When I hear
the word autism the image that pops
into my mind is 4-year-old Gary. He is lining up cars, end to end, while
children around him make their cars roll, beep, and drive over paper roads. Gary
doesn’t seem to notice what they are doing, even as he crawls over another
child’s leg to reach the bucket of toys.
Gary glances at a toy just long enough to reach for it before
looking away. He sits with his knees bent and feet outside his hips, in a
position called W- sitting because
his legs form a “W” shape (see photograph 1). While picking up cars with his
left hand Gary shifts his weight to his right side. His wrist is loose and
floppy. He grasps the cars with his fingertips, as though they were slimy fish
he was keeping from touching his palms. When another child jostles the
perfectly aligned cars, Gary grunts and, without missing a beat, adjusts them. Then
he stands up and flaps his hands while walking around in circles.
(photograph 1 Boy playing in W-sitting position)
You may have imagined a similar child—a
child who does not play with toys the way most children do (or spends more time
flapping hands than using them to play). A multidisciplinary team observing Gary
would all contribute important findings. An occupational therapist (OT) would
note that although his eye-hand
coordination seems fairly normal, Gary does not look directly at objects,
he avoids using his palms when grasping and seems unaware when his body moves
into a space occupied by another child, signs of a sensory processing disorder (SPD).
A physical therapist (PT) would note hypotonia
(low muscle tone) and poor postural control,
meaning his muscles seem weak and floppy and he leans on his hands to help
hold himself up. A speech-language pathologist (SLP) would note his lack of
social awareness—he doesn’t even protest when another child bumps his cars. He
doesn’t use toys functionally or vocalize while playing, the way the other
children are making their pretend cars drive and crash while saying “beep,
beep.” Gary’s lack of eye contact with
other children and the way he repetitively lines up his cars would draw a child
psychologist’s attention. Gary’s preschool teacher would be concerned that he
cannot name the colors of the cars or engage in pretend play, such as forming
an imaginary steering wheel with his hands and pretending to drive.
As the team discusses their
observations, the picture of Gary that emerges is typical of children on the autism
spectrum. The way he grasps, manipulates, and uses the cars while ignoring his
peers demonstrates difficulties with
·
Postural control: his body and hands seem to be floppy and weak.
·
Visual skills: he avoids looking directly at the objects in his hands.
·
Play skills: he lines up the cars rather than using them in pretend play.
·
Communication and
social skills: he does not imitate other
children or share the play experience with them.
·
Sensory processing: he has difficulty interpreting and responding to touch and other
stimuli.
Challenges in all of these developmental
areas contribute to Gary’s difficulty using his hands, which is my particular
interest as an occupational therapist. This book explains how atypical
development affects the way children with an autism spectrum disorder (ASD) use their hands. It also offers
intervention strategies aimed at helping children to experience success and be
as independent as possible in performing everyday tasks such as dressing,
cutting paper, or writing their names.
In chapter I you will be introduced to how children use their vision,
think, process sensory information and behave influence hand skill development
and learning in general.
The
technical term for hand skills is fine-motor
skills, because grasping and manipulating objects uses the small, or
“fine,” muscles of the hands in delicate movements. Traditional examples of
fine motor skills would be stringing small beads or stacking blocks. Effective
hand use, however, requires much more than good motor control. In this book I
take a comprehensive look at how children diagnosed with ASD typically use
their hands, what challenges they face, and what strategies will help them
reach their potential. I stress “reach their potential,” because there is
currently no cure for autism or its associated challenges. There are, however,
many effective and fun strategies that parents can implement.
Who This Book Is For
I wrote this book first and foremost for
parents. When I worked in early intervention and Head Start programs I saw how
family education enabled caregivers to carry over OT strategies throughout the
young child’s day and night, seven days a week, whether at home, in the
community, or on vacation. Many of these strategies are easily integrated into
everyday routines and continue to be useful as the young child grows to
adulthood.
As an example, four-year-old Abdul
preferred to line up objects rather than drop them into a container with a
small opening. Inserting objects is an early skill that develops the eye-hand
coordination to use shape sorters and push coins into a piggy bank. Abdul was
motivated to insert magnets into the can shown in photograph 2 when an electric
toothbrush was placed inside.
Caution: Use larger objects if
there is a choking risk. Magnets are dangerous if swallowed.
photo 2 Vibrating container adaptation
The toothbrush created vibration and
motor sounds that interested Abdul and made him want to hold the container. He had to use both hands together-an
important skill that will be discussed later, in order to separate the magnets.
Pulling magnets apart is an enticing activity by itself, but inserting them
into a vibrating container is irresistible. This is one of my oh-so-simple, yet
oh-so-effective strategies to help children to build hand skills.
This activity is also suitable for older
children or adults who are developmentally ready to learn insertion skills.
Many of the strategies described in this book can help individuals with
cognitive and/or motor delays to develop hand skills typically mastered at a
younger age. However, it is important that the materials be age appropriate and
the person have the prerequisite skills to learn them. For example,
six-year-old Bonnie refused to touch gooey substances such as paint or glue and
she had difficulty learning how to form letters. Her mother filled a sturdy zip
locked bag with paint, and Bonnie imitated her mother using her index finger to
form lines and shapes by pressing. Bonnie
had the prerequisite skills to use her index finger as a writing tool, visually
attend and imitate the movements. Bonnie liked this activity because she didn’t
have to struggle with controlling a pencil, it was fun to feel the paint move
through the plastic and she felt like an artist.
This adaptation is just one of many
strategies provided that may be beneficial to children with or without an
autism diagnosis. Many strategies may also help very young children who do not yet have a diagnosis but perhaps the
parents sense that they should be concerned.
Although children with ASD are typically not diagnosed until toddlerhood
or older, some parents may notice developmental differences in their babies.
Therefore, I include red flags and strategies relevant to babies. These may be
especially important if the baby has older siblings diagnosed with ASD. If the
descriptions in this book “resonate” with your child, speak to your
pediatrician or local child development center to get further information
specific to your child’s needs.
Much of the current literature on autism
focuses on the social, communication and behavioral aspects of the disorder. I
have written From Flapping to Function: A
Parent’s Guide to Autism and Hand Skills for the early childhood
professionals, educators, counselors, therapists, and other professionals
working in school, residential, community, or institutional settings who seek a
comprehensive, one-stop resource that focuses on how developmental challenges
impact building hand skills and the strategies that will enable children to
reach their potential. 
