The World is “Lighting Up Blue” for World Autism Month

By: Laura Bueche MOT OTR/L

Every April 2, in conjunction with the international autism community, Autism Speaks spreads awareness of autism spectrum disorder with its Light It Up Blue Campaign. Thousands of organizations around the world, such as Easter Seals DuPage & Fox Valley participate in this event to spread education, resources, and awareness for greater understanding and acceptance of Austism Spectrum Disorder (ASD).

What is Autism Spectrum Disorder?

Autism, also known as autism spectrum disorder (ASD), is a neurodevelopment disorder. It refers to a wide range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and non-verbal communication. The Term “spectrum”
reflects the wide variation in challenges and strengths possessed by each person with autism.
https://www.autismspeaks.org/what-autism

There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes.

In 2016, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the prevalence of autism had risen to 1 in every 68 births in the United States – nearly twice as great as the 2004 rate of 1 in 125 – and almost 1 in 54 boys.
http://www.autism-society.org/what-is/

Signs and Symptoms

People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things. Signs of ASD begin during early childhood and typically last throughout a person’s life.

Children or adults with ASD might:

• not point at objects to show interest (for example, not point at an airplane flying overhead)
• not look at objects when another person points at them
• have trouble relating to others or not have an interest in other people at all
• avoid eye contact and want to be alone
• have trouble understanding other people’s feelings or talking about their own feelings
• prefer not to be held or cuddled, or might cuddle only when they want to
• appear to be unaware when people talk to them, but respond to other sounds
• be very interested in people, but not know how to talk, play, or relate to them
• repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language
• have trouble expressing their needs using typical words or motions
• not play “pretend” games (for example, not pretend to feed a doll)
• repeat actions over and over again
• have trouble adapting when a routine changes
• have unusual reactions to the way things smell, taste, look, feel, or sound
• lose skills they once had (for example, stop saying words they were using)

https://www.cdc.gov/ncbddd/autism/facts.html

Meet Some People With Autism

Pierre https://www.youtube.com/watch?v=fnCzF2JdDWM

Max https://www.youtube.com/watch?v=IA5FHPUeWpQ

Lesey https://www.youtube.com/watch?v=GWPf9toT_3M

Cullen https://www.youtube.com/watch?v=EryEs1gIu4s

Ellie https://www.youtube.com/watch?v=56VCxks8jGA

Autism Diagnostic Clinic at Easter Seals DuPage & Fox Valley

Early detection and intervention is the best way to help children with Autism Spectrum Disorders and other developmental disabilities gain greater independence.  If you are concerned about your child’s development inquire about our medical diagnostic and autism diagnostic clinics.

Additional Services at Easter Seals DuPage & Fox Valley for Children & Young Adults with Autism Include:

• Occupational therapy to learn daily life skills and help integrate sensory processing difficulties
• Physical therapy to improve strength, endurance, and gait
• Speech therapy to help children with ASD improve speech, articulation, language , and interaction
• Assistive technology to give children a way to access language through technology devices
• Social Work services to support families and provide behavior strategies
• Parent Liaison services also offers parents support and are full of great recourses
• Case Management services to help coordinate this complex network of caregivers and providers
• Feeding Clinic and Nutrition Therapy provide families with feeding, digestive, allergy, food sensitivity, GI, and sensory related issues.
• Easter Seals also offers families a variety of community outreach programs including: social groups, physical fitness groups, feeding groups, and aquatics.

To learn more about Easter Seals DuPage & Fox Valley’s Autism services visit our website.

What is Occupational Therapy?

By: Laura Van Zandt, OTR/L

I’ve been an occupational therapist for seven years and it’s taken a long time to perfect the answer to the question “What is OT?” from people I just met. Today, I think I finally have a good answer.

To begin, occupational therapists see individuals across their lifespan and in a variety of different settings. We work closely with medical staff, parents, and educators. Typically there is some underlying problem that has initiated a meeting with an occupational therapist.

Depending on their training, there are a number of different approaches an OT may take to solve the problem.  One approach is the “Person, Environment, Occupation” (PEO) model. The PEO model (Law et al., 1996) is a well-known and established conceptual model of practice within occupational therapy. It offers a foundation for guiding assessment and intervention across all practice settings and client populations.

