Occupational Therapists are among the professionals who design and provide intervention services to Children with ASD and their families. To provide the most effective services and programs for children and adolescents with ASD, it is important that occupational therapists become informed about the interventions with best evidence of effectiveness.
Children with ASD have a range of occupational and performance problems that interfere with their full participation in school, home, and community activities. Predominant characteristics of autism that are often the focus of intervention include limited social interaction, delayed or deficit language and behavioral problems, and sensory-processing difficulty.
Early in life, children with ASD may lack imitation and may exhibit stereotypic behaviors. At young ages, they do not gesture to communicate or relate to others with eye contact and verbalizations. By 3 to 5 years, children with ASD may not have developed language or may have limited speech; many use words but not with communicative intent. Important aspects of social emotional functioning, such as reading facial expressions, understanding gestures and nonverbal communication, recognizing inflection, and using language, are delayed. The social play of children with ASD is substantially limited, lacking joint attention, creativity, and pretend scenarios.
Most children with ASD have sensory-processing disorders. Although visual–spatial skills may be more advanced, other sensory responses, such as those to touch and auditory input, suggest poor modulation, also many children with ASD demonstrate unusual sensory responses (e.g., hyporesponses and hyperresponses) to touch and auditory stimulations. These underlying impairments create barriers to their ability to develop social relationships, function in everyday environments (such as the classroom or playground), and learn social rules.
Children and adolescents with ASD need a range of interventions and educational programming. In young children with ASD, occupational therapists often focus on enhancing children’s sensory processing, sensorimotor performance, social–behavioral performance, self-care, and participation in play. In older children and adolescents, occupational therapy goals may focus on social and behavioral performance, transition to work, and independence in the community. In most settings, occupational therapists are members of an interdisciplinary team of professionals who evaluate, plan, and implement the child’s program.
Occupational therapists establish environments that challenge and motivate the child and reinforce the child’s engagement in the activity by creating activities that promote social interaction (e.g., sharing and cooperation), supporting the child as he or she works through a dilemma, imitating the child, and waiting for a response. These strategies differ from behavioral approaches in which interventionists give directives and rewards, because the occupational therapist establishes a natural play scenario, the child initiates the interaction, and then the therapist follows the child’s lead.