Integrative Case Study With Feedback

OCTH 6140 - Integrative Case Study #2 Name: _Whitney
This assignment involves synthesizing or integrating the information from OTCH

6120 (Theory), OCTH 6140 (Skills) and OCTH 6160 (Evaluation) on the module we
completed on preschool-aged children. The format for this case study replicates the
occupational therapy process from referral through evaluation and planning
intervention.
You are to complete all the questions in the order that they appear. As in the
therapy process, you will gain more information as you go through case. DO NOT
change your answers to earlier questions as you gain more information. It is
important for you to reflect on your thinking processes and to identify information
you need and want to obtain as you learn more about the youth and his or her
family.
It is recommended that you use the OTPF as a resource to guide you through this
assignment. Youre also allowed to use your notes, textbooks, or the internet to help
you answer the questions. References must be given on designated questions.
Case Study
1. Referral
Maria is a 4-year-old female who has been in a developmental preschool at
The Childrens Center for the past six months. Her teachers are reporting minimal
progress and continue to be concerned about her repetitive behaviors, lack of social
engagement, and difficulty talking. Her mother shares concerns about these areas,
as well as Marias insistence on eating the same foods every day and difficulties
with her morning/bedtime routine. Marias mother would like to get her the help she
needs and is seeking additional occupational therapy services through the
outpatient clinic located at the Childrens Center.
a) What are two possible diagnoses that Maria may have? (Include diagnostic
information for the diagnoses you select and relate it to information found in
the referral. Provide references.)
1. Autism Spectrum Disorder- It is not uncommon for autism to accompany a

developmental delay. Autism can be characterized by lack of social
engagement, highly restricted and intense areas of interest, and sensory
concerns, such as with food. Maria displays these signs of autism.
" Autism Spectrum Disorder (ASD) " (2016). CDC. Retrieved from
http://www.cdc.gov/ncbddd/autism/hcp-dsm.htm
2. Obsessive Compulsive Disorder- OCD in children can be characterized by the

child limiting behavior to set parameters and being unwilling to break out of
these routines because of an underlying fear that something bad will happen
if their behaviors are altered in any way. Obsessive compulsive disorder can
be hard to diagnose in children this young but does occur. The issues Maria is
facing could ultimately be OCD. Maria shows some signs of OCD in her
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inflexibility in eating, interest in only a few types of toys, and perhaps even in
her unwillingness to speak.
"Obsessive Compulsive Disorder" (2016). CDC. Retrieved from
http://www.cdc.gov/childrensmentalhealth/ocd.html
b) Pick one of these diagnoses. Name the diagnosis you selected and identify
four occupation from Table 1 of OTPF (ex: Activities of daily living-dressing)
that could be affected if the child has this diagnosis.
Diagnosis: Autism Spectrum Disorder
List four specific occupations that may be affected for Maria:
1. Activities of Daily Living- Eating_________________________
2. _Rest and Sleep- Sleep participation_____________________
3. _Play- Play Exploration_________________________________
4. _Social Participation- peer/friend_________________________
c) Based on childhood development, what performance tasks would you

typically expect a child of this age to be doing in each of the following areas
of occupation (be specific)? Not all areas may apply.
Area of Occupation Developmental Expectation
Activities of Daily Living Child can bathe self with minimal to

moderate assistance. Child can use toilet
and is becoming more independent with
toileting needs. Child can dress self except
for maybe clothes with small buttons or
zippers, with verbal cuing. Child can
effectively self feed and swallow food cut
to less than . Child has functional
mobility but may not trouble shoot tricky
situations, such as slippery bathroom floor
or not tripping over many toys. Child can
perform basic self care tasks with minimal
assistance.
Instrumental Activities of Daily Living Child can engage in many areas of iADLs
with maximum or moderate assistance in
some cases. May be able use phone or
computer. Child can be introduced to
concept of saving money. Child can assist
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in feeding pets or letting a pet outside. Can

exercise with a parent. Child can help with
yardwork. Child can help with meal prep
and clean up. Children can say a basic
prayer or perform religious routines. A child
may have limited understanding of safety
and emergency situations. A child can
contribute to a shopping list, hold the list
and help find items at store. Can
understand money is needed to purchase
items.
Rest and Sleep Child should be able to recognize when
they are tired, but may not always be
willing to participate in rest. Can
understand and expect steps in a bed time
routine, and can complete routine with
minimal to moderate assistance (getting
pajamas on, brushing teeth, picking a book
etc) Bed wetting is still normal at this age.
Child should understand sleep
expectations and be able to sleep all night
in their own bed most of the time. Children
at this age can benefit from a nap but not
all children nap.
Education At 4, formal education, such as preschool,
is optional but beneficial. Children are
capable of being introduced to the tasks of
a formal classroom. They also can
participate in community classes without
one on one supervision, and can identify
interests and look at books on interesting
topics. Some may be able to read etc.
Work N/A
Play Children should be able to fully engage in
play exploration, with or without peers.
Imaginary play is very common in order for
the child to view themselves in family or
future roles. Play participation includes
clean up with verbal cues or minimum
assistance for most play tasks.
Leisure Can give feedback on leisure planning for
family, can identify and participate in fun
leisure activities, can understand the need
to maintain equipment and can help in
these types of preparatory tasks.
Social Participation Can successfully interact with church
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group, preschool class, etc at community

level, can understand their role in the
family and participate in family life, and
maintain basic friendships with peers
including taking turns, playing together,
comforting one another, etc.
2. Preparation for Evaluation
You review the referral and learn the following: Maria lives with her mother, father,
and younger sister. Her mother is 25 years of age and stays at home with Maria
and her sister. Her father is 26 years old and works two jobs. During the day, he
works at Home Depot. He also works some evenings and weekends at Wal-Mart.
Maria has Medicaid insurance.
On an intake form completed before the evaluation, you read that Marias mother
speaks Spanish and some English. She said that Maria was born full term. As an
infant, Maria cried a lot and slept a lot. Her mother wrote that Maria often prefers to
play alone. It is also reported that Maria will sit for long periods of time lining up
objects, stacking objects, or watching television. She does not always respond to
her mother, father, or extended family members. Her pediatrician had her hearing
tested and found that her hearing is intact. Maria was referred to The Childrens
Center for further evaluation and treatment by the pediatrician. A psychologist
diagnosed her with autism spectrum disorder and recommended that she attend
their developmental preschool. As stated above, Marias mother would like to get
her the help she needs and is seeking additional occupational therapy services
through your clinic.
a) From the information above and your knowledge of conditions, identify three
associated risk factors and/or deficits associated with the diagnoses listed that
may influence Marias development (Cite information source).
Risk Factor or Deficit Discuss the barriers to

