Autism and Occupational Therapy: Part 2

We welcome pediatric occupational therapist Kristin Wittmayer, who discusses the role of OT and sensory integration in addressing the sensory challenges experienced by many children on the autism spectrum.  

Transcript

00:00:00 Johnandrew Slominski 

Welcome to this episode of the Autism Annex Podcast. I'm your host, Johnandrew Slominski. In our last episode, I spoke with Kayleen Schultz about the impact that occupational therapy has had on her son Dominic, who has autism. Kaleen shared that she and Dominic drive 90 miles each way every week for his OT sessions, and it's my guest today, Kristen Wittmeyer, who they're going to see. 

00:00:30 Johnandrew Slominski 

Today's episode picks up where that conversation left off, and we'll explore the professional’s perspective on occupational therapy and sensory processing. 

00:00:41 Johnandrew Slominski 

Kristen Wittmeyer, thanks for being here on the podcast today. Tell us a little bit about what you do as an occupational therapist at MoveU in Sioux Falls, SD. 

00:00:53 Kristin Wittmayer 

Thank you for having me to chat about these things. So, my name is Kristen Wittmeyer, and I'm a pediatric occupational therapist. I've been practicing for 17 years, and I specialize in the treatment of sensory processing and integration disorders here in Sioux Falls, SD, with our primary focus on that population with sensory processing challenges. But we also do treat children with other varying diagnoses: attention difficulties, behavior challenges, learning difficulties, emotional regulation, all of those things can be associated with sensory processing challenges, so we help kind of sort all of that out and meet the kids where they're at and serve the Sioux Falls and surrounding communities. 

00:01:41 Johnandrew Slominski 

Kristin, could you give us a working definition of occupational therapy? 

00:01:47 Kristin Wittmayer 

Som occupational therapy in general, occupation, you know, we think of it as a job, right? Or occupation of what we do. But in overall life, occupation means meaningful activity. And so, for an adult, that might look very different as compared to a child. Meaningful activities for children or occupation of children are primarily play. We learn a lot through play. We develop our motor skills, our ability to work together, to share, to do the social things we do so much learning through play. And so, a large part of pediatric occupational therapy is very play-based and fun. So essentially I get to—I have the opportunity to play and have fun all day, although it's quite a bit more complex with that, when we dive into sensory processing and integration theory. 

00:02:48 Johnandrew Slominski 

Let's dive into sensory processing and sensory integration for a moment. If we were a fly on the wall observing you working with a child, what would we see? 

00:02:58 Kristin Wittmayer 

So, using a sensory based approach, it's very child directly directed, but a therapist is providing artful vigilance. And so what that means is we are sort of—our brain wheels are churning all of the time, meeting the child where they're at, participating in the play together. So we're actually a play partner and not just another person telling a child what to do or where to go or how to do it. But we're actually intermixed in the play altogether. The reason for the play and making it fun and joyful is that it’s more motivating to a child and we can actually make brain changes much faster. And so, for a fly on the wall watching a session, if a child runs into the ball pit and wants to do a ball pit game, I've already completed a formalized assessment with this child, and I know what it is that their body needs and what they need to work on. And so maybe we're using the ball pit, but I add in little problems to the ball pit for us to solve together or ways that two sides of the body can work together or our posture system. 

00:04:10 Kristin Wittmayer 

It's sort of like a dance. And so, the child kind of leads; we are kind of navigating and adding in the just right challenge for that child keeping it motivating and building skill, whether it be emotional, cognitive, motor based for that child. So for a fly on the wall it should look like we are merely playing. 

00:04:37 Johnandrew Slominski 

And underlying that play, there's so much more than meets the eye. There's actually a lot going on for everyone involved. 

00:04:45 Kristin Wittmayer 

There is a lot that goes on under the surface, so sort of like a water drop that enters a body of water or a cup, you know, it enters, and you see where it's at. But all of these, like, ripples and movement beneath the water are still occurring. We just can't see that. And that's sort of what sensory processing and integration theory is: we're looking at the neurological functions from input from our muscles and joints that that inform our body, like how much force should I use to throw this ball or am I, you know, standing up? Am I, you know, is sitting at what body position am I in? 

