Model of Human Occupation (MOHO) & Autism

Join Lynette and Rich as they explore an intervention model for Autism called The S.U.C.C.E.S.S. Approach (SM). The model is designed to help you understand, respond, and help those in your world who live a life with Autism. Our goal is to help expand your thinking to better serve these amazing people, and to support you in your daily struggles and celebrations.  In this episode we will define The S.U.C.C.E.S.S. Approach (SM), discuss the overall goals, and discuss the advantages of building a team for your loved ones.  In this episode, Lynette and Rich (and special guest Ellen Winney) discuss how the Model of Human Occupation (MOHO) applies to The S.U.C.C.E.S.S. Approach (SM) as one of the 7 theories and/or models.  It’s a fascinating episode that digs deeper into the profession of Occupational Therapy.  Don’t miss it!

If you or someone you know could benefit from the full training for The S.U.C.C.E.S.S. Approach (SM), you can take the course online.  Just go to https://www.thesuccessapproach.org/online-course for registration and other details.

The S.U.C.C.E.S.S. Approach is a registered Service Mark protected under intellectual property law unless otherwise specified, all music, audio visual, and proprietary content shared in this podcast is property of AWEtism Productions, LLC and it’s sister agency Integrations Treatment Center. The use of this content is unlawful without the expressed written consent of the proprietor.  

Transcript

CONNECT WITH S.U.C.C.E.S.S. Transcription

Podcast Episode #11: 

Model of Human Occupation (MOHO) & Autism

 Want to help your child and your whole family using The SUCCESS Approach? Check out our online course: https://www.thesuccessapproach.org/online-course

{INTRO MUSIC} 

LYNETTE: Welcome to connect with success with Dr. Lynette Scotese-Wojtila where we help connect you with knowledge. Our mission is to lead you to a new and exciting way of understanding, responding to, and helping all those with autism. We hope to expand your thinking about how to best serve these amazing people and to support you in your daily struggles and celebrations. 

RICH: Welcome everyone to the 11th episode of Connect with S.U.C.C.E.S.S., a podcast built around the S.U.C.C.E.S.S. Approach and the person who coined it, Dr. Lynette Scotese-Wojtila. Today we have a great episode for you. We’re going to be talking about the Model of Human Occupation, or what they all MOHO. Dr. Lynette, what is our term for this episode?

LYNETTE: So the term for today is “Occupation.”

RICH: Well, what is occupation?

LYNETTE: Occupation in most people’s mind is associated with a job for which somebody gets paid, right? But it is so much more than that as we’re going to learn today. When looking at occupation through the eyes of occupational therapy. In a nutshell, occupation has to do with the roles that people live up to, live out, or have on a daily basis that sort of “occupy” them each and every moment of each and every day. Many of those roles we don’t really consider to be occupations and as we talk more we’ll start to define some of those roles and see which really are traditionally occupations that you kind of get paid to do, and which ones aren’t.

RICH: Great. We have the wonderful Ellen Winney with us again. We’re going to jump into the episode with both Ellen and Lynette in just a moment.

[music]

RICH: Welcome back everyone. We’re going to jump into one of the seven theories of The SUCCESS Approach that you can find on your self-based online course modules. If you’re a parent who really would love to learn more about the SUCCESS Approach but don’t have the time, you can check out our website at thesuccessapproach.org because we have a wonderful self-paced course by Ellen Winney and created by Lynette Scotese-Wojtila so you can learn at your own pace to benefit from TSA. Let’s start off by talking about today’s theory, Model of Human Occupation. Dr. Lynette, what is the Model of Human Occupation?

