Occupational therapy can help autistic children reach life goals

Dec. 18—When a parent hears the diagnosis that their child has autism, Dr. Michael Coldiron wants those parents to know it's isn't the end of their hopes and dreams for that child.

"It's not a death sentence. The things that they love about their child — the quirks, the humor — are still there. (They should know) that usually children with autism excel in some areas well above that of their peers," Coldiron said.

As an occupational therapist and part-owner of Total Pediatric Therapy, Coldiron often works with children diagnosed with autism — and works with their families as well. In many cases, the child's improvement is due directly to the work that the family puts in, he said.

"The outcomes of therapy goals for hands-on trained families is exponentially higher than those who aren't engaged hands-on," he explained.

"... We often get grateful families that tell us 'We're so thankful for you. You guys have made all the difference for our kid.' And we always bounce that back and say, 'No, we can give you the algorithm, we can tell you the direction to head, but nobody ever gets better if you're not working at home. You don't accomplish these goals bringing your child to one or two visits in an outpatient clinic each week. The work happens at home.'"

So, what is an occupational therapist and how does it help children with autism?

Coldiron explains that an "occupation" isn't how adults use the term.

"An occupation, in my world, is anything that you do as a human being. Your occupations are probably working, driving, eating, taking care of family or pets, getting yourself dressed in the morning. ... A child's occupational profile might be to feed themselves, or dress themselves, or complete toilet training."

Occupational therapy is about teaching a child the skills he or she needs to perform everyday tasks.

"Sometimes it's talking, and sometimes its sensory integration, which is the ability to handle an environment without a meltdown. They might be bothered by auditory, verbal, visual, olfactory — any of the senses that we process. Many children with autism experience them differently, so they tend to be very sensitive to different environments."

Therapists will build a profile for each individual child — and each child is absolutely an individual, he said. There is a reason autism has a "spectrum."

"No two people with autism look the same, act the same, have the same challenges, have the same progressions," he said.

Coldiron, who has a doctorate in Occupational Therapy from Eastern Kentucky University, said that sometimes therapists have to change tracks if a particular plan doesn't seem to be working.

"We're constantly looking for pieces of the puzzle, but we're backing up our suspicions with assessments and data that tells us when we're on the right track," he said.

"To a degree, it is sort of a guessing game in what you want to use as a measuring tool, for the right therapist. It's not that the therapist wants to change the child. If a therapy's not working, if my approach with 'Johnny' is ineffective over the course of a month or two, I'm not looking to say 'Something's wrong with Johnny, he's not responding.' I'm changing myself first."

But when a child clears a particular hurdle, it can mean the world to both Coldiron and the family.

"I enjoy getting to see kids get better, and families get better, and sometimes that's the smallest thing," he said. "Sometimes, it's they actually ate a vegetable at mealtime, and sometimes it's that they didn't hit their head on the wall when they got frustrated at school. It can be a small thing or a huge thing. But they are all weighted equally when you get to see the kids faces light up, and the families get a big sigh of relief. ... That's a burden off of a family, and that' s a huge ripple effect."

He said that early intervention is key in helping a child with autism.

"Evidence shows us early intervention leads overwhelmingly to the best outcomes. Once children are in [therapy], it's not like you're in physical therapy for a rotator cuff repair. There, you might have a six- or eight-week protocol, and then you're free to go.

"These kids, especially with congenital or long-term disabilities — even life-long — they might be in therapy for years. And it might be in and out, they might have six or eight months then they're off for a while and then they come back."

Unfortunately, there can be complications in getting that care to a child, especially when insurance is involved.

"Insurance companies seem to have a hard time providing access to therapy for as long as children need," he said.

If a parent suspects their child may be autistic, what should they do? Dr. Coldiron's first answer is to "trust your gut."

"Don't adopt a wait-and-see approach. A lot of times, wait-and-see is just fine, but if you have an inkling as a parent something's not right, it's not going to hurt anything if you go to your pediatrician and express your concerns. Then, maybe, if warranted, the child can undergo a thorough evaluation for autism."

Dr. Coldiron said concerned parents can visit the website Autism Speaks (https://www.autismspeaks.org/) for more information and details on what signs to look for in their child.

And for members of the public who are not familiar with autism, Coldiron had some advice as well.

"What I would want people to know and understand about autism — if I could have our entire community listening to me — I would tell them that children with autism might not look different, but children with autism process the world differently."

For example, if someone has a physical disability, it is usually obvious to outsiders. But autistic children can appear to be "normal."

"I would want [the public] to understand that just because children with autism look like things aren't bothering them, or that there shouldn't be anything wrong, sometimes some of the behaviors or challenges that you see in any area of childhood could be related to something that doesn't show itself on the surface.

"So give folks grace when you see the parent in the grocery store struggling with a child having a meltdown. Don't assume that that's just a bad parent. Don't assume that it's a spoiled child. It's very easy to do that, especially if you can't see the challenges that the child is having. But I promise you a conversation with that parent would really open your eyes to some things."