lose--> it really affects them and results in them being unable to control their emotions leading to meltdown
Special interest can limit common topics with friends
Things they may be interested in could be sophisticated e.g they know a lot of dinosaurs or MRT tracks --> however knowledge is beyond what other same age children can appreciate
Poorer motor coordination, also affecting physical play and sports
Influences how they play in e.g playgroud
May not be as adventerous and there are certain movements they may be more worried about e.g being on a swing
Other than that those with poor motor coordination/poor proprioception they may have less body awareness
during rough play --> they could be really rough and unintentionally hurt other children too
School
(1) Attention Span that they are not interested in
Usually common topics that they have least interest in is e.g chinese and english
Topics may be more abstract for children with autism to visualise
(2) Handwriting
Often the result of poor motor coordination that can be a challenge for pri school kids
Handwriting Challenges experienced by children with ASD
Children with ASD show worse quality of forming letters
but do not show differences in their ability to correctly size, align and space their letters
What are predictive factors of handwriting challenges for Children with ASD?
Significant predcitive factor of handwriting performance: Motor skills
Not predictive factors: age, gender, IQ, and visuospatial abilities
How OT can help children with handwriting
Work with individual and find out exactly which part of the handwriting is an issue
e.g quality of forming letters, sizing, alignment or spacing
in order to tailor intervention to individual child's handwriting issue
Doing a proper task analysis and detailed observation to understand where the child is having difficulty with and guide the child along and help them gauge on where exactly to improve on
Components that can be worked on
Targeting letter formation - in combination with general training of fine motor control to improve handwriting
(3) Participating in discussion
May be more common when they work on project groups OR even in class
May find difficulty reading cues on when is their turn OR know when to answer or not even if they know the answer
Have to learn not to blurt the answer out all the time --> challenge for them when they get told off shouting out the answer when in fact they are interested in the topic
(4) Group Projects
(5) Physical Education
Can be a challenge for those with motor coord issues
(6) Coping in overwhelming environment such as recess, assembly halls
In school there can be many transitions that are taking place
e.g children have to assemble to sing the national anthem, take the pledge OR moving on to one class to the next
A lot of times environment can be very noisy and it can be hard to cope with overwhelming environment such as recess, canteen or assembly hall with a lot of things going on
Social Participation
Interests in special topic which other children may not appreciate
Children with HFA may be able to converse with adults while about topics but not so much with other same-age children
difference in topics they may be interested in and the in depth knowledge
May be invested in wanting to talk about that topic that they do not want to talk about anything else --> affecting social interaction in terms of conversations they have
May develop expansive vocabularies but struggle with pragmatic and nuances of social exchanges
e.g may not be able to appreciate silly jokes the ppl may be laughing about
sometimes their use of language may not be appreciated by other children in the classroom as it may seem too bombastic for them to appreciate and have a meaningful exchange with
Preadolescents often become more aware of their limitation in communication and social skills --> as a result may deliberately avoid interaction with others at home and school --> increasing isolation
Not true that child w autism do not appreciate friendship and does not want to interact w other ppl
Therefore it is important to check with them how they are feeling (they may have problems with articulating what they feel)
By adolescence, many youth with ASD struggle with social anxiety and social stress
(as they may have a lot of hiccups/bullies along the way) --> affecting how they interact with others
AOTA believes that intervention for child and youth w ASD should be "individualised to foster occupational engagement and social participation"
Social communication challenge --affects --> Social participation --affects --> health and well being
e,.g unable to communicate and engage in play --> fewer peers --> less often play or for a shorter duration
Self Care
Beyond ADL
Especially for school going children
E.g must be able to change into their uniform, tie their shoelaces etc
How to manage "self" in studies, work
Exposing to the bigger world out there --> e.g participating in different job opportunities --> help build experience to eventually be able to find stable job and achieve meaningful productivity
As demand increases and tasks get more complicated and involve more planning
No longer just about dressing
About managing time so you can get ready in time with e.g brushing teeth, getting hair done up properly, wearing uniform so that you can be on time for the school bus to not miss it
Being able to manage adulting responsibilities
Those learning how to live independently in future
Managing finance
Transport (bus, train)
Household
Managing mobile phone
eg how to make sure they are not running out of data and spending too much money on mobile phone
Leisure
Finding leisure activities were individual with autism can relax and enjoy is important
Things they experience in their life may place a lot of stress+ anxiety on people with autism
Can be individual or with friends of common interest
Go beyond leisure online
Especially in realm of social media and playing games online
Very complicated things such as emoji, friends on facebook, etc
