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Autism is a processing disorder that disrupts the ability to understand and utilize language, organize incoming auditory and visual information. It is usually accompanied by repetitive motor movements, a need for routine and sameness (Siegal, 1996) and significantly poor social skills. This disorder affects the individual’s ability to socialize with others in an appropriate fashion. Individuals with Autism Spectrum Disorder (ASD) suffer direct and indirect consequences related to social interaction deficits. Socialization deficit is a major source of impairment regardless of cognitive or language ability for individuals with ASD (Carter, Davis, Klin & Volkmar, 2005). The social impairments in individuals with ASD are diverse and involve speech, linguistic conventions and interpersonal interaction.

Aim: Aim:

1.1.To incorporate the Occupational therapy and SpeechTo incorporate the Occupational therapy and Speech--language therapy treatment approach into language therapy treatment approach into

the group therapy session. the group therapy session.

2.2.To work on the standardized treatment DIR/Floor Time and SensoryTo work on the standardized treatment DIR/Floor Time and Sensory Integration in a team and Integration in a team and

follow up on the affectivity progress in the childfollow up on the affectivity progress in the child’’s social interaction development in a group.s social interaction development in a group.

ABSTRACTABSTRACT

INTRODUCTIONINTRODUCTION

CONCLUSIONCONCLUSION REFERENCESREFERENCES

EFFECT OF TRANSDISCIPLINARY APPROACH INEFFECT OF TRANSDISCIPLINARY APPROACH IN GROUP THERAPY GROUP THERAPY TO DEVELOPTO DEVELOP SOCIAL SKILLS SOCIAL SKILLS FOR CHILDREN WITH AUTISM SPECTRUM DISORDER FOR CHILDREN WITH AUTISM SPECTRUM DISORDER

Authors: RAJEEV RANJAN, KAJAL RAY PRADHAN, JOYCE WONGAuthors: RAJEEV RANJAN, KAJAL RAY PRADHAN, JOYCE WONGSociety for the Physically DisabledSociety for the Physically Disabled

SingaporeSingapore

The social impairments in individuals with Autism spectrum disorder (ASD) are diverse and involve speech, linguistic conventions and interpersonal interaction. 5 male children with ASD in the age range of 8 to 10 years were selected randomly. All the children were attending mainstream schools, receiving individual speech therapy and occupational therapy (45-minute session every fortnight) and were having difficulty in social interaction. The children were placed in a 3-hour group therapy program for 6 sessions, which were facilitated by two professionals, a speech–language therapist and an occupational therapist at our center i.e. (Society for the Physically Disabled). The rating score was performed by parents and therapists. The comparative pre and post therapy score among the two groups, that is by parents and therapist shows that the objectives for the group therapy were rated higher after the completion of the group therapy. Wilcoxon Signed Ranks Test shows there is significant difference (P<0.05) observed between pre and post group therapy rating scale by parents and therapists.

5 male children with ASD in the age range of 8 to 10 years were selected randomly. The children were in lower primary, that is Primary 1-4. All the children were attending mainstream schools and receiving individual speech therapy and occupational therapy (45-minute session every fortnight) and having difficulty in social interaction. The children were placed in a 3-hour group therapy program for 6 sessions, which were facilitated by two professionals, a speech–language therapist and an occupational therapist at our center (Society for the Physically Disabled). There were 5 objectives for the group therapy program :1.Listen and follow the instructions2.Interact with other children in the group3.Initiate in the activity4.Initiate and maintain interaction5.Initiate and complete activitiesEach objective was scored on a 4-rating scales which also indicate the percentage of achievement for the particular objective such as 1 - 25% (The child who needs maximum prompts - visual, verbal and physical guidance from the therapist), 2 - 50% (The child who needs moderate prompts - visual and verbal cues from the therapist), 3 - 75% (The child who needs minimal prompts –verbal cues from the therapist) and 4 - 100% (The child who does not need any prompt and able to perform himself/herself). The percentage was considered as total percentage of the performance for the particular child in the group. The rating scale was scored by the parent of each child and therapist before and after group therapy session. The scores were compared pre and post therapy to monitor the overall performance of the child for each objective.

