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Stack #4566477
| Question | Answer |
|---|---|
| ASD — Description | Neurological disorder with challenges in communication and social interaction. Early theories wrongly blamed parents. Prevalence has risen to 1 in 36. ASD is a major public health concern. |
| Before DSM-5 — Separate Diagnoses | Before 2013, autism was defined by three separate diagnoses: Autism, Asperger’s Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). |
| Autism (pre-DSM-5) | Abnormal or impaired development in social interaction and communication skills, requiring 6 or more difficulties noted in social interaction, communication, or repetitive stereotyped behaviors. |
| Asperger’s Syndrome (pre-DSM-5) | No delays in language, cognition, or adaptive/self-help skills, but impairment in social interaction and restricted behavior patterns; motor clumsiness may be present. |
| PDD-NOS (pre-DSM-5) | Severe impairment in the development of reciprocal social interaction not meeting criteria for other specific ASD diagnoses. |
| DSM-5 Criteria Overview | Diagnosis requires difficulties in social emotional reciprocity, nonverbal communication (e.g., abnormal eye-contact, body language), and deficits in developing and maintaining relationships. |
| DSM-5 Restricted and Repetitive Behaviors (RRBIs) | Individuals must demonstrate at least two of four types: repetitive behaviors, rigid routines, highly restricted interests, or unusual sensory reactivity. |
| RRBI Type 1 — Repetitive Behaviors | Includes stereotyped speech, repetitive motor movements, echolalia, or repetitive use of objects. |
| RRBI Type 2 — Rigid Routines | Rigid adherence to routines, ritualized patterns, or extreme resistance to change. |
| RRBI Type 3 — Restricted Interests | Highly restricted interests with abnormal intensity or focus (e.g., strong attachment to unusual objects). |
| RRBI Type 4 — Sensory Reactivity | Increased or decreased reactivity to sensory input or unusual interest in sensory aspects of the environment. |
| ASD Severity Levels Overview | Severity is categorized based on the required level of support, ranging from Level 1 (Requires Support) to Level 3 (Requires Very Substantial Support). |
| Level 1 — Requires Support | Deficits in social communication; lack of flexibility in routines or habits; difficulty with transitions, organization, and planning. |
| Level 3 — Requires Very Substantial Support | Severe deficits in verbal and non-verbal social communication severely limiting interactions with others; extreme difficulty coping with change. |
| Occupational Performance Impacts Overview | ASD affects multiple domains of occupational performance including social participation, play, ADLs/IADLs, sleep, and education. |
| Social Participation Impacts | Difficulties with social interaction and friendships, social isolation, and limited romantic relationships. |
| Play Impacts | Play may be atypical in type, quality, and complexity; often lacks pretense and may include uncommon use of objects and sensory seeking. |
| ADLs/IADLs Impacts | Common issues include limited diets, fear of toileting, and distress over hygiene or dressing tasks. |
| Sleep Impacts | Difficulties falling or staying asleep are very common and can negatively affect parental sleep. |
| Education Impacts | Children with ASD show a wide range of academic performance; social or behavioral struggles often affect classroom learning. |
| Performance Skills — Sensory | Unusual sensory responses and sensory processing impairments are common. |
| Performance Skills — Cognitive | Difficulty switching attention, impulse control, and taking others’ perspectives into account. |
| Performance Skills — Motor | Clumsiness, delayed motor milestones, dyspraxia, and motor planning difficulties. |
| OT Role Overview | The OT’s role is to promote full participation in occupations for the child and family. OT is the third most common intervention requested for ASD. |
| OT Evaluation Approach | Evaluation must be comprehensive, strengths-based, and family-focused. OTs assess unusual behaviors, safety concerns, and escapism. |
| OT Intervention Focus | Intervention may be adult-directed and structured, or child-directed, playful, and naturalistic. Evidence-based practice is critical. |
| Intervention — Social & Communication Supports | Includes social supports, behavioral strategies (e.g., Social Stories, visual/auditory supports), and programs like PEERS using CBT principles in parent-assisted social skills groups. |
| Intervention — Cognitive (CO-OP) | The Cognitive Orientation to Daily Occupational Performance approach uses a problem-solving strategy called Goal-Plan-Do-Check to improve functional performance. |
