Are Pediatricians Appropriately Referring Children to OT?

Vol. 27 • Issue 4 • Page 26


Occupational therapy assistant students at Wallace State Community College in Hanceville, AL, made some discoveries when they set out to see what kind of understanding pediatricians in their rural area had of occupational therapy, and whether the physicians were referring children to services when needed. Amy Humphres, Kellie Scott and Beverly Wheeler worked with the Arc of Walker County early intervention program.

The students reviewed 50 charts, documenting the age of each child at referral and his or her percentage of developmental delay based on the Developmental Assessment for Young Children that had been completed as part of the initial assessment. The students also developed a survey for physicians and nurse practitioners in the area. Eleven surveys were mailed.

Seventeen of the 50 children reviewed were age birth to one year. Four children were 13 to 17 months, and 29 children were 18 to 24 months.

Fourteen of the children were referred for developmental delay, seven for a diagnosed condition, five for motor delay and two for drug exposure. Forty-four percent were referred for speech only. Thirty-five of the 50 children qualified for occupational therapy services.

Thirty-six percent of the children referred for speech only demonstrated greater than 25-percent delays in at least one other area. The average age at time of referral for these children was 23 months.

Seven of the 11 surveys were returned from local physicians and nurse practitioners. Seventy-one percent reported they were aware that OT can be beneficial for children birth to 12 months of age. Eighty-six percent were aware that OT can be beneficial to children one to three years. The survey indicates that these health providers are aware of areas of practice by OTs. They refer most often for developmental delay and delayed motor skills, and least often for autism spectrum disorders and drug exposure.

Physicians were more aware of the need for OT in early intervention for children over the age of 12 months. This was certainly reflected in the chart review. Fifty-eight percent of the children referred were 18 months or older.

The survey revealed that health care providers are aware of OT practice areas, yet referrals are not indicative of this. Twenty two of the 50 children were referred solely for speech delay. Fourteen of those 22 children demonstrated a need for either OT, PT or both. Of the 50 children reviewed, 70 percent qualified for OT services.

Physicians refer least often for children exposed to drugs in utero and for concerns of autism spectrum disorder. This is of great concern. Autism is one of the most costly disorders. In 2006 it was estimated that the cost for lifetime care of one individual with autism was $3.2 million (Harvard, 2006). These lifetime costs could likely be reduced simply by referring a child to early intervention services.

Likewise, lifetime costs for children exposed prenatally to drugs or alcohol are significant. In 2002, costs were estimated between $750,000 to $1.4 million per individual (Kalton, 2002). These costs could potentially be reduced through EI services as well.


This study was completed in a rural, southern county. A limited number of charts were reviewed and were limited to a two-year period.

Moving Ahead

Duplication of this study throughout the nation is recommended. Duplication of the study would identify areas that require additional education regarding occupational therapy.

Locally, education for health care providers is being developed. A developmental checklist and information regarding infants’ and toddlers’ milestones will be provided through various avenues throughout the county.


Harvard School of Public Health. (2006. April 25). Autism has high cost to U.S. Society [Press Release]. Retrieved from

Kalotra, Christopher. (2002). Estimated Cost Related to the Birth of a Drug or Alcohol Exposed Baby.

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