OT services are provided to support a child’s academic success in public school setting

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Profile: 4th grade male with mild to moderate ASD

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What needs to be addressed?

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Cognition

• Regulation following direction: when teacher gives child  directions for a class assignment, he does not look at the teacher nor does he respond when asked if he understands the directions. ​

• He understands the big picture directions but will want to work quickly and therefore will end up skipping steps and getting stuck when trying to complete the task.

• Will get easily distracted and will want to talk about his favorite subjects to neighboring children instead of doing his work, which in turn also distracts his peers.

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Language

• Very talkative

• Enjoys talking about his favorite subjects: trains and movies

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Social impairments

• Difficult to have a conversation with; will monopolize talking and ​will steer conversation toward his favorite subjects while disregarding the original topic of discussion 

  • did not appear to be listening when it was the other persons turn to talk​

  • will also jump into other people's conversation abruptly, does not know how to insert himself into a group

• Able to respond appropriately to questions, 25% of the time

• Intense desire to talk about a specific subject, repetitively

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Motor skills

• Fine motor skills

  • Handwriting: hand writing skills are functional and legible, tends to write at a fast speed so letter formation is not uniform 

  • Has hand fatigue due to immense pressure in grip

  • Writing speed, fast

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Sensory processing​​

• Auditory processing​

  • Gets overly surprised with subtle noises like the door closing

  • Becomes agitated when there is a lot of noise in general (typical for 4th grade classroom)

  • Difficulty discriminating & filtering sounds

• Visual processing

  • Writes some letters in reverse

  • Gets lost when copying from the board or a textbook

 

Treatment Focus/ Suggestions

• Address sensory processing issues either by direct OT or by assistive device [noise cancelling headphones] 

• Attention to task; ability to follow directions

• Participation in play; classroom activities; assemblies

• Visual motor integration activities and visual perceptual activities

• Treatment may be 1:1, 30 min push in [inside the class]

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Medical Model (Outpatient OT)

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OT services are provided to facilitate functional progress and participation in home, and community activities

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Profile: 4 year old boy recently diagnosed with ASD, initial OT service

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What needs to be addressed?

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Cognition:

• Shows little interest in playing with toys, and imitating the words and actions of others

• Does not demonstrate typical play skills for his age such as exploring how toys work, taking toys in and out of container

• Limited imitation skills

• Needs repeated instructions for follow through

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Language

• Limitations in language comprehension and speech production

• Lack of verbal words

• First words never emerged

• Frequently babbles, and expresses his feelings through behaviors such as smiling or crying; able to signs “more” to request something desirable to happen again

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Social Impairment/ Behavior

• Repetitive behaviors during play

• Does not take turns with other kids when playing

• Shows frustration through crying, banging his head, and throwing himself on the ground

• Does not make eye contact with others during social interactions

• Repetitively turns the pages of books and walks aimlessly around a room

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Motor skills

• Gross Motor:

  • Delayed in mobility and ambulation skills

  • Poor balance and coordination

  • Weakness in upper body and extremities

• Fine motor:

  • Delay and weakness in handling eating utensils 

  • Inability to use dressing manipulatives

Sensory processing

• Musical or flashing toys capture his attention for a long time

• Easily distracted and requires moderate verbal cues for refocusing

• Dislikes wet, sticky materials

• Prefers to eat mashed potatoes, chicken nuggets only

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Treatment focus/ suggestions

***Hint: Highlight the medical necessity of these limitations to improve skills 

• Improve motor skills necessary to participate in basic ADL

• Grasp function or hand skills for handling eating utensils

• Sensory stimulation activities 

• Self regulation activities

• Sensory issues that may affect participation and engagement in ADL and IADL

• Treatment frequencies can range from 1x60 mins to 2x60 mins; 1:1