What Is Autism? How Is It Diagnosed? | p. 1 |
Criteria for Autistic Disorder | p. 2 |
Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) | p. 2 |
Asperger's Syndrome | p. 3 |
Rett's Syndrome | p. 3 |
Other Disorders With Autistic-Like Symptoms | p. 4 |
Childhood Disintegrative Disorder (Heller's Syndrome) | p. 4 |
Fragile-X Syndrome (Martin-Bell Syndrome) | p. 4 |
Landau-Kleffner Syndrome | p. 5 |
Mobius Syndrome | p. 5 |
Sotos Syndrome (Cerebral Gigantism) | p. 5 |
Tourette Syndrome | p. 6 |
Williams Syndrome | p. 6 |
Schizophrenia | p. 6 |
What Causes Autistic Spectrum Disorders? | p. 6 |
Characteristics of Autism | p. 7 |
A Need to Function | p. 10 |
Sensory Processing Issues | p. 12 |
Attention and Arousal | p. 14 |
Cognitive Issues and Functions | p. 16 |
How is Information Stored? | p. 16 |
Speech and Language Deficits | p. 17 |
How is Information Learned? | p. 18 |
Motor Control and Its Impact on Functioning | p. 20 |
The Role of Play in Learning | p. 22 |
Behavioral Issues: Analyzing the Behavior | p. 24 |
Primary Causes and Secondary Reinforcers | p. 25 |
Analyzing Behaviors | p. 28 |
Define Challenging Behaviors | p. 28 |
Are the Behaviors Linked? | p. 28 |
Warning Signs | p. 28 |
What Promoted the Behavior? | p. 28 |
Secondary Reinforcers | p. 30 |
Primary Cause | p. 30 |
Obtaining Behaviors | p. 31 |
Social/Communicative Obtaining Behaviors | p. 31 |
Obtaining Attention | p. 32 |
Obtaining a Need or Want/Object or Activity | p. 32 |
Internal/Systemic Obtaining Behaviors | p. 33 |
Nonproductive Sensory Behaviors | p. 33 |
Productive Sensory Behaviors | p. 33 |
Avoidance or Escape Behaviors | p. 34 |
Task or Event Avoidance | p. 35 |
Attention Avoidance | p. 35 |
Internal/Systemic Responses | p. 36 |
Sensory-Based Avoidance | p. 36 |
Systemic Avoidance | p. 37 |
Behavioral Issues: Creating an Environment for Optimal Functioning | p. 38 |
Design the Environment | p. 39 |
Defined Boundaries | p. 39 |
Clutter-Free Environment | p. 40 |
Sensory Environment | p. 40 |
Emotional Environment | p. 41 |
Maximize Strategies and Systems | p. 41 |
Schedules and Planned Activities | p. 41 |
Picture System Schedule | p. 43 |
Down Time | p. 43 |
Transitions | p. 43 |
Choices and Control | p. 44 |
Defined Rules | p. 44 |
Concise Instructions | p. 44 |
Interesting Tasks | p. 45 |
Quantified Tasks | p. 45 |
Behavioral Issues: Treatment Strategies That Facilitate Positive Outcomes | p. 46 |
Secondary Reinforcers | p. 46 |
Negative Attention | p. 46 |
Behavioral Philosophies and Strategies | p. 47 |
Intervene Before the Challenging Behavior Occurs | p. 47 |
Reinforcers | p. 49 |
Primary Reinforcers | p. 49 |
Secondary Reinforcers | p. 49 |
Grading Reinforcers | p. 49 |
Delayed Gratification and Reinforcement | p. 50 |
Time Out | p. 51 |
Taking Time Out | p. 51 |
Giving Time Out | p. 52 |
Therapist's Time Out | p. 52 |
Prompting | p. 53 |
Physical Prompts | p. 53 |
Visual Prompts | p. 54 |
Demonstration and Modeling | p. 55 |
Verbal Prompts | p. 56 |
Shaping Behaviors | p. 57 |
Approximating Desired Behaviors | p. 58 |
Behavioral Issues: Intervention Strategies | p. 59 |
Intervention Strategies for Obtaining Behaviors | p. 61 |
Social-Communicative Behaviors | p. 61 |
Attention | p. 61 |
Object, Need, or Want | p. 62 |