Persons with autism have to be able to learn how to navigate social media
Be aware of how do you not share so much that it is actually inappropriate for your instagram
Explore different interests
Getting them to explore different interests/sports/things such as running/swimming, art and craft etc can help them explore diff interest they may not be aware of
Work
Facing difficulties with employment, independence and meaningful social support and positive mental health
Some individuals also struggle with getting along with their colleagues
Environment for individuals with High Functioning Autism
Environmental factors that can affect child's occupational performance
(1) Home
Impact of autism on mental health of family
Reported impact (by parents)
Greater level of stress
Less involvement with community, social activities (due to commitment of time needed to take care of child with autism)
Diminished quality of life
What parents may do due to childcare demands
Quit jobs
Increase financial burden
Compromise attention to siblings
Chronically concerned about their child's learning ability, bullying, social isolation, physical safety and strained marital relationship
Level of parents stress in-turn negatively influences mental health of child with ASD
Possible strategies
Considerations on how to make home environment set up more calm and relaxed
Think about people at home --> how using family centered practice can work with family in order to help them relate to the child with autism and for them to be able to do things they enjoy
Things to take note of
Attending to the children's physical movement and use of time, space and objects to understand sensory, emotional, symbolic and social meaning of occupations for the
What looks like non-responsiveness or overfixation on minute details may reflect difficulty with or an alternative way of filtering and processing information
What looks like self-isolating or aggressive behaviours may be self-defense or communication strategies in the absence of adequate languages
Example: Elijah (Asperger's syndrome)
Found importance in modulating environment, tempering pace and structure of daily life routines
Designing a social network to promote one's physical, mental, cognitive and social health
Shifting lenses to intepret how child engages in occupations
E.g Rocking and Moaning Behaviours
Instead of judging it as self-stimulatory, she learned to read them as signals of stress and strategies for self-calming
E.g Son's repetitive drawing of the same cartoon characters
Rather than critcize it, she began to see the subtle variations in them that reflect an exploration of visual relationships of objects to other another from various angles
e.g Elijah's daily insistence about purchasing helium baloons only to release them into the air on exiting the store
Leanred that it is not the possissions of the balloons but rather the study of change in their size and light composition as they ascend that is imrpoatnt to him
(2) Community
Common environments such as shopping malls can be overwhelming and challenging for children with ASD
Video:
Can you make it to the end
Trying to register all the information that is occurring around them, paying attention to details down to the person's untied shoelace
May try counting to calm themselves down
Finding out more from the environment
Parents should try to observe aspects of the environment that may lead to difficulties such as
avoidance
non-compliance
overt distress
challenging behaviours
Note things such as
Who is present at the time
is there a certain person in the new environment that has been causing that distress
Features of the Environment
E.g visual, noise/sound, smell, time of the day) that causes their child's distress
Determine whether there are any patterns related to such behaviours/distress
How to help the child cope in an environment in community (e.g work with parents)
Possible interventions of managing within the environment
(a) Some parents may choose to avoid certain types of environment
not going to visit certain places during certain periods of time e.g visitig chinatown during new year OR visiting supermarket during busy hours (crowd may bother child)
However avoiding is not always possible
It is still very likely that child will still encounter other unexpected crowds happening in their lives
(b) Preparing child what to expect when visiting the environment
E.g if visiting somewhere you know it is crowded --> warn the child in advance so that they can think of a strategy that they can use that worked previously
(c) Help develop a coping strategy or solution
e.g use of iPOD to tune out noise
e.g use of blutack to play with when they are stressed
Bring along smth that they will be comfortable with when they are feeling stressed
(d) Use of "sensory stories" to develop sensory strategies for children
Importance of developing long-term self-management strategies
As it may be required throughout their lives
Do not want an OT to follow child through life --> therefore need to develop self management strategies to cope with unexpected environment/situations in the future
(3) School
Dilemma on whether school should be informed on child having autism
Fears parents have
Afraid that there is labelling of their child or if the teacher will treat the child very differently if they knew the child has special needs
Benefits of keeping school informed
Schools now are generally more inclusive and teachers have better awareness of special needs
E.g declaring that the child has special needs and working with them to know what are some strategies that work with the children
Support structure in place for example allied educator
Strategies can be put in place early to increase success in transition
If the school is warned ahead of time that the child has special needs
the child will benefit from extra help
ensure that they are not putting in too many children with special needs in the same class
Teachers can watch out for incidents of bullying