| Intervention — Structured Teaching (TEACCH) | The UNC TEACCH Program uses Structured TEACCHing: external organizational supports, individualized schedules, work systems, and visual structure of materials to promote flexibility, independence, and meaningful engagement. |
| Intervention — Early Start Denver Model (ESDM) | Behavioral intervention for children 12–48 months with ASD that integrates developmental, play-based, and relationship-based principles using ABA methods. |
| Intervention — Floor-Time (DIR) | Family-centered, naturalistic play-based intervention focused on following the child’s lead and expanding interaction through shared engagement and emotional connection. |
| Childhood Mental Health and OP Overview | Approximately 13.4% of children and adolescents have mental health conditions that interfere with daily occupations. |
| Neurodevelopmental Disorders Overview | Include Intellectual Disabilities (ID), Autism Spectrum Disorder (ASD), ADHD, and Specific Learning Disorders. |
| Intellectual Disabilities Definition | Defined by deficits in adaptive behavior, academic performance, and adaptive function. |
| Intellectual Disabilities — Severity Levels | Mild (IQ 50–70), Moderate (IQ 35–55), Severe (IQ 20–35/40), and Profound (IQ below 25). |
| ADHD Description | Characterized by inattention, hyperactivity, and impulsivity that interfere with function and participation. |
| ADHD — Inattention | Includes disorganization, distractibility, and avoidance of effortful work. |
| ADHD — Hyperactivity | Includes fidgeting, excessive movement, or difficulty staying seated. |
| ADHD — Impulsivity | Includes interrupting, difficulty waiting turns, and acting without thinking. |
| Other Childhood Mental Health Conditions | Include Anxiety Disorders, Obsessive-Compulsive Disorder (OCD), Conduct Disorders, and Post-Traumatic Stress Disorder (PTSD). |
| Obsessive Compulsive Disorder (OCD) | Characterized by compulsions and ritualized behaviors such as handwashing or checking. |
| PTSD and Adverse Childhood Experiences (ACEs) | ACEs and trauma can disrupt emotional regulation and alter neural pathways, impacting occupational performance. |
| Mental Health Evaluation Overview | Evaluation includes collecting the Occupational Profile, analyzing performance, and synthesizing information across motor, process, and social domains. |
| Standardized Evaluation Tools | Common tools include the BRIEF (Executive Function), CDI (Children’s Depression Inventory), and the Sensory Profile. |
| Executive Function (EF) Focus | Intervention often targets EF: sustaining/shifting attention, inhibition, memory, self-regulation, and emotion modulation. |
| CO-OP Approach | Client-centered cognitive behavioral approach using the Goal–Plan–Do–Check framework to guide skill learning and problem solving. |
| Emotional Regulation Strategies | Include deep breathing, self-talk, mental imagery, and sensory techniques to reach the “Just Right Level of Arousal.” |
| Zones of Regulation Program | Developed by Leah Kuypers, OT; uses four colored zones (Blue: low alertness, Green: regulated, Yellow: heightened but controlled, Red: extremely heightened/loss of control). |
| Behavioral Approaches | Focus on positive reinforcement and behavioral mapping (detailing behavior, its impact on others, and response). |
| Social Thinking Curriculum | Teaches social cognition and self-management using concepts like Superflex (flexible thinker) vs. Rock Brain (rigid thinker). |
| Problem-Solving Strategies Overview | Include Social Autopsies and SOCCS (Situation, Options, Consequences, Choices, Strategies, Simulation). |
| Role of OT in Mental Health | OTs address emotional regulation, executive functioning, and social participation to enhance engagement in meaningful occupations. |
| Hand Development Overview | Hand development progresses from proximal to distal, requiring postural stability and wrist stabilization. Important components include hand arches and web space. |
| In-Hand Manipulation Skills | Include translation, shift, and simple or complex rotation needed for object manipulation and handwriting. |
| Handwriting Evaluation Focus | Evaluations examine legibility and speed by assessing spacing, placement on the line, sizing, near/far point copying, dictation, and composition. |
| The Print Tool Overview | Formal assessment for ages 6+, evaluates 7 components: Memory, Orientation, Placement, Size, Start, Sequence, and Spacing. |
| The Print Tool — Orientation | Refers to facing letters and numbers in the correct direction. |
| The Print Tool — Start | Refers to where each letter begins; children should avoid starting from the bottom of the line. |
| Evaluation Tool of Children’s Handwriting (ETCH) | Criterion-referenced test for grades 1–6 measuring handwriting legibility and speed across various writing tasks. |
