bill's 2012 otac presentation final

8/3/2019 Bill's 2012 OTAC Presentation Final

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Presentation Overview

Overview of the Concept of CaregiverStress and Other Related Concepts

Gaps Between Caregivers and OTProfessionals

Identifying Sources of Caregiver Stress inAspergers Syndrome Context


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Presentation Overview (cont.)

Why OT Community Has to Pay Attention toWhat Was Said About Them Online

Limitations in Addressing the Needs of Caregivers in OT Settings

Identifying Solutions to Within OT Settings


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Terminology Overview

Life = Configurations of everyday patternsLife = Configurations of everyday patternsof occupation meeting essential humanof occupation meeting essential humanneeds (Matuska & Christiansen, 2008)needs (Matuska & Christiansen, 2008)

Lifestyle balance = unique patterns of Lifestyle balance = unique patterns of occupation enable needs essential tooccupation enable needs essential toresilience, wellresilience, well- -being, and quality of life arebeing, and quality of life aremet (Matuska & Christiansen, 2008)met (Matuska & Christiansen, 2008)


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Terminology Overview (cont.)

Role strain/Role burden = stress or strainRole strain/Role burden = stress or strainexperienced by an individual whenexperienced by an individual whenincompatible behavior, expectations, orincompatible behavior, expectations, or

obligations are associated with a singleobligations are associated with a singlesocial role. (dictionary.com)social role. (dictionary.com)


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5 Dimensions of the Model of Lifestyle Balance

Rewarding & self Rewarding & self- -affirming relationshipsaffirming relationshipswith otherswith others- - #1#1

Feeling interested, engaged, challenged,Feeling interested, engaged, challenged,and competent and competent- - #2#2

Creating meaning and a positive personalCreating meaning and a positive personalidentityidentity- - #3#3


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5 Dimensions of the Model of Lifestyle Balance (cont.)

Organizing time and energy to meet Organizing time and energy to meet importance personal goal and personalimportance personal goal and personalrenewalrenewal- - #4#4

Biological health and physical safetyBiological health and physical safety- - #5#5

(Matuska & Christensen, 2008; Stein et. Al,(Matuska & Christensen, 2008; Stein et. Al,2011)2011)


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(Stein et. Al, 2011) Bills research

#1- Caring for a child with ASD canalter a parents social supports andrelationships with friends, family, andothers.

#1- This is dependent on family to family. Some families can beaccepting. Some families can be indenial/refusal to accept. However,

proactive parents can find support bybefriending other parents andknowledgeable Aspies on placessuch as Facebook, where they could

find others who might betterunderstand what they are goingthrough.


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#2- Parents of children with ASD mayhave particular challenges withproviding appropriate services andcare, fostering development and

feeling engaged with their child, andmanaging behaviors. Thesechallenges can lead to feelings of incompetence in the parenting role.

#2- These challenges is caused by aproblem with health literacy in thegeneral public. So, parents would endup asking other parents or consumers

who happen to know more than theydo. Parents do feel incompetent whenthey posted questions about theirchallenges, but would often berelieved if someone can provide themwith possible solutions.


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#3- For some parents, caring for achild with ASD results in increased lifesatisfaction, but many othersexperience a loss of self and

feelings of being trapped in the role of caregiver as they struggle to maintaintheir individual identity

#3- This varies from parent to parent.Their support network and knowledgeof autism can have a correlation withtheir life satisfaction.


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#4- The lives of parents of childrenwith ASD are often dominated by theneeds of the child, leaving parentswith little time to engage in other

personally meaningful occupations.

#4- Same as the article hadmentioned, for the most part.However, proactive parents havelearned to enfold their occupations-

particularly when they are on thecomputer. Their interactions withother parents and Aspies can bepotentially therapeutic- whether its

finding answers to their ownquestions or other peoplesquestions.


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#5 - Parents of children with ASD areat increased risk for stress, anxiety,depressive feelings, poor sleep qualityand quantity, decreased daily mood,

and decreased perceived well-being.

