J.,
My sister-in-law is an Occupational Therapist and works in both a private school dedicated to children with autism as well as other behavioral/cognitive difficulties and as in early intervention therapist. Here's what she wrote back to me for information on what your sister in law might be able to do:
This little guy would definitely qualify for services. Sounds like currently he's getting home-based behavior services or respite care. Although, helpful, usually those employees are not trained in how to implement specific therapies. It is mostly to give the family some downtime, so they can get things done around the house or go to the market...etc. The exception would be if they were qualified for ABA therapy, which is a specific behavior modification program (I've never seen it be very effective, but I also did not see it being implemented properly...that was when I was working in CT). Since this little guy is 3 and 1/2 he no longer qualifies for early intervention services, however, is probably eligible for services and an IEP through his school deparment (I would be COMPLETELY SHOCKED if he didn't qualify). What they would need to do is connect with their town's school department and get the special education process started. They would first probably need to sign off to have evaluations done. Next, they would have an eligiblilty meeting to decide whether or not he qualified for services...he has autism...so he would qualify! They may even draft an IEP at that meeting...setting functional goals with the family. After that, a placement meeting would be scheduled to determine what type of program would be most beneficial and the least restrictive environment for the kiddo to be in while reaching the already determined IEP goals and objectives (is it a 1/2 day? full day? incusion class?, #of days per week? etc) Some parents don't want their child in a preschool setting at that age (why? I'm not sure...it is most beneficial), they can still get the therapy services recommended, but would have to bring their child for services during the week.
Another option is to ask their pediatrician for an "OT evaluation and treatment, as neeeded for sensory processing concerns". These are the types of referrals we got at Rehab New England (in Warwick). The doctor may also want to refer for a speech eval. (if they got the OT eval done...more than likely the OT would also recommend a speech eval). If services are necessary (I'm sure he would qualify...the potty training difficulty could be linked to sensory processing dysfunction, more specifically, sensory defensiveness) the families insurance would more than likely pick up the cost...since it is medically needed. If they are in the RI area...Meeting Street, Hasbro, and Rehab New England could all be resources for this type of service, as well as the Autism Project (located in Cranston), Autism Speaks (in Warwick) and RIPIN (RI parent information network) for more services in the RI area, parent support, rights, etc. If closer to MA area, there is a GREAT sensory based clinic in Watertown, MA with very well-known (in the OT world) clinicians. The school and/or the clinic where this child gets services can ultimately writeup a NEED for any therapeutic equipment, supplies needed at home and more than likely the insurance company will have to pick up the cost.
If you would like more info, feel free to email me back at ____@____.com and I'll reach my sister in law for the info.
Best of luck,
B.