00:05:29 Kristin Wittmayer 

Our vestibular system is responsible for telling us, am I tipping? Am I moving in circles? Am I moving fast? Am I moving slow on my upside down? It's informing our body about head position in space. Then beyond that we also have our touch system that's telling us, “My clothes are itchy or if this feels gooey” or all of those touch sensations that also contribute to our body. 

00:05:57 Kristin Wittmayer 

Beyond that, then, we have our vision, our taste system, our smell system. We have a whole lot that's going on kind of beneath the surface that one might not even think about or see unless you are trained in a sensory-based approach. 

00:06:16 Johnandrew Slominski 

You've named some really complex systems that operate in our bodies, but I doubt that children or parents come to you and say something like, “Hey, I'm having trouble with my vestibular system. And can you help me regulate that?” 

00:06:31 Johnandrew Slominski 

What are some of the things that bring people into your practice? 

00:06:35 Kristin Wittmayer 

So, a lot of the kids end up finding us due to emotional regulation challenges; emotional regulation could be associated with getting through the morning routine is so hard, like finding clothes that feel right for the body or getting through like brushing teeth or eating breakfast, let alone the transition to get out of the door. 

00:06:56 Kristin Wittmayer 

All of those things, depending on sensory systems and how they're functioning, could be impacted by sensory approaches. 

00:07:04 Kristin Wittmayer 

Just additionally, it might be like, my child is awkward and clumsy and just doesn't, despite trying so hard, like my child's trying 150% and still just not able to keep up with our peers or with, you know, join into the team. Maybe they lack confidence that could be associated with some of those motor-based challenges. But then also we get kids that are like, we don't know how to relate to our child. You know, have a conversation or do an activity together. Maybe this is a child that that does have a diagnosis of autism, which this approach is highly effective for. 

00:07:50 Johnandrew Slominski 

So, I'm curious about the point where sensory experiences become challenging for children with autism, and how that can impact their everyday lives. 

00:08:01 Kristin Wittmayer 

Right. So, for a child for children with autism, for that population greater than 90% of that population do struggle with sensory based challenges. And so there are a lot of sensory-based things that are sort of incorporated into a diagnosis for autism. 

00:08:22 Kristin Wittmayer 

Additionally, aside from that, just in general in the general population, approximately 1 in six children do struggle with sensory processing things. But when it becomes a challenge is when those difficulties really impact participation and function within everyday life.  So maybe I'm just avoiding all social engagements or all community outings at all costs, because is simply too loud and I, you know, I don't feel safe there or it causes big emotional outbursts. So now I'm restricting my occupation or my engagement in meaningful activity because of the sensation. So, when that starts to happen that that's when occupational therapy using a sensory based approach could be really beneficial. 

00:09:16 Johnandrew Slominski 

You've mentioned the framework of sensory integration and I wanted to circle back to that. Tell us a little bit more and maybe start if you would, with the origins of sensory integration as a theory and a practice. 

00:09:30 Kristin Wittmayer 

Yes. So, I could literally talk about this for hours. I love the history of sensory integration. I've known I’ve wanted to specialize in sensory integration for for an extended period of time. So this all began with a lady called Jane, her name was Jane Ayres, she started this work. She was seeing a lot of children that behaved differently. They reacted to sensation differently. They had challenges learning and she was curious about it. So, she was an occupational therapist and neuroscientist, and she kind of wondered what's happening in these children, making them do this differently, and so she started looking at this and began researching and developing an assessment tool, initially called the sensory integration and praxis test. 

00:10:25 Kristin Wittmayer 

She worked on this from the 60s and on, and she was hypothesizing things about the brain and how maybe sensory information was processed, prior to there even being scans that could show that. So, the sensory integration and praxis test became available to practitioners in 1989.  Some of the things that she was hypothesizing like now in evidence-based practice, we're proving that her theories were pretty spot on. 

