Occupational therapists strive to provide evidence-based practice to children with autism.
How occupational therapists are changing the field of treating autism in children
For this ideal to become a reality, dedicated researchers with experience in the field continually conduct studies to test, examine, and develop the best interventions for their clients.
Roseann Schaaf, PhD, OTR/L, FAOTA, is one of these researchers. As chair of the department of occupational therapy at Thomas Jefferson University in Philadelphia, and faculty for Farber Institute for Neurosciences at Thomas Jefferson University, Dr. Schaaf has worked in occupational therapy for over 30 years. In this time, she has researched the effectiveness of occupational therapy using sensory integration for children with autism.
Recommended course: Sensory Processing Differences in Children with Autism Spectrum Disorders 2nd Edition
Occupational therapy, sensory integration, and autism
Schaaf has conducted this research and has trained occupational therapists to treat this patient population. Her team includes occupational therapy coordinators and neuroscientists overseeing the multisensory integration EEG paradigm.
"Autism is a neurodevelopmental disorder present before birth. People who have autism process information differently," Schaaf said. "The approach that sensory integration takes, or that most of occupational therapy takes, is that we identify what challenges the child has in their daily activities."
Schaaf calls these ‘participation challenges.’ "If we're using a sensory integration approach or a developmental approach, we try to identify what the underlying sensory and motor factors are that are impacting their ability to perform in these everyday activities."
Tailoring OT interventions for children with autism
The therapy used in Schaaf’s study is designed to target underlying factors as a basis for improving participation challenges. “There are no ‘typical’ goals for parents with their children,” Schaaf said. “Each goal needs to be individually created for each child. That’s really the hallmark of occupational therapy. It’s client-centered and individually tailored.”
Schaaf's study, which included 200 children over a five-year timeframe, looked at occupational therapy using sensory integration. It compared this type of integration to discrete trial training to determine how these different approaches impact functional skills.
"For sensory integration, we do a thorough assessment of the child's ability to process and integrate sensation and use it for movement and behavior. Then we must identify what's difficult for them,” Schaaf said. These issues can range from tactile processing to vestibular processing, praxis, or a mix of the above. Many times, equipment such as ball pits, foam shapes and wedges, swings, and climbing walls will allow the therapist to design playful activities to make sure children receive the correct motor-sensory experiences. This, in turn, helps with the child's participation.
Behavioral interventions for children with autism
According to Schaaf, a behavioral approach works in a very different way. "Behavioral intervention targets the behavior itself. If the behavior that need to be addressed involves eating a variety of foods for participation in dinnertime, a behavioral intervention is going to start with a functional behavioral assessment and identify which kinds of factors in the environment and in the task need to be shaped, taught or reinforced to the child so they can eat a wider variety of foods," she said.
Since sensory integration and behavioral intervention are very different approaches to the same types of problems, it is important to understand why and how these treatments work for different children. "What we hypothesize is that some kids will do better with sensory integration, and some kids will do better with behavioral intervention," Schaaf said. "We have such a large sample, so we hope to find some answers about which kinds of children do better with which kinds of intervention, and which do best with a combined approach."
Goals of the study
As the researchers gather data, the team will examine the brain functioning of the participants. For the sensory integration approach, they hypothesize that working on these underlying sensory-motor factors will enhance neuroplasticity in the brain. This means that they will change the way the brain functions based on the experiences it has had.
"If in fact neuroplasticity does change, then this multisensory integration paradigm should show that," Schaaf said. "The behavioral intervention isn't working on the theory of neuroplasticity. It's working on the theory that if you repeat and train a behavior enough times, it will become a skill."
Schaaf believes this is a unique study not only because it compares two approaches, but because it is also looking to see whether there are brain biomarkers to determine which children will respond to which treatments.
Different patients, different treatments
As part of the study, Schaaf and her team asked parents about their child's strengths and identified some goals they would like to accomplish. Parents then shared the reasons they sought occupational therapy for their child with autism, and what they hoped to get out of it.
"There are no 'typical' goals for parents with their children," Schaaf said. "Each goal needs to be individually created for each child. That's the hallmark of occupational therapy. It's client-centered and individually tailored."
While treatments may not be the same for each, researchers required each participant to meet a few requirements in order to consider them for the study. Each child was between 6-9 years old, presented sensory difficulties on an assessment, and were not on certain types of medication. Researchers randomly separated the children involved in the study into three groups: sensory integration, behavioral intervention, and no treatment.
Sensory integration for children with autism
"Occupational therapy using sensory integration involves active, individually tailored sensory-motor activities contextualized in play at just-the-right challenge," Schaaf said. "[But] occupational therapy using sensory integration is only one of the tools in the therapist's toolbox for treating children with autism. I would be remiss if I suggested that it was our only tool."
According to Schaaf, it is the occupational therapist's job to perform a thorough assessment. First, they must get to know the child and the family. Then they can assess what might be impacting the challenges the child is experiencing.
"The OT should then go into their toolbox and find which approach will work best for this child. They need to ask themselves how they're going to use these approaches to help a particular child's needs," she said.
In the future, Schaaf hopes OTs will choose their interventions based on the specific child’s needs. She also hopes they will measure their outcomes consistently and systematically.
"What we're not always doing as occupational therapists is being very explicit about why we're doing what we're doing. You don't do the same thing with every child. You individually tailor it based on the child's needs. Then you think about what you can bring as an OT to the table," she said. "It's also about measuring outcomes throughout the entire process. Occupational therapy for children with autism is going to look like OTs helping children with autism gain the highest level of independence and participating in their daily activities, and being very data-driven about which approach they take."