Information available to parents on the internet : a thematic analysis of web pages providing information about occupational therapy for children with autism

Methods: An internet search using the Google search engine (www.google.com) was completed. Using the determined inclusion/exclusion criteria, the researcher vetted the first 100 returns on the Google search. One of the web pages presented a collection of links to contentspecific web pages and/or PDFs that were accessible within the same website (micro-sites) which were vetted for inclusion, bringing the total of assessed web pages/PDFs to 118. The content of each web page/PDF meeting the inclusion criteria was individually analyzed to determine the topics discussed pertaining to Autism Spectrum Disorders (ASD) and occupational therapy services for children with ASD. The researcher and interrater negotiated agreement for 43 topics. Topics that appeared in the content of five or more websites were deemed themes. Results: A total of 118 web pages/PDFs were analyzed according to the inclusion/exclusion criteria. Of the 118 web pages/PDFs analyzed, 16 met the inclusion criteria and were void of any exclusion criterion. After removing a duplicate web page from data analysis, 15 web pages/PDFs were included in the thematic analysis. Twenty two of the content topics were present in five or more web pages, qualifying as themes. Of the 22 themes found, 18 were related to occupational therapy and ASD, and four themes were ASD-specific information that was included in the web pages/PDFs. Conclusions: The information in the web pages analyzed provided a well-rounded picture of ways that occupational therapy can assist children with ASD and their families. The information presents sensory integration as the main symptom that occupational therapists focus on. Intervention for sensory integrative dysfunctions is however delivered in ways that improve other areas of concern, such as socialization; the second focus of occupational therapy intervention as presented in the web pages. INFORMATION AVAILABLE TO PARENTS ON THE INTERNET 3 Information available to parents on the internet: A thematic analysis of web pages providing information about occupational therapy for children with autism Children diagnosed with Autism Spectrum Disorders (ASD) receive referrals for occupational therapy services for a variety of reasons. Recently, it has become an increasing occurrence for legislation to specify that occupational therapy is a covered service for children with ASD. As occupational therapy continues to gain acknowledgement as a necessary service for children with ASD, referrals for occupational therapy will likely become more frequent. Parents may turn to the internet to research the relevance of occupational therapy services for the needs of their child with ASD. With legislation adding occupational therapy to the recognized services for ASDs, it is important to analyze the information available regarding the gamut of services provided by occupational therapy relevant to ASD. Since the internet is a commonly used resource for medical information, analyzing the themes across relevant web pages will assist in obtaining an overview of what information is currently available regarding occupational therapy services for ASD. The purpose of this study was to determine what information regarding occupational therapy services for children with ASD is available to parents on the internet. This was done though the completion of a thematic analysis of web pages returned through an internet search engine. Autism Spectrum Disorder The Center for Disease Control and Prevention (CDC) defines Autism Spectrum Disorders (ASD) as “A group of developmental disabilities that can cause significant social, communication and behavioral challenges” (CDC, 2012, paragraph 1). The diagnoses for ASD INFORMATION AVAILABLE TO PARENTS ON THE INTERNET 4 are categorized as: Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified. Symptoms of ASD affect socialization, communication, and language skill development. Behavioral concerns include repetitive actions, echolalia, and difficulty dealing with unexpected changes (CDC, 2012). Currently 1 in 88 children are diagnosed with some form of Autism. ASDs are diagnosed more in males than in females (CDC, 2012). To date, the exact cause(s) of autism are unknown. Genetics appears to have a role in increasing the risk (CDC, 2012). With ASD affecting so many children, the need to protect certain rights of those diagnosed has been addressed through legislation to ensure access to education and treatment interventions. Occupational Therapy Occupational therapy is one of the disciplines from which children with autism receive services. Under the Individuals with Disabilities Education Act (Department of Education, 2000), occupational therapy is one of the special education related services that can be designated to help a child achieve his/her Individual Education Program. Ohio has recently joined other states that provide legislation to ensure insurance coverage for occupational therapy services for children with ASDs (Autism Speaks, 2013). Occupational therapists work with children diagnosed with ASD to improve functional skills and performance of occupations, including: activities of daily living, sensory integration, coping skills, behavioral skills, social skills, and motor skills. Tanta (2004) asserts that “peer interaction is a crucial area for occupational therapy to address. Social skills interventions are also necessary for occupational therapists to provide to encourage positive social interaction. Some of the ways occupational therapists provide intervention for social skills include activitybased social skills groups and social stories (Greene, 2004). Play and praxis are also relevant to INFORMATION AVAILABLE TO PARENTS ON THE INTERNET 5 the services provided for children with an ASD. Motor planning is an important aspect of full engagement in play occupations (Trecker & Miller-Kuhaneck, 2004). Social skills, peer interaction, play, and motor and praxis skills are ultimately inter-related and interventions for one area will strengthen skills in the others. Children diagnosed with ASD often have difficulties with processing sensory stimulation. Occupational therapists provide a variety of intervention strategies to improve sensory registration and regulation (Maillouox & Smith Roley, 2004). Sensory-based interventions that seek to decrease sensitivity to tactile, visual andauditory stimuli, include: sensory integration therapy, therapeutic touch,, and listening systems (Case-Smith & Arbesman, 2008). Evidence is mixed for the effectiveness of these sensory-based treatments for long term outcomes for children with diagnosed with ASD (Baranek, 2002). Case-Smith and Arbesman (2008) completed a review of evidence-based interventions for children with ASD. The articles were analyzed for themes of evidence-based treatment and further categorized by the relevance to occupational therapy practice. Only one of the six themes that emerged, Intensive Behavioral Intervention was not in the scope of occupational therapy services; however, occupational therapists can provide consultative services to behavioral therapists (Case-Smith & Arbesman, 2008,). The other themes found were: “sensory integrative, relationship-based, developmental-skill based, social cognitive training, and parent directed approaches” (Case-Smith & Arbesman, 2008, p. 423). Case-Smith and Arbesman (2008) address the lack of evidence regarding the effectiveness of occupational therapy for ASD, suggesting that more research is needed to improve the understanding of occupational therapy as services they