Occupational therapy assessment and interventions for young autistic children in South Africa

Background

Occupational Therapy is among the top interventions for autistic children, hence the need for equitable and effective services in the public and private health and education sectors. Ongoing research into the therapies for autism spectrum disorders in different contexts is also required.

Objectives

To explore and describe occupational therapists' assessment and intervention for autistic children in South Africa.

Methods

A descriptive qualitative research design using semi-structured interviews to gather data from purposively recruited OTs (n=20). Data were audio-recorded, transcribed and analysed thematically, and compared across three sectors public health, special needs schools and private practice.

Results

South African practice across all three sectors was similar to international patterns of informal play-based assessment, sensory processing and Ayres Sensory Integration (ASI®) treatment. Developmental frameworks guided specific approaches. Strong team collaboration was present across sectors, with some transdisciplinary teamwork and co-treatment. Undergraduate and postgraduate training opportunities were, however limited.

Conclusions

Occupational therapy assessments had diagnostic value. Informal tools such as developmental checklists were found to have clinical utility, whilst standardised tools were most commonly used to assess sensory processing and visual perception. Recommendations included incorporating ASI® into undergraduate curricula and postgraduate training opportunities with multidisciplinary input to develop ASD professionals in South Africa. It is imperative to advocate for services in under-resourced rural areas and marginalised communities that lack financial and social resources. Occupational therapists need to find new ways of working collaboratively across sectors to ensure effective and comprehensive services in public health and special schools.

You Get What You Pay For: Three Years of Applied Behavior Analysis in Hong Kong With Relative Cost

There are decades of research literature that support the effective application of applied behavior analysis (ABA) in schools that have students with special needs, including autism spectrum disorder. Students ranging in age from preschool through secondary have benefited from ABA and its effectiveness. In light of the global economic downturn over the last decade, the costs of services for children with special needs has been analyzed and scrutinized across many levels of bureaucratic systems. Through its evidence-based methods, its focus on relevant outcome data, and its systematic measurement practices, ABA has offered many educational stakeholders the best way forward for one of modern society's biggest behavioral health problems. The present study replicates a cost-benefit analysis and shows the outcomes of instruction in terms of cost in dollars. We reviewed 3 years of outcome data from an international school for students with special needs in Hong Kong. Special instruction with ABA was provided in individual, group, and inclusive classroom settings using learn units as the basic unit of instruction. A cost-benefit analysis showed the relative dollar amounts of the learn unit and instructional objectives, adjusted for inflation and compared across previous studies.

Peer-mediated intervention to improve play skills in children with autism spectrum disorder: A feasibility study

BACKGROUND/AIM

Children with autism spectrum disorder (ASD) frequently demonstrate impaired play skills and poor quality social interactions compared to typically developing peers. Complex interventions to improve play skills should be investigated with randomised control trials (RCT) where possible to support evidence-based practice for occupational therapists. Prior to a RCT, multiple feasibility studies are recommended to identify barriers to the trial. The aim of this study is to adapt a complex intervention to improve play skills in children with ASD and investigate the feasibility of conducting a RCT.

METHODS

Participants were 10 children with ASD paired with typically developing playmates chosen by their families. Pairs attended 10 intervention sessions involving video modelling, therapist- and peer-mediation and free play. Participant numbers needed for future investigation of effectiveness were calculated and time and cost considerations were reviewed. The Test of Playfulness (ToP) was the primary outcome measure; both parent- and child-report outcome measures were evaluated for appropriateness.

RESULTS

To determine effectiveness of the intervention 34 pairs in both control and intervention groups will be needed to conduct a RCT over an 18-month timeframe. ToP scores showed a positive, but not statistically significant trend from pre- to post-intervention. These improvements were maintained at follow-up in both clinic and home environments. The Piers-Harris 2 and the Parent Relationship Questionnaire were identified as appropriate secondary outcome measures; additional parent- and teacher-report outcome measures are recommended for the RCT.

CONCLUSION

A RCT to investigate effectiveness of this intervention for improving play skills of children with ASD and their playmates are feasible.

Services for Children With Autism Spectrum Disorders

Recommendations for improving school and community-based services for children with autism spectrum disorders (ASD) in the state of Virginia were investigated. Participants consisted of 783 parents of children birth to age 22 with a medical diagnosis of ASD. Data obtained through an open-ended survey question were analyzed both quantitatively and qualitatively. Parents recommended improving the quality, quantity, accessibility, and availability of services; educating and training individuals to work effectively with children with ASD; increasing funding for services; and creating appropriate school placements and educational programs. The findings from this study suggest the need for increased individualization of and accessibility to services. Future state-level research must examine the variables that affect parent recommendations and evaluate the quality of existing services for children with ASD.

The Son-Rise Program® intervention for autism

With increasing availability of interventions for children with autism, it is important that these are backed by rigorous evaluation data that have high levels of ecological validity. To achieve this, a key prerequisite for any evaluation is to gather data on typical consumers and typical implementation patterns of the intervention. This study collected such data longitudinally in relation to the Son-Rise Program®, a home-based parent-run intervention for autism. Questionnaires and interview data on family demographics, implementation patterns, and perceived treatment fidelity were gathered three times over the course of a year from families who had attended a Son-Rise® initial training course. Although it proved possible to produce a profile of intervention use, findings indicated that the programme is not always implemented as it is typically described in the literature. The study also highlighted methodological challenges likely to be encountered in any future evaluation of this and similar interventions for autism.