#5 - The article is right on target.Hence, Internet (such as Facebookgroups and fan pages) have becomepopular sounding boards for parents

to express these feelings in theirquest of finding answers for theirchildren with ASD.


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Gaps Between Caregivers andOT Professionals

OTOTs capacities to develop effectives capacities to develop effectiverelationships depend on the institutionalrelationships depend on the institutionalenvironment of their workplace.environment of their workplace.

Parents are often involved in initiatingParents are often involved in initiatingreferrals or expressing their concerns, but referrals or expressing their concerns, but their involvement in framing the problem istheir involvement in framing the problem islimited. (Lawlor & Mattingly, 1998)limited. (Lawlor & Mattingly, 1998)


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Gaps Between Caregivers andOT Professionals (cont.)

A lot of parents might have little or noA lot of parents might have little or noknowledge of what they are in for, or what theknowledge of what they are in for, or what theprofessionals are looking for.professionals are looking for.

Time constraints make matters worse.Time constraints make matters worse.Even if the parents are wellEven if the parents are well- -informed, parentsinformed, parentsmight not realize the importance of their rolesmight not realize the importance of their roles

for their children. (Woods & Lindeman, 2008) for their children. (Woods & Lindeman, 2008)


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Even though parents and professionalsEven though parents and professionalsshare the same objectives, parents donshare the same objectives, parents don t t care as much about rules and regulationscare as much about rules and regulationsthat OTthat OT s and other professionals might haves and other professionals might have

to deal with.to deal with.AspiesAspies behavior might differ between thebehavior might differ between thetherapy setting and othertherapy setting and other commoncommon settingssettings


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Parents and OT professionals interpretingParents and OT professionals interpretingthings differently about the child.things differently about the child.

Parents could have tough times grasping theParents could have tough times grasping the

OT concepts/theories that we know.OT concepts/theories that we know.


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Parents Voices on theInternet and Their Importance

Parents are on online support groups for theParents are on online support groups for the following reasons. following reasons.

Finding support and/or solutions to theirFinding support and/or solutions to their

problems in their daily livesproblems in their daily livesOffering support and/or solutions to otherOffering support and/or solutions to otherparents or individual Aspiesparents or individual AspiesRanting about their current situationRanting about their current situation


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Notable Online Posts

I wonder if my nearly 9 yr old Aspie daughter willI wonder if my nearly 9 yr old Aspie daughter willever get to the point of doing things independent of meever get to the point of doing things independent of meguiding/prodding her along or doing it myself for her. Sheguiding/prodding her along or doing it myself for her. Shecan spend over a half hour just standing there in thecan spend over a half hour just standing there in theshower spacing out without even starting to wash upshower spacing out without even starting to wash up- - andandthat with being told several times to start shampooing.that with being told several times to start shampooing.Anyone with an older Aspie? Have they got past that, or isAnyone with an older Aspie? Have they got past that, or isstuff like that continuing to be a problem?stuff like that continuing to be a problem?


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Hello. My son is 11 and in year six in primary school.Hello. My son is 11 and in year six in primary school.Yesterday after school he sat down with me and i couldYesterday after school he sat down with me and i couldsee he was upset. He started to tell me that one of hissee he was upset. He started to tell me that one of hisclass mates told him that his dad said he was not allowedclass mates told him that his dad said he was not allowedto play with him anymore . of course being an aspi heto play with him anymore . of course being an aspi hecould not compute this one bit. He broke down in tears. Icould not compute this one bit. He broke down in tears. I

just had to say to my son that there will always be people just had to say to my son that there will always be peoplewho won't understand. Or don't want to understand. Allwho won't understand. Or don't want to understand. Allpart of the rocky road i think.part of the rocky road i think.


