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Autism spectrum disorder (ASD) has risen in public consciousness in recent years, creating the false impression that its diagnosis is a relatively new development. In fact, written evidence of the condition can be found as far back as the 1800s. That’s when Dr. Jean-Marc Gaspard Itard took an interest in a boy who had been found wandering in a forest near Aveyron, France. The boy did not speak, seemed deaf to speech, and was often hyperactive and uninterested in learning.
Ignoring contemporary medical opinion—which deemed the so-called “wild child” unable to adapt to social conventions—Itard cared for the boy, whom he called Victor, experimenting with behavioral programs centered around language and empathy. Two years later, he published his notes on his compassionate approach to care in a book called The Wild Boy of Aveyron. Today, his records provide the fullest pre-20th-century description of an autistic child.
This kind of “moral treatment” grew to become the dominant early-nineteenth-century approach in hospitals. This approach employed methods similar to modern-day occupational therapy, particularly in terms of treatment methods like systematic instruction and positive reinforcement. But the occupational therapy landscape we know today is far different than the medical field of Itard’s time.
According to the American Occupational Therapy Association (AOTA), the primary goal of occupational therapy is to support and enable an individual’s “health, well-being, and participation in life through engagement in occupation.” OTs work with patients who live with an injury, illness, developmental disorders, or disabilities that impede participation in a range of everyday activities. Through occupational therapy, these patients become more independent. For children with an ASD diagnosis, occupational therapy treatment plans often focus on play skills, learning strategies, and self-care—but that’s not all you need to know.
Our guide to occupational therapy for autism answers these questions:
Autism spectrum disorder (ASD) is a complex developmental condition encompassing challenges with social skills, repetitive behaviors, speech, and nonverbal communication. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need substantial help in their daily lives. Others need less.
According to the Centers for Disease Control (CDC), autism affects an estimated 1 in 54 children in the US. Characteristics of ASD tend to manifest during early childhood and last throughout a person’s life. They typically fall into these distinct categories:
There is no medical test for autism. When diagnosing a child, a trained professional—e.g., a developmental pediatrician, child psychiatrist, or pediatric neurologist—observes how they talk and act compared to other children of the same age and ask questions to parents and other caregivers about the child’s development. An ASD diagnosis now includes several conditions that used to be diagnosed separately. They include autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome.
While people with ASD have the same health problems that affect the general population, they face a greater risk for medical conditions such as sleep problems, seizures, and mental health challenges such as anxiety, depression, and attention issues. According to the American Journal of Occupational Therapy (AJOT), adults with autism also experience younger mortality rates. However, many people with ASD go on to live independently and productively with a positive quality of life.
Occupational therapists—OTs for short, or OTRs (registered), or OTR/Ls (registered/licensed)—break down the occupations or “jobs” of children into three areas of everyday life:
Occupational therapy services typically start with an assessment to determine a child’s functioning level. This may include a range of evaluations as well as observing the child to see how well they complete daily activities like brushing teeth, participating in a group activity, playing catch, or cutting paper with scissors. They may also pay attention to whether specific sensory inputs such as bright lights, loud sounds, or certain smells or textures create difficulties for the child.
Once tests and observations are complete, the OT develops an intervention program for the child’s individual needs that outlines the anticipated treatment approach, methods, and outcomes of therapy sessions. Whether an early intervention for children up to age three or for older children, these programs help the child build their strengths and improve skills in areas of weakness. Interventions may use methods of play therapy, sensory integration therapy, behavioral therapy, among other forms. Some common intervention areas include:
Many adults with autism also participate in occupational therapy. For some adults, the role of occupational therapy is to help build life skills like cooking, cleaning, managing money, or navigating higher education or the job market. For others, it’s a tool to learn how to manage stress, build physical abilities like strength and endurance, or improve self-advocacy skills.
Salary information for OTs who specialize in ASD or—even a broader range of developmental disabilities—is scarce. The Bureau of Labor Statistics (BLS) provides income data regarding all US occupational therapists, who make a median income of $84,950.
BLS data indicate that OT salaries are impacted by work settings. OTs at nursing care facilities, for instance, made a median annual income of $90,830 last year—the highest pay within the occupation based on employer type. OTs working in home health care service-settings made $89,220 per year. OTs at state, local, and private elementary and secondary schools reported a median annual income of $74,670, the lowest of the overall group.
Before 2007, programs accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) were offered at the bachelor’s, master’s, or doctoral level. Since then, all US states except Colorado have mandated OTs have at least a master’s degree. Traditional full-time master’s programs in the field tend to be two to three years in length and combine classroom learning with extensive fieldwork in hospitals, residential centers, rehabilitation facilities, clinics, and other healthcare settings. They also aim to prepare students to sit for the Occupational Therapist Registered (OTR) exam from the National Board for Certification in Occupational Therapy (NBCOT). Passing the exam qualifies them as registered occupational therapists.
However, change may be imminent. In September of 2017, the ACOTE announced that the entry-level degree requirement for the occupational therapist would move to the doctoral level by July 1, 2027. According to the organization, this mandate would not impact occupational therapy students currently enrolled in master’s programs or current occupational therapists practicing with a bachelor’s or master’s occupational therapy degree. Only students graduating after July 1, 2027, would be impacted. The organization put a hold on this mandate one year later, meaning the question remains unsettled for the time being. The trend toward more stringent degree requirements, however, is clear.
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