00:11:03 Johnandrew Slominski 

And I imagine that as we've learned a lot more about how the brain works in the 60-plus years since Dr. Ayers started her work, sensory integration has changed too. 

00:11:15 Kristin Wittmayer 

Right. Yeah. So, so the early research was really embedded within the neuroscience research of enriched versus impoverished environments. Now it's obviously progressed to the nosology and the research with sensory-based practice. We actually have categories and different subtypes of sensory processing challenges that now we can group children and how they behave and function. And in the subtype that they've been diagnosed with having, into treatment outcomes. And so. So now all of this—like it started way back with like rodents and things—now we've progressed. We have functional MRI's. Then things can show how the brain is responding. And we measure cortisol in saliva for stress reactions, we can measure a lot of things like in research. Not in the clinic setting obviously, but now because of all of that foundational work that she kind of put into place and her team and followers have continued to utilize, now we're able to apply this in in truly an evidence-based practice for children with sensory processing challenges. 

00:12:34 Johnandrew Slominski 

On the last episode of the podcast, we got to know Kaleen Schultz, whose son Dominic has autism, and he's had such a positive experience working with you. At this point, Dom has an OT routine, but everyone has to start somewhere. Could you walk us through what happens when someone comes to see you for the first time and how you kind of introduce them to occupational therapy and decide on some of the first steps? 

00:13:02 Kristin Wittmayer 

Right. That's a great question. What it looks like at MoveU is I send out in inventory kind of an interview process for family to be able to report what's happening, then gaining the background materials. So, I collect that remotely prior to the family coming depending on primary concern areas and things that kind of guides my next steps, whether I want to use a sensory based questionnaire. You know it, it gains good information, but you can't make a full treatment plan based on just a questionnaire and parent report. 

00:13:38 Kristin Wittmayer 

A skilled therapist also needs to see what's happening. So from there I generally have a set of sensory-based clinical observations that I complete. Those were originally utilized by Jean Ayers and Erna Blanche. Now there's a brand-new assessment tool, standardization, just finished earlier this year; that assessment tool is called the evaluation of Ayres sensory integration. So it does include some of the things that the SPD originally included, but it also advances from there based on research that has happened in those last, you know, 30 to 40 years essentially. 

00:14:20 Kristin Wittmayer 

So we have those. We also have other standardized assessments. Those include the Miller function and participation scale. So it's called the M-Fun, as well as the goal-oriented assessment of life skills can also contribute quite a bit of information. 

00:14:39 Johnandrew Slominski 

In the big picture, I know that one goal of sensory integration and occupational therapy is learning to generalize skills in other settings, and that includes the greater community. Could you give some examples of the community-based activities that have worked for your clients with autism and sensory challenges? 

00:14:59 Kristin Wittmayer 

Yeah. So we do that in a few different ways here at MoveU. One thing that I'm really proud of is our engagement within the community. We offer various community-based activities and outings for children that may have sensory based challenges as well as other developmental challenges like sensory craving, for example. Those kids are sort of, even though I've been on the trampoline for hours or I've been bouncing on the couch back and forth for hours, my cup never quite gets filled up. It's almost like I have a leaky cup for sensation. And so despite putting more and more in, I never quite, like, become satisfied with what I have. And also I might heighten my alertness level to where now my risk level is extremely high, safety is a challenge and listening is really hard. So an activity that we've found in the community where we try to really get these kids to is a rock climbing facility. 

00:16:04 Kristin Wittmayer 

And so that requires that a child climb pay attention to like, where are my hands going? Where are my feet going? They get really great muscle work for their body. They have to do the work to get to the top, but then they get to belay like quickly and briskly all the way down. So they sort of do the work, get the thrill. 

