Breaking the Mold. Objectives For Today. Autism statistics 10/24/2015. Justin Lundstedt, OTR/L. Currently 1/68 children are diagnosed with ASD

Transcription

1 Breaking the Mold Creating a Blueprint for the Adult with ASD using an Occupational Therapy Approach Justin Lundstedt, OTR/L Objectives For Today Brief introduction / reintroduction to autism Understand the background of occupational therapy Recognize occupational therapy s role as a service for the general ASD population Identify the need for continued services in clients with ASD through transition and adulthood Provide further methodology and services under the OT umbrella for the aging client with ASD provide case study descriptions of OT services Autism statistics Currently 1/68 children are diagnosed with ASD 1/42 boys ; 1/189 girls Center for Disease Control and Prevention 1

2 Autism defined under DSM-5 Persistent deficits in social communication and social interaction across multiple contexts: Deficits in social-emotional communication Deficits in nonverbal communication Deficits in developing, maintaining, and understanding relationships (Severity is based on social communication impairments and restrictive repetitive patterns of behavior) Autism defined under DSM-5 Restricted repetitive patterns of behavior, interest, or activities as manifested by at least two of the following: Stereotyped or repetitive motor movements, use of objects or speech Insistence on sameness, ritualistic Highly restricted fixated interests of abnormal or intensive focus Hyper or hypoactivity to or unusual interest in sensory aspects to the environment Autism defined under DSM-5 Symptoms must be present in early development Symptoms cause clinically significant impairment in social, occupational or other areas of functioning Disturbances are not better explained by intellectual disability 2

3 Autism defined under DSM-5 Severity levels 1. Level 3: Requiring very substantial support 2. Level 2: Requiring substantial support 3. Level 1: Requiring support Occupational Therapy Professionals focused on maximizing participation in all areas of life including but not limited to: ADL's (feeding, hygiene, dressing) Instrumental ADL's ( community, mobility, safety) Education / work Leisure / play / social interaction Tomcheck et al 3

4 Domains of OT Areas of occupation Activity demands ( physical, cognitive, spatial, social, properties) Client factors (specific abilities, characteristics, beliefs) Environment and context Performance patterns ( habits, roles, routines) Performance skills (communication, interaction skills, motor and processing skills) (Autism: A comprehensive Occupational Therapy Approach 2nd ed.) Scope of OT for individuals with ASD Support health and participation through engagement in life's occupations (AOTA, 2008) through: Evaluation Intervention Assessment of outcomes Providing of services to client and those in their lives Major life stages of OT intervention Early intervention ages 0-3 CPSE ( preschool) ages 3-5 School age 5-21 Transition age Adult ages 21 and up 4

5 Outcomes of Autistic Adults 81% of adults are living with their parents Based on recent research of those studied attended college 55% held paid employment during the first 6 years after graduation More than 50% after 2 years of HS had no participation in ed or vocation (Shattuck et al.) Why? Services cease at the end of schooling transition plans do not fully plan for the future The client needs to self advocate A difficult path to identify help In the past a lot of help has been private pay Outcomes Of Autistic Adults cont. It is important to look at data to see what those with ASD and their caregivers need Focus on both self reporters and legally represented sample There are recognized similarities between those that self report and those with legal representation 2015 Gotham et al. 5

6 What treatment is most utilized for adults with ASD Medication Behavioral / psychotherapy Alternative medicine Self help books Support / social groups Therapies (speech, OT, PT) What information is sought out most often? Understanding and acceptance of adults with ASD Employment Health care access Education Current treatments Gotham et al

7 Insurance reform N.Y. Insurance Law 3216, 3221 and 4303 Require specified policies and contracts that provide coverage for hospital or surgical coverage to not exclude coverage for the screening, diagnosis and treatment of medical conditions otherwise covered by the policy solely because the treatment is provided to diagnose or treat autism spectrum disorder. The law was amended by 2011 N.Y. Laws, Chap. 595 (AB 6305) to also require every policy which provides physician services, medical, major medical or similar comprehensive-type coverage to provide coverage for the screening, diagnosis and treatment of autism spectrum disorder. The law prohibits any limitations on visits that are solely applied to the treatment of autism spectrum disorder. Treatment of autism spectrum disorder is defined to include behavioral health treatments, psychiatric care, psychological care, medical care, therapeutic care and specified pharmacy care N.Y. Laws, Chap. 596 (SB 5845) amended these provisions to specify that coverage for applied behavior analysis is subject to a maximum benefit of $45,000 per year.citation: N.Y. Isc Law 3216 Initiating a blueprint for "success" 7

8 Occupational Therapy Evaluation of the Adolescent / Adult When does a client get referred to an OT How does a client get referred to an OT? Evaluate Evaluation should be tailored to the concerns of the client and or guardian Utilize skill based assessments to determine the client s abilities in the areas of motor function, cognitive processing, sensory processing Conduct a client centered assessment to identify interests, satisfaction, limitations, goals Conduct an assessment of their life environments ( community, school, workplace) to identify limitations or needs for adaptations Function based: Evaluation Tools / Assessments Goal Oriented Assessment of Lifeskills (GOAL) Pediatric Evaluation of Disability Inventory Computer Adapted Test (PEDI-CAT) TEACCH Transition Assessment Profile (TTAP) Canadian Occupational Performance Measure (COPM) Leisure / interest check lists 8

9 Evaluation Tools / Assessments cont. Cognitive Assessments: Behavior Rating Inventory of Executive Function (BRIEF) Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) Behavioral Assessment of Dysexecutive Syndrome (BADS) Executive Functioning Performance Test (EFPT) Evaluation Tools / Assessments cont. Sensory based: Sensory Integration Performance Test (SIPT) Sensory profile for Adolescent and Adults Assess and interpret Assess the client's strengths and weaknesses and interpret how they impact their daily lives It is important to look at this from a global standpoint. ASD presents with difficulties generalizing and transferring information from one area to the next. Do your homework about the client! Access all the resources available to you! 9

10 Communicate findings Provide feedback as soon as possible Identify client s and parents understanding of results Develop a document that identifies results and discussion (written evaluation) Identify next steps with client and / or family (recommendations) Provision of Therapy There is no "one size fits all" therapy. During first session create concrete goals Client centered process using a Person Centered Planning Approach This allows you to identify goals, strengths, weaknesses,etc. if a standard form doesn't work, BE CREATIVE (D&D) Have client take ownership. Identify REALISTIC goals Identify time frame, but allow for some flexibility Provision of Therapy cont. Maintain a structure or format for session, identifying daily goal and goal working towards Identify progress along the way Restructure goals as needed Plan ahead for discharge or transition / transfer of services Utilize the whole team 10

11 Case Study 1 18 year old male High IQ (test results identify high average) Secondary to poor social skills, difficulty adapting to school environment dropped out of school, took GED exam Current goals: to attend college and focus on life sciences and technology, to get a license Limitations: foresight, organization, time management, social interaction, initiation and planning, IADL's, ADL's Case Study 2 53 year old gentleman of high intelligence Recently diagnosed with ASD Struggled with obtaining a new job Struggles with marriage / relationships Strengths: motivated, intelligent Limitations: self reflection, empathy, flexibility, social awareness Case Study 3 15 y/o with mild to moderate cognitive deficits (expressive / receptive, working memory) Sophomore in high school, aspirations of becoming a musician with a back up job of administrative assistant. Would like to be accepted by others Strengths: dexterity, focus, intelligence Weaknesses: initiation, organization, restrictive thoughts, poor social skills, working memory, problem solving 11

12 Other forms of OT services 1:1 Didactic ( pairing, complimentary) Group (Interdsciplinary, transdiciplinary, single discipline) Consultation ( education, community, vocational, family) Tele-therapy Education (school based, business, community, professional) Advocacy Don't hold all of the weight Utilize team: Psychiatrist Psychologist SLP PT SW Vocational services Disability services Questions??? 12

13 Occupational Therapy practitioners ask, "what matters to you" not, "what's the matter with you?" AOTA PRESIDENT GINNY STOFFEL THANK YOU! Works Cited "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 12 Aug Web. 23 Oct Gotham, Katherine, Alison Marvin, Julie Lounds Taylor, Zachary Warren, Connie M. Anderson, Paul A. Law, Jessica K. Law, and Paul H. Lipkin. "Characterizing the Daily Life, Needs, and Priorities of Adults with Autism Spectrum Disorder from Interactive Autism Network Data." Pub Med. N.p., n.d. Web. 23 Oct Miller-Kuhaneck, Heather. Autism: A Comprehensive Occupational Therapy Approach. 2nd ed. Bethesda, MD: American Occupational Therapy Association, Print. Shattuck, P. T., S. C. Narendorf, B. Cooper, P. R. Sterzing, M. Wagner, and J. L. Taylor. "Postsecondary Education and Employment Among Youth With an Autism Spectrum Disorder." Pediatrics (2012): Pub Med. Web. 10 Oct Shattuck, P. T., S. C. Narendorf, B. Cooper, P. R. Sterzing, M. Wagner, and J. L. Taylor. "Postsecondary Education and Employment Among Youth With an Autism Spectrum Disorder." Pediatrics (2012): Pub Med. Web. 10 Oct Tomcheck, Scott, Patty La Vesser, and Renee Watling. "The Scope of Occupational Therapy Services for Individuals With an Autism Spectrum Disorder Across the Life Course." American Journal of Occupational Therapy 64.6_Supplement (2010): n. pag. Pub Med. Web. 10 Oct