1. 14 Professionals and ASD
1.1. Speech Language Pathologists

What is the role of a Speech and Language Pathologist (SLP) in working with a child with Autism Spectrum Disorder (ASD)?

  • The role of the SLP when working with a child with ASD is to assess their speech, language, and communication skills and provide services to effect significant changes within the following areas:
  • Speech – articulation and intelligibility of speech
  • Language skills – the understanding and use of language (also known as receptive/comprehension and expressive skills)
  • Communication skills - requesting skills, commenting, conversational skills, etc.
  • The social use of language - pragmatic language skills
  • Reading skills – the ability to decode words and read with meaning/comprehension
  • Written language skills – the ability to write for a variety of purposes
  • Vocal quality – the rate, rhythm, and speaking style
  • Augmentative and alternative communication (AAC) – sign language, Picture Exchange Communication System, voice-output devices such as GoTalk or iPad/iPhone with Proloquo2go.

What are some signs a child may require the assistance of a SLP?

The child may exhibit one or more of the following signs:

  • The child is not using any spoken words or is not using spoken language in a meaningful way
  • The child is not understood by unfamiliar people (e.g., babysitter, daycare provider, teacher, relatives, etc.) 
  • The child is not combining words to form lengthy phrases in order to request/ask for items that he/she wants
  • The child is not using aspects of grammar that would be expected at their chronological age (e.g, pronouns – I, you, he, she, we, they, etc.; past tense verbs – jumped, ate, drank, etc.; present progressive tense verbs – is [verb ing, for example, The dog is barking.)
  • The child is not using language for a variety of purposes such as requesting items, requesting attention, requesting help/assistance, answering yes/no questions, answering and asking Wh-questions (who, what, where, and when), requesting information, and for conversation purposes

Can a child see a SLP through the school board? Who would pay for this?

The child can often see an SLP through the school board; however, the type of intervention/services provided varies from school board to school board throughout Ontario. Many school boards have SLPs on specialized ASD teams. These professionals most typically offer only consultation services to the classroom teacher or training to the school staff on speech, language, and communication deficits in children with ASD.

There may also be school-based SLPs who may see the child for direct therapy, group therapy, assessments, consultation, or on a monitor-only basis.

There is also another service available to children within the school system and that is provided through CCAC (Community Care Access Centre). The school board SLP must make a referral to CCAC for specific disorders only such as articulation, voice problems, or stuttering. The services offered by CCAC SLPs also vary within the province. This service is also typically restricted to a set number of visits per child.

Can a child with Asperger Syndrome, who has advanced vocabulary, benefit from seeing a SLP?

Children with Asperger Syndrome may also demonstrate deficits in other areas of language and communication. Many children with AS require intensive intervention in order to develop appropriate conversational skills and social skills. They may also have difficulty extracting higher-level/abstract meaning from spoken language and/or written language (i.e., reading comprehension skills). Often their reading (decoding of words) is at a much higher level than their understanding of what they have read.

Can a SLP help teach a non-verbal child to speak?

There are emerging evidence-based approaches that do help some children acquire functional spoken communication such as the Picture Exchange Communication System (PECS). Unfortunately there is not a single method that can reliably teach non-vocal children to speak. The main concern is that the child has a functional communication system so that they can learn to request items and participate in their environments (e.g., PECS, sign language, voice output device, written language, etc.) even in the absence of speech or while speech is developing.

Can a SLP fill out and sign forms, such as Assistance for Children with Severe Disabilities and the Disability Tax Credit?

The SLP can fill out the Disability Tax Credit form but they can only comment on the area of the form specific to speech and communication skills. The disability must be significant and long lasting in order for the child to qualify under the program. The SLP has an ethical responsibility to accurately report the speech, language, and communication deficits for their clients and could jeopardize their registration to practice in Ontario if they are not honest in signing the form.

Can a SLP work with other professionals in supporting a child, such as an Occupational Therapist, or an ABA therapist?

The SLP can be a valuable team member in supporting the child with ASD. The SLP brings to any team the knowledge of typical speech and language development and the ability to assist the OT and ABA therapist/team with determining appropriate speech, language, and communication goals for programming purposes.

Can the Direct Funding Option (DFO) from the government for an IBI program be used to pay for a SLP who is working with a team of professionals?

No. The Direct Funding Option (DFO) can only be used to pay for Intensive Behaviour Intervention provided by qualified individuals. If the SLP is also dually certified as a BCBA (Board Certified Behavior Analyst) or has the equivalent qualifications then they may be paid by the parents through the DFO program. However, this SLP would then be acting as either the Senior Therapist or Clinical Supervisor on the IBI team and not solely as an SLP and therefore would be providing services encompassing many other areas of functioning beyond speech, language, and communication.

What questions should I ask a SLP when I contact them to provide service to my child?

There are a number of questions that a parent should ask the SLP in order to determine if the SLP is practicing within their ‘scope of practice’ and following the ethical guidelines of the College of Speech Pathologists and Audiologists of Ontario (CASLPO):

  • What training have you had specifically in Autism Spectrum Disorders?
  • How many children, approximately, have you treated with ASD?
  • What ages of children have you treated with ASD?
  • Have you had experience in providing service to non-vocal children or minimally vocal children with ASD?
  • Have you had formal training in evidence-based treatment such as the Picture Exchange Communication System, Pivotal Response Therapy, or Verbal Behaviour Therapy?

Can a SLP diagnose ASD? Can a SLP make a diagnosis that other professionals cannot?

SLPs practicing in Ontario cannot diagnose ASD, nor can they diagnose any disorder, including speech, language, and communication disorders. The act of diagnosing and communicating the diagnosis rests with physicians and psychologists within the province of Ontario. This is not the case elsewhere in Canada and the USA where SLPs can provide diagnoses for ASD and all other speech, language, and communication problems. It is not a matter of training as SLPs in this province undergo the same rigorous training as other SLPs. Rather, the Regulated Health Professions Act, 1991, has controlled the act of diagnosis and restricted SLPs from performing this Controlled Act.

Should a SLP provide written documentation of the assessment or treatment they provide?

Yes, the SLP should provide written documentation of the assessments and treatments provided. They are required by the College of Speech-Language Pathologists and Audiologists to keep detailed records of all contact with clients and the outcome of all assessments and treatment sessions. If a parent requests this information in writing then the SLP is obligated to provide the information.

What are different types of intervention a SLP would provide to a child with ASD? Are some therapies proven to help more than others?

There are many different types of intervention that can be provided to a child with ASD, among those are:

  • Direct one-to-one therapy
  • Small group therapy
  • Large group therapy
  • Consultation to other professionals (OT, teacher, IBI (Intensive Behaviour Intervention) team, ABA (Applied Behaviour Analysis) team)

There are also different types of therapy/treatment that may be provided. As a professional, the SLP is required to provide evidence-based practice. This means that where evidence exists for specific difficulties then the SLP must provide that treatment. However, many areas of speech, language, and communication lack evidence to guide the SLP. In these cases, the SLP must inform the client (or their parent if they are a minor) of the lack of evidence for the specific treatment that they are proposing and then they must document their own evidence through careful data collection and analysis. Currently the majority of evidence-based treatments for children with ASD fall under behaviour therapy practices. The current evidence for treatment of speech and language disorders for children with ASD can be found at: American Speech and Hearing Association (ASHA): www.ncepmaps.org/Autism-Spectrum-Disorders.php and at speechBITE: www.speechbite.com.

Are there an expected number of sessions for children with ASD?

There is no way to determine an ‘expected number of sessions’ for children with ASD. ASD is a genetic disorder with lifelong ramifications in the area of communication. All individuals with ASD are unique and present differently. Currently, there are no accurate tools or symptoms that can assist the SLP with identifying which children will become vocal/verbal and which children will make the most progress. The research and evidence for effects of intervention clearly state that early and intensive intervention offers the bests outcomes for children with ASD.

What else do I need to be aware of when working with or hiring an SLP?

You need to be aware that many individuals working with children with ASD (SLPs, OTs, teachers, etc.) do not have specific training in dealing with problem behaviour and may inadvertently reinforce inappropriate behaviours while providing therapy/intervention services. It is also your right to have informed consent for all aspects of assessment, goal setting, and treatment, meaning that the SLP should explain all assessment results fully, all goals should be explained and measured to determine progress, and the evidence for all treatment/intervention should be discussed prior to intervention.

What is the typical fee for a SLP? Is there funding available to families for SLP services?

There is not a ‘typical’ fee for private SLP services in Ontario. The Ontario Association of Speech- Language Pathologists and Audiologists (OSLA) does publish a fee schedule yearly to assist SLPs in determining appropriate fees. If the SLP you are working with is a member of OSLA then they may be able to provide the fee schedule to you for information. The 2010 OSLA recommended rates were $180.00 per hour for one-to-one services (including assessment, preparation and analysis for assessment/treatment, therapy/treatment, travel time, report writing, and telephone or e-mail consultations) and $90 - $125 per hour per client for group therapy.

  • There are some programs and charities that will fund SLP services:
  • Many families have extended health benefits that will cover a portion of SLP services.
  • Private SLP services can also be claimed under Medical Expenses on your Income Tax.
  • The Jennifer Ashleigh Children’s Charity will fund for SLP services for some families within a specific income bracket - http://www.jenniferashleigh.org/what.html.
  • The President’s Choice Children’s Charities will also fund for developmental therapies for children with Autism for some families within a specific income bracket - www.presidentschoice.ca/LCLOnline/aboutUsCharityHowWeHelp.jsp.

Will a SLP see my child in their office, in our home, or in the community?

Some SLPs may see your child in their office, clinic, in your home, or out in the community (e.g., daycare). When contacting the private practice SLP, enquire as to where they provide services and if they would provide services in alternate locations such as a daycare setting. There may also be extra travel charges (travel time + Km) for providing services out of the SLPs typical therapy setting.

