How OTs Can Support Autistic Students in the Schools

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As an occupational therapist working in a school setting, you play a crucial role in supporting autistic students. School-based OTs are uniquely positioned to support the needs and strengths of autistic students while fostering a culture of acceptance and appreciation for neurodiversity in the school community. Whether you’re a new OT or an experienced practitioner looking for fresh ideas, this post will offer practical strategies and valuable insights to help you better meet the needs of your autistic students.

Listen to Neurodivergent Individuals

First, listen to the actual people our therapy affects, which means paying attention to the students in front of you, as well as other autistic/ADHD individuals. Seek out their opinions when making therapy decisions. This can be incredibly illuminating, and you’ll learn to appreciate the real perspectives of people who have gone through OT and what they found helpful or harmful. 

Does this advice surprise you? Previously, medical professionals were considered to be the “experts” on autism and ADHD – I know that’s certainly what I was taught in OT school. But the neurodiversity movement shifts that principle and highlights the expertise that neurodivergent individuals themselves carry about their neurotype. So, as a non-autistic/ADHD therapist, the biggest piece of advice I can give you is to seek out the opinions of neurodivergent individuals on a regular basis. 

One of my favorite places to get autistic perspectives is the group Autism Inclusivity on Facebook. It is full of autistic adults who want to help all caregivers of autistic children do a better job of supporting them. If you do decide to join this group, keep in mind that this is a space that highlights autistic opinions. If you are not autistic, I recommend taking some initial time in the group to understand the rules, reading more than commenting, and just listening. 

P.S. Listening to autistic adults is also the reason that in this blog you’ll find identity-first language, such as saying “autistic students” instead of “students with autism.” I encourage you to make this shift as well!

Use the Right Visual Schedule

As a school-based OT, you probably are already familiar with visual schedules. So you know they can be a powerful tool for supporting the learning and development of autistic students. For autistic individuals, the world can often feel overwhelming and unpredictable, and a visual schedule can provide a sense of structure. 

While I’ve used visual schedules from the beginning of my OT practice, it wasn’t until I took The Learn Play Thrive Approach to Autism course that I started thinking more critically about how I was creating them. Before this, most of my visual schedules looked pretty similar – a word and a cartoonish picture that went alongside it. But this generic type of schedule doesn’t actually best serve all of our autistic students. Some of our students will be old enough that a cartoon representation of the activity may not be very age-appropriate. But if these same students are great readers, they could probably do fine with a schedule with only words. Some other students may not be able to connect a pictorial depiction of an activity to the real thing – so these kids would benefit from real pictures on their schedule. Others still might need a more concrete representation of what comes next – so you can design a schedule with actual physical objects in place of drawings or photos. 

In your session, you could consider actually co-creating these visual schedules with your students to make them even stronger. The more input a student can have on their school day, the more autonomy they’ll feel, which typically leads to an easier time transitioning and participating in various activities. And once the schedule is created, use it to support the time you spend pushing into the classroom to help your student understand and connect the schedule to real-life activities. 

If you’d like to learn more about making individualized visual schedules as well as other great strategies for working with autistic students, I can’t recommend The Learn Play Thrive Approach to Autism course enough. Plus, you can get 15% off the course with coupon code DEVON15!

school-based OT strategies for autistic students

Push for AAC Devices

Neurodivergent individuals often have communication differences. Many autistic individuals don’t speak at all, or may have extreme difficulty doing so. For these students, AAC can be a lifesaver. There are few interventions I’ve consistently seen make a bigger difference for my autistic students than implementing an AAC device. Unfortunately, there is still a lot of misinformation around AAC, and the IEP team – including the SLP – may be hesitant to recommend them because of persistent myths. If you’ve ever heard that AAC inhibits verbal speech, that a student is too young for AAC, or that there are certain “prerequisites” that a student needs to meet before trialing a high-tech AAC option, know that none of these are supported by evidence. While it is really challenging to be the only member of the IEP team bringing up AAC, please recommend AAC evaluations for any students that don’t have consistent methods to communicate – especially students who may be exhibiting behavioral difficulties. And if you get pushback, consider sharing some articles and research studies such as the following: 

Common Questions about AAC Services in Early Intervention

The Effects of Aided AAC Interventions on AAC Use, Speech, and Symbolic Gestures

If you’re looking to learn more about using AAC with autistic students, Learn Play Thrive also has a course on Authentic AAC that is a great place to get started. And my coupon code (DEVON15) will allow you to take 15% off this course as well!

