Behaviour as a form of Communication

Autism Spectrum Disorder, Sensory Integration Challenges and a School-Based Occupational Therapy Intervention

As diagnoses of autism spectrum disorder (ASD) increases, the waitlist to be diagnosed becomes longer, and the resources available are utilized. Soon, the percentage of school children that have ASD will continue to grow as the diagnostic criteria are expanding and the awareness of symptom behaviors develop. Additionally, the prevalence of sensory integration and sensory processing challenges diagnoses accompanying ASD diagnoses will also continue to increase. For some children, their sensory processes do not develop as efficiently, resulting in many difficulties faced, especially in educational settings, including learning, development, and behavior. Where apparent difficulties are existing in a child’s school life, there is often a response of interventions including teachers, support staff, parents, and intervention therapists. 

            

In an evidence-based case study involving a 6-year-old boy diagnosed with Autism Spectrum disorder and sensory processing challenges, it was stated that he was demonstrating disruptive behavior that drew attention from his teacher, parents, and principal, who then decided to involve the school occupational therapist (OT). This support system discussed challenges including difficulties with social interaction with peers, following classroom rules, and self-regulatory behavior; despite the teacher’s best efforts to make positive adaptations in the classroom. The classroom struggles lead the support system to involve a school-based occupational therapist to conduct an evaluation of the child in the classroom to understand how to support him best. 

 

            An evaluation of this child’s behavior resulted in detailed explanations as to why it was appearing that he wasn’t behaving ‘properly’ in class and revealed some challenges with his sensory processes that were contributing to his ‘disruptive behavior’. For example, it was determined that this boy would engage in unsafe behaviors on the playground which was stated in the evaluation as difficulty participating appropriately and safety in gross motor activities. The evaluation revealed contributing factors to these behaviors included difficulties with balance, bilateral coordination, motor planning, and poor body awareness resulting from difficulties processing input from several sensory systems in his body. Also, there were other areas of concern including self-regulation, fine motor and social skills that warranted the school OT to complete a review of effective evidence-based strategies existing in research. Therefore, evidence-based intervention methods were selected to be implemented in this child’s classroom, playground, and lunchroom. As well, the support system for this child worked out obstacles along the way as suited best to the child, such as adding a clinically-based OT into the child’s support system. After the collaboration of teacher, parents, principal, support staff and a school and clinic-based OT, this child was able to make progress in reaching or meeting his goals. 

Overall, OTs play a crucial role in facilitating assessments, team planning, evidence-based interventions and resources and encouraging environments for children with any developmental or intellectual disability, but specifically children with ASD and sensory processing challenges in a school setting. The OT’s use of a complete, extensive evaluation of the situation happening with the child in his environments provided the team with the groundwork knowledge to develop and implement evidence-based intervention strategies targeted to reduce his disruptive and unsafe behavior. This case study demonstrated the effectiveness of OT’s school support including complete evaluations and evidence-based intervention strategies in trying to reduce negative classroom behaviors while keeping the child in the class.

Matson, J., & Kozlowski, A. (2011). The increasing prevalence of autism spectrum 

disorders. Research in Autism Spectrum Disorders, 5(1), 418–425. 

https://doi.org/10.1016/j.rasd.2010.06.004

Parham, L., Clark, G., Watling, R., & Schaaf, R. (2019). Occupational Therapy Interventions for 

Children and Youth With Challenges in Sensory Integration and Sensory Processing: A Clinic-Based Practice Case Example. The American Journal of Occupational Therapy, 73(1), 7301395010p1–7301395010p9. https://doi.org/10.5014/ajot.2019.731002

https://occupationaltherapychildren.com.au/we-have-skills/what-is-sensory-integration-therapy/

Brain revival: Re-sparking connections

Alzheimer Society Canada predicts a 66% increase in dementia by 2031, that will almost double the current half a million Canadians living with dementia. The global population is ageing rapidly, a problem that may cause strain on many economies. 10 billion is spent annually on caregivers for people with dementia, this is also expected to increase to 17 billion by 2031. Dementia is likely to affect us personally at some point in our lifetime, 1 in 5 Canadians have experience caring for someone living with some kind of dementia. My grandmother was recently diagnosed with Alzheimer’s and it can be discomforting to see the changes and fast decline caused by the disease. While most of the treatments available are drugs, there is exciting research in neuroscience and other disciplines that may, one day, be used to treat this disease. 

witonworld.com / Dementia – Symptoms, Diagnosis, Causes and Treatments

What is dementia? It is not a specific disease, it is a combination of symptoms that has many different causes, including Alzheimer’s but many others. Certain causes, like vitamin deficiency, medication reactions, and under active thyroid gland can be reversible.   

What is Alzheimer’s disease? Alzheimer’s is a cause of dementia that is irreversible. Often fatal to people diagnosed with the disease.

soterixmedical.com / tACS device 

There is an indication that a rapid decline in cognition may be a result of changes in connections between different brain regions during the lifetime. A recent study at Boston University looked at how changes in the brain’s electrical waves can affect the elderly’s working memory, their ability to store and work with useful information during a task. The researchers used a new piece of technology that can safely change brain waves temporarily, transcranial alternating current stimulation (tACS), illustrated in the photo to the left. This non-intrusive method of brain wave manipulation allowed them to temporarily change brain waves in areas responsible for working memory, to see if that improved performance. They measured their performance by timing their response and tracking their accuracy on a short memory task. The results are fascinating and show promising functions for this new technology. Older adults, 62-75 years old, showed great improvements in working memory while receiving stimulation and even after it was over. Their performance improved even 50 mins post-stimulation. Additionally, when compared with the younger adults’, their performance was the same as the 20-29 year olds.  

Pharmacological (drug) treatments are important and needed to help manage and slow down symptoms. However, their effects tend to stop working as time goes on and the disease deteriorates the brain. Some dementia is treatable and responds well to drugs, like the ones induced by toxic reactions to prescription drugs or B12 deficiency. But other more severe types, like Alzheimer’s, is irreversible and most often fatal to people living with it. Depending on the drugs necessary and what other medication is taken, the side effects may make life harder for people living with dementia. Family taking care of relatives with dementia struggle, 2 in 3 people find the caregiving experience to be isolating. Sadly, people with dementia are often taken advantage of financially by people around them, like family and friends. All these factors illustrate the importance of maintaining good cognitive ability for as long as possible.

Brain wave stimulation may be an avenue to treat and manage dementia. It’s important to note that the research conducted was on healthy individuals not suffering from dementia. It would be irresponsible to assume that this technology can help treat diseases without doing controlled clinical trials. However, future research can help determine the limitations of this technology. Brain communication happens through both electrical and chemical signalling, tACS changes the electrical aspect of brain communication. Future research could help decipher if chemical brain signalling is also affected. Most pathological brain diseases have chemical underpinnings where non-drug alternatives may not be an option. It would be interesting to know how tACS could work alongside or instead of medication. 

References: 

Reinhart, R. M. G., & Nguyen, J. A. (2019). Working memory revived in older adults by synchronizing rhythmic brain circuits. Nature Neuroscience, 22(5), 820–827. https://doi.org/10.1038/s41593-019-0371-x

What is dementia? (n.d.). Retrieved January 17, 2020, from https://alzheimer.ca/en/Home/About-dementia/What-is-dementia