Autism Spectrum Disorders Across the Life Course and Occupational Therapy Services

Abstract

The primary purpose of this position statement is to define the role of occupational therapy and the scope of occupational therapy services available for persons on the autism spectrum to audiences external to the occupational therapy profession. In addition, this document is intended to articulate for occupational therapy practitioners the role and support of the practice of occupational therapy for this population. 1

AOTA’s updated position statement defines for audiences external to the occupational therapy profession the role of occupational therapy and the scope of occupational therapy services available for persons on the autism spectrum and articulates for occupational therapy practitioners the role and support of the practice of occupational therapy for this population.

Many medical providers and related professional organizations have long advocated for the use of person-first language (i.e., “person with autism”) when referring to recipients of their services. However, identity-first language (i.e., “autistic person”) is preferred by many within the autism community (Bottema-Beutel et al., 2020; Bury et al., 2020; Foley & den Houting, 2020; Kapp et al., 2013; Kenny et al., 2016; Shakes & Cashin, 2019), though parents were much less likely to endorse “autistic person” than were persons on the autism spectrum (Kenny et al., 2016). The American Occupational Therapy Association (AOTA) recognizes the complexity of determining appropriate identifying language for persons on the autism spectrum. In the absence of a clear consensus regarding the preferred language (Botha et al., 2021; Vivanti, 2020), this document uses “person on the autism spectrum.” Its use aligns with the profession’s core values of altruism, equality, and dignity and has been supported as a suggested more neutral alternative to “person with autism” (Botha et al., 2021; Bottema-Beutel et al., 2020; Bury et al., 2020; Kenny et al., 2016). Practitioners are encouraged to use professional judgment and collaborate with service recipients to guide their selection of language in accordance with the preferences of their clients.

Background

Autism spectrum disorder (ASD) is the diagnosis used in the Diagnostic and Statistical Manual of Mental Disorders (fifth ed.; DSM–5; American Psychiatric Association, 2013) to describe two clusters of symptoms that range in type and severity and include (1) “persistent deficits in social communication and social interaction” and (2) “restricted, repetitive patterns of behavior, interests or activities” (p. 31). Severity ratings are assigned to the core social communication and focused behavior symptom areas, and the presence of other differences (i.e., intellectual, language related) and association with comorbid conditions (e.g., Rett syndrome, Fragile X syndrome, or epilepsy; anxiety or depressive disorders; feeding, elimination, or sleep disorders) is documented. Taken together, the recording of diagnostic feature severity, accompanying differences, and associated conditions (if present) allow the DSM–5 ASD diagnosis to reflect the full spectrum of symptom presentation, removing the need for other historic diagnostic categories (e.g., autistic disorder, Asperger disorder, and pervasive developmental disorder–not otherwise specified) outlined in earlier editions of the DSM.

In contrast to a medical diagnosis, the educational definition of ASD was designed to identify children eligible for special education and related services in publicly funded schools under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA 2004; Pub. L. 108–446). Under IDEA 2004, autism is defined as a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences (IDEA 2004, 34 CFR §300.8[c][1][i–iii]).

The child’s symptoms must adversely impact their educational performance to be determined eligible for services in school. Occupational therapy is recognized under Part B of IDEA 2004 as a related service and as a primary service under Part C. Thus, occupational therapy must be provided to children on the autism spectrum if those services will help the child benefit from special education (IDEA 2004, §602[26][A]). Because educational classification and identification criteria vary considerably from state to state, readers are referred to specific state policies and requirements for additional information.

Prevalence rates for ASD have increased significantly over the past four decades, with a reported 181% increase since 2002 (Centers for Disease Control and Prevention [CDC], 2020; Chiarotti & Venerosi, 2020; Fombonne, 2020). Recent CDC data from the Autism and Developmental Disabilities Monitoring Network on the prevalence of ASD in the United States identified 1 in 54 children as having ASD (CDC, 2020), with boys 4.3 times more likely to have ASD than girls (1 in 34 boys; 1 in 145 girls). Parent-reported ASD data from available national health surveys (i.e., National Survey of Children’s Health, National Health Interview Survey) note a higher prevalence of 1 in 40. The estimated global prevalence of ASD in children is 0.9% to 1.5% (Elsabbagh et al., 2012; Fombonne, 2020; Meyers et al., 2019).

