Cohesive Therapy for Children with Autism Spectrum Disorder

            My major is Pre-Physical Therapy, which is derived from the Interdisciplinary Studies: Multi-field option. I took classes from Physical Education, Health Education, and Psychology to create my major. Physical Therapy requires many different fields to come together as one. You need to be able to help patients physically, mentally, and be able to educate them on how to prevent injury in the future. Physical education classes have taught me skills and knowledge from multiple areas of expertise, such as Kinesiology, which is also known as biomechanics or the physics of body movements, and Life Span Motor Development, which will help me understand the motor learning at each stage of life. Health education classes have taught me nutrition and ways to educate patients on how to improve their overall health. Psychology classes have shown me the ways the brain processes information and coping strategies for people who been going through stressors, such as a traumatic car accident that leads them into a physical therapist’s office.
          All of these important concepts come together to create the interdisciplinary field of physical therapy. You cannot just focus on the physical injury, you need to consider the person as a whole. For my project, I created a website that details a comprehensive look at therapy options for children with autism. You need more than one type of therapy to properly treat someone suffering from Autism Spectrum Disorder (ASD). The different therapists have to come together to create therapy programs for each individual case because ASD is an individualistic disorder.
At the beginning of this semester, I had no idea what I would base my project off of. As the semester progressed, the class started bouncing ideas off of each other and it became clear that I wanted to work on a project that involved children with autism spectrum disorder (ASD). I have a cousin that has high-functioning autism and I wanted to learn more so I could understand what goes on in the different aspects of the disorder. Then, I did some research of the therapies that are options for children and adolescents with ASD. I found speech language pathology was the biggest one, followed by occupational therapy and physical therapy, followed by psychology. I found the Connections Therapy Center in the Washington D.C. area that included three of the four therapies in one location and it gave me the idea for my project. As I had learned over the years of having an autistic cousin, children with autism love routine. If a child could go to one center for all of their therapies, it would make it easier to create a routine for the child. I wanted to create an online outlet that parents could use to find out about different therapies and how they are integrated together to create a cohesive program for their child. I wanted to give them a place to go to search for answers. Once I decided on what I wanted to do, I had to do some research. I searched for the articles that best fit with what I needed.  I found multiple articles that sufficed and exceeded my expectations. Once I had all of the information I needed, I created my website. 

          After creating the website, I applied my project to the steps of the broad model. The first step of the broad model is to, “define the problem or state the research question” (Repko, 2014, p. 293). I wanted to find what the benefits are of the multiple therapies and how they interact with each other? This research includes multiple sources from the four disciplines of physical therapy, occupational therapy, speech language pathology, and psychology. I find this project important. Throughout my research, I found that the long-term effects of these different types of therapies were not well known because the funding of the disorder has been limited in the past. As a society, the prevalence of ASD is rising and we are in need of scientific evidence explaining the effectiveness of therapies for these individuals, so that they can get the best treatment they can receive.
The next step of the broad model is to “justify using an interdisciplinary approach” (Repko, 2014, p. 293-294). For this project, I needed to use an interdisciplinary approach because one discipline cannot answer all the questions of how ASD effects people. One discipline also cannot treat the individual completely. The four disciplines need to integrate their own therapies to help this one child/adult. Autism is characterized as, “qualitative impairments in social interaction, communication, patterns of behavior, and symbolic play” (Mieres, Kirby, Armstrong, Murphy & Grossman, 2012, p. 32). In the same article, the authors discuss that individuals with ASD also have motor deficits. For example, the way autistic children learn motor skills can cause the deficits that professionals see on their motor assessment tools, such as Movement Assessment Battery for Children. These definitions show that there are many facets to this disorder, such as the social, motor/physical, and communication aspects, that require an interdisciplinary approach to treat it.
            The next step of the broad model is to “identify relevant disciplines” (Repko, 2014, p. 294). In my research endeavors, I found an abundance of disciplines that I narrowed down to four more broad disciplines. There were disciplines such as speech language pathology, psychology, dietary counseling, behavioral therapy, physical therapy, occupational therapy, neurology, and gastroenterology. After researching I found that speech language pathology, physical therapy, occupational therapy, and psychology were the most important. Speech language pathology was the most common therapy that came up when searching for therapies of autistic children, due to the lack of communication skills or general lack of communication that is characteristic of autism. Occupational therapy was the second most common due to the extensive amount of time that children with ASD need to learn/perform activities of daily living (ADLs). Physical therapy was not as common because it was recently adopted into the treatment of autism. More and more research has come out discussing that motor deficits, as discussed above, can affect the social component of the child’s development. When it comes to motor learning and motor deficits that’s where physical therapy comes into play a big role. I also included psychology, due to the fact that many parents have resorted to treating their child’s symptoms with medications, and they are prescribed by psychologist or psychiatrists.
            The next step of the broad model is to “critically analyze the disciplinary insights into the problem and locate their sources of conflict” (Repko, 2014, p. 294). The key elements of speech language pathology therapy are focusing on assessing the individual and the interventions to promote skills for nonverbal and verbal communication (Morgan et al., 2014). Morgan et al. (2014), discusses that speech language pathologists focus on joint attention. The authors define joint attention as, “establishing shared attention, social reciprocity entails maintaining interactions by taking turns, language and related cognitive skills applies to the use and understanding of nonverbal and verbal communication, and behavioral and emotional regulation is the successful regulation of one’s emotions and behaviors” (p. 246-247). These defining elements are used to create therapy programs for the individual because they are the core issues for someone suffering from ASD. The therapists will evaluate the child based on these elements and design a program from there. One source of conflict in this discipline is the different types of therapy each speech language pathologist uses for the child with autism. In the article by Morgan et al. (2014), the authors studied the effects of social communication interventions on infants and toddlers who have or are at-risk for autism. Social communication interventions consist of targeting the language component and or the social communication needs of the child. The results are then grouped into outcomes of pre-linguistic (before speech) or emerging language within the categories of joint attention, social reciprocity, language and related skills, and behavioral and emotional regulation. A different article by Preis and McKenna (2014) discusses the effect of sensory therapy on verbal expression. The authors state that sensory processing is one of the areas that people with ASD struggle with. They also address that sensory integration therapy (SIT) assesses the individual’s “ability to organize sensory information for use, specifically the sensations from one’s body and from the environment that makes it possible to use the body effectively in the environment” (p. 477). SIT focuses on the constant adaptation needed to properly integrate sensations. These two conflicting therapy choices exhibit a reason for needing continued research on individuals and the effectiveness of the different treatments. Both articles point out that even though they received positive outcomes, it does not necessarily mean it will work for everyone.

