Autism and the Need for Occupational Therapy in School Aged Children

1
Autism and the Need for Occupational Therapy in
School Aged Children

• Stacey Baboulas
• Lynne Dart
• Lauren Hershfield
• Marcia Hopcraft
• Shannon McCready
• Melissa Peressotti
• Candace Skinner

2
Agenda

• Position Statement
• Definition of Autism
• Current state of affairs in Ontario
• Role of Occupational Therapist
• Legal Precedent
• Discussion and Questions

3
So Why are we here?

• As advocates in the fight for funding for autism,
  we believe it is essential that children over the
  age of six still require occupational therapy
  treatment.
• We believe that occupational therapy treatment is
  necessary to improve the quality of life for
  children with autism.

4
What is Autism?

• Autism is a neurobehavioural syndrome caused by a
  dysfunction in the central nervous system. It
  leads to disordered development in the skills of
  social interaction, communication as well as
  restricted, and repetitive patterns of behaviours
  interests and activities (Auton v. British
  Columbia, 2002).

5
Current Funding in Ontario

• Intensive Early Intervention Program includes
• Assessments and individual service plans
• Intensive behavioural intervention
• Training for parents to support their children at
  home
• This treatment is only available for children
  with autism under the age of 6.

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So, Who is Eligible for this Program?

• Children aged two to five with an autistic
  disorder considered to be at the severe end of
  the spectrum disorder
• Individual must have a diagnosis from a doctor or
  psychologist
• Children who do not begin Intensive Behavioural
  Intervention until they are between the ages of
  five and six may be eligible for a maximum of up
  to 12 months
• (www.children.gov.on.ca)

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Burden on the Parents

• The annual cost for treatment for children after
  the age of six is between
• 45,000 60,000
• (www.children.gov.on.ca)

8
Clinical Issues with Autism

• Late diagnosis (after age 4) often occurs
  because
• - Professionals are hesitant to diagnose at an
  early age
• - Onset may occur after childhood events such as
  environmental stressors or immunization
• - Children are often misdiagnosed
• - Lost skills tend to be those of higher level
  cognitive, social and linguistic functioning
• (Obmbudsman Ontario Goldberg, Osann, Filipek,
  Laulhere, Jarvis, Modahl, Flodman, Spence,
  2003)
• Regression
• - Regression may be acute or gradual
• - May develop normally and then regress all or
  some of their skills
• (Goldberg et.al., 2003)

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So What?

• Successful treatment usually takes at least 2-4
  years
• (Goldberg et. al., 2003)
• Autistic children often require repeated
  instruction and practice before a specific skill
  becomes an ingrained part of their repertoire
  (www.autism.ca)
• Periodic reassessments of a treatment plan need
  to be made to assure that individual needs are
  continuing to be met as the person with autism
  matures.
• (Rogers, 1996)

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The Role of an Occupational Therapist

• Address areas that interfere with the childs
  ability to function in life tasks such as
  feeding, writing and proprioception.
• Develop coping skills, fine motor skills,
  socialization and play skills to enable
  independence.
• Enhance or maintain play, self-help and
  school-readiness skills.
• Improve the quality of life for the individual
  through successful and meaningful experiences.
• (www.autism.ca)

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Why are OTs particularly well-suited?

• OTs provide one-on-one intervention (Rogers,
  1996). This ratio has been shown to be the most
  effective format for early intervention programs
  and behavioral programs (Lovaas, 1987).
• Because OTs have the expertise to evaluate
  environmental, attitudinal, and functional
  barriers/issues, they are able to contact the
  necessary professional and train others
  (co-workers, supervisors, family members) on the
  interventions (Capo, 2001).

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Why are OTs particularly well suited--continued

• OTs often use play-based intervention and
  sensory integration approaches that promote the
  childs ability to modulate sensory input, reduce
  sensory defensiveness, and adapt the childs
  daily sensory environment so that he or she is
  better able to modulate sensory input (Watling,
  Deitz, Kanny, McLaughlin, 1999).
• OTs emphasis on sensory integration may make a
  unique contribution to programs for children
  (Case-Smith Miller, 1999).