This model of practice helps an OT consider the whole child…their roles, activities, where their performance may need help, areas of strength, and more. Since I work with children, I am going to define the person as a child. The environments are the places a child interacts (e.g. home, school, community) and the occupations are the things he/she does in those places (e.g. get dressed, feed themselves, learn to write/color/draw, play). It is an occupational therapist’s job to evaluate a child and determine what makes it hard for those occupations in all his/her environments. It could be strength, sensory, visual, etc. or a combination of all those areas. It could also require a team approach, short term services, or long term services.

Let’s look at an overview of the assessment process with a simple case study to make it easier to understand:

ASSESSMENT PROCESS (Person, Environment, Occupation)

Referral: A 7-year-old is referred by a doctor for occupational therapy services based on her parents’ concerns with difficulty sitting still at home and completing homework tasks. She also has difficulty focusing and getting ready for the morning.

Occupational Roles:
An OT would consider the child’s role as both a developing child, sibling, daughter, student, and friend. What is preventing her from participating fully in those roles? We would also consider the family’s values, interests and daily roles. We try to look at the client’s pattern of engagement in occupations (i.e. getting ready) and how they changed over time.

Photo by Marita Blanken

In the example above, we would consider the entire family. This child has many roles. She is not only a child of a two parent working family, but she is also a sibling with a younger brother. She is also a first-grade student. In further conversations, we discover she also participates in gymnastics after school. In order to best support this child and her family, we would need to consider each of those roles and how they contribute to the overall profile of this child.

Occupational Performance Areas:
Then we consider the areas of occupational performance (e.g. activities of daily living, instrumental activities of daily living, rest and sleep, education, play and leisure, and social participation).

In the example above, this child is possibly presenting concerns with activities of daily living. Specifically, we might look at her ability to dress herself and completing grooming/hygiene tasks. Her mother, also mentions the child is having difficulties with staying focused and managing her assignments in school. Is this also impacting her social participation both at home, school and community where she does gymnastics?

Occupational Performance Components:
What components need to be addressed that may explain underlying difficulties?

Body Structure and Function – This may include muscle tone, range of motion, posture and alignment, postural control, strength, joint stability, endurance, fine motor skills, manipulation and dexterity, gross motor skills, coordination, bilateral coordination, etc. We may also evaluate her nutrition, respiration and gastrointestinal background to make referrals.

Sensory motor – This may include a child’s under or over responsiveness to touch, movement, sight, sound, taste and smell as well as their visual perceptual skills and body awareness. This may also include a child’s behavioral responses to activities.

Cognitive – This may include perceiving, understanding concepts, learning, and executive function skills (initiating, planning, organizing, sustaining, sequencing, flexibility, problem solving, managing emotions, etc.). We may make referrals to further understand the role cognition plays in your child’s abilities.

Social-Emotional – This may include self-regulation, self-esteem, as well as inner drive and motivation to participate in activities. It could also include the ability to relate to other children and adults.

In the example referral above, we would need to determine what areas of occupational performance are making it difficult for her to participate to the best of her abilities. We could evaluate her strength by having her climb to see how she manages her body in space and uses her arms to support her body weight. We might also look at her core strength to see if she is weak and if that is causing her to feel unstable while sitting which impacts focus (e.g. if she is having to concentrate hard on keeping her body upright to be able to use her eyes and hands, then it will be hard for her to also concentrate on math facts).

We will also look at her hand skills. There might be concerns with weakness, grasp, manipulation, etc. that make it hard for her to use writing tools to complete tasks.

We can create a sensory profile, by asking questions, having a parent fill out questionnaires, and observing a child during activities. We would use our background in sensory integration too during our observations. For example, perhaps the feeling of clothing is too irritable to this child and she is having trouble focusing because she is needs to move to readjust how her clothing feels on her skin. We can evaluate vision to determine if we need to make a referral to another doctor. By planning some activities to do together, we can look at how her sequencing and planning behavior.

Finally, occupational therapists are mindful of the social-emotional development of children and how difficult things impact his/her daily function. We might ask the parent further questions if we notice that she is getting frustrated easily during a task and has trouble managing her frustration.