Private practice SLPs are typically not allowed to provide speech and language services within publicly funded schools. However, many private schools do allow private practice SLPs to provide services within their schools.

Are there organizations or associations a SLP has to be, or may want to be affiliated with?

In Ontario the SLP must belong to the College of Speech-Language Pathologists and Audiologists of Ontario (CASLPO) as this is a regulatory body which provides public protection. The SLP may also want to be affiliated with the Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA) for federal representation, as well as, the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) for provincial representation.

If they are working primarily with children with ASD then they may also want to be affiliated with the organizations that support Autism such as Autism Ontario, Association for Science in Autism Treatment (ASAT), and Autism Speaks, to name a few.

What education must a person have to call themselves a Speech and Language Pathologist?

In order to call yourself a Speech-Language Pathologist in Ontario you must hold a Master’s degree in Speech-Language Pathology from an accredited University and be registered with CASLPO.

In order to meet the registration requirements of CASLPO, the SLP must have acquired in their academic program:

  • 270 hours of course work in basic communication
  • 200 hours of course work in related areas
  • 360 hours of course work in the major professional area which provides in-depth study of disorders of speech and language and clinical evaluation and treatment of communication disorders
  • 90 hours of course work in the minor professional area which provides study in audiology for speech language pathology majors, and
  • 300 hours of supervised university accredited clinical practicum with both children and adults representing a wide variety of communication disorders
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Interviewee: Tracie Lindblad, Reg. CASLPO, M.Sc., M.Ed., BCBA

Tracie is a Board Certified Behaviour Analyst (BCBA) with over 20 years experience working with children and youth with Autism Spectrum Disorders (ASD). Tracie is also the founder and President of Four Points, a private centre providing intensive Applied Behavioural Analysis (ABA) therapy to children with ASD. She is the Clinical Director within the ABA programs for the centre-based clients and functions as the Clinical Supervisor for clients in funded (DFO) home-based programs. Tracie has presented workshops and training sessions to numerous school boards, agencies, and organizations throughout Canada and the United States on a variety of topics related to the fields of speech-language pathology. Tracie is also a research investigator on a number of current projects within the field of ASD, ABA, and Developmental Disabilities through various agencies such as Surrey Place Centre and York University.

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.2. Social Workers

What is the role of a social worker with a child with Autism Spectrum Disorder (ASD) and their family?

Social workers can play a broad role in supporting children and youth with ASD and their families. Parents and other family members can benefit from talking to a social worker to address the various emotions and stress of having a child with ASD in the family and to ensure that their own needs are also met. This could include providing information about the diagnosis, assessment and treatment approaches, processing what the diagnosis means to parent, siblings and other family, and working together to assist the child with ASD to meet their goals.

It is beneficial to work with a social worker who has an understanding of the characteristics and gifts that someone with ASD possesses and experience working with people with ASDs. The social worker can work with the child or youth in processing friendship and relationships concerns, difficulties with social skills, mood and anxiety, and provide help in various life transitions and tasks (such as leaving high school, looking for work, developing intimate relationships, etc).

How is counselling helpful for a child with ASD?

Children with ASDs may face challenges specific to home life, school life or participation in the community. Help with family issues may include talking about family conflict, negotiation and communication, an impending divorce or separation of parents, or the loss of a loved one. With respect to school, it is can be helpful for a child with ASD to see a social worker to discuss peer interaction, stresses related to academic performance, changes in schools or classrooms, classroom placement, and behaviour in the school setting.

Ideally, the social worker will also communicate with parents or school personnel to get their perspectives on the functioning of the child in these contexts. As with other children, they will also benefit from counselling if they have experienced or witnessed abuse or trauma.

What are some signs that a child could benefit from seeing a social worker?

Children and youth with ASD experience challenges beyond those that are typical for other children. They are at increased risk for bullying, increased anxiety, or feelings of decreased self-esteem or sadness. They may recognize that they are different than their peers or express that they want to harm themselves or others. Counselling can provide a safe environment for a child to process some of their observations, concerns and worries. A social worker can also work with a child to develop goals and strategies for addressing these problem areas.

Can a child of any age benefit from seeing a social worker?

There is no precise age to determine whether a child could benefit from counselling. For counselling to be beneficial, he or she has must have some functional communication and be able to interact in a productive way with a professional. Young children often do best with experiential types of therapy such as play therapy or art therapy. Younger children (and some older ones) may have difficulty processing difficult emotions or attending for a longer period of time. Sessions may therefore need to be more frequent and shorter in length, when possible. Teens or even pre-teens may benefit from “talk therapy” with structure to the sessions facilitated by the social worker. These sessions may be complimented with joint sessions including parents and siblings.

Is it helpful for parents of children with ASD to see a social worker?

Parents and other family members of children with ASD can benefit from seeing a social worker. A social worker can work with a parent individually, provide couple counselling or family counselling. The counselling can focus on a number of areas including the adaptation to the child’s diagnosis, processing feelings about the diagnosis, providing guidance and support in addressing concerns, or helping during times of transitions. To facilitate this, the social worker will develop goals in collaboration with the family.

Can a social worker fill out and sign forms, such as Assistance for Children with Severe Disabilities and the Disability Tax Credit?

A social worker is not able to complete these forms. They can only be completed by a psychologist or medical doctor.

Can a social worker work with other professionals in supporting my child, such as an occupational therapist, or an ABA therapist?

A social worker can be an important part to any team in supporting your child. Social workers are concerned with the various systems that individuals come into contact with, and therefore value collaboration with other professionals to ensure treatment goals are consistent. Social workers are also trained to help people access resources and will be aware of suitable sources of support for the family.

Social workers often take a “case management” role in ensuring that members on the professional team are communicating with each other and have a consistent perception of the family’s strengths and needs and a collaborative plan to help the child and family accomplish their goals.

What questions should I ask a social worker when I contact them to provide service to myself or my child?

You should ask a social worker if they have had previous experience in supporting individuals with ASDs and their families, if they are a “Registered Social Worker”, their method of working with a client, their proposed length of involvement, means of assessment and treatment, how communication will occur with parents or others who are involved, and methods of billing and payment.

Can a social worker diagnose ASD? Can a social worker make a diagnosis that other professionals cannot?

A social worker cannot diagnose Autism Spectrum Disorder--only a psychologist or a medical doctor/psychiatrist can make this diagnosis. They can however assess for areas of concerns and strengths, and develop recommendations based on their assessment.

Should a social worker provide written documentation of the assessment or treatment they provide?

A social worker is required to keep records about sessions with clients and some provide written assessments and reports about work done with clients. If this is something you are interested in or require you should speak about this with your social worker. Additional fees will be applied for the time taken to write reports.

What are different types of therapy a social worker would provide to a child with ASD? Are some therapies proven to help more than others?

Social workers draw from a variety of therapeutic modalities. Some work mainly from one or two theories (for example, narrative therapy or solution focused therapy), while others take a more eclectic approach and integrate a number of therapies based on client needs and presentation. Cognitive Behavioural Therapy (CBT) has strong evidence in the treatment of anxiety disorders and depression in children and youth, and there is promising research for the effectiveness in children and youth with ASD.

Are there an expected number of therapy sessions for children with ASD? For our family?

The length of time that you are involved with a social worker depends on the nature of the problem that they are addressing, their model of intervention, the costs involved for a family, and demands of for the social worker to see other families. Often, serial involvement with a social worker is helpful in which the social worker sees the child for a period of time, closes the file when the problem is resolved, and re-opens the file if there are new challenges for the child or family at a later time.

Will a social worker see my child in their office, in our home, or in the community?

Most social workers see clients within an office setting as it is private and safe. However, some social workers can be flexible and meet clients in the community, such as at a client’s home. This is often either to observe a client in a natural setting, or as an initial step to help clients transition to the office setting.

Will a social worker be able give me information about the therapy sessions (s)he has with my 16 year old son/daughter?

Content from sessions with a 16 year old is confidential and the social worker must seek the youth’s consent to share information with another individual. The exceptions to this rule are if the client is an imminent danger to themselves or to others.

How much should I expect to pay for the services of a social worker? Is there funding available to pay for social work services?

Social workers generally have a sliding scale and their fee depends on their experience, academic qualifications and the nature/purpose of the involvement. Fees for social workers in Ontario range from $100.00 per hour to $150.00 per hour, but could be more or less than this.

Are there organizations or associations a social worker has to be, or may want to be affiliated with?

All social workers must be registered with the Ontario College of Social Workers and Social Service Workers (www.ocswssw.org). Often, they have a membership with the Ontario Association of Social Workers (www.oasw.org), but this is not required to practice in Ontario. They may also be members of organizations related to autism or other developmental disabilities.

What credentials and education must a person have to call themselves a social worker?

In order to call themselves a social worker, a professional must be registered and in good standing with the Ontario College of Social Workers and Social Service Workers (www.ocswssw.org).

The College exists to protect the public from unethical, incompetent or unprofessional behaviour of social workers and responds to complaints from the public about Registered Social Workers.

The title “Social Worker” is protected by the Social Work and Social Service Work Act. Most social workers have a Bachelor of Social Work (BSW), Masters in Social Work (MSW) or occasionally, a Doctorate in Social Work (PhD or DSW). Other degrees may be recognized as equivalent by the OCSWSSW on a case-by-case basis. A social worker signifies their registration with the College by the designation “R.S.W.”(e.g., Roy Jones, M.S.W., R.S.W.).