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How do other parents of asperger children dealHow do other parents of asperger children dealw/family members who exclude them from familyw/family members who exclude them from family

functions. The most recent was his cousins wedding, he functions. The most recent was his cousins wedding, hewas only invited to the ceremony and the family pictureswas only invited to the ceremony and the family picturesafter the ceremony, but, not to the reception. He wasafter the ceremony, but, not to the reception. He wasalmost 12 at that time and he would have been fine.almost 12 at that time and he would have been fine.

We almost did not go, and we have decided that We almost did not go, and we have decided that when he 2 other cousins get married if Josh is not invitedwhen he 2 other cousins get married if Josh is not invitedwe will not go. What would others do in this situation?we will not go. What would others do in this situation?


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my son was diagnosed with aspergers syndromemy son was diagnosed with aspergers syndrome2009 and for a single parent like myself can be very2009 and for a single parent like myself can be verystressful at times i would like to take this opportunity andstressful at times i would like to take this opportunity andshare this with you all hoping you can give me someshare this with you all hoping you can give me someanswers first of my son is a compulsive eater he attends aanswers first of my son is a compulsive eater he attends adietician he cant stop eating i try my best to give him thedietician he cant stop eating i try my best to give him thebest fruit and veg he has plummetted to nearly 9 stone andbest fruit and veg he has plummetted to nearly 9 stone andhe is only 9yrs of age pls can you advise me if this is allhe is only 9yrs of age pls can you advise me if this is allpart of the autism too :@?part of the autism too :@?


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Finding Support/Solutions

Parenting is aParenting is a 24/7/36 524/7/36 5 occupation.occupation.

OT sessions for their child only represents aOT sessions for their child only represents asmall percentage their overall life.small percentage their overall life.

The initial poster is usually desperate forThe initial poster is usually desperate foranswersanswers- - feelings included feelings included anxiety, self anxiety, self- -blame, grief, and acknowledgement blame, grief, and acknowledgement (Klein et.(Klein et.Al, 2011)Al, 2011)


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Offering Support/Solutions

Everyone treats each other as family,Everyone treats each other as family,especially in advices goes.especially in advices goes.

They understand that some of theThey understand that some of theprocesses can be overwhelming forprocesses can be overwhelming forparents who are new to the diagnosis.parents who are new to the diagnosis.

Potential therapeutic benefitsPotential therapeutic benefits


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Rants

Typically they are things that are left unsaidTypically they are things that are left unsaidin OT settingsin OT settings

If they are said, you have to reflect on theIf they are said, you have to reflect on the

comments and see if you have done your job.comments and see if you have done your job.Support groups (particularly ones on theSupport groups (particularly ones on theInternet) has become a commonplace forInternet) has become a commonplace forthese rants.these rants.


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Why Do We Have to Be Aware?(cont.)Assistance to parents on how to giveAssistance to parents on how to giveconstructive criticism to our colleagues (if constructive criticism to our colleagues (if necessary).necessary).

Avenue to educate parents where we might Avenue to educate parents where we might not have otherwise due to time constraints.not have otherwise due to time constraints.

Practice to explain your clinical reasoning andPractice to explain your clinical reasoning andwhat we know in clinic settings!what we know in clinic settings!


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Why Do We Have to Be Aware?

Open dialogue between parents and OTOpen dialogue between parents and OT- - in ourin ourrole to be advocates for them and their childrole to be advocates for them and their child

Parents will join as many of these groups asParents will join as many of these groups as

possible to find answers.possible to find answers.Our interventions shouldnOur interventions shouldn t be only childt be only child- -specific with narrow sensory perspectives.specific with narrow sensory perspectives.(Rodger et. Al, 2010)(Rodger et. Al, 2010)


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Hands On Activity

Hands on the ActivityHands on the Activity- - 5 minutes5 minutesBrainstorm potential sources of caregiverBrainstorm potential sources of caregiverstress.stress.


