Participation Difficulty Predictors in Children With Autism Spectrum Disorder and Intellectual Disability

PURPOSE: Individuals who participate in meaningful occupations have higher quality of life, more satisfaction with life, and are physically and mentally healthier (Bohnert et al., 2019). Many children with autism spectrum disorders (ASD) and intellectual disability (ID) have difficulty participating in occupations, which contribute to adult problems with living independently, employment, secondary education, and getting married. Greater understanding of the of participation difficulty predictors can increase our knowledge and intervention effectiveness for addressing these problems in children with disabilities.

DESIGN: Using a retrospective cross-sectional design, we examined participation predictors in children aged 6-17 years from the 2011 Survey of Pathways to Diagnosis and Services (CAHMI, 2015).

METHOD: The study subjects were 415 children with ID, 774 with ASD, and 203 with ASD+ID. The participation measures were individual parent survey items about whether their children experienced difficulty in home life, friendships, classroom learning, and leisure activities (CAHMI, 2015). The participation predictors were four sensory factors (sensory seeking, sensory avoidant, low registration/difficulty with multisensory processing, and repetitive behaviors; Lee et al., 2019), the Strengths and Difficulty Questionnaire (emotional symptoms, conduct problems, hyperactivity/inattention, peer relationships problem, prosocial behavior; Goodman, 1997), and skill-related variables (activities of daily living, fine motor, attention, anxious, and acting out). Contextual factors were age, sex, income level, parent education level, and having insurance. We conducted four multivariate regression models to examine the relationship and predictive capacity of strengths and difficulties, skills, and environmental factors on participation in home life, friendships, classroom learning, and leisure activities for the three diagnostic groups. We also utilized propensity score matching with inverse probability of treatment weight to balance the age and sex distributions across the three diagnostic groups.

RESULTS: Sensory. The sensory score, low registration/difficulty with multisensory processing, was a predictor of participation in all four participation areas and was a predictor for all groups. Sensory seeking and repetitive behaviors were also important predictors for the ASD group. Sensory factors were most represented as predictors in the group with ASD alone. Emotional regulation. Conduct problems, high emotional symptoms, Hyperactivity/inattention and acting out were predictors of several areas of participation problems across groups. Social. Prosocial behaviors were common predictors of fewer participation problems for all groups. Social problems were predictors for more participation problems for all groups. Other factors. Lower income and Lower parent education were predictors for the ASD + ID group. Being male predicted classroom learning problems for the ID alone group.

CONCLUSION: Most of the predictors of participation difficulties are within the scope of occupational therapy intervention. The strongest predictors were sensory and emotional regulation items, suggesting the importance of addressing these areas in OT intervention. Impact Statement. The connections between these areas and their relationship to participation suggest the importance of focusing our interventions on sensory, emotional regulation and social skills areas to address the underlying neurological processing in these children that will support increased participation.

References

Bohnert, A., Lieb, R., & Arola, N. (2019). More than leisure: Organized activity participation and socio-emotional adjustment among adolescents with autism spectrum disorder. Journal of Autism Developmental Disorders, 49(7), 2637-2652. https://doi.org/10.1007/s10803-016-2783-8

Child and Adolescent Health Measurement Initiative. (2015). 2011 Pathways outcome measures SPSS Codebook, Version 1. Retrieved from: www.childhealthdata.org

Goodman R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581-586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x

Lee, M. J., Ratcliff, K., Hilton, C. L., & Hong, I. (2019). Validation of sensory outcome measure: Findings from the 2011 Survey of Pathways to Diagnosis and Services. Korean Journal of Occupational Therapy, 27(4), 167-182. doi.org/10.14519/kjot.2019.27.4.13