AOTA (2020b) asserts that “Occupational therapy practice emphasizes the occupational nature of humans and the importance of occupational identity to healthful, productive, and satisfying living” (p. 4). Occupational therapy practitioners work collaboratively with people on the autism spectrum, their families, other professionals, organizations, and community members in multiple contexts to advocate for and provide a range of needed resources and services that support individuals’ ability to participate fully in their self-determined life (Case-Smith & Arbesman, 2008; Kuhaneck et al., 2015; Tanner et al., 2015; Tomchek & Koenig, 2016; Watling & Hauer, 2015; Weaver, 2015). The importance of occupational therapy services is demonstrated by the consistent identification of occupational therapy as the second most frequently accessed service by individuals on the autism spectrum (Bilaver et al., 2016; Interactive Autism Network, 2011; McLennan et al., 2008; Monz et al., 2019; Yingling & Bell, 2020).

Occupational Therapy Domain and Process

The term occupations refers to “the everyday activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to, and are expected to do” (World Federation of Occupational Therapists, 2012, para. 2). They denote personalized and meaningful engagement in daily events by individuals. Occupations are categorized into activities of daily living (ADLs), instrumental activities of daily living (IADLs), health management, rest and sleep, education, work, play, leisure, and social participation within their natural and daily contexts (AOTA, 2020b).

Occupational therapy practitioners’ holistic understanding of person, occupation, and context uniquely positions them to highlight the strengths of people on the autism spectrum and address client-specific goals and priorities for participation in daily occupations. Occupational therapy interventions focus on engaging clients in activities and occupations of daily life. This particular focus on participation in occupations often differentiates occupational therapy from other providers on a care team. Whereas many service providers focus services on skill building with the intent to generalize, occupational therapy services start by considering function and participation in authentic contexts. Practitioners may engage with clients and their support system in various settings, including the home, clinic, workplace, and community. Examples of occupations across the life span that are the focus of evaluation and intervention by occupational therapy practitioners are included in Table 1.

Table 1.

Common Occupations in Which Occupational Therapy Practitioners Partner With a Person on the Autism Spectrum to Maximize Successful Participation

Occupation	Toddler/Childhood	Adolescence	Adulthood
ADLs	▪ Tolerating the sensory aspects of grooming activities ▪ Accepting a healthy variety of foods while participating in mealtime	▪ Participating in daily self-care routines, such as showering, toileting, and dressing	▪ Engaging in sexual expression
IADLs	▪ Cleaning up toys ▪ Wiping up small spills	▪ Planning, preparing, and cleaning up for a snack after school ▪ Participating in the care of animals ▪ Developing safe communication management for cell phone use	▪ Accessing the community by driving or using public transportation ▪ Managing finances ▪ Preparing a shopping list to guide the selection, purchase, and transport of groceries
Health management	▪ Developing self-management skills to regulate emotional state ▪ Expressing changes or needs in health	▪ Learning own past medical history, physician provider, and insurance information ▪ Developing strategies for managing and regulating emotions	▪ Navigating and accessing health care ▪ Communicating with physicians regarding health needs ▪ Managing medications (i.e., dosage, refills, adherence schedule)
Rest and sleep	▪ Participating in routines and rituals that support sleep ▪ Tolerating a nap at day care	▪ Achieving a calm state to rest ▪ Developing self-advocacy skills to communicate sleep routine preferences	▪ Independently preparing the environment for sleep ▪ Achieving restful sleep
Education	▪ Participating in developmental education activities, such as circle time, sensory play, music, and snack time ▪ Participating in various school environments and activities (e.g., cafeteria, playground, gym)	▪ Engaging in formal education activities, such as reading, writing, and math ▪ Organizing and using school tools and materials ▪ Identifying and pursuing informal educational interests and needs	▪ Participating in prevocational and vocational educational activities ▪ Navigating adult or continuing education courses ▪ Advocating for accommodations in college courses ▪ Participating in job training
Work	▪ Understanding work–reward routines ▪ Participating in both child- and adult-led activities	▪ Sequencing job tasks ▪ Developing effective job performance and interaction skills ▪ Exploring and participating in volunteer work	▪ Identifying and pursuing employment options ▪ Seeking and acquiring employment ▪ Developing self-advocacy skill to alter work environment for success
Play	▪ Initiating and persisting in a play activity ▪ Identifying a range of play interests ▪ Exploring and participating in a variety of play activities	▪ Tolerating a variable understanding of rules when playing games	▪ Participating in activities with no set purpose or goal that are enjoyable and internally motivating
Leisure	▪ Engaging in self-led explorations	▪ Exploring and participating in community recreational leisure activities ▪ Developing leisure skills and interests	▪ Maintaining balance between preferred interests and other occupations ▪ Planning for leisure activities (e.g., materials, locations, participants)
Social participation	▪ Participating in family gatherings and rituals ▪ Interacting with others and developing peer friendships	▪ Appreciating a variety of individual friendships with in a core peer group ▪ Demonstrating social independence from family and friends ▪ Understanding social nuances during social and leisure interactions with others	▪ Engaging in community-based social activities and outings ▪ Tolerating sensory preferences with faith-based activities or ceremonies ▪ Navigating digital social networks ▪ Developing intimate relationships

