Jill Ashburner

Understanding the sensory experiences of young people with autism spectrum disorder: A preliminary investigation

BACKGROUND/AIM Unusual responses to sensations can impact upon the daily activities for individuals with autism spectrum disorder. Current understandings of these sensory experiences have been drawn from the proxy reports from parents/caregivers, standardised self-report questionnaires and autobiographical accounts. As sensory experiences are intensely personal, the first-hand accounts of people with autism spectrum disorder may have greater validity than caregiver reports, but these have never been systematically researched. This study explored the utility of using a semi-structured interview protocol augmented with visual cues to facilitate our understanding of the way people with autism spectrum disorder experience sensory input, and use coping strategies to manage sensory issues that interfere with participation. METHOD A semi-structured interview augmented by visual cues was used to investigate the sensory experiences of three adolescent males with autism spectrum disorder. As is common in this population, two of the participants also had a diagnosis of Attention Deficit Hyperactivity Disorder and were taking stimulant medication. RESULTS Participants shared a preference for expected, predictable and controllable sensory input, whereas unexpected, unpredictable and uncontrollable sensations were perceived as unpleasant. A heightened awareness of and difficulty filtering extraneous sensory input, high levels of movement seeking and an over-focus on salient sensory input were also described. Strategies employed to manage sensory challenges included avoiding, increasing predictability and control and meta-cognitive adaptations. CONCLUSIONS Further research involving a larger sample of participants is recommended to determine the utility of using a semi-structured interview protocol augmented with visual cues to understand the sensory experiences of individuals with high-functioning autism spectrum disorder.

Engaging young people with Autism Spectrum Disorder in research interviews

Accessible summary: Listening to young people with autism spectrum disorder is important. Researchers can help support young people to have their say. Each young person is different. The supports used need to match their needs. Summary: This study draws on the first authors doctoral research on the mainstream schooling experiences of young people with autism spectrum disorder (ASD) and their parents in Queensland, Australia. The aims are to share some of the practical strategies that were adapted and developed to engage the young people in the research and to critically reflect on what this means for future inclusive methodological approaches in this area. The key message is that diagnostic-related assumptions about impairments can lead researchers to develop strategies which exclude or restrict rather than maximise participation of disabled people in research. To enable young people with ASD to provide rich and meaningful insights researchers need to acknowledge and plan creatively and flexibly for the interactive dynamic that is unique to each individual as well as for needs which might be shared.

Occupational therapy services for people with autism spectrum disorders: Current state of play, use of evidence and future learning priorities

BACKGROUND A dramatic increase in the prevalence of autism spectrum disorders and increased funding to support children with autism spectrum disorders have added to the demand for occupational therapy services. This study explored current practices and future learning priorities of Queensland occupational therapists who work in this field. METHOD A survey in relation to occupational therapy services for people with autism spectrum disorders was distributed to all registered Queensland occupational therapists (N=2547). The development of the survey was informed by a series of focus groups comprising occupational therapy clinicians, supervisors and academics. The survey covered demographics, caseload composition, collaboration, context/setting, service-delivery models, information gathering, goal setting, interventions, perceived challenges and confidence, use of evidence, and experience of professional development and support, and future learning priorities. RESULTS Of 818 surveys returned, 235 respondents provided services to clients with autism spectrum disorders, with young children being more likely to receive a service than adolescents or adults. A pervasive focus on sensory processing was apparent in relation to assessment, intervention, and key areas of knowledge. Around half the respondents indicated that they lacked confidence at least some of the time. Autism spectrum disorders-specific experience was a significant predictor of confidence. Many therapists reported challenges in finding useful information in the literature and reliance on conferences or workshops as their main source of evidence. Commonly identified learning priorities included new developments in the field, early intervention, school support, sensory processing and clinical reasoning. CONCLUSION This research highlights the need for comprehensive autism spectrum disorders-specific, face-to-face training focusing on evidence-based and occupation-centred practices.

Optimizing participation of children with autism spectrum disorder experiencing sensory challenges: A clinical reasoning framework

