Ep. 1 Play With Purpose: An OT Motor Skill Intervention for Autism

Did you know that over 80% of children with autism are at risk for motor impairment (Bhat, 2022)? Today, we're diving into new research that's changing how we approach motor development in autism. You'll learn five evidence-based steps you can implement immediately in your practice, including a surprising twist on video modeling that goes beyond just visual learning. Whether you're an OT or PT,  this episode will transform how you think about motor-based intervention. Join Dr. Michele Alaniz and Dr. Lacy Wright as we explore ideas that will impact your therapy sessions.

Bhat, A. (2022). Multidimensional motor performance in children with autism mostly remains stable with age and predicts social communication delay, language delay, functional delay, and repetitive behavior severity after accounting for intellectual disability or cognitive delay: A SPARK dataset analysis. Autism Research, 16, 208 - 229. https://doi.org/10.1002/aur.2870.

Jin, Y. R., Sung, Y. S., Koh, C. L., Chu, S. Y., Yang, H. C., & Lin, L. Y. (2023). Efficacy of Motor Interventions on Functional Performance Among Preschool Children With Autism Spectrum Disorder: A Pilot Randomized Controlled Trial. The American Journal of Occupational Therapy, 77(6), 7706205020.  https://doi.org/10.5014/ajot.2023.050283 

Keywords: Occupational therapy; OT; evidence based practice; OT ideas; Peds OT; pediatric occupational therapy; autism; motor skills; motor-based intervention; video modeling

Stay informed, stay curious, and stay playful!

Email us at IdeasAtPlayPodcast@gmail.com

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Transcript

Michele: Welcome to Ideas At Play where we discuss pediatric research and help you  apply the ideas to your daily practice. Each week, we'll review evidence-based ideas to make you a better therapist. I'm Dr. Michele Alaniz, Director of Pediatrics at a rehab hospital in Southern California, and with me is my good friend and former coworker, Lacy.

Lacy: That's me, I'm Dr. Lacy Wright, an Occupational Therapy Professor in Kansas City. We're Peds OTs who love research and making it fun. We've helped thousands of therapists just like you to become more informed, more playful, and more effective in their sessions.

Michele: Today, we'll be discussing how to improve motor skills in kids with autism. Let's get started.

Lacy: Our first segment is Nailed it or Failed It, [00:01:00] where we discuss things that worked and what didn't in our practice this week because if you're pushing for the just right challenge, sometimes you nail it, and sometimes you fail it. So we're going to be real with you on both sides. Michelle, I think you have a failed it for us this week. 

Michele: Oh, do I ever, Lacy, as you know, I sometimes work with kids in the pool, so I do clinic-based OT, but I also do aquatic-based OT. And I have this little guy that I'm working with and he's been progressing. So nicely, my focus for him is on drowning prevention. That's really what I want to achieve with him. And so it's really important that if he submerges accidentally, that he can make it back to the surface of the water. Right? So he's been doing so good and making so much progress. So this week I was like, yes, I'm going to test him. So I had him jump off this little Island to the wall, knowing that he wasn't going to make it.

And he was going to [00:02:00] sink to see if he would come back to the surface. And I'm telling you. This child sunk like a rock. He had no reaction to save himself and come to the surface of the water. And to make matters worse, he is a kid that has high medical needs. He doesn't take water by mouth normally.

Lacy: oh no

Michele: He's cleared to be in the pool, but I'm telling you, I felt like, okay, now I'm murdering children in the pool. So that was definitely my failed it for this week. I will know next time to go a little bit slower before I test him for that skill set.

Lacy: Oh Michelle, I totally know that feeling when you're excited and think your kid is ready for that next step, but they're just not.

Michele: Well, Lace, as you know, sometimes you're going to nail it. Sometimes you're going to fail it. And it was my week. to fail it. So lift us up with [00:03:00] your example of how you nailed it this week.

