ASD Tranes OT App PDF

Maria Ruby Farinas Alvior, Batain, Co, Duran, Oblea, Torre,Q., Pineda, A. Collado, Tizon, Ronquillo, Dungo, Aquino, Capuli, Fosana 3S2L: OT FOR ASD, ADHD OUTLINE ○ From 3, DSM-V only hav...

Maria Ruby Farinas Alvior, Batain, Co, Duran, Oblea, Torre,Q., Pineda, A. Collado, Tizon, Ronquillo, Dungo, Aquino, Capuli, Fosana 3S2L: OT FOR ASD, ADHD OUTLINE ○ From 3, DSM-V only have 2 domains : social and communication skills and restricted interests ○ DSM-V has a new feature: Hyperreactivity and Hyporeactivity to sensory input TRIAD OF IMPAIRMENT As stated, in DSM IV, it has deficits in the social interactions, communication, and activities and interests ○ In DSM V, deficits in social interaction and communication were combined (social communication), restricted interests and repetitive behavior, and the new feature — hyperreactivity and hyporeactivity to sensory input SOCIAL COMMUNICATION AND SOCIAL INTERACTION PROBLEMS Socio-emotional reciprocity ○ Abnormal social approach and failure of normal back and forth conversation; reduced sharing of interests, emotions, or affect; and failure to initiate or respond to social interaction ○ Deficits in joint attention Joint attention: sharing an experience ○ Does not respond when name is called or when spoken to directly ○ Does not initiate conversation ○ Does not show, bring, or point out objects of interest OT FOR CHILDREN WITH ASD & ADHD to other people ○ Has impairments in joint attention AUTISM SPECTRUM DISORDER ○ Lacks a responsive social smile A developmental disability characterized by differences in There are tendencies magmumukha silang social communication development and a pattern of masungit, but they just have difficulty in social restricted interests and repetitive behavior. cues What were the changes made from DSM IV-TR to DSM ○ Rarely shares enjoyment, excitement, or V? achievements with others ○ Elimination of the multiaxial system ○ Initiates interaction with others mainly to get help, ○ Elimination of categorical system infrequently for social purposes ○ Removal of Global Assessment of Functioning (GAF ○ Has difficulty with engaging in social games. score) ○ NOTE: Not all clients with ASD manifest all of these ○ Reorganization of the classification of the disorders manifestations, to some very minimal concern but ○ Change of how disorders that result from general mostly they have problems in socio-emotional medical conditions are conceptualized reciprocity.  OT FOR ASD, ADHD Nonverbal communicative behaviors Question: Is this something (sameness) that OTs ○ Poorly integrated verbal and nonverbal need to correct? communication, abnormalities in eye contact and ○ The cx needs to learn how to be flexible. We could body language or deficits in understanding and use of break the routines and instill change. When gestures, and total lack of facial expression and change is necessary, OTs help the children nonverbal communication regulate and accept changes. ○ Makes eye contact but does not use for social Question: Is this inflexibility the same as the purposes executive function? ○ Has diminished use and understanding of gestures ○ This inflexibility can be translated into an EF or Do not use pointing, thumbs up, “give” higher cognitive function issue. They cannot bend ○ Has differences in volume, pitch, intonation, rate, or with their routines, because they cannot accept rhythm of speech changes. ○ Has difficulty coordinating verbal and nonverbal ○ Example client: One week prior to the doctor’s communication appointment, the parent needs to tell the child eye contact or body language with words about it. The parent needs to prepare and ○ can imitate well but cannot adjust their own speech condition the child beforehand. Monotonous or tunog cartoons Question: When it comes to EF it is a higher level Developing, maintaining, and understanding skill but for example, sameness is something relationships simple, but does not necessarily mean higher ○ Difficulties adjusting behavior to suit various social order? contexts, difficulties in sharing imaginative play or in ○ Example : Wearing the same t-shirt on a daily making friends, and