development/performance
that may present due to this
risk factor or deficit (cite
information sources)
1. Gastrointestinal problems Individuals with autism are
Medical comorbidities in autism spectrum at higher risk for diarrhea,
disorders. (2013). Treating Autism. Retrieved reflux, and enzyme
from: deficiencies. There is a
http://nationalautismassociation.org/docs/comorbi higher mortality rate from
dities.pdf digestive diseases among
people with autism as well.
These GI issues can affect
performance in many
different ways, including
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eating and toileting routines,

ability to potty train, meeting
social development
milestones (these children
are much more irritable and
engage in self harm
behaviors at a higher rate
during GI episodes), and the
higher risk for death
certainly seems worthy of
note.
2. food and environmental allergies (Medical This article states that
Comorbidities in Autism Spectrum Disorders, certain types of allergies,
2013) commonly found in people
with autism, have been
found to contribute to higher
rates of anxiety and mood
disorders. They can also
contribute to difficulty
focusing, irritability, tics,
daytime fatigue and sleep
problems found in both
children and adults.
Therefore, if Maria has these
types of allergies shes at
risk for emotional
dysregulation affecting
essentially all her social
interaction skills, inability to
focus affecting her ability to
attend, initiative, continue,
sequence and terminate
tasks, and disruptions of her
sleep routines.
3. Seizure Disorder (Medical Comorbidities in People with autism are at
Autism Spectrum Disorders, 2013) significantly higher risk for
seizure disorders when
compared with the general
population. Seizure disorders
are also a contributing factor
to higher mortality rates
among people with autism.
Seizures affect almost every
aspect of ones life, and can
reduce a persons motor and
processing skills as brain
damage occurs if left
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untreated.
b) Pick two of the risk factors or deficits you identified above. Next to each risk
factor or deficits identify:
a. How it may affect Marias occupational performance
b. How it may the affect Marias family.
#1_Gastrointestinal Problems______________________________
Impact on Marias occupational performance

a. Marias extreme food selectivity could be linked to GI problems that she isnt
able to articulate. This affects her ability to eat appropriate to gain the
nutrition she needs, appropriately engage in the social activity of meal time
or snack time at school, and could also affect her ability to independently go
to the bathroom if she has issues with diarrhea or constipation. In addition, if
she is irritable frequently due to an upset stomach, this could affect all of her
social occupations with peers or family, since she will be less willing to
engage when she isnt feeling well. Feeling sick can also affect play
participation, and essentially any other developmentally appropriate
occupation a 4-year-old should engage in.
Impact of occupational performance problems on family

b. If Maria did have GI issues, there may be testing costs involved, doctors
appointments etc. to figure out whats wrong. This would impact the familys
ability to fulfill basic iADLs at home, leisure activities, or if costs are high
enough, buying basic needs to fulfill ADL tasks (toothpaste, food, etc.).
Devoting time to Marias diagnosis and therapies leaves less time for other
occupational pursuits. Also, when one child has many medical needs, therapy
appointments, etc. it can be difficult to balance out the occupational needs of
the other child. So, Marias sister may not experience as many occupational
opportunities, social opportunities etc. as a result if her family is busy taking
care of her sister.
Risk #2 food and environmental allergies_____________
Impact on Marias occupational performance
a. As stated in the article cited in the table, allergies are much more common in
individuals with autism. For someone with autism who may already have
abnormal responses to sensory input, allergies can greatly inhibit
occupational engagement. Food allergies may contribute to reduced dietary
variety or refusal to eat at all. Environmental allergies can greatly restrict
Marias play participation in outdoor activities. Some allergies have been
found to be linked to mood disorders such as anxiety or depression. These
interactions could affect Marias ability to engage in healthy habits and
routines overall at home.
Impact of occupational performance problems on family
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b. Maria, being so young and also having trouble talking, may have difficulty
pinpointing her discomforts for her family except for her refusal to engage in
some occupations related to allergies. Her caregivers may experience
increased stress or disruptions in every day routines if Maria is upset and
needs attention.
c) Domain Analysis: Based on what you know, highlight domains that you think
need further investigation during your initial evaluation to see how they might
be impacting the childs occupational performance and their school and family
life?
Occupation Client Performanc Performanc Context &

s Factors e Skills e Patterns Environment
ADLs Values Motor Skills Habits Cultural

Beliefs Personal
IADLs
Spirituality
Rest & Sleep Routines
Education Body Process Physical

Functions Skills Social
Work Rituals
Play
Leisure Body Social Roles Temporal

Structures Interaction Virtual
Social
Skills
Participation
3. Evaluation Plan
a) Practice Models Guiding your Evaluation & Assessment
Based on what you know so far (age, diagnosis, concerns, setting, risk factors, etc.)
and all the factors considered above:
Choose an organizing practice model (i.e. PEO, MOHO) that will help guide
you in the overall evaluation process. Be specific and describe how this model
would direct your evaluation process.
Choose at least 2 (two) complementary OT models that will help guide you in
the overall evaluation process. Be specific and describe how this model
would direct your evaluation process. List only those most pertinent.
REMEMBER you want to choose a model that provides a foundation for a
COMPREHENSIVE evaluation plan.
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Practice Brief description of the How this practice model

Models practice model would direct your
evaluation (i.e. what would
you be looking for based on
this model)
Organizing: I would be sure to watch for
PEO- PEO focuses on bringing environmental factors that help
person, environment, and or inhibit Maria. Its also
occupation into congruence in important to keep in mind how
order to achieve maximum her personal factors and
occupational performance and environment transact with her
participation. There is a occupational demands to
particular focus on considering produce her occupation
the environmental factor. performance on a given task.
Complementa Developmental Theory- I would consider the

ry #1: Developmental theory focuses developmental milestones
on identifying the appropriate Maria has met in social
developmental sequence for a participation, eating, and play,
set of skills, then identifying as compared to the ones she
where a childs skills lie in has not yet reached in
reference to the entire comparison to her peers, then
developmental sequence. use that information and apply
it to her overall functioning.
Developmental theorys
pyramidal view considers what
building block is missing for a
child to achieve the next step
in development. Is Maria
behind her peers in
development? What pieces are
missing for her to achieve her
next milestone? And, most
importantly, how do these
things affect her daily
occupations, routines, and
ability to interact with the
world around her? Assessing for
development compared to
peers would be crucial to
determining her current
occupational functioning.
Complementa Sensory Integration- SI I would seek information about
ry #2: describes a childs innate need Marias neurological sensory
to seek meaningful experiences thresholds and how that affects
from their environment and her interactions with her
how sensory experiences shape environment. Does Maria
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a childs adaptive responses possess adaptive responses to

and ability to organize and her environment? If not, in
process sensory info. what areas can I facilitate the
organization of her sensory
experiences by promoting
sensory interaction with her
environment?
b) Obtaining Occupational Profile
List the three most important questions you would ask Marias parent(s) at her
evaluation. State the questions in the words you would use with her parents.
1. If you had to choose one most important thing to work on during therapy, what
would it be and why?
2. What are Marias interests and strengths?
3. Walk me through a typical day with Maria.
List 4 occupational performance tasks that you would want to observe/analyze

