THE ECHO APPROACH FOR NEONATAL ABSTINENCE
SYNDROME
CINDY AYO, OTD, OTR/L
NEHA TRIPATHI, OTD, OTR/L, CDP
By the end of the session, attendees will be able to:
1. Demonstrate understanding of Neonatal Abstinence Syndrome (NAS), neurodevelopmental complications associated with it, and the areas of occupational performance impacted across a child’s life span
2. Demonstrate understanding of the Early Collaborative Holistic Occupation-focused (ECHO) treatment approach to achieve optimal independence with daily occupational performance for children with NAS
3. Identify relevant evidence-based occupational therapy treatment interventions and strategies for multidisciplinary collaboration based on the ECHO approach designed to address the various neurodevelopmental deficits associated with NAS
OBJECTIVES
• Incidence and risks associated with prenatal drug exposure• Preterm birth• Neurodevelopmental Complications• Neonatal Abstinence Syndrome (NAS)
• Complications associated with specific drugs (opiates, cocaine, cannabis, tobacco, alcohol)
• Client factors, performance skills and areas of occupation affected
CLASS OUTLINE
• ECHO Approach & Interventions
• Early intervention
• Sensory Integration
• Perceptual-motor
• Developmental-play
CLASS OUTLINEContinued
• Cognitive interventions
• Social-emotional interventions
• Behavioral interventions
• Case studies
• Conclusion
CLASS OUTLINEContinued
NEONATAL ABSTINENCE SYNDROME (NAS)
• Infant exposed to drugs in utero Drug withdrawal at birth
• Constellation of health issues: immediate & long-term consequences and manifestations
Lambert & Bauer, 2012; McQueen & Murphy-Oikonen, 2016
INCIDENCE OF PRENATAL DRUG EXPOSURE
• Increased incidence of NAS in the United States
• 2016: 1 every 25 min 5-fold increase from 2000 to 2012
• 2018: 1 every 15 min 7-fold increase from 2000 to 2014
• Corresponds with the increased use of opioid drugs while pregnant: 18-22 % use some opioid while pregnant
• 5.1 % of pregnant women ages 15-44 report using illicit drugs• Actual reporting statistic for cocaine use during pregnancy:
11%
Lambert & Bauer, 2012; McQueen & Murphy-Oikonen, 2016
INCIDENCE OF PRENATAL DRUG EXPOSURE
• Average hospital stay 17 days• Global problem• Preventable
Lambert & Bauer, 2012; McQueen & Murphy-Oikonen, 2016
• Why lack of reported drug use during pregnancy?
• Fear of prosecution/loss of freedom
• Fear of loss of job/income
• Fear of losing their child
• Stigma
INCIDENCE OF PRENATAL EXPOSUREContinued
Thompson, Levitt, & Stanwood, 2009
• Affect fetal blood through the placenta
• Cross the fetus’ blood-brain barrier
• Cause vasoconstriction
• May alter neurotransmitter levels
EFFECTS OF PRENATAL DRUG EXPOSURE WHILE IN UTERO
MacMullen, Dulski, & Blobaum, 2014; Minnes, Lang, & Singer, 2011; Thompson, Levitt, & Stanwood, 2009)
Ayo, 2017
• Maternal Stress
• Malnutrition
• Untreated medical conditions
• Complicated lifestyle
• Preterm birth and low birth weight
• Short-term and long-term fetal complications
RISKS ASSOCIATED WITH DRUG USE DURING PREGNANCY:
Kocherlakota, 2014; McQueen & Murphy-Oikonen, 2016; Stover & Davis, 2015; Sui & Robinson, 2014; Thompson et al., 2009
• Cerebral white matter development
• Neonatal intensive care unit (NICU) stressors affecting
the infant’s brain development
• Neurodevelopmental complications
RISKS ASSOCIATED WITH PRETERM BIRTH
Broring et al., 2017; Mitchell et al., 2015
Ayo, 2017
- Cognitive delays/executive functioning deficits
- Behavioral impairments - Attention deficit hyperactivity disorder (ADHD)
- Autism spectrum disorder (ASD)
NEURODEVELOPMENTAL COMPLICATIONS ASSOCIATED WITH PRETERM BIRTH
