Conditions Impacting Occupational Performance: ASD, Sensory Processing & ADHD

Autism Spectrum Disorder (ASD)

• Working definition

  • Developmental condition affecting social interaction, communication, and behavior; hence the term “spectrum” to capture wide variability.
  • Video speaker: Dr. Meg Stone-Heberlin (Cincinnati Children’s Medical Center).

• Core developmental areas impacted

  • Social interaction (e.g., eye contact, understanding facial expressions, reciprocity).
  • Communication (speech, non-verbal language, use of pictures/assistive devices).
  • Behavior & flexibility (preference for routine, repetitive actions, hyper-focus on interests).
  • Sensory processing (sound, touch, movement sensitivities) overlaps strongly with OT concerns.

• Risk factors ("increase risk" ≠ "cause")

  • Positive family history.
  • Advanced maternal or paternal age.
  • Pregnancy & birth complications.
  • Inter-pregnancy interval < 1 year.

• Etiology

  • Multifactorial: complex gene–environment interaction; no single known cause identified yet.
  • Research is ongoing to parse out precise mechanisms.

• Diagnosis & detection

  • Multidisciplinary (MD or psychologist); relies on developmental history + direct assessment + caregiver reports.
  • Can be detected as early as 18 months.
  • American Academy of Pediatrics: routine universal screening because “early detection → early intervention → better outcomes.”

• Characteristic challenges

  • Speech / non-verbal cues.
  • Joint attention, pretend play, peer engagement.
  • Transitioning between routines; coping with change.
  • Sensory over- or under-responsivity.

• Common strengths

  • Detailed memory for facts, events, stories.
  • Visual problem-solving and puzzles, STEM aptitude.
  • Strong adherence to routines can be leveraged vocationally.
  • Novel perspectives → creative, innovative ideas.

• Top 3 myths vs. realities

  • “People with ASD lack empathy.” → They experience emotions; expression may differ.
  • “They can’t handle change at all.” → Change is hard for most; preparation & planning help.
  • “They aren’t interested in friendships.” → Many actively seek social connection, especially around shared interests.

• OT relevance

  • Early play-based interventions, social-skills groups, sensory diets, parent coaching.
  • Environment modification to reduce sensory overload and support participation.

Sensory Processing & Integration

• Definition

  • “How we feel the world and ourselves in it” — the brain–body system that converts sensation into adaptive action.

• Eight sensory systems (beyond the traditional five):

  • Visual, Auditory, Olfactory, Gustatory, Tactile, Vestibular (movement/balance), Proprioceptive (body position), Interoceptive (internal organs/physiology).

• Functions across the lifespan

  • Builds body schema & spatial map.
  • Underpins relational skills, identity formation, motor competency, speech, academic learning, self-preservation.

• When processing “goes wrong”

  • World feels disorganized, threatening; individual may never feel truly calm or safe.
  • Possible outcomes: developmental delays, anxiety, disorganization, coordination issues, reduced participation, challenging behaviors.

• Prevalence note

  • ~16\% of people show identifiable sensory processing challenges, yet better sensory-aware design benefits 100\% of people (classrooms, workplaces, hospitals).

• Therapeutic approaches

  • Occupational therapists (OTs) or allied health professionals with advanced training in Sensory Integration (SI) can:
    • Provide controlled sensory input to improve modulation and discrimination.
    • Teach self-regulation strategies.
    • Recommend environmental tweaks (lighting, sound dampening, movement breaks).
    • Advocate for inclusive, sensory-friendly communities.

• Paradigm shift pitched by the video

  • Sensory health is a universal wellness principle—not just disability remediation.
  • Improved sensory literacy can lower school behavior crises, support mental health, and unlock human potential.

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Terminology evolution

  • Pre-1987 term “ADD” (Attention Deficit Disorder) replaced by “ADHD” to include hyperactivity & impulsivity spectrum.
  • ADD and ADHD are synonymous today; ADHD subdivides by presentation.

• DSM-5 subtypes & symptom clusters

  • Inattentive (9 criteria)
  • Hyperactive-Impulsive (9 criteria)
  • Combined (meets both).
  • Diagnostic threshold: ≥6 of 9 symptoms in a cluster persisting ≥6 months; onset between ages 6–12; behavior exceeds developmental norms.

• Representative symptoms

  • Inattentive: careless mistakes, poor listening, easy distraction.
  • Hyperactive-Impulsive: fidgeting, leaving seat, excessive talking, interrupting.

• Etiological factors

  • Genetics:
    • Sibling with ADHD ↑ risk; identical twin concordance much higher (shared DNA).
    • Likely polygenic — multiple genes tweaking neurotransmitter production/regulation.
  • Neurotransmitter hypothesis: lower dopamine & norepinephrine levels → attention & impulse-control deficits.
  • Environment: prenatal exposures, toxins, psychosocial stressors (still under investigation).

• Treatment paradigms

  • Behavioral Psychotherapy
    • Children: structured routines, positive reinforcement, parent & teacher training.
    • Adults: distraction reduction, organizational coaching.
  • Pharmacotherapy
    • First-line: stimulant medications (e.g., methylphenidate, amphetamine salts).
    • Mechanism: controlled, gradual ↑ in dopamine/norepinephrine between neurons → symptom reduction.
    • Distinction from illicit stimulants (e.g., methamphetamine): therapeutic dosing = slow release, avoids euphoric dopamine spike.

• Occupational therapy intersection

  • Task analysis to fit environmental demands to attentional capacity.
  • Sensory modulation techniques to manage hyperactivity.
  • Collaboration with MDs/psychologists for medication monitoring & holistic care.

Integrated Implications for Occupational Performance

• Shared OT strategies across ASD, sensory processing differences, and ADHD

  • Sensory-friendly environments & routines.
  • Visual supports (schedules, timers, social stories).
  • Strength-based engagement: channel special interests or high energy into purposeful occupations.
  • Family & community education to dismantle myths and build inclusive participation opportunities.

• Early, interdisciplinary, and person-centered care consistently emerge as critical themes for positive outcomes in all three conditions.