Autism Spectrum Disorders: An Interdisciplinary Education Module

Transcription

1 Autism Spectrum Disorders: An Interdisciplinary Education Module

2 Contents Introduction... 3 Learning objectives... 3 What are Autism Spectrum Disorders?... 4 Autistic Disorder (autism)... 4 Asperger s Disorder... 4 Pervasive Developmental Disorder Not otherwise specified (PDD-NOS, also known as atypical autism)... 5 Rett s Disorder... 5 Childhood Disintegrative Disorder... 5 Diagnosis of ASD... 6 Prevalence and early intervention... 7 Early warning signs... 7 Role of the health professionals... 8 General practitioner... 8 Child and adolescent psychiatrist... 9 Paediatrician... 9 Psychologists... 9 Speech pathologists Occupational therapist Team management Services available for children with ASD Government funded services for children with ASD Typical service pathway to assessment and intervention Directory of autism associations Links to allied health professional associations

3 Introduction Welcome to the Autism Spectrum Disorder (ASD) Interdisciplinary Education Module. This Education Module has been produced by Allied Health Professionals Australia (AHPA), the Australian Psychological Society (APS), Speech Pathology Australia (SPA) and OT Australia. The development of this module has been funded by the Department of Health and Ageing, as part of the Australian Government s Helping Children with Autism package. You may complete the Education Module either by working your way through this manual, or alternatively, a health professional with expertise in the field may deliver this training using the PowerPoint slides that accompany this manual. Both the manual and PowerPoint slides are available on the AHPA Autism website: Learning objectives The aim of this Education Module is to provide health professionals with an understanding of the key roles of the interdisciplinary team involved in the assessment and treatment of children with ASD and other Pervasive Developmental Disorders (PDD) and of the pathways to service provision. A particular emphasis will be on the interdisciplinary nature of the care provided by psychologists, speech pathologists, and occupational therapists for children with ASD and their families. Included in this material are links to other sources of relevant information. The Education Module will cover the following: What is Autism Spectrum Disorder (ASD)? Diagnosis of ASD Prevalence The role of medical and allied health professionals Team management Access to services for children with ASD 3

4 What are Autism Spectrum Disorders? An autism spectrum disorder (ASD) is a lifelong neuro-developmental disability that is part of the broader category of Pervasive Developmental Disorders (PDD). The following table outlines the relationship between PDD and ASD. Autistic Disorder (autism) Autistic Disorder is the most common of these PDD disorders and the abilities of children with Autistic Disorder can be said to be on a spectrum ranging from low functioning, (including those with intellectual disability), through to high functioning. Children with Autistic Disorder demonstrate difficulties in specific areas of functioning. These areas of difficulty include social functioning, verbal and non-verbal communication, having a narrow set of interests or unusual interests and behaviour, and coping with change. The daily functioning of children with Autistic Disorder can vary enormously with some requiring high levels of support and lifelong care and supervision and others being able to function largely independently. Asperger s Disorder The primary characteristics of Asperger s Disorder are the same as those of Autistic Disorder, with the exception that there is no significant delay in language development or in cognitive development in children before the age of three. It is unclear whether high functioning Autistic Disorder and Asperger s Disorder are separate entities. However treatment programs for children with high functioning Autistic Disorder and Asperger s Disorder are identical. The difficulties experienced by children with Asperger s Disorder are often more evident when interacting with other children than with adults. Their difficulties include some or all of the following: topics of intense interest with a lack of awareness that others do not share interest in their obsession; 4

5 narrow range of interests; difficulty establishing and / or maintaining relationships and friendships; impaired use and understanding of non-verbal behaviours; difficulties with conversation skills; inflexibility of thought and behaviour; learning difficulties at school; difficulty understanding emotions in self and others; and literal interpretation of language problems with sarcasm, metaphor and jokes. Pervasive Developmental Disorder Not otherwise specified (PDD-NOS, also known as atypical autism) PDD-NOS is used when there is impairment in social interaction and communication and the presentation of stereotypical patterns of behaviour or interests, but not all of the features of ASD or another PDD are identified. Children with PDD-NOS have severely impaired social skills similar to those found in Autistic Disorder and Asperger s Disorder, but are only significantly impaired in one of the other two areas, communication or behaviours. They may or may not have delays in the development of intelligence. Rett s Disorder Rett s disorder appears only in females and is characterised by deteriorating cognitive and physical development (usually occurring between 6 and 12 months of age) following a period of normal development. Rett s Disorder is rare and will not be discussed further in this Education Module. However, children with Rett s Disorder are eligible for services under the Australian Government s Helping Children with Autism package. Childhood Disintegrative Disorder Childhood disintegrative disorder is characterised by deterioration in cognitive, language and social functioning following a period of at least two years of normal development. The child with Childhood Disintegrative Disorder loses previously acquired skills such as language, social skills, bowel or bladder control, play and motor skills. Childhood Disintegrative Disorder is rare and will not be discussed further in this Education Module. However, children with Childhood Disintegrative Disorder are eligible for services under the Australian Government s Helping Children with Autism package. 5