Lacy: All right. I work with, transitional age, youth and adults with intellectual and developmental disability. And we were doing a class learning about conflict management, and I found the best video. Um, and we shared it kind of like a video modeling thing on conflict resolution.. Not only did it go well, but the video was an English as a second language video and it was perfect because the the actors, talked a little bit slower. They had better facial expressions and the video was the perfect cognitive level. So it was like one of the best classes that I've ever taught with my

Michele: Woo.

Lacy: Yay

Michele: Now that is a good nailed it. I mean, finding a good social modeling video is worth its weight in gold. That is so hard to get.

Lacy: Yes. Especially for that older age group. There's a lot of videos for like [00:04:00] really younger kids. You think of Disney movies, cartoons, but this was great because it was adults modeling work behaviors for adults. So I was thrilled. Nailed it!

Michele: Nailed it. 

Lacy: Our next segment is the Research Review, where we break down the latest in pediatric research and explore how to apply it to your sessions. This week, Michelle has an article about motor skills in autism. 

Michele: Lacy, I'm excited about this article that we're reviewing today. Because it is so applicable to our daily practice. I feel like by the end of this, you're going to be able to take ideas from this study, push it into your practice and, hey, maybe it'll show up in our nailed it and failed it next week. I guess we'll see.

Lacy: That'd be great.

Michele: The research is titled efficacy of motor interventions on functional performance among preschool children with autism spectrum disorder, a pilot randomized control trial.

Now [00:05:00] that is a mouthful.

Lacy: That is long. Uh, you got to break it down for me.

Michele: I'm telling you all of these research studies, like who names these, they need to have a character restriction. Basically, this is a study where they're looking at autistic kiddos who are in that preschool age range, and they want to see what type of intervention is going to be really effective for improving their motor skills. And the reason I love this is because almost every kid I see with autism, I'm working on motor skills because it's something like, I think the statistic is 86 percent of kids with autism also have a motor skill delay. And so it's really important for our kiddos.

Lacy: Oh, yeah, definitely. So, what did they do in this article?

Michele: Okay. In this study, they gave us a step by step play by play of how to implement the intervention in your session. But the first thing they did was they identified a target motor skill. [00:06:00] And the motor skills that they were choosing from are called fundamental motor skills. 

Lacy: Okay, fundamental motor skills. Tell me more about that.

Michele: So it's skills that we would test on the bot or the Peabody like balance or locomotion or bilateral coordination, things like that. So first you identify what is the target skill you're trying to improve. And then you do three different activities that are targeting that skill. So for example, if you're working on balance, they have one where they have the child on a BOSU ball, and they're collecting bullets off the ground to throw at the monster, and they're working on balance in that way. And they have another one where they have them also on a unstable surface and they're trying to avoid being hit by the monster. So they have these three different activities. Yeah, it's play based, it's targeting balance, and the key difference between just like a regular session is they're videotaping some of this. So after they've done the three [00:07:00] activities, they sit down and they talk with the child and they say, what was hard that we did today? And then they go back and they do that one hard thing again and they videotape it. And that video is going to serve as their starting point for the next session. So when they come back the next week, they review that video together, they talk about what made it hard, what made it successful, and then they try it again.nAnd then they just build on it week after week, session after session. So that's the summary of the intervention.

Lacy: Oh, I love a good routine. So it was like the same kind of three steps every session and they just kind of kept building on each other. Right?

Michele: Isn't that great? I love it when they provide me with a recipe. Step one, step two, step three, and do this much of it. Yes, thank you. I need a little bit less problem solving in my life.

Lacy: Well, it sounds like a great study, but let's get down to it. Did it help the kids or not?

Michele: It actually did help the kids. I am always shocked when I see that someone [00:08:00] improves on the BOT. Cause I feel like none of my kids ever showed a change.

Lacy: Yes.

Michele: But they did. They improved on the BOT and they also improved on the Vineland Motor skills. So win win.

Lacy: Excellent. And it sounds very cognitive. Did they use the CO-OP at all? Did they mention that?

Michele: Yeah, it does sound very CO-OP ish. CO-OP stands for Cognitive…

Lacy: Orientation to daily Occupational Performance? I think.