absence of interest in peers basis or playing only with one toy. ○ Laughs or smiles out of context Shifts emotions out of context Highly restricted, fixated interests that are abnormal in ○ Does not notice another’s distress or disinterest intensity or focus (social cues) ○ Strong attachment to or preoccupation with unusual ○ Does not play in groups of children objects, excessively circumscribed or perseverative Mostly, parallel play or solitary play interests ○ Does not respond to the social approaches of other ○ Has a narrow range of interests children ○ Focuses on a few objects, topics, or activities ○ Has limited interest in peers and others ○ Strongly focuses on non relevant or nonfunctional parts of objects RESTRICTED, REPETITIVE PATTERNS OF ○ Carries around or holds onto specific objects that are BEHAVIOR not common (e.g., piece of string, rubber band) Stereotyped or repetitive behaviors Hyper- or hypo-reactivity to sensory input or unusual ○ Lining up toys or flipping objects, echolalia, interest in sensory aspects of environment idiosyncratic phrases ○ Apparent indifference to pain/ temperature, adverse ○ Uses echolalia and other memorized language response to specific sounds or textures, excessive reciting lines from commercials or shows, etc. smelling or touching of objects, visual fascination with ○ Refers to self by own name lights or movement ○ Uses repetitive hand movements ○ Has high tolerance for pain clapping, finger flicking, flapping, twisting ○ Is averse to having hair or toenails cut or teeth ○ Has abnormalities of posture brushed toe walking, full body posturing ○ Looks at objects or people out of the corner of the eye ○ Repetitively puts hands over ears ○ Squints eyes while looking at objects Possibly for no reason at all ○ Has differences in responding to sensory input (e.g., ○ Engages in nonfunctional play with objects sound sensitivity) waving objects, dropping items, visual inspection ○ Has atypical or persistent focus on sensory input of objects but does not play with them ○ Explores sensory aspects of toys and objects (e.g., ○ Lines up toys or objects licking, touching, sniffing) ○ Repetitively turns lights on and off Example: Insistence on sameness and inflexible adherence to Aversions to certain textures routines, or ritualized patterns of verbal or nonverbal Sensitivity to sounds / light behavior Persistent focus on sensory input. ○ Extreme distress at small changes, difficulties with Looks at people / object through side transitions, rigid thinking patterns or greeting rituals, glance need to take same route or eat same food every day ○ It is a sensory concern, the client ○ Prefers to adhere to routines is not mad at you ○ Excessive resistance to change ○ Rigid thinking ATTENTION DEFICIT HYPERACTIVITY ○ Becomes upset if a different route is taken to the store DISORDER ○ Has difficulty with transitions between activities Most common neurobehavioral disorder of unknown ○ Has difficulty understanding attempts at humor cause that often occurs in childhood but persists Can’t really understand jokes through adolescence and adulthood. ○ Asks repetitive questions about a particular topic Characterized by 3 possible presentations: Fixated on the topic 1. Inattentive Difficulty sustaining attention, to focus, easily distracted and usually disorganized  OT FOR ASD, ADHD or forgetful with activities and loses important items. Fails to give close attention to details or makes careless mistakes Cannot self-monitor schoolworks and worksheets. Sustaining attention in tasks or daily activities, somehow seem to daydream even inside the classroom. “Nakatulala”, it may seem that the child's mind is somewhere else, but is actually just inattentive Difficulty following instruction and fails to finish school work Problems with organization in task and activities Loses things necessary for tasks, forgetful. 