Linn Wakeford

Preliminary Efficacy of Adapted Responsive Teaching for Infants at Risk of Autism Spectrum Disorder in a Community Sample

This study examined the (a) feasibility of enrolling 12-month-olds at risk of ASD from a community sample into a randomized controlled trial, (b) subsequent utilization of community services, and (c) potential of a novel parent-mediated intervention to improve outcomes. The First Year Inventory was used to screen and recruit 12-month-old infants at risk of ASD to compare the effects of 6–9 months of Adapted Responsive Teaching (ART) versus referral to early intervention and monitoring (REIM). Eighteen families were followed for ~20 months. Assessments were conducted before randomization, after treatment, and at 6-month follow-up. Utilization of community services was highest for the REIM group. ART significantly outperformed REIM on parent-reported and observed measures of child receptive language with good linear model fit. Multiphase growth models had better fit for more variables, showing the greatest effects in the active treatment phase, where ART outperformed REIM on parental interactive style (less directive), child sensory responsiveness (less hyporesponsive), and adaptive behavior (increased communication and socialization). This study demonstrates the promise of a parent-mediated intervention for improving developmental outcomes for infants at risk of ASD in a community sample and highlights the utility of earlier identification for access to community services earlier than standard practice.

Development of everyday activities: A model for occupation-centered therapy

Models of practice serve to organize a disciplines knowledge and conceptual explanations for how changes occur. This article presents a model of practice in occupational therapy for children and identifies the professions area of interest as the development of everyday activities rather than child development. Changes in childrens engagement in activities are the product of the interdependent influences of a communitys investment in childhood activities and cultural practices of adults, interpersonal interactions with other people during activities, and young childrens effort to do the things that they find interesting or activities expected of them. Clinical reasoning and activity analysis focus on the childrens activities in their natural environments and the quality of their engagement. A case example illustrates how the model generates occupational therapy services centered on an everyday activity and enables a young childs satisfactory engagement in drawing as part of his inclusive child care program.

Predictors of Parent Responsiveness to 1-Year-Olds At-Risk for Autism Spectrum Disorder.

Parent responsiveness is critical for child development of cognition, social-communication, and self-regulation. Parents tend to respond more frequently when children at-risk for autism spectrum disorder (ASD) demonstrate stronger social-communication; however, it is unclear how responsiveness is associated with sensory characteristics of children at-risk for ASD. To address this issue, we examined the extent to which child social-communication and sensory reactivity patterns (i.e., hyper- and hypo-reactivity) predicted parent responsiveness to 1-year-olds at-risk for ASD in a community sample of 97 parent-infant pairs. A combination of child social-communication and sensory hypo-reactivity consistently predicted how parents played and talked with their 1-year-old at-risk for ASD. Parents tended to talk less and use more play actions when infants communicated less and demonstrated stronger hypo-reactivity.

Parent-Mediated Intervention for One-Year-Olds Screened as At-Risk for Autism Spectrum Disorder: A Randomized Controlled Trial

Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.

Educational Implications of Taking a Transactional Perspective of Occupation in Practice

In this chapter, we explore educational issues related to helping professional students apply a transactional perspective in the practice of occupational therapy with children. We address students’ and the literature’s persistent habit of locating development within the child. We offer a transactional description of a childhood occupation as a social process, then highlight how the essence of intervention lies in providing opportunities for children’s engagement with occupations in new ways, utilizing the relational and interdependent elements of occupational situations. We introduce an educational process that helps students see children and their occupational situations as a functioning whole system. We discuss how students are challenged to reflect critically on views of childhood, and we illustrate how through facilitated discussion students are led to adopt a highly contextualized perspective, particularly in terms of how children and their families experience their life situations. The use of storytelling, case-based groups and fieldwork assignments are shown as opportunities for applied learning, and we discuss the structure of assignments to guide thinking along transactional lines.

Occupational Therapy in Early Intervention and Early Childhood Special Education

Young children with disabilities and their caregivers often face multiple challenges as they engage in everyday life, and occupational therapists provide vital services to help address these and other challenges by focusing on goals related to participation in daily life activities and routines, collaborating with others, and providing resources and other supports to family members and teachers. OTs working in early childhood settings make use of a holistic assessment process that considers the child, family, and other caregivers, the activities and routines that comprise the child’s day, and the environments in which the child and family participate. Goals are then established based on family priorities, child strengths and needs, and assessment results. The OT designs individualized intervention plans that incorporate relevant research evidence, the therapist’s clinical reasoning, understanding of the child and family situation, and input from the child’s parents, teachers, and other professionals. Core philosophies regarding family-centered care, evidence-based practice, theory-based practice, and the importance of occupation and social participation for health and quality of life, all form the foundation for the work of OT in early childhood/early intervention. This chapter provides an overview of the domain, process, and principles of OT practice with very young children and their caregivers, and includes challenges and future directions for growth for OTs in this practice setting.

Repetitive Behaviors and Sensory Features: Evidence-Based Intervention Strategies

There is a history of clinical and first-person accounts reflecting the impact of repetitive behaviors and sensory features on the daily lives and occupations of individuals with autism. In Kanner’s (Nervous Child 2:217–250, 1943) original account, he remarks on the odd, repetitive patterns of behavior displayed by case number one, Donald T., the first known individual to be diagnosed with autism, stating, “Most of his actions were repetitions carried out in exactly the same way in which they had been performed originally. If he spun a block, he most always started with the same face uppermost. When he threaded buttons he arranged them in a certain sequence that had no pattern to it but happened to be the order used by the father when he first had shown them to Donald” (p. 219). In her autobiography of childhood autism, Grandin (Emergence: Labeled autistic, 1996) recollects difficulties modulating responses to sensory stimuli across visual, auditory, and tactile modalities that subsequently interfered with overall social and adaptive development. She describes several examples of extreme sensory responsiveness: “The pain that racked my head when the fog horn sounded was excruciating. Even with my hands over my ears the hurtful sound assaulted them to the point that I’d throw myself down on the deck and scream” (p. 22). She adds paradoxically, “Intensely preoccupied with the movement of the spinning coin or lid, I saw nothing or heard nothing. People around me were transparent. And no sound intruded on my fixation. It was as if I were deaf. Even a sudden loud noise didn’t startle me from my world” (p. 23). Although repetitive behaviors and sensory features are quite salient symptoms of autism, there has been debate about whether or not they represent distinct phenomena, and thus, whether differential treatment approaches should be used.