Occupational Therapy: Meeting the Needs of Families of People With Autism Spectrum Disorder

Caregiver burden among caregivers of children with autism spectrum disorder

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with deficits in social communication and interaction, restricted and repetitive patterns of behaviour, interests and activities. Autism spectrum disorder is associated with multiple comorbidities. As a result, caregivers of children with ASD experience increased levels of burden and poor quality of life. However, there is a paucity of information on the burden.

Aim

The study aimed to describe the sociodemographic profiles and determine the extent of the burden experienced by caregivers of children and adolescents with ASD.

Setting

The Child, Adolescent and Family Unit (CAFU) outpatient services at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Methods

A quantitative, descriptive, cross-sectional study was done. Two self-administered questionnaires were used: a sociodemographic questionnaire and the 12-item Zarit Burden Interview questionnaire.

Results

The questionnaires were completed by 77 caregivers, of which the majority were female (n = 56 or 72.3%), mothers to children with ASD (n = 49 or 64.3%) and identified as Christian (p < 0.001). Most had completed secondary school or had a tertiary education (p = 0.003) and were employed (p < 0.001). Among the caregivers, 41.6% experienced mild to moderate burden, 33.8% experienced high burden and only 24.9% reported no to mild burden.

Conclusion

Caregivers of children and adolescents with a diagnosis of ASD are mostly mothers and experience mild to moderate levels of caregiver burden, suggesting the need for improved screening and psychosocial support programmes.

Contribution

This study highlights the burden experienced by primary caregivers of children with ASD and is one of the few comprehensive studies on this issue within the context of South Africa.

Choosing Performance-Based Outcome Measures of Daily Living Skills and Socialization for Clinical Trials in Autistic Children

IMPORTANCE

Robust and psychometrically sound performance-based outcome measures are needed for clinical trials of occupational therapy interventions for children with autism.

OBJECTIVE

To demonstrate a systematic approach for choosing psychometrically sound performance-based outcome measures of daily living skills and socialization for use in clinical trials of occupational therapy interventions for children with autism.

DESIGN

Rapid literature review to identify appropriate measures for studies with this population followed by quality indicator ratings and a nominal group process.

SETTING

University.

PARTICIPANTS

Four experts in autism and pediatric outcome measurement. Outcomes and Measures: Twenty-one outcome measures of daily living skills and socialization were identified and reviewed.

RESULTS

Seven measures met the inclusion criteria. The Assessment of Motor and Process Skills and the Evaluation of Social Interaction-Second Edition, received the highest ratings and group consensus. Several other measures were also scored highly.

CONCLUSIONS AND RELEVANCE

Careful assessment of psychometric properties is an important component of choosing outcome measures for a clinical trial, but burden of assessment and study objectives are important considerations. What This Article Adds: This project demonstrates use of a systematic process for choosing outcome measures for a planned clinical trial.

Establishing a pediatric occupational therapy clinic in the public-sector in Trinidad: The quest for clinical and professional expansion

BACKGROUND

Pediatric occupational therapy (OT) in Trinidad is limited to costly private sector provision, which restricts access to only those families that can afford it. Public-sector healthcare, however, is offered free of charge to citizens. Establishing public-sector OT can increase the well-being and quality of life of children with disabilities and their families, as well as broaden the professional paths available to occupational therapists.

OBJECTIVE

In the absence of local studies, primary research was undertaken to demonstrate the demand for services. The results of this study will be presented to government officials to argue for the inclusion of pediatric OT into one public-sector hospital in Trinidad.

METHODS

Eighty-eight parents/caregivers of a child with special needs were surveyed at one public sector-waiting room or two private-sector therapy clinics. Surveys questioned parents' desire for occupational therapy services for their child, their willingness to use public-sector-provided therapy and their belief that such therapy would benefit families in Trinidad, among other items.

RESULTS

Of the 88 participants surveyed, 98.8% believed that occupational therapy offered at one public-sector clinic in Trinidad would benefit families. The main deterrents to accessing the proposed public-sector therapy included satisfaction with the current therapist (40%) and concerns with convenience (33%) and efficiency (27%). Parents whose children were not currently receiving therapy cited cost (67%) and location (38%) as the main barriers.

CONCLUSIONS

Primary research findings demonstrate that the vast majority of parents/caregivers believe that public-sector pediatric occupational therapy would benefit families. Service free of charge will increase access for many families who cannot currently afford treatment. Implications of a pediatric public-sector clinic also include the expansion of occupational therapy as a profession in Trinidad.

Lived experiences of caregivers of children with autism spectrum disorder in Kenya

Background

Autism spectrum disorder (ASD) is a global public health concern. In African countries such as Kenya, there is a greater need for establishing support services for developmental disorders such as ASD. The emotional, social and economic burden of ASD on caregivers is unknown because of a number of challenges. Citizens of Kenya have a unique view of disability and inclusion.

Objectives

To explore the perspectives of caregivers who are responsible for caring for both family and children living with ASD and to highlight the needs of children with ASD as well as the needs of their caregivers.

Method

A qualitative, descriptive phenomenological study utilising focus group discussions (FGDs) was conducted. Verbatim transcription was used. QSR N 'Vivo 10 was used to organise and analyse the data. Content analysis was used to identify important ideas and concepts.

Results

One theme, namely 'the burden of caring for children with ASD', was identified. Children with ASD and their caregivers experience isolation and stigmatisation.

Conclusion

Occupational therapists in Kenya should collaborate with the relevant national and global stakeholders for the promotion of the inclusion of children with ASD and their families. Responsive and context-appropriate occupational therapy interventions may begin to address service barriers.

Keywords

autism spectrum disorder; children; needs of caregivers; context-appropriate services.

Occupational Therapy Interventions for Adolescents With Autism Spectrum Disorder

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an adolescent with autism spectrum disorder. The occupational therapy assessment and treatment processes for school, home, community, and transition settings are described. Findings from the systematic reviews on this topic were published in the September/October 2015 issue of the American Journal of Occupational Therapy and in AOTA's Occupational Therapy Practice Guidelines for Individuals With Autism Spectrum Disorder. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.