•Mean and standard deviation was obtained using SPSS version 16 and Wilcoxon Signed Ranks Test was used to see any significant difference among the pre and post therapy rating scores among parents and therapists.

METHODS METHODS

RESULTSRESULTS

DISCUSSIONDISCUSSION

Parents’ Scores

Pre Therapy Post Therapy

ObjectivesCh.Ma

Ch.Jo

Ch.Al

Ch.Ve

Ch.Je

Ch.Ma

Ch.Jo

Ch.Al

Ch.Ve

Ch.Je

Listen and Follow instructions 2 3 3 2 4 4 4 4 3 4

Interact with other children in the group 2 1 3 1 3 3 3 4 3 3

Initiate in the activity 2 2 3 2 2 3.5 3 4 2 3

Initiate and maintain interaction 2 1 2 2 2 3 3 3 3 3

Initiate and complete activities 2 2 2 2 2 3 3.5 3 3 3

Parent Rating (Pre and Post)

0

0.5

1

1.5

2

2.5

3

3.5

4

O.1 O.2 O.3 O.4 O.5

Objectives

Pa

ren

t S

co

res

fro

m t

he

Ra

tin

g

Sc

ale Pre-Therapy (avg)

Post -Therapy (avg)

Chart 1. Comparative Column Graph for ObjectivesChart 1. Comparative Column Graph for Objectives Chart 2. Comparative Column Graph for Client ProgressChart 2. Comparative Column Graph for Client Progress

Table 2. Therapist rating ScoreTable 2. Therapist rating Score

Therapist Scores

Pre Therapy Post Therapy

ObjectivesCh.Ma

Ch.Jo

Ch.Al

Ch.Ve

Ch.Je

Ch.Ma

Ch.Jo

Ch.Al

Ch.Ve

Ch.Je

Listen and Follow instructions 2.8 3.5 4 3 4 4 4 4 3.6 4

Interact with other children in the group 2 2 3 2.75 3 3 3 4 2.8 4

Initiate in the activity 2.4 2.2 3.5 2.5 3 3.4 3.6 4 3.2 4

Initiate and maintain interaction 2 2.2 3 2 2.4 3.2 3.2 3.8 3 4

Initiate and complete activities 2 2.2 3 2.25 2.6 3.4 3.4 4 3 4

Therapist Rating (Pre and Post)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

O.1 O.2 O.3 O.4 O.5

Objectives

Th

era

pis

t S

co

res

fro

m R

ati

ng

Sc

ale Pre-Therapy (avg)

Post-Therapy (avg)

Chart 1. Comparative Column Graph for ObjectivesChart 1. Comparative Column Graph for Objectives Chart 2. Comparative Column Graph for Client ProgressChart 2. Comparative Column Graph for Client Progress

ACKNOWLEDGEMENTACKNOWLEDGEMENT

Our Sincere Thanks to :

SPD Executive Director, Mr Pal for his kind approval for the clinical study and the training grant from Society for the Physically Disabled, Singapore;

All clients and parents for their consent and active participation in the research study;

Ms Joyce Wong, Ms Debbie Chow and Ms Tay Hwee Lin for their guidance and encouragement;

Mr Kumar for his statistical analysis; Mrs Trivedi, Ms Petra and all support staff at SPD for their constant help throughout the entire clinical study.

Carter, A.S., Davis, N.O., & Volkmar, F.R. (2005). Social development in autism, In F.R. Volkmar, R.Paul, A. Klin, & D.Cohen (Eds.), Handbook of autism and pervasive development disorders: vol.1. Diagnosis, development, neurobiology, and behavior. Hoboken, NJ: John Wiley & Sons.