LYNETTE: Well, I think before we get into that we need to first remind ourself what a theory is. So, a theory is sort of like a framework or conceptualization of how we come to understand a concept. Humans and how they occupy themselves everyday are pretty complex ideas. They’re pretty complex concepts. So this theory of human occupation that is decades old, that many occupational therapists have been studying for years, has all to do with almost the schematic that you might be able to understand if you think of a triangle. So, this theory that we conceptualize how humans function and live out their life roles is contained visually in this wonderful schematic that the theorist Gary Kielhofner and later Burke joined in helped define. If we picture a triangle, which is wide at the bottom and narrow at the top, we all together can conceptualize this kind of heavy, maybe lofty, theory of how humans function and perform. At the base of this schematic, this special triangle, is something called “performance,” so that’s where we are using our bodies to do certain things and using our mind to do certain tasks or skills, and that’s the basis for our existence, how we move and think and operate. So that is going to give rise to how we function. So going up this triangle, building on all of our skills and our thinking and our ability to function is next category of what they call “habituation,” and that just means that we have formed these motor skills into routines everyday. Things that become a habit, for instance, in the lower system, I can use my hands to hold my pants and I can use my feet to thread my legs into my pants when I am getting dressed. So that’s the motor performance sort of system and the thinking system that helps me know to do that. But, in habituation, we think about the automaticity or the second naturedness, if you want to think of it that way, of that pattern of movement that we’ve put into a habit over time. Because in my 50+ years of dressing myself, you can bet I’m not really thinking about it anymore. It’s quite a habit, which is part of a routine, which is kind of defined by the societal norms. I would get feedback, and Ellen might talk about this later in the open feedback system, I would get feedback from the society, maybe like my neighbor or the mailman, if I left my house without my pants on. That feedback might come in a variety of ways, but the point is that habit needs to be honored for me to fit into society. So that’s the middle part of this schematic triangle that tells us about how we function in our roles everyday and our performance. At the very tip of this beautiful concept is this volition is more of the selective process of the intentionality around our life outcome. I always use this example when I talk about volition, which is kind of translated to “human will,” I always use the example of way back when, when we used to have the USSR, former Russia. We would think about their gymnasts, and I remember Nadia Kominiche, I’m really dating myself here, but little girl then, Nadia Kominiche, was such an inspiration to me as a little girl. I remember thinking “wow, this girl must have woken up every day and said to herself, ‘I’m going to be the best gymnast I can be!’ She must have been a toddler when she was tumbling around. I’m going to think about what I want to do with my life and I’m going to be as good as she is at gymnastics!” Somebody told me that back then, the way the USSR ran their gymnastics so to speak or ran their maybe societal rearing of children, was children didn’t select necessarily what they wanted to do or be. It was kind of chosen for them. I don’t know the ins and outs of Russian government and I don’t even know the ins and outs of American government. Anyone who knows me knows that that’s not my strongsuit, but I got the message loud and clear like “oh my gosh, Nadia didn’t choose this? Someone chose it for her and gave her the supports to do it really well, but it wasn’t in her heart? What? How does that work?” I really understand, or understood as I was an OT student learning this Model of Human Occupation and the volitional system, which is that will or desire, that ability to forecast and see yourself in the future. I understood it because for the first time in my life, I was exposed to someone who maybe didn’t have that. It kind of shocked me into understanding that. Kind of pulling way back then into this schematic idea, if we’re strong at the bottom part of our pyramid and we have good thinking skills, good language skills, and good motor skills, and we have the ability to do many tasks from a physical and mental standpoint, and we do them enough that we’re growing and becoming more adapted doing those skills so they’re second nature, they form into habits and such, then we’re going to be able to automatically, so to speak, land where we want to land in life. We’re going to make informed choices, we’re going to rely on our good routines and capacities and skillsets, to be the best version of ourself we can be. And that’s kind of how we conceptualize the hierarchical human system from skills to basically self-actualization. 

RICH: So this is a neurological response to how to maintain your control of your environment.

LYNETTE: You know, I am not even sure I would say it’s neurological. The theory is more a conceptualization for how humans sort of make day to day existence functional and independent. It’s kind of a ‘how humans evolve into functional members of society’ I think is the best way to put it. We’re going to talk a little bit about roles and how they fall on the habituation system. That will concretize what it means to work through this hierarchical schematic. 

ELLEN: Maybe I can jump in with one more example a lot of times that I use when I’m teaching the course. If you take for example, brushing your teeth. Again, you have the skill of being able to hold the toothbrush, put the toothpaste on, brush your teeth, all of that. That would be your performance at the bottom of the triangle. And then, in the middle, your habituation is you get into the habit of doing that, hopefully twice a day if you have good dental hygiene. You evolve over time that it’s not Mommy telling you to brush your teeth but you start to get into that habit of doing it on your own. And then that volition, a lot of times we think about in that volition top of the triangle is what we value. So we’re able to brush our teeth because we have the motor skill for it, we’re in the habit of brushing our teeth, but in the top of the volition, we want to brush our teeth because we don’t want to get cavities or we don’t want to have bad breath when talking to our coworkers. So that’s one daily occupation that most of us have that we can break down into how and why we do it. 

