Autism Spectrum Disorder

Question 1

Information collected during Ax

Answer 1

1. ADLs
2. Emotional regulation
3. Family occupations
4. Play
5. Participation in school
6. Sensory integration and praxis
7. Social skills
8. Technology needs

Ax tools:
1. Record review: review of significant information and medical records
2. Skilled observation: preferred over long standardized tests; observe variables that affect performance and participation (home, school, community)
3. Interviews: gathering of information about areas of concern to parents and children
4. Measures: norm-referenced, criterion-referenced tests and ecological tests

1. Adaptive Behavior Assessment System
2. Autism Behavior Checklist
3. Bayley Scales of Infant Development
4. Bruininks–Oseretsky Test of Motor Proficiency
5. Coping Inventory
6. Peabody Developmental Motor Scales
7. Pediatric Evaluation of Disability Inventory
8. Sensory Integration and Praxis Tests
9. Scales of Independent Behavior–Revised
10. School Function Assessment
11. Sensory Processing Measure
12. Sensory Profile
13. Vineland Adaptive Behavior Scales

Question 2

Occupational performance issues

Answer 2

1. Impairments in communication, social skills, and performance in most activities
2. Difficulties in ADL and IADL performance, play, and ability to study and work
3. Failure to develop speech or failure to use speech functionally
4. Impaired social interactions
5. Presence of selective attention, stereotypical behaviors, and routinized and unproductive patterns of behaviors

Question 3

Components of praxis often affected in children with autism

Answer 3

1. Ideation: ability to conceptualize and identify a motor goal with an idea of how to achieve a goal
2. Motor organization: ability to plan and organize a series of intentional motor actions in
   response to environmental demands
3. Feed forward praxis: process of sending a motor plan to the brain, comparing previous
   performance, and detecting potential errors in the plan before or after execution
4. Execution: performance of motor responses with precision
5. Feedback processes: recognition of and response to a motor act and its consequences

Question 4

Tx goal and Tx plan (decrease disruptive behaviors)

Answer 4

Behavioral and sensory integration intervention

Sensory–perceptual interventions may decrease disruptive behaviors and increase functional behaviors e.g. the ALERT program for self-regulation

Question 5

Occupational performance issues (Asperger’s syndrome)

Answer 5

1. sensory processing disorders
   e.g. Hypersensitivity to stimulation
2. Problems in negotiating in the community and with social skills deficits
   e.g. difficulty standing in line (because of hypersensitivity to touch), inability to tolerate crowds at social events, and hypersensitivity to noise in a gymnasium
3. be anxious, poorly coordinated, or eccentric. They often have problems with hearing, vision, movement, and touch
4. Nonverbal communication deficits include an inability to infer what others are thinking or to pick up on social context cues
5. Professorial speech, or speech with little regard for the interest of the listener, is typical; other speech and language characteristics may include delayed development; superficially perfect expressive language; formal pedantic language; odd prosody; peculiar voice characteristics; and
   impairment of comprehension, including misinterpretation of literal versus implied meanings

Question 6

Tx goal and Tx plan (Asperger’s syndrome)

Answer 6

1. A behavioral analysis –> identification of environmental factors that cause anxiety and should include an examination of the positive or negative consequences of a behavior as reinforcing or extinguishing subsequent behavior
2. Social skills training can teach pragmatic language skills, including the appropriate use of gestures and expressions, appropriate physical proximity to others, and vocal inflection
3. A consistent routine helps people with autism function more independently. Whereas predictability may decrease distress
4. Preparation for transitions is often helpful. For example, telling a child in school, “In 10 minutes, we’ll go to recess” can lessen anxiety around the transition
5. Reducing distractions in the environment can promote function. Eliminating unrelated sensory
   stimuli—for example, by removing clutter on bulletin boards and providing worksheets with one math problem per page—can help students focus attention on the task at hand
6. Planned breaks for getting up and moving around can promote function
7. Skills learned in one setting may not readily generalize to other settings
8. Sensory integration treatment often benefits children and adults who are on the mild end of the autism spectrum. Treatment may reduce the client’s anxiety, improve motor coordination, and increase the client’s social participation in a variety of contexts

Question 7

OT Tx

Answer 7

sensory integrative therapy

highly structured and specialized education programs

visual supports (e.g., picture
checklists, communication boards

Question 8

Difficulties with sensory processing and sensory modulation

Answer 8

a. Children with ASD have been known to respond to stimuli differently from neurotypical children

b. Children with ASD can overrespond to sensory stimulation; they may have difficulty ignoring stimuli in the environment and appear to be hypersensitive to certain types of stimuli. This overresponsivity can have a negative impact on occupational performance. For example, children may not be able to tolerate getting their hair or fingernails cut or eating foods that are of a certain texture, or they may not be able to complete schoolwork if a light is flickering.

c. Children with ASD can also be underresponsive to sensory stimulation. Their sensory systems may be habituated to certain types of input, which means that they need more of this type of input to register it. This underresponsivity can have a negative impact on occupational performance. For example, children may seek out vestibular input by spinning around while they are waiting in the lunch line, or they may roughhouse with peers who do not want to engage in full body contact.

Question 9

Difficulties with cognition

Answer 9

a. Children with ASD may have difficulty with empathy or with taking others’ perspectives and hypothesizing about what they might do next (theory of mind).

b. Children with ASD often have an acute sense for detail, almost to the point of missing the bigger picture (weak central coherence).

c. Children with ASD may have cognitive inflexibility and may be easily upset by changes in their routine and by unexpected circumstances.

Question 10

Difficulties with motor skills

Answer 10

a. Many children with ASD have dyspraxia or poor motor planning abilities.
b. Dyspraxia can be seen with fine and gross motor activities.
c. The underlying sensory integrative functions are often addressed as a way to remediate this dysfunction.