Occupational Therapy and Autism Spectrum Disorder: A Scoping Review of 70 Years of Literature

SIGNIFICANCE: As the profession strives to meet the Centennial Vision, it is an appropriate time to look backward and think forward. Given changing conceptualizations of autism spectrum disorder, increasing numbers of individuals diagnosed with autism spectrum disorder, the increased demand for occupational therapy, and concerns about the focus of occupational therapy intervention, it is especially prudent to take a historical stance to guide future research and practice.

INNOVATION: This study is innovative in that we used a scoping procedure to examine the occupational therapy literature from 1943 through 2013. Scoping reviews can inform practice and policy and determine priorities for future research.

METHOD: How has the occupational therapy literature addressing autism spectrum disorder changed since autism was first identified? Occupational therapy has been an important service for individuals with autism spectrum disorder. However, occupational therapy is often conflated with sensory integration intervention, leading to criticisms both inside and outside the profession. It is important, particularly in light of the profession’s commitment to becoming evidence-based and science driven, to take stock of occupational therapy from a historical vantage point to develop future priorities for practice and research. To conduct this scoping review, we identified articles addressing autism spectrum disorders from five peer-reviewed occupational therapy journals. A total of 108 articles published between 1980 and 2013 were located and analyzed.

Using a charting form, we recorded full citations, article purpose, and key findings. For intervention studies, the population, study design, type of intervention, context of intervention, outcomes, and outcome measures were recorded. Studies were sorted by date chronologically. A master chart for each decade was then developed.

Analysis began with grouping the studies into categories according to article type. A similar process of coding occurred for the intervention studies. Data analysis entailed tabulating frequencies in each category across decades and by decade. Each decade was analyzed for themes and major shifts in focus, and a narrative was constructed.

RESULTS: There was a large increase in number and type of articles over the 70-yr period. The most frequent article type was intervention studies, followed by description of sensory processing. Results indicate that the most commonly used intervention was sensory processing, followed by sensory integration, with alternative interventions becoming more prevalent recently. Interventions focused primarily on children; no interventions addressed the needs of adults. Single subject/case report was the most frequently used design, with more sophisticated designs emerging. Intervention outcomes shifted from performance skills to more occupation-focused outcomes. The context of intervention remained primarily therapy-specific environments.

CONCLUSION: Overall, articles from each decade reflected trends in the profession and the interdisciplinary field of autism spectrum disorder more broadly. Results of this scoping review provide researchers and practitioners with a historical perspective from which to consider future directions for the profession. Limitations include choice of journals and types of articles reviewed.