A pilot study of the effects of a social-pragmatic intervention on the communication and symbolic play of children with autism

The acquisition of social communication skills is a major challenge faced by children with autism. This pilot study investigated the effects of the Stronger Families Project, a social-pragmatic intervention, on the communication and symbolic abilities of 16 children aged 2–4 years with autism. Standardized measures of the child's communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention, and parents were interviewed to determine the impact of variables such as maternal stress and competence on the child's social communication. Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report. However, improvements based on ratings by independent observers were not significant. Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report.

Department for Education and Skills/Department of Health Good Practice Guidance on the education of children with autistic spectrum disorder

Currently, it is held by many that educational interventions are those most likely to make a significant difference to the prognosis and well-being of a child with an autistic spectrum disorder (ASD). Yet, decision making about educational interventions and provision in ASD is often based on beliefs, tradition and assumptions, rather than on empirical evidence. This can lead to inappropriate or ineffective provision and can cause confusion and conflict between and within professional groups and parents. Little rigorous research evidence exists to guide decisions for children with ASD. This is true for educational practice generally, and for children with other special educational needs. Practitioners and parents alike are keen for good information on how best to educate children with ASD. It was against this background that the Department for Education and Skills (DfES) and Department of Health (DoH) convened a working group of experienced practitioners and parents to produce the 'Good Practice Guidance on ASDs'. This paper explores the need for the DfES/DoH Guidance, describes its structure and content and then suggests why research evidence is sparse and how future research might be enhanced to inform practice.

Modifying the affective behavior of preschoolers with autism using in-vivo or video modeling and reinforcement contingencies

The purpose of this study was to modify the affective behavior of three preschoolers with autism in home settings and in the context of play activities, and to compare the effects of video modeling to the effects of in-vivo modeling in teaching these children contextually appropriate affective responses. A multiple-baseline design across subjects, with a return to baseline condition, was used to assess the effects of treatment that consisted of reinforcement, video modeling, in-vivo modeling, and prompting. During training trials, reinforcement in the form of verbal praise and tokens was delivered contingent upon appropriate affective responding. Error correction procedures differed for each treatment condition. In the in-vivo modeling condition, the therapist used modeling and verbal prompting. In the video modeling condition, video segments of a peer modeling the correct response and verbal prompting by the therapist were used as corrective procedures. Participants received treatment in three categories of affective behavior--sympathy, appreciation, and disapproval--and were presented with a total of 140 different scenarios. The study demonstrated that both treatments--video modeling and in-vivo modeling--systematically increased appropriate affective responding in all response categories for the three participants. Additionally, treatment effects generalized across responses to untrained scenarios, the child's mother, new therapists, and time.

The effectiveness of interventions for children with autism

Over the past 50 years very many different treatments have been promoted as bringing about significant improvements, or even cures, for children with autism. However, few interventions involve controlled studies of any kind; randomised control trials are virtually non-existent and when appropriate research methodology has been applied the results are generally far from positive. Recent research suggests that the most effective results stem from early intensive behavioural interventions. Although many questions remain concerning the optimal age at which treatment should begin, the intensity of treatment and the many other variables that may affect outcome, there is growing evidence of general strategies that can be effective in ameliorating the problems associated with autism.

Developmental psychiatry and intellectual disabilities: an American perspective

The Natalie Cobbing Travelling Fellowship gives the opportunity to medical professionals trained in the Psychiatry of Intellectual Disabilities to gain experience in their field from centres overseas. This article concentrates on specialist work settings and the practice in developmental disabilities in Boston, USA. The authors conclude that such training opportunities not only are important educational milestones but also help in creating a network of professionals who can work together to improve standards of research and clinical practice across different cultural and ethnic divides.

Prologue: Autism Spectrum Disorder

As the need for services for children with autism and related disorders has increased, so has the need for information about communication assessment and intervention for these children. Each of the articles in this forum considers essential knowledge for meeting the social, behavioral, and communication challenges presented by this population, as well as considerations for the individual variation noted within this population. It is hoped that the knowledge contained in this forum will provide interdisciplinary insight into the challenges of autism and related disorders and a research-based framework for making assessment and intervention decisions.

Early Identification of and Intervention for Infants and Toddlers Who Are at Risk for Autism Spectrum Disorder

Providing intensive early intervention is critical to maximizing outcomes for children with autism spectrum disorder (ASD), and evidence suggests that the earlier intervention can begin, the better the outcome. The first purpose of this article is to review the earliest indicators of ASD in very young children—social and communication impairments—which have important implications for early identification. The second purpose is to review evidence-based intervention practices for children with ASD and to develop a set of guiding principles for providing intervention for infants and toddlers who are at risk for ASD. Issues that are delineated include providing intervention in natural environments, supporting families in early intervention, and embedding intervention in daily routines.