6 Diagnosis of ASD The diagnosis of ASD is currently made on the basis of observed behaviours or absence of certain behaviours, as well as the individual s developmental history. These are described in two publications that guide diagnosis: the DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, and ICD -10 International Statistical Classification of Diseases and Related Health Problems. ASD is the focus of this Education Module. ASD is characterised by impairments in three areas of development and functioning: social interaction, verbal and nonverbal communication, and restricted and repetitive interests, behaviours, and routines. These impairments are usually present before the age of three and features can vary markedly. The majority of children with Autistic Disorder also have low general intelligence (IQ < 70). However, around 10 percent demonstrate high intelligence, with this sometimes occurring in a particular area such as maths, art, music, or computer studies. Those children without an intellectual disability are often referred to as having high-functioning autism. Children with a diagnosis of Asperger s Disorder do not have associated intellectual disability; however some may have learning difficulties. In addition to the difficulties identified above for children with Asperger s Disorder, children with ASD will have some of the following features: - difficulty with the use of eye contact; - difficulty with the use and understanding of gestures; - difficulty sharing interests with others; - difficulties with, or no, verbal language; - echolalia (i.e. repetition of words spoken to them); - delayed development of receptive and expressive language; - sensory sensitivities; - motor impairments; - difficulty with, or absence of symbolic or imaginative play; - unusual preoccupations; - stereotyped behaviours; - a preference for routines; and - impaired social skills. 6

7 Prevalence and early intervention Research suggests that ASD affects at least 1 in 160 children, with Autistic Disorder being the most common. ASD is more commonly diagnosed in boys than in girls at a rate of four to one. There is no known cure for ASD, however, there is now significant evidence to indicate that early intervention, specialised therapy, education and support for young children with an ASD and their families make a significant difference to their long term outcomes. Early concerns may be noted by the family, the child s general practitioner, a maternal and child health nurse, childcare staff or kindergarten teacher. Early warning signs The Raising Children Network has published a list of early warning signs or red flags that are usually evident in children with ASD in their first two years. While no single indicator will necessarily mean a child has ASD, children showing a majority of these signs should be referred to an appropriate health professional for further screening and assessment for ASD. By Raising Children Network Area Social Red flags The child: doesn t consistently respond to her name doesn t smile at caregivers doesn t use gestures independently for example, she doesn t wave bye-bye without being told to, or without copying someone else who is waving doesn t show interest in other children doesn t enjoy or engage in games such as peekaboo or patty cake. Communication The child: doesn t use gestures for example, she doesn t raise her arms when she wants to be picked up or reach out to something that she wants doesn t use eye contact to get someone s attention or communicate for example, she doesn t look at a parent and then look at a snack to indicate she wants the snack doesn t point to show people things, to share an experience or to request or indicate that she wants something for example, when she s being read to, she doesn t point to pictures in books and look back to show the reader doesn t engage in pretend play for example, she doesn t feed her baby doll doesn t sound like she s having a conversation with you when she babbles doesn t understand simple one-step instructions for example, Give the block to me or Show me the dog. Behaviour The child: has an intense interest in certain objects and becomes stuck on particular toys or objects focuses narrowly on objects and activities such as turning the wheels of a toy car or lining up objects is easily upset by change and must follow routines for example, sleeping, feeding or leaving the house must be done in the same way every time 7

