1. Relationship between Participation and Initiation of Therapy Services among Children with ASD Diana Amend, OTS & Ruth Benedict, DrPH, OTR RESEARCH DESIGN & METHODS Background In 2011, 1 in 50 U.S. school-aged children were reported by parents to be diagnosed with an Autism Spectrum Disorder (ASD) 1 Children with ASD who received early interventions have better social and school outcomes 2, 3,4 Children with ASD participated significantly less frequently in school, social & physical activities 5, 6, 7 However, these studies used small samples. It is important to assess whether early therapy services leads to improved participation in a large, representative sample of children with ASD Hypothesis Among children diagnosed with ASD, those receiving therapy services later in childhood are less likely to participate in a diverse range of community activities than those receiving services early in childhood. RESULTSCONCLUSIONSINTRODUCTION ACKNOWLEDGEMENTS Two-way contingency analysis evaluating the relationship between participation limitations of children with ASD who received therapy services before 6 years old compared to those who did not. Five logistic regression models were created to determine whether age of initiation or covariates were independently associated with each of the areas of participation  Hypothesis was not supported: after controlling for covariates, relationship between age of initiation of therapy services and participation limitations was not significant Significantly Correlated Covariates: Severity of Condition: Children with moderate ASD were significantly more likely to report limits in general participation (AOR=4.34; CI=2.50-7.53) and children with severe ASD were significantly more likely to report limits in general and school participation than children with mild ASD (AOR= 21.99; 5.93- 81.50 and AOR=.16; CI=.07-.37). Age: Children ages 12-14 were significantly more likely to report limits in school participation (AOR=1.89 ; CI=1.06-3.38) and children ages 15-17 years were significantly more likely to report limits in physical participation than children 6- 11 years old (AOR=.48; CI=.25-.91). Income Level: Children below 100% of the poverty line reported significant limits in leisure and school participation (AOR=2.74; CI=1.18-6.35 and AOR=2.78; CI=1.34-5.80). A huge thank you to Dr. Benedict and Dr. McCurdy for their guidance and expertise throughout the course of this project and to the survey respondents for taking time to answer the NSCH survey questions. Also, thank you to my family, friends, and to all of my classmates whom provided energy and support. IMPLICATIONS FOR PRACTICE  Consistent with the literature, the strongest predictors of limitations in participation were poverty status and severity of diagnosis  Other factors that may influence participation: characteristics of activities and lack of awareness of available services  Although other covariates demonstrate a stronger association with participation in this study, the trend suggests that early initiation of therapy services may influence participation and should be explored in future studies  Future research should examine specific type, frequency & duration of services provided to children with ASD in relation to participation  Occupational therapists:  Are experts in participation and are well equipped to provide family education, community support programs, particularly for children with ASD from low income families  Can target and develop interventions for children with severe ASD to promote participation  Should advocate for coverage of affordable services of children with ASD from low income families Participants  Data from the 2011/2012 National Survey of Children’s Health (NSCH)  Cross-sectional, random-digit-dial telephone survey of households with children from all 50 states and the District of Columbia. One child randomly selected from each household to be the subject of the survey; respondent was a parent or guardian  Representative sample of children diagnosed with ASD, ages 10-17  n = 1,393 Independent Variable Age at initiation of therapy services (2 levels) Before 6 years old After 6 years old Dependent Variables Participation Limitations (5 levels) Covariates Age, gender, race, income level, and severity of condition REFERENCES 1. Blumberg, S. J., Bramlett, M. D., Kogan, M. D., Schieve, L. A., Jones, J. R., & Lu, M. C. Center for Disease Control and Prevention, (2013). Changes in prevalence of parent-reported autism spectrum disorder in school-aged u.s. children: 2007 to 2011–2012. Retrieved from website: http://www.cdc.gov/nchs/data/nhsr/nhsr065.pdf 2. Fenske, E. C., Zalenski, S., Krantz, L. E., & McClannahan, L. E. (1985). Age at intervention and treatment outcome for autistic children in a comprehensive intervention program. Analysis and Intervention in Developmental Disabilities, 5(2), 49-58. Retrieved from http://www.sciencedirect.com.ezproxy.library.wisc.edu/science/article/pii/S027046848580005 3. Greenspan, S. L., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders, 1, 87–141. 4. Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: a four- to six-year follow-up. Journal Of Autism And Developmental Disorders, 30(2), 137-142. 5. Houtrow, A., Jones, J., Ghandour, R., Strickland, B., & Newacheck, P. (2012). Participation of Children with Special Health Care Needs in School and the Community.Academic Pediatrics, 12(4), 326-334. 6. King, G., Tucker, M., Baldwin, P., Lowry, K., LaPorta, J., & Martens, L. (2002). A life needs model of pediatric service delivery: services to support community participation and quality of life for children and youth with disabilities. Physical & Occupational Therapy In Pediatrics, 22(2), 53-77. 7. Shattuck, P. T., Orsmond, G. I., Wagner, M., & Cooper, B. P. (2011). Participation in Social Activities among Adolescents with an Autism Spectrum Disorder. Plos ONE, 6(11), 1-9. doi:10.1371/journal.pone.0027176 Occupational Therapy Program, Department of Kinesiology, University of Wisconsin-Madison Proportions of children with ASD not participating in selected activities by age of initiation of therapy services (unweighted) * = significant VariablesPercentSurvey Questions Independent Variable Age at Initiation of services < 6 years >= 6 years (n=1,276) 59.5% 40.5% Q: How old was your child when he/she began receiving services? Dependent Variables Social Limitations Yes No (n=1,295) 55.3% 44.7% Q: During the past 12 months, did your child participate in any clubs or organizations after school or on weekends? School Limitations ≥ 5 days < 5 days (n=1,276) 35.4% 64.6% Q: During the past 12 months, how many days did your child miss school because of illness or injury? Physical Limitations < 3 days ≥ 3 days (n=1,287) 30.5% 69.5% Q: During the past week, how many days did your child exercise, play a sport, or participate in physical activity for at least 20 minutes that made him/her sweat and breathe hard? Leisure Limitations Yes No (n=1,063) 64.8% 35.2% Q: During the past 12 months, did your child participate in any other organized activities or lessons such as music, dance, language, or other arts? General limitations Yes No (n=1,290) 36.6% 63.7% Q: Is your child limited or prevented in any way in his/her ability to do the things most children of the same age can do?