Autism and Occupational Therapy
If this is your first visit to my series on Autism, my name is Mackenzie and I’m the mother of five okay-ish, I mean amazing children, two of whom have autism. This is the fourth article in a series I am writing to help those who don’t know much about autism develop a basic understanding of the disorder. Please check out my first three articles on stimming, emotional dysregulation, and speech and language.
Before we dive in, I have a little housekeeping to take care of and I’m going to do that through food metaphors. My initial goal was to deliver a handful of bite-size nuggets on parenting little people with autism, and to publish those nibbles during April, which is Autism Awareness Month. However, I am suffering from scope creep and those bites are now hearty appetizers for a much grander feast, for which I have not yet grocery shopped. So, the lovely and wonderful Jill Devine has blessed my menu of blog posts, to be released monthly. Welcome to the first course!
My last article discussed speech and language, which is an important part of treatment since autism is fundamentally a communication disorder. But a comprehensive treatment plan should include Occupational Therapy, Behavior Therapy, and, sometimes, Physical Therapy. Today, I’m going to discuss Occupational Therapy, which has changed everything I thought I knew about kids and parenting and chocolate pudding.
Don’t worry, I’ll explain.
First, let’s make sure we know WTF we’re talking about. Occupational Therapy (OT) is about helping people with injuries, disabilities, or other conditions, including autism, enjoy meaningful participation in everyday activities. These angels/experts in human development work to improve the ways in which we interact with the world around us. OT helps people work on cognitive (thinking), physical, social, sensory, and motor deficits. The overall goal is to help people learn how to take care of themselves and be as independent as possible.
Occupational therapists (also sometimes just called “OTs”) often work with children experiencing physical limitations, which come in a variety of forms ranging from accidents or injuries to chronic conditions like cerebral palsy and autism. Children with autism often don’t have obvious physical disabilities, but many nevertheless struggle with daily activities due to other physical, emotional, or behavioral limitations that aren’t initially apparent. These include:
· Unusually weak muscles (low muscle tone)
· Too much or too little response to touch, sound, light, smell, or taste (sensory dysfunction)
· Difficulty with motor planning (lack of coordination)
· Lack of imitative skills that help typically developing children learn how to play and how to carry out everyday tasks
· Lack of social skills that help typically developing children learn how to engage in physical activities in a group setting
Every child’s needs are unique, and OT typically begins with a licensed OT conducting an evaluation. This process often includes talking to teachers, parents, and other caregivers about observed areas of concern. After major areas of concern are identified, the OT can create a treatment plan with goals specific to the child. For example, play therapy can be used to model appropriate social interaction and communication, like turn-taking, waiting, sharing, etc.
Occupational therapy offers many benefits to autistic children. For example, OTs can work on daily living skills, such as brushing teeth, using a zipper on a coat, or putting on socks. These tasks may need to be broken down into small steps and explicitly taught because children with autism struggle to learn through verbal instruction or by watching others.
I remember how Charlie was taught how to wash his hands after using the restroom. This one task was broken down into several steps: turn on the water, get soap, rub hands together, rinse hands, turn off water, get a paper towel, dry hands, discard paper towel. The OT would take him through this same set of steps several times a day, several days in a row, and then one day they would take him through the first seven steps of this process and leave him to complete the final step, throwing away the paper towel, on his own. Once he was consistently performing this step, the OT would then take him through only the first six steps and prompt him to complete the final two steps on his own, and so on until he had the whole routine down.
If this sounds tedious and exhausting, that’s only because it seriously is.
This painstaking process of building up his competency with a routine behavior like hand-washing may seem like a small thing, but OT was seriously life-changing, and not just for my boys. It changed the way I view all my kids, other people’s kids, even my own husband. Without question, OT taught me some of the most practical skills that I still use every day. This type of therapy really hit peak relevance during the 2020-2021 school year, when the Multiverse decided it was time to try the Autism Level of the Game of Life on expert mode and threw us a ONCE IN A CENTURY PANDEMIC that required our children to wash their hands compulsively and wear face masks for 7 hours a day.
Through Occupational Therapy, people with autism can learn to:
· Focus on tasks
· Communicate appropriately
· Transition between activities
· Share and work as part of a team
· Be patient and wait your turn
· Regulate responses and emotions
· Be more independent
I learned how to set my child’s expectation for the work he needed to do by using a white board and listing each task, with breaks built into the schedule. I let him choose if his break would be five or seven minutes long (two minutes difference to me, MASTER OF THE UNIVERSE to him) so that he could feel like he had some control over the process. The visual schedule (use pictures if your child can’t yet read!) gave my kids much needed parameters and their anxiety lessened with each completed task. Crossing them off, one by one, gives the unknown a little shape and a little context. Who doesn’t want that?