Sensory-Seeking Internal/Systemic Behaviors | p. 63 |
Intervention Strategies for Avoidance or Escape Behaviors | p. 64 |
Avoidance of Attention, People, and Events | p. 64 |
Avoidance of a Task or Object | p. 68 |
Task Is Too Difficult | p. 69 |
Task Is Boring, Not Challenging or Stimulating | p. 69 |
Change in Routine and Activity | p. 71 |
Anger, Frustration, and Escalating Stress | p. 72 |
Internal/Systemic, Sensory-Based Avoidance Reactions | p. 72 |
Internal/Systemic, Visceral-Based Avoidance Reactions | p. 73 |
Temper Tantrums and Challenging Behaviors | p. 74 |
Anticipating the Challenging Behavior | p. 78 |
Working Together as a Team | p. 78 |
Sensory Integration Theory and Treatment | p. 80 |
Sensory Integration | p. 82 |
The Senses | p. 83 |
Processing and Decoding the Information | p. 83 |
Spinal Cord Level | p. 84 |
Brain Stem and Midbrain | p. 84 |
Cerebellum | p. 85 |
Cerebral Cortex | p. 86 |
The Sensory Systems | p. 87 |
Tactile System | p. 87 |
Anterolateral System | p. 87 |
Dorsal Column Medial Lemniscus (DCML) System | p. 88 |
Proprioception | p. 88 |
Vestibular System | p. 90 |
Sensory Integration and Normal Development | p. 90 |
Sensory Integrative Dysfunction | p. 93 |
Impact on Development | p. 95 |
Key Components of SI Intervention | p. 96 |
The Adaptive Response | p. 96 |
The Child's Inner Drive | p. 97 |
Treatment Technique and Equipment | p. 98 |
Individualization and Variety | p. 98 |
Summary | p. 98 |
Neuro-Developmental Theory and Its Integration Into Treatment | p. 99 |
Key Components of NDT | p. 99 |
A Living Concept | p. 100 |
Importance of the Sensorimotor Experience | p. 100 |
Atypical Development in Autism | p. 101 |
Integrating Treatment Techniques | p. 102 |
Function is the Goal | p. 104 |
Grading the Treatment Session | p. 105 |
Preparation | p. 105 |
Facilitation and Strengthening | p. 105 |
Function | p. 105 |
Integrating the Two Theories | p. 106 |
Sensory Modulation | p. 107 |
Normal Sensory Modulation | p. 108 |
Sensory Registration | p. 109 |
Orientation | p. 109 |
Arousal | p. 110 |
Sensory Modulation Disorders | p. 110 |
Predictable Sensory ROA Difficulties | p. 111 |
Fluctuating and Defensive Modulation Disorders | p. 112 |
Functional Implications | p. 113 |
ROA Disorders: Predictable and Discrete? Fluctuating or Defensive? | p. 114 |
ROA Disorders: Predictable and Discrete | p. 114 |
Discrete Problems With Sensory Registration | p. 114 |
Predictable Problems With Orientation | p. 115 |
Predictable Problems With Arousal | p. 115 |
Fluctuating or Defensive Sensory Modulation Disorder | p. 117 |
Registration and Orientation Problems: Defensive or Fluctuating | p. 118 |
Arousal Problems: Defensive or Fluctuating | p. 118 |
Seizures | p. 119 |
Theories of Sensory Modulation | p. 120 |
Working Theories for Intervention | p. 122 |
Intervention Strategies for Sensory Modulation Disorders | p. 125 |
Obtain the Calm-Alert State | p. 127 |
Underaroused | p. 127 |
Overaroused | p. 129 |
Fluctuating or Defensive Disorders and the Calm-Alert State | p. 129 |
Anxiety and Its Impact on the Calm-Alert State | p. 136 |
Initial Therapy Sessions | p. 136 |
Change and Transitions | p. 136 |
Prepare Children for Stressful Situations | p. 137 |
Provide Boundaries | p. 137 |
Use Rhythmic Activities | p. 138 |