Stop Using Hand-Over-Hand

At this point, I have completely removed hand-over-hand from my practice and I suggest you do the same. The most important reason to stop doing this immediately is that it violates an individual’s bodily autonomy. By moving someone else’s body without permission, you are teaching them that they do not have a right to their own body. They learn that other adults can do as they please to their body. Kids and adults with disabilities are already a vulnerable population when it comes to sexual assault, and this kind of teaching can put them in an even riskier position. And neurodivergent individuals often have trouble communicating, so they are even more at risk of having their bodies violated without the proper tools to speak up about it. 

If that alone doesn’t convince you, it should also be stated that hand-over-hand isn’t even really that effective at teaching new skills. It often instead teaches students to be dependent on adults. I’ve worked with many older autistic students who literally wouldn’t even attempt tasks without grabbing for an adult’s hands to guide them. Is this really teaching students the independence that we so highly value as OTs?

If you’re wondering what to do instead, try modeling, visual cues, verbal cues, and tactile cues. Don’t forget that learning a new skill takes practice. So if these strategies don’t look as effective right away, remember that our students need a lot of structured opportunities to develop their skills. And above all else, make sure you’re asking students to do tasks that are meaningful and interesting to them. This is sometimes challenging in the school setting where there are a lot of competing demands and expectations, but is usually the disconnect when you find a student that simply won’t/can’t participate in assignments without hand-over-hand support. 

If you must continue using hand-over-hand, make sure you have explicit consent from your student, even if they are non-speaking and this may be difficult to obtain. Unless it’s an emergency and you’re keeping a student safe, there’s not much we do in therapy that is important enough to justify hand-over-hand. We can always try another therapy activity during that session  – but we can’t necessarily undo the damage that hand-over-hand can cause. 

school-based OT strategies for autistic students

Allow Stimming

You may have been taught that self-stimulatory behavior, or “stimming,” was harmful and something that needed to be redirected. But in actuality, there’s no good evidence for this. In fact, we now know stimming serves important functions for neurodivergent individuals and should not be “managed” just for the sake of it. Stimming should never be attempted to be stopped or redirected just to make a student appear more neurotypical. If you or an IEP team member is considering whether you should attempt to stop a stim, ask the following questions:

  • Is this stim harming the student or others around them?
  • Does the student want to stop the stim?
  • Is the stim interfering with a task that is important to the student?

Unless the answer to at least one of these questions is “yes,” the stim should probably not be redirected. And if the answer is yes, work collaboratively with the student as much as possible to explore other ways to stim that will still meet their needs. 

This can be a really hard shift to make, especially if you have parents or teachers asking you for strategies to stop the student from stimming. Sometimes I’ve had luck with explaining how we all engage in self-stimulatory behaviors to a certain extent – such as spinning in an office chair, twirling our hair, tapping a pen against a desk, jiggling a leg, etc. The stims our autistic students have just may look a little different. Other times I’ve brought it back to sharing the perspectives of autistic individuals, such as the ones found in this study. Ultimately, it’s important to remember that families and teachers are just worried that their student will not be accepted or happy in the “real world.” Hearing perspectives from autistic adults who stim and are living good lives can help assuage some of those fears. 

Use a Strengths-Based Lens

One of the best changes we can make in our school-based OT practice is to shift from a deficits-model to a more strength-based lens. And really, this is true for all of our students, not just the neurodivergent ones. Be sure that when you’re evaluating, you’re not just piling on all the things the student isn’t great at. Can you imagine someone writing a report about you at work with that focus? If it sounds incredibly demoralizing, it’s because it is. Instead, take time to get to know your student, find out their strengths, and use them to guide goals, interventions, and educational curriculum. 

If you’re looking for more guidance on how to shift to a strengths-based approach, I can’t recommend The Learn Play Thrive Approach to Autism enough. I took this course a couple of years ago, and it completely shifted the way I approach working with autistic students, especially in regard to visual schedules, behavioral strategies, and intervention design. I truly believe it should be required training for any OT working with autistic students. Plus, you can get 15% off the course with coupon code DEVON15!

If you’re looking to be more effective with your autistic students, implementing these strategies will help. And if you’re committed to taking this even deeper, The Learn Play Thrive Approach to Autism is the perfect next step. It’s one of the best CEU courses I’ve taken in general, and I couldn’t imagine a better, more evidence-based primer for working with autistic students. When you’re ready to sign up, feel free to use my coupon code (DEVON15) to save 15%. Cheers to supporting our autistic students as authentically as we can!

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