8 Sensory repeats body movements or has unusual body movements such as back-arching, hand-flapping and walking on toes. The child: is extremely sensitive to sensory experiences for example, she is easily upset by certain sounds, or will only eat foods with a certain texture seeks sensory stimulation for example, she likes deep pressure, seeks vibrating objects like the washing machine, or flutters fingers to the side of her eyes to watch the light flicker. Sourced from the Raising Children Network's comprehensive and quality-assured Australian parenting website Role of the health professionals The team of professionals who work with children with an ASD to provide a diagnosis and interventions includes the GP and medical specialists, mainly paediatricians and child and adolescent psychiatrists, and allied health professionals, mainly psychologists, speech pathologists and occupational therapists. Each professional plays an important but different role in contributing to the assessment and differential diagnosis of an ASD from other childhood developmental disorders. This Education Module will cover information about the following health professionals: General practitioner Child and adolescent psychiatrist Paediatrician Psychologist Speech pathologist Occupational therapist These professionals each have training and expertise and work as members of a team to benefit children with ASD and their families. Research shows that the best outcomes for children with ASD are achieved when health and education professionals work collaboratively using an interdisciplinary team approach to provide high standards of intervention that includes support for parents and carers. The roles of GPs and medical specialists will only be covered briefly, as most readers will be familiar with these. The roles of psychologists, speech pathologists and occupational therapists will be outlined in greater detail, including their qualifications, assessments and treatment approaches. General practitioner General practitioners are usually the first point of contact for people seeking assistance and referrals for their health care needs. The Royal Australian College of General Practitioners (RACGP) defines general practice as the provision of primary continuing comprehensive whole-patient medical care to individuals, families and their communities. The College states that during the course of managing their patients, general practitioners may make appropriate referrals to other doctors, health care professionals and community services as they must be able to make a total assessment of the person's condition without subjecting a person to unnecessary investigations, procedures and other treatment, and that general practitioners have both core clinical 8

9 skills and the ability to assess and address the learning needs arising from differing clinical contexts over a professional lifetime. Sourced from The Royal Australian College of General Practitioners (RACGP) Child and adolescent psychiatrist The Royal Australian and New Zealand College of Psychiatrists (RANZCP) defines psychiatrist as a qualified medical doctor who has obtained additional qualifications to become a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems. Psychiatry has a number of specialist practice areas, with child and adolescent psychiatry being one such speciality. The RANZCP is responsible for the specialist training and examination of doctors as psychiatrists in Australia and New Zealand. Psychiatry training takes a minimum of five years in a range of settings with various patient groups and a full range of psychiatric problems. This is done under mandatory supervision by fully qualified and experienced psychiatrists. In addition, candidates are also subject to rigorous examinations to ensure their competencies. Candidates who have fulfilled these training and examination requirements can be elected as Fellows of The Royal Australian and New Zealand College of Psychiatrists. Sourced from The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Paediatrician The Paediatrics and Child Health Division of The Royal Australasian College of Physicians (RACP) recently published a Consensus Approach for the Paediatrician s Role in the Diagnosis and Assessment of Autism Spectrum Disorders in Australia. A full text of the Consensus can be downloaded from the RACP website: Psychologists Qualifications A registered psychologist has completed a minimum of six years of professional training. This training includes the completion of a four-year Australian Psychology Accreditation Council (APAC) endorsed university degree followed by an APAC endorsed postgraduate degree or two years supervised professional training. Through postgraduate and further training, some psychologists choose to specialise in assessing the intellectual, social and behavioural functioning of children, and in diagnosing and treating ASD. A list of psychologists specialising in ASD can be found on the Australian Psychological Society website at Assessment Professionals who are concerned about a child s intellectual, behavioural, social and/or communication abilities should refer the child for assessment by a psychologist. This will provide information about whether the child is developing at an appropriate level for his or her age. For example, a child should be referred for assessment by a psychologist if he or she is exhibiting unusual levels of fear, stress, and anxiety; has difficulty socialising; is experiencing difficulties with learning; or is engaging in unusual behaviours. When psychologists assess children they evaluate whether the child is developing at an age-appropriate 9