LYNETTE: So that value piece is the distinction, Ellen, it’s very helpful. So we talk about in MOHO, personal causation. I can see myself doing it and value, belief system, being at the same caliber. Another example is, I, from the get-go, envision myself being a Mommy. I think I envision being myself as a Mommy when I was a little girl myself because I saw my mother being a Mommy. And she impacted me, which we will get into how that happens through this open system we might be defining soon with Ellen’s help, but she impacted me in such a way that I saw myself, I envisioned being, I valued being, I wanted to become part of that class or part of that role, so to speak. That must have happened around first, second, third, fourth grade as you’re forming as a young person. None of those skills that I need to be a mommy were a risk for me not to develop. I have 2 hands, they work well, they can therefore put a diaper on a baby. I can develop a routine of getting up and making sure that baby has a bath, feeding the baby, caring for the baby, getting the baby to doctor’s appointments, all those habitual sort of secondary, second-nature kind of things happen because I am in the body and brain that I am. I want to point out that the tip of this triangle, this personal causation or willingness or idea of what we value or how we see ourself is supported by the habitation system and the more primal or primitive performance system. Most definitely.

RICH: So in all 3 of the areas (performance, habituation, volition), this is where, if the schemas are not forming correctly, someone on the spectrum would need assistance helping to form it.

LYNETTE: That’s right. That would be squarely in the performance system. When you talk about neurological, it’s not a wrong idea, it’s just that neurologically, we kind of think about neurological deficits or strengths impacting that bottom system. If you can’t think, or remember, or can’t use your intellect or you’re not organized enough or your language systems don’t work right to be able to communicate, you’re not going to have second-nature habits of greeting people or knowing when to take a turn. Those are all communicative, social kind of habits. We know when to pause when someone has a question. We know how to initiate a new topic. Those are subtle things that our brain does all the time that are part of that performance system. It definitely neurologically impacts that subsystem of performance, but the whole thing in itself wouldn’t be considered a neurological theory. It’s more of a functional performance kind of theory I would say. 

ELLEN: I think it’s really the theory that’s at the heart of occupational therapy because it’s a holistic approach to looking at the human person and conceptualizing the human person and all their complexities and in what motivates what they do or what dictates you know how they spend their time and occupy their day. So it really is the cornerstone theory of the profession that Lynette and I both share. It’s key for understanding what an occupational therapist does. They don’t just help people get jobs

LYNETTE: Right. It is funny to think about how many people think occupational therapy helps people get jobs. Ultimately, it is kind of like the truth. A job for a child isn’t employment, we’ve talked about this in developmental theory you might remember, folks, a job for a child is play. A job for a child is learning and engaging, figuring out gravity, figuring out up from down, all those things that are developmentally their work, their job. This is what occupies them. Play occupies a child. For an adult, oftentimes work does. If we’re working members of society, then absolutely work occupies us. This is where we’re going to have to stretch the idea of occupation.

ELLEN: I think a key way to do that is to think about one of the key parts of MOHO which is the roles that people partake in, the roles that they hold. SO if you think about the roles that you hold, that kind of dictates what your occupations will be. So for myself, I’m a mother, I’m a homeschooling mother so I am a teacher, I am an employee as an occupational therapist, I am a sister, I am a daughter, I am a church member, I am a citizen of the country that I live in. Each of those different roles have different responsibilities or occupations that go along with them. So, as a mother I have to make sure my children are fed and dressed and get where they need to go, and be responsible for their ethical and moral formation in addition to the physical needs. So, there’s many many things that would go into that role. So, as we start to pattern our days, as we have these different performance skills and get into these different habits, those habits are dictated by the roles that we hold. So, as an employee, you have certain habits based on your job responsibilities in the role that you hold specifically. So, that’s a key concept: these roles. As we apply that to autism, our kids on the spectrum have roles that they are expected to hold as well. They are supposed to be a player, as one who plays like Lynette just referenced, they’re a student, they’re a sibling, they’re a daughter/son, a grandson/granddaughter, a neighbor. So, all of those roles that they hold have certain responsibiltiies and occupations that go along with them. When they are not able to fulfill those occupations because of difficulties in the performance subcategory or in the habituation subcategory to start, not even at volition yet, that really impacts their ability to function in their families and in society. That’s where this kind of comes into play in the field of autism. And really, I’ll just add in to, any human being. That’s why it is such a holistic theory. We are fulfilled as humans when we are doing a good job in the roles that we hold. When my house is clean, when my children are fed and getting along with each other, and I feel that their needs are met, I am fulfilled in my role as a mother. I have the causation, the belief that I can keep going in this role. That really impacts our happiness and satisfaction in our life roles and the ability to which we are able to perform that. It’s not just kids with autism that we really need to be paying attention to. It’s looking at us as whole human beings.