00:16:24 Kristin Wittmayer 

But they have to go back to attending to the work in order to get more instead of just repetitive crashing or jumping. Or, you know, swinging from thing to thing. So that's one example that we do. You know, a lot of kids with sensory challenges might also be picky eaters. And so we've coupled with Oh My Cupcakes, which is a local business here in Sioux Falls where I have parents come in with the kids. We do a food group food learning session. It's fun because it's cupcakes, but there's so many different colors of frosting and colors of cupcakes and sizes and different fillings and tastes and flavors. And so we can really go through some food learning components using that local business. And then it's kind of a fun outing where families don't feel like they're all alone. So they kind of have that community support. 

00:17:21 Johnandrew Slominski 

I'm glad you brought up families because I wanted to ask you also about the role of parents and caregivers in OT sessions. Are they invited to participate?  And what does that look like? 

00:17:33 Kristin Wittmayer 

We love to have families participate within the session and during a session we're constantly educating. You know, the thing we're looking for within these playful activities is something called an adaptive response. And so, the activities provided at the just right challenge so the child's always going to feel success and joy and build confidence. Sometimes it doesn't work out and then it's like, oh, that activity did not work and we name it as such. And we work through that frustration. But also for kids with autism that maybe have moderate to severe difficulties, you know, to be able to educate that parent, and OK, what nugget did we find that this child really, really enjoys, but also is really like regulating and fun and then passing that magic moment off to a parent and incorporating the parents into the play so they can feel the connection and then help bring that back home, within those activities or similar activities like that? 

00:18:39 Johnandrew Slominski 

Kristin, when you're talking with families and caregivers, what are some of the most common experiences that they report their child struggling with and do you have any tips? 

00:18:49 Kristin Wittmayer 

Yeah. So probably haircuts and dentist between the two of them like those, those two things are of biggest difficulty for a child who can be sensitive to touch or to noises, anything like that. So, dentist-wise, we did a series like that. And we actually went to a dentist to show some of the materials and things in that way, a child would be able to see some of the materials. You know, you walk in here. You know, you might have this, but also really chatting with the parent. Now some dentists are going to probably be a better fit than others. We happened to find one that is actually, like, just really go with the flow. 

00:19:38 Kristin Wittmayer 

He takes time. He's slow. He might even just have somebody sit in the chair the first time and chat with them, just to keep the visit pleasant and positive. So the next time she goes back, like, maybe it's just about getting in the chair and a quick open your mouth and he peeks. And he's like, Yep, I see. Yeah, you know, and come back. So kind of those baby steps of keeping it positive. Probably don't, you know, expect to do like the whole thorough exam where they, you know, do everything that they would do with an adult within that first visit, but starting young and then just keeping it. Those little bits of positive will really help, and so if we can backtrack and kind of look at these underlying sensory systems within a child, we can help progress and improve the ability to participate within the community. 

00:20:37 Johnandrew Slominski 

As an aside to listeners, be sure to check out the March 2024 episode of the podcast. That episode is called Autism and Accessible Dentistry. My guests include Dr. Dennis Dunn, a pediatric dentist in Eugene, OR who has specifically designed his practice to serve and support children with autism and sensory challenges. 

00:21:00 

You have been listening to my conversation with pediatric occupational therapist Kristin Wittmayer from move U in Sioux Falls, SD. Kristin, thanks so much for your time today and for sharing your passion and expertise on the podcast. 

00:21:16 Kristin Wittmayer 

Thank you so much for having me. 

00:21:20 Johnandrew Slominski 

The Autism Annex podcast was developed by STAR Autism Support. I'm your host, Johnandrew Slominski 

00:21:29 Johnandrew Slominski 

If you like what you've heard on the podcast, please consider sharing it this month with someone who you think would enjoy it too. And if you have a topic that you'd like us to cover in a future episode, we're always happy to hear from you. 

00:21:44 Johnandrew Slominski 

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00:21:52 Johnandrew Slominski 

Thanks for listening, and until next time, take good care of yourself and one another.