- Motor developmental delays
- Visual-motor integration problems
- Learning disabilities - Sensory processing difficulties
Broring et al., 2017; Case-Smith, Clark, & Schlabach, 2013, Mitchell et al., 2015
• Tremors
• Irritability
• Weight loss
• Seizures
• Feeding patterns
• Digestive difficulties
NEURODEVELOPMENTAL COMPLICATIONS ASSOCIATED WITH ILLICIT DRUG USE
DURING PREGNANCY
• Motor development
• Cognitive abilities
• Visual-motor integration
• Social-emotional development
• Behavioral regulation
• Attention
Long-termShort-term
Kocherlakota, 2014; Lon, Brown, & Hayes, 2013; MacMullen, Dulski, & Blabaum, 2014; McQueen & Murphy-Oikonen, 2016; Stover & Davis, 2015; Wiles, Isemann, Ward, Vinks, & Akinbi, 2014
• Impaired heart rate
• Increased respiration rate
• Mottling skin
• Sweating
• Sneezing/yawning
• Fever
NEONATAL ABSTINENCE SYNDROME
• Hypertonicity
• Seizures
• Tremors
• Irritability
Central Nervous System Complications
Autonomic Nervous System Complications
Kocherlakota, 2014; Logan et al., 2013; MacMullen et al., 2014 ; McQueen & Murphy-Oikonen, 2016; Stover & Davis, 2015; Wiles et al., 2014
Gastrointestinal System Complications
• Weight loss
• Poor feeding patterns
• Diarrhea
• Vomiting
• Inordinate amount of sucking
NEONATAL ABSTINENCE SYNDROME
Kocherlakota, 2014; Logan et al., 2013; MacMullen et al., 2014; McQueen & Murphy-Oikonen, 2016; Stover & Davis, 2015; Wiles et al., 2014
• Difficulty integrating sensory input
• Impaired self-regulatory skills
• Impaired motor control and muscle tone
NEONATAL ABSTINENCE SYNDROMEDevelopmental complications
Velez & Jansson, 2008
• Medical management
• Environmental adaptations
• Multidisciplinary approach
NEONATAL ABSTINENCE SYNDROME
• Early interventions and multidisciplinary approach
• Medical follow up
• Caregiver support
• Environmental adaptations
Long-term InterventionsNICU
Kocherlakota, 2014; McQueen & Murphy-Oikonen, 2016; Saunders et al., 2014
Medical Management
• Opiates
• Cocaine
• Cannabis
• Tobacco/Nicotine
• Alcohol
PRENATAL ILLICIT DRUG COMPLICATIONS
OPIATESInformation
Opiates:- Water soluble- Transfer easily across
placenta- Able to cross infant’s blood-
brain barrier- Affect neurotransmitter
production- Increases enzyme activity-Vasoconstriction
Kocherlakota, 2014; Minnes et al., 2011; National Institute on Drug Abuse, 2017; Sui & Robinson, 2014
Ayo, 2017
• Preterm birth/low birth weight
• NAS
• Sudden infant death syndrome
• Decreased head circumference
• Central nervous system changes
OPIATESMedical complications
Minnes et al., 2011; Stover & Davis, 2015
• Cognitive developmental delays/Intellectual disability
• Diminished verbal skills
• Impaired academic skills
• Behavioral issues
• ADHD
• Motor delays
OPIATESNeurodevelopmental Complications
Hunt, Tzioumi, Collings, & Jeffery, 2008; Minnes et al., 2011; Stover & Davis, 2015
• NAS
• Diminished motor control
• Decreased IQ
• Hyperactivity
• Limited attention span
• Behavioral regulation difficulties
ALTERNATIVE TREATMENT FOR OPIOID ADDICTION
• Decreased risk of NAS
• Decreased hospital stay
BuprenorphineMethadone
Jones et al., 2010; Kocherlakota, 2014; Logan et al., 2014; Wiles et al., 2014
COCAINEInformation
- Psychostimulant- Cross the placental barrier- Vasoconstrictor- Affects neurotransmitter levels- Alters central nervous system
development
Ackerman, Riggins, & Black, 2010; Lambert & Bauer, 2012; Thompson et al., 2009
• Preterm birth
• Diminished fetal growth
• NAS
• Central nervous system changes
COCAINE
Medical complications
MacMullen et al., 2014; Minnes et al., 2010;
• Intellectual Disability (ID)
• Language delays
• Executive function difficulties