RICH: Looking at when I transitioned from one school to the next, I was shopping at Giant Eagle and I heard these 2 students who were at my previous school. They were going up and down the aisle next to me saying, “It’s gotta be him, it’s Mr. Smith.” And I could hear them saying “No, he died because he’s not at school anymore.” And I’m like looking around, checking for a pulse, making sure I’m still here. It was really funny to listen to them have this conversation about how I couldn’t possibly still be alive because I am not at the school anymore, because they only saw me as teacher, not father, not human being outside of school. They weren’t necessarily getting the idea that I had multiple roles. That might be a hang-up for some people too, right?

ELLEN: Absolutely. And especially for our kids on the spectrum, when we tie it into information processing and the schemas kids hold, if they need to adjust as their teacher or their therapist, you couldn’t possibly have a family of your own or other things because that’s not their schema for Mr. Smith was encoded initially. Now I’m sure if you went over to them and said “Hey guys! I actually do shop and I am not dead” they would be able to expand their schemas and accommodate their concepts for Mr. Smith. Whereas, for children on the spectrum, it requires a lot more work and effort to expand those kind of schemas.

RICH: I did look around the corner and met up with them in the next aisle and said, “No, it is me. I’m very much alive,” and you should’ve heard “I told you it was him!” It was a lot of fun. To take it back to the episode, that can be kind of hard for some children to rationalize the multiple roles that some people play.

ELLEN: I was just going to say, you can see the beauty of the interplay in the SUCCESS Approach how all of these theories melt together. TO understand MOHO we have to undertand information processing and how that can impact things. In order to understand the performance subsystem, we have to understand developmental model and the skills that are prerequisites for building and developing as a human being, so if they can’t fully develop that performance subsystem, we’re not going to be able to get up to the habituation subsystem and have meaningful life roles. So there’s this beautiful interplay of all of the theories that comprise the SUCCESS Approach that really help us to inform and understand individuals as whole people. 

LYNETTE: I think too, one of the things that I am always compelled to talk about when I lecture on MOHO or teach the class for this lecture, is this: Society has a heavy weigh-in on habituation. Society defines a lot of habituation like my silly example of leaving the house without pants, that would probably evoke, potentially, a visit from the police. I mean, if you think about that, it’s a societal thing. Now, if we were in a different part of the world where pants, I don’t want to see were optional, but weren’t really part of the culture, I may not look so odd walking around in that scantily glad situation. But some of the obstacles that children with autism face or other disabilities is this: sometimes school, school itself, as a highly routinized, habitual sort of routine sort of place, sometimes don’t even accept a child until they’re toilet trained because that’s an expected norm/habit kind of system or kind of skill that they expect. And oftentimes, the hard part about autism and special needs is, it’s not that the family ahsn’t tried and it’s not that the child may not even want to do it, it’s that in the performance system, something isn’t right - a sensory problem, a control problem, the cognition/understanding problem, a motor problem, etc. So, the performance system, the very bottom of that triangle is the culprit. So that’s where you see a lot of day treatment programs, like Integrations Treatment Center, really hit hard that performance subsystem because, like Ellen said, unless that is solid, you’re not going to develop good habits. That’s going to limit your options in life.

RICH: So, we’ve referenced these open systems. What are open systems?