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Interviewee: Dr. Kevin Stoddart, MSW, PhD, RSW

Dr. Stoddart is Director of The Redpath Centre and Assistant Professor (Status) at the Factor-Inwentash Faculty of Social Work, University of Toronto. He has worked in the fields of Autism Spectrum Disorders (ASDs), Asperger Syndrome and child and adult mental health for over 25 years. For the last 15 years, his clinical focus has been children, youth and adults with mild ASDs and in particular, Asperger Syndrome. His research and publications focus on understanding the clinical and psychosocial needs of individuals with developmental disabilities, ASDs, and their families.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.3. Paediatric Dentist

What is the role of a Paediatric Dentist?

Paediatric Dental specialists are dentists who have received training in the discipline of dental care for children. This includes comprehensive training in treating those children with individualized, special needs. A Paediatric Dentist can act as a primary care dentist, such that they will see a returning base of patients and take care of their oral health on an ongoing basis. This means seeing patients at specific intervals for teeth cleaning and check-ups. Alternatively, they may act as a referral base for general dentists. In these referral-base situations, they may treat a child only once when specific care is required beyond the ability or comfort level of the general dentist.

For some children and youth with Autism Spectrum Disorder (ASD), a trip to the dentist can be a very anxiety-provoking experience. Paediatric Dentists are aware a trip to the dentist can be frightening and are equipped to meet the special needs of their young patients.

Sedation is an Option. Many Paediatric Dentists offer conscious sedation services in their practices. These sedation services can include light sedation, while other dentists offer patients a sedation option but have visiting dental or medical anaesthesia specialists administer deeper levels of sedation. Some Paediatric Dentists have access to hospital operating rooms and are able to bring their patients to these facilities for treatment. Finally, some sedation services are provided by dental anaesthesiologists and although they are not specialists in Paediatric Dentistry, they are highly trained in the field of anaesthesia for dentistry.

How does a Paediatric Dentist help a child with ASD?

Because Paediatric Dentists might see more children with ASD, they may be more familiar with the special needs children or youth with ASD might have. This is helpful when it comes to developing an effective course of treatment that can meet the needs of the patient sitting in the dental chair. In addition, Paediatric Dentists typically have reinforcing activities available to those waiting or undergoing procedures in their offices that might be of interest to those with ASD. Toys, video games and other sensory items can help to make their visit more enjoyable.

Children with ASD often experience sensory challenges. How will a dentist mitigate these difficulties in their practice?

This is one of the biggest challenges that dentists face treating children and youth with ASD. The mouth is a very sensitive place for anyone. Add a sensory sensitivity, and this makes for a huge challenge.

After slow and steady ‘systematic desensitization,’ a child with ASD and adults alike, may learn to accept the stimuli that come with visiting the dental office for regular check-ups.

A Gradual Introduction. One method of reducing the impact of multiple new sights, sounds, smells, tastes and feelings is to introduce the patient to them very slowly. The first few visits can be structured in such a way that the person with ASD is allowed to simply walk around the office and get used to the environment, see the room and touch the dental chair. The next few visits, more time can be spent sitting in the dental chair, turning on the over-head light and sitting in the dental chair. The next few visits can involve the dentist or hygienist using a toothbrush and dental mirror to look inside the mouth. These visits could happen more frequently than the usual 6 – 9 month intervals, or even monthly to help reinforce the memories of the new situations.

After slow and steady ‘systematic desensitization’, a child with ASD and adults alike, may learn to accept the stimuli that come with visiting the dental office for regular check-ups. If the treatment required provides too much stimuli, an anaesthesiologist can assist with sedation, to alleviate some of the sensory impacts a dental procedure can have on a child or youth with ASD.

‘Some people with ASD require an anaesthesiologist’

Unfortunately, some people with ASD, children and adults alike, are unable to allow invasive dental care. This is when the need for anesthesia becomes necessary. There are different levels of anaesthesia from light sedation to general anaesthesia.

Sometimes giving people with ASD lighter forms of sedation does not help. With lighter forms of sedation, the patient is still awake and is able to respond to what they are feeling. Because the feeling of light sedation can be disorienting, the patient may have difficulties understanding what is happening to them. As a result, the patient may become more agitated. In many cases, general anaesthesia is the best method of ensuring the best possible dental care is provided without causing undue stress to the patient. There are some dentists in Ontario who are trained and licensed to provide general anaesthesia services in their dental offices.

How can a family locate a dental anaesthesiologist?

Families can go online to find these dentists, or they can ask their family dentist to refer them to such clinics. As well, a family can contact the Royal College of Dental Surgeons of Ontario to find out if a particular dentist is licensed in Ontario to provide general anesthesia services. Some Paediatric Dentists have operating room privileges in a hospital; this is another method of accessing general anaesthesia for dental treatment.

In larger cities in Ontario, there are likely to be both Paediatric Dentists and dental anaesthesiologists. Unfortunately, smaller cities have fewer specialists available and possibly longer waiting times for treatment. Many families with members who have special needs end up traveling to more populated areas to access specialized services. If you live in a smaller city, you can ask a local dentist to help you find the nearest paediatric or anaesthesia specialist if local dentists are unable to provide the necessary treatment.

‘In many cases, general anaesthesia is the best method of ensuring the best possible dental care is provided without causing undue stress to the patient.’

How will a dental office accommodate families with children diagnosed with ASD?

A caring and compassionate attitude towards an individual affected by ASD and their family is paramount. Understanding the approaches that best serve the unique needs of each patient is important. With patience, many patients with ASD can successfully tolerate dental treatment.

A general dentist who treats patients with ASD should have patience and understanding. As well, the knowledge of how and when to access supportive services like a Paediatric Dentists or dental anaesthesiologists are necessary if the general dentist and the family feel that these services are required.

Will a dentist recommend solutions/practice for improving oral hygiene a home?

Dental offices have oral hygiene programs that they recommend to people based on their needs and abilities. Both the dentist and the dental hygienist should suggest different ways to help those with ASD maintain their oral hygiene. There are aids like mechanical toothbrushes and special flossing devices, to name a few, that can be recommended. In addition, families should be counseled about which foods and drinks increase the risk of tooth decay and methods to reduce this risk, such as, eating cheese and drinking lots of water.

What else do I need to be aware of when looking for a dentist who is knowledgeable about supporting children with ASD and other challenges?

Similar to searching out any professional service, families should find a level of comfort with both the dentist and the staff members within the office. All members should be welcoming and open to answer any questions or concerns that are presented. If you do not have that level of comfort, simply look for someone else. Smaller communities in Ontario, of course, are more limited with the choices available.

Please describe the training and experience of those who would be working with my child.

A general dentist has four years of dental school training. The training of Paediatric Dental specialists and dental anaesthesiology specialists includes an additional two or three year program after dental school training. A family can contact the Royal College of Dental Surgeons of Ontario to find out if a particular dentist is licensed in Ontario to provide general anaesthesia services. Many of the dental anaesthesiologists are experienced in supporting children with ASD symptoms.

Dental Hygienists and Dental Assistants complete a one year program in their disciplines. After that, there are various continuing education programs that dentists, hygienists and assistants must complete to keep their license valid. Continuing education programs are numerous and cover all of the different aspects of providing dental care, including how to provide service to people with special needs and issues around different syndromes. When it comes to treating children or adults with ASD, some dentists might have never seen a patient who falls within the Spectrum; however, others may be more experienced.

It is important to ask your dentist if they are comfortable and have experience treating patients with ASD.

 

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The interviewee: David A. Isen, Bsc, DDS.

David Isen of Sleep for Dentistry in Toronto, enjoys helping patients of all ages overcome dental anxiety. He has practiced in Toronto since graduating from his dental training in 1991, and remains an active member of his community. David was born in Toronto, Ontario and attended the University of Toronto to study neuroscience as a young adult, he then enrolled at the University of Western Ontario to study dentistry. In addition to general dental training, David received advanced training in intravenous sedation at the Montefiore Medical Centre in New York. He has been featured in the TV shows Marketplace and The Right Fit in episodes about dental phobia and anxiety. In addition, he is President of the Ontario Dental Society of Anaesthesiology.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.4. Physiotherapists

What is the role of a physiotherapist? What services does a physiotherapist provide?

A physiotherapist is a member of an interdisciplinary team. A paediatric physiotherapist is an expert in gross motor skill development. As part of a team, a physiotherapist ensures that your child is working towards their gross motor milestones and skills so that they are able to physically keep up with their peers. These are some of the activities a physiotherapist can help with:

 

  • Sitting
  • Crawling
  • Walking
  • Jumping
  • Hopping
  • Throwing
  • Targeting
  • Dribbling
  • Catching
  • Riding a bike

 

A physiotherapist can assist your child in improving their strength and endurance so they can keep up with their peers on the playground or when they are out in the community.

‘Children with ASD often achieve early gross motor milestones (sitting and walking) within normal timelines, but tend to fall behind their peers as the gross motor skills become more refined and sophisticated.’

A physiotherapist can also assist a child if s/he is recovering from an injury, such as, a broken ankle or arm.

A physiotherapist can provide:

 

  • An assessment of your child’s skills to determine their gross motor development.
  • 1:1 therapy.
  • Group based therapy.
  • Consultation to other professionals involved in providing a service to your child.

 

How does a physiotherapist help children with Autism Spectrum Disorder (ASD)?

Motor skill development. A physiotherapist can help children with ASD learn and achieve gross motor skills and milestones. Gross motor skills are the abilities acquired during infancy and early childhood. Typically developing children usually are able to stand, walk and run by the time they are two years of age. These skills are continuously built upon as the child develops, even into adulthood. With development, skills become more refined from practice and maturity.

Children with ASD often achieve early gross motor milestones (sitting and walking) within normal timelines, but tend to fall behind peers as their gross motor skills become more refined and sophisticated. Skills, such as handling a ball (rolling, catching, throwing, targeting, dribbling), bike riding and hopping are more difficult for children with ASD. As a result, specific instruction and training on how to achieve these goals and skills are necessary. These skills will impact a child’s overall participation in community activities, and their ability to interact positively with their peers will affect their overall development.