• Behavioral dysfunction
• Social-emotional delays
• ADHD
COCAINE
• Visual-motor skills
• Impulsivity
• Sleep disturbance
• Motor developmental delays
• Impaired muscle tone
• Risky behaviors
Neurodevelopmental Complications
Ackerman et al., 2010; Golding, Emmett, Iles-Cave, Steer, & Lingham, 2014; Lambert & Bauer, 2012; Minnes et al., 2011; Singer, Minnes, Min, Lewis, & Short, 2015
• Common drug used during pregnancy
• Vasoconstriction
• Able to cross the placental barrier
• Affects neuronal and synaptic formation in the fetus
CANNABISInformation
Minnes et al., 2011; Wu, Jew, & Lu, 2011
• Preterm birth
• Low birth weight
• Congenital Abnormalities
• Decreased cortical gray matter
• NAS
CANNABIS
Medical Complications
MacMullen et al., 2014; Wu et al., 2011
• Enhanced startle response
• Hyperactivity
• Learning disabilities
• Diminished executive function
• Language delays
• Decreased working memory
CANNABIS
• Cognitive developmental delays
• Poor visual-motor skills
• Visual-integration deficits
• Impulsivity
• Emotional-behavioral difficulties
• Motor delays
Neurodevelopmental Complications
Golding et al., 2014; Minnes et al., 2011; Wu et al., 2011
• Vasoconstriction
• Crosses the placenta barrier
• Binds with receptors in central nervous system
TOBACCO/NICOTINEInformation
Minnes et al., 2011; Thompson et al., 2009
• Preterm birth
• Low birth weight
• Decreased head circumference
• NAS
• Sudden infant death syndrome
TOBACCO/NICOTINEMedical Complications
Minnes et al., 2011; Thompson et al., 2009
Ayo, 2017
• Cognitive deficits
• Intellectual disability
• Learning disabilities
• Attention deficits/ADHD
• Hyperactivity
TOBACCO/NICOTINE
• Social-emotional development
• Self-regulation difficulties
• Depression
• Anxiety
• Decreased visual-motor control
Neurodevelopmental Complications
Golding et al., 2014; Minnes et al., 2011; Motlagh et al., 2011; The Arc, 2011; Thompson et al., 2009
• Pharmacological depressant
• Decreases cortical activity
• Cross placental barrier
• Affects central nervous system
ALCOHOL
Information
Thompson et al., 2009
ALCOHOL
Medical Complications
- Fetal Alcohol Spectrum Disorder- Low birth weight- Microcephaly- Central nervous system damage- Intellectual disability- Craniofacial deformities
Golding et al., 2014; Nguyen et al., 2013; Thompson et al., 2009; Williams & Smith, 2015
Ayo, 2017
• Intellectual disability
• Executive function deficits
• Impulsivity
• Learning disability
• ADHD
• Sensory processing deficits
ALCOHOL
• Motor delays
• Decreased motor coordination
• Decreased visual-perceptual skills
• Diminished handwriting skills
• Decreased postural stability
Neurodevelopmental Complications
Duval-White, Jirikowic, Rios, Deitz, & Olson, 2013; Franklin, Deitz, Jirikowic, & Astley, 2008; Golding et al., 2014; Thompson et al., 2009; Williams & Smith, 2015
• Sensory
• Mental
• Endocrine
• Neuromuscular
• Perceptual
CLIENT FACTORS IMPACTED BY PRENATAL DRUG EXPOSURE
• Central nervous system
• Growth
Body Structures Body Functions
Ackerman et al., 2010; Franklin et al., 2008; Golding et al., 2011; Hulle, Lemery-Chalfant, & Goldsmith, 2015; Lambert & Bauer, 2012; Logan et al., 2013; Minnes et al., 2011; Mitchell et al., 2015; Nguyen et al., 2013; Singer et al., 2015; Thompson et al., 2009; Wu et al., 2011
• Working memory
• Executive functions
• Fine motor skills
• Gross motor skills
• Social interaction
• Emotional regulation
PERFORMANCE SKILLS AFFECTED BY PRENATAL DRUG EXPOSURE
• Eye-hand coordination
• Sensory processing
• Visual-motor skills
• Attention
• Visual attention and memory
