Building School Capacity to Facilitate Participation of Students With Autism Spectrum Disorder (ASD): A Multitier Approach

PURPOSE: Children with autism spectrum disorder (ASD) face multiple occupational challenges in elementary school. Schools need support to foster their full participation. While multi-tier approaches like Response-to-intervention are recommended for school-based practice (Basyk et al., 2012; Clark & Polichino, 2013), they are not commonly used to address the needs of a specific population. Study objectives were to (1) identify the main concerns of school staff members regarding the participation of children with ASD and (2) identify recommendations that could help implement a multi-tier practice model to build school capacity to facilitate participation of children with ASD.

DESIGN AND METHOD: A descriptive qualitative study was carried in Quebec (Canada) to explore the perspectives of school staff and occupational therapists working with children with ASD. Quota-sampling was used to integrate various school staff perspectives (i.e. class teachers, special education teachers, professionals, daycare educators). Participants were recruited via e-mails and participated in one of three focus groups: a) one with school staff from special education schools (n=6), b) one with school staff from mainstream schools (n=8), and c) one with occupational therapists (n=10). During the sessions, school staff members voted for five school activities that prompted concern regarding the participation of children with ASD and explained their choices. All groups identified what could be done to ruin the implementation of the practice model, and then to make it successful. Occupational therapists also described an ideal multi-tier practice model to promote the participation of children with ASD. Group transcripts were analyzed thematically using both deductive (using the PEO model) and inductive content analysis. Triangulation of various sources and double-coding enhance validity.

RESULTS: School staff members were primarily concerned with frequent outbursts and limited independence in a wide range of school activities. More than 50% identified writing, play with peers, classroom routines, music or physical education classes, and transitions as priorities for support. School staff discussed the mismatch among characteristics of children with ASD, school environment, and activities. Common characteristics of children with ASD appear to interfere with optimal participation (e.g. anxiety, social and communication skills, rigidity, restricted interests, sensory processing disorder). Characteristics of the school environment that were perceived to interfere included: over-stimulating physical environment, lack of training in human resources, and various levels of peer acceptance. In addition, some characteristics of school activities came out as less favourable to the participation of children with ASD (e.g. lack of structure and predictability). The key recommendations identified provide guidelines to foster successful implementation of a multi-tier practice model for children with ASD. These give indications regarding collaborative practices, support to occupational therapists, and provide a structured and iterative process (i.e. 1) define your role, 2) evaluate common needs, 3) establish and implement an action plan, and 4) conduct follow-ups).

CONCLUSION: School staff working with children with ASD in elementary schools are concerned with participation in a variety of school activities in contexts beyond the classroom. The practice model developed based on the study findings will guide occupational therapists who seek to develop school capacity to support the participation of children with ASD. Congruent with recommendations on school-based occupational therapy, it uses a multi-tier approach that requires close collaboration with school staff.

References

Bazyk, S., Berthelette, M., Cahill, S., Frolek Clark, G., Csanyi, C., McCloskey, S., & Schefkind, S. (2012). AOTA practice advisory on occupational therapy in Response to Intervention. Retrieved from https://www.aota.org/-/media/corporate/files/practice/children/browse/school/rti/aota%20rti%20practice%20adv%20final%20%20101612.pdf

Clark, G., & Polichino, J. (2013). Chapter 17: Best practices in early intervening services and response to intervention. In G. Froleck Clark & B. E. Chandler (Eds.), Best practices for occupational therapy in schools (p. 173-182). Bethesda, MD: AOTA Press.

American Occupational Therapy Association, Inc. (2015). Occupational Therapy’s Role in Mental Health Promotion, Prevention and Intervention with Children and Youth: Inclusion of Children with Disabilities. School Mental Health Toolkit. Retrieved from: https://www.aota.org/∼/media/Corporate/Files/Practice/Children/Inclusion-of-Children-With-Disabilities-20150128.PDF