ELLEN: So, the concept as a human being as an open system means that we can change based on the feedback that we receive. So, if we think of a young man who is learning how to play basketball and he’s working on his free-throw shots. He takes a shot and he missed. Well, he’s getting a lot of feedback. He’s knowing how his body was, what his motor pattern was. Were his knees bent? Were his wrists extended? When he made that shot that missed. Now, he could also be getting feedback from his coach on the sidelines telling him, “Bobby, you need to bend your knees a little bit more and spring up.” So, if he takes that feedback both internally from how his body was positioned, if we go back to sensory, we think about his proprioception and kinesthetic systems, and his external feedback from his coach and changes his stance and bends his knees and extends his wrists and he makes the shot and it goes in, well, he’s now gotten the feedback from seeing the shot go in to know, “Ok, this is how my body needs to be. This is how I need to position myself.” So he changes and so going forward he can utilize the feedback he’s received to be successful again in the future. So, it’s just this idea that we are able to change and go from a neurological standpoint and from a cognitive standpoint based on the feedback that we receive. We’re not widgets in a factory that have to go the same way every single time. We’re able to change and grow and to learn.

LYNETTE: And I think I would add to that, Ellen, which was really a good example of the tangible and intentional very distinct feedback, there’s also everyday sort of subtle, not distinct feedback that informs us for the future and how we evolve and what we become. An example of that, like I mentioned to you earlier in my own personal life, I very early on was sort of shaped if you will, because I am an open system, every human is, we’re influenced by what goes on around us, and part of what was going on around me as a little girl was seeing my mom and my sisters for that matter really enjoy caretaking and really enjoy raising children and doing it well and finding, like Ellen said, joy and value and satisfaction. And so my particular influence, as an open system, the thru-put of that information, how it processed through me, was positive. That influenced me to want to seek that, to emulate that, to become that, to envision with personal causation or personal will, something to strive for by becoming a mother. But if I didn’t, and some people don’t, have that early experience. That sort of fortifying or enriching or impacts us so positively and they got a different message that being a mother is daunting or taxing or sad or hard or difficult or any other adjective, which it can be of course, at times. But if that’s all they saw, or that won out for this person who is processing this thru-put as an open system, then they may come on the other side of this experience of being raised in that environment, deciding ‘I don’t want kids. I’ve seen nothing but heartache, stress, whatever.’ And actually, very plainly, Temple Grandin talks about marriage. I very distinctly remember her response when asked, “Would you ever consider being married?” And I think without misquoting her, the idea of what she said was, actually I have chosen to be selibet. Elationships are confusing to me and in addition to that, I have never seen a successful marriage that I can replicate or be able to replicate. So that is an example in her own infleucned way as an open system, she was influenced to not necessarily seek that. She talks about other reasons why that have to do with the performance subsystem, like not really being good at intimacy. That is a performance sort of subsystem. So, this is a great example of someone with autism, an amazing human being with autism, that has plenty of skills in the performance subsystem that I, personally, will never have. She doesn’t necessarily have those skills or interest or desire, and it changed her vision for her future from a marriage vs. non-marriage standpoint. [~28:00]

RICH: So, conceptualizing or being able to process this feedback are some of the dysfunctions we’ve talked about. What are some other occupational dysfunctions that we can see as far as someone who’s on the spectrum through MOHO
 ELLEN: So something that we can see is if a child or individual kind of gets stuck in the performance subsystem, their routines or their occupations, the way they spend their days, can lack meaning behind it. So, we can um never really understand why we’re doing what we’re doing. It’s almost like in certain ways that a lot of times autism is treated, we almost reinforce this where we just stay at rewarding the child for the performance skills, but never teach the bigger meaning behind it and it’s almost like we’re creating little robots of, you know, there’s no volition behind it. There’s no causation, that belief ‘In can do it’ and the desire to do it, not because I’m being externally motivated, but because internally ‘I value this’ or at least ‘I’m in the habit of this.’ We can get children that don’t greet somebody because they want to have that social connection but because they’ve been told they need to do it or been reinforced to do it. We can get young men, or I don’t know if this is just kids on the spectrum, but teenage boys that have the skill to put deodorant on every day and brush their teeth, but they don’t have the habit of doing it independently and they don’t value doing that. So a lot of times we get skills that lack value or meaning behind them. Children can also develop growth skills, we talked about that in information processing. For example, the idea that a child can do multiplication facts, they can say their multiplication facts, they can recite them, but they don’t have the meaning behind it, so they are never going to have the application of what that means if you’re doing a recipe and need to double it, if you just have rote memorization. So, kids or adults can develop these rote splinter skills that lack meaning and function behind them, so they’re never organized into a pattern that then becomes part of the role that they assume and find meaningful. 