Suitable partners or friends can be introduced to help with social interaction
Transitions between and within school environment
Types of transitions
Transition from preschool to primary school (e.g extremely difficult compared to primary school) --> a lot of things can be done in order to help child get ready
Transition between lessons (especially involving change of environment)
May take a while for the child to get used to the change in environment, change in subject taught etc
Change of teachers
Especially relief teachers who do not know quite how to interact with child with special needs may be problematic
Transition from one level to next - e.g pri 2 to pri 3 different classmates, start all over (also have to know new teacher)
Social environment: bullying
Higher functioning children with autism - found to be at greater risk of being bullied
E.g Found to be 3X more likely to be bullied compared to those that have less conversational skills or absence of conversational ability
Those educated in mainstream classroom were almost 3x more likely to be bullied than those who spend most of their time in special education
Social awkwardness was more obvious because they actually interacted more with mainstream peers
Made their actual disability less visible, likely making their condition harder for heir peers to understand --> may result in bullying and they are not sure on how to deal with it
Universal Design
Definition
Design of products and environment to be usable by all people , to the greatest extent possible, without the need for adaptation or specialized design
Means scientifically valid framework for guiding educational practices that
(a) Provides
flexibility in the ways information is presented,
in ways students respond or demonstrate knowledge and skills, and in ways student are engaged
(b)
Reduces barriers in instruction
, provides appropriate
accommodations, supports and challenges
, and maintains high achievement expectation for all students, including students with disabilities ad students who are limited english proficient
Video:
UDL at a Glance
How to practice UDL to build a flexible curriculum
Goal (what teacher wants students to know)
Barriers in classroom that might interfere with diverse students reaching the goals
Ways to eliminate barriers experience
(a) Representation
showing the information in different ways (e.g multi media and provide various supports such as graphics and animation)
(b) Action and expression
give students plenty of options to express what they know
providing models, feedback and supports
(c) provide multiple means of engagement
what fires up one student wont fire up another (give students choices to fuel their interest and autonomy)
Help them risk mistakes and learn from them
Examples of Universal Designs for Learning (in classroom)
(1) Use of Visual Schedule
Helps to visualise the class routine
having the timetable on the whiteboard: helps all children be more clear on what is going on and how long to sit for
Prepare child for transition between lessons or environment
Tap on visual strengths of child with ASD
Also being fair for all the children in the class
(2) Movement breaks for whole class
Helpful for children e.g autism, adhd, etc
e.g children can be asked to touch their toes ten times, stand up and do twn tiwst, or do a littl epush up on the wall
(3) Reduce Sensory Overload
Children with autism and other children with sensory processing difficulty lack the ability to tune out the sensory information around them (things you and I may not ordinarily notice) , leaving them overwhelmed
e.g if classroom has too much decoration: it is impt to watch out for over stimulation (can be overwhelming in terms of where to look at/focus etc)
e.g teachers can be more careful in wearing strong perfume, or notice whether certain aspects of classroom need sto be changed e.g fan breaking down and making noises
Intervention for individual with high functioning autism
School age and Adolescence
School age: Important to develop friendship and explore personal interests
Adolescence: Social participation helps contribute to formation of
Self concept
Self-esteem
Awareness of personal attributes
Why transition in adolescence can be confusing and emotionally charged period for people with ASD
Due to hormonal, emotional, social issues associated with puberty exacerbate feelings of frustration and isolation
Particularly because social interaction is not their strength: makes it additionally hard for them to relate to others
(1) Social Skills
Social skills training curriculum
Addresses social challenges of children and youth
Critique
Often do not generalize skills beyond the social skills group
do not sustain skills over time
they may not be able to demonstrate the same skill set when they are out of the clinic, or without the presence of the therapist in the natural environment
Intent: for children to learn skills for interacting and participating in social activities with others
Important components to include in social participation intervention
1. Integration of strategies for practicing explicitly taught social skills in natural environment
What you have learnt in class --> how can you apply in natural environment or when the real bully in school approach you
2. Practicing skills with typical developing peers
just by practicing skills with other children with autism in social skills class --> get to practice it in outside world with typically developing peers
Such programs that incorporate peers have shown to
increase social competence
ability to generlize skills to settings outside intervention group
Types of Intervention
(1) Inclusionary Intervention
Found to promote social participation
Peer support to decrease barrier and increase acceptance
Opportunities to learn and apply social skills
Consider involving peers, siblings, neighbours whom they can practice the skills with
the OT can be working within school context that can involve peers to support them and promote social participation
(2) Cognitive-Behavioural Therapy
What CBT can help with?