Background. Remedial sensory interventions currently lack supportive evidence and can be challenging to implement for families and clinicians. It may be timely to shift the focus to optimizing participation of children with autism spectrum disorders (ASD) through accommodation and self-regulation of their sensory differences. Purpose. A framework to guide practitioners in selecting strategies is proposed based on clinical reasoning considerations, including (a) research evidence, (b) client- and family-centredness, (c) practice contexts, (d) occupation-centredness, and (e) risks. Key issues. Information-sharing with families and coaching constitute the basis for intervention. Specific strategies are identified where sensory aversions or seeking behaviours, challenges with modulation of arousal, or sensory-related behaviours interfere with participation. Self-regulatory strategies are advocated. The application of universal design principles to shared environments is also recommended. Implications. The implications of this framework for future research, education, and practice are discussed. The clinical utility of the framework now needs to be tested. Description. Il y a actuellement peu de données probantes sur les interventions sensorielles thérapeutiques et ces interventions peuvent être difficiles à mettre en œuvre pour les familles et les cliniciens. Il peut être judicieux de mettre l’accent sur l’optimisation de la participation des enfants atteints de troubles du spectre de l’autisme (TSA), en proposant des aménagements, de même que des stratégies d’autorégulation de leurs différences sensorielles. But. Un cadre visant à aider les praticiens à choisir des stratégies est proposé; ce cadre est basé sur les différents aspects du raisonnement clinique, soit (a) les données probantes; (b) l’intervention centrée sur le client et la famille; (c) les contextes de la pratique; (d) l’intervention centrée sur l’occupation; et (e) les risques. Mots clés. Le partage d’information avec les familles et l’encadrement forment la base de l’intervention. Les stratégies spécifiques mises en relief étaient les comportements d’aversions sensorielles ou de recherche sensorielle, les difficultés liées à la modulation de l’état d’éveil ou les comportements difficiles liés à des troubles sensoriels qui interférent avec la participation. Les stratégies d’autorégulation sont préconisées. L’application des principes de la conception universelle dans les environnements partagés est également recommandée. Conséquences. Les conséquences de ce cadre pour la recherche, la formation et la pratique dans l’avenir sont discutées. L’utilité clinique du cadre doit maintenant être testée.

Improving transfer of learning: an innovative comentoring program to enhance workplace implementation after an occupational therapy course on autism spectrum disorders

Introduction: Research suggests that learning gained through training is infrequently implemented in the workplace. A short-term postcourse comentoring program was developed with the aim of facilitating workplace implementation of learning after a 3-day course for occupational therapists. The program was evaluated for usefulness, successes, challenges, recommended improvements, and associations with changes in self-rated knowledge and confidence. Method: Two months after the course, 42 participants completed an evaluation of the comentoring program with closed- and open-ended questions addressing usefulness, successes, challenges, pairing preferences, and recommendations. They also completed a record on whether or not they had worked on goals nominated in their comentoring contract. Before and 2 months after the course, they completed a self-rated questionnaire on knowledge and confidence. Results: The comentoring program was recommended by 80% of participants. Benefits included opportunities for information and resource sharing, debriefing, problem solving, reassurance, and implementation of ideas. Ninety-five percent of participants worked on some or all their comentoring goals. Although there were significant improvements in knowledge (P < 0.001) and confidence (P < 0.001), the total comentoring evaluation score was not significantly associated with these changes. It is therefore possible that these improvements related to the course itself rather than the comentoring program. Challenges related to time, scheduling, distance, and pairing of comentors. Conclusion: Reported benefits of the program included enhanced psychosocial support and prompting to trial newly learned strategies. Effectiveness may be improved by setting aside time for comentoring in the workplace and better matching of comentors.

Comment on: ‘An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial’ by Schaaf et al. (2013)

The purpose of this letter to the editor is to comment on a recently published paper in the Journal of Autism and Developmental Disorders, ‘An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial’ by Schaaf et al. (2013). The authors are commended for undertaking a randomised clinical trial (RCT) examining the efficacy of occupational therapy using sensory integration (OT/SI). The study complies with many of the recommended standards of RCT’s including: (a) detailed eligibility criteria, (b) well-matched experimental and control groups, (c) use of gold-standard instruments to measure the symptoms of autism spectrum disorder, (d) the use of functionally relevant outcome measures, (e) fidelity checking, and (f) manualization of the intervention. Additional aspects of rigour that could be considered in subsequent research include: (a) independent blinded measure of observational outcomes, (b) treatment and control interventions of equivalent dose, (c) public access to the manualized treatment guidelines, and (d) the use of a comparison occupational therapy intervention to address the same goals as the OT/SI intervention.

Evaluation of an Innovative Interest-Based Post-School Transition Programme for Young People with Autism Spectrum Disorder

Abstract After leaving school, young people with autism spectrum disorder often struggle with social, educational and employment participation. A post-school transition programme underpinned by individualised case management, where mentees are guided to complete self-selected projects by mentors with multimedia skills, was evaluated using a qualitative approach. The programme’s impact on mentees’ social participation, emotional well-being, project skills and awareness of and transition to post-school options was examined. Eleven mentees (17–21 years), 12 family members and 7 mentors participated in semi-structured interviews. Mentors completed fortnightly records. Findings included positive impacts on mentees’ motivation and enjoyment, social participation, emotional well-being and skill development; and an appreciation of the programme flexibility and the high-quality mentor–mentee relationships. Some mentees developed their awareness of future options, while others struggled to articulate their goals. Two of 11 mentees transitioned to further education. Overall, the programme appeared to fulfil a critical need for nurturing, post-school transition programmes.