2. Hyperactive Impulsive Does things without thinking or deciding Commonly described as “On the go” Walang preno, hindi napapagod, sobrang daldal Blurting out answers even when it is not turn to speak In this figure it can be seen what part of the body is affected by Difficulty to stay in their sit, fidgets and taps sensory processing problems. hands and feet. Often leaves sit when they are expected to QUADRANTS OF THE SENSORY PROFILE stay seated It is divided into two continuums: ○ Ex. In school or church ○ Self regulation continuum Difficulty waiting for turn Passive and Active approach ○ Neurological threshold continuum 3. Combined (most of the time / majority) High and Low threshold These are further divided into four quadrants: Question: How does this manifestations / problems ○ Registration translate to areas of concern? Need additional input to respond to stimuli but ○ In schoolworks, easily distracted, when there is small take a passive approach. movement or sound, they may stare at it until it ends. “I don’t seem to notice when my face or hands During lessons, they may focus on accessories in the are dirty.” hand. ○ Seeking Difficulty to return to tasks, because they are Need additional input to respond to stimuli and easily distracted actively seek stimuli. ○ Play may be affected, specifically impulsivity. “I like to attend events with a lot of music.” Difficulty in waiting turns and blurting out ○ Sensitivity answers. There may be problems with Respond readily to lower threshold stimuli but sportsmanship and social relationship with their does not actively avoid stimuli. peers. “I startle easily at unexpected or loud noises.” These children have difficulty with social ○ Avoiding skills and play skills, so most commonly they Respond readily to lower threshold stimuli but are given social skills training actively avoid stimuli. “I only eat familiar foods.” SENSORY PROCESSING ○ In ma’am Maru’s experience, she commonly Seen in both children with ASD and ADHD encounters problems with seeking, sometimes Behaviors seen in ASD and ADHD may be attributed to sensitivity. Sensory Processing Disorder 3 Types of Problems ○ Sensory Modulation ○ Sensory Discrimination ○ Sensory based Motor Problems  OT FOR ASD, ADHD ○ School Function Assessment OT PROCESS Occupation What happens in the OT process? Recall concepts. ○ Play Screening/Referral (Doctor’s Order) ○ ADLs, IADLs Evaluation ○ Education ○ Occupational profile ○ Social Participation ○ Intervention Planning ○ Rest and Sleep Intervention Transition Planning Client Factors Discharge ○ Work Behaviors ○ Motor Skills ANALYSIS OF OCCUPATIONAL PERFORMANCE ○ Cognitive Skills/Executive Functions We can do standardized tests ○ Communication Skills Interview ○ Visual perceptual Skills ○ Caregivers ○ Social Skills ○ Teachers ○ Sensory Processing/Sensory Integration ○ Significant adults School and Home visits OT FOR ADHD Use standardized tests which are applicable to our clients Modifying the classroom environment ○ Canadian Occupational Performance Measure ○ Provide recommendations to the teachers (COPM) ○ Suggestions (i.e. reduce clutter sa room or other sources of distractions, ilipat ng upuan, mas malapit sa teacher, etc.) Social Skills Training (SST) ○ Based on the behaviors/presentations, ito ang binibigay as they tend to be disruptive sa class affecting social interaction ○ Have to correct what is appropriate sa classroom Self Management Techniques ○ To be able to regulate behaviors ○ Make them aware of their behaviors and what they are doing “Nagiging disruptive na ako, ano gagawin” Interventions to enhance sensory modulation ○ Occupational Therapy Psychosocial Assessment for ○ May mga sensory concerns Learning (OTPAL) ○ Provide sensory-based approaches (i.e. sensory diet, routines) OT FOR ASD Interventions for Occupations ○ Not all children with ASD present the same way but most of them have problems in all areas of occupation, so we have to provide intervention for all of those  OT FOR ASD, ADHD ○ May iba’t ibang severity lang pero lahat sila may Motor skills problems with all areas Sensory processing Mostly, given by their sensory issues, Functional cognition sensitivities, inflexibility Restricted and repetitive behaviors Feeding (sensitivities and preferences na ‘di Regulation skills basta basta nasosolusyunan) ○ Need to undergo multiple sessions and INTERVENTION evaluations for us to provide proper Sensory Based Interventions interventions