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Occupational Therapy Intervention Plan Name: Matt____ DOB: ___ Age: _8 year 7 months___ 11/14/13___________ Gender: M F Date of Report Primary diagnosis/condition: Autism Other diagnoses/concerns: Multiple food allergies and yeast overgrowth. Precautions/Contraindications: Food allergies Reason for referral: Parents concerned about development, attention, activity level, and ability to develop socially appropriate skills and behaviors. Parents and teacher also concerned about performance in school. Teacher and parent expressed desire for him to be happier and not get so frustrated over things. Therapist: Ruth Walton, OTS FINDINGS Occupational Profile: Matt is an 8 year 7 month boy in a regular third grade classroom with a diagnosis of autism. Matt has multiple food allergies and yeast overgrowth. He is on a gluten and casein free diet with supplements. He typically met most motor milestones. He has mild language delay. It is reported that Matt was a good baby but was unresponsive to his name and did not fuss to be held, but did not like stranger’s faces. He did not like being moved between the car and house or car and store. Matt receives one-on-one instruction in his classroom for two hours per day and speech and language therapy twice weekly for 30 minute sessions. He is better than average in math and reading. He is skilled and interested in the computer. He shows good mastery of material if there are no time constraints, but he fails timed tests. Matt’s mother reported that he likes to scratch his mattress in the morning before getting up. He eats three bowls of cereal in the morning and his mother says that the cereal has to be the right temperature and the sugar cannot have any “bumps” in order for him to eat the cereal. His mother reported that wearing shoes and socks used to be a challenge, but he now wears very tight shoes which enabled him to wear his shoes and socks. His mother also reported that he wears long pants and long sleeves always. His mother reported that he pushes kids that are waiting in line to swing before school. She also reported that if she picked him up at school with a bike trailer he would hit her even with other kids around. He gets frustrated with kids playing in the front of his house and hits them. His mother reported that he gets frustrated when doing his homework and scribbles on the paper, punching holes in the paper and the table with the pencil. She reported that he takes a week to do homework that should be done in two days. Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 1 His mother reported that he is able to ride a bike, but prefers to ride a bike that is lower to the ground (12” rather than a 16” that fits him). He likes to swing and dig in the sand. He likes to take a bath. He wraps himself in blankets and covers his head when he goes to bed. His teacher reported that Matt is a bright child but homework seems difficult for him. His teacher also reported that she does not feel that he is living up to his potential. She reported that his is disruptive to children around him and that she wished that he could be happier and not get so upset at little things. Matt’s mother requested an occupational therapy evaluation to determine if occupational therapy could bring about better performance in school and to assess his development. She is also concerned about his attention, activity level, and ability to develop socially appropriate skills and behaviors. Analysis of Occupational Performance: After analyzing evaluation data from records, interview with mother, and assessments given, it was concluded that Matt has decreased tactile discrimination and tactile defensiveness as well as motor deficits that include balance deficits in standing and walking, bilateral coordination deficits, sequencing and oral praxis deficits, kinesthesia deficit and motor accuracy deficit as determined by Sensory Integration and Praxis Tests. His visual perception as test by the Motor-Free Visual Perception test was above average and space visualization, design copying, and figure ground were WNL as tested by the SIPT. Matt is a bright child with good memory and high cognitive skills. Matt’s strengths are math and reading. Matt is able to participate in a regular third grade classroom with an instructional aid. Matt demonstrates difficulties in paying attention and difficulties in activity level. These could contribute to behaviors that are not socially appropriate in the classroom, at home, and on the playground which make children not want to be by him because he is disruptive. The lack of social communication with peers could be contributing to his depression, sadness, frustration, and anger. Matt presents with behaviors that are consistent with sensory processing. Scratching his mattress in the morning, wrapping blankets tightly around his body and head, disliking wearing shoes and socks, only wearing long pants and long sleeve shirts throughout the year, and wearing shoes that are very tight indicate that he has difficulties in organizing sensations that are being input to his body. These behaviors are adaptations in trying to organize his sensory information. Matt’s deficits in sensory processing, motor, and praxis deficits most likely influence his inability to cope with his environment. His deficits interfere with his occupational performance in social participation and play skills. Child presents with following strengths (bulleted list) Good memory High cognitive abilities Better than average skills in reading and math Skilled and interested in computer Able to master material when given untimed tests Rides a bike Likes to swing and dig in the sand Bright child Receives one-on-one instruction in 3rd grade classroom Likes to bathe Has developed coping mechanisms such as wearing tight shoes and wrapping in blankets Child Presents with following problems: (Bulleted list) Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 2 Unable to independently structure time or interaction with others Poor coping skills with social and temporal demands Aware of his limitations with causes him to feel depressed, sad, frustrated, and angry Fails timed tests Mildly delayed language Gets overwhelmed and may get aggressive if routine disrupted Hits and pushes other kids at times Gets frustrated with homework Disruptive in classroom Rides a bike that is smaller than appropriate for his size Problems prioritized: #1 _Difficulty in maintaining activity and attention level_____ #2 _Difficulty with developing socially appropriate skills and behaviors. #3 _Difficulty in completing homework and school work_______ Supports and Barriers Personal Bright child Good memory and high cognitive abilities Able to ride a bike Likes to swing and dig in the sand Gets along well with brother Likes to bathe Has developed coping mechanisms Rides a bike that is smaller than appropriate for his size Unable to independently structure time or interaction with others Poor coping skills with social and temporal demands Hits and pushes other kids at times Aware of his limitations with causes him to feel depressed, sad, frustrated, and angry Supports Barriers Environmental (context) Supportive mother Supportive teacher Aid at school Occupation Able to master material with given untimed tests Better than average skills in math and reading Skilled and interested in computer Gets overwhelmed and may get aggressive if