Roseann C. Schaaf, Ellen S. Cohn, Janice Burke, Rachel Dumont, Amy Miller, Zoe Mailloux; Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder. Am J Occup Ther 2015;69(5):6905185005. https://doi.org/10.5014/ajot.2015.018036
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© 2020 American Occupational Therapy Association
Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.
Parent-identified goals are an essential part of the occupational therapy process for children with ASD.
Parents are interested in goals that would improve their child’s ability to participate in ADLs, play, and rest and sleep, and thus occupational therapy practitioners should consider interventions that will address these goals.
In their clinical reasoning, occupational therapy practitioners must remain mindful of the importance of communicating effectively with parents to identify goals for a child’s occupational performance and of considering the relationship between performance challenges and sensory-based difficulties.
Although many children with ASD have difficulty processing and integrating sensory information, not all of their behaviors are related to sensory factors. Thus, it is important to use assessment data to identify whether sensory integrative factors are affecting behavior related to the goals identified by parents. If so, occupational therapy using sensory integration may be a useful approach. If not, however, other occupational therapy approaches may be more appropriate.
When providing occupational therapy using sensory integration, it is important for practitioners to explicitly link (hypothesize) the sensory integrative factors to the areas of occupation embedded in the parent-identified goals and to communicate these hypothesized links to parents.
When parents of children with ASD identify goals that may be related to difficulty processing and integrating sensation, a comprehensive evaluation of sensory integrative factors that includes sensory perception and reactivity, vestibular bilateral functions, and praxis should be undertaken (Schaaf, Burke, et al., 2014). This evaluation will allow the occupational therapist to determine whether a sensory integration approach is warranted.
In research examining the outcomes and effectiveness of occupational therapy using sensory integration, it is important to use a systematic process such as DDDM to identify the child’s areas of challenge and develop operationalized goals that explicitly identify the areas of occupation affected. In addition, it is imperative to use assessment data to identify the sensory–motor factors that are hypothesized to be influencing these goals because these factors should be the targets for intervention. Outcome measurement at both the proximal (sensory–motor) and distal (occupation) levels is needed.
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