| Test of Handwriting Skills-Revised (THS-R) | Norm-referenced test assessing manuscript and cursive writing through dictation, copying, and writing the alphabet from memory. |
| Instructional Handwriting Curriculums | Common approaches include D’Nealian, Zaner-Bloser, and Handwriting Without Tears. |
| Benefits of Vertical Writing Surfaces | Using an easel or chalkboard encourages mature grasp, improved web space, and greater hand arching. |
| Visual Information Processing (VIP) Definition | The process responsible for the reception and cognitive interpretation of visual stimuli. |
| VIP Major Skill Areas | Includes Visual Spatial skills, Visual Analysis skills, and Visual Motor Integration (VMI). |
| Visual Analysis Skills Definition | Enable the child to analyze and discriminate visually presented information accurately. |
| Visual Discrimination | The ability to notice similarities and differences between objects or symbols. |
| Figure-Ground Discrimination | The ability to focus on relevant visual information while filtering out background distractions. |
| Visual Closure | Recognizing a complete figure or object when only a fragment is visible. |
| Visual Memory | Remembering a visual image or pattern after a short delay. |
| Form Constancy | Mentally recognizing and manipulating a figure in different orientations or positions. |
| Visual Motor Integration (VMI) Definition | The ability to integrate visual information with fine motor movement, essential for handwriting and eye-hand coordination. |
| VMI Difficulty Red Flags | Include letter reversals, poor line awareness, difficulty copying written work, and general clumsiness. |
| Assistive Technology (AT) Definition | The WHO defines AT as enabling people to live healthy, productive, independent, and dignified lives and to participate in education, work, and civic life. AT reduces need for health/support services; without AT, people may be isolated and excluded. |
| Accessible Education Materials (AEM) Definition | Materials and technologies usable regardless of format or features. They may be accessible from the start or made accessible for learners with disabilities. |
| AT — Categories Overview | AT is commonly categorized by technology complexity: low-tech, mid-tech, and high-tech devices. |
| Low-Tech AT Examples | Include communication boards, pencil-and-paper devices, built-up handles, graphic organizers, page protectors, and enlarged size materials. |
| Mid-Tech AT Examples | Include screen magnifiers, adapted seating, audiobooks, adapted keyboards, word prediction software, and adapted switches. |
| High-Tech AT Examples | Include power wheelchairs, specialized computer software, Augmentative and Alternative Communication devices (AAC), Smartboards, and iPads. |
| AAC Overview | Alternative and Augmentative Communication (AAC) supports communication using unaided or aided methods. |
| AAC — Unaided | Uses the child’s body: vocalizations, gestures, facial expressions, sign language, eye gaze, and pointing. |
| AAC — Aided | Uses non-electric or electronic aids such as Picture Exchange Communication Systems (PECS) or speech generating devices. |
| AT Evaluation Approach | OTs collaborate with the educational team to evaluate, select, implement, and train on AT. Evaluations should be ongoing, team-conducted, and include device trials in natural settings. |
| AT Evaluation Frameworks | Frameworks following PEOP include HAAT, SETT (school settings), MPT, and WATI. |
| AT Evaluation — Motor, Sensory, and Perceptual | Assess ability to access AT, positioning, strength, endurance, use of both hands, and identification of objects by feel. |
| AT Evaluation — Cognitive/Communication | Consider attention span, cognitive level, sequencing, cause/effect understanding, and language/written communication skills. |
| AT Evaluation — Psychosocial/Motivation | Assess what the child enjoys, how they indicate wants/needs, and whether the device enables new capabilities. |
| AT Evaluation — Context | Consider where the device will be used, optimal positioning, portability, and available supports in different environments. |
| AT Device Procurement | Securing funding through grants, Medicaid, private insurance, nonprofits, schools, or state agencies; requires letters of justification and assessment summaries. |
| Assistive Writing Technology Overview | Supports prewriting, drafting, reviewing/editing, and sharing/publishing. |
| Writing — Prewriting | Use graphic organizers to support planning. |
| Writing — Drafting | Use word processing or word prediction software. |
| Writing — Reviewing and Editing | Use text-to-speech tools and talking word processors. |
| Writing — Sharing/Publishing | Use word processing software. |
| Writing Tools & Environmental Adaptations | Include preferential seating, lighting, adapted paper, stamps, labels, weights, splints, clipboards, and Dycem. |