Endurance, strength, balance and coordination. A physiotherapist can work with a child to improve their endurance, overall strength and coordination of movements during complex activities. Children with ASD sometimes have low endurance and/or strength; therefore, they get tired quickly with physical activity and have a difficult time keeping up with the activities of their peers. A physiotherapist can support a child to improve these areas using various techniques, strategies and practices during each session.

‘A paediatric physiotherapist will have experience working with children who are non-verbal or are just learning to use words. A physiotherapist may also use communication devices to facilitate the sessions.’

What is the difference between an occupational therapist and a physiotherapist?

An occupational therapist (OT) is a specialist with regard to fine motor skill development. Fine motor skills reflect how a child uses their arms and hands. An OT is trained to work with a child’s upper extremities, specifically, to improve strength and coordination of arm and hand muscles.

Scenario 1. If a child has difficulty sitting in their desk for long periods of time, which professional would best support the child’s development? An OT may apply attention and sensory regulation strategies to help the child sit for longer periods of time. Differing, a physiotherapist may work with the child to improve their balance, coordination and core strength to assist them in sitting at a table. Depending on the specific needs of the child and why s/he is experiencing challenges, an assessment will determine if an OT and/or physiotherapist is best suited to support the child’s goals. In many cases, occupational therapists and physiotherapists work side-by-side to provide children with the best possible care – it’s a collaborative effort.

In summary, a physiotherapist typically focuses on physical skills – Endurance, strength, balance and coordination. An occupational therapist supports the regulation and development of fine motor skills in the hands and arms.

Scenario 2. If a child needs support doing up their buttons, zippers, holding a pencil and/or organizing materials, who would provide treatment? An occupational therapists skills are likely better suited to meet the needs of a child with these types of difficulties as they are educated and trained in the development of fine motor skills in the arms and hands.

Scenario 3. If a child has difficulty with sportsmanship with respect to winning and losing games, collaborating with teammates and learning from his/her mistakes, how would a physiotherapist support their needs? A physiotherapist can support a child to develop skills that will promote the development of positive sportsman-like behaviour.

A physiotherapist may incorporate activities that promote social skills development, interactions with peers and sessions about how to engage peers appropriately. Depending on the clinic, type of facility and treatment offered, a paediatric physiotherapist may provide small group sessions that facilitate peer interactions and group behaviour, specifically. The structure of the session, however, will depend on what the child’s needs are and how s/he progresses.

Scenario 4. If a child has difficulty walking to school or making it to school on time, who would support his/her needs? A physiotherapist may support the development of speed and endurance so that a child can navigate their way to school on time and without tiring quickly.

What are some signs a child may need the experience of a physiotherapist?

A child may need to see a physiotherapist if they are not meeting their gross motor milestones. A physiotherapist can do an immediate assessment of your child to tell you if s/he is meeting typical motor milestones.

A child may need support if they are having difficulty:

 

  • Catching and throwing a ball.
  • Hitting a target.
  • Hopping on one foot.
  • Playing with their peers.
  • Participating in community programs.
  • Learning new physical skills.
  • Sitting in a chair properly.
  • Posture.
  • Walking up stairs without relying on a railing.
  • Climbing the stairs while alternating one foot at a time.

 

Describe the structure of a physiotherapy session for a child with ASD.

A physiotherapy session for a child with ASD would be tailored to their needs. A physiotherapist will incorporate sensory or behavioural strategies depending on the needs of the child. For example, if the child benefits from using a visual schedule, this can be incorporated into their sessions. A paediatric physiotherapist will have experience working with children who are non-verbal or are just learning to use words. A physiotherapist may also use communication devices to facilitate the sessions too.

‘A physiotherapist may incorporate activities that promote social skills development, interactions with peers and sessions about how to engage peers appropriately.’

Can physiotherapists make diagnoses?

A physiotherapist can communicate a diagnosis as long as the diagnosis is related to a disease or physical disorder within the scope of their physiotherapy practice; for example, a dislocated ankle or a gross motor delay. A physiotherapist cannot provide a diagnosis of ASD.

Can a physiotherapist sign forms, such as, Assistance for Children with Severe Disabilities and the Disability Tax Credit?

Yes, a physiotherapist can generally fill out sections of these forms. A physiotherapist can fill out the Walking Section of the Disability Tax Credit form too.

Can a physiotherapist be part of an inter-professional team supporting children with ASD; for example, with occupational therapists, speech-language pathologists or applied behaviour analysts?

Yes! Physiotherapists are an important part of a team, as they address a child’s gross motor skills, balance, strength and overall endurance. They are the only professional on their team who is specialized in gross motor development. Physiotherapists can also provide consultation to your child’s applied behaviour analyst (ABA) to incorporate the development of gross motor skills; for example, physiotherapists can provide a breakdown of the skills needed to learn to ride a bike and support an instructor therapist in implementing these goals.

Can the Direct Funding Option (DFO) for an Intensive Behavioural Intervention (IBI) program be used to pay for a physiotherapist?

No, however, many private health insurance plans cover physiotherapy assessment and treatment. In some cases, charities have provided funding for physiotherapy assessment and treatment.

Are there an expected number of sessions required for children with ASD?

The number of sessions a child needs depends on the goals of the family and the child’s current skills. Typically, 1-2 sessions per week for 3 months will work towards a very specific set of gross motor skills for a child.

Where does a physiotherapist schedule sessions to work with my child?

Physiotherapists who practice in a paediatric-specific centre or clinic typically have more access to specialized paediatric equipment that is designed to meet children’s developmental needs. Alternatively, sessions can occur at the child’s home, playground, school or elsewhere in the community depending on the needs of the family and the goals of the client.

Will a physiotherapist teach parents some of the recommended rehabilitative treatments to practice at home?

Absolutely! A physiotherapist can provide support to parents or other caregivers to show them the equipment needed and/or the techniques used during physiotherapy sessions to support the child’s learning.

Physiotherapy sessions are focused on promoting independence. The activities the physiotherapist and the child work on together are completed in a clinic initially, however, these learned skills are transferrable to other environments, such as, the home, school or playground.

‘Choosing a physiotherapist who has worked with children with ASD and who has been involved with a team is also very important as s/he will be much more aware of the different professionals involved with your child.’

What else do I need to be aware of when working with or hiring a physiotherapist?

Physiotherapists can have a very broad range of training and experience. When looking for a physiotherapist to work with your child, it is important they have expertise and experience working with children. Working with children is very different than working with adults. As well, ensuring that they have access to the correct equipment is important to be able to provide the best treatment possible for your child. Choosing a physiotherapist who has worked with children with ASD and who has been involved with a team is also very important as s/he will be much more aware of the different professionals involved with your child.

‘When looking for a physiotherapist to work with your child, it is important they have expertise and experience working with children. Working with children is very different than working with adults.’

What organizations or associations should a physiotherapist be affiliated with, or regulated by?

A registered physiotherapist must be a member in good standing with the College of Physiotherapists of Ontario. As well, a physiotherapist should be a member of the professional association: Canadian Physiotherapist Association (CPA). They may also be a member of the Paediatric Division of CPA, which is a group of physiotherapists working with children across Canada.

Please describe the training and experience of those who would be working with my child.

There are many clinics and facilities that operate as a multi-disciplinary team to provide the best possible treatment for their clients. There are clinics across Ontario with a diverse team of professionals who have experience working with children with ASD. It is important to ask if the clinic’s physiotherapists work alongside other professionals to provide the best treatment possible. Other professionals include: speech-language pathologists, occupational therapists, behaviour therapists, instructor therapists, psychologists or neuropsychologist as well as music therapists. These professionals should be open to discussing their facility, their team and treatments related to providing the best possible care.

It is important that a physiotherapist has experience working with children in the past and knowledge of gross motor skill development. As well, they should be involved in continual professional development, through involvement in courses, conferences and seminars.

Please provide a breakdown of the services you provide and their costs; for example, some of the services may include:

A Formal Assessment of your child’s gross motor skills includes completion of a standardized test that allows you to see exactly where your child’s gross motor skills are compared to their peers. This assessment will give you scores and provide you with percentiles so you can see your child’s current level of skills. You may receive a full report detailing your child’s skills, scores and areas for improvement. This type of assessment can be very helpful in getting support for your child, as it will give specific information about your child’s skills and current capabilities, in addition to areas requiring support for improvement. This information may assist with getting additional education assistant (EA) support at school during recess, gym class or during other activities.

An Informal Assessment includes an observation of your child’s gross motor and physical skills. This assessment will give you a general idea of where your child is compared to his or her peers, but it will not provide you with exact scores and/or tell you how far ahead or behind your child is compared to his/her peers. This type of assessment is good if you have very specific goals that need to be worked on.

1:1 Treatment and Therapy involves the physiotherapist working 1:1 with your child. Treatment typically is focused on building your child’s skills towards the goals that you have set together with your team. Treatment may sometimes look like ‘play’ but it includes pushing your child’s physical skills to improve their gross motor skills.

Small Group Therapy provides children with an opportunity to engage their peers in small group settings. These groups may be run by a physiotherapist or physiotherapy assistant and may also include other professionals, such as, an occupational therapist or speech-language pathologist. These groups vary in price and length depending on the physical goals of the group.

Clinical Consultation can be provided by a physiotherapist to other members of your child’s team in order to assist them in supporting your child. An example of this would be consulting to your child’s IBI team to assist them in teaching your child how to catch a ball or ride a bike. A physiotherapist would generally need a few hours of time with your child and the team to support them and provide a breakdown of activities to promote his/her development. This service is typically billed at $125.00 per hour.

What specific skills/experience should a physiotherapist have to effectively support children with ASD?

The therapist should be trained and have experience working with children with ASD and other developmental challenges. The therapist should have an understanding of the challenges that children with ASD face, including sensory integration and possesses behaviour management techniques for different situations and environments.