10 level. They do this using a range of assessment processes. A psychologist s assessment of a child for ASD involves interviewing significant people in the child s life. These people usually include parents, other carers, and teachers. The psychologist would also observe of the child in different settings, and administer formal tests including ASD screening tools, tests of intelligence, and tests of adaptive behaviour. Areas that the psychologist will look at as part of this process include: how the child responds emotionally to physical contact; how the child responds to his or her name; the child s capacity to express themselves and to reason and problem solve; the child s ability to perform everyday activities; evidence of unusual levels of fear, distress, or anxiety; the child s interest in other children; the child s play; and the quality of the child s interactions with adults and other children. The psychologist will also look at the behaviour and communication skills of a child in different settings including home, pre-school centres, and/or school. In particular, the psychologist will look for: evidence of stereotypical or repetitive body movements or mannerisms like rocking or hand flapping; distress at changes to daily routines; interactions with other children and adults; the child s manner of communicating wants and needs; unusual formation and use of words, phrases, and sentences; unusual or intense interests in particular topics or activities; use of eye contact, gestures, and facial expressions; and abnormal or repetitive use of language. The information gathered during this process is then combined with other available information (in particular the results of a language assessment performed by a speech pathologist), to provide the psychologist with a clinical picture of the child s development and current abilities. Using a set of criteria that come from the DSM-IV-TR, the psychologist will consider if the child meets the criteria for autistic disorder, Asperger s syndrome, or PDD-NOS or whether a different diagnosis or further assessment is warranted. A DSM-IV-TR specific diagnosis has been identified by the Federal Government as a requirement for access to services under its Helping Children with Autism package. 10

11 Formal assessment Formal assessment may involve the administration of instruments that have particular relevance to the diagnosis of ASD. The main tests that may be used include: The Child Autism Rating Scale (CARS); Autism Detection in Early Childhood (ADEC); The Social Communication Questionnaire (SCQ); The Autism Diagnostic Observation Schedule (ADOS); and The Autism Diagnostic Interview Revised (ADI-R). In addition, psychologists often administer more general tests to gather information about the child s developmental level or intellectual functioning. These tests include the: Psychoeducational Profile (PEP); Mullen Scales of Early Learning; Weschler Pre-school and Primary Scale of Intelligence (WPPSI); Wechsler Intelligence Scale for Children (WISC); Universal Nonverbal Intelligence Test; and Stanford-Binet Intelligence Test. Psychologists will also administer scales of adaptive functioning, such as the Vineland Adaptive Behaviour Scales, to gather information about how the child copes in everyday situations. Formal assessment provides the psychologist with a more comprehensive understanding of a child s difficulties, along with their intellectual abilities and adaptive functioning. Assessments of this kind also provide information about the child s strengths and weaknesses and their ability to learn new skills. This information is used to guide both the direct treatment of a child with ASD and the work of other health professionals involved in delivering care. Treatment In addition to being involved in the assessment and diagnosis of a child, a psychologist works in conjunction with other health professionals and develops a treatment plan that is tailored to the child s needs. Intervention by a psychologist is important for children with an ASD. Psychologists use a range of techniques to help children with ASD cope better in their everyday lives, including: behavioural interventions to reduce specific behaviours that are undesirable, while simultaneously promoting new behaviours and skills that are desirable. skills training, including: 11

12 o social skill development which may involve the use of role-play, social/behavioural scripts, and social stories (scenarios and stories that explain social situations in a clear, visual way and which set explicit rules and expectations in order to make it clear to a person exactly how he or she is expected to behave in that situation), o improving interaction skills such as making eye contact and using appropriate greetings, as well as increasing a child s understanding of emotions and social cues, and o communication skills such as listening, turn-taking, and beginning and ending conversations. emotional regulation particularly helping children to manage their anxiety levels. Because children with ASD have difficulty understanding their environment and the behaviour of others, they are often at high risk of developing anxiety disorders. Psychologists work with children who have ASD, as well as with their families and other carers, to teach them how they can monitor and reduce anxiety. For example, this may involve teaching a child and family strategies for dealing with changes in routine (which can sometimes trigger an anxiety attack) and promoting an environment that is highly structured and predictable. psychological interventions to help children to develop a greater awareness of their difficulties and emotions, and of conventional behaviour. In addition to delivering treatment to children with ASD, psychologists work with parents and other carers, and with other professionals such as teachers so that these people can develop strategies to help them work with children and assist children to function better in the home and school environment. Psychologists also provide family members and other carers, teachers, general practitioners, and other relevant health professionals with further information about the diagnosis as well as information about related support services to assist with the child s development and learning. Children with an ASD often need assistance when facing significant milestones such as their first year of school or their entry into adolescence, so they may require intervention by a psychologist over the course of their lives during such transitions. Speech pathologists Qualifications Speech pathologists are tertiary educated professionals who have completed a minimum four year undergraduate degree or two year graduate-entry masters degree. Speech pathology courses provide extensive training in the areas of child development, disordered and delayed speech, and language development, including social communication and interaction skills, and appropriate remediation and intervention. It is important to seek a practitioner who has the skills and expertise to provide assessment and treatment for children with ASD. The Speech Pathology Australia website provides a list of members who have a special interest in working with children who have developmental disorders such as ASD. 12