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Consequences of Discontinuing Our Treatment

• There are many life skills that still need to be
  learned as a child grows learning does not stop
  at 6.
• How one interacts with the world changes through
  various stages of life. Through an occupational
  lens, identity is an ever changing phenomenon.
• Studies of adults with autism show that they are
  still capable of learning various skills (Van
  Bourgondien, Reichle, Schopler, 2003).
• Independent living skills cannot be taught until
  a certain level of maturity.

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Why continue therapy?

• If one thinks of these treatment strategies as
  prosthetic devices that help the individuals with
  autism compensate for their deficits (similar to
  glasses or hearing aids), it makes sense that
  their continued use is necessary to maintain the
  positive effects (Van Bourgondien et. al.,
  2003).

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Conclusion from an Occupational Therapist
Perspective

• It is now recognized that people with autism not
  only improve but can and do lead happy productive
  lives with proper intervention (Rogers, 1996)
• The public needs to begin to see this disorder as
  treatable and to invest the same energy, funds,
  and effort into treating autism as we currently
  do with other chronic medical conditions that
  affect young children

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Supreme Court of British Columbia Decision

• Overview
• Court Decision
• Charter of Rights and Freedom
• Determination of Discrimination
• Convention on the Rights of the Child (UN)

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Something to Ponder

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Discussion  

• Do you think that the Province of Ontario has a
  legal responsibility to provide occupational
  therapy for children with Autism? Why or why not?
• Given the limited amount of funds this Province
  has, at what stage of the life span do you feel
  these funds should be allocated?

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References

• Anton v. British Columbia (Attorney General),
  (2002) B.C.J. No. 2258 (C.A.).
•  
• Autism Treatment Services of Canada. (2003).
  Early Intervention. Retrieved on September 28,
  2004 from http//www.autism.ca/interv.htm.
•  
• Autism Treatment Services of Canada. (2003).
  Occupational Therapy and Austistic Children.
  Retrieved on September 28, 2004 from
  http//www.autism.ca/occther.htm.
• Capo, L.C. (2001). Autism, employment, and the
  role of occupational therapy. Journal of
  Prevention, Assessment, and Rehabilitation, 16,
  201-207.
• Case-Smith, J., Bryan, T. (1999). The effects
  of occupational therapy with sensory integration
  emphasis on preschool-age children with autism.
  American Journal of Occupational Therapy, 53,
  489-497.  
• Case-Smith, J. Miller, H. (1999). Occupational
  therapy with children with pervasive
  developmental disorders. American Journal of
  Occupational Therapy, 53, 506-513.
•  
• Goldberg, W.A., Osann, K., Filipek, P.A.,
  Laulhere, T., Jarvis, K., Modahl, C., Flodman,
  P., Spence, M.A. (2003). Language and other
  regression assessment and timing. Journal of
  Autism Developmental Disorders, 33, 607-616.

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References

• Lovaas, O.I. (1987). Behavioral treatment and
  normal educational and intellectual functioning
  in young autistic children. Journal of Consulting
  and Clinical Psychology, 55, 3-9.
•  
• Rogers, S. J. (1996). Brief report Early
  intervention in autism.  Journal of Autism and
  Developmental Disorders, 26, 243-246.
  Obmbudsman Ontario Annual Report 2003-2004.
  Toronto, Ontario
•  
• Watling, R., Deitz, J., Kanny, E. M.,
  McLaughlin, F. (1999). Current practice of
  occupational therapy for children with autism.
  American Journal of Occupational Therapy, 53,
  498-505.
•  
• Website of the Ministry of Community and Social
  Services. Intensive Behaviour Intervention.
  Retrieved on September 28, 2004 from
  http//www.cfcs.gov.on.ca
•  
• Van Bourgondien, M.E., Reichle, N.C., Schopler,
  E. (2003). Effects of a model treatment approach
  on adults with autism. Journal of Autism
  Developmental Disorders, 33, 131-140.