‘Parents should feel free to ask a physiotherapist about their specific paediatric experience and coursework; specifically, how their skills apply to supporting children with ASD.’

What education must a physiotherapist have? Is there any specific education that makes a physiotherapist competent in supporting children with ASD and other challenging developmental disabilities?

Physiotherapists must complete a university degree in an accredited physiotherapy program. In most parts of Canada, university physiotherapy programs are at a Master’s level of education. All graduating physiotherapists must pass a national exam to enter professional practice. Physiotherapists who are working with children should complete continuing education, and there are a variety of courses that physiotherapists may take. Parents should feel free to ask a physiotherapist about their specific paediatric experience and coursework, specifically how their skills may apply to helping a child with ASD. It is necessary to understand their overall comfort-level before working with your child.

The Interviewee: Andrea Switzer, MScPT. Andrea received her Master’s of Science in Physical Therapy from Queen’s University. Upon graduation, she was presented with the Canadian Physiotherapy Association’s Paediatric Division Award for achievement in paediatrics. Andrea also holds an Honors Bachelors of Science Degree in Human Kinetics from the University of Guelph. Her Master’s degree explored the impact of a community based swimming program on children with cerebral palsy. Prior to joining the team at Blue Balloon Health Services, Andrea worked in Calgary, AB serving children with complex neuromotor conditions. Through this position, she treated children in both preschool and home settings, providing direct therapy support as well as assistance in attaining appropriate adaptive equipment and consultation to parents, teachers and teaching assistants. Andrea has also taken post graduate courses in sensory integration and the assessment and treatment of praxis. As well, she has taken courses in kinesiotaping, functional exercise for the neurologically impaired child, sign language and is CME Level l certified. Andrea loves working as part of a multidisciplinary team and incorporating a variety of therapeutic goals to assist a child in reaching his or her potential.

 

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Interviewee: Andrea Switzer MScPT.

Andrea Switzer, MScPT. Andrea received her Master’s of Science in Physical Therapy from Queen’s University. Upon graduation, she was presented with the Canadian Physiotherapy Association’s Paediatric Division Award for achievement in paediatrics. Andrea also holds an Honors Bachelors of Science Degree in Human Kinetics from the University of Guelph. Her Master’s degree explored the impact of a community based swimming program on children with cerebral palsy. Prior to joining the team at Blue Balloon Health Services, Andrea worked in Calgary, AB serving children with complex neuromotor conditions. Through this position, she treated children in both preschool and home settings, providing direct therapy support as well as assistance in attaining appropriate adaptive equipment and consultation to parents, teachers and teaching assistants. Andrea has also taken post graduate courses in sensory integration and the assessment and treatment of praxis. As well, she has taken courses in kinesiotaping, functional exercise for the neurologically impaired child, sign language and is CME Level l certified. Andrea loves working as part of a multidisciplinary team and incorporating a variety of therapeutic goals to assist a child in reaching his or her potential.

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.5. Occupational Therapists

What is the role of an Occupational Therapist (OT)?

An occupational therapist is trained on assessing and treating the impact of a developmental delay, injury, illness or disability on the function of a person. An OT views the person as a whole and considers the physical, cognitive, spiritual and social aspects of a person.

  • The environment and demands of the environment are considered
  • The impact of the environment on the function of a person is considered
  • The impact of the injury/delay or disability on a child’s self care (such as eating, dressing, hygiene), school skills and play skills are considered

How does an OT help children with ASD?

  • Assess a child’s level in gross motor/fine motor/visual motor/ activities of daily living
  • Assess sensory processing skills
  • Make recommendations for specific items that can make function easier (laptop, pencil grips, rubber matting, weighted vests, etc.)
  • Make suggestions to modify a child’s environment for success
  • Provide therapy to help remediate a child’s delays
  • Provide education to parents/caregivers and teachers to support a child’s development
  • Make referrals to other professionals that can also support a child’s development

What are some signs a child may need the expertise of an OT?

  • Delays in gross motor skills, like walking, crawling, jumping

  • Delays in fine motor skills, like buttoning, holding a fork and opening a zipper
  • Challenges with motor skills, like drawing, writing, dressing and putting together a puzzle
  • Challenges with sensory processing -the sensation from their body and from the environment may not consistently make sense
  • Behavioural difficulties, fears and anxiety

Can a child with Asperger Syndrome benefit from seeing an OT?

Yes! There may be delays in the areas addressed in question two where an OT can help. Children with Asperger Syndrome often experience anxiety and an OT can help support them in ways to manage anxiety through cognitive strategies, environmental modifications, sensory diets and education. Educating family members and school staff can enable others to help identify anxiety and better support a child with Asperger Syndrome.

Are there an expected number of sessions for children with ASD?

An assessment usually takes one to two sessions of an hour each. There may also be a need to see a child for extra sessions if they are anxious and have difficulty expressing their skills. Goals are made with the family, the child and the OT and a time line is prepared with scheduled times to re-evaluate goals. Most children see an OT for six months on a weekly/biweekly basis. Every effort is made to accommodate the child, the family and the course of the child’s development.

Can an OT sign forms such as Assistance for children with Severe Disabilities and the Disability Tax Credit?

Yes OTs can do that! We can also sign for disabled parking permits.

Can an OT work with other professionals in supporting my child, such as a Speech and Language Pathologist or an ABA therapist?

Definitely! An OT can be a valuable part of any team. OTs can provide another perspective to the function and behaviour that a child may be exhibiting.

Can the Direct Funding Option (DFO) for an IBI program be used to pay for an OT who is working with a team of professionals?

No. The Direct Funding Option (DFO) can only be used to pay for Intensive Behaviour Intervention provided by qualified individuals. However, some OTs may also possess a certification as a Board Certified Behavior Analyst (BCBA), or may have the equivalent qualifications. In this case they would be acting as a Senior Therapist of Clinical Supervisor of the IBI team, and not simply as an OT. Therefore they would be providing guidance and services that were more broad-based and encompassing than if they were providing services only as an OT.

What questions should I ask an OT when I contact them to provide service to my child?

Ask about training

  • Ask about training in sensory processing as this is post graduate training. An OT can have the Sensory Integration and Praxis Test (SIPT) certification which means that s/he is certified in giving the Sensory Integration and Praxis test and has some training in when to use it. There are many OTs that have taken courses in sensory processing assessment and treatment that may not be certified in the SIPT. These OTs can have wonderful skills!

 Ask about experience

  • Where have they worked?
  • What kind of children did they see?
  • What results did they see?

Ask about their flexibility

  • What happens if your child is having a challenging day?
  • How would they support your child?

Ask if you can visit the clinic

  • Ask to visit with your child so s/he can become familiar with it before then begin the assessment
  • Ask if your OT works in conjunction with other team members
  • Would they be able to communicate with others on your child’s team?

Ask about fees, cancellation policies and location

Can an OT diagnose ASD? Can an OT make a diagnosis that other professionals cannot?

An OT cannot diagnose ASD. This can only be done by a psychologist or a doctor. An OT cannot make any diagnosis; they can describe function and speak about development.

Should an OT provide a written report of the assessment provided?

An OT will take notes of the assessment and during each session with a child. Often OTs will give parents a copy of these notes that parents can share with other team members. A formal assessment can be provided to parents by OTs in private practice, parents will be charged for the report. Reports are very useful when parents are seeking extra support from their school or daycare.

What is Sensory Integration?

This theoretical framework enables an OT to assess and treat a child who is having difficulty making sense of the sensory input received from their body and from the environment.

Children with this difficulty may perceive sensation differently from others. They may be over sensitive and perceive everyday sensations, like the waistband of pants, as painful and therefore intolerable. They may be under sensitive and may not perceive a sensation until it is at maximum. For example, they may not hear you when you call their name at a regular volume, but can hear the bell for recess. Sometimes children with sensory processing disorder (SPD) mix up the sensation and have difficulty attaching the correct meaning to it.

Other children with SPD may have difficulty consistently responding to sensation and sometimes can tolerate and other times cannot. They can have difficulty regulating their response to sensation; even sensation generated by their own body. For example, a child who always speaks at a loud volume and when asked to whisper, whispers at a loud volume.

What types of intervention does an OT provide to a child with ASD?

  • Provide traditional remediation of gross motor/fine motor/visual motor function
  • Provide suggestions for adaptive equipment and environmental modifications to better suit the child with ASD
  • Sensory Integration therapy
  • Can assess and offer treatment to help a child who has SPD
  • Provide intervention that enables children to be more aware of their own body and better able to choose strategies to enable a calm state.
  • Provide intervention to address difficulty with balance, difficulty maintaining posture or making transitions between positions
  • Provide intervention to address difficulty with motor planning of an activity
  • Educate parents and school staff to enable better understanding of behaviour

Does an OT see my child in their office, in our home or in the community?

An OT is very flexible. Children can be seen in all three settings if the OT has the flexibility. Every effort should be made to accommodate the needs of the child and the family. If a child is receiving OT for SPD, it is suggested that the child come to the clinic as there is specialized equipment to facilitate progress.

Will an OT teach parents and caregivers some of the recommended interventions for the home?

Definitely! Children do better in their learning with many opportunities to practice across many environments. It is also empowering for parents to have strategies to interact and play with their children that promote their learning and develop the depth of their relationship. Education of parents and caregivers is a priority to OTs.

What else do I need to be aware of when working with or hiring an OT?

  • What is their training and experience?
  • What goals to they usually address?
  • What are their fees?
  • What do they charge for?
  • What is their cancellation policy?
  • Are they a member of their College in good standing?
  • Do they issue receipts for service?
  • Do they provide ongoing written communication of each session?
  • Will they connect with the other members of your team?
  • How and what frequency?
  • Where are they located?
  • Where is the parking?
  • Can you speak with other parents who receive OT through this clinic?

What is the typical fee for an OT? Is there funding available to families for OT services?

Fees range from $100 - $135 per hour. Some clinics are flexible; you pay as you go and can choose to have a report written or decline this report until you need it. Reports usually take 3 – 5 hours to write and can be costly. Other clinics request that parents pay up front for a certain number of sessions and reports/meetings are a given; they are not negotiable. Ask what each clinic requires and choose the clinic that you feel has the expertise, is within the range of payment you prefer and is close to you. Your CCAC can also provide funding for OT. Other parents obtain funding through grants. President’s Choice Children’s Charities and the Jennifer Ashleigh Foundation are two examples of these agencies.

Are there organizations or associations an OT has to be, or may want to be affiliated with?

In Ontario, an OT must be a member of the College of Occupational Therapists of Ontario and must have insurance. OTs who practice sensory integration therapy may want to be a member of a study group or an on-line research group to stay up to date with interventions and strategies employed with children who have autism.

What education must a person have to call themselves an OT?

An OT must have a Master’s of Science in Occupational Therapy. OTs who have worked for a longer length of time would have graduated with a Bachelor’s of Science in Occupational Therapy as this was the requirement when they began their career. 

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Interviewee: Paula Aquilla, OT

Paula Aquilla is a graduate of the University of Toronto and has practiced in a variety of clinical, home and community settings since 1986. Paula is currently working on her thesis in osteopathic manual practice. She is the director of Aquilla Occupational Therapy; a family oriented practice that is full of fun and learning. Paula also consults to the Muki Baum Treatment Centres in Toronto and the French School Board. Her practice encompasses all types of children and young adults and her specialty is sensory integration therapy. Paula has been a guest lecturer for the University of Toronto, McMaster University and Humber College. She is a co-author of Building Bridges through Sensory Integration: Occupational Therapy for Children with Autism and other Developmental Disorders (1998) and is a contributor to Children, Youth and Adults with Asperger’s Syndrome.

 

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.6. Teachers

What are the academic requirements for a person to become a certified teacher?

In order to become a member of the Ontario College of Teachers, a person must have the minimum of a three year Bachelor’s degree in a subject domain, such as Arts, Commerce or Science, and a Bachelor of Education. All teacher education programs include a substantial practice teaching component where practice and performance are rigorously evaluated.

Are there ASD credits for teachers?

Through the College of Teachers, an Additional Qualification (AQ) course is offered in Special Education-Communication-Autism. It is offered through various institutions, including Queen’s University, the Ontario English Catholic Teacher’s Association and the Ontario Teachers’ Federation. In order to enroll in an AQ course, a teacher must be a member of the Ontario College of Teachers. Also, courses beyond the introductory level have specific requirements regarding the number of years of experience. As locations for this AQ course can vary from year to year, specific information can be acquired through an on-line search or by an inquiry to the Ontario College of Teachers.

Some universities in Ontario, such as McMaster University and the University of Windsor, offer courses in Autism Spectrum Disorders and offer students opportunities to conduct research; however, to date, they do not offer a specific qualification in the field of ASD.

Several colleges in Ontario offer a post-diploma program in Autism and Behavioural Science, designed to prepare graduates to work directly with children with ASD. The program is offered on campus and online. Teachers have found this program appealing because of its in-depth focus on both ASD and Applied Behaviour Analysis (ABA). For more information, visit: http://www.ontariocolleges.ca/searchresults/education-community-social-services-behavioural-science/_/n-ll0t

If a teacher works for a school board, are they allowed to do private work?

Yes, teachers are permitted to work privately as long as it is outside of school hours. As well, when working privately, a teacher is always accountable to the College of Teachers and not to their school board, as the College of Teachers is the provincial regulatory body.

If a teacher is not working for a school board, to whom are they accountable?

When a teacher graduates from their training institution, they can apply to become a member of the Ontario College of Teachers, which then evaluates their qualifications, gives them a College registration number and a Certificate of Qualification and Registration. A teacher must pay a fee each year to renew their membership. All school boards and school authorities in Ontario, as well as most private schools will only hire teachers who are members of the Ontario College of Teachers. If a teacher is a member of the College, he or she is accountable to the College. If a teacher is not a member of the College, they are not accountable to any professional body.

On the website of the Ontario College of Teachers (www.oct.ca), a citizen may search for anyone who has been certified to teach in Ontario’s publicly funded schools. As listed on the website, information includes:

 

  • a teacher’s qualifications
  • date of initial certification
  • status with the College
  • disciplinary history, if applicable. 

 

Should I hire a teacher to work with my child at home?

The decision about whether or not to hire a teacher to work with your child in the home environment outside of school hours will depend upon the needs of your child and his or her instructional goals. This will be an individual decision based on your particular situation. If your child is struggling with a particular subject area, such as mathematics or literacy skill development, or if your child experiences frustration with executing and completing assignments, it would be worthwhile to discuss this with his or her classroom teacher and determine if supplemental home instruction would be worthwhile. In many cases, it would be very beneficial.

If you wish to hire someone to work as an academic tutor in a home instruction setting, your needs may be best served by hiring a teacher. Teachers are trained to be self-directed and to know how to deliver educational content. When working with students who have an ASD, the teacher/instructor should have a solid foundation of knowledge about the learning style of students with ASD and relevant methodological approaches. However, if your goals are primarily non-academic, such as social interaction skills, you may be better served by hiring someone who is skilled in that particular area, such as an instructional assistant or therapist in the field of ASD.

Sometimes, a retired teacher may become an academic tutor. Usually, this person would have a great deal of teaching experience; however, it would be critical to find out how much specific experience they have with students who have an ASD. A retired teacher may have let their membership in the College lapse; however, if a person wishes to pursue a second career in tutoring, they usually maintain their membership in the College.

Sometimes, a teacher who has recently graduated from university and has not yet been hired by a school board may wish to work with a student who has an ASD in order to gain experience. Working with your child can make a significant contribution to this person’s knowledge base; however, it would be important to make sure that this person comes with a good understanding of ASD, displays a willingness to learn and demonstrates that he or she is in an active process of learning (reading, professional development opportunities, courses). 

Can I hire my child’s teacher?

Yes, in some situations, you can hire your child’s teacher; however, policies regarding this may differ from board to board. Before approaching your child’s teacher, check with the school principal to find out whether or not this practice is permitted. In any case, hiring your child’s teacher for home instruction may not be a wise decision for several reasons:

 

  • Your child may have difficulty separating the role of the teacher between the home and the school environments. The familiar interaction pattern that may evolve in the home environment should not be transferred to the school environment. For instance, in the classroom, the student may expect more individual attention than the teacher is able to give.
  • Your child and her/his teacher already see each other for several hours a day. Over exposure may lead to relationship burn out and classroom management difficulties.
  • By having your child’s teacher in your home on a regular basis, it may become difficult to separate the formality of the teacher-parent relationship from the familiar and friendly relationship usually established with someone who regularly works in the home.

 

Payment for service can become an awkward element in the relationship.

Can I request to see a teacher’s qualifications?

Yes, you must ask to see an official record of qualifications for any person you are considering to work with your child. This would include documentation for training in any specialized program, such as PECS or ABA. You can ask to see the applicant’s Certificate of Qualification and Registration from the Ontario College of Teachers. If they do not have one, you can ask for substantiation of teacher training, e.g. graduation certificate or diploma. You must make your own decision about whether or not to consider this person as a potential instructor for your child. You can suggest that the candidate actively pursue having their qualifications evaluated, particularly in the case where the applicant is a teacher from another country.

What are some questions I should ask a candidate in order to gain an understanding of their experience and knowledge of ASD?

 

  • What is autism? What are the identifying features of ASD?
  • What is your previous experience with persons who have Autism Spectrum Disorders?
  • What was the last book or article you read about ASD? What can you tell me about it?
  • When did you last participate in ASD-specific training? What did you learn?
  • What subject areas do you most enjoy teaching?
  • Why do you want to work with my child?
  • My child’s area of difficulty is ______. What experience do you have in teaching that subject?
  • What would you want to know about my child before starting to work with him/her?
  • What would you see as a starting point for home instruction?
  • What sources would you want to consult for information about the content of a home instruction program? (parents, teachers at school, Individual Education Plan, student interest)
  • How would you structure a home instruction session?
  • What are your feelings about the use of positive reinforcement?
  • What would you do if my child had a meltdown during an instructional session or engaged in off-task responses? (if appropriate)
  • How would you evaluate progress? What kind of data would you collect and how?
  • Can you supply references? 

 

What steps are involved in starting a home instruction program?

A) Preparing the environment:

 

  • Use a calendar to indicate the days and times when home instruction will take place. To the extent possible, establish a regular time for sessions.
  • Choose an appropriate location in your home, one where your child is comfortable and will not be distracted by the television or other people working on a computer. A work table or desk should be available, as well as a place to store materials. It would be the expectation that the door of the room is open during instructional sessions.
  • In determining a time for home instruction sessions, make sure that your child has had time to rest and engage in a recreational activity before starting “work” again. Provide a snack and/or opportunity to engage in a preferred activity after the instructional session.
  • If you hire more than one instructor, clearly indicate on the calendar which instructor is coming and what subject they will be working on, e.g. Mathematics or Literacy Skills. Each instructor should work on specific subject areas so that the student does not become confused by different approaches, speech patterns or language of instruction.

 

B) Preparing your child:

 

  • When you make the decision to hire a home instructor, let your child know well in advance of the first session. Explain the purpose of the home instruction and the plan – how many times per week, what will be studied and what your expectations are regarding his or her participation.
  • If the instructional periods interfere with watching a favourite TV program or other activity, assure your child that you will be able to record the program and that he can watch it when the session is finished or that he will be able to participate in the activity at another time. Assure your child that he or she will not miss anything.
  • Frame this instructional plan in positive terms explaining that this will help him or her to better understand the things that are difficult, as well as help to keep up with homework and assignments.