There are many hats that an OT wears in this therapeutic relationship….another adult, parent, teacher, friend, etc. When we begin, we often know very little about each other. However, we work together and figure out plans that best help a family address their wants for their child. In the process, we may not know all the answers yet and it may take time to figure them out. That is one of the hard parts of an OT’s job but also a fun aspect too. Wearing these different hats while at the core serving as an occupational therapist, is what I love about my job. To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

How Sensitive is Too Sensitive?

By Maureen Karwowski, OT

I am sure that I am not the only person to buy a wool sweater that I thought looked great.  I bought this sweater despite the fact that it might be a bit itchy.  The first cold morning of the year I decide it is time to wear this sweater, and it feels okay, but not great.  As the day progresses, I am more and more aware of the feeling of my new sweater.  After a long day of working, and a brutal commute home, my skin is crawling.  This sweater is intolerable.  For many of the children that I work with as an occupational therapist who have sensory processing difficulties, this experience may be familiar to them.   

Sensory processing challenges occur when a child has difficulty interpreting  and responding to the sensory experiences in daily life.   It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).   When I assess a child who has a suspected sensory processing difficulty, I look at 3 areas:

• sensory regulation
• sensory modulation
• sensory discrimination

In my last blog, I discussed sensory regulation.  It is generally understood that sensory regulation is the ability to keep ourselves at the optimal activity and alertness level for the situation.  For instance, being able to sit through a meal or story time at the library all requires a child to be regulated.   We all have tricks to keep us “regulated”.  Drinking coffee, chewing gum, or working out are just a few examples of how adults naturally regulate themselves.

Sensory modulation impacts a child’s ability to function at home, in the community and at school.  Sensory modulation refers to how sensitive a person is to different touches, sounds, sights, smells or movement. 

As I described my sweater experience, this may be similar to how some children respond to a variety of clothing.  The seams of jeans, or the texture of socks may be very hard for some children to tolerate.  We encounter textures every day, all day and for most of us, we are hardly aware of them.  For others textures such as soap suds, food textures, glue, hand sanitizer, t-shirts with writing on them, and band aids are just a few textures that can be troublesome.

Many children with sensory processing disorders can have extreme challenges in busy environments such as a family party, the school cafeteria, or even McDonald Land.  The sensory input in these situations is immense.  Noise levels are higher and unpredictable.  Large spaces, or crowded spaces can be very hard for children who are sensitive to visual experiences.  Novel foods have new smells, tastes and textures.  All of these experiences can cause an over-reaction.  Some children react by getting so revved up that they can lose control.  Other children cling to their parents or cover their ears.  Some children avoid these situations entirely.    For most children, climbing ladders, and spinning on a merry-go round at the park are delightful.  Others prefer to keep their feet on the ground as movement can be very scary and uncomfortable for them.

On the other side of the coin are the children who are under-reactive to sensory input.  These children often seek intense input in order to register it, and to feel calm.  For instance, a child may be bouncing up and down in their seat at the dinner table without even realizing that they are moving at all.  Another child may seek intense “rough and tumble” play at inappropriate times, climb or jump on furniture despite being asked to stop repeatedly.  These children may have difficulty judging how hard to touch someone or something which can impact them socially.

We can all identify some sensory “quirks” that we have.  I know that the sound of Styrofoam makes me cringe.  My co-worker cannot stand the smell of my peppermint tea (crazy right?).  We all have things that are “triggers” for us, certain noises, textures or smells.  When a child has enough of these “triggers” that it is interfering with their ability to learn at school, socialize with other children, and function at home, an evaluation by an Occupational Therapist may be appropriate.

The good news is that a skilled OT can work with you and your child to help them with these sensory issues.  The key is a comprehensive evaluation, using parent interview, observations of your child, and a standardized assessment.  Once that is complete, treatment sessions are typically enjoyable for your child while they are working towards their goals.  You can work with your child’s OT to problem solve the sensory situations that are challenging at home, and when in the community.

For more information about Easter Seals DuPage & Fox Valley and Occupational Therapy please visit EasterSealsDFVR.org.