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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
• American Occupational Therapy Association. (2014). Occupational therapy practice framework:
Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.
• American Occupational Therapy Association. (2011). Tips for living life to its fullest: Building play
skills for healthy children and families. Retrieved from http://www.aota.org/-
/media/corporate/files/practice/children/browse/play/building%20play%20skills%20tip%20sheet%2
0final.pdf
REFERENCESContinued
• Bayzk, S., Michaud, P., Goodman, G., Papp, P., Hawkins, E., & Wlech, M. A. (2009). Integrating occupational
therapy services in a kindergarten curriculum: A look at the outcomes. American Journal of Occupational
Therapy, 63(2), 160-171.
• Bigsby, R., LaGasse, L., Lester, B., Shankaran, S., Bada, H., Bauer, C., & Liu, J. (2011). Prenatal cocaine
exposure and motor performance at 4 months. The American Journal of Occupational Therapy, 65(5), e60-
e68.
• Blanche, E., Chang, M., Gutierrez, J., & Gunter, J. (2016). Effectiveness of a sensory-enriched early
intervention group program for children with developmental disabilities. American Journal of
Occupational Therapy, 70(5), 7005220010p1-7005220019p10
REFERENCESContinued
• Broring, T., Oostrom, K. J., Lafeber, H. N., Jansma, H. N., & Oosterlaan, J. (2017). Sensory
modulation in preterm children: Theoretical perspective and systematic review. PLOS One, 12(2),
e01708282. doi: 10.1371/journal.pone.0170828
• Buckingham-Howes, S., Berger, S., Scaletti, L., & Black, M. (2013). Systematic review of prenatal
cocaine exposure and adolescent development. Pediatrics, 131(6), e1917-e1936. Doi:
10.1542/peds.2012-0945.
• Case-Smith, J. (2013). Systematic review of interventions to promote social-emotional
development in young children with or at risk for disability. American Journal of Occupational
Therapy, 67(4), 395-404.
REFERENCESContinued
• Case-Smith, J., Clark, G. J., & Schlabach, T. L. (2013). Systematic review of interventions used in
occupational therapy to promote motor performance for children birth-5 years. American Journal of
Occupational Therapy, 67(4), 413-424.
• Chang, S., Yu, N. (2017). Visual and haptic perception training to improve handwriting skills in children
with dysgraphia. American Journal of Occupational Therapy, 71(2), 710220030p1-710220030p10.
• Clark, G. J., & Schlabach, T. L. (2013). Systematic review of occupational therapy interventions to
improve cognitive development in children ages birth-5 years. American Journal of Occupational
Therapy, 67(4), 425-430.
REFERENCESContinued
• Cornelius, M. D. & Day, N. L. (2009). Developmental consequences of prenatal tobacco exposure.
Current Opinion in Neurology, 22(2), 121-125.
• Craig, J., Glick, C., Phillips, R., Hall, S., Smith, J. & Browne, J. (2015). Recommendations for involving the
family in the developmental care of the NICU baby. Journal of Perinatology, 35(1), S5-S8.
doi:10.1038/jp.2015.142.
• Cramm. H., Frupa, T., Missiuna, C., Lysaght, R. M., & Parker, K. C. (2013). Broadening the occupational
therapy toolkit: An executive functioning lens for occupational therapy with children and youth.
American Journal of Occupational Therapy, 67(6), e139-e147.
REFERENCESContinued
• Duval-White, C. J., Jirikowic, T., Rios, D., Deitz, J., & Olson, H. C. (2013). Functional handwriting performance
in school-aged children with fetal alcohol spectrum disorder. American Journal of Occupational Therapy,
67(5), 534-542.
• Fedewa, A. L., & Erwin, H. E. (2011). Stability balls and students with attention and hyperactivity concerns:
Implications for on-task and in-seat behavior. American Journal of Occupational Therapy, 65(4), 393-399.
• Franklin, L., Deitz, J., Jirikowic, T., Astley, S. (2008). Children with fetal alcohol spectrum disorder: Problem behaviors
and sensory processing. American Journal of Occupational Therapy, 62(3), 265-273.
REFERENCESContinued
• Golding, J., Emmett, P., Iles-Caven, Y., Steer, C., & Lingam, R. A review of environmental contributions
to childhood motor skills. Journal of Child Neurology, 29(11), 1531-1547.
• Hahn-Markowitz, J., Manor, I., & Maeir, A. (2011). Effectiveness of Cognitive-Functional (Cog-Fun)
interventions with children with attention deficit hyperactivity disorder: A pilot study. American
Journal of OccupatinalTherpay, 65(4), 384-392.
• Howe, T., Roston, K. L., Sheu, C., & Hinojosa, J. (2013). Assessing handwriting interventions
effectiveness in elementary school students: A tow-group controlled study. American Journal of
Occupational Therapy, 67(1), 19-27.
REFERENCESContinued
• Hulle, C., Lemery-Chalfant, K., & Goldsmith, H. (2015). Trajectories of sensory over-responsivity
from early to middle childhood: Birth and temperament risk factors. Public Library of Science One,
10(6), 1-16. doi: 10.137/journal.pone.01299968.