Client-centered occupational therapy service delivery includes evaluation and intervention to achieve targeted outcomes building upon individual strengths and using occupations to promote health, well-being, and participation in life (AOTA, 2020b). The client accesses services at the person, group, or population levels; they may include direct service, consultation, education, and advocacy to support the person, family members, health professionals, educational staff, and communities in which the client engages. The intervention plan is customized to the client’s unique characteristics, needs, desires, and priorities and is built upon the client’s personal strengths and interests. The frequency and duration of intervention are individually determined.

Persons on the autism spectrum can demonstrate complex challenges across multiple occupations and performance areas. Therefore, as goals are achieved, intervention implementation is changed and modified to address all client priority areas. Occupational therapy practitioners work with persons, groups, or populations to promote engagement in occupations. At the person and group levels, practitioners collaborate with family, caregivers, educators, and other team members to understand the daily life experiences of individuals on the autism spectrum and those with whom they interact. At the population level, practitioners may educate staff and design programs and environments for individuals or groups who are served by an organization to be more inclusive of persons on the autism spectrum. At the population level, occupational therapy practitioners may also engage in education, consultation, and advocacy initiatives with communities or ASD consumer groups.

The evaluation and intervention components of the occupational therapy process across all client categories are illustrated through case examples, which are presented in Exhibits 1–8. Specific interventions highlighted in the case examples are based on evidence from the most recent AOTA systematic reviews (Kuhaneck et al., 2015; Tanner et al., 2015; Tomchek et al., 2017; Watling & Hauer, 2015; Weaver, 2015), and guidelines from the National Autism Center (NAC, 2015), and National Clearinghouse for Autism Evidence and Practice (NCAEP; Steinbrenner et al., 2020). Specific discussion of evaluation and intervention components of the occupational therapy process are identified in the sections that follow.

Exhibit 1.