with regards to feeding ○ To address sensory concerns Education (novel activities, handwriting, Joint Attention worksheets, coloring, reading) Social Learning Dressing Environmental Modifications Interventions for Motor Skills Behavioral ○ Hindi structural ang deficit ng mga children with ASD ○ Behavioral Modification Techniques (BMTs) (wala namang impairment) Emphasize the teaching-learning strategies ○ Not because of limitations caused by musculoskeletal integrity but because of delayed development and EDUCATION sensory concerns FACTORS Sensory Integration / Processing Interventions Behavior Modification Techniques Grade Level ○ Need to observe properly the behaviors presented School Type (Traditional, Progressive, Montessori) ○ Some kasi are behavioral and some are sensory in Type of Classroom (Self Contained vs. Inclusive) nature, so we really have to be careful Know the demands of the school ○ There is a specific trigger ○ Expectations of school ○ Sensory ang trigger hindi behavior (covering of ears, ○ Lessons taken by the child hand-clapping) ○ School type, Type of classroom, etc. Sensitive to auditory stimulus What activities can we provide? EVALUATION Routine Activities PLAY ○ Class schedule We need to look at how the child play and how he/she play Instruction / Curriculum / Environment with others LRE measures EVALUATION Push in or Pull out Services IEP: Team Approach Social Communication Environment / Object / Toys Developmental Cognitive INTERVENTION We have to look into how does the child manipulate the Maximizing Special Interest Areas (SIAs) toys (age-appropriate or age-inappropriate) ○ SIAs may pertain to stereotypical behaviors or We have to look at the child’s current stage of play fixations (According to Parten, Piaget, etc.) since it will serve as our ○ Does not need to be corrected all the time as long as baseline for intervention these do not hinder the participation of the client in Identify the child’s current level of play activities ○ May use these as motivation or reward for the child to INTERVENTION do certain activities ○ Word search Facilitate Playful engagement Using the interest of the child (countries) ○ In order to improve and develop age-appropriate play Targets concentration, attention span, visual skills, we have to help them to play properly perceptual skills ○ The best tool that we can use in terms of facilitating ○ Ginamit natin yung interest mo pero in return also play is ourselves comply with teacher’s request Expand Variety in Play ○ Flexibility ○ Through exposure to different types of activities Need talaga turuan si client na mag-adjust especially in motor praxis skills deficits Need to find a way para makipag coordinate kay Enhance Complexity and Creativity in Play teacher and ma adjust siya sa mga activities ○ Provide more opportunities for the child to interact ○ Not all kids present in the same way, it’s a with environment case-to-case basis, kaya need i adjust/match sa level Develop Participation in Peer Play and interest nila ○ To develop social play behaviors Performance Skills and Client Factors Generalize Play Skills across Social or Physical Environmental, Curriculum and Instruction Modifications Environment Sensory Processing ○ Ultimate goal: Generalize the skills and for the child to Executive Functions transfer learnings in clinic across different settings Emotional Regulation Social Perspective Taking ADL ○ Need natin sila maturuan ng social skills training, read EVALUATION social cues (non-verbal), how to act in certain Communication scenarios, read other’s behaviors in relation to ○ Ability of the child to communicate and express education his/her wants and needs Social interaction  OT FOR ASD, ADHD FEEDING AND MEALTIME PARTICIPATION ○ BUFFET (Building Up Food Flexibility and Exposure Feeding Challenges Treatment) ○ Any difficulty that hinders proper nutrition, food ○ EAT UP parent training to increase dietary variety acceptance, inappropriate mealtime interactions or typical family routines SKILL DEVELOPMENT AND MEALTIME Mealtime Participation PARTICIPATION ○ Being part of the eating experience with the family Before (Prep) according to culture ○ Establish familiar routines ○ Examine utensils, tableware, set-up FEEDING CHALLENGES ○ Provide proper seating and positioning when eating Restricted Diets and Food Selectivity During ○ Very important to consider the child’s history or family ○ Model positive feeding behavior culture ○ Food exposure ○ Ensure their context ○ As long as possible, maiksi lang yung duration ng Oral Motor Challenges pagkain Health Concerns ○ Match food to the child’s skill Maladaptive Behaviors Look for problems for oral motor Kaya hindi pwede basta basta magbigay ng EVALUATION food textures na hindi naman appropriate sa Feeding Culture, Values, and Goals level ng bata ○ Paano ba sila kumain ○ Use of gadgets para ma engage yung kid na kumain Fork or knife Try to avoid it as much as possible! Spoon or fork Limit screen time because hindi dapat masanay Chopsticks si kid na laging may gadget para lang makakain Kamayan Outside of family mealtimes Baka mamaya meron silang hindi kinakain bec of ○ Therapy meals or snacks for skill building belief ○ Interventions of feeding in the clinic ○ Sama sama ba sila kumain? Do they put high value in Ex. client ni maam during lunch time eating together with the family? So advice ni ma’am sa caregiver is huwag ○ May nagpapakain ba sa kanila? muna busugin si client ○ Saan kumakain? Kakain si client ng lunch with teacher Yung iba okay lang kahit sa sala, hindi kailangan Pwedeng sabay para ma model si kid yung nasa dining behavior, correct use of spoon and fork, and ○ Anong oras sila kumakain? What are their schedule, ma expose gradually yung textures sa foods their routines? ○ Do they have snacks in between? REST AND SLEEP Feeding Hx Common to children with ASD to have sleep problem Current Status Non-REM sleep and REM sleep Family Dynamics Sleep Problems: Mealtime Environment, Schedule and Routines ○ Insomnia and Hypersomnia Self help Skills and Oral Motor Skills ○ Parasomnia Sensory Processing ○ Decreased sleep efficiency Behaviors and Rigidity ○ Periodic limb movement disorder Regulation ○ Sleep Anxiety and Heightened bedtime resistance Posture, Tone and Motor Skills ○ Restless Leg Syndrome Health ○ Sleep Apnea Nutrition Ex. Kid with sleeping problem because of epilepsy; nagkakaroon ng silent attacks in the middle of the night INTERVENTION and then nahihirapan siya to go back to sleep; super irregular yung sleep; and dahil doon affected yung Behavioral Approach (reinforcements) learning, therapy and buong araw niya. ○ Operant Conditioning ○ Systematic Desensitization Table 1. Recommended sleep duration for each expected age Gradual introduction of textures Question: What if introduce pero iluluwa po nila? AGE RECOMMENDED SLEEP Answer: ang pag introduces sa feeding not DURATION (HOURS) necessarily sa mouth agad. 32 steps in feeding, involving all the senses. Introduction starts with 0-3 mos 14 - 17 vision. Lagi niya nakikita yung food, nagiging familiar siya sa food na yun but not necessarily 4-11 mos 12 - 15 kinakain niya. Madalas nakikita ng bata sa 1-2 yrs 11 - 14 hapag-kainan then eventually hinahawakan na niya yun. Then ine explore then tinitikman na 3-5 yrs 10 - 13 niya. Interventions 6-13 yrs 9 - 11 ○ Sequential Oral Sensory (SOS) *special lecture will be discussed 14-17 yrs 8 - 10 ○ Autism MEAL Plan parent training for food selectivity  OT FOR ASD, ADHD EVALUATION Exploration Sleep routines and habits ○ Nagbubuild of Tolerance; explore iba’t ibang sensory Sleep Preparation and Sleep Participation input; child does not have sensitivity or avoidance; we Sleep Latency want the child to explore all sensory input Sleep Duration Modification of Monitoring of Sensory Environment Sleep Maintenance Modification of Sensory Input Other factors that affect rest and sleep Basically we need to understand why the child is having a FUNCTIONAL COMMUNICATION problem in sleep Learning Supports ○ Where does the problem lie? ○ AAC ○ Modified activities in learning environment INTERVENTION ○ Reduce of the complexity of environment Modify Sleep Environment Interpersonal Supports ○ Recommend dim yung light, tagalin tv sa room, ○ We have to be goodmodels provide sheets that the client’s prefer Establish