Autism is a neurological condition caused by a combination of genetic and environmental factors and is characterized by deficits in social skills, communication skills, and restricted and repetitive behaviors. These deficits all begin before a child is 3 years old. Autism can manifest itself in a wide spectrum from “high functioning” where the deficits are slight and do not obviously impact an individual’s daily living, to more severe forms in which an individual is unable to communicate or take care of himself. Clinicians often group individuals with a variety of the above symptoms into a single category called “Autism Spectrum Disorders” (ASD) which includes Autism, Asperger’s syndrome, Sensory Processing Disorder (SPD), Pervasive Developmental Disorders, and others.

Autism differentiates itself from Asperger’s syndrome in that individuals with Asperger’s do not demonstrate a language delay, and often actually demonstrate above average verbal skills. Though hyper-verbal, individuals with Asperger’s syndrome still lack the ability to understand the full context and pragmatics of language, and will be very concrete in their language patterns.

In addition, individuals with Autism Spectrum Disorders often have difficulty with executive functioning. Executive functioning involves having the attention, organization, sequencing, and problem solving skills required to solve life’s everyday problems. Individuals with poor executive functioning skills are often referred to by teachers as “being very bright, but having no common sense”. Even though he may be highly intelligent, the individual may have great difficulty navigating through everyday problems such as paying bills, traffic, meal planning, social situations, making a doctor’s appointment, finding employment, etc.

Sensory Processing Disorder (SPD) is a neurological condition causing difficulties with processing and responding to sensory information from the environment and from within one’s own body. This information is in the form of auditory, visual, tactile (touch), olfaction (smell), gustatory (taste), vestibular (relation of body to earth’s gravity), and proprioceptive (relation of body parts to self) input. Individuals with SPD can demonstrate a series of seeking behaviors, avoiding behaviors, or both seeking and avoiding behaviors that are outside the normal range.

It is difficult to determine if individual negative behaviors are due to a sensory processing response, or a poor behavior response. Most negative behaviors are a combination of sensory and behavioral deficits, but determining which plays a stronger role can be tricky, even for a trained professional. However, a general rule of thumb is that if an individual can turn on/off a negative behavior like a switch, then the negative behavior is behavioral based. If the individual has a more difficult time calming down, even after the problem has been resolved, then the negative behavior is more likely to be sensory based.

For example, a child might be crying and throwing a tantrum when getting a hair cut. If the child stops crying immediately after the haircut is over and he calmly steps down from the barber chair, then the tantrum was more likely behavior based. However, if the child continues to be tearful and hesitant even after stepping out of the barber chair, then the tantrum was more likely sensory based.

In this instance “occupation does not refer to employment. Rather it refers to activities/tasks which occupy one’s time. For example, an infant’s occupation is eating, sleeping, and beginning to observe/interact with his environment. After a major car accident or a stroke, one’s primary occupation may be simply to relearn how to get dressed, go to the bathroom, and take basic care of himself. A young adult’s occupation might be to actually gain employment. The goal of occupational therapy is to evaluate an individual’s strengths and weaknesses and to determine the most appropriate way to improve one’s independence in their occupations at every stage of life.

A child who is in preschool/school has many occupations as well. His “jobs” include being a son, friend, student, and possibly even brother. Examples of specific skills that the occupational therapist may assist the child with include handwriting, scissor cutting, attending to task, following verbal instructions, playing sports, playing board games, getting dressed, and socializing with peers/adults.

The treatment concepts related to sensory integration therapy were developed by A. Jean Ayres, PhD, OTR in the 1950’s and 1960’s. Dr. Ayres was interested in the way in which sensory processing and motor planning disorders interfere with daily function and learning. Sensory integration therapy attempts to apply sensory input through the seven senses to help an individual increase their functional independence including the improvement of developmental milestones and behavior. The seven senses included in sensory integration therapy include sight, hearing, taste, touch, and smell; as well as vestibular input (movement input), and proprioceptive input (pressure input felt through the joints). Sensory integration therapy has been shown to be effective in individuals with Sensory Processing Disorders (SPD), Autism Spectrum Disorders (ASD), ADHD, developmental delay, traumatic brain injury, and a variety of other neurological conditions.

Occupational therapists help individuals participate in the things they want and need to do through the therapeutic use of everyday activities or “occupations”. OT’s have a holistic perspective in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team. (www.aota.org)

Physical therapists restore and improve movement, activity, and health to enable individuals to have optimal functioning and quality of life. (www.moveforwardpt.com)

If one were to observe a pediatric occupational or physical therapy session, many similarities could be found in the actual activities. However, each therapist might be working on very different goals. For example, both OT’s and PT’s often utilize obstacle courses as a treatment technique. The physical therapist might use the obstacle course to focus on the gross motor skills of balance, jumping, endurance, strengthening, motor planning, etc. as needed for an individual to more fully participate in school PE or in playing with peers. An occupational therapist might use the exact same obstacle course, but would focus on the skills of attending to task, auditory processing skills, motor planning/body awareness, sequencing skills, and short term memory skills as needed to maximize functional abilities in a classroom setting. In addition, the OT might also be addressing the proprioceptive, tactile, and vestibular sensory input that is provided in the obstacle course.

There are many fabulous occupational and physical therapists who work in the public school system. However, the nature of therapy through the schools is that the therapist is restricted to only working on deficits that directly negatively impact a child’s ability to function in the school setting.

In addition, most children who receive services through the schools only receive 30 minutes of therapy per week. Many times, these therapy sessions are completed in a group setting rather than providing one on one attention. Finally, school therapy sessions often get interrupted by assemblies, tests, field trips, etc. Receiving therapy through a private clinic allows for a more intensive therapy regime of 2-3 hours per week per discipline of individual attention. Numerous studies support the theory that more intensive therapy allows children to make greater progress more quickly. This objective at Jarvis Pediatric Therapy is to create an intensive therapy regime so that each child will meet his goals more quickly, thus being discharged from therapy more quickly.

The sooner the better! The younger the child is, the more moldable their neurological system. Numerous studies show that the sooner a child begins therapy, the more likely they are to make the most significant gains, and to be discharged from therapy more quickly. We at Jarvis Pediatric Therapy really focus on starting therapy early (birth to 3 years old) with the objective that, with intensive therapy, the child will no longer require services once they reach kindergarten. This said, many of our clients do not begin therapy until they are well into elementary school. These older children benefit from intensive therapy as well and can also make significant gains through this therapeutic approach.