Kamau, Age 2-1/2, in Early Intervention

Occupational Therapy Process	Clinician’s Findings
Client Description	Kamau, age 2-1/2 yr, has ASD. His language consists of single-word utterances and approximations. He has a strong interest in cars, trains, and pounding a ball tower. Kamau has an SLP on his early intervention team. An applied behavioral analysis program was recommended by Kamau’s pediatrician, although the family has not been able to access services.
Occupational Profile	The OT developed the occupational profile of Kamau’s play behaviors, family interactions, and food preferences through a review of available medical records and parent interview. The EI program family assessment noted strong family supports with a large extended family. Kamau’s mother, Jill, identified mealtime and play routines as her priorities for the IFSP. Her primary concerns were his limited social interaction with her and his dad, delayed pretend play, activity level, and limited diet.
Analysis of Occupational Performance	The OT observed and reflected with Jill about shared attention, self-regulation, and interaction after Kamau’s free play and interactive parent–child play routines in the home. Kamau rolled his cars and trains across the end table. He and Jill played “parking lot” and lined up the fronts of the cars on the table edge. When Jill tried to take turns or hold the cars to see if Kamau would make a request, he became upset and scattered the cars on the floor. The OT conducted a structured analysis of Kamau self-feeding and parent–child interactions during an authentic breakfast routine. Kamau frequently tried to climb out of his high chair. He finger-fed himself dried Cheerios from his Paw Patrol bowl and refused yogurt and fruit when Jill tried to feed them to him. She reported that Kamau throws a spoon or fork when offered. He drank milk from a red sippy cup. The TSP–2 (Dunn, 2014) revealed Kamau’s sensory-seeking preferences. Sensation avoiding was also reported, primarily during mealtime and grooming and hygiene routines. These differences correlated with concern about AEPS performance in cognitive, adaptive functioning, and social communication areas.
Goal Setting	The established IFSP goals centered on social communication development, play, and mealtime routines. Joint planning with Jill indicated that by the end of the IFSP she wanted him to ▪ Be less active so he can attend to a 5-min story being read to him, play with her, and sit at the table for meals ▪ Engage in cooperative play with her for at least 15 min with his cars and ball maze/tower ▪ Add at least three new foods to the established list of foods he will eat. ▪ Use gestures, eye gaze, or pictures to communicate his needs and desires in daily play or mealtime routines
Intervention Approach	Weekly EI coaching between Jill and the OT occurred in the home setting to help establish shared attention, self-regulation, social engagement, and play skills. Consultation with the SLP supported preverbal communication. The OT collaborated with Jill to observe and practice sensory processing and self-regulation strategies, initially during play. Strategies included recognizing Kamau’s sensory seeking preferences to include additional or intensified sensory input during activities. Play included more banging and natural movement instead of simply sitting on the floor. Jill had Kamau crawl in a tunnel to get his cars and trains to play, and she always read him books in a rocking chair or sitting on a textured yoga mat. These strategies supported Kamau’s shared attention naturally and, along with positive reinforcement strategies, improved his focus, reciprocal play, and interaction. Reflective questions and feedback with Jill created additional insights that generalized to mealtime and bath-time routines. Teaming with the SLP regarding Kamau’s intervention program led to a joint visit to collaborate on Jill’s mealtime and early social communication priorities. Kamau’s preference for tan, crunchy foods allowed the team to explore with Jill other foods to expand Kamau’s food repertoire. Parent coaching during weekly visits targeted Jill’s priorities. Joint plans most often centered on improving the family’s mealtime routine and the variety of foods Kamau would eat, or play interactions that included other family members when present.
Outcomes	At the end of the IFSP reporting period, Kamau pulled Jill toward things he wanted and used hand gestures to communicate his preferences during daily routines. Jill was adept at reading Kamau’s temperament and level of engagement to skillfully alter activities or the environment to support his self-regulation. She reported that Kamau was sitting to have a story read to him most nights and had noticed that he was calmer for story time when rocked after his bath. Kamau will play “racetrack” and “chase” with his cars for up to 20 min outside on the slide or in the play area of the living room. During mealtimes, Kamau sat at the table for breakfast and with the family for dinner. He had added four new foods, one of which was red. Jill felt equipped with the problem-solving skills she needed to introduce new foods, often through chaining.
Research Evidence and Related Resources to Guide Practice	▪ Toddler Sensory Profile–2 (TSP–2 (Dunn, 2014) ▪ Assessment, Evaluation, and Programming System for Infants and Children (AEPS^®), Third Edition (Bricker et al., 2021)

Exhibit 2.