Maria participating in during the evaluation (consider what a child this age should
be doing).
1. Mealtime and events leading up to mealtime- Marias file indicates that she is
very rigid concerning food. Id like to observe her responses to potential foods for
her to eat, her parents interactions with her concerning her food refusal. Also, is
there a sensory component to her eating habits? I hope to gain insight as to which
area to address; Marias tolerance of novel foods, Marias environment surrounding
meals (her familys interactions with her), the occupation of eating itself, or a
combination of these factors in order to gain congruence and improve Marias
occupational performance in this area.
2.Play with a peer present- Marias case file reports a lack of social engagement
and that she prefers to play alone. I would like to analyze what developmental level
she is at in regards to her play. What pieces does she need in order to move into
developmentally appropriate play with her peers? Does she show interest in others
but not understand how to make friends? Stacking blocks indicates development
around 12 months, but is Marias development following a predictable path or
something different because of her autism? How does her language delay factor
into this?
3.Ideally, getting ready for bed- Marias file indicates she has trouble sleeping, not
an uncommon problem for children with autism. I would be searching for anything
implicating Marias sensory processing preventing her from going to sleep. What are
the components within this occupation that give Maria trouble? How can her
environment or the routine be change to better fit with her sensory needs? As I
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probably could not observe this, Id like to get a lot of details from her mother about
bedtime, if possible.
4. Play with her mother- Marias primary caregiver is her mother. Id like to observe
what her mother does to promote developmentally appropriate play, and if her
mother is aware of Marias sensory needs. In other words, in what ways in Marias
mother an environmental support to her, and where can I give assistance to Marias
mother in providing her as a caregiver information and suggestions for managing
Marias day to day needs, both in play and in other areas of her life.
c) Assessments/Tools
Identify 1 or 2 appropriate assessment tools or strategies you would use to evaluate

Maria during this initial two-hour session, other than your interview for your
occupational profile and observation of performance skills (these are listed for you
in the table below). Be sure to consider the practice setting and remember that
asking questions for the occupational profile, observation and analysis of
occupational performance and assessments should take no longer than two hours
collectively. Next to each assessment, briefly describe information you hope to
obtain using this method. Also identify the practice model that guided your choice
of this tool with a brief rationale.
Also, in the Observation row, list the information you would hope to obtain, practice
model and rationale. In the Interview role, identify if your interview would be
informal vs structured/standardized (such as the COPM), what information you
would hope to obtain, the practice model, and rationale for your choice.
Strategy/Assess Information you would Practice Model & Rationale

ment Tool hope to obtain
Observation - Underlying causes of - PEO- Factors contributing
Marias food habits to Marias
- Aspects of Marias unsatisfactory
environment that occupational
could be altered to performance are
fit her occupational complex. Her personal
needs factors, environment
- Marias personal both physical and social,
factors that prevent and occupational
her from optimal demands placed on her
occupational all must be considered
performance in a when formulating an
given task intervention aimed at
- Occupations she maximizing her
excels at and ones occupational
she has trouble with performance.
- Where she seems to - Developmental Theory-
be at developmental theory
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developmentally in a provides developmental

given area, i.e. play, markers in many areas
communication, of occupation. When
feeding, etc. Marias specific markers
are identified, it provides
the therapist with
information on what the
next step is and how to
move forward.
- Sensory Integration-
looking for known
behaviors indicating a
childs sensory
processing profile can
help to identify
underlying issues that
impact occupational
performance.
Interview- Information on areas of -PEO- PEO centers on bringing
Type/Tool: COPM, occupation in which Maria person, environment, and
Structured seems dissatisfied or her occupation into congruence
mother is dissatisfied. when a person is dissatisfied
Which factors play into with their occupational
Marias occupational performance.
performance.
Assessment #1: Information about Marias Developmental Theory- In order
PEDI overall functioning in to formulate an appropriate
general areas such as intervention for Maria, I need to
functional skills (including know in which areas she is
eating and getting developmentally behind (if
dressed), social any). With baseline
participation, and information, I can successfully
functional mobility. It will begin moving her through the
also tell me how developmental sequence to
independent Maria is in hopefully achieve development
these areas in her day to in all areas that is appropriate
day life. PEDI can also for her age. This will help her
provide a framework for engage in occupations in an
providing developmentally age appropriate way.
appropriate goals in these
areas.
Assessment #2: Information about Marias Sensory Integration-Some
SPM-P sensory functioning, as behaviors arent based on a
well as areas her sensory developmental sequence, but
processing may be rather on the sensory needs of
effecting her day to day the child. If Maria is mostly
occupations. Im most experiencing non adaptive
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interested in the social responses, we need to help her

participation, touch, visual, to have sensory experiencing
taste and smell, and body which are organizing and will
awareness sections of the increase her adaptiveness. We
test. However, Id get want to identifying and target
valuable information from underlying sensory modulation
all sections on the issues rather than specific
underlying deficits in her behaviors or train narrowly on
sensory system. specific skills.
4. Evaluation
In addition to previous information provided in the case study, you know have the
following pieces of information from your evaluation.
Mom reports that Maria rarely smiles or makes eye contact

Maria has a limited diet. She really likes Spaghettios and Cheerios. She will
only drink apple juice from a box using a straw.
Maria gets upset with changes in her routine such as when theres a holiday
and she doesnt attend school.
She wears the same hat everyday and goes crazy if the hat is removed.
She becomes very upset when its time to change into pajamas at the end of
the day and cries during teeth brushing.
Maria does not take turns with you when you attempt to engage her in a
simple game, even with verbal prompts. She lies down on her side halfway
through the game.
When asked what color shirt she is wearing, she repeats shirt. When told its
purpose, she says purple.
Maria eventually gets up and walks around the room, touching table tops and
different pieces of therapy equipment. She trips easily over toys and
thresholds.
She finds the sand table and picks up sand, then letting it sift through her
fingers. She uses her hands to fill the bucket with sand, empties it, then
repeats this several times.
When other children in the clinic join her at the sand table, she doesnt seem
aware of them.
When it is time to transition from the sand table after 15 minutes, she
requires several verbal prompts and physical cues.
You had Marias mother complete the functional performance section of the PEDI.
Domain Raw Score Standard Score Scaled Score
Self-Care < 10 <10 51
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Mobility 54 34.4 64.6
Social Function 29 <10 47.9
Self-Care (caregiver assist) 16 13.7 37.8
Mobility (caregiver assist) 30 35.2 51.4
Social Function (caregiver assist) 4 <10 14.7
In addition, you asked Marias mother to complete the Sensory Processing Measure-
Preschool Home Form.
Preschool Home Form