| Digital Writing Tools | Include portable spell checkers, grammar checkers, portable word processors, electronic pens (Echo), and handheld scanners. |
| Computer Access Solutions | Include keyboard aids, mouse alternatives, alternate keyboards (on-screen or switch-activated), and voice recognition software. |
| Sensory Integration (SI) Definition | SI is the neurobiological process where the brain organizes sensory information to produce an Adaptive Response (successful, goal-directed action). Lack of adaptive response can disrupt daily activities and participation. |
| Vestibular Input Overview | Senses gravity, head position, and movement (linear/rotation). Provides postural control and body position awareness; rotary/angular input is alerting, linear input is calming/organizing. |
| Proprioception Overview | Traction, compression, and muscle contraction provide body awareness, guide force/intensity of movements, and support skilled motor control. |
| Tactile Input Overview | Involves texture, pressure, and light touch; guides fine motor skills and initiates motor and social behaviors. |
| Sensory Reactivity (Modulation) Difficulties | Hypersensitivity or hyposensitivity to sensory stimuli. |
| Gravitational Insecurity | Over-responsiveness to vestibular input; excessive fear during ordinary movement or fear of heights/head movement. |
| Postural Insecurity | Fear of full-body movement due to limited postural stability. |
| Praxis / Dyspraxia | Difficulty conceptualizing, planning, and executing movements. |
| Proprioception Difficulties | Children may appear clumsy, overuse force, break objects, or misjudge personal space. |
| Precautions for SI | Negative reactions to sensory input may not appear for hours (up to 12); children may not recognize when they’ve had enough vestibular input. |
| Ayres Sensory Integration (ASI) Intervention Overview | Systematic sensory input elicits adaptive responses; registration of meaningful sensory input is necessary before adaptive response. |
| ASI Core Fidelity Elements | Includes safety, 2–3 sensory opportunities, supporting sensory modulation, challenging motor skills and praxis/organization, providing the Just Right Challenge, and promoting intrinsic motivation and play. |
| Just Right Challenge (JRC) Definition | Matches the child's developmental skill, provides a reasonable challenge, engages/motivates the child, and can be mastered with focused effort; intensity, duration, speed, complexity, or position can be adjusted. |
| Sensory Diet (SD) Definition | A variety of organizing, calming, and alerting activities occurring at structured times in the child’s schedule; uses Heavy Work (HW), Deep Pressure (DP), Proprioceptive, and Vestibular input. |
| Organizing Input | Decreases over-responsivity using rhythm, proprioception, linear vestibular input; heavy work is both alerting and organizing. |
| Alerting Activities | Include rapid input, quick tempos, fast spinning/rotation, sour/spicy/cold flavors, and fast-moving bright visuals. |
| Calming Input | Slow, steady, rhythmic, predictable input; firm steady pressure (massage, bear hugs, heavy blankets); bland/sweet flavors; slow linear movements. |
| Heavy Work Examples (School) | Washing desks, arranging desks, carrying books, using manual pencil sharpener, or taking a chewy/crunchy food break. |
| Pediatric Feeding Overview | Feeding is a fundamental ADL; feeding difficulties affect 25–45% of typically developing children and up to 80% of children with developmental disabilities. |
| Swallowing Overview | Swallowing requires coordination of 31 muscles and 6 cranial nerves; serves nutritive purposes and protects the lower airways. |
| Infant Anatomy | Infants have a small oral cavity, a large tongue housed entirely within it, buccal pads, and a higher larynx (C1–C3) compared to adults. |
| Feeding Developmental Progression | Nipple feeding (0–6 months), spoon-feeding/purees (4–6 months), chewing (primitive munching at 5–6 months, later mature biting), self-feeding, and cup management. |
| Oral Preparatory Stage | Voluntary phase: Food introduced, lips seal, bolus formed and moved to grinding surfaces. |
| Oral Transport/Propulsive Stage | Voluntary phase: Mastication stops; tongue elevates to hard palate, moving bolus toward pharynx. |
| Pharyngeal Swallow Stage | Involuntary phase: Soft palate elevates, respiration reflexively ceases, vocal folds close, larynx moves up/forward, pharyngeal constrictors propel bolus. |
| Esophageal Swallow Stage | Involuntary phase: Peristaltic contractions and gravity move bolus to stomach in 10–20 seconds. |
| Clinical Swallow Evaluation (CSE) Overview | Starting assessment for safe/effective swallowing without imaging; includes pre-eval chart review, caregiver/child interview, direct assessment, screenings, and counseling/recommendations. |