Michele: That's it. That's it. So, yeah, it does sound very CO-OP ish. They didn't explicitly reference that intervention, but it's definitely leaning in on collaborating with the child, reviewing the work, and discussing how to improve it. So, of course, the kids that were included in this study are those kids that have less severity of their autism, have more language ability, have more ability to have that kind of discussion.

Lacy: It sounds like you'd have to have a lot of self-insight, right, to pick the [00:09:00] hardest thing and then do it and on it again afterward.

Michele: Yeah, absolutely. So I can see that I have a subset of kids that I could definitely use this with, but a large majority of the population I see are not quite at that level of being able to do that reflection, especially if they're at the preschool age. So, I've been thinking about how I might play this out in my session.

Lacy: Yeah, what do you think you do with, those kids?

Michele: Well, I'm thinking like, okay, so I've used video modeling and tons of sessions before. For example, I have one kiddo who's just an emerging verbal client. He is still learning how to sit and follow directions and all those things. And he's working on shoe tying. And so we've worked on video modeling to facilitate that shoe tying. And I do think that that's been helpful for him. But the difference between that and the study is in this study, they're not. video taping a particular occupation like shoe tying. They're actually videotaping the [00:10:00] performance skill, you know, like the balance because I think the concept is let's improve this fundamental motor skill and then in turn, that's going to have an amplifying effect where it's going to prove a bunch of occupations of narrowing down and focusing on just this one occupation of like shoe time, for example. For my kiddo that maybe has less language ability, I would still use the video modeling, but instead of recording the occupation, record the actual session and then just, put it on a playback for him. Maybe give it to the parent because I know with those kids, a lot of times just more repetition helps so they could play it at home over the week until I see them the next time and see if that helps with it.

Lacy: Wow, that's really interesting.

Michele: Yeah, I will tell you something kind of funny that when I've tried doing this before.

Lacy: okay. Is this like a bonus failed it?

Michele: No, no. Well, well, maybe

Lacy: Or, or maybe it's a nailed it. I'm assuming the worst.

Michele: it's kind of both. [00:11:00] Okay. So a lot of the studies have shown that, uh, video modeling is helpful and that it should be first person perspective, right, when the child's looking at the video, it should look at what they're seeing when they're looking. So I was trying to record a task with the video camera in first person. And I had it propped up on a thing and it kept falling over and the kid got obsessed with the camera. And then it was like recording me on accident because I had the camera reversed. So I haven't many failed it when it comes to video modeling. I highly suggest having a student with you when you're doing this because they can be your extra set of hands.

Lacy: Yes.

Michele: Or maybe a GoPro, you know, I mean, that could work.

Lacy: Yes. Yeah, it is so nice. Shout out to students. 

Michele: I love it. Yeah.

Lacy: So, what else do we need to know before putting this into practice? 

Michele: There's three things we should always think about when we're reviewing research and seeing how we can apply it to our clinical population. [00:12:00] We want to think about what was the population of kids that were included in the study, what were the key ingredients, and what was the mechanism of action,

Lacy: Perfect. And I think you covered the population already, right? Uh, children who had autism. Great. So we got the population down. Tell me next, what are the key ingredients? 

Michele: The key ingredients are the things that need to be present in any session if you're going to try to apply this into the session. So you want to make sure that you include targeted practice, augmented feedback, and in this study, the augmented feedback was the video modeling and the discussion around what was happening. You want to do collaboration with the child and also engage in that guided review.

Lacy: Excellent. And what was the mechanism of action?

Michele: So the mechanism of action is why did this actually work? And it's so [00:13:00] important when we're thinking about how we can apply it, because maybe our population is kind of different. Maybe we can't do every single piece of the study exactly like it was done. But if we understand why it worked, then we can apply it to a bunch of different types of clients.

So the mechanism of action in this study is really heavily leaning into the motor learning theory. And I know you as a professor know what I'm talking about. When I say motor learning theory..

Lacy: I love some motor learning theory.

