Sleep practice in occupational therapy: an educational program to improve sleep quality for autistic children
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Citation
Abstract
Sleep is a critical occupation that supports and promotes participation in occupational performance in all individuals (AOTA, 2014). It builds the foundation for cognitive development and supports learning in children (Ashworth et al., 2014; Schlieber & Han, 2018; Kurz et al., 2019). Children with poor sleep habits may exhibit dysregulation in their daytime activity level (Foitzik & Brown, 2018; Johnson et al., 2017). Consequently, sleep difficulties affect their academic performance and social participation at school (Taylor et al., 2012; Deliens & Peigneux, 2019). Sleep problems in autistic children are two to three times greater than in neurotypical children (Moore et al., 2017; Souders et al., 2017). Of further concern is that a significant increase in sleep problems in autistic children has been associated with the Covid-19 pandemic (Bruni et al., 2022).
Occupational therapy practitioners (OTPs) in schools recognize the importance of sleep as an essential building block for learning (Beisbier & Cahill, 2021; Gronski & Doherty, 2020) and specialize in assessing sensory behaviors using evidence-based assessments (Kirby et al., 2019; Schoen et al., 2018). However, due to a lack of sleep knowledge and resources, many school-based OTPs do not address sleep problems during the assessment and intervention process (Gentry & Loveland, 2013). Sensory assessments can help to detect atypical sleep patterns and inform a proactive approach to nurturing a healthy lifestyle (Tauman et al., 2017; Reynolds et al., 2012). OTPs are encouraged to provide sensory-informed sleep health education and consultation to support autistic children in school-based practice.
A literature review was completed based on current occupational therapy (OT) practice in sleep care. Several key findings suggested that (a) the teaching and clinical training in sleep health are lacking in formal OT educational programs, (b) teachers are unaware of OT scope of practice, and (c) most OTPs in school experience heavy caseloads and have time constraints which may hinder interdisciplinary collaboration and family partnership. Furthermore, research studies from OT, psychology, neuroscience, and education were identified and carefully reviewed to determine effective therapies that fall within the scope of OT practice. Through this doctoral work, an evidence-based educational program was developed for OTPs to fill this practice gap and address sleep difficulties in autistic children within the school setting.
Sleep Practice in Occupational Therapy (SPOT) is a research-informed program for OTPs who provide school-based services to autistic children in Hong Kong. The main objective of this program is to extend OT school-based practice in areas of sleep assessment, intervention, interprofessional collaboration, and family partnership within this student population. This four-week online educational course consists of mini-lectures on the neurobiological evidence in sleep in autistic children, multiple group discussions regarding sleep health education, and individual work projects to build competence in sleep assessment and intervention. Upon completion, OTP participants will be equipped with evidence-based sleep hygiene resources and sleep health educational presentation materials generated by the program author. Qualitative and quantitative data will be collected for program evaluation and to inform the efficacy of this OT-led sleep health education program in school settings. It is anticipated that the SPOT program will advance our professional service delivery and advocacy within schools and, ultimately, improve the academic learning and quality of life of autistic children. Furthermore, this training program is applicable to school-based OT practice in other geographic regions of the world that advocate for an inclusive approach to serving children with diverse sensory needs.