ACCESS TO THERAPY FOR CHILDREN WITH AUTISM: A POPULATION-BASED ANALYSIS

Children with autism spectrum disorder (ASD) represent a growing category of children who have special health care needs. Recent Centers for Disease Control and Prevention (CDC) estimates suggest that 1 in 88 children in the United States have an ASD (CDC, 2012). Due to difficulty with communication, social skills, and restricted and/or repetitive behaviors that comprise current diagnostic criteria (APA, 2013), children with ASD require significant medical, mental health, and therapeutic supports that contribute to greater heath care utilization costs than persons without ASD (e.g., Shimabukuro, Grosse, & Rice, 2008). Therapies such as occupational, physical, and speech therapy are among recommended services provided to remediate functional or behavioral needs (Johnson & Myer, 2007). Studies investigating access to healthcare services such as diagnostic and genetic screening or primary care are frequently published in the literature; however, few studies examine access to needed therapy services. The purpose of this study was to examine population-based trends in therapy service access in children with ASD compared to children with attention deficit hyperactivity disorder (ADHD) and cerebral palsy (CP) using two waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN). Additionally, this study aimed to identify predisposing, enabling, and need characteristics that predicted lack of access to therapy across the two cross-sectional points in time. Parent-reported contextual characteristics that potentially limited access to needed therapy services were compared between survey time periods (2005-06 and 2009-10). Results of this study suggest that children with ASD are significantly more likely to not receive needed therapy services than children with attention-deficit hyperactivity disorder (ADHD), but are similar in their unmet need for therapy compared to children with cerebral palsy (CP). Significant predictors of an unmet need for therapy were having a current ASD diagnosis, age, uninsured status, greater functional limitation, and having a reported behavior problem. The only access problem that differentiated children from ASD from ADHD and CP was “difficulty finding a provider accepting insurance”. Implications of these results are discussed in the context of Andersen’s Behavioral Model of Health Service Use and recommendations for future research are presented

Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study.

Objective: To examine the feasibility, safety, and acceptability of a manualized protocol of occupational therapy using sensory integration principles for children with autism. Methods: Ten children diagnosed with autism spectrum disorder ages 4-8 years received intensive occupational therapy intervention using sensory integration principles following a manualized protocol. Measures of feasibility, acceptability and safety were collected from parents and interveners, and fidelity was measured using a valid and reliable fidelity instrument. Results: The intervention is safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocol with adequate fidelity. These data provide support for implementation of a randomized control trial of this intervention and identify specific procedural enhancements to improve study implementation

Cross-cultural comparison of sensory behaviors in children with autism.

Parents of children with autism frequently report that their children exhibit unusual responses to sensory experiences. Little research is available, however, describing how parents\u27 and children\u27s culture and environment might influence parents\u27 reports of their children\u27s behaviors. This study compared the frequency of parent-reported responses to sensory experiences in children from two countries-Israel and the United States. We administered the Short Sensory Profile to primary caregivers of children with autism spectrum disorders (ASD) and typically developing peers. Results indicate that Israeli parents reported unusual responses to sensory experiences less frequently than U.S. parents for both ASD and typically developing children. U.S. children with ASD demonstrated significantly greater difficulty in the Auditory Filtering and Visual/Auditory Sensitivity domains than Israeli children with ASD. These findings indicate a need to further explore the influence of culture and environment on caregiver perceptions of the responses to sensory experiences of children with ASD

Parasympathetic functions in children with sensory processing disorder.

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child\u27s ability to engage in everyday social, communication, and daily living skills

Prevalence and Utilization of Medical Care Services in Persons with Autism Spectrum Disorder using Medicare Claims

Objective: To characterize the prevalence of autism spectrum disorder (ASD) among persons in Medicare claims and contrast with prevalence documented during disability determination in Social Security Administration (SSA) Supplemental Security Income (SSI) files. Poster presented at APHA in Chicago Illinois

Use of Medicare Claims as a Source for Research Prevalence and Utilization of Medical Care Services in Persons with Autism Spectrum Disorder Over and Under Age 65

Objective: 1. To evaluate the feasibility of using Medicare claims by determining the number of identifiable persons with autism spectrum disorder (ASD) in a three year limited data set (2008-2010) 2. To describe the structure, types, and limitations of Medicare claims files for ASD researc

Supporting the Occupational Therapy Student in the Production and Dissemination of Systematic Reviews: An Interprofessional Collaboration among Librarians and Occupational Therapy Faculty

Objectives This poster describes the outcomes of a curriculum-based collaboration between librarians and OT faculty (‘collaboration’) to enhance graduate student skills for conducting a systematic review (SR); the collaboration included database instruction, bibliographic management software, and culminated in student presentations to healthcare practitioners for continuing education credit. Three outcome areas are discussed: impact of the collaboration on student satisfaction and perceived competence; characteristics of the included literature; and the dissemination of SR findings to healthcare practitioners. Methods Three librarians participated in the instruction and the institutional repository (Jefferson Digital Commons; JDC) deposits. A total of 132 students over a period of two years (2013-2014) completed the curriculum, engaging with librarians and OT faculty to iteratively build on skills. At the conclusion of their curriculum, the capstone presentations were recorded and made freely available through the JDC. Quantitative data were examined with descriptive statistics in SPSS, and qualitative data were thematically coded by hand: course evaluations, practitioner attendance, bibliographic evaluations of the systematic reviews, and download statistics from the institutional repository. Results Students reported on open-ended course evaluation questions that among the top three concepts learned was ‘how to conduct a replicable and effective search.’ On multiple answer questions 83.6% of students selected the ‘collaborative librarian-faculty lecture’ as among the most helpful lectures offered, and 78.2% selected ‘working with librarian staff and course mentors to develop a search strategy’ as highly rated among course activities. Bibliographic data were extracted from 22 of 28 capstone presentations available for analysis (2013-2014) in the institutional repository, which contained 305 citations from 157 journals. The average of age of included articles was 4.8 years (SD=4.2, Range=0-24). Among the top 10 cited journals were 2 occupational therapy, 5 rehabilitation, and 3 specialty. Overall health care practitioner attendance at student capstones from 2012-2014 was 323. JDC recordings (as of 1/6/2015) had been accessed from 25 different countries, and are located most frequently via Google, JDC, and GoogleScholar. The total number of views was 1,446, and the total number of hours viewed was 163 hours. Conclusions Librarian-faculty collaborations resulted in high student perception of competence to conduct systematic reviews, utilization of a broad variety of peer-reviewed journals, and enhanced dissemination of evidence

Enhancing Occupational Therapy Student Systematic Reviews: An Occupational Therapy Faculty and Librarian Collaboration

Objective: To describe the outcomes of a curriculum-based collaboration between Occupational Therapy faculty and librarians (‘collaboration’) to enhance graduate student skills for conducting and disseminating a systematic review (SR

An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial.

This study evaluated a manualized intervention for sensory difficulties for children with autism, ages 4-8 years, using a randomized trial design. Diagnosis of autism was confirmed using gold standard measures. Results show that the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) than the Usual Care control group (n = 15). The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol, and provides support for the use of this intervention for children with autism. Findings are discussed in terms of their implications for practice and future research

Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source.

BackgroundResearch on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs.MethodsWe conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending.FindingsThe majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries.ConclusionsPublic health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities