The Role of Occupational Therapy in Pediatric Developmental Disorders

1. The Role of Occupational Therapy in Pediatric Developmental Disorders Thursday, April 30, 2009 Presented by: Dr. Skip Freedman, and Dr. Kari Kassir www.allmedmd.com

2. Agenda Discuss the role and medical necessity of Occupational Therapy in the treatment of: • Autism Spectrum Disorder • Sensory Integrative Disorder • Pediatric Feeding Disorder Live Q&A Session www.allmedmd.com

3. Sensory Integrative Disorders Most people aware of five basic senses: • Hearing • Sight • Taste • Touch • Smell Fewer aware of two fundamental, and even primitive senses: • Vestibular (gravitational) • Proprioceptive (muscle and joint perception) www.allmedmd.com

4. Sensory Integrative Disorders • In a typical child, the first seven years or so are devoted to sensorimotor development. Process Breakdown • When this process breaks down and the brain cannot integrate sensations from one or more of the senses, the child will not adapt to the incoming information. • Sensory integrative disorders are “a heterogeneous group of disorders that are thought to reflect subtle, primarily subcortical, neural dysfunction involving multisensory systems.” www.allmedmd.com

5. Sensory Integrative Disorders Sensory integrative disorders fall within one of four categories: • sensory modulation problems • sensory discrimination and perception problems • vestibular-proprioceptive problems • praxis problems Pediatric Occupational Therapy • In a controlled trial it clearly shows that children with sensory modulation disorder, in sensory integration treatment group made significant gains, as well as positive trends, in the areas studied. www.allmedmd.com

6. Sensory Integrative Disorders What to Consider • Consider therapist’s credentials • Treatment should include: • (SIPT Results) • Short- and Long-term treatment goals • Body of literature is small now, but it’s growing www.allmedmd.com

7. Autism Spectrum Disorder A.K.A. pervasive developmental disorder (PDD), is defined as a biologically-based neurologic disorder affecting childhood development. www.allmedmd.com

8. Autism Spectrum Disorder • 1 in 150 children has ASD • 4x as common in boys Behavioral Characteristics: • disturbances in social interaction • deficits in communication • behavioral abnormalities • disturbances of sensory and perceptual processing -CDC www.allmedmd.com

9. Autism Spectrum Disorder Using Occupational Therapists • Interventions based on analysis of: • child’s skills • challenges • occupations • including the environment www.allmedmd.com

10. Autism Spectrum Disorder Current Thinking • Studies show that: • Sensory integration intervention appears to enhance the child’s ability to modulate behavior and participate in social interaction • Massage decreases stereotypic behaviors and improves attention • Current Recommendation: Pairing sensory based interventions with functional tasks to maximize performance outcomes www.allmedmd.com

11. Autism Spectrum Disorder Relationship-based Intervention • Adult imitation • Structured play activities Additional Interventions • Social skills training Parent education is an important component of occupational therapy intervention approaches. www.allmedmd.com

12. Pediatric Feeding Disorder A feeding disorder is an inability to consume adequate and appropriate nutrition by mouth. www.allmedmd.com

13. Pediatric Feeding Disorder How many affected? • 25% of all children • 80% of developmentally disabled children Causes • Anatomical abnormalities • Neuromuscular abnormalities • Physiologic disruption • Inadequate interaction with caregivers • History on invasive procedures www.allmedmd.com

14. Pediatric Feeding Disorder Speech and Language Pathologists consider: • Oral motor skills • Swallowing dysfunction Occupational Therapists focus on: • Oral sensory responses • Muscle tone • Positioning • Self-feeding www.allmedmd.com

15. Pediatric Feeding Disorder • Feeding disorders are as unique and individualized as the children who are affected by them. • Inadequately treating feeding disorders can unfortunately have long-lasting and debilitating consequences. www.allmedmd.com