13 Assessment Referral to a speech pathologist for assessment is appropriate when a parent, teacher, or other professional is concerned because a child is demonstrating any of the following difficulties: delayed onset or delayed development of speech and language; regression or loss of communication skills; problems with understanding spoken language; frustration and challenging behaviours resulting from communication difficulties; difficulty with conversation, forming relationships, and socialising with peers, family members, and others; and learning difficulties. Speech pathologists are specialists who are able to identify whether a child s language and communication development is delayed or different from that of other children, and shows signs typical of ASD. Assessment of the language and communication skills of a child suspected of having an ASD involves a number of steps. The speech pathologist will interview the parents and observe how the child interacts with family members and other people in different contexts such as home, preschool or school. Adequate hearing is crucial to the development of speech and language. If the child s hearing has not been formally assessed by an audiologist, then a referral should be arranged for this assessment. The type of assessment and the tools required to assess a child suspected of having an ASD will vary greatly and will depend on the age and skills of the child. The assessment usually incorporates examining one or more of the language areas of speech, comprehension and pragmatics (social communication). Developmental assessments and observation of play and interaction are used by the speech pathologist to assess verbal and non verbal early communication skills. One of the areas that the speech pathologist will assess is joint attention. Children with an ASD have difficulty sharing their focus of attention with other people. Speech pathologists consider the child s use of eye gaze, attention and responsiveness in shared activities. The speech pathologist will assess the child s use and understanding of non-verbal communication such as the use of gestures to communicate, for example raising arms to be picked up, and the use of pointing to indicate what he or she wants, or to show things of interest. The child s development of early verbal communication will be assessed and will include the range of sounds, words and word combinations being used in a meaningful way. The speech pathologist will note the presence of echolalia, which is the repetition of words said by others and is commonly seen in children with ASD. Many children with an ASD have difficulty with receptive language; that is, understanding what is being said to them, and understanding non-verbal communication. Younger children often seem to have difficulty with responding to their names, identifying familiar people, identifying common objects and actions, and following simple instructions. Social communication is recognised as a specific area of difficulty in children with an ASD. The speech pathologist will observe the child s ability to initiate, continue and maintain the topic of a conversation, and 13

14 whether the child prefers to talk about his or her own topics of choice. A pragmatic language assessment will determine if the child is developing a range of communicative functions such as greeting; requesting; gaining attention; commenting; giving information; asking for help and asking questions. The speech pathologist will make careful observation of the child s play skills to determine the presence of imaginative play, or the presence of unusual or repetitive play. Formal Assessment At the stage when a child has developed speech and language, developmental checklists and formal language tests may be used to determine whether the child s receptive and expressive language and articulation is age appropriate, delayed or disordered. Speech pathologists use tests such as: The Clinical Evaluation of Language Fundamentals 4 (CELF - 4); The Preschool CELF P2; Rosetti Infant-Toddler Language Scale; and Preschool Language Scales 4 (PLS - 4) Additional assessment may confirm any difficulty with understanding complex instructions, difficulty understanding inferences, humour, and double meanings, and whether the child is interpreting other people s language literally. Many children with an ASD also use pedantic or adult like language and may have speech which is marked by unusual prosodic features such as a monotone voice or an unusual accent and poor volume control. Pragmatic language is assessed in a variety of ways including parent and teacher reports and the completion of profiles and questionnaires, observations of the child in a range of different environments, as well as through the use of formal pragmatic language tests, such as: The Children s Communication Checklist 2 (CCC 2); The Test of Problem Solving 3 (TOPS-3); and The Test of Pragmatic Language 2 (TOPL -2). The information gained from the speech pathology assessment will be considered in conjunction with information from the other members of the interdisciplinary team to determine whether a child is given a diagnosis of an ASD. Treatment The speech pathologist will design and implement a program in partnership with the parents and other key people, such as educators, based on the individual needs of the child. Information gained during the interdisciplinary diagnostic assessment process will be used to plan the child s intervention program and will incorporate the child s receptive and expressive language and communication skills. For the child who has not yet developed effective verbal communication, this may involve teaching another way of communicating using an augmentative communication system, through the use of photos, pictures, gestures and signing. This form of therapy will develop the child s receptive and 14