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Potential Sources of Caregiver Stress

Ability to accessAbility to access s services (e.g.ervices (e.g.Socioeconomic status)Socioeconomic status)

Search for appropriate services and/orSearch for appropriate services and/ormedicationsmedications

Attempt to understand what they couldAttempt to understand what they couldabout AS and the things they will be in forabout AS and the things they will be in for


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Altered routine in getting their kids toAltered routine in getting their kids todifferent services, on top of the existingdifferent services, on top of the existing

family family- -related occupations. (Wernerrelated occupations. (Werner- -DeGrace, 2004; Mailick Seltzer et. Al, 2001)DeGrace, 2004; Mailick Seltzer et. Al, 2001)

Their aspiesTheir aspies behaviorbehavior

Differences in opinion between the parentsDifferences in opinion between the parentsand the professionals (e.g. over services)and the professionals (e.g. over services)


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Running out of tricksRunning out of tricks to keep their aspiesto keep their aspies behavior in checkbehavior in check

Seeing that their aspies have few or noSeeing that their aspies have few or no

friends. friends.Their aspies transitioning into a teenagerTheir aspies transitioning into a teenageras well as adulthood and their abilities to beas well as adulthood and their abilities to beindependent.independent.


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Knowledge about AspergerKnowledge about Asperger s and how thes and how thediagnosis presents itself in their aspies.diagnosis presents itself in their aspies.

The news of the diagnosis impactingThe news of the diagnosis impacting

themselves and their families.themselves and their families.Process of waiting for the diagnosis. (Lewis et.Process of waiting for the diagnosis. (Lewis et.Al, 2010)Al, 2010)

Lack of support from family and/or friends.Lack of support from family and/or friends.


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People (family or strangers) makingPeople (family or strangers) making unjust unjust criticism (well intended or not) about theircriticism (well intended or not) about theirchild in public.child in public.

Sensory differences affecting choices of Sensory differences affecting choices of occupations; preparation and planning of occupations; preparation and planning of occupations; overall experiences, meaning,occupations; overall experiences, meaning,and feelings of occupations (dependent onand feelings of occupations (dependent onquality of experience) (Bagby et. Al, 2012)quality of experience) (Bagby et. Al, 2012)


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Explanation of Factors

Parental stress is positively correlated withParental stress is positively correlated withemotionalemotional- -focused strategies and poorer focused strategies and poorerquality of life.quality of life.

Perception of experiences as a threat have aPerception of experiences as a threat have apositive correlation with poor ability to adapt.positive correlation with poor ability to adapt.Parents perceiving their experiences as aParents perceiving their experiences as achallenge has a better relationship with theirchallenge has a better relationship with their

child and greater self child and greater self- -fulfillment. fulfillment.


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Parental feelings of ineffectiveness inParental feelings of ineffectiveness inparenting, lack of feelings for responsibility forparenting, lack of feelings for responsibility forchildchild s behavior, and perception of their childs behavior, and perception of their child ssneeds dominating their lives are associatedneeds dominating their lives are associated

with the increased reports of stress.with the increased reports of stress.Parents who have external loci of control andParents who have external loci of control andblame themselves for the problem tend to feelblame themselves for the problem tend to feelthey have less control of their lives and theirthey have less control of their lives and theirchild.child.


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Parents feel a higher level of coherence areParents feel a higher level of coherence areassociated with seeking social support andassociated with seeking social support andself self--controlling copingcontrolling coping

Parents who reported more guilty feelings adParents who reported more guilty feelings adwho felt having poor control over their childwho felt having poor control over their child ssdevelopment have less available socialdevelopment have less available socialsupport.support.


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Parents who employ emotion focusedParents who employ emotion focusedstrategies are more stressed, feel morestrategies are more stressed, feel moredisturbed in more areas of their lives, havedisturbed in more areas of their lives, havedecreased welldecreased well- -being, tend to experience morebeing, tend to experience more

guilt and false beliefs of autism. (Cappe et. Al,guilt and false beliefs of autism. (Cappe et. Al,in press)in press)


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OT Settings Limitations

Rigid specialization tend to cause gaps inRigid specialization tend to cause gaps inservice delivery, miscommunication, andservice delivery, miscommunication, andlimited attention tolimited attention to gray areasgray areas (Lawlor &(Lawlor &

Mattingly, 1998)Mattingly, 1998)E.g. SchoolE.g. School- -based OT settingsbased OT settings


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OT Settings Limitations(cont.)

Rarely services are available for Aspies once theyRarely services are available for Aspies once theyare past 21. Hence parents can have moreare past 21. Hence parents can have moredifficulty finding services for their Aspies who aredifficulty finding services for their Aspies who arediagnosed at that age or later.diagnosed at that age or later.

Transitions (to high school and adulthood) areTransitions (to high school and adulthood) aremajor areas of weakness of school based OT (frommajor areas of weakness of school based OT (fromInteractive Session at Autism West SpecialtyInteractive Session at Autism West SpecialtyConference)Conference)


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Solution #1- Pediatrics

Have parents observe your sessions, at least Have parents observe your sessions, at least early on.early on.

Pro: Parents can learn on the spot and ask questions.Pro: Parents can learn on the spot and ask questions.

Con: Not necessarily feasible in all clinic settings.Con: Not necessarily feasible in all clinic settings.


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Give parents your email address (work orGive parents your email address (work orpersonal), allow parents to send you friendpersonal), allow parents to send you friendrequests on Facebook, and/or provide yourrequests on Facebook, and/or provide yourphone number.phone number.

Pro: Time to answer parentsPro: Time to answer parents question and/or explainquestion and/or explainyour clinical reasoning in detailyour clinical reasoning in detail

Con: Parents generally want answers ASAP.Con: Parents generally want answers ASAP.


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Solution #3- Pediatrics (alsoapplies in M.H./H & W)

Provide links/information on online and/orProvide links/information on online and/oroffline support groupsoffline support groups

Pro: Helps parents to not feel that they are alone.Pro: Helps parents to not feel that they are alone.

Con: Quality of these groups might vary. ParentsCon: Quality of these groups might vary. Parentsmight or might not like them.might or might not like them.


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Provide stress management sessions for theProvide stress management sessions for theparents while their child receive services.parents while their child receive services.

Pro: Can directly address potential wellPro: Can directly address potential well- -being andbeing andquality of life issues.quality of life issues.

Con: Feasibility issues for the clinic as well asCon: Feasibility issues for the clinic as well asperhaps the parents.perhaps the parents.


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Solution # 5 - Pediatrics (alsoapplies in M.H./H & W)

Linking up parents with similar issues offlineLinking up parents with similar issues offlineand/or online.and/or online.

Pro: Parents can get reassurance that they are not Pro: Parents can get reassurance that they are not alone.alone.

Con: HIPPA/Confidentiality (offline), might not haveCon: HIPPA/Confidentiality (offline), might not havethe time to go online (online)the time to go online (online)


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Create a blog that speaks about yourCreate a blog that speaks about yourexperiences in OT, with its target audienceexperiences in OT, with its target audienceare parents.are parents.

Pro: Parents can get a betterPro: Parents can get a better general ideageneral idea of what isof what isgoing on inside the setting you are working in.going on inside the setting you are working in.

Con: Blog must be updated regularly in order for thisCon: Blog must be updated regularly in order for thisto be useful (at least once a week).to be useful (at least once a week).


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Collaborate with other OTCollaborate with other OT s in the facility tos in the facility toapply aapply a divide and conquerdivide and conquer approach to goapproach to goon different online support groups.on different online support groups.

Pro: Great way to create an open dialogue betweenPro: Great way to create an open dialogue betweenOT professionals and parents.OT professionals and parents.

Con: Many different groups out there.Con: Many different groups out there.


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Organize anOrganize an Ask an Expert Ask an Expert forum for forum forparents about stress management.parents about stress management.