 

C) Preparing the home teacher/instructor:

 

  • In order to understand your child’s areas of difficulty and the kinds of remediation or assistance that are necessary, you will need to share information about your child’s areas of strength and areas of difficulty. Allowing the home instruction teacher to read previous school reports may be very helpful, as well as any psycho-educational assessments that are available.
  • Provide the home instruction teacher with a copy of the child’s Individual Education Plan so that he or she can ensure that the educational plan can be reinforced.
  • You may wish to discuss the issue of confidentiality with regard to your child’s documents and have the teacher sign a confidentiality agreement. You can discuss this with a lawyer; however, in the teaching profession, it is commonly understood that personal information of this nature is confidential. Additionally, you may need to clarify with your child’s teacher and the home instruction teacher that they have permission to communicate and, generally, this would need to put in writing.
  • It will also be useful to explain to the teacher your child’s unique expression of ASD with particular regard to their communication, sensory sensitivities, stamina, signs of fatigue or irritability, i.e. how to discern when enough is enough, and what kinds of praise or reinforcement are most effective.
  • As you get to know the teacher, you may wish to share any articles, books or DVD’s about ASD that you have found particularly useful and interesting.
  • Ensure that you have a conversation with the teacher/instructor about whether or not you will leave your child in their care or whether you will be in the home during all sessions. It is highly advisable that you be present in the home at all times as your absence can be very unsettling for your child and puts the instructor in the position of being both a babysitter and teacher. 

 

D) The teacher-child relationship:

 

  • The first meeting for your child and the home instruction teacher should be social in nature – a “getting to know you” session. This can take place in an area of your home that is comfortable for your child, e.g. in the kitchen, having a snack or treat at the table.
  • The teacher can ask your child about interests, favourite activities, family, pets, what they like to do at school – the kinds of questions one would ask any child. If your child has limited verbal skills, you and the teacher can have a conversation and involve the child to the extent of his or her ability.
  • Encourage your child to show the teacher his or her room, favourite toys, books or movies.
  • The teacher can suggest that they read a story together or engage in another preferred activity.
  • The teacher should tell your child something about him or herself – pets, children, hobbies, etc.
  • The teacher can also talk about the kinds of work that they will do together and then set a start date so that your child knows when and what to expect. The teacher can also provide your child with a picture of him or herself enabling your child to become increasingly familiar and “used to” this new person in her/his life.
  • From time to time, the teacher should feel free to bring something new or interesting for your child to look at, read or do. This will keep the relationship interesting and give your child more reason to look forward to instructional sessions.
  • If you or the school uses reinforcers with your child, share this information with the home instruction teacher – what reinforcers or incentives are effective?

 

E) The home-school relationship:

 

  • Seek input from your child’s teacher at school regarding his or her area or areas of difficulty and where supplemental instruction would be beneficial.
  • Whenever possible, the classroom teacher and home instruction teacher should communicate, even briefly, about specific skills to be taught,* the language of instruction used at school, timelines for when a specific skill will be necessary or evaluated in the school environment and when assignments are due. This communication might take place through communication with you or written communication to the home instruction teacher, such as a note in the backpack. You can decide on whatever method works best in your situation.
  • The classroom teacher may also be able to inform the home instruction teacher about particularly effective strategies, as well as upcoming areas of study for which your child can be primed/prepared.
  • If home instruction is successful, at some point you may wish for the home instruction teacher to accompany you to IEP meetings or other meetings where your child’s program and progress will be discussed.

 

*For instance, the solving of math equations or problems may require specific formats and steps. It would essential for the home instruction teacher to have this information so that he or she does not teach steps or solutions that differ from what is expected in the classroom.

Additional Suggestions:

Your child may have a specific interest which can be studied in the home instruction setting as an Independent Study Unit. Time can be set aside during each session for work and research in this area. This can be very useful as, often, there is not time for this kind of individualization at school. Your child may find study in a preferred topic to be very stimulating and it may serve to develop a wide range of skills.

For many students, the development of computer skills, such as keyboarding, may not be possible at school. This could be an important skill for development in the home setting, particularly for students who have difficulty with printing or writing. Access to a keyboard would be necessary. As well, a segment of the home instruction session could be devoted to keyboard skill development, noting it on the work schedule as a regular feature of instruction. For some students, learning to use Microsoft Word and PowerPoint™ may significantly enhance their composition and presentation skills.

Parents may also want to consider the use of educational software for the reinforcement of skills in the home setting and your child can be guided in its use by the home instruction teacher. Your child’s classroom teacher or resource teacher may be able to recommend a particular program or one can seek advice from an educational software distributor. Guidelines for the effective use of educational software can be found on Autism Ontario’s website.

What fees are appropriate for a home instruction teacher?

There is no regulated or set fee for home instruction teachers. You can inquire about local rates for tutoring, understanding that these rates reflect the grade levels and subjects that are taught, the more complex the subject, the higher the rate. You can also check with local agencies, such as Autism Ontario or the Learning Disabilities Association of Ontario to see what information they have to offer about what other parents generally pay home instruction teachers. The financial arrangement is usually worked out on an individual basis. When a candidate suggests a fee, you can ask how the amount was derived. Usually it will be based on their level of education and experience, as well as by an understanding of fees charged by persons in similar positions.

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Interviewee: Leslie Broun, M.Ed.

For more than twenty years, Leslie Broun worked for the Peel District School Board as a teacher in a self-contained classroom, an itinerant resource teacher and a consultant for students who have an Autism Spectrum Disorders (ASD) or other developmental disabilities. In 2007, she was a member of the cross-ministerial ASD Reference Group that helped formulate new policy for students with ASD in the province of Ontario. For six years she served on Autism Ontario’s Board of Directors and in 2008 received the Gerry Bloomfield Award for Outstanding Professional Service. Leslie has worked for both the Ministry of Education and the Geneva Centre for Autism and has been a teaching instructor and presenter at workshops and conferences across Canada and internationally. She co-authored Literacy Skill Development for Students with Special Learning Needs with Patricia Oelwein. Her primary professional focus has been the development of effective learning strategies and materials for teaching academic skills to students with special needs.

 

1.7. Dietitians

Question and Answer:

Registered Dietitian: What to Expect

1. What is a Registered Dietitian and what service do they provide to clients?

A Registered Dietitian (also referred to as a dietitian or RD) is a Regulated Health Professional with extensive knowledge of food and nutrition. Dietitians are held to professional standards and are regulated in each province; in Ontario the regulatory body is the College of Dietitians of Ontario (CDO). The CDO works to protect the public. Dietitians are accountable to the college to provide nutrition services that are competent, safe, and ethical.

A dietitian is trained to assess the nutritional health and the risk of malnutrition of a person by collecting important information such as:

  • Diet history – e.g. what one usually eats, when, where, & how
  • Physical measurements – e.g. height & weight
  • Relevant blood work values – if applicable
  • Gastrointestinal (GI) issues or symptoms
  • Medication & supplement use
  • Social & family supports

 

This information is used to assess nutritional health and together with the client, help create a nutrition care plan to meet their nutritional goals and needs. Registered Dietitians use current research to help make nutrition recommendations.

2. What is the difference between a dietitian and a nutritionist?

The term “nutritionist” is not regulated in Canada. This means that there are no education standards to use this title.

The title of “Registered Dietitian” (including “dietitian” and “RD”) is protected and only those who have successfully completed regulated training programs and are registered with the governing college can use this title. Registered Dietitians are the only food and nutrition professionals recognized to work in the publically funded health care system.

Registration with the College of Dietitians involves completion of both an accredited university program in Food and Nutrition, and an accredited dietetic internship. All Registered Dietitians must write and pass the Canadian Dietetic Registration Exam. All Registered Dietitians are also required to participate in an annual quality assurance program with the College of Dietitians of Ontario.

For more information please visit: www.collegeofdietitians.org or www.dietitians.ca

3. Do dietitians specialize in providing service/support to people with ASD?

There is no specific dietetic training providing a specialization to work with individuals with autism. Although there are some educational resources available, most dietitians gain the skills required to support individuals with Autism Spectrum Disorder (ASD) through experience.

4. What questions should I ask when looking for a dietitian for my child?

The nutritional concerns of individuals with autism are unique. It is suggested that one works with a Registered Dietitian with previous experience addressing the nutritional needs of individuals with autism.

It is important to ask a potential Registered Dietitian about their past experience and if they have worked with individuals with autism or similar disorders. For example, asking whether the dietitian has had any experience with sensory feeding difficulties (sensitive to the tastes, textures, and smells of food), food chaining (using already accepted foods to transition to new types of food), and sensory play (activities that use and stimulate the senses). Another helpful question to ask is whether the dietitian can either provide a referral, if required, to other health professionals like an Occupational Therapist or Family Counsellor, or liaise with the individual’s General Practitioner to provide such referrals. A team approach is the best way to support an individual with ASD.

5. When should a dietitian be contacted to provide service?

As with any child, the diet of a child with ASD is best when it is well balanced. Based on the research at this time, there is no specific diet those with ASD must follow. Ensure your child is consuming a variety of food groups to support their growth and development. If this is challenging or you are considering starting a specific diet, meet with a Registered Dietitian.

A dietitian should be contacted if:

  • There are poor growth patterns – including too much or too little weight gain
  • One or more food groups are completely avoided – The four food groups include: vegetables & fruit, grain products, milk & alternatives, and meat & alternatives
  • A hunger strike is started – e.g. individual stops eating favourite foods, or stops eating for days
  • There is interest in starting complementary or alternative nutrition – e.g. a special diet
  • There is severe constipation affecting intake – e.g. can be related to insufficient water or fibre intake
  • There is concern regarding feeding or nutrition from parents and/or caregivers

 

In general, if the child is growing well and the eating patterns work for the family then there is often little need for concern. However, if parents are concerned, seeking the help of a Registered Dietitian to assess the overall dietary intake of the child can be helpful to determine if there are nutritional deficiencies.