15 expressive language skills. Therapy for the more verbal child may include the development of vocabulary, syntax, semantics and articulation. Other areas of focus may include teaching the child how to communicate effectively by developing listening skills and comprehension, turn taking, conversation skills and the use and understanding of facial expressions and body language. The use of visual aids such as timetables, schedules, behavioural scripts and social stories assist the child with organisation, to cope with change and transitions, as well as improving understanding and receptive language. As recommended by current research, the speech pathologist s goals for intervention will also incorporate predictable routines, motivating activities and generalisation of skills to different environments in which the child functions. Speech pathology sessions can be delivered in a variety of ways, including providing individual therapy, working in small groups and working within a classroom. Speech pathologists also work in home-based programs to train parents to generalise communication strategies in everyday situations. Occupational therapist Qualification Occupational therapists are tertiary educated health professionals who have completed a minimum four year undergraduate degree or two year graduate-entry masters degree, and whose training includes knowledge about health conditions and child development. Occupational therapists assist children to engage in occupations (school, play and self care) and support their participation in important life roles with their families at home, school and in their local communities. It is important to seek a practitioner who has the skills and expertise to provide assessment and treatment for children with ASD. The OT Australia website provides a list of members who have a special interest in working with children who have developmental disorders such as ASD. Assessment The OT will talk with the parents or carers (the child, if appropriate) and other professionals about a child s strengths, weaknesses, likes, dislikes, and behaviour. OTs use their knowledge of children s activities, and their sensorimotor, cognitive, language and social-emotional development as the basis for understanding the challenges a child faces, and the abilities he or she possesses. An OT will use both formal and informal assessments to identify the nature of the child s difficulties. Occupational therapy assessment may identify problems in one or more of the activities that the child undertakes at home, at school, in the playground, or in the community. Formal assessment Formal assessment may include: developmental assessments such as Bayley Scales, Batelle Developmental Inventory, the Carolina Curriculum or the Hawaii Early Learning Profile (HELP); motor assessments such as the Peabody Developmental Motor Scales; 15

16 Treatment sensory measures such as the Sensory Profile; or measures for evaluating performance of everyday activities, such as the Canadian Occupational Performance Measure. The aim of an occupational therapy session is to improve a child s ability to perform a wide range of play, self-care, social, and school-related activities to maximise the child s skills for living. The OT will consider the physical, social, and cultural circumstances of each child before developing a treatment plan that is tailored to the child s development and needs. The OT will work collaboratively with the child and parents to identify goals for intervention and develop a plan of action with short term objectives that they will work on together. As part of this process the OT might modify and provide more structure for the activities the child finds difficult; for instance, dressing, playing with other children, or coping with change. Over time, the OT will also work with the child and family to assist the child to learn new ways of doing things and developing new skills. Occupational therapy sessions for a young child might involve: developing play skills that include social interaction, sharing, and taking turns; modelling and support for parents learning to interact and play with their child; teaching self-care activities like toileting, bathing, and feeding; engaging in activities to improve the child s fine and gross motor skills; behaviour management such as learning to sit and wait; and strategies and interventions that address sensory difficulties. For a school aged child, an occupational therapy session might involve additional activities such as active movement, role play, stress reduction techniques, handwriting practice, or participation in a social skills group with other children. As the child gets older, these activities might expand to include organising and managing friendships, interests, and responsibilities. OTs make use of visual strategies such as visual timetables, social stories, and visual cue-cards. They may teach the child self-management or self-regulation strategies to cope with challenges such as personal organisation, social skills, or sensory sensitivity. For instance, the OT may work with the child and the teacher to modify classroom expectations to allow new ways to demonstrate knowledge, despite the child s poor handwriting and difficulties with personal organisation. In summary, OTs are skilled in a variety of types of intervention: promoting and maximising a child s occupation performance, health, well-being, and participation; assisting a child to develop new skills; ensuring new skills are maintained and built upon; modifying the environment or activity to ensure a child can participate in a meaningful way; and 16

