The RPRI-OT Program
A functionally-based retained reflex integration program utilizing the structure of the AccessOAP Core Clinical Services program, custom-developed and led by an Occupational Therapist.
This program is geared towards students age 4-14 on the Autism Spectrum who struggle greatly with self-regulation, sensory overwhelm, aggression, self-harm, are at risk of eloping, and/or are non-speaking or unreliably speaking, especially as these limit the student’s ability to:
- Participate in daily activities at home
- Participate in academics/schooling
- Progress in their current ABA program
- Be accepted into standard ABA/IBI programs
What are Retained Primitive Reflexes?
Everyone has primitive reflexes at birth. Normally, as we grow, these become ‘integrated’, in other words, we learn to make them dormant. When a child has not been able to integrate their primitive reflexes, they are called Retained Primitive Reflexes. This can happen for any number of reasons, and if the reflexes remain, they can interfere with fine motor development, learning, behaviours, sensory responses and create abnormal muscle movement patterns.
Retained Primitive Reflexes can often be seen in children on the Autism Spectrum Disorder (ASD). The signs vary depending on the Retained Primitive Reflex, and a student can have multiple Retained Primitive Reflexes active at the same time. Some of the most obvious signs can be poor balance, hand-eye coordination problems, speech delays, weak upper body and trunk, reluctance to staying seated, ‘toe-walkers’, eating challenges/food avoidance, ‘sensory-seekers’, and impulsivity, among many other signs.
Here are some examples of Retained Prmitive Reflexes and their impact in the school aged child:
The Effects of Trauma/Loss on the Nervous System
Retained Reflexes can also present themselves/re-emerge after having witnessed or experienced trauma/loss. In these instances, the child’s fight-or-flight impulses and startle reactions can be activated, and other behavioural signs can develop or increase dramatically. The RPRI-OT Program is specially designed for children on the Autism Spectrum Disorder who have experienced trauma and loss in the course of their young lives (witnesses or victims of aggression, experiences of loss when change-over in staff is frequent). These students often have the hallmark of an overactive flight-or-fight response (aggression, self-harm, running away), extreme reactions to changes in routine, sudden emotional overwhelm (‘meltdowns’), and intensified behavioural rigidity, among many other signs. In this instance, the focus of the program is that of healing. Healing of the nervous system, calming the nervous system, which allows the student to regain their confidence and improves their functional outcomes at school and at home.
The RPRI-OT Program Outline
- OT-supervised AccessOAP Core Clinical Services program
- Clinic-based program with OT and OTA-Therapist
- Direct Occupational Therapy intervention throughout the program
- The RPRI-OT program takes place during school hours
- Morning or afternoon sessions, 5 days a week
- Sessions vary in length, depending on level of need (1, 2 or 3-hour daily sessions)
- Supervised therapy programming with a 1-to-1 Student to OTA-Therapist ratio
- Functional goals are included throughout the program and can include both academic (reading/writing) and task-based (toothbrushing/zippers/buttons)
RPRI-OT Program Duration and Cost
There are no additional costs outside of a student’s approved AccessOAP funding.
Just as our Primitive Reflexes would naturally take 1+years to integrate during infant development, there is generally a 12 to 24+ month horizon for helping a student ‘integrate’ their Retained Reflexes (depending on severity), and a 6 to 8+ month horizon for helping a student with ASD heal from their trauma/loss. Students who have both trauma-induced re-activation and also Retained Reflexes likely require access to both treatment programs.
Students who are participating in augmentative communication therapies that are currently outside of AccessOAP funding (S2C, RPM) are likely to be able to have these program costs captured within their AccessOAP funding upon admission to the RPRI-OT Program; this is not an option under standard ABA-programming as it is outside the scope of BCBA.
The ultimate goal of the RPRI-OT program is for students to continue improving their skills and independence without the neurological barriers that had been blocking them. The students can return to traditional occupational therapy programming, sports/recreational activities, return to full-time academics, or resume traditional ABA programming, all with significantly higher chances of success.