Jordon Casey, age 10, has been diagnosed with autism and intellectual disabilities, as well as a speech impairment. In addition to speech therapy, Jordon was treated at KidsCare Therapy with occupational therapy for obstacles with Activities of Daily Living (ADLs). When occupational therapist Deborah Ledbetter first saw Jordon, the prognosis was that he had independent capability, but wasn’t able to do simple, age-appropriate ADLs such as brushing his teeth, tying his shoes, going on errands, cleaning his room and other activities to ensure he was on the path to becoming an independent adult.
While occupational therapy often works with improving fine motor skills that are causing patients to be unable to complete the tasks of everyday living, Jordon needed help with another barrier to ADLs, executive function. Executive function is the sequencing of tasks and the ability to stay focused on the next step in a process. Many of us take for granted the many steps that are involved with processes such as brushing our teeth because we are so accustomed to doing this process each day. For a child learning these activities for the first time, breaking down the steps and working on each one helps them to not become overwhelmed and slowly learn the entire task.
In order to help Jordon, Deborah would break down each task into a step-by-step process to help him remember what comes next. She worked with visual scheduling strategies and made the process into a game so that Jordon would enjoy working on the daily tasks he had to learn. Making activities playful and celebrating every success with animated verbal feedback was something that encouraged Jordon. In addition, Deborah explained to his mom how to decrease the complexity of verbal instructions to Jordon, helping their communication. Deborah also worked on social stories with Jordon on her iPad™ so that he could put together stories about his tasks and relationships, learning from a third-person perspective. Deborah’s student, Courtney Mcguire, was also able to use these strategies to quickly teach Jordon simple ADLs, such as how to tie his shoes and brush his teeth.
As Deborah built a relationship with Jordon’s mother, they talked about his developmental level, as well as keeping expectations for behaviors and reasoning skills at Jordon’s level, not those of other children his age. Setting expectations for parents of children with autism is important, because often they struggle with understanding their child’s abilities and limitations. While Deborah said that Jordon will most likely—for safety reasons—need supervision his entire life, there is so much he can do. She feels that with the right direction and proper supervision he will be able to live in an apartment, work at a job, do his laundry, and make himself a meal.
Jordon’s mom said that before therapy she could not get Jordon to do any of the tasks that he needed to do on a daily basis. Because of this, there was a strain on their relationship that caused a lot of stress for both her and Jordon. She said that she was stressed to the point of tears on most days, and she knew that Jordon could sense this tension, only making the problem worse. The only alternative she previously had was to put Jordon on medication to ease the tension and try and get him to focus.
When Deborah and Courtney came onto the scene and started helping Jordon to not only be able to do the tasks, but to want to do them each day, things changed drastically. She said that they were able to help her and Jordon work and grow together. Their relationship isn’t without struggles, but it is back to the loving one that a mother and son should have.
In addition, before occupational therapy, Jordon’s mom said she was receiving calls from his school regarding behavioral problems. Since his therapy has ended she hasn’t had any calls from the school, as he is focusing better on his work and improving his progress even further.
After six months of therapy, Jordon was discharged because he had met his goals. While he will still need support in the future, Jordon’s mom expressed how much of an impact six months of occupational therapy services had on her son and on the promise of his future, and couldn’t have imagined where they would be now without it.
Deborah said, “The most important improvement factor when it comes to ADLs is having the parents’ involvement.” This is why she believes home health is so valuable, especially concerning problems with executive function. “It’s a gift to be able to interact with the parent. When you have the parent there, you have the number one impact in that child’s life, and that’s where you can really make a difference.”