LYNETTE: Ellen, one important thing that you made me think about as you were talking about sort of these rote skills and working on things that are skills but not necessarily valued, I think the word generalization is really, really important. MOHO, this model of how we occupy ourselves as human, how we function as humans, it absolutely has to do with the combination of motor skills and cognitive skills. Whenever you’re working on one versus the other, there’s not a way to help both at the same time as fully as both might need to be helped, you’re going to get sort of a splinter skill.

ELLEN: I think, too, the other thing that we’re talking about with individuals on the spectrum is that idea beginning with the end in mind. What roles do we foresee this individual needing to fulfill, and having that end goal as far as we know. You don’t necessarily have to have their college graduation planned, but we do want to know the roles that they’re going to assume or assume right now as a sibling, family member, etc. What are the skills that they’re going to need to do that? That should inform things like IEPs and school plans, etc. How is this individual going to be a functional member of society, not just academically, but if the child is a sibling and therefore is part of a family, family members all pitch in and do chores. If the child who has a disability never has to do a chore, that is going to cause friction in sibling relationshiups in addition to teaching responsibility and things like that. We need to build in teaching them things like maybe putting away all the plastic things from the dishwasher. Things that show they have a role as a family member, which has such repercussions, not only responsibility but family harmony and building those relationships. So really, looking and saying ‘what are the roles that the child fulfills right now and where are they going’ and teaching those skills and getting those skills into habits. Then, as the child gets older, looking at intrasurveys and values. What are they good at? Are they phenomenal at building legos and come up from their own mind these amazing designs? How can we funnel from a life skill that can turn into a career someday? And not treating them as just another cog in the system and everybody being funneled. It really goes into the individualization of treatment and looking at where are the skills and, you know, where are their interests lying and help form that even at a young age to a measurable life outcome

RICH: I think what you’ve both said beautifully is that the environment in which and the purposeful situation of what you’re teaching in the moment is what makes the SUCCESS Approach and why everyone really should join and take these classes so you can see how everything interweaves with one another. I was thinking about chores and we’re working with Finn right now on the dishes. He has non problems putting the dishes away when it’s coming out of the dishwasher, but he struggles with wanting to put the dishes into the dishwasher. So, we had to have a whole conversation in that moment about what’s the barrier. What is it that you don’t like about putting the dishes in the dishwasher? And then a whole, of course, conversation about making the dishes, right? If you make the dishes you gotta help with the dishes. But, finding that the some of the dishes still had stuff on them, so we had to get him gloves so that he could get past that barrier, having that conversation in the moment and working through it as a team.

ELLEN: Right. And right there, if he can’t do it because of the feel, that is a sensory issue that goes into the performance areas. So, we help overcome that and teach that skill and come over whenever we need to do that so he can get into the habit. So now, Finn every Tuesday, it’s your job to do that in this family. And as we’re doing it, we reinforce verbally the role that the child is fulfilling of, “You know what Finn, you are a great family member. You’re a great Smith because you’re pitching in and Smith’s all work together to make this house function.” So that’s how we kind of step it to start helping people understand the roles and value it - like, “Yeah, I want to be a good family member! I want to be a strong part of the team, so I’m going to do the dishwasher chore because I value being a part of this family.” 

LYNETTE: I think that leads to good team playing and we haven’t said the word, but I’m going to introduce it as a role. We are really stewards within our community, within our home, within our workplace. We are stewards of the environment. Stewardship is an important role. And that helps Finn know his role as a steward in the Smith household, how it can contribute. And guess what? When he’s out there on a job interview and he has experience of something that frustrated him once and he talks about how he had to learn and get over the hump of loading and unloading the dishwasher and how dishes get made, that potential employer is going to see that kid as a candidate who’s on the other side of team play. He understands how to be a team member because you work and Kristi work with him early enough to shape that skill. Not everybody is a team player. I’ve interviewed hundreds and hundreds of people over the past 26 years and you can sometimes tell who’s really got that teaming, collaborative, stewardship kind of mentality and who really doesn’t. It’s a skillset!