| CSE — Red Flags Overview | May indicate need for instrumental assessment or medical referral. |
| Red Flag — Pharyngeal Dysphagia | Suggested by throat clearing, effortful swallowing, or coughing. |
| Red Flag — GI Referral | Indicated for gastroesophageal reflux (GER), food allergies, or esophageal dysmotility. |
| Red Flag — ENT Referral | Indicated for upper airway obstruction concerns, such as snoring, hyponasal resonance, or open jaw/lip at rest. |
| Instrumental Assessment — VFSS | Video Fluoroscopic Swallow Study uses barium and X-ray to evaluate oral preparatory, oral transport, and pharyngeal stages. |
| Feeding Recommendations | Include a Feeding Plan (daily nutrition/efficiency strategies) and a Treatment Plan (skill development, strength, coordination). |
| Feeding Clinics Team | Often staffed by Speech-Language Pathologists (SLP) and Occupational Therapists (OT). |
| NICU Practice Overview | NICU OT is a specialty requiring advanced knowledge; generally not recommended for OTAs or entry-level OTs due to high-risk, complex interventions. |
| NICU Care Models | Most commonly used is the Neonatal Integrative Care Model (IDC), expanded from the NIDCAP program. |
| NICU Environment | Loud/mechanical sounds, bright lights, invasive tactile input, rapid position changes; OT protects fragile neonates from excessive or inappropriate sensory input. |
| NICU OT Focus — Physiological Stability | Identify stress signs (pauses, mottled color, tremors) versus stability (smooth breathing, pink color, clear states). |
| NICU OT Focus — Positioning | Prevents deformities, simulates contained/flexed midline posture of utero; improves sleep. |
| NICU OT Focus — Feeding | Oral feeding (nutritive sucking) requires complex coordination of sucking, swallowing, and breathing. |
| Early Intervention (EI) Overview | Services for children birth to 3 years, mandated by IDEA Part C, delivered in the child’s natural environment. |
| EI Eligibility | Children with medical diagnoses automatically eligible; children with suspected delays evaluated within 45 days of referral by multidisciplinary team. |
| Individualized Family Service Plan (IFSP) | Legal document outlining care plan; outcomes must be functional, contextualized, jargon-free, and discipline-free. |
| EI Intervention Approach | Family-centered services using Coaching Families model: observe, act, reflect, evaluate; addresses self-care, adaptive behavior/play, sensory/motor/postural needs. |
| EI Transition Planning | Begins at age 2; transition to school-based special education (IEP) on 3rd birthday if eligible. |
| School-Based Practice (SBP) Overview | OT is a Related Service Provider under IDEA Part B (ages 3–21), supporting access to special education. |
| SBP Key Concept — Least Restrictive Environment (LRE) | Children with disabilities educated with non-disabled peers to the maximum extent appropriate; OT integrates services in classroom/playground. |
| SBP Key Concept — IEP | Blueprint for services including Present Levels of Performance, Measurable Goals, Special Education & Related Services, Supplementary Aids/Services (including AT), and Transition Plan (starting by age 16 or 14 in some states). |
| SBP Key Concept — Section 504 | Provides accommodations for students not eligible for IDEA but requiring support; OT-only services possible under a 504 plan. |
| SBP Key Concept — Workload vs Caseload | Focus on workload (total activities for effectiveness) rather than number of children served; includes hands-on service, collaboration, documentation. |
| SBP Key Concept — RtI/MTSS | OTs support all three tiers: Tier 1 (universal), Tier 2 (targeted), Tier 3 (intensive individualized interventions). |
| Hospital & Outpatient Services Overview | OT evaluation requires physician orders; tools include PEDI-CAT and Wee-FIM II; specialty inpatient/outpatient care. |
| Hospital OT Intervention Approaches — Create/Promote | Enhance engagement in meaningful activities. |
| Hospital OT Intervention Approaches — Establish/Restore | Regain or maintain ROM, strength, or function. |
| Hospital OT Intervention Approaches — Modify/Adapt | Alter task method, equipment, or environment (visual schedules, adaptive equipment, lighter tools). |
| Hospital OT Intervention Approaches — Prevent | Education to family and child to prevent future difficulties. |
| Specialty Unit — Burn Units | Focus on splinting to maintain ROM, therapeutic activity, and ADL retraining. |
| Specialty Unit — TBI | Initial focus on sensory stimulation, ROM, positioning, splinting; later focus on ADLs/IADLs, perceptual skills, executive functioning, and community re-entry. |
| Specialty Unit — Oncology | Palliative focus on energy conservation, positioning, coping skills, and age-appropriate play participation. |
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