• Hwang,A., Chao, M. & Liu, S. (2013). A randomized controlled trial of routines-based early
interventions for children with or at risk for developmental delay. Research in Developmental
Disabilities, 34(10), 3112-3123. https://doi.org/10.1016.j.ridd.2013.06.037
• Hunt, R. W., Tzioumi, D., Collins, E., & Jeffery, H. E. (2007). Adverse neurodevelopmental outcome of
infant exposed to opiate in-utero. Early Human Development, 84, 29-35.
REFERENCESContinued
• Jones, H. E., Katlenbach, K., Heli, S. H., Stine, S. M., Coyle, M. G., Arria, A. M…, Fischer, G.
(2010). Neonatal abstinence syndrome after methadone or buprenorphine exposure.
New England Journal of Medicine, 363(2320-2331). Doi: 10.1056/NEJMoa1005359.
• Kocherlakota, P. (2014). Neonatal abstinence syndrome. Pediatrics, 134(2), e547-e561.
• Kreider, C., Bendixen, R., Huang, Y. & Lim, Y. (2014). Review of occupational therapy
interventions research in the practice area of children and youth 2009-2013. American
Journal of Occupational Therapy, 68(2), e61-e73.
http://dx.doi:.org/10.5014/ajot2014.0111114
REFERENCESContinued
• Lambert, B., & Bauer, C. (2012). Developmental and behavioral consequences of prenatal cocaine
exposure: A review. Journal Perinatol, 32(11), 819-828. Doi: 10.1038/jp2012.90.
• Lander, l., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and
children: From theory to practice. Social Work Public Health, 28(0), 194-205.
• Logan, B. A., Brown, M. S., & Hayes, M. J. (2013). Neonatal abstinence syndrome: Treatment and
pediatric outcomes. Clinical Obstetrics and gynecology, 56(1), 186-192.
• LaRossa, M. M. (2017). Understanding preterm infant behavior in the NICU. Retrieved from
http://www.pediatrics.emory.edu/divisions/neonatology/dpc/nicubeh.html
REFERENCESContinued
• Lust, C. A., & Donica, D. K. (2011). Effectiveness of a handwriting readiness program in Head
Start: A two-group controlled trial. American Journal of Occupational Therapy, 65(5), 560-568.
• MacMullen, N. J., Dulski, L. A., & Blobaum, P. (2014). Pediatric Nursing, 40(4), 165-172, 203.
• Maeir, A., Fisher, O., Bar-Ilan, R. T., Boas, N., Berger, I., & Landau, Y. E. (2014). Effectiveness of
cognitive-functional (cog-fun) occupational therapy interventions for young children with
attention deficit hyperactivity disorder: A controlled study. American Journal of Occupational
Therapy, 68(3), 260-267.
REFERENCESContinued
• May-Benson, T. A., Koomar, J. A. (2010). Systematic review of the research evidence examining the
effectiveness of interventions using sensory integrative approach for children. American Journal of
Occupational Therapy, 64(3), 403-414.
• McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal abstinence syndrome. New England Journal of
Medicine, 375(25), 2468-2479. Doi: 10.1056/NEJMra1600879.
• Miller, E., & Kuhnaneck, H. (2008). Children’s perceptions of play experiences and play preferences:
A qualitative study. American Journal of Occupational Therapy, 62(4), 407-415.
REFERENCESContinued
• Minnes, S., Lang, A., & Singer, L. (2011). Prenatal tobacco, marijuana, stimulant and opiate exposure:
Outcomes and practice implications. Addiction Science and Clinical Practice, 6(1), 57-70.
• Mitchell, A. W., Moore, E. M., Roberts, E. J., Hachttel, K. W., & Brown, M. S. (2015). Sensory
processing disorder in children ages birth-3 years born prematurely: A systematic review.
American Journal of Occupational Therapy, 69(1), 6901220030p1-6901220030p11.
• Motlagh, M. G., Sukhodolsky, D. G., Landeros-Weisenberger, A., Katsovich, L., Thompson, N., Scahill,
L... & Leckerman, J. F. (2011). Adverse effects of heavy prenatal maternal smoking on attentional
control in children with ADHD. Journal of Attention Disorders, 15(7), 593-603.
REFERENCESContinued
• National Institute on Drug Abuse. (2017). Heroin. Retrieved from
https://www.drugabuse.gov/publications/drugfacts/heroin
• Nguyen, T. T., Levy, S. S., Riley, E. P., Thomas, J. D., & Simmons, R. W. (2013). Children with heavy
prenatal alcohol exposure experience reduced control of isotonic force. Alcohol ism, clinical and
experimental research, 37(2), 315-324.
• Nwabara, O., Rogers, C., Inder, T. & Pineda, R. (2017). Early therapy services following neonatal
intensive care unit discharge. Physical and Occupational Therapy in Pediatrics, 37(4), 414-424.
http://dx.doi.org/10.1080/01942638.2016.1247937
REFERENCESContinued
• Ohl, A. M., Graze, H., Weber, K., Kenny,S., Salvatore, C., & Wagreich, S. (2013). Effectiveness of a 10-
week tier-1 response to intervention program in improving fine motor and visual-motor skills in
general education kindergarten students. American Journal of Occupational Therapy, 67(5), 507-514.
