When diagnosed with ASD, children are often referred to occupational therapy (OT) services due to common limitations experienced with self-care, feeding, sleeping routines, play skills, social development, fine and gross motor skills, sensory processing, emotional regulation, and executive functioning skills (American Occupational Therapy Association [AOTA], 2020). Unfortunately, many parents who have a child with a disability report receiving inadequate assistance from healthcare professionals, including occupational therapists, due to discrepancies between the demand for and availability of services, resulting in unmet needs while seeking out information on supportive developmental and behavioral strategies for their child (Little et al., 2018; Miller-Kuhaneck & Watling, 2018). Insufficient access is frequently attributable to family scheduling conflicts, lack of transportation, a clinical facility’s inability to accommodate a time when the child is most alert, limited financial resources, lack of childcare, geographic isolation, and lengthy waitlists (Pickard et al., 2016; Teleman et al., 2021). This can be frustrating to feel a lack of support, especially if the child recently aged out of the early intervention system, where support was previously consistently provided. Thankfully, parents can be relieved knowing that there are meaningful activities that can be completed at home to support their child’s development and overall well-being.
Sensory Regulation: Each child has their own sensory needs and challenges. A well-regulated sensory system is essential for children to succeed, as it is the foundation for all higher-level learning and skills.
- Keep notes for appointments: It can be helpful to take notes on your observations (e.g., my child is spinning, bumping into items, seems unaware of their body in space)
- Every child is different: Just because something is marketed as “sensory”, it may not benefit your child.
- Create a calming space: Is your child sensitive to sound, or is the environment overwhelming? Set up a “calm corner” where your child can regulate with calming visuals, music, fidgets, and noise-cancelling headphones.
- Try Heavy Work: Heavy work activities can help organize and regulate your child’s sensory system. Some examples include: carrying heavy objects like laundry baskets or bags of groceries from one place to another, using a wagon or toy cart to push and pull items around the house, and involving your child in household chores like vacuuming or sweeping to help in regulating their nervous system.
- Use Calming Movements: Use a sheet or large blanket and rock the child in a linear back-and-forth motion, or pull the child around the house while they are lying on a sheet or large blanket.
- Incorporate movement and deep pressure: animal walks (bear walks, crab walks, or frog jumps), body compression by rolling a therapy ball or foam roller over your child’s back, arm, and legs, create a “sandwich hug” by gently squeezing your child between large cushions (couch cushions or pillows work well).
Mealtimes: Having a meal with your child not only involves eating, but also provides opportunities to foster positive social interactions and support their sensory processing and motor development.
- Create a consistent mealtime routine by serving meals at the same time and in the same place each day, helping your child know what to expect and feel more comfortable.
- Include at least one preferred food on the plate when introducing a new food to reduce anxiety
- Make mealtime a fun and positive experience: focus on engaging with your child and not pressuring them to eat a certain food
- Encourage exploration of food through play: Messy play assists with their sensory processing skills and feeding development
- Observe if your child is avoiding certain textures, like crunchy or mushy food. This can be because they have a dislike for certain textures or because it is hard for them to chew or move the food around in their mouth.
- Introduce new food on a separate plate and never force your child to take a bite
- Include your child in cooking/preparing the food, or shopping for the food
- Provide calming sensory input before meals: If your child is often dysregulated before meals, encourage “heavy work” activities through pushing and pulling objects
- Promote good positioning during meals with proper foot and back support, and the hips, knees, & ankles all at 90 degrees
Fine Motor Skills: Fine motor skills involve the use of the small muscles in the hands and fingers, which can be developed through play and everyday activities. Strong fine motor skills can help children with tasks such as writing, dressing, and feeding.