bedtime routines and rituals (1 hour before) SOCIAL SKILLS Pharmacological: Melatonin Group based Social Skills Training Programs ○ Hanggat maari di binibigay sa cx Peer mediated Social Skills Interventions Behavioral Activity based social skills interventions ○ Social Story (Sleep Story) Computer based social skills interventions ○ Supervision and Fading Social Stories Emphasize that this skills have to be explicitly taught; cx need to have the opportunity to practice; generalize the SLEEP HYGIENE skills that we taught in the clinic and use in the outside How do we improve sleep hygiene? world ○ Consistent bedtime schedule ○ Relaxing night time routine before bedtime BEHAVIOR MANAGEMENT ○ Level of physical activity, suggest to have moderate to Simulation high level of physical activity during the day Least to Most Prompting ○ Reduce screen time Fading ○ Have comfortable and relaxing sleep environment Chaining Technology Supported Interventions FINE MOTOR SKILLS EVALUATION ANTECEDENT BASED INTERVENTIONS Hand Dominance We do this to prevent or promote a behavior; mahlaga dito Grasp and Prehension Patterns na identify ano yung reason or function ng behavior Manipulation Skills Escape / Avoid Sensory Features, Activity Demands Interactions with Objects Seek Obtain Attention or Sensory Input Communicate INTERVENTION Setting Events Sensorimotor (Perceptual Motor - SI) Skill Building Problem Solving (Cognitive) REFERENCES Behavioral Teaching Learning Strategies Notes from the discussion by Maria Ruby Farinas PRAXIS Ideation University of Santo Tomas powerpoint presentation: OT for ○ Object affordance children with ASD & ADHD ○ Action affordance Motor Planning Center for Behavioral Health Statistics and Quality. (2016). Sequencing 2014 National Survey on Drug Use and Health; DSM-5 Changes: Implications for Child Serious Emotional SENSORY INTEGRATION Disturbance (unpublished internal documentation). EVALUATION Substance Abuse and Mental Health Services Patterns of self regulation within each environment Administration, Rockville, MD. Attention to Task Performance Changes in Social Behavior Impact of Environment on Participation INTERVENTION Desensitization ○ When we desensitize we want the child to tolerate; child has sensitivity that's why need to graduate and introduce to have sensory tolerance ○ Sensory Tolerance  OT FOR ASD, ADHD QUICK QUIZ FREEDOM WALL TRUE OR FALSE 1. T or F. ADHD is the most common neurobehavioral disorder of unknown cause that often occurs in childhood solely. 2. T or F. In play intervention, the best tool that we can use in terms of facilitating play is ourselves. 3. T or F. Hyperreactivity and Hyporeactivity to sensory input are the ones added to DSM-V. 4. T or F. All children with ASD present the same way and most of them have problems in all areas of occupation. 5. T or F. Sensitivity refers to the need for additional input to respond to stimuli but take a passive approach. 6. T or F. Desensitization is graduating and introducing sensory input to have sensory tolerance. 7. T or F. Social skills need to be generalized and explicitly taught. 8. T or F. SIAs may pertain to stereotypical behaviors or fixations. 9. T or F. In DSM V, deficits in social interaction and communication were separated. 10. T or F. Social Skills Training is given to children to make them aware of their behaviors and what they are doing. MULTIPLE CHOICE 1. ADHD presentation that is commonly described as “on the go”. a. Inattentive b. Hyperactive Impulsive c. Combined 2. Poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language or deficits in understanding and use of gestures, and total lack of facial expression. a. Socio-emotional reciprocity b. Nonverbal communicative behaviors c. Developing, maintaining, and understanding relationships 3. Lining up toys or flipping objects, echolalia, idiosyncratic phrases. a. Stereotyped or repetitive behaviors b. Insistence on sameness 4. Respond readily to lower threshold stimuli but does not actively avoid stimuli. a. Registration b. Seeking c. Sensitivity d. Avoiding 5. Sensory processing disorder can be seen in? a. ASD b. ADHD c. both A and B d. NOTA FTTFFTTTFF bbacc