Michele: Uh, this is a funny backstory with me and Lacy, but when we used to work together, she was always talking about the frame of reference or the theory. And I'd always be like, what is that relevant to anything? And I just, it's always a point of discussion with us, but now I think that I…

Lacy: it's coming back around today, Michele. It’s important after all.

Michele: Yeah, I have to say definitely you're the winner in this debate. The theory is important. So in this one, the motor learning theory, of course, relies heavily on [00:14:00] high repetition practice. And then also identifying what type of feedback you're giving to the client in order to improve that motor action. And there's tons of different types of feedback and tons of different types of feedback schedules. But in this case, they're using that video modeling as visual feedback to help the child to improve their performance time after time. 

Lacy: I love how the researchers really play to the strengths, uh, using video modeling, right? Because we know a lot of kids with autism really rely on their visual skills.

Michele: Yeah, it's actually really interesting because when you read the studies on autism, they find that people with autism, ironically, tend to rely on proprioceptive feedback as their primary feedback for motor skills, even though their visual skills are so much stronger. It's like there's something about that body sense that that inward sense that they rely, they want to rely on that more. But we know that [00:15:00] oftentimes the proprioceptive system isn't working that great for them. And so it's not giving them the best feedback. So it is interesting how they decide to use a visual. support to help with that feedback, even though it might not be intuitive that that's the way someone with autism wants to learn the feedback.

Lacy: Wow. Fascinating. So yeah, using visual system shows them where their body is in space so that they can learn more about their proprioceptive sense. Yes?

Michele: Exactly. Yep. That's it.  And that's it for our research review for this week. Now, Lacy's going to share with us our next segment called People, Places, and Products, where we give a shout out to something we're really loving this week. Lacy?

Lacy: Yes. My shout out this week is to the most fabulous toy store in Lawrence, Kansas. Ironically it's called The Toy Store. It's three stories tall and has every kind of toy you want. I went with my family recently [00:16:00] and we spent so much time in that toy store.

Michele: I feel like I might not ever leave if I went in there.

Lacy: No, it was, we got lost on like the different floors and it felt like Indiana Jones adventure, everything. But anyway, I came across a section that was cooperative board games for younger kids. And it brought me back to when we were working together and, and with our dear friend, Kristin working with pediatric groups, right? These are our groups where we're working on making friends, sportsmanship, taking turns, all those good things. And these cooperative board games were from Game Wright and Peaceable Kingdom. And they had these really cute games. One was like Hoot Owl Hoot. I remember doing one like Dinosaur Escape, um, so anyway, these games are just really, really fun. I see a lot of cooperative games for adults. I love a good cooperative game. But these are tailor made for like preschool, young elementary age. And they're so special and fun when you want to work on these [00:17:00] skills, but don't necessarily want that competitive edge. Losing can really mess up a session if that's not something you're targeting at the moment. So, shout out to The Toy Store, Kristen, and Cooperative Board Games.

Michele: Well, I can't wait to come out to Kansas City and see that toy store. We'll have to take a little, a field trip together. 

Lacy: Yes, we'll get lost together in there. So fun.

Michele: In this next section, we are going to answer listener questions because we know you have questions and we have answers for you. But because this is our first episode, we don't have a question yet. So we're relying on you. Please send us your questions to ideasatplaypodcast@gmail.com or you can DM us on social media and we may include your question in a future episode.

Lacy: Yes, please send us your questions. We want to hear from you.

Michele:  This week, we reviewed how to use high repetition practice partnered with [00:18:00] video modeling to help our autistic preschoolers learn new motor skills. Remember, the steps include: choose a fundamental motor skill to target like balance or manual dexterity, provide augmented feedback, collaborate with the child, and do a guided review of how it went at the end of the session.

Lacy: And that's it for today. Thank you for listening to Ideas at Play.  If you learned something new from today's podcast, be sure to leave a rating and review. This helps others find our podcast so we can all be evidence-based therapists.

Michele: Until next time, try to make each session better than the last. Stay informed, Stay curious, and stay playful!