Preparing my sons for what comes next, along with the assurance of several breaks, is critical to their success because they aren’t able to predict the order of events so, to them, it’s like being super hungry, ordering food, and then having absolutely no idea when the food will appear. If I’m being honest, this strategy works for all of my children and – GASP – even my husband. My husband isn’t on the spectrum but he is better able to move through our busy days if he knows where he’s going, who he’s taking where, and what time is Beer O’Clock, which is similar to Xanax o’clock but usually includes literally any sporting event, Fritos, and a layered taco dip.
For whatever reason, kids on the spectrum just can’t go with the flow. This isn’t exclusive to kids on the spectrum; lots of typical kids struggle to play things by ear. But kids with ASD struggle so much with shifting their attention from one activity to another. Again, it’s that inability to look at the bigger picture and predict what comes next. Fortunately, this is a relatively easy thing to mitigate. It takes some time to get into the habit of mentally planning so that you can give your child a warning for an upcoming change in activity, such as moving from a preferred activity - like playing in the bath - to a non-preferred activity – like going to bed. The water is warm, the toys are fun, and your three-year old is only interested in blowing bubble raspberries.
No judgment, that’s a good time.
Depending on the age of your child, a 10-minute, 5-minute, 2-minute, 1-minute, and 30-second warning, followed by a 10-second count down, is more than enough to prepare them for a smooth transition. If that doesn’t work, it’s probably because the thing they’re doing is highly preferred and there’s just no easy way to ease them out of something that is so engaging. The good news is, if your child flips out, he has just presented you with yet another learning opportunity: how to regulate his emotional response. You can model deep breathing, apply deep pressure by gently but firmly squeezing his arms and legs, distract and/or redirect their attention, hit or scream into a pillow, take enough melatonin gummies to sedate a small horse… the sky really is the limit here so get creative.
One of the things I loved about OT in a group setting was how they taught kids how to pass a pitcher of water around at snack time. Several skills were built into this one activity. Joint attention: the first kid has to get the second kid’s attention and then they have to coordinate the exchange with eye contact, body language, words, etc. Fine motor: they also must use their fine motor skills to manipulate the pitcher of water to pour the water into a cup which is being held by the other hand. Hopefully, this will also involve crossing midline, which is something I would probably never have otherwise considered but is important in your child’s development. Crossing the midline of the body (imagine a line being drawn vertically down the center of the body which separates the right side from the left side). Using both sides of the body together, such as putting on shoes and socks, writing, and using scissors, promotes the coordination and communication of the left and right hemispheres of the brain. Social: learning to share the water and understanding that the pitcher of water is meant to be enough for everyone at the table is not something that is intuitive to children on the spectrum. Sharing something as basic as a drink can give kids that feeling of belonging and connectedness that is so important to us as humans.
As parents, we want our kids to feel and be successful. With that in mind, the goal of occupational therapy as part of a multi-disciplinary team treating a person with autism is to improve the individual’s overall success in all aspects of life and to help them be as independent as possible. A clever and dedicated OT will get creative and find solutions that not only engage the child but steadily work towards that independence. I’ve come to view parenthood similarly. When your baby is brand new, you must do everything for them because they are completely dependent on you. If you put an infant outside, they have no way to keep themselves alive. You, as the parent, then have 18 years to take them from being one hundred percent dependent on you to, like, ninety-five percent dependent on themselves. Afterall, as your baby, they never stop needing you in some way. Those 18 years represent your timeline to teach them so much of what they need to survive in the world and it’s so tough to gauge when they need to learn which lessons and at what age can they take on more responsibility. If that isn’t difficult enough, each kid’s timeline is a little different. For our babies whose development goes sideways, it’s even more difficult to know what they need and when they need it. Learning about Occupational Therapy and working with several of them over the past six years has helped me see that my role is to meet my kids at their level, teach them any way that I can, get creative, love them fiercely, and never, ever give up.
I know this has been a long post and I’m so grateful you’re still with me. Last thing, I promise. Charlie has an extremely limited diet which is quite common in people with autism. I’m not entirely sure why he will only eat about 10 different foods. I suspect it’s a sensory issue since anytime we try to get him to eat even the tiniest bit of anything other than those foods, he could take home the Academy Award for his one-man dry-heaving drama.
But I know exactly why he won’t eat chocolate pudding and it’s because that shit is nazzzzzzty.
Mackenzie is a SAHM to five beautiful, hysterical, annoying-as-f#@k-sometimes kids. She worked so super hard in her twenties to earn an MBA only to retire and become her kids’ bitch. Now she spends her days dashing into the fray and taking power naps. You can catch her tossing quarters into her swear jar on her blog Mommy Needs A Swear Jar and on Facebook. She is confused by Twitter.