Establish and Maintain Communication | p. 138 |
Foresee Emotional Crisis | p. 138 |
Create a Positive Atmosphere | p. 138 |
Facilitate Sensory Registration | p. 139 |
Facilitate Normal Levels of Attention, Arousal, and Effort | p. 143 |
Coping Strategies | p. 144 |
Empowering the Child to Maintain the Calm-Alert State | p. 146 |
Sensory Diets | p. 146 |
Teach Self-Regulation | p. 147 |
Develop an Action Plan | p. 147 |
Oral Motor Programs | p. 151 |
Minimize Anxiety | p. 151 |
Deep-Touch Pressure | p. 152 |
Face | p. 152 |
Mouth | p. 152 |
Jaw and Teeth | p. 153 |
Cheeks and Lips | p. 154 |
Respiratory Control | p. 154 |
Food as a Tactile and Sensory Experience | p. 155 |
Oral Motor Program Schedules | p. 156 |
Facilitate Sensory Integration | p. 156 |
Enhanced Sensory Activities | p. 157 |
Trampoline Activities | p. 157 |
Net Hammock Swing | p. 158 |
Total-Body Activities | p. 159 |
Weight-Bearing and Resistive Upper-Extremity Activities | p. 159 |
Push-Pull Games | p. 161 |
Resistive Equipment | p. 161 |
Neoprene and Weighted Vests | p. 161 |
Deep Pressure and Proprioceptive Technique (DPPT) | p. 162 |
Sports and Extracurricular Activities | p. 163 |
Principles of Sensory Integrative Treatment Sessions | p. 163 |
The Comprehensive Treatment Program | p. 169 |
The Somatosensory System and Tactile Discrimination Disorders | p. 172 |
The Tactile and Proprioceptive Systems | p. 173 |
Normal Development | p. 173 |
Oral Motor | p. 173 |
Body Scheme | p. 174 |
Fine Motor Development and Haptic Exploration | p. 175 |
Summary | p. 177 |
Neurological Pathways for Somatosensory Processing | p. 178 |
Impairment of the DCML System | p. 178 |
Tactile Discrimination Difficulties | p. 179 |
Personality Types and Behavioral Responses | p. 181 |
Characteristics of Tactile Discrimination Difficulties | p. 183 |
Evaluation Findings | p. 187 |
Sensory and Activity History | p. 187 |
Sensory Testing | p. 188 |
Gross Motor Testing | p. 188 |
Fine Motor Testing | p. 189 |
Oral Motor Testing | p. 189 |
Maximum Potential | p. 190 |
Academic, Cognitive, Visual-Motor, and Visual-Perception Skills | p. 190 |
Clinical Observation | p. 190 |
Tactile Discrimination Disorders and Intervention Strategies | p. 191 |
Improving Body Scheme | p. 193 |
Preparation | p. 194 |
Sensory-Based Activities | p. 195 |
Facilitation | p. 197 |
Enhancing Sensory Input Through Active Physical Involvement | p. 198 |
Improving Slow, Sustained Postural Control | p. 200 |
Improving Slow, Sustained Pelvic and Shoulder Stability | p. 203 |
Improving the Ability to Narrow the Base of Support | p. 204 |
Grading Arm and Leg Movements | p. 205 |
Improving Total-Body Awareness and Motor Control | p. 207 |
Function | p. 207 |
Improving Fine Motor Control | p. 207 |
Preparation | p. 208 |
Massages | p. 208 |
Myofascial Release Techniques | p. 208 |
Sensory-Based Activities | p. 209 |
Muscle Tone, Arousal, and Slow, Sustained Postural Control | p. 209 |
Facilitation | p. 210 |
Shoulder Stability and Graded Arm Control | p. 210 |
Isolated Finger Control and Haptic Exploration | p. 212 |
Developing Thumb Abduction and Prehension | p. 215 |
Function | p. 217 |
Developing In-Hand Manipulation Skills | p. 217 |
Skilled Tool Usage and Adaptive Equipment | p. 219 |
Improving Oral Motor Control | p. 224 |
Problems Encountered | p. 225 |
Facilitation | p. 226 |
Vibration | p. 226 |
Deep-Touch Input | p. 227 |
Rib Mobilizations | p. 228 |
Blowing | p. 229 |
Establishing a Sensory-Based Oral Motor Program | p. 229 |
Eating as a Functional Activity | p. 230 |
Prerequisites to Food Introduction | p. 230 |
Introducing Food | p. 230 |
Sensory-Seeking Behaviors and Self-Stimulation Patterns | p. 232 |
Why Does the Child Do These Behaviors? | p. 232 |
Eliminating Sensory-Seeking Behaviors Associated With Tactile Discrimination Disorders | p. 233 |
Somatodyspraxia and Intervention Strategies | p. 237 |
Types of Dyspraxia | p. 238 |
Characteristics of Somatodyspraxia | p. 239 |
Somatosensory Processing and Tactile Discrimination | p. 239 |
Motor Planning | p. 239 |
Clinical History of a Child With Somatodyspraxia | p. 242 |
Behavioral Characteristics | p. 243 |
Evaluation Findings | p. 244 |
Fundamental Concepts of Praxis | p. 245 |
Conceptualize a Plan | p. 246 |
Facilitating Concept Development | p. 248 |
Sensory Registration and Ideation | p. 248 |
Planning, Sequencing, and Organizing the Information | p. 252 |
Vestibular-Proprioceptive Deficits | p. 252 |
Postural-Ocular Movement Disorder | p. 253 |
Bilateral Integration and Sequencing Deficits | p. 254 |
Facilitating Sensory Integration | p. 254 |
Planning, Sequencing, and Organizing Information | p. 254 |
Grading Feedback and Feedforward | p. 255 |
Sample Activities | p. 257 |
Carrying Out the Sequence: Task Execution | p. 271 |
School- and Home-Based Programs | p. 271 |
Enhanced Sensory Feedback | p. 271 |
Bilateral Integration and Sequencing | p. 272 |
Feedback and Feedforward | p. 272 |
Verbal Feedback | p. 273 |
Carryover Into Other Environments | p. 273 |
Facilitating Language and SI | p. 273 |
Neurological and Sensory System Connections | p. 274 |
Acquisition of Speech | p. 274 |
Speech and Language as Related to Praxis | p. 275 |
Motor Control and Coordination Difficulties | p. 278 |
Motor Control Theories | p. 278 |
Hierarchal View | p. 278 |
Systems View | p. 279 |
Motor Learning Concepts | p. 279 |
Feedback Versus Feedforward | p. 279 |
Plans or Engrams | p. 279 |
Alterations in Neuromotor Status | p. 280 |
Effects of Sensory Input on Motor Control | p. 281 |
Motor Control in Children With Autism | p. 282 |
Sensory Processing and Motor Control Problems | p. 283 |
Problems That May Be Tactile-Based | p. 284 |
Problems That May Be Vestibular- and Proprioceptive-Based | p. 290 |
Effect of the Visual System on Motor Control | p. 292 |
SI Techniques to Increase Motor Control | p. 295 |
Vestibular Components in Motor Control | p. 295 |
Proprioceptive Components in Motor Control | p. 295 |
Intervention Strategies for SI Dysfunctions | p. 298 |
Intolerance of Movement and Gravitational Insecurity | p. 298 |
Postural Insecurity | p. 298 |
High Tolerance to Vestibular Stimulation | p. 298 |
Bilateral Integration and Sequencing | p. 299 |
Postural-Ocular Movement Disorder | p. 299 |
Important Considerations in Treatment | p. 301 |
Postural Control | p. 301 |
The NDT Perspective | p. 302 |
The SI Perspective | p. 302 |
Tests for Postural Control | p. 303 |
Poor Head Control and Stability | p. 304 |
Poor Scapular Stability | p. 306 |
Poor Pelvic Stability | p. 313 |