- Playing with playdough (can also use cookie cutters, rolling pins, child-safe utensils, or practice cutting with scissors)
- Threading beads onto a string or Cheerios on noodles
- Picking up objects with child-sized tongs
- Provide small writing utensils (broken crayons, small chalk, and golf-sized pencils) for their small hands. This will help your child develop their grasp
- Writing on a vertical surface (e.g., wall or easel) helps build the wrist strength kids need for writing
- Peel and place stickers
- Use clothespins to pick up small objects (e.g., pom poms)
- Practice with buttons, snaps, and zippers during dressing routines
- Cut papers or magazines of various thickness
- Tearing or crumbling paper into small pieces
- Origami or folding paper
- Additional Activities/Games: Hungry Hungry Hippo, Operation, Pick-up sticks, Jenga, Rock painting, Legos, Kerplunk, Sneaky Snacky Squirrel, High Ho Cheerio
Toileting: Toileting involves motor skills, sensory regulation, and body awareness. Keeping the experience positive and providing the appropriate environmental supports can help your child be successful
- Whether a child is speaking or non-speaking, all children will show signs of being ready for toileting: Is the child waking up dry from naptime? Is the child understanding the sensation of when to go? Is the child comfortable with the bathroom and toilet? Are they showing any interest in the bathroom? Does your child dislike being in a wet/dirty diaper?
- Establish a consistent routine
- Use a visual schedule to help with the steps associated with toileting
- Bring your child with you into the bathroom to help them learn about toileting
- Practice sitting on the toilet, flushing the toilet, and washing hands
- Read “potty” training books
- Have your child blow bubbles while on the potty to relax their body
- Increase fluids to help your child feel the sensation of needing to urinate
- Bring your child to the toilet every hour to “try”. They do not need to be there any longer than a few minutes
- When staying home, allow your child to wear underwear (not a pull-up) to allow them to feel any accidents
- Ensure the toilet seat fits your child’s size and their feet are stabilized on the floor or a stool (hips at 90 degrees or higher)
- Have your child “potty train” a doll or toy (Tot on the Pot is a great program)
- If your child is afraid of automatic toilet flushes in public bathrooms, a sticky note over the sensor will prevent the flushes
- Create a calm and relaxing environment in the bathroom
- What NOT to do: Give punishments for accidents, use negative language, keep your child sitting on the toilet for extended periods of time, ignore any sensory needs in the bathroom, attempt “potty” training when your child is dysregulated
Sleep: Sleep is essential for your child’s growth and development. Addressing their sensory needs and establishing a consistent bedtime routine will help support restful sleep.
- Provide calming sensory input: massage or body squeezes, slow & rhythmic linear rocking (in a bed sheet or arms), jump into couch cushions, pillow squeezes, or “burrito” rolling in a yoga mat, bath (encourage play to help with regulation), vibrating toothbrush, comfortable temperature, lighting, and noise, complete “heavy work” activities (pushing, pulling, lifting)
- Have a consistent routine: Bath, rocking, singing, reading, visual schedule to help with the steps before bed, limit screen time and no screen time before bed, increase physical activity during the day, consistent bedtime and wake times, offer age-appropriate choices (select between two sets of pajamas or books)
We hope these tips are helpful while you wait! You are also free to join the waitlist at multiple clinics; you never know which one might open up first.
Alysha Skuthan, PhD, OTR/L, CWHS, is Post-Professional Doctorate in Occupational Therapy and Assistant Professor at Shenandoah University. For more information, contact Melanie Jablonka, OTD, OTR/L, at meljab33@gmail.com.
References
American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-based coaching by means of telehealth for families of young children with autism spectrum disorder. The American Journal of Occupational Therapy, 72(2). https://doi.org/10.5014/ajot.2018.024786
Miller-Kuhaneck, H., & Watling, R. (2018). Parental or teacher education and coaching to support function and participation of children and youth with sensory processing and Sensory Integration Challenges: A systematic review. The American Journal of Occupational Therapy, 72(1). https://doi.org/10.5014/ajot.2018.029017
Pickard, K. E., Wainer, A. L., Bailey, K. M., & Ingersoll, B. R. (2016). A mixed-method evaluation of the feasibility and acceptability of a telehealth-based parent-mediated intervention for children with autism spectrum disorder. Autism, 20(7), 845–855. https://doi.org/10.1177/1362361315614496
Teleman, B., Vinblad, E., Svedberg, P., Nygren, J. M., & Larsson, I. (2021). Exploring barriers to participation in pediatric rehabilitation: Voices of children and young people with disabilities, parents, and professionals. International Journal of Environmental Research and Public Health, 18(19), 10119. https://doi.org/10.3390/ijerph181910119