6. What does the research say around getting a dietitian involved to support a person with ASD?

According to a 2010, consensus report published in the journal Pediatrics, having the support of a physician or dietitian can help minimize the risk of malnutrition by working in collaboration with parents and/or caregivers to ensure optimal nutritional health.

A 2012 report from Dietitians of Canada, regarding healthy eating and mental health promotion, showed that there is a role for Registered Dietitians when GI issues affect the nutritional intake of the individual. It was also noted that nutrition is not typically used to treat the symptoms associated with autism, however a dietitian can assist with concerns sometimes experienced by those with ASD including: limited food intake or intake that is not nutritionally balanced, weight concerns, potential interactions between medications and foods, the eating of non-food items, and connecting families with community support systems.

7. Are there key topics parents of children with ASD are inquiring about?

There is significant interest from parents in using nutrition or nutritional supplements to treat the symptoms of ASD, with particular interest in gluten and/or casein free diets. There is currently insufficient evidence to support the introduction of restrictive diets to affect behaviour, as there is the added risk of developing nutrient deficiencies. The ultimate goal is to include as much variety as possible to ensure optimal nutrition and avoid complicating meal times. However, if a restricted diet is to be introduced, it is best initiated under the supervision of a dietitian or physician to ensure nutritional adequacy. Therefore, it is recommended that a restrictive diet (e.g. gluten and/or casein free) not be started until after you have met with a Registered Dietitian.

8. How can a dietitian work with other professionals who are supporting my child, such as a Behaviourist, Occupational Therapist or Paediatrician?

Support for individuals with ASD is best provided in the context of a team. Dietitians work collaboratively with other health care professionals to provide optimal care for clients. Therefore, with the consent of the child and/or caregiver, the dietitian can communicate with other members of the child’s health care team to relay the nutrition care plan and coordinate therapies. For example, the dietitian can communicate sensory or textural issues with the Occupational Therapist to allow for complementary therapy to address these aversions.

9. What can I expect when receiving services from a dietitian?

Dietitians are trained to assess and evaluate the dietary intake of an individual in the context of their unique nutrition requirements – e.g. to support growth and development. In general, a dietitian will ask about the individual’s typical eating patterns through questions of what, when, where, and how. The dietitian may also inquire about other clinical symptoms (such as GI issues) or conditions that can affect intake or nutritional needs, including the use of medications or supplements. Together, this information, alongside the nutritional goals of the individual with ASD, will be evaluated and a nutrition care plan will be developed.

It can also be expected that a dietitian will determine whether there are gaps in the child's diet and use the child's preferences to introduce greater food variety through food chaining or other intake strategies. For example, if a child will only eat pasta without sauce, other healthy bland choices can be explored (e.g. small pasta without sauce, followed by whole wheat pasta, then quinoa without sauce.)

A dietitian may also be able to identify which eating behaviours are typical of all children, for example picky eating, as opposed to behaviours resulting from the symptoms of ASD.

Also, based on the ability of the individual with ASD, the dietitian may identify an appropriate level of participation in food related activities. Those individuals with a greater capacity for involvement should be encouraged to be active in food preparation to foster the development of basic food skills.

You should feel free to ask questions to clarify information and offer your ideas, collaborating with the dietitian, to achieve the nutrition goals. The dietitian will monitor the plan, and if it is not working, together you can discuss new ideas.

10. How much should I expect to pay for the services of a dietitian?

The fees for dietetic services range based on location and the services provided. In general, one can expect an initial assessment to cost between $85-150 and last approximately one hour; and follow up appointments can range from $50-90 and typically last about 30 minutes. Some private insurance plans provide coverage for dietetic services.

For quick food and nutrition related questions, such as questions about food groups or portion sizes, Ontario residents have free access to a dietitian, through EatRight Ontario. You can either speak to a dietitian directly by calling the toll-free number 1-(877)-510-5102 or email your questions through www.eatrightontario.ca. There are also a variety of nutrition articles, recipes, and resources available on their website.

11. How do I find a dietitian in my area?

Two ways to begin your search for a dietitian in your area are through the Provider Listings available on the Autism Ontario Spirale database, or through Find A Dietitian available on the Dietitians of Canada website.


Completed by: Laurie Wybenga, RD – In consultation with Stefania Palmeri, RD

Laurie Wybenga is a Registered Dietitian with a passion for nutrition education. She completed her dietetic internship at St. Michael’s Hospital in Toronto, and her undergraduate degree at Ryerson University. Laurie enjoys working with clients individually, but also enjoys advocating for the role of dietitians and accurate nutrition information in public forums. Her research to date includes exploring the role of nutritional supplements in preventing malnutrition in hospital, and the use of probiotics in managing tube-feeding related diarrhea.

Stefania Palmeri works as a Registered Dietitian at The Medcan Clinic in Toronto, and her own dietetic practice, in Whitby, Ontario. She completed both her undergraduate degree and Master’s degree in nutrition communication at Ryerson University. Stefania has worked with children with feeding difficulties, including those with autism, during her dietetic internship at North York General Hospital, in Toronto. She continued to work at this clinic for several years, and now sees paediatric clients in day-to-day practice. Her past research has included studying the rates of nutrient deficiencies amongst children with autism and bowel issues, and how nutrition information is communicated in children’s storybooks.

Additional information from: PEN – Practice-Based Evidence in Nutrition (Dietitians of Canada); and Dietitians of Canada Learning On Demand Seminar by Patricia Novak, MPH, RD.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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1.8. Optometrists

1. What questions should I ask when I am trying to find an optometrist for my child?

It is important to know if the optometrist is willing to examine a pediatric patient on the autism spectrum. A parent or guardian should ask what experience the doctor has working with this special population. Does the clinic have hours that would be convenient (early, evenings, Saturdays?) What is the cancellation policy? Is the optometrist willing to communicate with the teachers or other professionals on the team? It is most important that the child and their family feel comfortable and welcome in the office and the doctor and staff are friendly and accommodating.

2. Would an optometrist be open to consulting with a parent before the appointment, to review and plan best strategies in order to ensure the visit is a success for both the child and optometrist? Would there be an additional fee for this meeting?

Most optometrists would be open to scheduling this type of meeting, so this is another question that should be asked when searching for an optometrist. This would not be covered under OHIP, and different offices may have varying policies regarding fees. Our office does not charge for this service, but we ask that as much information as possible is provided in advance (e.g. by email) in order to have the most productive meeting possible. It is helpful to know medical/ocular health history, sensory issues, behavioural triggers, level of functioning etc. A phone consultation is often the most convenient method.

3. Children with autism often have difficulties with transitions and new environments. Is it reasonable for a parent to request that their child visit the office prior to the appointment?

Absolutely! Depending on the needs of the patient, several visits may be appropriate. Sometimes the patient will come and play with the toys in the reception area, and meet the doctor and staff. The next visit may include a “tour” of the exam room, to see the equipment, & touch or sit in the chair. Often it is helpful if a parent or sibling has an eye examination while the ASD child observes. They can receive some positive reinforcement (stickers, jelly beans, toys etc.) as an enticement to return to the office for their appointment. We would recommend scheduling it when the office isn’t as busy, such as mid-morning or around noon, and when the child is well rested.

4. Many children with autism have sensory issues, how can an optometrist accommodate this?

Knowing in advance what particular sensory issues there are would be helpful. For example, if noise is a concern, then the stereo system would be turned down or off during the visit. Lighting can be dimmed in the examination room. Some bright lights are used to assess the health of the eyes, but the intensity can also be reduced as much as possible. Children who are uncomfortable sitting on a vinyl surface would be encouraged to bring a soft blanket they like that they could sit on. If perfumes or other scents are a concern, they would be eliminated as much as possible during the visit. If a child has a particular comfort object/toy, they are encouraged to bring it with them. We have ”examined “ many stuffed animals’ eyes before the child has his turn.

5. Are optometry services covered by OHIP? What other fees may I need to pay?

Children are covered for one complete eye examination per year until they turn 20 years of age. Partial re-assessments are covered as needed. After the age of 20, people on disability are covered every two years. Fees would be charged for eye glasses or contact lenses.

6. How often should my child see an optometrist?

Children grow very quickly, and should be seen at least once a year for a routine eye exam or more often if recommended by the doctor. It is not unusual for several shorter visits to be necessary to obtain and confirm all the information regarding visual acuity, refraction, binocular vision & ocular health, especially if they are new to the office. If any changes or problems are detected, then the child should return to the office as soon as possible.

7. How do you test the eyesight of children who are non-verbal or who have difficulty expressing themselves verbally?

It is necessary to rely on objective tests if the child is non-verbal. Some of these tests are observational – for example, ocular motility can be assessed while watching the child follow a toy moving side to side or in different positions of gaze. Refraction can be determined by “neutralizing” the reflection of light from the back of the eye. Ocular health can be checked by looking inside the eye. In certain cases, it is necessary to put drops in the eyes to determine the refraction and ocular health (which is only done with parent/guardian permission). The more co-operative the child, the more accurate and complete the tests results will be.

 

Dr. Linda Kwasnick, O.D. received her degree from the University of Waterloo and was named on the Dean’s Honour Role. Her private practice in Orleans has been operating for over 30 years. She is the mother of two sons, who are both studying at Carleton University and she developed a special interest in ASD after her eldest son was diagnosed with Asperger’s Syndrome 10 years ago. Linda has been active in local parent support groups, attending seminars, and working with charities that support children on the spectrum and their families.

 
 
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Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.
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