I've been a therapist for 4 years, but am new treating kids and new to the public school system.  I work in a regular ed school and I see a boy twice a week who is severely autistic.  He really belongs in a different kind of school, but his mother is resisting.  Anyway, he's here and I have to treat him.  The last time I saw him, he was off the wall; throwing himself on the floor, running down the halls, yelling, screaming, etc.  Tried many different activities to engage him, but nothing worked.  Since I don't work in in a sensory gym, I can't quite put him in a swing for slow linear movements to calm him.  I need a seasoned therapist to give me an idea of what might work with this child who is at times all over the place like this.  Would appreciate any and all ideas since I am new to kids.  Thanks so much!  :)

How old is the child? How is the child managing in the classroom?  Does he have an aide?  Is he verbal?

Many autistic children benefit from a daily planner of the days events. It can be extremely useful to set up a visual picture schedule e.g. 10am OT with a photo of you, 12pm lunch with a picture of food, 3.30 home time with a picture waving goodbye.  His aide could take him through this schedule at the beginning of each day.  He may also benefit from active seating such as a move n sit if he is craving movement. Perhaps consider other organization strategies also such as colour coding books (green= spelling). Also social stories may be useful.

In terms of vestibular & proprioceptive activities it is definitely harder without a sensory room of some description, although I guess a reality of what many parents face at home.  

 Some activities I have had success with have included:

-Peanut/ gymball- sit on this and bounce up and down, or roll over it on tummy and press hands into floor (check the sports cupboard, these are also cheapish to buy).  I also have the kids lie down and roll a fitball/ gymball up and down their backs (great for calming).

-Crash mat- squashing/ sandwiching kids in a crash mat/ blankets (great for calming).  (You can make a cheap one by sewing together a duvet cover stuffed with rubber offcuts). 

- Encouraging 'heavy work' in the classroom such as wiping down tables, helping to move furniture, pushing chairs in, helping roll the TV into the room etc. 

-Swinging (I know you don't have one but what about in the playground?)

-Jumping on a mini trampoline (check the sports cupboard) 

- Animal walks (crab walks, bear walks) 

In addition, I find bubbles (blowing, chasing, catching) a pretty big hit generally as well as musical instruments (playing drum, keyboard). Quite motivating for kids.

If he is disruptive in the classroom, it may be that he needs a sensory diet that can be completed at various intervals during the day.   

It sounds like it is very difficult to engage him.  Sometimes I just have several activities set up in my room (e.g. put out a fitball, crash mat, some drums and a puzzle) and then just follow the child's lead as to activities.  

Good luck. 

  

This child is in kindergarten and is verbal.  His K teacher has a picture schedule already instituted in her class. His IEP has a fine motor and graphomotor goal.  Should I start off the session with some of the activities you suggested and then try to work on some of those goals or are those goals to lofty for him now.  Still holds pencil in a full grip.

Thanks,Erika 

 

I am a school based therapist who primarily works with children in all ranges of autism diagnoses. My first response to your post was one of disappointment. Your comments regarding a "special school" and "he's here and I have to treat him" are not only inappropriate but unprofessional. It has been some time since this post and I'm hoping that you have found some appropriate activities to assist this child in maintaining a better regulated state of arousal, and in the meantime earned a greater appreciation for the population with which you work.

I just wanted to say that the fact that you are asking for assistance shows your professionalism, willingness to learn, and desire to help this student despite limited resources.  Keep up the good work.  This sounds like a challenging situation.  I would agree about the sensory diet piece, the picture schedule of events in your session, and have one additional piece to add that has worked for me:  It has helped me to really focus on maintaining a calm demeanor even if the child shows stress and also limiting the amount of talking and stimulation.  Show the child that you are there for him, set limits as necessary, but maintain a calm and matter of fact voice.  Allow the child to calm and then reintroduce the task.  Start with a little at a time and then build upon it. 

Also, I was skeptical at first, but I tried "The Astronaut Program" with a child and she demonstrated significant improvement in visual attention and visual-motor skills.  It may be worth trying. Is there a chair that spins in the school?  This may work.  Also, use the playground.  Water play and play in a bin of rice and beans- scooping and pouring can help.  Take anything the child likes and build upon it. 

Best wishes! 

 

I realize that when it comes to children, people are very sensitive, so I guess I can understand your reaction.  However, #1, I did not say "special school", I said "different school" meaning a District 75 school (which is what a special ed school in the public system is called in NY).  #2, when I said that he's here and I have to treat him, I did not mean it in such a way that it was a bother, but more of a fact that because he is in this general ed school and there is an IEP that has an OT mandate, I need to treat him and that I need some advice.  Sometimes the written word is understood differently by different people.  You don't see my facial expression or hear the tone in my voice, so please try not to assume that someone means the worst.  And by the way, I already had an appreciation for the population I work with including this child and have tried various interventions with him. 

Don't be so quick to assume.  It probably would have been more helpful if YOU had given me some advice since you're such an advocate and seem to be knowledgeable with the autistic population.!!

 

Saying that he belongs in a "different school" or "special school" amount to the same thing - you feel (as you clarified in your follow up post) that this child doesn't belong with the "regular" children, and should be sent to a separate place.  This is why IDEA was created, so children with disabilities such as autism could be treated with their typical peers.  And I happen to agree with the previous poster, my reaction was also disappointment - to read "he's here and I have to treat him" is pretty hard to interpret in a kind or professional way.  If, as you said, you were referring to the OT mandate, that doesn't really help - you are still only treating this child because you are mandated to, not because he or she needs help!

Erika,

I totally understand where you are coming from.  I am also a therapist that has 4 years of experience and currently have a contract position in a school setting.  I also understand about the different setting or school in which you referred to.  I am very much a professional and I am well aware of IDEA and providing children with the treatments they need, however, as a professional I also feel we must take into consideration the rest of the class as well who may not be getting all that they need due to distractions from the student.  I feel that sometimes the children we treat within the school environment may not be in the best classroom and/or school that would most provide for them and where they could be the most successful. I can honestly say that working in the school environment is much different than working in a pediatric outpatient clinic. Good Luck! 

I'm an OTA student just completing my first year, but I have an autistic child and so wanted to offer some advice. Is this child currently using a weighted vest? I find that when my son gets overstimulated and I need to calm him down, using his weighted blanket works miracles. I don't have a vest for him right now because he's growing very rapidly and I don't have the money to keep replacing it, but when he was smaller I had one that worked well for him.

Also if he has any special area of interest he's really focused on right now, dinosaurs, trains, legos, etc. you could use those to help focus his attention. That could be coloring pictures of the object, building them, anything. Once you have him focused and calmed down it may be easier to shift his attention to something else. You could also use the interest activity as a reward to get him to do some of the things he's less inclined to cooperate with.  

 

Thank you all for your suggestions.  Since my original post, I've discovered that he likes to be a "insert name here" sandwich, being smushed by two gym mats.  He also likes to push and pull me on a scooter board.  After these two things, I can get him to focus slightly longer on table top activities.  By the way, his parents are pushing to have him go to a special ed school with a smaller class size since he is not learning very much in his current classroom setting which is a special ed classroom in a Gen Ed school.  In the meantime, I will mention the weighted vest to his mother.  Thanks again.

I think it's ridiculous to critize someone who is seeking information on how to treat a challenging child.  This therapist noted that she was new to the school setting and to the diagnosis.  There is nothing wrong with the request; AND some of these very severe children do NOT belong in the general ed curriculum.  Not only are they disruptive to the classroom, the setting can be too much for the child: too noisy, too much movement, too many people, unexpected noises and sounds, etc etc.