Interpretive Range
Raw Typical Some Definite
Score Problems Dysfunction
Social 24/32 x
Participation
Vision 17/44 x
Hearing 19/36 x
Touch 37/56 x
Body 24/36 x
Awareness
Balance and 24/44 x
Motion
Planning 18/36 x
and Ideas
Total 121/23 x
2
With all of this information in mind, write 1-2 brief paragraphs summarizing your
occupational profile and analysis of occupational performance for Maria:
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Maria is a 4-year-old girl with autism spectrum disorder. She was born full term but
her mother reports that she was a fussy baby. She received a referral for
occupational therapy due to her teachers concerns with her repetitive behaviors
with toys, lack of social engagement, slow academic progress, as well as her
mothers concerns with her limited diet and trouble sleeping. She also shows signs
of a language delay and insists on certain clothing items such as a specific hat.
Maria was observed tripping over objects which can indicate a lack of body
awareness. She enjoys stacking blocks, lining up objects, watching television, and
sensory stimulation such as running sand through her fingers. Spanish is spoken in
the home.
Based on initial assessment, Maria is behind her peers in all areas of functioning
measured by the PEDI. She is most behind in self care and social function, where
she is below the 10th percentile when compared to her peers. This indicates a
significant issue in performing things like getting dressed, eating, and playing with
friends in her everyday life. Marias food refusal, problems with social participation,
clumsiness, and intense interest in sensory experiences indicate dysfunction with
her sensory processing systems. This is indicated by her scores of definite
dysfunction in social participation, touch, body awareness, and balance and motion
on the Sensory Processing Measure-Preschool assessment. This means that Maria is
so focused on either getting the sensory input she craves in these areas, or avoiding
sensations that are uncomfortable to her, that it is affecting her ability to function
socially and get through her daily routine. Through occupational therapy, Maria will
improve her occupational performance in feeding and play, and improve social
participation with family and peers.
a) From the evaluation information you gathered, identify two specific areas of
occupation that Maria is having difficulties with. From those two
occupations, identify two activity demands, two personal factors, and two
possible contextual factors that may limit Marias participation in home,
school, community, and/or vocationally related activities. Be specific and
relate information provided to you in case study to the categories you select
(i.e. Client factors: Specific mental functions-Child demonstrates decreased
attention to tasks during tabletop activities.)
Potential Limitations or Barriers

Occupations Occupation #1 Occupation #2
Social participation- Sleep preparation (Dressing
Family for bed)
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Client Factors (Table 2 Sensory Functions- touch

of OTPF) functions- Marias Sensory functions- touch
tendency to crave only functions- Maria may prefer
certain types of touch, the feeling of being dressed
such as running sand which contributes to her
through fingers rather unwillingness to change
than something like hugs, clothes.
affects her ability to
interact socially with her Experience of self and time-
family. Maria may not understand
the need for her evening
Voice and speech routine and feel confused or
functions- Marias sad at the natural routine of
inability to express getting ready for bed then
emotions limits her ability going to sleep.
to interact with them
positively
Performance Skills Sequences- Maria does not
(Table 3 of OTPF) Attends- Maria doesnt perform the steps for
attend to social tasks dressing and may not
such as playing games understand the order.
Approaches/starts- Maria Benefits- Maria changes

does not start social clothes daily but does not
interactions with family benefit from repeating the
members steps or improve her
performance.
Performance Patterns Habit- Marias habit of not Routine- fighting about

(Table 4 of OTPF) providing any verbal cues changing into pajamas has
or interaction for her become part of the bedtime
needs impedes her ability routine. This makes it more
to interact meaningfully difficult to alter this
with her family. interaction.
Routine- Many of Marias Role- Marias role as a child

routines are based around with autism may make her
her sensory needs and family feel as though her
are solitary activities like maladaptive behavior around
lining up cars or playing these everyday tasks is
with textures. This impossible to change or a
detracts from engaging in lost cause reducing the
routines involving family. redirection or guidance she
receives during refusing to
change for bed.
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Contextual/Environme Cultural- Marias Hispanic Cultural- Marias Hispanic

ntal Factors (Table 5 culture may leave a lot of culture may make her mother
of OTPF) child rearing more inclined to perform
responsibilities on her tasks like dressing for her
mother, making it even rather than working together
more difficult for her to find a solution more
father to connect and agreeable for Maria.
have a relationship with
her. Personal- Maria as a 4-year-
old girl may want to find
Social- because her ways to assert her
family speaks mainly independence as is
Spanish, Maria may have developmentally appropriate
difficulty addressing for her age. This may result in
social participation in total obstinance when it is
English with the therapist. time to dress for bed.
Activity Demands Relevance and Relevance and importance to

(Table 7 of OTPF) importance to client- it client- Maria does not hold
appears that social any importance for dressing
participation with family for bed, which is one reason
is not important to Maria, therapy will be difficult for
or at the least she is too this occupation.
involved with her sensory
seeking behavior to make Required actions and
social participation a high performance skills- with
priority. Marias low body awareness
and vestibular dysfunction,
Required actions and its possible that she cannot
performance skills- or is afraid to perform some
responds- Maria doesnt of the actions in the dressing
always respond to her task i.e. pulling shirt over her
name or when her head, standing on one food to
parents are talking, which don pants etc.
inhibits social interaction.
b) From the evaluation information you gathered, identify two specific areas of
occupation that are strengths for Maria. From those two occupations,
identify two activity demands, two personal factors, and two possible
contextual factors that may support Marias participation in home, school,
community, and/or vocationally related activities. Be specific and relate
information provided to you in case study to the categories you select (i.e.
Client factors: Specific mental functions-Child demonstrates decreased
attention to tasks during tabletop activities.)
Potential Strengths or Supports
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Occupations Formal Education Play participation

participation
Client Factors (Table 2 Memory- Maria Values- Maria values her

of OTPF) remembers and is current play routines which
comforted by her daily enables her to engage in
routines from school, them.
which facilitates better
occupational Attention- Maria can attend to
performance overall as tasks she enjoys, such as play
long as the routine is in activities she prefers, very
place. well. Through these tasks she
demonstrates that she is
Vision- Since Marias capable of attending to tasks.
vision was rated as
normal, this is likely her
best modality to
understand information
at school. This is a
strength that will enable
her to learn new material.
Performance Skills Heeds- through Attends- Marias ability to stay