• Oostlander, S., Falla, J, Dow, K. & Fucile, S. (2019). Occupational therapy management strategies for
infants with neonatal abstinence syndrome: Scoping review. Occupational Therapy in Health Care,
33(2), 197-226, DOI:10.1080/07380577.2019.1594485
• Park, H. Y., Maitra, K., Achon, J., Loyola, E., & Rincon, M. (2014). Effects of early intervention on
mental or neuromusculoskeletal and movement-related functions in children born low
birthweight or preterm: A meta-analysis. American Journal of Occupational Therapy, 68(3), 268-276.
REFERENCESContinued
• Patrick, S. W. (2015). The triple aim for neonatal abstinence syndrome. Journal of Pediatrics, 167(6),
1189-1191.
• Polatajko, H. J., & Cantin, N. (2010). Exploring the effectiveness of occupational therapy
interventions, other than the sensory integration approach, with children and adolescents
experiencing difficulty procession and integrating sensory information. American Journal of
Occupational Therapy, 64(3), 415-429.
• Price, P. & Miner, S. (2007). Occupation emerges in the process of therapy. American Journal of
Occupational Therapy, 61(4), 441-450.
REFERENCESContinued
• Purdy, I., Craig, J. & Zeanah, P. (2015). NICU discharge planning and beyond:
recommendations for parent psychosocial support. Journal of Perinatology, 35(1),
S24-S28. doi: 10.1038/jp.2015.146.
• Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M., Kuaneck, H. M., Pfieiffer,
B…, Bodison, S. C. (2017). Multifaceted approach to working with children who
have differences in sensory processing and integration. American Journal of
Occupational Therapy, 71(2), 7102360010p1-7102360010p10.
REFERENCESContinued
• Ross, K., Heiny, E., Conner, S., Spener, P. & Pineda, R. (2017). Occupational therapy,
physical therapy and speech-language pathology in the neonatal intensive care unit:
Patterns of therapy usage in a level IV NICU. (2017). Research in Developmental
Disabilities, 64, 108-117. http://dx.dio.org/10.1016/j.ridd.2017.03.009.
• Saunders, C., Pharm, T., Smith, S., Buchheit, J., Cook, K., Edds, J., & Mefford, L. (2014).
Neonatal abstinence syndrome. Journal of Perinatal Neonatal Nursing, 28(3), 232-240.
• Singer, L. T., Minnes, S., Min, M. O., Lewis, B. A., & Short, E. J. (2015). Prenatal cocaine
exposure and child outcomes: a conference report based on a prospective study from
Cleveland. Human Psychopharmacology, 30(4), 285-289.
REFERENCESContinued
• Siu, A. & Robinson, C. A. (2014). Neonatal abstinence syndrome: Essentials for the
practitioner. Journal of Pediatric Pharmacological Therapy, 19(3), 147-155.
• Starks, H., & Trinidad, S. (2007). Choose your method: A comparison of
phenomenology, discourse analysis and grounded theory. Qualitative Health
Research, 17(10), 1372-1380.
• Stover, M. W. & Davis, J. M. (2015). Opioids in pregnancy and neonatal abstinence
syndrome. Seminars in Perinatology, 39(7), 561-565.
REFERENCESContinued
• The Arc. (2011). Causes and prevention of intellectual disability. Retrieved from
http://www.thearc.org/what-we-do/resources/fact- sheets/causes-and-prevention
• Thompson, B. L., Levitt, P., & Stanwood, G. D. (2010). Prenatal exposure to drugs: Effects on brain
development and implications for policy education. Nature Reviews Neuroscience, 10(4), 303-312.
• Velez, M. & Jansson, L. M. (2008). The opioid dependent mother and newborn dyad: Non-
pharmacological care. Journal of Addiction Medicine, 2(3), 113-120.
• Watts, T., Stagnitti, K., & Brown, T. (2014). Relationship between play and sensory processing: A
systematic review. American Journal of Occupational Therapy, 68(2), e37-e46.
REFERENCESContinued
• Wiles, J. R., Isemann, B., Ward, L. P., Vinks, A. A., & Akinbi, H. (2014). Journal of Pediatrics, 165(3), 440-446.
• Williams, J., & Smith, V. (2015). Fetal Alcohol Spectrum Disorders. Pediatrics, 136(5), e1395-e1403. doi:
10.1542/peds.2015-3113
• Wu, C., Jew, C. P., & Lu, H. (2011). Lasting impacts of prenatal cannabis exposure and the role of
endogenous cannabinoids in the developing brain. Future Neurology, 6(4), 459-480.
• Wuang, Y., Wang, C., & Huang, M. (2009). Prospective study of the effects of sensory integration,
neurodevelopmental treatment, and perceptual-motor therapy on sensorimotor performance in
children with mild mental retardation. American Journal of Occupational Therapy, 63(4), 441-452.
REFERENCESContinued