Ackerman, Riggins, & Black, 2010; Broring, Oostrom, Lafeber, Jansma, & Oosterlaan, 2017; Golding et al., 2014; Lambert & Bauer, 2012; MacMullen, Dulski, & Blobaum, 2014; McQueen & Murphy-Oikonen, 2016; Minnes et al., 2011; Mitchell, Moore, Roberts, Hachtel, & Brown, 2015; Nguyen et al., 2013; Patrick, 2015; Saunders et al., 2014; Thompson, Levitt, & Stanwood, 2009; Williams & Smith, 2015; Wu, et al., 2011
• Activities of daily living
(ADL)
• Rest/sleep
• Social participation
• Play
OCCUPATIONAL PERFORMANCE IMPACTED BY PRENATAL DRUG EXPOSURE
McQueen & Murphy-Oikonen, 2016; Velez & Jansson, 2008
Ayo, 2017
• Instrumental activities of
daily living (IADLs)
• Education
• Leisure
• Work
OCCUPATIONAL PERFORMANCE IMPACTED BY PRENATAL DRUG EXPOSURE
Ackerman et al., 2010; Duval-White et al., 2013; Nguyen et al., 2013; Williams & Smith, 2015
Ayo, 2017
• Early Collaborative Holistic Occupation-focused approach
• Builds on Reynolds et al’s (2017) multifaceted approach to address sensory integration (SI) issues
• Emphasis on interdisciplinary collaboration
THE ECHO APPROACH
Reynolds et al. (2017)
• Multifaceted Approach when working with children exposed
to drugs in utero
• Complicated clinical presentation
• Requiring a variety of treatment strategies
REYNOLDS ET AL’S MULTIFACETED APPROACH
Reynolds et al., 2017
Early• Intervene early: Starting at birth up until at least 3 yrs of age
• Goal: Enhance a child’s developmental skills, decrease his or her developmental delays, support medical health, improve functional performance/independence and provide caregiver support
• Often begins in Neonatal Intensive Care Unit (NICU)
THE ECHO APPROACH
Arbesman, Lieberman, & Berlanstein, 2013; Case-Smith, Clark, & Schlabach, 2013 Park, Maitra, Achon, Loyola, and Rincon (2014); Blanche, Chang, Gutierrez, & Gunter, 2016
• NICU
• Client-family-caregiver centered care (admission to discharge)
• Team collaboration essential (including family/caregivers)
• OT interventions
• Family/caregivers training/education
• Bridge gap between NICU and community
EARLY INTERVENTION
Oostalander, Falla, Dow & Fucile, 2019; Purdy, Craig & Zeanah, 2015; Ross, Heiny, Conner, Spener & Pineda, 2017)
• Finger spread
• Hyperextension posture
• Limp posture
• Flailing motions
SIGNS OF OVERSTIMULATION
• Skin color changes
• Changes in heart and respiration rate
• Hiccups
• Sneezing
• Yawning
• Gagging
Autonomic signsMotor signs
LaRossa, 2017
Arousal signs
• Daydreaming/starring • Irritability• Panic• Avoid eye-contact
POSTNATAL ENVIRONMENTHome environment plays a critical role in a child’s development - Cognitive skills- Executive function- Academic performance- Communication abilities- Social/emotional development- Motor development
Lambert & Bauer, 2012; Lander, Howsare, & Byrne, 2013
Ayo, 2017
• Federally mandated programs• Evidence shows that infants born prematurely or
with low birth weight or with developmental delay benefit from EI
• Improve social, emotional, cognitive and motor skills
EARLY INTERVENTION
Hwang, Chao & Liu, 2013; Nwabara, Rogers, Inder & Pineda, 2017; Park, Maitra, Achon, Loyola, and Rincon (2014); Blanche, Chang, Gutierrez, & Gunter, 2016
• “Routine-based early intervention” (Hwang, Chao & Liu, 2013)
• Shift to family-caregiver-centered model• Family/caregiver goal incorporation• Child demonstrated improved functional outcomes in
self-care and social participation
EARLY INTERVENTION
Hwang, Chao & Liu, 2013
EARLY INTERVENTION
• Evidence supporting early intervention
• Improvements noted in:• Cognition/executive function
• Movement skills
• Functional motor control
• Language skills
• Neuromuscular skills
Park, Maitra, Achon, Loyola & Rincon, 2014
