The document discusses occupational therapy services for individuals with autism spectrum disorder across the lifespan. It provides statistics on autism prevalence and definitions. It outlines the scope and domains of occupational therapy, including areas of occupation, performance skills, and contexts. The document discusses outcomes for autistic adults, barriers to continued support, and the need for transition planning. It proposes using occupational therapy evaluations and interventions to create a "blueprint for success" for autistic clients in areas like independent living, employment, and social participation. Case studies are presented to illustrate occupational therapy approaches.

1. Breaking the Mold
Creating a Blueprint for the Adult with ASD using an
Occupational Therapy Approach
Justin Lundstedt, OTR/L

2. Objectives For Today
• Brief introduction / reintroduction to autism
• Understand the background of occupational therapy
• Recognize occupational therapy’s role as a service for the
general ASD population
• Identify the need for continued services in clients with ASD
through transition and adulthood
• Provide further methodology and services under the OT
umbrella for the aging client with ASD
• provide case study descriptions of OT services

3. Autism statistics
• Currently 1/68 children are diagnosed with ASD
• 1/42 boys ; 1/189 girls
Center for Disease Control and Prevention

4. Autism defined under DSM-5
• Persistent deficits in social communication and social
interaction across multiple contexts:
• Deficits in social-emotional communication
• Deficits in nonverbal communication
• Deficits in developing, maintaining, and
understanding relationships
(Severity is based on social communication impairments
and restrictive repetitive patterns of behavior)

5. Autism defined under DSM-5
• Restricted repetitive patterns of behavior, interest, or
activities as manifested by at least two of the following:
• Stereotyped or repetitive motor movements, use of
objects or speech
• Insistence on sameness, ritualistic
• Highly restricted fixated interests of abnormal or
intensive focus
• Hyper or hypoactivity to or unusual interest in
sensory aspects to the environment

6. Autism defined under DSM-5
• Symptoms must be present in early
development
• Symptoms cause clinically significant
impairment in social, occupational or other areas
of functioning
• Disturbances are not better explained by
intellectual disability

7. Autism defined under DSM-5
• Severity levels
1. Level 3: Requiring very substantial
support
2. Level 2: Requiring substantial support
3. Level 1: Requiring support

9. Occupational Therapy
• Professionals focused on
maximizing participation in all areas
of life including but not limited to:
• ADL's (feeding, hygiene,
dressing)
• Instrumental ADL's ( community,
mobility, safety)
• Education / work
• Leisure / play / social interaction
Tomcheck et al

10. Domains of OT
• Areas of occupation
• Activity demands ( physical, cognitive,
spatial, social, properties)
• Client factors (specific abilities,
characteristics, beliefs)
• Environment and context
• Performance patterns ( habits, roles,
routines)
• Performance skills (communication,
interaction skills, motor and processing
skills)
(Autism: A comprehensive Occupational
Therapy Approach 2nd ed.)

11. Scope of OT for individuals with ASD
• Support health and participation through
engagement in life's occupations (AOTA, 2008)
through:
• Evaluation
• Intervention
• Assessment of outcomes
• Providing of services to client and those in their lives

12. Major life stages of OT
intervention
• Early intervention ages 0-3
• CPSE ( preschool) ages 3-5
• School age 5-21
• Transition age 14-21
• Adult ages 21 and up

13. Outcomes of Autistic Adults
• 81% of adults are living with
their parents
• Based on recent research
• 34.75 of those studied
attended college
• 55% held paid employment
during the first 6 years after
graduation
• More than 50% after 2
years of HS had no
participation in ed or
vocation
(Shattuck et al.)

14. Why?
• Services cease at the end of
schooling
• transition plans do not fully
plan for the future
• The client needs to self
advocate
• A difficult path to identify help
• In the past a lot of help has
been private pay

15. Outcomes Of Autistic Adults
cont.
• It is important to look at data to
see what those with ASD and
their caregivers need
• Focus on both self reporters
and legally represented sample
• There are recognized
similarities between those that
self report and those with legal
representation
2015 Gotham et al.

16. What treatment is most
utilized for adults with ASD
• Medication
• Behavioral / psychotherapy
• Alternative medicine
• Self help books
• Support / social groups
• Therapies (speech, OT, PT)

18. What information is sought
out most often?
• Understanding and acceptance of adults with ASD
• Employment
• Health care access
• Education
• Current treatments
Gotham et al. 2015

20. Insurance reform
N.Y. Insurance Law § 3216, § 3221 and § 4303
Require specified policies and contracts that provide coverage for hospital
or surgical coverage to not exclude coverage for the screening, diagnosis and
treatment of medical conditions otherwise covered by the policy solely because
the treatment is provided to diagnose or treat autism spectrum disorder. The law
was amended by 2011 N.Y. Laws, Chap. 595 (AB 6305) to also require every
policy which provides physician services, medical, major medical or similar
comprehensive-type coverage to provide coverage for the screening, diagnosis
and treatment of autism spectrum disorder. The law prohibits any limitations on
visits that are solely applied to the treatment of autism spectrum disorder.
Treatment of autism spectrum disorder is defined to include behavioral health
treatments, psychiatric care, psychological care, medical care, therapeutic care
and specified pharmacy care. 2011 N.Y. Laws, Chap. 596 (SB 5845) amended
these provisions to specify that coverage for applied behavior analysis is subject
to a maximum benefit of $45,000 per year.Citation: N.Y. Isc Law §3216

21. Initiating a blueprint for "success"

22. Occupational Therapy Evaluation
of the Adolescent / Adult
• When does a client get
referred to an OT
• How does a client get referred
to an OT?

