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I have shared before my sense of puzzlement when I first heard that occupational therapy, or OT, would be a big part of the autism early intervention process for our family.
Initially I could not see what occupational therapy had to do with autism at all. And I bet I’m not the only one who struggles to make this connection at first.
In my mind, occupational therapy helps people with physical impairments or injuries to be able to do routine, normal, everyday activities. I really could not see how it could help those with autism.
After all, the diagnostic criteria for autism are social communication deficits and repetitive behaviours – there’s nothing there about physical impairments at all.
So why DO people with autism require more targeted help with everyday activities? Why is occupational therapy such an essential component of autism early intervention?
Well, in addition to the social communication deficits and repetitive behaviours that are key to obtaining a diagnosis, most people with autism also experience significant difficulties with processing sensory input. Which is why an estimated 60-70% of all people on the spectrum are also diagnosed with some form of sensory processing disorder.
This often results in difficulties with fine motor (coordination of small muscles with the eyes), gross motor (coordination of arms and legs), proprioceptive (position of the body in space) and vestibular (balance) skills.
In other words, these sensory processing issues make it even harder for people on the spectrum to undertake normal everyday tasks. Hence the greater need for occupational therapy.
We’ve benefited from OT in so many ways over the last 8 years. It has helped my kids to better cope with every day life and find strategies to stay calm and better regulate their senses. OT has also helped my son accept new food, learn to jump and improve his core strength, among many other things.
OT has also helped me as a parent to better understand my kids’ needs and the reasons behind their behaviours. I have learned ways to actually help them each day, also benefiting our family as a whole. I definitely feel more confident as a parent after having had the benefit of many hours of OT – I can now see real results.
So, if you are puzzled by the link between occupational therapy and autism (as I once was), here’s 7 ways occupational therapy can help and why OT is so important in autism early intervention.
7 ways occupational therapy can help with autism
Establish motor planning skills
Motor planning is the ability for the mind and body to work together to perform a task or action and it’s key to how we learn new skills. It’s knowing which actions to take in the correct sequence in order to achieve the desired outcome. For instance, the steps required to get dressed or drive a car or write a word.
Motor planning problems are largely due to issues in processing sensory information. Being able to correctly process incoming sensory stimuli is essential in successfully planning and carrying out a particular task. Since many people on the spectrum experience sensory processing issues, it’s inevitable that motor planning function can be affected.
An OT can help improve motor planning by recommending activities that will improve general sensory processing skills (see sensory processing below). They can also help by setting tasks to encourage problem solving and practice motor planning skills.
Here are some of the activities we have undertaken over the years to establish motor planning skills:
- Scooter board – lying down on a scooter board and using the arms to manoeuvre around the floor helps develop motor planning skills in a few ways. The child needs to navigate obstacles, keep their balance, push forward with their arms and keep their legs off the ground, all at the same time. This takes some serious planning.
- Obstacle courses – this is a fun way for kids to plan how to avoid obstacles, all the while working out how to move their body to get over, under or around the obstacle course.
- Simon Says – this classic children’s game is perfect for helping with motor planning as it requires kids to copy “Simon.” This activity provides the opportunity to practice a range of movements in an age appropriate and fun way.
- Dancing games – video games like Just Dance and Dance Central are all about mimicking the actions of the avatar in front of you. This can be a fun way to introduce movement to kids (like mine) who are more likely to prefer playing a video game to any form of exercise.
Develop fine motor skills
Fine motor skills describe how the smaller muscles throughout the body (like in the wrists and hands) coordinate with the eyes. Daily activities that use fine motor skills include handwriting, threading, using scissors, using cutlery to eat and typing on the computer. Many kids on the spectrum (including my own) struggle with handwriting and using scissors properly due to poorly developed fine motor skills.
Some of the therapies we’ve undertaken over the years with an OT to develop these skills include:
- Tracing activities – important in practicing hand-eye coordination, improving pencil grip and tackling handwriting difficulties.
- Working with play doh – manipulating play doh helps to develop more strength in the fingers and allows kids to practice rolling, pinching, patting, squeezing and flattening the doh with their hands.
- Playing games like Operation – games requiring hand dexterity (such as using tweezers) are great for getting kids to practice and refine their fine motor skills.
- Threading beads on string – a favourite activity in most pre-schools, threading encourages kids to refine their fine motor skills and helps improve hand-eye coordination.
- Building items with Lego – manipulating small Lego bricks is a fun and practical way to improve fine motor skills.
Improve gross motor skills
Skills like jumping, climbing and riding a bike are part of our gross motor system, the system of larger muscle groups that control our arms, legs and torso. A lack of general coordination in those on the spectrum can point to problems with gross motor function, including difficulties in catching or throwing a ball, general muscle weakness and becoming easily tired.
There are many activities and exercises that have been recommended to us over the years to address gross motor issues:
- Animal walks – pretending to walk like a bear (on all fours) or as a crab (sideways) challenges kids to use a variety of big muscles and can help develop their gross motor skills
- Fit ball work – this is handy for undertaking a variety of activities designed to improve coordination. The most useful activity for my son has been laying on the ball and balancing on his arms (keeping his legs off the ground). Great for balance and core strength as well as for his gross motor ability.
- Hopscotch – such an old school game but perfect for promoting hopping, balancing and jumping skills, involving the arms and the legs.
- Climbing ladders – climbing ladders around the home or at the playground helped our son improve both his gross motor as well as motor planning skills.