Addressing anxiety, mood and stress
Who can these be used for?
Child/adolescence with HFA esp when they have good language communication
Components
Assessment of the nature and degree of mood disorder using self reporting scales and a clinical interview
Affective education with discussion and exercises on the connection between cognition, affect and behaviour and the way in which individuals conceptualise emotions and construe various situations
Activities to help practice new cognitive skills
Cognitive restructuring
can correct the distorted conceptualization and dysfunctional belief
the person is encouraged to establish and examine evidence for all against the tall
build new perception of a specific event
Stress Management
Stress Management and cue control relaxation programmes are often used to promote responses which are incompatible with anxiety or anger
In other words if they are overly anxious/angry and they respond inappropriately --> what are some self management practices they can use and strategies they can use in those situations
Self-reflection
Help the person recognize the internal state & to monitor & reflect on their thoughts and construct (a new self image)
A schedule of activities to practise new cognitive skills
e.g Graded schedule
Developed to allow the person to practice this new ability and closely monitored by the therapist
(3) Social Stories
Useful to help children cope in different environments and address particular behaviours
What are social stories
Written in clear, concise terms designed to teach children and youth with ASD about appropriate social behaviors for a particular situation
Components of social stories
A description of the situation
Examples of visual and auditory cues to anticipate
S6eps to compete the task or handle the social dilemma
(4) Sensory Stories
Similar to social stories: but sensory stories have a similar sentence structure and style, but serve to prepare for challenging sensory situations
Components of sensory stories
Introduction of targeted experience
Identification of potential negative sensory input during that experience
Acknowledgement that the experience can be unpleasant (e.g the child may realise why isnt anybody else upset)
Strategies that can prepare the child for the experience
Outlining the steps of experience and strategies to be used during the experience
Strategies at the conclusions of the experience
Ending with a positive note
When is sensory stories more appropriate than social stories
Child has a sensory processing challenge that influences activities and participation
Activity has challenging sensory features that needs to be addressed
Challenging behaviors are associated with activity and have a sensory basis
Sensory features of the environment can be modified and child needs to learn the sensory strategies to cope better
Social Stories
Better in terms of addressing social situation esp when it comes to greeting a person, or certain ways to behave in situations
VS
Sensory Stories
Better in event where there are certain environment that challenges sensory processing system and there are difficulties relating to sensory features
(5) Relationship Development Intervention (RDI)
Developed by Gustein and Sheely (2002)
Components of the intervention
Differentiate social skills into two separate skills
Instrument skills
e.g eye contact, smile
Taught through direct instruction, behavior shaping
Relationship skills
e.g create an emotional connection
Taught through systmatic, layered strategies of referencing social partners (to develop friendship)
Who can implement this strategy
Certified consultant to work with family and children
but as therapist it is impt for you to know what other families are going through in order to implement it
(6) Peer Support Programme
Examples
Circle of friends
Lunchtime clubs
Best Buddies
Aim of intervention
Promote greater peer understanding of adolescents or children with disabilities
To prevent isolation and bullying
Inclusionary intervention - some of these peer support programmes are very good (inclusionary practices)
E.g OT can recruit students in the inclusive classroom to work on project, school athletes to work on exercise machine or in swimming pool with youth (inclduing peer within programme itself for helping children be able to participate in environment)
(7) ZIggurat Model
Developed by Aspy and Grossman (2008)
Structured framework, step by step approach to assess underlying characteristics of autism and student's strength
Components of the Ziggurat Model
(Incorporate five different levels)
Sensory and Biological
Provide a sensory diet and Monitor and address environmental stressors
Sound, light, proximity/personal space, textures
Movement needs
Monitor and address
Appetite/hunger
Activity level
Posture and Movement
Medical Needs
Reinforcement
Provide reinforcement
