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Occupational Therapy as Management of Autistic Children in Malaysia

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According to Diagnostic and Statistical Manual of Mental Disorders 5th Edition American Psychiatric Association (2013), it specified two major characteristics of impairment in autism spectrum disorder which are deficits in social interaction and social communication, restricted, repetitive patterns of behaviour, interests, or activities. Children with autism may demonstrate a variety of behaviour which affects their ability to participate in their activities of daily living. These behaviours may affect themselves to impose rigidity on their daily activities, habits and patterns of play, motor and sensory problems (Frolek Clark et al. 2004). Autistic children may also experiences with other difficulties such as fear or phobias, sleeping and eating disturbances, temper tantrums and aggression. The characteristics of autism spectrum disorder may change as the children grow older. However, they may still have the difficulties in socialization, communication, and interests continue in adulthood (World Health Organization 1993). It typically begins before the age of 3, creating challenges throughout their lifespan and it is at least four times more likely to happen in males than females (Fombonne 2003). The prevalence of autism spectrum disorder in Malaysia was approximately at 1.6 per 1000 (Mohd Kassim Ab et al. 2009).

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According to Malaysian Occupational Therapy Association, occupational therapy promotes health by enabling people to perform meaningful and purposeful occupations. These include work, leisure, self-care, domestic and others. Occupational therapists work with individuals, families, groups and communities to facilitate health and well-being through engagement or re-engagement in occupation. In term the role of occupational therapy with autistic children, they focus on the needs of the children and their families. Occupational therapy evaluation is used to know the autistic children’s abilities and difficulties in performing daily activities such as play, school, leisure, and personal care activities. Furthermore, the process of evaluation also will look at the child’s development in other domains which include motor, perceptual, communication and interaction skills, habits and routines. Interview with the autism children, parents, siblings, teachers and caregivers and observation of the children during activities at school and home such as classroom tasks, mealtimes and play are carried out to gain a better understanding of the autistic child’s abilities, needs and goals.

Ministry of Health Malaysia (2014) reported that the occupational therapy management with autistic children in Malaysia include sensory integration therapy, social skills, self-care skills and behavioural intervention. According to Bumin et al. (2015), more than 80% children with autism accompanied with sensory processing problems. Sensory integration therapy often used in occupational therapy to manage autistic children with sensory processing problems. Sensory integration is a process of organizing sensory information in brain in order to create an adaptive response. Therefore, the children can form responses that require integration of those sensations appropriately (Bumin et al. 2015). The intervention involves provision of sensory input by using appropriate modalities. For instance, using different textures for bathing, massage, vibrating toys, finding objects from a bag full of rice or beans can be used to improve sensation.

Self-care skills interventions improve those skill which deficits in autistic children. Self-care skills are oriented toward taking care of their own body which include bathing, toilet hygiene, dressing, eating, feeding, bowel and bladder management, personal care. Autistic children generally have limited engagement in their activities of daily living. At the initial stage of intervention, occupational therapist uses an activity analysis to define which steps of activity process is the problem and defines behavioural, educative methods to be used. Reinforcement or reward systems are used in attainment and sustainment of skills with autistic children. Besides guiding learning, they may facilitate visual, verbal, tactile and cues. Cue is important to improve the quality of performance and to brief autistic children on what to do for the next step.

Autistic children have difficulties in using non-verbal social skills such as eye contact, facial expression and gestures to regulate their social interaction. Besides that, they also face the difficulties to interaction with peers, problems on sharing enjoyment and interest with other people. Thus, social skill training is used to improve the social skills of the autistic children. The basic social skills such as eye contact, using expressions such as “hello”, “thank you” which are the basics for social communication, answering questions such as “how are you”, playing with peers and getting in line in plays are the targeted in social skills training (Leaf et al. 2009; Matson et al. 2007). There are many advanced social skills that should be attained after the accomplishment of basic social skills. It can be classified under four main groups which are communication skill, social interaction skill (friendship), social interaction skill (playing), emotion recognition and management skill (Attwood 2000; Howlin et al. 2011; Myles 2003). Social skills training based on occupational therapy intervention with autistic children should be client-centred, supporting active engagement in cooperation with families and teachers in children’s natural settings such as home and classroom with consider of emotional differences. Therapists can link social skills training with to the routine daily activities of the children creatively.

Cognitive behavioural therapy is used to help autistic children to regulate their emotions and improve their behaviour. In addition, some autistic children will struggle with fears, anxiety and depressed. Cognitive behavioural therapy is helpful to reduce the depressed, anxiety feelings and behaviour by making changes in thinking and perceptions of situations through a change in cognition. In term of cognitive behaviour therapy based occupational therapy, therapists seek to reduce challenging behaviours such as angry outburst and also teach the children how to become familiar with and manage certain feelings that may arise during activities of daily living (Haglund L et al. 2000; Ikiugu Mn 2004). For instance, therapists help autistic children to learn about emotions so that they able to recognize the connections between thinking and feeling, helping them to identify the physiological effects of anxiety on the person such as sweating, increased heart rate or crying.

In conclusion, the key role for occupational therapist is to early detection of features autism and making recommendations for services that give the positive outcomes. Overall, occupational therapy management varies according to the needs of the autistic children. The goal of occupational therapy is to help the children with autism spectrum disorder improve in their quality of life and engage in daily occupations. It can provide opportunities to develop wide range of skills by using the effective strategy in occupational therapy management. 

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