Parental Strategies to Support Participation in Home and Community Activities for Children With Autism Spectrum Disorder

PURPOSE: The purpose of this study was to identify the strategies used by caregivers to encourage their children with autism spectrum disorder (ASD) to participate in a variety of home- and community-based activities. Childhood participation has tremendous benefits, including skill development, promotion of physical and emotional health, and formation of interpersonal relationships (Bedell et al., 2005; Law et al., 2013). General research comparing participation levels of children with and without disabilities indicates that children with disabilities participate in fewer activities, are engaged for a shorter length of time, and are less involved than children who do not have a disability (Law et al., 2013). Understanding the strategies parents use to encourage participant of their children with ASD can help occupational therapy practitioners suggest options for families with limited participation.

METHOD: A cross-sectional approach was used for this mixed method design study to understand the types and frequency of strategies used by parents of children with ASD. Participants were recruited from a database of a previously completed study, autism research fairs, and social media. Participants (N = 44) were legal guardians of a child aged 2–7 with symptoms or a diagnosis of ASD based on DSM–V criteria who had either an Internet-accessible computer to complete a web-based questionnaire or telephone access to answer survey questions.

Qualitative data were collected using an electronic, self-administered survey we created to gather the experiences of parents. Survey questions addressed strategy use in targeted domains of activities of daily living (ADLs) in home (nine questions) and community (13 questions) environments. The ADL questions were based on a prior qualitative study (Pfeiffer et al., 2017) that identified the most common areas of participation by children with ASD. A research team analyzed the data through a process of open and axial coding, followed by identification of three central themes and development of a final visual theoretical representation through a structured analytical process.

RESULTS: Three primary themes were identified: strategies were (1) person related, (2) environment related, or (3) cross related. The three most frequent subthemes of parental strategies across all areas of participation were (1) behavior modification (n = 15), (2) instructional support (n = 20), and (3) avoidance of participation (n = 20). Behavior modification strategies included praise, rewards, consequences, punishments, and bribes. Instructional support strategies entailed setting expectations for activities, reviewing rules, explaining the activity, and demonstrating participation in the activity. Forty-one of the 44 participant questionnaires elicited responses related to avoiding participation in at least one home or community participation area.

CONCLUSION: Currently, research has identified that children with ASD participate in activities less frequently than their neurotypical peers. This research highlights strategies that parents commonly use with their children to increase participation in home- and community-based activities. Themes, subthemes, and individual strategies identified through this research can be used to guide occupational therapy interventions to support families and children with ASD in natural environments. With these strategies in mind, occupational therapy practitioners can use information gathered from the occupational profile, assessment results, and clinical reasoning to identify the best strategies to present to parents with the hope of increasing their child’s participation.

References

Bedell, G. M., Cohn, E. S., & Dumas, H. M. (2005). Exploring parents’ use of strategies to promote social participation of school-age children with acquired brain injuries. American Journal of Occupational Therapy, 59, 273–284. https://doi.org/10.5014/ajot.59.3.273

Law, M., Anaby, D., Teplicky, R., Khetani, M. A., Coster, W., & Bedell, G. (2013). Participation in the home environment among children and youth with and without disabilities. British Journal of Occupational Therapy, 76, 58–66. https://doi.org/10.4276/030802213X13603244419112

Pfeiffer, B., Coster, W., Snethen, G., Derstine, M., Piller, A., & Tucker, C. (2017). Caregivers’ perspectives on the sensory environment and participation in daily activities of children with autism spectrum disorder. American Journal of Occupational Therapy, 71, 7104220020. https://doi.org/10.5014/ajot.2017.021360