Continent on expected behaviour
Frequent and consistent
Self selected
Gradually decrease use
Provide range of reinforcers
Concrete activities, privileges
Use restricted interests
Pair social with tangible reinforcement
Structure and Visual/Tactile Supports
Create predictability
Prepare for change --> provide information in order to allow child to know how to cope with transition and routines
Provide routine
Walk through new activities
Use visual supports to hold information still
Video
Stories and cartoons
Schedule and checklists
Graphics/tactile organizers
Task Demands
Remove obstacles
Social
Restricted patterns
Communication
Sensory
Cognitive
Motor
Emotional
Skills to teach
Address Skill Deficits
Social
Restricted patterns
Communication
Sensory
Cognitive
Motor
Emotional
in terms of training certain skills in order
Increase communication
Increase social and address skill issues which are impeding activities/participation
Consistent with research-based trends
Prevention of challenging behaviour
Functional assessment based on a functional behaviour analysis
Comprehensive intervention that address student's characteristics, strengths and skills
System change to allows for maintenance of learned skills
(8) Response to Intervention Model
Lies in the use of tiered instructional processes (model guides therapist in terms of understanding where to work)
Working the child within the system
Working with the child within the classroom
With child individually to address the difficulty
Tiered instruction represents a model in which instruction delivered to students varies on several dimensions that are related to the nature and severity of the student's difficulties
Tiering system helps to decide where to intervene at
Aside from helping the child directly, advocating for the child to teachers etc can help to make environment more supportive for child to learn
Benefits of using the tiered model
Prioritization of time
Consider the nature and severity of student/child or adolescence
targeting intervention at right level
Prioritization of workload
Understanding how much time can be spent as a consultant to organise information across the school VS within the classroom VS one on one with child
Component of the tiered model (Three tiers
Bottom Tier
Universal monitoring and classroom interventions to increase learning
Foundation
Standards-aligned instructions for all students (Benchmark)
All students in tier on receiving high quality scientifically based instructions and differentiate it to meet their needs and are screened periodically
Also identifies people who are struggling that may need additional support
Links to the idea of universal design of learning
Middle Tier
Increased monitoring, data collection and small group interventions
Supplemental interventions for students at some risk (Strategic)
For students that are not making adequate progress in core curriculum
Provided with increasingly intensive instructions matched to their need and on the basis of level to their performance and rates of progress
10-20% of them require special education
Top Tier
Intensive monitoring, data collection and one-on-one interventions
80-90% of them require special education
Supplemental interventions for students at high risk
Intensive
The students then receive the individualized intensive intervention targeted on skill deficit for remediation of exist problems OR prevention of more serious problem
Additional Information
Size of instructional group decreases up the pyramid
% of students requiring intensive support decreases
Intensity and frequency of progress monitoring and interventions increases up the pyramid
Continuum of time, intensity and data increases
Example of how this can be applied in school
Chapter 8 Case Study (Pg 182) Box 8.3: Hester
OT should collaborate with school in order to work and collaborate with school and interdisciplinary team to design and decide which tier of intervention level is needed
Tier 1 (Example)
OT can organize informational programs to teachers and extra curricular instructors on strategies to promote social participation
e.g instead of working individually in the classroom, the role of OTs is about advocacy and about introducing instruction to everyone in the school system to know how do we help children with special needs, what are some features of children with autism that everybody can play a part/support
Tier 2 (Example)
OT can work with teacher in classroom to facilitate a "circle of friends" to work on class projects and social events e.g parties
Working more specifically with the child within a certain classroom - OT can work with teacher to facilitate a group of friends that can help child with auitsm work with peers
Tier 3 (Example)
OT can work on direct individualized intervention to help with social anxiety and stress or handwriting issues