16. Conclusion In conclusion, appropriately trained and experienced occupational therapists are an essential part of the treatment team for children with sensory integration disorders, autism spectrum disorders, and feeding dysfunction. Their ability to incorporate a child’s strengths, taking into consideration challenges and environment, when formulating an individualized treatment plan optimizes the child’s chances of successful mastery of skills. www.allmedmd.com

17. References Sensory Integration Disorders – • Sensory Integration and the Child, 25th Anniversary Edition. A Jean Ayres. Western Psychological Services, Los Angeles CA, 2005. • Occupational Therapy for Children, 5th Edition. J Case-Smith, Ed. Elsevier Mosby, St. Louis MO, 2005. • S Smith Roley, Z Mailloux, H Miller-Kuhaneck, T Glennon. Understanding Ayres Sensory Integration®. OT Practice 2007; 12(17):CE1-CE7. • LJ Miller, JR Coll, SA Schoen. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. Am J Occupational Ther 2007; 61(2):228-238. • RC Schaaf, K McKeon Nightlinger. Occupational therapy using a sensory integrative approach: A case study of effectiveness. Am J Occupational Ther 2007; 61(2):239-246. • JE Roberts, L King-Thomas, ML Boccia. Behavioral indexes of the efficacy of sensory integration therapy. Am J Occupational Ther 2007; 61(5):555-562. www.allmedmd.com

18. References Autism Spectrum Disorders – • Occupational Therapy for Children, 5th Edition. J Case-Smith, Ed. Elsevier Mosby, St. Louis MO, 2005. • Autism and Pervasive Developmental Disorders, 2nd Edition. FR Volkmar, Ed. Cambridge University Press, New York NY, 2007. • J Case-Smith, M Arbesman. Evidence-based review of interventions for autism used in or of relevance to occupational therapy. Am J Occupational Ther 2008; 62(4):416-429. • Y Fazlioglu, G Baran. A sensory integration therapy program on sensory problems for children with autism. Perceptual Motor Skills 2008; 106:415-422. www.allmedmd.com

19. References Feeding Disorders – • K-T Ayoob, I Barresi. Feeding disorders in children: Taking an interdisciplinary approach. Pediatr Ann 2007; 36(8):478-483. • A-C Bernard-Bonnin. Feeding problems of infants and toddlers. Can Fam Physician 2006; 52:1247-1251. • AL Delaney, JC Arvedson. Development of swallowing and feeding: Prenatal through first year of life. Dev Disabil Res Rev 2008; 14:105-117. • G Frolek Clark, W Avery-Smith, LS Wold, P Anthony, SE Holm. Specialized knowledge and skills in feeding, eating, and swallowing for occupational therapy practice. AmJ Occupational Therapy 2007; 61(6):686-700. • AJ Greer, CS Gulatta, EA Masler, RB Laud. Caregiver stress and outcomes of children with pediatric feeding disorders treated in an intensive interdisciplinary program. J Pediatr Psychol 2007; 1-9. • L Kornhaber, E Ridgway, R Kathirithamby. Occupational and physical therapy approaches to sensory and motor issues. Pediatr Ann 2007; 36(8):484-493. • R Manikam, JA Perman. Pediatric feeding disorders. J Clin Gastroenterol 2000; 30(1):34-46. • CK Miller, KA Burklow, K Santoro, E Kirby, D Mason, CD Rudolph. An interdisciplinary team approach to the management of pediatric feeding and swallowing disorders. Children’s Health Care 2001; 30(3):201-218. • JWL Puntis. Specialist feeding clinics. Arch Dis Child 2008; 93:164-167. www.allmedmd.com

20. Live Q&A • Simply type your questions into the chat window on the GoToWebinar toolbar Or • Click the Raise Your Hand button to ask your question live if you are listening via Telephone. www.allmedmd.com

21. Thanks for Attending We will be emailing all participants the latest edition of The Cutting Edge For more information, contact us at:AllMed Healthcare Management, Inc.621 SW Alder Street, Suite 740 Portland, OR 97205 (800) 400-9916 www.allmedmd.com www.allmedmd.com