Arbitrary charges in the therapy of autism

He went to a children's clinic after receiving a suggestion from doctors to undergo therapy to improve habits, temperament, behavior and speech. However, after the therapy there did not improve much, he was admitted to school. Now a teacher conducts therapy in the school, whose monthly fee is Rs 20,000. The school fee is an additional Rs. 25,000. However, the parents are worried because their son is not improving. Expensive therapy is now impossible for them to swallow.

'It's very expensive, it's like sending him only for 'day care','' the mother said, complaining that we have to pay 45,000 every month.

A children's clinic in Kathmandu has increased the therapy fee, which is being expensive, since last December. Parents would take their children with autism there because the therapy was effective even though it was expensive. The clinic's 'fee revision' notice on December 20 shocked parents. 1,400 for an hour of occupational therapy has now been paid to 1,700. The fee for 45 minutes of behavior therapy has been increased from Rs 900 to Rs 1,200. The fee for one hour of occupational therapy assessment is fixed at Rs 2,000. A parent said that since they could not pay the expensive amount, they started getting therapy elsewhere.

"The therapy was good, effective, after the fee was increased to an unaffordable level, other parents like me stopped taking their children with autism there," she said. If therapy is not done regularly, the child is deprived of learning opportunities. Every child's learning ability is different. If there is an environment where parents practice the same therapy method given in the therapy center and the method taught in the school, there is a possibility that the child will learn faster. "But the therapy centers don't let us know what they are teaching," complained another parent.

These are some examples of therapy centers, children's clinics, special classes in Kathmandu charging arbitrary fees in the name of providing therapy to children with autism. There are at least 60 such organizations across the country. There are 41 such as Nepal Autism Care Society, Neo Clinic, Bloom Park Clinic, Autism Center in Kathmandu Valley alone. However, the parents complain that there are no criteria for opening a therapy center, how many therapists there will be, and how much they can charge for therapy.

'Therapy clinics charge 600 to 1800 rupees for a 45-minute session, we are forced to pay for our child to improve,' said another parent, 'In foreign countries, therapy is done with the parents, here the parents learn and do therapy in a closed room so that they cannot come. In the name of toys, sensory materials, etc., we collect huge amount from the parents.

Occupational, speech, physiotherapy, and behavior therapies have to be done at once, and the therapy fees and education fees are expensive. According to Nepal Autism Care Society's 2018 study report, most of the parents who participated in the survey (66.67 percent) said that the cost of therapy for a child with autism is expensive.

Prakash Budhathoki, the spokesperson of the Ministry of Health, admitted that there are no therapy methods, methods, and standard guidelines for people with autism. "There are standards for physiotherapy, therapy rooms, and therapists in the hospital infrastructure standards, but there are no standards for the type of therapy center for people with autism, the qualifications of therapists, how many people a therapist can treat, and what kind of infrastructure is needed," he said. We have made a plan to set the standards.''He said that if the therapy centers charge voluntary fees and cause pain to the parents, they can file a complaint anonymously. "After that, it will be on the notice of the ministry, monitoring will be done," he said.

According to the guidelines of the American Association of Pediatricians (AAP), therapy is important to facilitate daily living by improving the temperament and behavior of those with autism. Therapy is a form of learning. The sooner therapy is started after autism is diagnosed, the more effective it is. Improvements in speech, behavior, and language are rapid. The AAP recommends screening (testing) for children suspected of having autism, usually between 18 and 24 months of age.

30 percent of children with autism never speak. Some of them communicate by exchanging pictures, symbolically or alternatively. The World Health Organization defines autism as a developmental disorder in children. To make the brain active, therapy such as vision, hearing, speech, smell, tongue taste, therapy related to air flow, water, touch of soft and hard objects, body feeling internally and externally, and lifting heavy objects are necessary.

People with mild autism can be improved with therapy and learning, while those with severe autism need lifelong care and support.