routine disrupted Disruptive in classroom Fails timed tests Mildly delayed language Gets frustrated with homework Areas of occupation to be addressed: (highlight or bold those that apply) Activities of daily living Education Leisure/play Instrumental activities of daily living Work (voc or prevoc) Social participation Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 3 Long-term goal: #1 _Within six months Matt will complete school work and homework tasks with minimal assistance as needed per parent and teacher report._ #2 _Within six months Matt will engage in socially appropriate behavior at home and at school with minimal verbal cues by parent or teacher report. __ Short-term objectives for Problem #1 Intervention approach (es)/practice model with rationale Within 3 months Matt will complete 4/5 homework tasks per week for three consecutive weeks with minimal assistance per parent report. Practice model/Frame of Reference: Sensory integration – increase ability to organize oneself, increase ability to participate in activities, deal with sensory processing and motor planning difficulties Acquisitional frame of reference – through positive reinforcement, a behavior or a skill can be learned, reinforcement at both school and home will likely bring about better results Intervention Type: Therapeutic use of self (I would use my experience as a mother to help Matt design a card that would be useful and motivating to him); Purposeful activity (Filling out a card will help Matt to develop his occupational performance of doing homework) Intervention Approach: Establish (The card reminder system would help Matt establish good patterns of completing homework at home) Intervention Activity: Matt and his parents would be provided with a reminder card on which Matt can keep track of assignments that have been completed. The card can be filled in by stickers of Matt’s choice. As each week is filled up, Matt would be able to pick an activity such as extra computer time to celebrate his accomplishment. Having similar activities at school would help to positively reinforce the behavior. Practice model/Frame of Reference: Sensory integration – increase ability to organize oneself, increase ability to participate in activities, deal with sensory processing and motor planning difficulties Acquisitional frame of reference – through positive reinforcement, a behavior or a skill can be learned, reinforcement at both school and home will likely bring about better results Intervention Type: Therapeutic use of self (I would use my experience as a mother to help Matt design a card that would be useful and motivating to him); Purposeful activity (Filling out a reminder card help Matt to develop his occupational performance in school tasks) Intervention Approach: Establish (the use of a card reminder system would help Matt to establish good patterns of doing school tasks) Intervention Activity: Matt and his teacher would be provided with a reminder card on which Matt can keep track of school tasks that he completes per the teacher’s guidelines. When a certain number of tasks have been completed, as agreed upon by Matt and his teacher, Matt would be able to Within 3 months Matt will complete 4/5 school work tasks per week for three consecutive weeks with minimal assistance per teacher report. Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 4 Short-term objectives for Problem #2 Within 3 months Matt will play with peers at school for 10 minutes with no behavioral eruptions with minimal verbal cues from teacher in 3/5 days for three consecutive weeks. Within 3 months Matt will interact with children in a home or community setting for 10 minutes with no behavioral eruptions with minimal verbal cues from parent or adult in 3/5 opportunities for three consecutive weeks.. pick a treat such as free time in the class room. Having similar activities at home would help to positively reinforce behavior. Intervention approach (es)/practice model with rationale Practice model/Frame of Reference: Sensory integration – increase ability to organize oneself, increase ability to participate in activities, deal with sensory processing and motor planning difficulties Social participation model – increase social participation, increase self-regulation Intervention Type: Therapeutic use of self (I would use my experience as a mother and my judgment to help Matt create a social story); Purposeful activity (the use of a social story would enable Matt to practice skills to interact with other children before interacting with them to increase his occupational performance of social interaction) Intervention Approach: Establish (the use of a social story would help to establish social skills for Matt in interacting with others) Intervention Activity: Matt would create, with help from therapist and teacher, a social story about playing with children at school. The social story would include what would happen if Matt pushed children he was playing with and what would happen if Matt was nice to the children. Matt would read the social story before interacting with children to remind him of proper behavior in the situation. Having a similar activity to use at home would help to generalize the behavior. Practice model/Frame of Reference: Sensory integration – increase ability to organize oneself, increase ability to participate in activities, deal with sensory processing and motor planning difficulties Social participation model – increase social participation, increase self-regulation Intervention Type: Therapeutic use of self (I would use my experience as a mother and my judgment to help Matt create a social story); Purposeful activity (the use of a social story would enable Matt to practice skills to interact with other children before interacting with them to increase his occupational performance of social interaction) Intervention Approach: Establish (the use of a social story would help to establish social skills for Matt in interacting with others) Intervention Activity: Matt would create, with help from therapist and mother, a social story about playing with kids in the neighborhood. The social story would include what would happen if Matt hit kids that made him frustrated and what Matt could do instead of hitting the kids and come up with a socially acceptable way of interacting with the children in the social story. Matt would read the story to his mother before playing with children to remind him of proper behavior. Having a similar activity to use at school would help him to generalize the behavior. Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 5 Service delivery mechanisms: Service provider (s): Ruth Walton, OTS Location: School and home weekly Frequency and duration of services: 45 minutes, Plan for discharge (criteria and follow-up): Goals will be evaluated monthly. Matt will be discharged upon satisfactory completion of goals or of demonstrating progress of therapeutic goals. Outcome measures (highlight or bold those that apply) 1. adaptation 2. client satisfaction 3. health and wellness 4. occupational performance 5. prevention 6. quality of life 7. role competence Name and position of person(s) developing plan: Ruth Walton, OTS Date plan developed: 11/15/13_____________ Date plan modified or reviewed: _________________ Intervention Format Adapted from Sames, J. M. (2005). Documenting occupational therapy practice (pg. 104). Upper Saddle River, NJ: Pearson/Prentice Hall. 6