Manage sensory processing difficulties
There are seven sensory systems which OTs concentrate on to address sensory processing issues. The 5 commonly recognised senses of taste, touch, sight, hearing and smell, together with 2 more – the vestibular system (balance) and the proprioceptive system (where the body is in space).
An OT will normally ask for a sensory questionnaire to be completed by parents and teachers/carers to pinpoint the areas of greatest sensitivity/under-sensitivity. Based on the results, therapies are introduced to address these needs. Some of the therapies we have tried over the years to address the many different sensory processing needs of my kids include:
- Brushing protocol – using a bristled brush to de-sensitise the skin of those with tactile defence issues, like my daughter. Joint compressions are also often part of this protocol which is designed to help calm the child as well as get them used to greater tactile sensation.
- Deep pressure therapy – using weight to provide greater sensory input to those who are under-sensitive, like my son. We have used weighted blankets and activities such as the hot dog (where the child is rolled up in a blanket to give them the deep pressure they crave).
- Ear defenders (ear muffs) for both kids to prevent auditory overwhelm in loud environments. These have been especially useful in the school hall for assemblies, during group time in class and in the echoing COLA during lunch breaks.
- Swings and hammocks to calm an overactive vestibular system. Both kids love to swing and the back and forth/side to side motion of a swing or hammock really does make a difference to their ability to cope each afternoon.
- Jumping on a trampoline to activate the proprioceptive system. Before our trampoline literally fell apart, my son would jump on it each morning before school in order to calm himself before a stressful school day.
Address restrictive diets and oral sensitivity
I’ve shared my son’s food preferences before and the methods we have used to challenge and increase his diet. He is one of many on the spectrum who experience oral sensitivity. As his sensory system is under-responsive, he is always seeking more sensation to provide the input he craves. So he tends to prefer food with crunch and avoids foods with soft textures.
Our OT provided a program for us to follow to introduce the idea of new food to him. It involves:
- talking to him about the new food,
- modelling us eating the new food,
- showing him the new food,
- allowing him to smell and touch the new food and
- then encouraging him to finally give it a taste.
He still doesn’t really like trying anything new but we can now put something new in front of him and not witness an immediate meltdown. This is definitely a step in the right direction.
On the other hand, our daughter is over-responsive to sensation and tends to want to chew on something to keep calm, usually her collars and other items of clothing. Our OT has helped us address our daughter’s need for greater oral stimulation by recommending chewy jewellery and suggesting alternate activities (see sensory processing above) to help her regulate all this extra sensory input.
Assist with developing concentration skills
Often sensory sensitivity can inhibit concentration and learning as the child is distracted by the overwhelming sensory input coming at them. The solution is to address the cause of their sensory overwhelm and attempt to anticipate some of the more common reasons for their distraction.
Our OTs have come up with a variety of suggestions over the years to help increase our kids’ concentration levels in the classroom and we have found the following tools and strategies to be of most help:
- Using/wearing weighted items – these provide deep pressure to the muscles and joints and help achieve a state of calm by releasing serotonin, a natural relaxant. We’ve used weighted blankets and toys in the past and will be trialling weighted clothing soon.
- Regular breaks – my son in particular needs regular breaks to remain calm and maintain concentration and focus in the classroom. This can be as simple as a toilet break, running an errand to the office or having a quick jump on the trampoline.
- Ear defenders – these are great to help remove unwanted auditory distraction and increase concentration levels. Both our kids have benefited from using ear defenders in a variety of settings at school.
- Providing more desk space – my daughter really struggles with personal space and has not been able to share a desk with others without suffering sensory overwhelm, due to her tactile defensiveness. We’ve found that sitting her at the end of the table and giving her extra room to spread out has helped increase her concentration levels.
Increase core strength
To this day, my two eldest kids have poor core strength. They just don’t have the natural ability to sit up for long periods, climb or complete too many physically demanding tasks. This is due to another common issue among those with autism, low muscle tone and poor muscle strength.
Core strength is vital for motor planning and gross motor skills and can have significant impacts on concentration levels, including the ability to sit still and write for long periods of time in the classroom.
An OT can recommend a series of exercises and activities to help increase core strength, similar to the ones below which we have used over the years:
- Fit ball work – my son is currently using a fit ball to watch TV as it allows him to bounce and address his sensory needs, while also helping increase his core strength by relying on him to keep himself upright, rather than slouching against the back of a chair.
- Wheelbarrow walks – these are always a laugh (unless you drop their legs, then they are not so much fun for your child who could likely face plant themselves). A wheelbarrow walk involves getting the child to lay face down on the ground with their palms flat. You then lift their legs so they are forced to walk forward on their arms, working on their upper body and core strength in the process.
- Superman – in this exercise, the child is again laying face down on the floor. They are encouraged to maintain a superman pose for as long as possible, by raising their head, arms and legs at the same time. The aim here is to slowly increase their endurance by encouraging them to hold the position a little longer for each attempt.
A word of caution: I am not an occupational therapist. I am a huge fan of OTs and very grateful for the help they have given our family over the years. So please consult a qualified OT before embarking on any sort of program with your child. These activities have worked for us, but they may not work for you so it’s best to develop your own program under the guidance of a qualified OT.
In future posts I plan to cover some of these areas in more detail and highlight some of the products and techniques that have helped us over the years – products that could definitely help you too.
In the meantime, what experience do you have with occupational therapy and autism? Were you puzzled too when you first heard them linked together?