Autism and Energy Conservation

New Application for a Tried and True Therapeutic Tool

Though there is controversy about the actual rate of autism throughout the world, at some point in our careers virtually all school-based occupational therapists will encounter students diagnosed with autism spectrum disorder (ASD). Autistic students can have a laundry list of challenges and deficits; social, communication, motor planning, executive function, learning and sensory processing difficulties can all impact an autistic student's ability to function in a world not tailored to his or her needs. As medical professionals. within the educational environment, therapists can get stuck making deficit amelioration their primary role. We often start with neurotypically normed assessments, so treatment goals become focused on bringing our students as close to “normal” as possible. But, is this what is best for our autistic clients? How do our clients feel about constantly working on deficits that therapists have predetermined to be important? In our university programs, occupational therapists learn about energy conservation as an important consideration for adults with physical disabilities. Perhaps it is time that therapists recognize the consequences of fatigue and over-efforting for our autistic pediatric students as well. How would this recognition change our work and focus in the schools?

Occupational therapists have traditionally been given very circumscribed roles within the schools. According to the American Occupational Therapy Association (AOTA), school-based occupational therapists support academic achievement and social participation by promoting occupation within all school routines, including recess, classroom, after-school activities and the cafeteria. Though this is the ideal, often occupational therapists are relegated to working on fine motor skills and looking at the impact of sensory processing as related to the classroom only. However, to truly be of service, we may need to get back to our occupation roots and look at the broad impact of autism on the student, peer and player. What is important to the child? Are fine motor skills, such as handwriting, important to most autistic children? If not, then why is this still a major focus for many school–based occupational therapists?

Schools are busy, over-stimulating places. For our autistic clients these overwhelming sensory environments can be a significant source of stress. As occupational therapists we are very good at looking at classroom sensory environments and creating plans to help students to navigate them more skillfully. Yet, do we consider how these environments exhaust our students and how this might impact academic success? It is not sufficient to want to help our students meet their sensory needs in a vacuum. We need to consider what happens to each child when there is a sensory stressor. For example, how long does a child take to recover from a fire drill, or, for students in classrooms with multiple autistic students, what happens when one child has a sensory meltdown? Are academics modified to accommodate the child, or is the child supposed to carry on as though nothing has happened? These are important considerations because a child’s energy is impacted by changing sensory conditions.

As therapists, we can start with the premise that autistic children are constantly bombarded with stressful situations in school. Through the autistic neurodiversity movement, we are learning more and more about the lived experiences of autistic individuals. For example, communication can be exceedingly difficult even for those who speak, but it is especially challenging for minimally speaking and non-speaking individuals who do not have robust communication systems. Countless times a day, well-meaning adults ask children to respond verbally. Are we considering how exhausting this can be for many children? Perhaps we accept a gesture as communication? Adult autistics have explained that under stress they can lose the ability to speak and that the expectation for them to speak can even cause physical pain. We must remember this when working with our students. Instead of constantly looking at neurotypical ways of communication, we may sometimes need to lower our demands in order to reduce stress, which would ultimately allow for developmental growth.

Coming back to occupational therapy goals: Does handwriting serve an autistic child with significant dyspraxia? Should we keep handwriting as a goal year after year, as we do for many autistic students in schools right now? Could we instead find ways to make written communication easier? There are many ways to do this using technology, but there are also low-tech ways that autistic clients can use to access school based curriculum. For many autistic children, visual processing is a strength, so we can increase visual supports instead of constantly asking these children to perform motor tasks that are not personally meaningful or necessary in our increasingly technological age.

Lastly, perhaps we can reconsider the idea of independence and instead focus on interdependence. We all need each other; none of us navigates this world alone. For example, perhaps learning how to tie shoes costs a child too much energy and is not meaningful. Adults can tie a child’s shoes or encourage him or her to wear shoes without shoelaces. Maybe the morning routine in a crowded area of the school causes sensory overload for a particular child? If so, a teaching assistant can be charged with putting a child’s belongings away, which would allow the child to start the day without the chaos of the morning rush. Every child and situation is different, but we should not be rubber-stamping independence goals in every IEP without considering the energy costs to the child.

Energy conservation is not about creating so much ease that it does not challenge our clients. It is about putting our energies toward what is most important and meaningful. What brings a child joy? What are the skills, based on their neurology and not on our neurotypical ideals, that will help them to be the best version of themselves? As therapists we can support our autistic students by reading an individual student’s signs of dysregulation, and we can alter our plans accordingly. We can become autistic allies and remind our colleagues that stress and exhaustion is relevant and consequential when choosing interventions. Within our holistic practice frameworks, occupational therapists have been given many tools that we tend to forget as we specialize. Energy conservation may be a tool that school-based occupational therapists return to as we advocate for autistic students within our schools.