Ayo, 2017
Collaborative• Close continuous collaboration between various care
providers for simultaneous commencement and consistent maintenance of client-family-caregiver care
• Physicians, nurses, social workers, occupational and physical therapy practitioners, speech language pathologists, developmental specialists, school staff, special education teachers, community members, behavioral specialist, psychologist, family, caregivers, child
• Enhance infant development, ensure caregiver well-being, maximize resources, support complementary coordinated healthcare
THE ECHO APPROACH
Collaborative• Begins in NICU
• Specialty training• Collaborative team• Caregiver training
• Emotional support
• Facilitate bonding
• Address transition between hospital and home• Caregivers/family members essential NICU team member
THE ECHO APPROACH
Craig, Glick, Phillips, Hall, Smith & Browne, 2015; Purdy, Craig &Zeanah, 2015
Collaborative
•Therapeutic use of self
•Therapeutic relationship
THE ECHO APPROACH
Price & Miner, 2007
Collaborative
• Along the continuum of care of the child• Infancy• Early childhood• Middle childhood• Adolescents
THE ECHO APPROACH
1
Holistic• Addressing the complete child
• Understanding the interrelationship amongst various states
• OT examining
• Developmental sequence/Development of occupational performance
• Multifaceted impact of neonatal drug exposure
• Impact of both prenatal and post natal environments
• Client factors/performance skills/performance patterns/context
THE ECHO APPROACH
Henderson, 2014; Kreider, Bendixen Huang & Lim, 2014
Occupation-focused• Occupational Therapy promote occupation
• “Preparatory, Purposeful and Occupational activities” (Price & Miner, 2007, p.441)
• Meaningful• Doing
• End goal occupational performance/participation
THE ECHO APPROACH
Kreider, Bendixen, Huang &Lim, 2014; Price & Miner, 2007
Occupation-focused• Holistic performance-based evaluation and intervention
• Family-caregiver-client centered goals and occupational outcomes
• Systematic interdisciplinary intervention with occupational performance as the outcome of interest
• Use of various/multiple evidence-based treatment methods, techniques, and approaches
THE ECHO APPROACH
• Developmental Frame of Reference
DEVELOPMENTAL PLAY-BASED INTERVENTIONS
• Improved motor development
• Improved social interaction
• Limited long term affects
Evidence-based intervention
Rationale
Case-Smith et al., 2013; Miller & Kunaneck, 2008; Watts et al., 2014
IMPORTANCE OF SENSORY-MOTOR EXPLORATION AND PLAY
Spiral effect:- Improved mobility- Improved exploration- Increased input- Enhanced learning- Increased social interaction- Occupation participation
Case-Smith et al., 2013
Mobility
Exploration
Input
Learning
Social Interaction
Occupational Performance
“JUST
RIGHT
CHALLENGE”(Miller & Kuhaneck, 2008, p.414)
CHILDREN’S PERCEPTION OF PLAY
Miller and Kuhaneck (2008
• Sensory integration (SI)
theory
• Application with
children exposed to
drugs in utero
SENSORY INTEGRATION
Cole & Tufano, 2008; Hulle et al., 2015; Mitchell et al., 2015; Reynolds et al., 2017; Watts, Stagnitti, & Brown, 2014
Ayo, 2017
• “Interdisciplinary sensory-enriched early intervention program” (Blanche et al., 2016)
• ISEEI multidisciplinary design
- Monthly consultations in the home
- Activities within the community
- Caregiver/parental childhood development classes
- ISEEI program interventions two to three days a week for three hours
each day
SENSORY INTEGRATION
Blanche et al.., 2016
SENSORY INTEGRATIONISEEI continued
- Multisensory teaching strategies- Sensory enriched environment- Adapted strategies- Format facilitating social interactions
