Children with autism often have difficulties with self-regulation (i.e. easily overexcited or lethargic), attention, motor skills and sensory processing (interpreting touch and other stimuli). Occupational therapy treatment options for autism include sensory integration therapy provided directly by the therapist and implementation of a sensory diet designed by the occupational therapist but implemented by the classroom team. The sensory diet should be used throughout the day to help the student to maintain an optimal level of attention. In other words, the sensory diet activities might help an overexcited student to remain calm and focused and a lethargic student to be more alert and engaged. Therapists may also recommend that family members carryover the sensory diet into the home and community with adaptations such as using a weighted blanket or activities such as swimming or horseback riding.
Self-regulation is the ability to reach an optimal level of alertness. A child’s brain may be compared to an engine that is sometimes running high when the child is hyperactive, unfocused or on the verge of a temper tantrum. On the other hand, the child’s engine may be considered low when he has difficulty sitting up and acts lethargic. Occupational therapists Mary Sue Williams and Sherry Shellenberger, creators of the “Alert Program” and authors of “How Does Your Engine Run?”, recommend specific activities which help children to bring their brains to an optimal alertness level in order to focus and learn. Occupational therapist frequently incorporate this program into the classroom by teaching the students how to recognize their “engine levels” throughout the day and then seek out the sensory activities that will help them to remain calm but ready to learn. Possible activities include: chilling out in a darkened corner on a bean bag chair while sipping water through a straw or taking a break from desk work to perform jumping jacks.
Sensory Integration Treatment
Occupational therapists use sensory integration treatment to help children improve abilities to take environmental information such as how things look and feel and use it to play and learn. Children with a sensory processing disorder often have poor body awareness, motor control and visual perceptual problems because their right and left brain hemispheres don’t communcate efficiently. Symptoms of a sensory processing disorder may include lack of hand dominance, avoidance of crossing midline (i.e. reaching with right hand to left side fo the body), poor balance, rhythm and sequencing skills. Occupational therapist and creator of sensory integration theory, A. Jean Ayres, explained that certain types of movement and touch stimulation help the child’s brain process information so that he can develop the higher level cognitive and visual perceptual skills required to read and write. This treatment often involves fast rotary, linear or vertical movements and deep pressure activities. For example, a child may find that jumping off a suspended swing to crash into a mountain of pillows provides the type of sensory stimulation that helps him brain be better organized and focused.
Sensory Diet Activities
Sensory diet activities are individualized to help the child achieve an optimal state of alertness for learning, socializing and feeling good. The therapist combines her knowledge of how different types of sensory stimulation effect children and after some trial and error learns how an individual child responds to specific sensory experiences. Sensory diets are often effective occupational therapy treatment options for autism that can help them seven days a week in all settings. A typical sensory diet might include:
- swinging, gliding, jumping or bouncing on suspended equipment
- snuggling up inside a heavy sleeping bag
- eating crunchy foods
- stretching rubber bands or tubing apart
- using an electric toothbrush
Adaptations may also be implemented to avoid stimuli that the student perceives as aversive. For example, a student may wear headphones at noisy times, avoid eating lunch in a crowded cafeteria or be allowed to take breaks from a long sedentary activity such as watching a school play. In addition, students who find touch aversive often benefit from being last on line to avoid being jostled.
Developing Fine-Motor and Visual Perceptual Skills
As the sensory diet helps the student achieve an optimal state of alertness, he will be better able to engage in fine motor and visual perceptual activities that will help him learn to read and write. Occupational therapists treatment includes adaptations to make learning easier and fun while addressing the student’s sensory needs. Possible adaptations include:
- Using paper with raised lines that indicate where to write
- Using squeeze scissors that are easier to manipulate
- Writing on a table easel or vertical surface to improve pencil grasp
- Providing greater color contrast on work sheets and highlighting sections to be completed
- Providing lacing boards with fewer and extra large holes
- Adding a sensory component such a music or vibration to an activity such as stacking rings.
- Sitting on a chair cushion that allows movement during desk work.
There are many different types of occupational therapy treatment options for autism. However, they should all address the individual’s unique sensory motor needs in order to improve self-regulation, eye-hand coordination and visual perception. These are the skills that will help students learn to perform reading and paper and pencil tasks.
“Building Bridges through Sensory Integration”; Ellen Yack, Paula Aquilla & Shirley Sutton; 2004.
“How Does Your Engine Run?”; Mary Sue Williams and Sherry Shellenberger; 1994.
“Sensory Integration and the Child”; A. Jean Ayres; 2005