Jorge, Age 6 Yr, School Setting

Occupational Therapy Process	Clinician’s Findings
Client Description	Jorge, age 6 yr, is a kindergartener with a diagnosis of ASD. He lives at home with his mother. He demonstrates minimal social initiation with peers. When his peers try to engage him, Jorge often does not respond, withdraws, or responds aggressively. Jorge responds more frequently to adults than to children talking to him. He will approach adults to initiate interaction and request help. He needs direct adult supervision to manage his school materials and complete school tasks.
Occupational Profile	The occupational profile was developed through parent and teacher interviews. Jorge did not receive early intervention before entering the school district services at age 3 yr. He has participated in OT services for 1 full academic year. He enjoys spinning on the swings on the playground and sitting with his peers during music time. Jorge has limited sustained interaction with peers and does not initiate new play ideas with peers. At times, he will copy the movements of a peer, such as copying a peer playing with the marble tower.
Analysis of Occupational Performance	The OT conducted structured clinical observations of self-regulation, social communication participation, adult–child interaction, and play skills in school environments (i.e., hallway, classroom, lunchroom, gym, and playground). The SP–2 revealed sensitivity and avoiding sensory patterns. The SFA highlighted current cognitive/behavior task assistance and adaptations supporting Jorge’s activity participation.
Goal Setting	Collaborative discussion with the parent and teacher identified the following goals for Jorge: ▪ Maintain shared attention with an adult during a 5-min turn-taking activity ▪ Complete a 3-step tabletop activity (e.g., color, cut, paste) given graded adult support ▪ Complete a 4-step gross motor movement pattern following a peer model in physical education ▪ Manage his lunchbox and food containers, opening and closing zippers, snapping lids, and Ziplocs
Intervention Approach	OT services were provided in the school setting, initially using a combination of direct services with Jorge and teacher consultation and then fading to consultative only. The OT initially collaborated with the teacher to implement structured teaching methods for tabletop activities and visual supports throughout the classroom. Positive behavior supports and sensory-based interventions, including strategies for self-regulation, were implemented by the OT in the classroom during circle time and centers based on a functional analysis of aggressive behaviors. Social narratives were developed and used before challenging school situations (e.g., standing in line, assemblies, fire drills) to encourage appropriate behavior responses. The OT and teacher developed a peer buddy and modeling program to improve Jorge’s social communication skills for participation during recess and naturally occurring play activities. Ongoing, open communication and consultation with the classroom teacher and family promoted generalization of strategies across home and school settings.
Outcomes	When reporting progress data for the annual IEP, the teacher noted that Jorge is using a visual schedule to independently follow the classroom routine of the day. Jorge is able to cope with changes in the school day if he is prepared by his visual schedule. Breaking activities into smaller, manageable steps supported his success, leading to fewer episodes of overwhelm and dysregulation. He continues to need to use playground time to self-regulate. He was engaging in some collaborative symbolic play in centers with peers and accepted his milk and snack during snack time. Jorge had also handed out snacks to peers on one occasion with a peer buddy.
Research Evidence and Related Resources to Guide Practice	▪ Sensory Profile–2 (Dunn, 2014) ▪ School Function Assessment (SFA; Coster et al., 1998)

Exhibit 3.

Asa, Age 15 Yr, Outpatient

Occupational Therapy Process	Clinician’s Findings
Client Description	Asa, age 15 yr, has autism and attends high school through her local public school district. She accesses special education services and communicates verbally. Asa’s parents note concerns with daily living independence and general organization. Asa comes home from school alone. At present, she does not make herself a snack, assist with requested family chores, or start homework until her parents get home. Asa reports difficulty keeping her mind on what she is doing, persisting when tasks become difficult, and prioritizing work when she is home alone. Homework is therefore started late and takes longer than all would like. This causes Asa to miss out on spending time with her friends. Her parents have sought individualized occupational therapy services from an outpatient clinic.
Occupational Profile	An occupational profile of leisure, adaptive, and IADL performance was developed through interview with Asa and her parents. Asa has interests in anime and J-pop and has two friends from her neighborhood with whom she spends leisure time. These friends share her interests in anime and J-pop. She would like to spend more time with these friends but reports she is always doing homework and working around the house.
Analysis of Occupational Performance	The OT conducted a clinical analysis of self-regulation, executive functioning, parent–child interaction, social responsivity, and IADL performance during simulated activity participation in the clinic. Asa initiated preparing a snack and straightening a room but did not complete the tasks. Her parents prompted her to complete these activities. Executive functioning and environmental awareness differences were seen as contributing factors to Asa’s performance. She was easily distracted, especially by her phone. She often checked it to see if she had new messages and for new posts from others on social media. She did not explore environments to find items she needed, and she asked “How long is this going to take?” five times in 10 min. Consistent with parent concerns, Asa showed weaknesses in the Home Living, Health and Safety, Self-Care, and Self-Direction skill areas of the ABAS–3. Her overall General Adaptive Composite was 75, with Conceptual and Practical areas identified as relative weaknesses. The COSA identified Asa’s most valued occupations as follows: ▪ Get my homework done ▪ Take care of my things ▪ Have enough time to do things I like ▪ Do things with my friends
Goal Setting	Asa and her parents collaboratively set the following goals. Asa will ▪ Independently use 2 small appliances (if needed) to prepare a snack daily after school ▪ Start homework daily in at least 2 subject areas ▪ Independently put her clothes away and straighten her room to her parents’ criteria every Saturday
Intervention Approach	The OT partnered with the OTA to implement the intervention plan (AOTA, 2020a). The OTA provided weekly occupational therapy initially in a clinic setting with the parent present. Services were transitioned to telehealth for generalization as Asa gained functional independence (AOTA, 2018). Self-advocacy intervention was initiated during OT services for Asa to identify preferred snack foods and prioritize considerations to develop her own after-school home routines. She wanted some down time with friends before starting homework and built an initial 30 min of video calls with friends into her routine. Asa clearly defined contextual (space and time), physical environment, and action steps of a snack preparation routine. She set goals for task completion. The OTA used task analysis visual supports and video modeling interventions to support independence in small meal prep and kitchen cleanup. Executive functioning intervention strategies were also used to build problem-solving skills, working memory, and impulse control. Self-regulation was also fostered using technology (video self-prompting), and self-monitoring (work completion checklist and activity log) interventions were implemented. These methods supported activity organization and sequencing as well as sustained attention. Strategies were also used to clearly define expectations for weekly room cleanup.
Outcomes	Asa developed an after-school routine that consisted of an initial check-in with friends on social media before transitioning to initiating her homework and snack preparation using small appliances. She was able to use her phone to follow the routine and stay on task to complete homework in one subject matter. To break up her homework, Asa then independently used task analysis, video prompts, and self-monitoring checklists to use a blender to make a smoothie or microwave to heat ramen. These strategies also allowed Asa to independently straighten her room. Asa’s gained efficiencies with her after-school routine allowed her additional leisure time with friends.
Research Evidence and Related Resources to Guide Practice	▪ Adaptive Behavior Assessment System–3 (ABAS-3; Harrison & Oakland, 2015) ▪ Child Occupational Self-Assessment (COSA; Kramer et al., 2014)