RICH: So, are they any treatment methods? We’ve discussed a couple of how to work through them, but are there any others that you can think of off the top of your head that might be associated with MOHO specifically, or how it interacts with TSA?

LYNETTE: It’s very complex actually the treatment of MOHO because it’s about each of the categories, like Ellen and I have been saying. The most common way that occupational therapists approach occupation is through the performance subsystems, making sure the body, the musculoskeletal system, the nervous system, the sensory system, all those systems together, body and brain, kind of work together so the kid comes to any task with the best version of themselves they can be. Sometimes that’s hard for our kids on the spectrum so we’ll do a developmental approach to make sure they have that good skill. From there, it’s a matter of practice over and over. I just did a skill drill with somebody, a little 4 year-old here on our caseload, and we called it the ‘tag game.’ I had 5 shirts that his mommy sent in. He puts his clothes on backwards, right, or not 100% the right way, so we’re treating that, developing that habit, right Ellen? That would be a habituation sort of thing. I had 5 shirts, he had 5 opportunities, and I would show him where the tag was. He would pick up his end of it, slide the tag from where he could see it over his eyes to where he couldn’t on the back of his head, and then I’d give him a little squeeze on the back of the neck and said, “Now the tag is back there!” I practiced that 5 times in a row. So, one approach that you’re asking about, Rich, in terms of treatment would be repetition as we’re trying to get that habit to stick and to be a thing. The other thing I will talk almost top-down about is partnering with the kids to get in their brain about their interests. This isn’t just for kids who are verbal. There are kids who are nonverbal or pre-verbal or inconsistently verbal, inconsistently communicators or unreliable communicators that really have great ideas about what they want to do with their life but no one has really asked them. You have to find the just-right way to get those individuals to express themselves. It might just be watching what they cling to or walking down Walmart at an outing one day Integrations Treatment Center, and someone ends up in the electronic aisle. What does that tell you? Either that they really like them or they don’t know where else to go, and chances are they really like them. Does that person have a future in computers or gaming or making video games? There’s lots of ways you can discern interests and kind of work with that angle, if you can, kind of milk it. Temple, again, second time I am referencing her, she always says, “Find their strengths and make them even better.” Let them lean on their strengths and that will be the path to their happiness and fulfillment, which is all part of that volition subsystem, and a functional member of society could result and tht’s what we want for all of our kids.

RICH: Absolutely. Well, I appreocate you guys taking the time today to talk about Model of Human Occupation. Stick around, we’re going to talk about some final thoughts for this episode.

LYNETTE: So, today’s challenge for everyone listening whether you’re professional or parent or caretaker of someone on the spectrum, ask yourself this: What role do I really want to nurture in this individual? And what are some key skills that are going to help that person acquire or achieve that role to the best of their ability?

RICH: As we wrap up this episode, a couple things that have stuck out to me that I’ve heard is: first one is the term investment. I’m going to throw my own term in there and say investment. Taking the time to getting to know who it is that you’re working with that needs that development, and the other part for me is that this is something that can be developed for everyone. We don’t have enough conversation amongst each other to talk about ways to discern roles to talk about our own paths and skills that can be developed into something meaningful as a part of their vocation. Ellen, we’re going to let you wrap things up for this episode today. What are some of the final thoughts that you have for us on MOHO?

ELLEN: I think some of the key takeaways and those summary bulletpoints is that understanding of what occupation is in the bigger sense of it and that in order to have meaningful occupation, we have that performance subsystem, those skillsets, the habituation where we organize our behavior into routines that form our roles, and then our volition – what we value and what motivates us. And that when we’re functioning, not just those on the spectrum but as human beings, we’re able to find fulfillment and happiness and contentment in our existence as human beings. We really want to be mindful and say if we’re finding struggles in maintaining our occupations, really breaking it down and saying, “Where is that breakdown happening?” Remembering that we really are open systems. If something is a struggle for us now, it doesn’t mean it always is going to be that way. Our kids are young now and we’re struggling as parents to envision where they are going to be in the future. Just trust in that open system that we’re created and know that with the right supports, that feedback will become salient with that transdisciplinary team around you, our kids can have meaningful life roles regardless of their diagnosis.

LYNETTE: We hope that you learned something today to help you on your journey with autism. We’ll share more on our next Connect with S.U.C.C.E.S.S. podcast. Until then, expect SUCCESS!

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