Pro: Parents could get valuable information on how toPro: Parents could get valuable information on how toreduce their stress.reduce their stress.

Con: Logistics required (finding anCon: Logistics required (finding an expert expert , parents, parentshave to set aside time to attend the forum, etc.)have to set aside time to attend the forum, etc.)


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Set aside time for heart Set aside time for heart- -toto--heart talk withheart talk withthe parents on your caseloadthe parents on your caseload- - whether it whether it ssemail, text/video chat, or phone call once aemail, text/video chat, or phone call once amonth.month.

Pro: FamilyPro: Family- -centered servicecentered service

Con: How much time do you really have for eachCon: How much time do you really have for eachparent, especially if you work full time?parent, especially if you work full time?


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ReferencesBendixen, R. M., Elder, J. H., Donaldson, S., Kairalla, J. A., Valcante, G., &Ferdig, R. E.(2011). Effects of father-based in-home intervention onperceived stress and family dynamics in parents of children with autism.American Journal of Occupational Therapy, 6 5 (6), 679-68 5 .

Benson, P. R., & Karlof, K. L. (2009). Anger, stress proliferation, anddepressed mood among parents of children with asd: A longitudinalreplication. journal of autism and developmental disorders, 39, 3 5 0-360.

Bhatia Seth, S. (2011). Autism: the impact on caregivers. Journal of psychosocial research, 6(1), 149-1 55 .

Bourke-Taylor, H., Howie, L., & Law, M. (2010). Impact of caring for aschool-aged child with a disability: Understanding mothers' perspectives.Australian occupational therapy journal, 5 7, 127-134.


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References

Boyd, B. A. (2002). Examining the relationship between stress and lack of social support in mothers of children with autism. Focus on autism andother developmental disabilities, 17(4), 208-214.

Cappe, E., Wolff, M., Bobet, R., & Adrien, J. L. (2011). Quality of life: a keyvariable to consider in the evaluation of adjustment in parents of childrenwith autism spectrum disorders and in the development of relevant support and assistance programmes. Quality of life research, 20, 1279-1291.

Caronna, E. B., Augustyn, M., & Zuckerman, B. (2007). Revisiting parentalconcerns in the age of autism spectrum disorders: The need to helpparents in the face of uncertainty. Archives of Pediatrics & Adolescent Medicine, 161(4), 406-408.


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ReferencesCohn, E. S. (2001). From waiting to relating: parents' experience in thewaiting room of an occupational therapy clinic. American Journal of Occupational Therapy, 55 (2), 167-173.

Cuskelly, M., Pulman, L., & Hayes, A. (1998). Parenting and employment decisions of parents with a preschool child with a disability. Journal of intellectual disability research, 23(4), 319-331.

Dunn, M. E., Burbine, T., Bowers, C. A., & Tantleff-Dunn, S. (2001).Moderators of stress in parents of children with autism. Communitymental health journal, 37(1), 39- 5 0.

Factor, D. C., Perry, A., & Freeman, N. (1990). Brief report: stress, socialsupport, and respite care use in families with autistic children. journal of autism and developmental disorders, 20, 139-14 5 .


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References

Green, S. E. (2007). "we're tired, not sad": Benefits and burdens of mothering a child with a disability. Social science & medicine, 64, 1 5 0-161.

Hare, D. J., Pratt, C., Burton, M., Bromley, J., & Emerson, E. (2004). Thehealth and social care needs of family carers supporting adults withautistic spectrum disorders. Autism, 8(4), 42 5 -442.

Harrington, J. W., Patrick, P. A., Edwards, K. S., & Brand, D. A. (2006).Parenting beliefs about autism: Implications for the treating physician.Autism, 10, 4 5 2-460.

Hines, M., Balandin, S., & Togher, L. (in press). Buried by autism: Older

parents perception of autism. Autism.


