Validated Outcome Measures Used by Occupational Therapists for Clients With Autism Spectrum Disorder: A Systematic Review

PURPOSE: There are currently gaps in the research when it comes to children with autism spectrum disorder (ASD) and outcome measures that can be used in the field of occupational therapy. The purpose of this systematic review is to identify and compile a list of valid and reliable outcomes measures used by occupational therapists to assess children with ASD.

DESIGN AND METHOD: This study is a systematic review that examined only randomized controlled trials (RCTs), making it Level I research. Automated and manual search methods were used to identify articles that focused on outcome measures for children with ASD. Inclusion criteria included RCTs, articles published from 2000 to 2016 in English, a focus on adolescents (age 18 and under), study participants that have a primary diagnosis within the ASD spectrum, and intervention methods that are occupational therapy based. All articles used in the review are scholarly, peer-reviewed, and available in full text.

Electronic databases searched included CINAHL, Academic Search Premier, PubMed, ProQuest, Cochrane Library, and PLos One. Some specific journals were hand searched, along with the first 10 pages of Google Scholar. When searching databases we used combinations of the following search terms: occupational therapy, therapy, randomized controlled trials, autism, autism spectrum disorders, and outcome measures. The researchers determined the rigor of methodology of each RCT using the PEDro rating scale. Data extracted from the articles included demographics of study: year, population, authors, intervention, sample size, and outcome measures. Data were also extracted to determine the clinical utility: time it takes to administer, validity, cost, population it is designed for, and what the outcome measure is assessing.

RESULTS: After a thorough search of the literature, methodological quality, and inclusion criteria, nine articles were included in our systematic review. In total, 46 outcome measures were identified and categorized by the following areas of development; gross motor, fine motor, speech/language, cognitive/problem solving, and social/emotional characteristics. The six most commonly used outcome measures were selected on the basis of the number of uses within the articles and their relevance in relation to occupational therapy. These outcome measures included Autism Diagnostic Observation Schedule, Vineland Adaptive Behavioral Scales, Goal Attainment Scaling, Social Responsiveness Scale, Pervasive Developmental Disorders Behavior Inventory, and Mullen Scales of Early Learning. Our study found that the majority of the outcome measures used with this population measured social and emotional characteristics, followed by speech and language characteristics. Gross and fine motor skills were the least commonly measured. When comparing the results from our study to similar studies, it was made apparent that various outcome measures were used, even if measuring the same characteristics.

CONCLUSION: This systematic review looked at RCTs to determine outcome measures used to diagnose and assess children and adolescents birth to age 18 who have ASD. Although not all outcome measures identified are directly targeted to be used for occupational therapy practice, they can be used in combination to address areas of ASD that occupational therapists most commonly assess. These findings provide occupational therapy with a simple way to find outcome measures appropriate to their clients’ needs as part of being evidence based. The profession’s practice framework has stated the usefulness for outcome measures and the necessity in everyday occupational therapy practice.