(Table 3 of OTPF) repetition, Maria knows focused on preferred tasks
what to expect demonstrates her ability to
throughout the school attend, which is a strength.
day even though she
doesnt set the schedule. Endures- Maria will sit and
She heeds the line up cars for a long time
dictations of her teacher. with no apparent signs of
fatigue. This may
Walks- Marias ability to demonstrate great endurance
walk enables her to full for the postures and skills this
participate in the task utilizes.
classroom and potentially
practice the skill of
navigating.
Performance Patterns Routines- Marias play
(Table 4 of OTPF) Routines- Marias school routines seem to calm her
routines are very much a and allow her to find joy in
strength to her as her something by herself.
occupational
performance on days she Roles- Marias role as a 4 year
does not go to school old in the household is a
suffers. support for her to be assisted
in engaging in play by her
Roles- Marias role of mother or even her sister.
17
student opens up
opportunities to learn and
interact with peers
beyond what she would
have at home.
Contextual/Environme Temporal context- Maria Physical environment- Maria

ntal Factors (Table 5 goes to school most days lives in a safe apartment
of OTPF) and associates different where she is free to
tasks with different times. participate in play as she
These associations help chooses.
her make sense of her
world. Temporal context- Maria has
free time during her day to
Virtual- Marias school engage in preferred activities.
may use computers or
tablets, introducing her to
a new mode of learning
and possibly
communication with
teachers.
Activity Demands Relevance and Objects used and their
(Table 7 of OTPF) importance to client- properties- Maria plays with
Maria values her school objects that are meant as
routines and toys, which lays good ground
demonstrates better work to improve her play
emotional regulation on even more in the course of
days she attends. therapy.
Space Demands- Marias Required actions and

school is has adequate performance skills- because
space for her needs to Maria chooses what play
learn and grow. activities to participate in, she
chooses activities that match
her performance skills.
b) Projected Outcomes
Identify and describe appropriate projected outcomes (Table 9) based on familys
priorities, occupational profile, evaluation, and analysis of occupational
performance. Only identify those pertinent to the case.
Occupation Preventio Health & Quality of Participati Well-

al n Wellness Life on being
18
Performanc
e
Occupation Marias
al participati
performanc on in
e these
improveme occupatio
nt in ns,
Dressing, especially
Eating, social
Social participati
Participation on, formal
with family education,
and peers, and play
Formal participati
education, on will
Play enable her
Participation to fulfill
, and play her roles
exploration. as
Improveme daughter,
nt in these sister,
areas is friend, and
desirable as student.
Maria is
currently
experiencin
g decreased
performanc
e in these
areas due
to her
autism.
5. Intervention Process: Developing the Treatment Plan
a) Based on evaluation information, list three priority intervention/goal areas for

Maria.
1.Social Participation with family
2. Sleep preparation
19
3. Play exploration
b) Selecting one of your priority intervention/goal areas for Maria listed above,
write one long term goal and two supporting short term goals for Maria. Be
sure goals are in SMART/COAST format.
Annual Long Term Goal 1: In one year, Maria will independently take turns
for a minimum of 10 minutes during a game with her mother 4/5
opportunities.
o Short Term Goal 1: In 4 months, Maria will independently tolerate

her mother joining her in a play activity or game for 5 minutes in
3/4 opportunities to improve social participation with family.
o Short Term Goal 2: In 6 months, Maria will independently display

joint attention at home with her mother for 5 minutes during a play
activity requiring acknowledgement of the play partner during 4/5
opportunities.
c) Identify the practice models that you will utilize to guide intervention and
activity selection in order to accomplish your established goals. These may or
may not be the same as the practice models you selected to guide your
evaluation
Review your choice of an organizing practice model (PEO, MOHO, OA, EHP,
Lifestyle Balance). Is it still a good choice to guide intervention for your
client? (If not revise your choice) Justify and provide a rationale for your
choice with research/readings support your choice for this child. (see below)
Choose at least 2 (two) complementary OT models that will help guide you in
the overall intervention process. Be specific. List only those most pertinent.
Justify and provide a rationale for each one with research/readings support
your choice for this child. (See below)
Scientific Reasoning and Evidence: What researched evidence is available to
help you with your evaluation and/or treatment process? Give references to
readings or research.
Practice Rationale:
Models Briefly Describe the practice model Explain how these models address
and postulates for change. Describe the goals and overall outcomes you
how postulates of change are identified for this child. **Use
relevant to child/family. research articles to support your
rationale.
Organizing: PEO- The family is experiencing difficulty Maria is experiencing non congruence in
in helping Maria attain maximum the areas of ADLs, social interactions,
occupational performance due to her and age appropriate play. In order to
personal factors not meeting up with the increase her occupational performance in
20
environment and the occupation these areas, there are personal factors
demands of family life. PEO gives that can be addressed, such as Marias
perspective on how to address all of sensory tolerances for activities,
these factors and bring them into environmental factors, such as Marias
congruence. mothers interactions with her or the
physical environment distracting her,
and ways that we can modify the
occupation to work for Maria, such as
using a different kind of toothbrush or
starting and evening routine earlier. One
article noted a trend toward in OT to
focus only on sensory issues with ASD
and emphasized the need to address
person, environment, and occupation
together and use sensory integration as
one tool in the comprehensive
intervention plan
Rodger, S., Ashburner, J., Cartmill, L., &
Bourke-Taylor, H. (2010). Helping
children with autism spectrum
disorders and their families: Are we
losing our occupation-centred focus?
Austrailian Journal of Occupational
Therapy 57(4) pp 276-280.
http://doi.org/10.1111/j.1440-
1630.2010.00877.x
Complement Social participation- Maria and her family One qualitative study identified the
ary #1: have found it difficult to attain crucial role Latino mothers play in
meaningful and positive social structuring routines and obtaining
interactions with one another. As the services for their children with
therapist assists Marias parents in autism, as well as the mothers
engaging in positive pleasurable primary role of caregiver for the
activities in the daily and weekly child.
routines that enhances and enriches Blanche, E. I., Diaz, J., Barretto, T.,
their relationship, Maria will be more Cermak, S. A. (2015). Caregiving
able to evaluate her social reactions and experiences of latino families with
more readily engage is aspects of children with autism spectrum
everyday family life. disorder. American Journal of
Occupational Therapy, 69(5),
6905185010p1.
http://doi.org/10.5014/ajot.2015.017
848
21
Another study identified correct parent

training and naturalistic settings as
crucial variables in language acquisition,
one of many components to social
participation in children with autism
.These findings indicate appropriate use
of the social participation model for
Maria, which stresses parent child
relationship, parental coaching and
modeling by clinician, and a family
centered approach.
Kaiser, A. P., Hancock, T. B., & Nietfeld, J.
P. (2000).
The effects of parent-implemented
enhanced
milieu teaching on the social
communication
of children who have autism. Early
Education
& Development, 11(4), 423446.
http://doi.org/10.1207/s15566935eed110
4_4
Complement Sensory Integration- Because Maria Sensory integration is a common
ary #2: needs an optimum state of arousal in approach for children with ASD, and
order for adaptive responses to occur, researchers are currently interested in
her sensory needs need to be accounted the effectiveness of combining sensory
for as part of the larger organizing interventions with social participation
model. If intervention is directed at the interventions for individuals with autism
underlying sensory deficits rather than Charney, L., McLaughlin, E., Maas, K.,
Marias behavior responses, well see Makadon-Malone, D., Zaklukiewicz,
better outcomes in her occupational C., & Zeitler, L. (2016). Linking
performance overall at home. Right now, sensory strategies & social skills
her sensory processing style is causing training to improve the social
stress and frustration for the family participation of children with autism.
overall, as well as holding Maria back Retrieved from
from social development. Wed like to http://programme.exordo.com/cotec-
obtain better outcomes through sensory enothe2016/delegates/presentation/
based interventions for Maria. Note: SI 109/
incorporates addressing a childs sensory
needs at the childs current Sensory differences among people with
developmental level. Some aspects of ASD are well documented. Many
developmental theory may still be comprehensive interventions integrate
relevant to therapy. sensory components (Baranek, 2002).
See attached file
Sensory integration interventions have
been found to be effective for children
22
with autism in small the small sample

sizes that have been studied (Baranek,
2002). Since Maria has documented
sensory deficits, using clinic based
sensory treatment would be appropriate.
d) Service Delivery:
What type(s) of services do you anticipate will best meet Marias needs?
Consider the practice setting. (Direct/Consult/Collaboration/Co-treat, etc.)
Type(s) of service Rationale:

Direct Services Marias mother is seeking additional services at an
outpatient clinic, seeking additional services to fit
Marias needs. Direct services gives both Maria and
her family the tools they need to achieve the
occupational outcomes desired.
As therapy continues, parent may assume a more
Coaching/modeling active role during social participation aspects of
individual sessions, and therapist will give feedback
and guide interactions between parent and child.
This will provide good framework to have carryover
at home.
What setting(s) will the services take place (be sure to consider all of the
information from the case so far)? Outpatient occupational therapy clinic.
Maria has likely aged out of early intervention (in Utah it only is up to 3
years) and likely has some services through her developmental preschool.
These additional services will be at our clinic and billed through Medicaid.
Home evaluation would also be beneficial as part of our treatment.
What is frequency & length of services? Maria will be seen 1x per week for
1 hour, until she achieves functional participation in all areas or no longer
demonstrates progress overall. We will reapply for services through
Medicaid as needed so long as we continue to demonstrate progress.
6. Implement the Plan

a) Treatment Sessions: Plan your first two 60-minute treatment sessions.
23
Treatment Session #1:

What goal are you addressing? STG 1: tolerating mother during play
activity, LTG 1 (broadly)
Intervention Description (Be very specific. Indicate that you understand

how the postulates of change from your chosen practice models will
bring about change in the client during your session, as well as what
your role as the OT is during the session. In other words, how is this a
skilled service?): First, wed start out talking with mom about how things have
been going this last week, and perhaps discuss some of the results of Marias
evaluation if we have not done that already. Id also explain to mom that I will
take Maria for therapy on my own for the first part of the session, and then she
will join us after the warm up activity. Maria would start therapy with a stimulating
sensory activity to give her body the input it needs to focus later on in the
session. Maria would lay on the flat swing in prone, and we would swing and throw
bean bags into rings on the ground. This gives her proprioceptive and vestibular
input. We could also add a weighted blanket for some deep pressure
proprioceptive input. Multiple inputs are required for optimum arousal.
Next, we would move into a quieter room and Id ask mom to come with us during
the transition, and instruct her to watch and notice things Maria is doing. Id allow
Maria to choose some fine motor toys to work with. Its important that the
occupation is comfortable for Maria, because the work today will primarily focus
on changing her personal factors to tolerate more social interaction in her
environment. Were going to assume that she selects small blocks.
While Maria is playing, Id explain to mom that our goal is for Maria to first
tolerate others playing with the same toys she is, and then ultimately to take
turns with others and acknowledge others who are playing with her. Since Mom is
Marias primary caregiver, its crucial that she understands our therapy and can
use the same concepts at home. This will help Maria gain consistency in the social
situations she encounters and engaging in play together as part of their daily
routine will strengthen the bond between Maria and her mother.
After talking to her mother, I sit down next to Maria and find a way to be involved
in her play. If she is stacking blocks vertically, I stack one on top. I may use some
blocks close to Maria for a tower of my own. I am sure to position Marias mother
in a place where she can see the interaction, especially since she may not have
understood everything I said as English is her second language. I will gage
Marias reaction. Does she allow me to take blocks? Does she become upset if I
put a block on top of her tower? If not, I may talk to Maria during our play time,
but not expecting a reply. Things like that tower is very tall Maria! or can I put
one here? etc. This is modeling appropriate interaction for both Maria and her
mother.
We will play for about 15 min, and then take a sensory break. If Maria seems
upset, we will do something calming like bouncing on the yoga ball or swinging in
24
the hug swing, providing repetitive vestibular and proprioceptive input. If she
seems bored or unengaged, well do something more arousing like playing in the
ball pit or pushing a heavy load on the scooter board. This will be for 5-10 min.
Next, I will allow Maria to pick a new activity, perhaps with a sensory component,
but not the sand table or something that she focuses on so intensely as to make
attending to therapy even more difficult. She chooses the beans container with
toys hidden with the beans. I work with her for the first five minutes, focusing on
her allowing me to sit by her and also go through the beans. I will also show her
that Im looking for and playing with the toys.
After 5 minutes, Ill invite Marias mother to take my place next to Maria while I
stay close to mom. This allows her mother to practice the techniques I used with
Maria. I will give feedback to Marias mother as appropriate, stressing the goal is
to find a way to enter Marias play rather than forcing eye contact or directing
Marias play habits. Marias mother should focus on fostering enjoyable
interactions with Maria every day as this will be the main mechanism of change
that affects Marias social reactions.
Then, it would be time for our cool down activity, which would be based on
Marias sensory needs. I would likely incorporate heavy work with bean bags,
either for Maria to stack or if she would allow us to place them on her back while
she lays down. She could also fill buckets with bean bags and carry them around.
Marias mother and I would synthesize the therapy session, and Id give her a
handout on the importance of play for kids with autism, preferably in Spanish to
try and bridge that communication gap between us. Id let her know that I want
her to go home and try these things with Maria, then report to me how it went.
Setting Activity Demands Anticipated outcome

(what skills you hope
to see change in based
on your session):
Relevance and Improving
OT clinic importance to client- occupational
Many of the activities performance in social
for this session will participation with
be preferred tasks for family
Maria that will be
slightly altered to Improving
introduce something occupational
non preferred: performance in play
socialization. exploration
25
Objects used- blocks, Improving

beans bin, flat swing, participation in family
hug swing, roles
Space Demands- Improving

Room with table, participation in play
large area and
bearing for swings.
Social Demands-
tolerating someone
playing with her her
play items
Sequencing and
timing: 1. Stacking
blocks task,
repetitive. 2. Swing
on swing or other
repetitive sensory
activity. 3. Play with
beans, likely in a
repetitive way. 4.
Sensory cool down,
repetitive heavy work
task.
Reqd performance
skills and actions:
expresses emotion,
regulates, transitions,
accommodates,
benefits.
Intervention Approach (Table 8 of Intervention Type (Table 6 of