            In occupational therapy, the main focus is on the impairments of activities of daily living and helping them learn how to do them on their own, if possible (Kao, Kramer, Liljenquist & Coster, 2014). In the article by Kao, Kramer, Liljenquist, and Coster (2014), they mention that as we get older the responsibilities of doing certain tasks transfer from the parents to the own child performing the tasks. The authors state that taking full responsibility of a task requires many steps, including understanding what the task is, when to do it, getting it done by yourself, determining if the task was done right or not, and identifying solutions if a problem comes up. The authors state that the core symptoms of ASD such as “difficulty initiating conversation, poor generalizability of skills from one context to another and limited awareness of others’ perceptions may make it more difficult for young people to take full responsibility for important adult tasks, such as communicating with health care providers, adapting to changes in work schedule, and maintaining personal hygiene” (p. 1). These are all tasks that we take for granted because we do not have to think twice when performing them, but if we were autistic we would not be able to complete these tasks on our own. In the article, the WHO’s International Classification of Functioning, Disability and Health (ICF) is brought up as a framework for occupational therapists (OTs) to use when treating an individual. ICF proposes a working relationship between body structures and function and skills that allow for performing functional activities, such as self-care and interpersonal relationships. OTs also rely on the parents of the child to continue to teach the tasks when the child is home.

            Physical therapy focuses mainly on the motor deficits that occur within the autistic population. In the article by Mieres, Kirby, Armstrong, Murphy & Grossman (2012), the authors discuss that motor deficits can affect the child’s interaction with other children because most children make friends during playtime or on the playground. The way autistic children learn motor skills is different than a child without autism and that is a major component that needs to be recognized. Physical therapists are here to learn how these children process information to make learning motor skills easier, but more studies need to be done for that to occur. The three articles I found agreed that there are motor deficits or motor impairments that occur with autistic children and that it affects other areas, such as social development. One article by Aksay and Alp (2014), examined the effects of a physical activity rehab program on ASD children. They found that when the children had the physical activity program, which consisted of three days a week for 50 minutes, the children all had lower amounts of severe crises. Some of the children had zero severe crises by the end of the program. An article by Bhat, Landa and Galloway (2011) also stated that motor impairments cause social impairments due to the lack of interaction on the playground. One area of conflict is implementing these experimental programs on these children. In the article by Mieres, Kirby, Armstrong, Murphy & Grossman (2012), the authors urge that physical therapists “join the interdisciplinary efforts as researchers, scholars, educators, policy analysts, and advocates in ASD” (p. 36) based on the findings in their study. The other two articles discussed above state that the results of their experiments were in agreement with their hypothesis, but that the community of physical therapists need to perform more studies to be conclusive to the majority of the population before implementing them on more children.