Intervention strategies
Blanche et al., 2016
Results
Significant improvements Gross motorReceptive languageExpressive languageCognition
SENSORY INTEGRATION• SI interventions
improvement • Sensory motor
• Motor planning
• Social skills
• Academic skills
• Play
• Motor skills
May-Benson and Koomar, 2010
Ayo, 2017
Examining various OT interventions
• SI
• Neurodevelopmental Treatment
(NDT)
• Perceptual-Motor (PM)
SENSORY INTEGRATION
Wuang, Wang, Huang & Su, 2009
Ayo, 2017
SENSORY INTEGRATION BRAIN STORMING
Ayo, 2017
Remember to watch for signs of overstimulation
• Perceptual-Motor (PM) interventions
assume there is a cause and effect
relationship between motor
performance and processing of
perceptual information (Wuang et al.,
2009).
• Broad range of OT interventions
PERCEPTUAL-MOTOR INTERVENTIONS
Duval-White et al., 2013; Golding et al., 2014; Logan et al., 2013; Minnes et al., 2011; Nguyen et al., 2013; Thompson et al., 2009; Williams & Smith, 2015; Wuang et al., 2009
Ayo, 2017
PERCEPTUAL-MOTOR INTERVENTIONS
PM interventions can improve the following:
• Visual-motor control• Gross motor skills• Balance• Strength
May-Benson and Koomar , 2010; Wuang et al. ,2009
Ayo, 2017
• Components
• Academic importance
• Association with prenatal
drug exposure
PERCEPTUAL-MOTOR INTERVENTIONS
Handwriting
Bazyk et al., 2009; Case-Smith, Holland, & Bishop, 2011; Chang & Yu, 2017; Duval-White et al., 2013; Lust & Donica, 2011; Ohl et al., 2013
Ayo, 2017
PERCEPTUAL-MOTOR INTERVENTIONSHandwriting
• Practice based group
• Visual-perceptual-motor group
• Both groups demonstrated improved handwriting legibility
Handwriting Club
Howe, Roston, Sheu, & Hinojosa, 2013
• School OT program
• Classroom material incorporation
• Therapeutic materials
• Consultation
• Direct OT services
• Results
PERCEPTUAL-MOTOR INTERVENTIONS
Handwriting school program
Bazyk et al., 2009:
PERCEPTUAL-MOTOR INTERVENTIONS
• Multisensory approach
• “Handwriting without tears-get set for school” (Lust & Donica, 2011, p. 560)
• 20 participants
• Improved prewriting, kindergarten readiness and fine motor skills
Handwriting multisensory approach
Lust & Donica, 2011
PERCEPTUAL-MOTOR INTERVENTIONS
• Perceptual-motor
• Visual-motor OT interventions
• Improved gross and fine motor skills
Case-Smith et al., 2013
Ayo, 2017
PERCEPTUAL-MOTOR BRAIN STORMING
Ayo, 2017
• Cognitive deficits correlated to prenatal drug exposure
• Executive function
• Effects on occupational performance
COGNITIVE INTERVENTIONS
Ackerman et al., 2010; Clark & Schlabach, 2013: Cornelius & Day, 2009; Frolek & Schlabach, 2013; Hunt et al., 2008; Lambert & Bauer, 2012; Minnes et al., 2011; Thompson et al., 2009; Williams & Smith, 2015
• Cognitive-functional OT intervention sessions
• Improved occupational performance and satisfaction
• Improved executive function
COGNITIVE-FUNCTIONAL THERAPY INTERVENTIONS
Maeir et al., 2014
Ayo, 2017
COGNITIVE-FUNCTIONAL THERAPY INTERVENTIONS
• Effectiveness of stability balls on attention
• Improved scores on the Attention-Deficit/Hyperactivity Disorder Test
• Improved on-task performance and ability to remain in seat
Attention and Hyperactivity
Fedewa and Erwin, 2011
Ayo, 2017
COGNITIVE INTERVENTION BRAIN STORMING
Ayo, 2017
• Social and emotional deficits
associated with prenatal drug
exposure
• Critical skills involved in a child’s
social development
SOCIAL-EMOTIONAL INTERVENTIONS
Lambert & Bauer, 2012; Minnes et al., 2011; Thompson et al., 2009
SOCIAL-EMOTIONAL INTERVENTIONS
• Joint attention refers to two or more individuals’ ability to share their attention during a task or an activity.