OTPF): Establish/Restore, Modify OTPF): Preparatory tasks,
Occupations and activities,
Education and training (for mom).
Practice Model(s):
PEO, Sensory Integration, PEO, Social Participation.
Rationale & evidentiary support for use of interventions/activities:
The mechanism for change in PEO is to bring the persons attributes, the
26
environment, and the occupational demands together in a way that

promotes congruence and occupational performance. This intervention
incorporates sensory integration, as Marias system must be exposed to
adaptive and organizing input in order to elicit adaptive responses in
many occupational situations including social participation. Sensory
integration is an example of using the environment to bring about
change in the person. For the social participation sections of the
intervention, we are creating an environmental support in Marias
mother, as well as increasing the demands of Marias preferred play
occupations to include a social component. It would be unwise to
introduce these challenging social demands to Maria during a task that
also challenged her in terms of motor skills or her sensory processing.
That approach would not bring the three PEO rings into congruence, but
instead further apart. Change occurs in the social participation model as
parent and child make no pressure, enjoyable social interactions part of
their everyday routine, and therapist modeling is the crucial piece in
establishing those routines. These situations serve to teach Maria how
to control her emotions and tolerate more and more social interaction.
(Charney et al., 2016) (Baranek, 2002) (Kaiser et al., 2000) (Blanche et al., 2015)
(Rodger, Ashburner, Cartmill, & Bourke-Taylor, 2010)
Treatment Session #2:

What goal are you addressing: Annual Long Term Goal 1: In one
year, Maria will independently take turns for a minimum of 10 minutes
during a game with her mother 4/5 opportunities.
o Short Term Goal 1: In 4 months, Maria will independently tolerate

her mother joining her in a play activity or game for 5 minutes in
3/4 opportunities to improve social participation with family.
o Short Term Goal 2: In 6 months, Maria will independently display

joint attention at home with her mother for 5 minutes during a
play activity requiring acknowledgement of the play partner
during 4/5 opportunities.
o
Intervention Description (Be very specific. Indicate that you understand
how the postulates of change from your practice models will bring about
change in the client during your session, as well as what your role as the
OT is during the session. In other words, how is this a skilled service?):
First, Marias mother and I will discuss how this last week went at home.
Was she able to play next to Maria without Maria getting upset or
leaving the area? How long? If she is comfortable, I may ask her to act
27
out or demonstrate what she did at home, just to make sure I

understand with our language barrier. Next, we will do a sensory warm
up activity, based on what Maria seemed to prefer last session and what
appeared to calm her and prepare her for therapy best. Sensory
integration is child directed as Maria is the person who knows best what
her sensory systems needs. We also want to guide her into performing
the swinging or heavy work or deep pressure exercises more
independently as part of this child directed principle. So, if we start with
the plank swing again, I want to to position her in a way where she can
push with her own feet, or show her to use her body weight to rock it
back and forth. Maybe we would try a weighted vest today if she
responded well to deep pressure and encourage her to try and put it on
herself.
Next, wed again move into a different room with fine motor toys, and
let Maria pick something to play with, but not have the blocks from last
week be available. If she doesnt pick something independently, Id get
two choices down, perhaps jenga blocks and tinker toys and encourage
her to pick from these. Im assuming she will choose jenga blocks. At
this point, Id let Marias mother know that Id like her to play with Maria
and I will watch for a few minutes and give feedback. I want to see
Marias mother talking to Maria, not in a directive way but just
commenting on the play, as a demonstrated in the first session. I will
also watch to make sure Marias mother is making efforts to interact
with Marias play environment, such as taking a block within Marias line
of sight, adding a block to Marias vertical train, or even stacking a block
vertically even if that is not what Maria seems to be doing. I would give
Marias mother feedback after a few minutes, first telling her all the
things shes doing right, then giving suggestions on ways should could
elicit more interaction from Maria, or maybe explaining the methods Im
presenting work even though they seem like such small changes. I would
also be monitoring Maria for any signs of agitation or distress, indicating
that shes reached her tolerance for this activity before she is angry or
crying. After stepping back for the first portion, I would sit next to
Marias mother and give her feedback or suggestions on how to play
with Maria in real time. Then after several minutes of this, based on
Marias affect and needs, we would take a sensory break.
Today, I would be looking to reduce the amount of time Maria needs to

feel organized and calm by these breaks, so I would be timing in order to
establish a baseline to measure from, in order to provide evidence that
these sensory experiences are helping her system produce more
adaptive responses to sensory stimuli. I would also be looking to see if
Marias demeanor during challenging social tasks was calmed by her
wearing the weighted vest, which we would be taking off during this
break. Again, the type of activity we engage in will be based on her
needs, ie playing in the ball pit to promote arousal, hug swing for
28
calming, laying in prone on scooter board and pushing with hands for
heavy work to promote organization of the sensory system, etc.
Next, Im going to take the lead and introduce an activity that will
require Maria to interact with me in order to complete it. I will tell
Marias mother to watch Maria and I and let her know Im aiming to set
up this situation in a way to push Maria to interact with me during the
task. We will have a marble run to bring out for this session, and several
marbles. I will show Maria how the marble run works, and well continue
with the activity if she seems interested. If not, the key is an activity
that has small pieces required to perform the task. Then, I will give
Maria the marbles and help her put them at the top of the run if she
needs help. As a marble reaches the bottom of the run, I will take it and
use it for my turn. I will alternate taking marbles at the bottom with
Maria, until gradually I will take two in a row, then three in a row etc.
until I have all the marbles. I will continue to use the marble run and see
what Marias reaction is (later, I ll explain to her mother that the goal
isnt to antagonize Maria, it is to get her to indicate to me that she
would like a turn or wants a marble from me). If Maria is upset, I can
model social behavior to her Oh, would you like a turn Maria? Hold out
your hand and Ill give you a marble! or something similar and see if
she will comply. If she isnt upset and just sits there, I may give another
verbal cue like I have the marbles Maria. Do you want want one? and
see what she does. If nothing, then Ill ask her to hold out her hand. I
will try to be on her level to facilitate eye contact, and be sitting side by
side. When she receives one marble, I will see if she will indicate
wanting another marble unprompted. This interaction is the first step to
acknowledging and attending to another person for joint attention
during play. My affect will be open and playful, something I will explain
to Marias mother for when she tries this type of interaction at home
this week. If Maria is very upset by this type of interaction, she may not
be ready yet for this step and I will have her mother continue to just
work on having Maria tolerating someone entering her play. When
instructing for homework this week, I may have Marias mother role play
with me being Maria during the explanation, again so I can make sure
she understands the goal of the interaction and her role in achieving
positive social participation with her daughter.
Finally, we would do one more sensory activity as a cool down. If it isnt

distressing to Maria, I may encourage her help me put the marbles back
in the bag, and then carry the bag around as part of helping cleaning
up. If not that, perhaps we could engage in a tactile activity like the
sand table, putting the sand in a bucket and dumping it out also
incorporates heavy work. This particular activity would not be advisable
however if Maria has trouble transitioning away from the clinic.
29
Setting Activity Demands: Anticipated outcome