23. Evaluate
• Evaluation should be tailored to the concerns of the client
and or guardian
• Utilize skill based assessments to determine the client’s
abilities in the areas of motor function, cognitive
processing, sensory processing
• Conduct a client centered assessment to identify interests,
satisfaction, limitations, goals
• Conduct an assessment of their life environments
( community, school, workplace) to identify limitations or
needs for adaptations

24. Evaluation Tools /
Assessments
• Function based:
• Goal Oriented Assessment of Lifeskills (GOAL)
• Pediatric Evaluation of Disability Inventory Computer
Adapted Test (PEDI-CAT)
• TEACCH Transition Assessment Profile (TTAP)
• Canadian Occupational Performance Measure
(COPM)
• Leisure / interest check lists

25. Evaluation Tools /
Assessments cont.
• Cognitive Assessments:
• Behavior Rating Inventory of Executive Function
(BRIEF)
• Dynamic Lowenstein Occupational Therapy
Cognitive Assessment (DLOTCA)
• Behavioral Assessment of Dysexecutive
Syndrome (BADS)
• Executive Functioning Performance Test (EFPT)

26. Evaluation Tools /
Assessments cont.
Sensory based:
• Sensory Integration Performance Test (SIPT)
• Sensory profile for Adolescent and Adults

27. Assess and interpret
• Assess the client's strengths
and weaknesses and interpret
how they impact their daily lives
• It is important to look at this
from a global standpoint. ASD
presents with difficulties
generalizing and transferring
information from one area to the
next.
• Do your homework about the
client! Access all the resources
available to you!

28. Communicate findings
• Provide feedback as soon as possible
• Identify client’s and parents’ understanding of
results
• Develop a document that identifies results and
discussion (written evaluation)
• Identify next steps with client and / or family
(recommendations)

29. Provision of Therapy
• There is no "one size fits all" therapy. During first session create
concrete goals
• Client centered process using a Person Centered Planning
Approach
• This allows you to identify goals, strengths, weaknesses,etc. if
a standard form doesn't work, BE CREATIVE (D&D)
• Have client take ownership.
• Identify REALISTIC goals
• Identify time frame, but allow for some flexibility

30. Provision of Therapy cont.
• Maintain a structure or format for session,
identifying daily goal and goal working towards
• Identify progress along the way
• Restructure goals as needed
• Plan ahead for discharge or transition / transfer of
services
• Utilize the whole team

31. Case Study 1
• 18 year old male
• High IQ (test results identify high average)
• Secondary to poor social skills, difficulty adapting to
school environment dropped out of school, took GED
exam
• Current goals: to attend college and focus on life
sciences and technology, to get a license
• Limitations: foresight, organization, time management,
social interaction, initiation and planning, IADL's, ADL's

32. Case Study 2
• 53 year old gentleman of high intelligence
• Recently diagnosed with ASD
• Struggled with obtaining a new job
• Struggles with marriage / relationships
• Strengths: motivated, intelligent
• Limitations: self reflection, empathy, flexibility, social
awareness

33. Case Study 3
• 15 y/o with mild to moderate cognitive deficits
(expressive / receptive, working memory)
• Sophomore in high school, aspirations of becoming a
musician with a back up job of administrative
assistant. Would like to be accepted by others
• Strengths: dexterity, focus, intelligence
• Weaknesses: initiation, organization, restrictive
thoughts, poor social skills, working memory, problem
solving

34. Other forms of OT services
• 1:1
• Didactic ( pairing, complimentary)
• Group (Interdsciplinary, transdiciplinary, single discipline)
• Consultation ( education, community, vocational, family)
• Tele-therapy
• Education (school based, business, community, professional)
• Advocacy

35. Don't hold all
of the weight
Utilize team:
Psychiatrist
Psychologist
SLP
PT
SW
Vocational services
Disability services

36. Questions???

37. –AOTA PRESIDENT GINNY STOFFEL
“Occupational Therapy practitioners ask,
"what matters to you" not, "what's the matter
with you?" ”

38. THANK YOU!

39. Works Cited
• "Data & Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention,
12 Aug. 2015. Web. 23 Oct. 2015.
• Gotham, Katherine, Alison Marvin, Julie Lounds Taylor, Zachary Warren, Connie M. Anderson, Paul A. Law,
Jessica K. Law, and Paul H. Lipkin. "Characterizing the Daily Life, Needs, and Priorities of Adults with Autism
Spectrum Disorder from Interactive Autism Network Data." Pub Med. N.p., n.d. Web. 23 Oct. 2015.
• Miller-Kuhaneck, Heather. Autism: A Comprehensive Occupational Therapy Approach. 2nd ed. Bethesda,
MD: American Occupational Therapy Association, 2004. Print.
• Shattuck, P. T., S. C. Narendorf, B. Cooper, P. R. Sterzing, M. Wagner, and J. L. Taylor. "Postsecondary
Education and Employment Among Youth With an Autism Spectrum Disorder." Pediatrics 129.6 (2012):
1042-049. Pub Med. Web. 10 Oct. 2015.
• Shattuck, P. T., S. C. Narendorf, B. Cooper, P. R. Sterzing, M. Wagner, and J. L. Taylor. "Postsecondary
Education and Employment Among Youth With an Autism Spectrum Disorder." Pediatrics 129.6 (2012):
1042-049. Pub Med. Web. 10 Oct. 2015.
• Tomcheck, Scott, Patty La Vesser, and Renee Watling. "The Scope of Occupational Therapy Services for
Individuals With an Autism Spectrum Disorder Across the Life Course." American Journal of Occupational
Therapy 64.6_Supplement (2010): n. pag. Pub Med. Web. 10 Oct. 2015.