• Joint attention is associated with social interaction, social response, positive emotions and empathy (Case-Smith, 2013).
Joint Attention
Case-Smith, 2013
Ayo, 2017
OCCUPATIONAL THERAPY
• Social skills training
• Peer cooperation
• Team building
SOCIAL-EMOTIONAL INTERVENTIONS
Arbesman, Bazyk, and Nochajski, 2013
SOCIAL-EMOTIONAL BRAIN STORMING
Ayo, 2017
• Children exposed to drugs while in
utero can exhibit behavioral
regulation deficits
• Importance of behavioral regulation
in occupation
BEHAVIORAL INTERVENTIONS
Ackerman et al., 2010; Lambert & Bauer, 2012; Reynolds et al., 2017; Thompson et al., 2009
BEHAVIORAL INTERVENTIONS
• Based on Behavioral Theory
• Environmental and/or activity modifications
• Teach a child alternate behaviors
• Social Stories
Positive Behavioral Support
Case-Smith, 2013; Reynolds et al., 2017
Social Stories
• Teach social skills to an individual or to a small group
• Utilize instructional methods to teach social skills
• Research indicates
• Decrease in target behaviors
• Improved interactive communications
BEHAVIORAL INTERVENTIONS
Case-Smith, 2013
BEHAVIORAL INTERVENTIONS
Ayo, 2017
BEHAVIORAL INTERVENTION BRAIN STORMING
Ayo, 2017
• Early intervention
• Collaborative interdisciplinary involvement
• Holistic view
• Occupation-focused evidence-based intervention
TAKE HOME MESSAGE
Sensory integrationPerceptual-motorDevelopmental-play
CognitiveSocial-emotionalBehavioral
CASE STUDIES
Ayo, 2017
CONCLUSION
• Abersman, M., Bazyk, S., & Nochajski, S. M. (2013). Systematic review of occupational therapy and
mental health promotion, prevention, and intervention for children and youth. American Journal
of Occupational Therapy, 67(6), e120-e130.
• Abersman, M., Lieberman, D., & Bertlanstein, D. R. (2013). Method for the systematic reviews on
occupational therapy and early intervention and early childhood services. American Journal of
Occupational Therapy, 67(4), 389-394.
• Ackerman, J., Riggins, T., & Black, M. (2010). A review of the effects of prenatal cocaine exposure
among school-aged children abstract. Pediatrics, 125(3), 554-565. Doi: 10.1542/peds.2009-0637.
REFERENCES
• American Occupational Therapy Association. (2017). Learn through play. Retrieved from
http://www.aota.org/about-occupational-therapy/patients-clients/childrenandyouth/play.aspx
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REFERENCESContinued
• Bayzk, S., Michaud, P., Goodman, G., Papp, P., Hawkins, E., & Wlech, M. A. (2009). Integrating occupational
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e68.
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REFERENCESContinued
• Broring, T., Oostrom, K. J., Lafeber, H. N., Jansma, H. N., & Oosterlaan, J. (2017). Sensory
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REFERENCESContinued
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occupational therapy to promote motor performance for children birth-5 years. American Journal of
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