Autism Spectrum Disorder in Children

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder described by a behavioral outline existing in first stage of childhood. It is a disorder that is seen in all races, cultures, and societies. In America, the Center for Disease Control (CDC) reports that 1.5% (one in 68) of children are diagnosed with ASD.

Autism Spectrum Disorder is presented by deficits in communication and social interaction, as well as the existence of limited interests, monotonous and repetitive behaviours such as hand flapping, jumping, rocking and toe-walking. Also,  affected children come to be engrossed by a specific parts of objects for instance spinning the wheels of a toy car. Research has shown that young children with ASD also demonstrate an inability to engage in joint attention, lack impulsive imitation, limited mutual and creative play, and struggle understanding social cues such as facial expressions. These incapacitates the ability to form communal associations and cause deficit in social interaction which is fundamentally connected to difficulties with communication.

Social deficits include reduced nonverbal communication (e.g., eye contact, gestures, pointing), and a refusal to share experiences with others. At a higher cognitive level, individuals with ASD may fixate on a circumscribed topic or object of interest such as construction signs, train schedules, and types of cars. Similarly, individuals with ASD may strictly adhere to specific routines or specific daily schedules.

Many children with ASD experience a delay in acquiring language, and some never gain the ability to communicate verbally. However others naturally develop to an extent some structural aspects of language, and yet will demonstrate impairments in pragmatics, or the social use of language.

The cause of ASD is poorly understood however problems related to the brain, its cells and synapses has direct link with ASD. It is a disorder of three spectra, autism, Asperger syndrome and pervasive developmental disorder.

The effect of stress on an ASD child

The effects of an ASD are not limited to the child, but transcends to the primary caregiver and family members at large. One of such challenges is stress. A challenge that impacts the well-being of the family as a whole and those of individual family members’ health, well-being, and experiences across the lifecycle. It is also associated with high levels of stress in primary caregivers, and it contributes to the overall high incidence of anxiety and depression among primary caregivers.

Three main groups of factors have been found to add to prominent levels of stress in primary caregivers of children with autism:

• Child characteristics
• Lack of sufficient professional assistance and poor relationships between parents and
• Social attitudes towards individuals with autism.

While some amount of parenting stress is typical, and even beneficial, significant levels of parenting stress can lead to lower parental self-efficacy, poor quality of life and distressed parent-child relationships. Not only does parenting stress have deleterious effects on parents’ mental health and self-efficacy, it also influences the child’s level of functioning, affecting the child’s very make up by increasing risks of mood disorders and deteriorating ASD.

These stressors include the challenges of navigating through medical, educational, behavioral services, monetary hardships associated with the high cost of care, and the psychosocial distress associated with bringing up a child with a disability.

The goal of prevention or reduction of the negative effects of stress over time is paramount. The correlation between stress and negative health outcomes needs to be recognized and addressed.  Occupational therapists design and develop specific assessments with which to identify stress and its associated variables in primary caregivers’ post- diagnosis. Primary caregivers who are considered to be at risk for development of parenting stress should receive intervention to curb it before it surfaces.

Autism spectrum disorder has been considered to cause elevated level of stress in primary caregivers however with the right resources and education issues of stress can be controlled to a point if not completely resolved.

The role of Occupational Therapists

Some health professionals that work with children with ASD include Occupational therapists (OT), speech and language therapists and physiotherapists. OT’s study human growth and development and a person’s interaction with the environment through daily activities. OT’s are experts in social, emotional and physiological effects of illness and injury. This knowledge helps them promote skills for independent living. In ASD,  OT’s concentrate on these areas to help children live independently.

• Concentration/attention
• Stamina
• Play skills
• Ability to move from one activity to the other
• Sensory integration
• Personal space
• Response to touch or stimuli
• Motor skills (posture, balance, manipulation of toys or other objects)
• Aberrant and aggressive behaviors
• Caregiver and child interactions
• Coordination

These areas enable one perform daily activities effectively. The occupational therapist builds goals around these areas to improve functionality and independence amongst children with ASD.

Although, there is no single ideal treatment program, early, structured, individualized care has been shown to work best. Once an occupational therapist has gathered information, he or she develops a program for affected child, using single or combined strategies with the aim to help the child respond better to his or her environment.

Strategies occupational therapists may use include:

• Physical activities, such as stringing beads or doing puzzles, to help a child develop coordination and body awareness.
• Play activities to help with interaction and communication.
• Developmental activities, such as brushing teeth and combing hair.
• Adaptive strategies, including coping with transitions

The overall goal of occupational therapy is to help the person with autism improve his or her quality of life at home and in school. They do so to help introduce, maintain, and improve skills so that people with autism can be as independent as possible.

Occupational therapy foster various skill activities and these may include;

• Daily living skills, such as toilet training, dressing, brushing teeth, and other grooming skills
• Fine motor skills required for holding objects while handwriting or cutting with scissors
• Gross motor skills used for walking, climbing stairs, or riding a bike
• Sitting, posture, or perceptual skills, such as telling the differences between colors, shapes, and sizes
• Awareness of his or her body and its relation to others
• Visual skills for reading and writing
• Play, coping, self-help, problem solving, communication, and social skills

By working on these skills during occupational therapy, a child with autism may be able to:

• Develop peer and adult relationships
• Learn how to focus on tasks
• Learn how to delay gratification
• Express feelings in more appropriate ways
• Engage in play with peers
• Learn how to self-Regulate

Most health professionals who deal with children with ASD may only work directly with child to improve on deficits. Most parents are not involved in intervention process and therefore do not understand the situation of their children. It is imperative that as part of intervention process of health professionals, parents must be thoroughly educated and involved with during therapy to be able to measure outcomes of child and appreciate child better. This will go a long way to reduce stresses of parents and yield better results for children.

Also, a lot of focus should be put on training the child to become as functional as possible to enable them become independent.

Ann Sena Fordie

Occupational therapist