Neuro OT in action - Pervasive Developmental Disorders
Neuro occupational therapy in action: how Krysalis supports autistic people and others with Pervasive Developmental Disorders (PDDs).
In the wake of World Autism Day this month, we look at the many ways our neuro OTs are supporting people living with Pervasive Developmental Disorders (PDDs).
Our neuro OTs provide holistic support for autistic people and others with PDDs to maximise their ability to function independently. 
Describing Pervasive Developmental Disorders is a pervasive challenge made more complex by conflicts in PDD-linked research, history, and human rights.
Evidence setting the different PDDs apart is lacking, and there is disagreement over some of the PDD category names and discontent with how society views people with PDDs.
Regardless of all this, however, our neuro occupational therapists (neuro OTs) can offer a wide range of evidence-backed support for people living with PDDs.
So, with the caveats in mind, let’s have a look at the five main PDDs recognized so far:
Autism
There are around 700,000 autistic adults and children in the UK, with one in 100 people on the autism spectrum. [1]
Many find their symptoms improve with age, and they can live independently, with some therapy or treatment support.
Being a spectrum condition means autism can cause a range of different challenges for different people.
Mainly, these challenges fall into the following areas:
- Communication and interaction
- Emotions and expressions – their own and understanding of others’
- High focus on routines or objects
- Repetitive/restrictive behaviour
- Sensory difficulties
Some may also have difficulties with fine motor control, coordination, and learning.
The causes of autism are uncertain, but it is believed there is a genetic link.
Asperger Syndrome
Due to controversy over the origins of the term Asperger, some people with Asperger's symptoms may prefer a diagnosis of ASD (autism spectrum disorder) or autism.
People with this condition may have challenges with:
- Communicating
- Expressing emotions
- Interacting with others
- Their behaviour
They may be obsessed with the things they like or have limited interests. They may also prefer a daily living routine and may become upset if it changes.
Children and adults with this condition may also have difficulties controlling their emotions.
And they may have additional difficulties such as:
- Dyspraxia – movement and coordination difficulties
- Attention Deficit Hyperactivity Disorder (ADHD)
- Learning difficulties
Rett
Rare in men, Rett Syndrome affects around 1 in 10,000 women and almost every area of daily life.
It can cause challenges with:
- Breathing and sleeping
- Eating and digestion
- Hand function
- Mobility and gait
- Muscle weakness
- Tremors and seizures
- Speech
It may also cause scoliosis (abnormal curvature of the spine) and microcephaly (smaller head size).
Rett Syndrome is linked with a gene mutation but rarely runs in families as it affects the ability to reproduce.
Childhood disintegrative disorder (CDD)
CDD is a rare condition, usually diagnosed between the ages of two and 10. It severely affects:
- Communication
- Emotions
- Language
- Self-care abilities
- Social skills
People with CDD may also have repetitive interests.
PDD-NOS
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) is the diagnosis given when other categories do not match the PDD symptoms.
PDD-NOS may cause challenges with
- Social skills
- Senses
- Motor skills
- Learning
- Behaviour
There may also be difficulties with speech, language, and communication.
How Krysalis helps
Our neuro OTs provide holistic support for autistic people and others with PDDs to maximise their ability to function independently.
The support they provide is based on evidence-based assessments of their client’s needs.
This could include assessing:
- Abilities in activities of daily living (ADLs)
- Sensory processing skills
- Communication skills
- Social interaction
- Executive function
- Sensory processing skills
They use a combination of assessment methods:
- Observational – they study their client’s function in different settings
- Standardized – this provides a recognized rating system
They may also carry out a risk assessment to ensure home, educational or work environments are safe.
After the assessments, our neuro OTs may identify necessary adaptations or suggest using aids and equipment to help their clients in daily life.
And they may recommend other strategies and tools that can assist with self-care, routine, or managing emotions, behaviour, or sensory challenges.
Our neuro OTs keep track of their client’s progress by making and keeping records of it.
They may also agree to goals with their client that can help to motivate them and speed up recovery.
Assessing: ADLs
PDDs can affect every area of a person’s life, including their activities of daily living; the basic skills needed to live independently.
Our neuro OTs understand their clients may have difficulties learning and managing how to do these everyday tasks, such as bathing, shopping, and making meals.
They can provide tools and strategies that make planning, remembering, and carrying out tasks easier.
Assessing: Sensory needs
Some autistic people and others with PDDs are over or under-sensitive to stimuli such as pain, temperature, touch, taste, smell, sounds, light and colour.
Some find specific sensory experiences so overwhelming that it causes them physical pain.
Our neuro OTs assess their client’s sensory needs and then guide and support them in reducing sensory overload.
For some, that may include sensory integration therapy to help control sensory stimulation and the brain/body response.
Assessing: Communication and social interaction
Our neuro OTs use information given by their client and other people and health professionals who know them to assess their abilities to:
- Express emotion
- Interpret language, tone of voice or gestures
- Process information
- Recognise or understand other people’s feelings and aims
- Speak, read, and write
- Understand abstract ideas
Helpful tools and strategies here include:
- Making environmental changes to reduce noise and distractions
- Communication aids, such as memory boards or sign language
- Practising speaking, reading, and writing
Assessing: High focus and executive function
Some autistic people and others with PDDs place a high focus on their personal interests and become intensely involved in them.
Our neuro OTs know, however, that it is important for physical and mental well-being to balance and manage all activities of daily living (ADLs) - and they can help with this.
They can suggest strategies and tools that can help if there are executive function challenges with:
- Self-control and self-awareness
- Learning
- Following rules
- Feeling motivated
- Thinking freely
Assessing: Behaviour and emotions
Having a routine for their activities of daily living (ADLs) may be very important to some autistic people and others with PDDs.
Any changes to their routine may cause them upset and anxiety. Our neuro OTs understand this.
They also understand how autism and other PDDs can affect a person’s behaviour in other situations.
Some may have difficulties controlling their emotions or may experience high anxiety levels.
They may experience a temporary loss of behavioural control, called a meltdown, or they may go into shutdown, which is falling silent and appearing to switch off.
Our neuro OTs help their clients understand the causes of mood changes and explore their behaviour.
And they suggest strategies and tools they can use to help manage their emotions and how they behave socially.
Further reading…
Neuro occupational therapy: supporting autistic people
Autism and chiari malformations