1.1.Siegel, B. (1996). The World of the Autistic child. New York/ OxSiegel, B. (1996). The World of the Autistic child. New York/ Oxford: Oxford University Press.ford: Oxford University Press.White. S. W., Keonig. K. & Scahill. L. (2006). Social Skills DevWhite. S. W., Keonig. K. & Scahill. L. (2006). Social Skills Development in Children with Autism elopment in Children with Autism

Spectrum Disorders: A Review of the Intervention Research. JournSpectrum Disorders: A Review of the Intervention Research. Journal of Autism Developmental al of Autism Developmental

Disorders.Disorders.

http://www.autismweb.com/floortime.htmhttp://www.autismweb.com/floortime.htmhttp://www.icdl.com/dirFloortime/overview/index.shtmlhttp://www.icdl.com/dirFloortime/overview/index.shtml

The study aimed to see the effectiveness of incorporation of occupational therapy and speech language therapy treatment approachduring group therapy session. The rating scoring was performed by parents and therapists.

Table 1. ParentsTable 1. Parents’’ Rating ScoreRating Score

Chart 2. Comparative line graph for objectives by parentsChart 2. Comparative line graph for objectives by parents

Chart 2. Comparative line graph for objectives by therapistChart 2. Comparative line graph for objectives by therapist

The Wilcoxon signed ranked test shows that there is significant difference among the therapists’ pre and post score for objective 2, 3, 4 and 5. However, the therapist’s pre and post score for objective 1 is not significant as P value is less than 0.05 for all the children.

Wilcoxon Signed Ranks Test shows there is significant difference (P<0.05) observed between pre and post group therapy rating scale by parents in objective 4 and 5. However, there was no significant difference observed pre and post rating scale by parents for objective 1, 2 and 3. Overall, there is significant difference between pre and post group therapy treatment.

From our study, it is concluded that the individual therapy may have limitation on socialization, whereas a group therapy facilitates a conducive social environment for children with ASD. In the group therapy session, children have the opportunities to engage various social interactive skills with other children of their age group in a safe environment. The group therapy environment enhances the confidence level of the children to initiate and interact with their peers. Therefore, transdisciplinary approach in group therapy plays a significant role to develop social interaction skills in children with autism. It is a platform where the children receive rehabilitation therapies by different professionals with various treatment strategies.

Client Progress (Pre and Post)

0

0.5

1

1.5

2

2.5

3

3.5

4

Ch.Ma Ch.Jo Ch.Al Ch.ve Ch.Je

Client's NameP

are

nt

Sc

ore

s f

rom

Ra

tin

g

sc

ale Pre-Therapy

Post-Therapy

Client Progress (Pre and Post)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Ch.Ma Ch.Jo Ch.Al Ch.ve Ch.Je

Client's Name

Th

era

pis

t S

co

res

fro

m R

ati

ng

Sc

ale Pre-Therapy

Post-Therapy

Progress in Objectives (Pre and Post)

2.8

22.2

1.82

3.8

3.2 3.1 3 3.1

0

0.5

1

1.5

2

2.5

3

3.5

4

O.1 O.2 O.3 O.4 O.5

Objectives

Pare

nt Score

s fro

m the R

ating S

cale

Pre-Therapy (avg)

Post-Therapy (avg)

Progress in Objectives (Pre and Post)

3.46

2.552.72

2.32 2.41

3.92

3.363.64

3.44 3.56

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

O.1

O.2

O.3

O.4

O.5

Objectives

Thera

pis

t Score

s fro

m R

ating S

cale

Pre-Therapy (avg)

Post-Therapy (avg)

As this study involved only 5 children, the results may not be representative of the population of children in the same age group and diagnosis in Singapore. Further studies on a larger scale may be required. There were also some variation in inter-child, inter-parent and inter-therapist rating for the performance. A number of researchers have mentioned in their treatment study for children with ASD that there is a necessity of an outcome measurement that is socially valid and sensitive to change. The outcome measurement should have the strength to measure the child’s new specific skills learnt in context to both treatment and in real environment (White, Koenig & Schill, 2006).

Progress in Objectives (Pre and Post)

2.8

22.2

1.82

3.8

3.2 3.1 3 3.1

0

0.5

1

1.5

2

2.5

3

3.5

4

O.1 O.2 O.3 O.4 O.5

Objectives

Pare

nt Score

s fro

m the R

ating S

cale

Pre-Therapy (avg)

Post-Therapy (avg)