17 implementing steps to prevent the development of behaviours or performance that would diminish a child s strengths or abilities in the long term. Team management Children with ASD have many complex problems that impact upon their ability to function independently. In addition, the lives and wellbeing of carers and families of children with ASD can also be adversely affected. Effective management of ASD requires intervention from a number of health professionals. This interdisciplinary approach is shown to be effective. The following strategies should be considered by members of the interdisciplinary team to achieve quality outcomes for children with ASD: 1. Each health professional seek to become aware of the roles of other health professionals. 2. Clear communication between all health professionals of each others intervention goals, objectives and strategies. 3. Use written communication, and always maintain a record for your own information. 4. Participate in regular communication and sharing of information between health professionals including exchange of progress reports and other key information, such as when the child misses appointments. 5. Include key relevant findings based on professional clinical assessment. 6. One of the health professionals takes on a coordinating or case management role, including consideration of case conferences with other health professionals, parents and carers where necessary, to discuss the child s progress and to plan the next stages of intervention. 7. Explore networking opportunities with other health professionals by inviting or joining them in your local area. 8. Facilitate active involvement of parents and carers. 9. Empower and assist parents and carers in their decision making by providing relevant information. 10. Refer parents and carers to additional services, including those from State Governments, local health centres and other specialist services. 17

18 Services available for children with ASD Government funded services for children with ASD The Helping Children with Autism package is an Australian Government initiative introduced on 1 July 2008, and being implemented by the Department of Health and Ageing; and Department of Families, Housing, Community Services and Indigenous Affairs. The package includes the introduction of new items under the Medicare Benefits Schedule (MBS), funding to provide training for teachers and playgroups, and funding for early intervention and individuals assistance packages for children and their families. MBS Items for children with an ASD Under the Australian Government s Helping Children with Autism package, Medicare rebates have been introduced for consumers for the assessment of children who may have ASD and for treatment once diagnosed with ASD. Medicare items have been introduced for: 1. Paediatricians and child psychiatrists to diagnose and develop a treatment plan for children under the age of 13 years upon referral from a GP; 2. Psychologists, speech pathologists and occupational therapists to provide up to four sessions (in total per child) in the assessment of a child suspected of having ASD; and 3. Psychologists, speech pathologists and occupational therapists to provide up to 20 sessions (in total per child) of early intervention treatment consistent with the treatment and management plan of the referring practitioner, following a diagnosis of ASD. Treatment may be provided to children under the age of 15 years, who were younger than 13 years of age at the time of receiving their treatment and management plan. A typical pathway to the assessment and intervention process of children with ASD under the new Medicare arrangements can be found on page 20 of this Education Module. Please visit the Department of Health and Ageing website for more information: Other programs under the Helping children with Autism package There is also funding through the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) for the following services: Autism Advisors to provide information and referrals for the most appropriate early intervention services, including access to programs and services. Following a diagnosis of an ASD, the family can contact an Autism Advisor in their state or territory to receive information on available funding and eligibility. Details for locating an Autism Advisor can be found on the FaHCSIA website. 18

19 Funding for early intervention services through an interdisciplinary team for children aged 0 to 6 years with ASD. This will facilitate improved emotional, cognitive and social development prior to the child commencing school. Eligible families can access services to the value of $12,000 ($6,000 per financial year) through the panel of Early Intervention Service Providers. Families must apply for these services using an application form which is also available on the FaHCSIA website. PlayConnect Playgroups offering play based learning opportunities for children and support networks for families and carers. Early Days family workshops to assist families and carers better support their children who have recently been diagnoses of ASD or are starting the assessment and diagnosis process. FaHCSIA website providing information and resources about ASD for parents, carers and professionals. Please visit the FaHCSIA website for more information: px Other funded services There are a number of other publicly funded services available. These services and their eligibility criteria vary across Australia. The autism association in your State/Territory usually has a listing of these services. Contact details of your State/Territory autism association can be found at the end of this module as well as on 19

20 Typical service pathway to assessment and intervention A typical service pathway to access services under the new Medicare item numbers is shown on the following page. 20

21 Directory of autism associations ACT Autism Asperger ACT Ph: (02) NSW Autism Spectrum Australia (ASPECT) Ph: (02) NT Autism NT Ph: (08) QLD Autism Queensland Ph: (07) SA Autism SA Ph: 1300 AUTISM ( ) TAS Autism Tasmania Ph: (03) VIC Autism Victoria Ph: (03) or WA Autism Association of Western Australia Ph: (08)

22 Links to allied health professional associations The following resources can direct you to psychologists, speech pathologists, and occupational therapists who practise in the area of ASD. Australian Psychological Society Autism and PDD Identified Practitioner List You can also call on Speech Pathology Australia You can also call on (03) The Australian Association of Occupational Therapists You can also call on (03) Acknowledgement: This Educational Module has been developed with finding from the Australian Government Department of Health and Ageing. 22