The #1 Reason OTs Feel Ineffective with Kids On the Autism Spectrum

Why OTs feel ineffective with autism

Most OTs want so badly to make a real impact in the lives of the people we work with. We want to feel like what we are doing matters for our kids and their families, that it is effective, and that our time has been well spent.

When I first started out as an OT in early intervention working with kids on the autism spectrum, I felt immense pressure to really help the families I was seeing. The parents were exhausted, confused, and out of other options. They were counting on me to help. I did the best I could, but every day I felt awful. I felt ineffective, confused, and terribly stressed. I worked all the time and felt like I accomplished nothing.

The thing is, we don’t come out of school ready to be successful with kids on the spectrum. Sure, there are a few lectures on autism in our pediatrics classes. And we get some experience on fieldwork. But when we really dive into the work, whether we are new therapists or have been doing this for years, eventually we begin to feel that we don’t really know how to be effective with our autistic kids.

The insecurities creep in. We may start to think, “Do I know what I’m doing?” We may feel like imposters and dread going to work. We stay up late trying to look at research (even though we no longer have a research database logins, so we are reading abstracts and clicking on links that won’t actually load).

We eventually settle in and start to do the same uninspired interventions over and over again. They don’t really feel individualized or effective. They often don’t even feel like skilled interventions. But we really don’t know what else to do, so we keep plugging along and try not to think about it.

We take continuing education courses, and they feed us more theory and superficial ideas. We are taught to consider the environment, to use a new theoretical framework, or to use more visuals. But we still don’t really know what that means or how to do it in a way that will really make a difference for our young clients on the autism spectrum.

Have You Been There?

It’s easy to get caught in an uninspired rut, and to feel like no continuing education could get you out of it. However it’s not so complicated to become a truly effective therapist for your clients on the autism spectrum. When we begin to deeply understand autism learning styles, it’s entirely possible to feel skilled, competent, successful, and inspired in our work once again.

Doing Something Different

If we never deeply learn about how autistic kids think and learn, we try to get by on what we think we know. We use clipart in our instructions because, “They’re visual learners, right?” The clipart picture schedules and visual instructions get ripped up, ignored, and thrown on the floor. We aren’t sure what we are doing wrong, but we keep plugging along, spending hours putting pictures onto pages.

We try to teach social skills, because we know that kids on the autism spectrum have social differences. And somehow we wind up teaching new, rigid routines that don’t help our kids at all. We try to teach our kids to play, and they won’t imitate us. So we just keep trying, feeling ineffective once again.

We teach fine motor activities, even though we aren’t sure that it will ever make any real difference in daily activities. And we teach tons of handwriting, because after all of this time we’ve gotten good at teaching handwriting, while we still feel uncertain working on other daily routines and activities.

When we do behavior problem solving, we continually write, “The purpose of the behavior is to gain attention or to get out of something” even though this generic hypothesis isn’t really helping us generate effective interventions for our autistic kids.

Working like this eats away at our confidence. It leaves us numb or even dreading our work, and it makes us question our abilities as therapists.

If you are dragging yourself along in your therapy without a true, deep understanding of autism learning styles, you have the opportunity to do something different. You can become a more skilled therapist and begin creating interventions that really speak to your clients. You can clarify your therapy process from start to finish so that you show up knowing exactly where to start each day with your clients on the autism spectrum. And you can rekindle your excitement about your work and your confidence in yourself knowing that you are truly an expert with deep knowledge of autism that guides your work.

Using Autism Learning Styles to Guide Your Work

When I work with OTs in one-on-one consultation or in my continuing education courses and workshops, I start with a deep and thorough exploration of how kids on the autism spectrum think and learn. Then, we practice going through each part of the autism learning style and using it to problem solve a behavior and develop an intervention plan.

Here’s an example of how this process took one therapist from stuck to totally rocking it.

The therapist’s client, Kyle was an autistic five year old who dumped out all of the toys during free play. Kyle’s behaviorist hypothesized that this behavior was to gain attention. But the OT wasn’t so sure. She suspected that the behavior related to poor play skills. But she didn’t know how to make the leap from her suspicion to a full intervention plan.

After working together to problem solve using autism learning styles, here is what we came up with.

Our first hypothesis was that Kyle’s dumping toys may be related to his difficulty with social relationships and social communication. We hypothesized:

  • He may not pay attention to how others play and therefore does not imitate others.

  • His peers’ social play may not capture his attention, so he doesn’t look around and join in with the other kids.

  • He is not motivated by his parents’ and teacher's social responses to how he does or doesn’t play,