Integrating NDT and SI in Treatment for Postural Control | p. 318 |
Motor Control in the Extremities | p. 320 |
Inability to Co-Activate for Weight Bearing | p. 321 |
Concentric-Eccentric Control | p. 323 |
Graded Control | p. 324 |
Skilled, Precise Control | p. 326 |
A Final Word | p. 331 |
Improving the Child's Ability to Communicate | p. 333 |
Communication Impairments in Children With Autism | p. 334 |
Sensory- and Motor-Based Problems | p. 334 |
Dyspraxia | p. 334 |
The Motor Planning of Communication | p. 335 |
Ideation | p. 335 |
Motor Components | p. 337 |
Execution | p. 337 |
When Speech Emerges | p. 338 |
Impact of Impaired Play Skills on Communication | p. 339 |
Intervention Strategies | p. 341 |
Registration, Orientation, and Arousal | p. 341 |
Environmental Considerations | p. 341 |
Provide Feedback and Develop Motor Engrams | p. 343 |
Supine Flexion | p. 344 |
Teach Communication Skills | p. 346 |
Gestural Communication | p. 347 |
Picture Cues | p. 347 |
Speech and Language | p. 348 |
Teach Play Skills | p. 348 |
Teach Pragmatic Skills | p. 349 |
Use Communication Temptations | p. 349 |
Expansions and Extensions | p. 350 |
Modeling | p. 350 |
Follow the Child's Lead | p. 350 |
Wait-and-Signal | p. 350 |
Limited Questions | p. 350 |
Scaffolding | p. 351 |
Chains | p. 351 |
Have Fun! | p. 351 |
Strategies for Promoting Receptive Language Skills | p. 351 |
Gestural Cues | p. 351 |
Picture Cues | p. 351 |
Written Cues | p. 351 |
Voice Inflection | p. 352 |
Physical Prompts | p. 352 |
Repeating Commands | p. 352 |
Routines | p. 352 |
Attention | p. 353 |
Sentence Length | p. 353 |
A Final Word | p. 353 |
Augmentative and Alternative Communication | p. 354 |
Why Use AAC Strategies With Individuals With Autism? | p. 355 |
AAC and Children at Different Stages of Communicative Development | p. 357 |
Pre-intentional Level | p. 357 |
Intentional, Pre-symbolic Level | p. 357 |
Symbolic Level | p. 358 |
Types of AAC Systems | p. 359 |
Advantages of AAC Strategies That Use Picture Symbols | p. 359 |
Developing AAC Intervention Programs | p. 360 |
Picture Symbols | p. 360 |
Voice-Output Communication Aids | p. 363 |
Manual Signs | p. 363 |
Frequently Asked Questions About AAC | p. 364 |
Interviewing the Potential Speech-Language Pathologist | p. 366 |
AAC Training and Experience | p. 366 |
AAC Resources and Equipment | p. 367 |
The Actual AAC Evaluation or Intervention Program | p. 367 |
Funding for AAC Devices and Services | p. 368 |
Resources | p. 369 |
The Importance of Play in Learning and Development | p. 370 |
Typical Development of Early Play Skills | p. 372 |
Later in the Development of Play | p. 374 |
Adolescence | p. 375 |
Play At Any Age | p. 375 |
Intervention Strategies | p. 376 |
Basic Strategies for Promoting Play | p. 377 |
Provide the Just-Right Challenge | p. 377 |
Develop Communication | p. 378 |
Initiate Varied Play | p. 379 |
Form Concepts | p. 379 |
Pretend Play | p. 379 |
Role Play | p. 379 |
Shared Joint Attention | p. 380 |
Cooperative Play | p. 381 |
Abstract Play | p. 381 |
Combine Strategies | p. 382 |
Put It All Together | p. 382 |
A Final Word | p. 383 |
Additional Reading | p. 385 |
References | p. 393 |
Index | p. 401 |
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