(what skills you hope
to see change in based
on your session):
Improving
OT clinic Relative importance occupational
to client: Many of the performance in social
activities for this participation with
session will be family
preferred tasks for
Maria that will be Improving
slightly altered to occupational
introduce something performance in play
non preferred: exploration
socialization.
Objects used: jenga Improving
blocks, swings, ball participation in family
pit, marble run and roles
marbles, weighted
vest, Improving
Space Demands: play participation in play
gym, fine motor
room,
Social Demands:
tolerating someone
playing with her play
items, indicating
appropriately to
another person a
desire for a specific
item.
Sequencing and
timing: repetitive,
stacking blocks,
taking sensory break,
for calming input,
putting marbles into
run,
Required actions and
performance skills:
gesticulates, Turns
toward, looks,
regulates, expresses
emotion, transitions,
accommodates,
30
benefits.
Required body
functions and
structures: emotional
functions, sensory
functions, muscle
functions,
Intervention Approach (Table 8 of Intervention Type (Table 9 of

OTPF): Establish/Restore, Modify OTPF): Preparatory tasks,
Occupations and activities,
Education and training (for mom).
Practice Model(s): PEO, Sensory Processing, Social Participation
Rationale & evidentiary Support: The mechanism for change in PEO is to

bring the persons attributes, the environment, and the occupational
demands together in a way that promotes congruence and occupational
performance. This intervention incorporates sensory integration, as
Marias system must be exposed to adaptive and organizing input in
order to elicit adaptive responses in many occupational situations
including social participation. Sensory integration is an example of using
the environment to bring about change in the person. For the social
participation sections of the intervention, we are creating an
environmental support in Marias mother, as well as increasing the
demands of Marias preferred play occupations to include a social
component. It would be unwise to introduce these challenging social
demands to Maria during a task that also challenged her in terms of
motor skills or her sensory processing. That approach would not bring
the three PEO rings into congruence, but instead further apart. Change
occurs in the social participation model as parent and child make no
pressure, enjoyable social interactions part of their everyday routine,
and therapist modeling is the crucial piece in establishing those
routines. These situations serve to teach Maria how to control her
emotions and tolerate more and more social interaction.
During this session we grade up by aiming for less time during sensory
breaks and also by introducing the idea to Maria of interacting with
another person during play. By modeling these things to Marias mother,
we ensure that concepts are built upon at home as well as at the clinic.
The sensory breaks enable Maria to emotionally regulate, which in turn
allows her to perhaps evaluate her reaction to social situations before
responding. (Charney et al., 2016) (Baranek, 2002) (Kaiser, Hancock, & Nietfeld,
2000) (Blanche et al., 2015) (Rodger, Ashburner, Cartmill, & Bourke-Taylor, 2010)
31
7. Review the Plan
a. Explain how & I will also be examining objective data of each session
when you will to ensure that Maria is demonstrating progress, and/or if
review/re-evaluate I need to frame goals or objectives differently in her
your plan. treatment.
b. Modifications to I will be analyzing our plan during every session, and

plan (Are they may change approaches in real time based on Marias
needed? How do you needs, feedback, skills, and ability to complete sessions
implement them?) as theyve been presented. I will also know
modifications are needed if 1. Maria either shows an
incredible amount of progress in a short time or doesnt
show any progress 2. Her mother indicates to me that
the homework required is beyond either Marias or the
familys capability 3. She flat out tells me she wants to
work on something else or modify this goal in some way.
While Marias mother doesnt dictate the nature of the
service I provide, its important for her to be able to
collaborate with me to help Maria achieve things that
will be functional for their entire family.
c. Continuation/DC
from Services Maria will receive skilled occupational therapy services
until she achieves functional participation at an age
appropriate level in all areas addressed in therapy or no
longer demonstrates progress overall.
32

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OCTH 6140 - Integrative Case Study #2 Name: _Whitney

This assignment involves synthesizing or integrating the information from OTCH

1. Autism Spectrum Disorder- It is not uncommon for autism to accompany a

2. Obsessive Compulsive Disorder- OCD in children can be characterized by the

Diagnosis: Autism Spectrum Disorder

List four specific occupations that may be affected for Maria:

1. Activities of Daily Living- Eating_________________________

2. _Rest and Sleep- Sleep participation_____________________

3. _Play- Play Exploration_________________________________

4. _Social Participation- peer/friend_________________________

c) Based on childhood development, what performance tasks would you

Area of Occupation Developmental Expectation

Activities of Daily Living Child can bathe self with minimal to

in feeding pets or letting a pet outside. Can

group, preschool class, etc at community

2. Preparation for Evaluation

Risk Factor or Deficit Discuss the barriers to

eating and toileting routines,

Impact on Marias occupational performance

Impact of occupational performance problems on family

Risk #2 food and environmental allergies_____________

Impact on Marias occupational performance

Impact of occupational performance problems on family

Occupation Client Performanc Performanc Context &

ADLs Values Motor Skills Habits Cultural

Education Body Process Physical

Leisure Body Social Roles Temporal

a) Practice Models Guiding your Evaluation & Assessment

Practice Brief description of the How this practice model

Complementa Developmental Theory- I would consider the

a childs adaptive responses possess adaptive responses to

b) Obtaining Occupational Profile

2. What are Marias interests and strengths?

3. Walk me through a typical day with Maria.

List 4 occupational performance tasks that you would want to observe/analyze

Identify 1 or 2 appropriate assessment tools or strategies you would use to evaluate

Strategy/Assess Information you would Practice Model & Rationale

developmentally in a provides developmental

interested in the social responses, we need to help her

Mom reports that Maria rarely smiles or makes eye contact

Domain Raw Score Standard Score Scaled Score

Self-Care < 10 <10 51

Mobility 54 34.4 64.6

Social Function 29 <10 47.9

Self-Care (caregiver assist) 16 13.7 37.8

Mobility (caregiver assist) 30 35.2 51.4

Social Function (caregiver assist) 4 <10 14.7

Preschool Home Form

Potential Limitations or Barriers

Client Factors (Table 2 Sensory Functions- touch

Approaches/starts- Maria Benefits- Maria changes

Performance Patterns Habit- Marias habit of not Routine- fighting about

Routine- Many of Marias Role- Marias role as a child

Contextual/Environme Cultural- Marias Hispanic Cultural- Marias Hispanic

Activity Demands Relevance and Relevance and importance to

Potential Strengths or Supports

Occupations Formal Education Play participation

Client Factors (Table 2 Memory- Maria Values- Maria values her

Performance Skills Heeds- through Attends- Marias ability to stay

Contextual/Environme Temporal context- Maria Physical environment- Maria

Space Demands- Marias Required actions and

Occupation Preventio Health & Quality of Participati Well-

5. Intervention Process: Developing the Treatment Plan