            Psychologists’ key elements are how the brain of an individual with autism works and figuring out how to treat them. In an article by Roncaglia (2014), she discusses that the most important part of treating someone with autism is getting to know them first. She states that getting to know the individual requires understanding their personal situation outside of therapy, their social support system, their emotional and communication (how they communicate with others) environment. She discusses that when they learn these things from an individual, they can then find what stresses them out and how they deal with their stress (coping mechanisms). Focusing on coping mechanisms allows individuals to get inside of someone’s head and determine what is going through their mind when stressors occur. Once someone finds out how they cope, the psychologist can relay this information to people who can help them when resources are scarce. This article focused on working on the individual and their coping mechanisms, while another article discusses the effects of medication on the symptoms of autism. This is an area of conflict because as stated in the article by Broadstock, Doughty and Eggleston (2007), medication can only treat the symptoms of autism, such as depression, hyperactivity, repetitive behaviors, and inattention. In their study, the authors discuss that medication should be used in conjunction with other therapies. They also go on to say that there are no studies that look into the long-term effects of medication for autistic individuals, but they have found a decrease in affect (emotion) with age.

            The final step of the broad model is to “reflect on how using an interdisciplinary approach has enlarged your understanding of the problem” (Repko, 2014, p. 295). When I first looked at the problem, I was surprised to find so many therapies. Before researching, I would have assumed that a majority of the therapies would come from psychology because I believed that autism was a matter of brain abnormality. This project challenged those thoughts and I came to find out that the most common therapy is speech language pathology. When reading each journal article, I found myself questioning them because they were so focused on their one discipline or expertise. With a disorder such as autism, you have to think outside of your own discipline as well, which causes a problem for most researchers because they are experts in their field and that is all they know. Using an interdisciplinary approach opened my eyes to the possibility of a program that can comprehensively treat autism instead of multiple programs focusing on individual issues. If all therapists came together and worked on each individual case, they could create less confusion for the individual who has to see four different therapists all telling them something different to work on. Autism needs to be thought of as a whole instead of each discipline breaking off a piece of the problem and trying to fix that one thing. There needs to be more interdisciplinary research for autism so therapists or researchers can join together to create something wonderful.
 Catrina Wade

Aksay, E., & Alp, A. (2014). The effects of a physical activity rehabilitation program on themotor skills and physical performance of children with autism spectrum disorder.International Journal of Academic      Research. (6)1. 12-19.

Bhat, A., Landa, R.J., & Galloway, J.C. (2011). Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. American Physical Therapy Association Journal. (91)7. 1116-1129.

Broadstock, M., Doughty, C., & Eggleston, M. (2007). Systematic review of the effectiveness of  pharmacological treatments for adolescents and adults with autism spectrum disorder. SAGE Publications. (11)4. 335-348.

Kao, Y., Kramer, J.M., Liljenquist, K., & Coster, W.J. (2014). Association between impairment,function, and daily life task management in children and adolescents with autism. Developmental Medicine & Child Neurology. 1-6.

Mieres, A.C., Kirby, R.S., Armstrong, K.H., Murphy, T.K., & Grossman, L. (2012). Autism  spectrum disorder: an emerging opportunity for physical therapy. Pediatric Physical Therapy. (24). 31-37.

Morgan, L.J., Rubin, E., Coleman, J.J., Frymark, T., Wang, B.P., & Cannon, L.J. (2014). Impact of social communication interventions on infants and toddlers with or at-risk for autism: A systematic review. Hammill Institute on Disabilities. (29)4. 246-256.

Preis, J. & McKenna, M. (2014). The effects of sensory integration therapy on verbal expression and engagement in children with autism. Rehabilitation. (21)10. 476-486.

Repko, A.F., Szostak, R., & Phillips Buchberger, M. (2014). Introduction to Interdisciplinary Studies.

Roncaglia, I. (2014). Coping styles: a better understanding of stress and anxiety in individuals with autism spectrum conditions through sport and exercise models. Psychological Thought. (7)2. 134-143.


1 comment:

  1. Nice work! You did very well taking the information from your LitSearch and integrating it smoothly into this narrative, and then embedding all of that in the Broad Model steps. Try to keep the steps of the Broad Model in mind when you continue your studies, since they will help you deal more comprehensively with almost any research assignment that you are given! Wishing you all the best in your next steps, Catrina!!