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References

Hoffman, C. D., Sweeney, D. P., Lopez-Wagner, M. C., Hodge, D., Nam, C. Y.,& Botts, B.H. (2008). Children with autism: Sleep problems and mothers'stress. Focus on autism and other developmental disabilities, 23(3), 1 55 -163.

Honey, E., Hastings, R. P., & McConachie, H. (200 5 ). Use of thequestionnaire on resources and stress (qrs-f) with parents of youngchildren with autism. Autism, 9(3), 246-2 5 3.

Hurlbutt, K. S. (2011). Experiences of parents who homeschool theirchildren with autism spectrum disorders. Focus on autism and otherdevelopmental disabilities, 26(4), 239-249.


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References

Johnson, N., Frenn, M., Feetham, S., & Simpson, P. (2011). Autism spectrumdisorder: parenting stress, family functioning and health-related quality of life. Families, services & health, 29(2), 232-249.

Klein, S., Wynn, K., Ray, L., Demeriez, L., LaBerge, P., Pei, J., & St. Pierre, C.(2011). Information sharing during diagnostic assessments: What is relevant

for parents? Physical & occupational therapy in pediatrics, 31(2), 120-130.

Lawlor, M. C., & Mattingly, C. F. (1998). The complexities embedded in familycentered care. American Journal of Occupational Therapy, 5 2(4), 2 5 9-266.

Lecavalier, L., Leone, S., & Wiltz, J. (2006). The impact of behaviourproblems on caregiver stress in young people with autism spectrum

disorders. Journal of intellectual disability research, 5 0(3), 172-182.


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References

Little, L. (2002). Differences in stress and coping for mothers and fathers of children with asperger's syndrome and nonverbal learning disorders.Pediatrics nursing, 28(6), 5 6 5 -5 69.

Mailick Seltzer, M., Greenberg, J. S., Floyd, F. J., Pettee, Y., & Hong, J. K.(2001). Life course impacts of parenting a child with a disability. American

journal on mental retardation, 106(3), 26 5 -283.

Mankey, T. A. (2011). Occupational therapists beliefs and involvement withsecondary transition planning. Physical & occupational therapy inpediatrics, 31(4), 34 5 -3 5 7.

Matuska, K. M., & Christiansen, C. H. (2008). A proposed model of lifestyle

balance. Journal of occupational science, 1 5 (1), 9-16.


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References

Miller Kuhaneck, H., Burroughs, T., Wright, J., Lemanczyk, T., & RowntreeDarragh, A. (2010). A qualitative study of coping mechanism in mothers of children with an autism spectrum disorder. Physical & occupational therapyin pediatrics, 30(4), 340-349.

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Preece, D., & Jordan, R. (2007). Short breaks services for children withautism spectrum disorders: Factors associated with service use and non-use. Journal of autism and developmental disorders, 37, 374-384.


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References

Pruchno, R. A., & Meeks, S. (2004). Health-related stress, affect, anddepressive symptoms experienced by caregiving mothers of adults with adevelopmental disability. Psychology and aging, 19(3), 394-401.

Richmond Mancil, G., & Boyd, B. A. (2009). Parenting stress and autism: arethere useful coping strategies. Education and training in developmentaldisabilities, 44(4), 5 23- 5 3 5 .

Rodger, S., Ashburner, J., Cartmill, L., & Bourke-Taylor, H. (2010). Helpingchildren with autism spectrum disorders and their families: Are we losingour occupation-centered focus. Australian occupational therapy journal, 5 7,276-279.


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References

Trapaguier, C. (1999). Families with autism. Infants and young children,12(2), 37-46.

Wang, P., Michaels, C. A., & Day, M. S. (2011). Stresses and copingstrategies of chinese families with children with autism and otherdevelopmental disabilities. journal of autism and developmental disorders,41, 783-793.

Werner DeGrace, B. (2004). The everyday occupation of families withchildren with autism. American Journal of Occupational Therapy, 5 8( 5 ),5 43- 5 49.

Woods, J. J., & Lindeman, D. P. (2008). Gathering and giving information with

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