Neurodiversity, Inclusive OT Practice, and Feeding Intervention Notes

Developmentally-Oriented Interviewing & Assessment

• Begin histories with broad, open invitations, then narrow:
  • "Tell me about concerns with gross motor, fine motor, social skills, cognition, response to caregivers."
  • Follow with targeted prompts: "Describe Colton’s ability to follow directions."
  • Ask about preferred home activities to reveal developmental level, interests, habits and routines.
• Ask BOTH child and caregiver (often twice) to triangulate answers and fill gaps.
• Demonstrations (e.g., “Show me how you put on your shoes”) reveal praxis, sequencing, body awareness.
• Skill for next semester (POP 3.1 with Dr. Fairfield): systematically progress from global to specific questioning.

Building a Foundation for the Populations Course

• Current session = bridge between last week’s pure development content and upcoming condition-specific material.
• Goal: solid baseline so later comparisons (where child is vs. where they need to go) make sense.
• Faculty encourage continuous questioning; textbook alone ≠ mastery—must link to lived experience and reflections.

Neurodiversity Paradigm in OT

• Conditions commonly labelled “neurodiverse”: Autism Spectrum Disorder (ASD), ADHD, Down Syndrome, etc.
• Shift focus: from dysfunction → understanding brain-based differences & amplifying strengths.
• Inclusive language:
  • Reduces stigma, supports self-esteem & mental health.
  • OT role = match person’s strengths with graded tasks & environments across home, school, work.
• Society’s yardstick = “neurotypical” functioning; neurodiversity challenges that lens.

Inclusive vs. Deficit Language – Class Dialogue Highlights

• Sensory-friendly private rooms as practical inclusion example.
• Documentation sometimes reverts to deficit/disability-first wording for reimbursement.
• Residential setting enforced consequences for non-inclusive peer language—promoted respectful culture.
• Adults may prefer direct, label-first talk (“blind,” “autistic”) → always ask individual/family preferences.
• Identity-first vs. person-first:
  • Autistic community advocacy sites (e.g., Autism Speaks) guide current preferred usage.
  • Context matters: “Maddie is autistic” viewed differently from “This is an autistic adult named Maddie.”
• Ethical OT duty: model preferred language, update vocabulary continuously.

Autism vs. Sensory Processing Disorder (SPD)

• Overlap statistic from textbook p. 121: 60\% - 95\% of children with ASD show sensory-processing differences.
• SPD can exist alone; may also co-occur with ADHD, mood disorders, etc.
• Thorough differential evaluation essential; symptom cluster, not label, should guide OT care.

Diagnostic Access & Insurance Realities (Minnesota Example)

• Autism diagnostic eval = ~4 hours, multi-disciplinary; NOT covered by insurance.
• Out-of-pocket cost: \$1\,000-\$2\,000.
• Wait time: 6\text{–}9 \text{ months} → OT often treats functional goals before formal Dx.
• Formal Dx, once obtained, expands service portals (funding, school supports, community programs).

OT Case Video: Elena – Feeding Intervention

Session Goals

• Immediate: Elena reaches for a loaded spoon and brings it to mouth independently.
• Long-term: initiates scooping from bowl.

Equipment & Environmental Set-ups

• Suction-cup bowl to prevent tipping.
• Non-skid shelf liner (low-cost Dycem alternative) suggested for home.
• OT positions spoon, supports at elbow; child seated with back against wall (postural stability & focus).
• Caregiver repositioning advice: start side-by-side → progress to behind child for greater independence.
• Paper towels used to wipe quickly (clean hands act as reinforcement rather than sensory distraction).

Strengths Observed

• High intrinsic motivation (hungry, excited) & positive affect.
• Maintained attention; frustration remained low.
• Responsive joint attention & eye contact with mom; used sign for “more.”

Limiting Factors / Symptoms

• Weak grasp, limited wrist/elbow dissociation; impulse to hand-scoop food (tactile seeking).
• Repetitive motor patterns; reliance on adult loading.

Task Grading & OT Strategies

• Backward chaining: therapist loads spoon, child completes last step.
• Incrementally moves spoon closer to bowl to fade assistance.
• Uses elbow facilitation to model correct flex-extend pattern.
• Encourages caregiver to practice same pattern at home, integrate textured utensils if helpful.
• Reinforces success verbally (“Look at you go!”) to build self-efficacy.

Ethical / Practical Take-aways

• Mess often therapeutic, but here cleaned quickly because residue reinforced maladaptive mouthing.
• Demonstrates collaboration triad: OT ↔ child ↔ caregiver.

Breakout Room Themes & Sample Intervention Ideas

Occupational Performance (Home/ADLs)

• Bathing: gradual exposure to water temps; textured washcloths for tactile tolerance.
• Dressing: clothing with varied, acceptable textures; brushing protocols for sensory prep.
• Feeding: suction bowls, weighted/texture-grip utensils; quiet, low-stim eating niche.

Safety / Environmental Mods

• Elopement prevention: door/window alarms, bells, or Velcro alerts.
• Specialized seat-belt harnesses to prevent self-release in vehicles.
• Locked or elevated storage for cleaners/meds; baby-proofing during dysregulation periods.

Remediation Interventions

• Sensory room lighting adjustments; dim lights, limit visual clutter.
• Noise cancelling headphones; scheduled sensory breaks to reduce overload.
• Cognitive skill building via structured games; graded executive-function tasks.

Compensation / Adaptation

• Visual supports: calendars, Velcro schedules, step-by-step picture checklists.
• Task simplification & chunking; single-step cueing paired with icon prompts.
• Fidget items as alternate motor outlet, maintaining participation during lectures/therapy.

Administrative / Course Logistics

• Worksheet (Part 3) due 11:59 pm; minimum 3 scholarly references; bullet points acceptable if clear.
• Breakout groups remain consistent; remember group number for quicker entry next week.
• Office hours available for follow-up; ask early & often for clarity.