Exhibit 4.

T.J., Age 20 Yr

Occupational Therapy Process	Clinician’s Findings
Client Description	T.J., age 20 yr, is a young man on the autism spectrum. He lives independently in an apartment and is currently enrolled in a junior college. T.J. is having difficulty finding a needed part-time job. He would also like to engage in more leisure activities with friends he has met at school. He feels these difficulties may relate to grooming and hygiene as well ass pragmatic language differences he is aware of and would like to improve. T.J. has several interests but spends most of his free time reading about antique cars. His interest in cars has led to distractibility during driving and resulted in a minor auto accident and a traffic citation for failing to stop at a stop sign.
Occupational Profile	The OSA was used to identify T.J.’s priorities for treatment. He wanted to find a job and “hang with friends.” His priorities from the OSA included bathing, grooming, and driving areas. He thought it would help him in this process of finding a job. He also wanted help learning how to interview. The OT developed an occupational profile of ADL and IADL performance, leisure activities, and driving behaviors through a personal interview with T.J. about his concerns and his interests. The OT also developed an occupational profile for behavior regulation and interpersonal relatedness through interview to inform the job search process.
Analysis of Occupational Performance	Structured analysis of ADL participation indicated that T.J. performed grooming and hygiene tasks quickly, and he often missed important steps (e.g., using soap). The OT noted that T.J. had difficulties staying on topic and with pragmatic language when role playing a job interview.
Goal Setting	T.J.’s self-determined goals included ▪ Thoroughly complete bathing, grooming, and hygiene tasks independently ▪ Find a job related to antique car interests ▪ Use self-management and self-advocacy strategies when needed when engaging with friends and supervisors
Intervention Approach	The OT initially provided weekly occupational therapy in the clinic. As T.J.’s plan progressed, telehealth and intervention in the community were included. Direct intervention targeted improving grooming and hygiene needs through use of task analysis, visual supports, and a self-monitoring system. Consultation with the division of vocational rehabilitation assisted the employment search. The OT and T.J. used role playing, video self-modeling, and collaborative problem solving to build social communication and pragmatic language for the interview process and interactions with friends and eventually coworkers. They worked on greeting the interviewer, preparing responses to commonly asked interview questions, increasing awareness of body language, and following up with the interviewer. Job coaching was initiated for T.J. to learn and master job functions and problem-solve when needed. Self-advocacy was coached so T.J. could address vocational challenges with his supervisor and explore opportunities to engage with autistic self-advocates on campus. T.J. was also referred to an OT driving rehabilitation specialist to assess driving safety and provide interventions to improve executive functioning and focused attention when driving.
Outcomes	T.J.’s personal hygiene quickly improved with supports. While fine-tuning his interview and interaction skill set, he interviewed for multiple positions at auto parts stores and auto resellers. He ultimately found a job with an auto auction organization coordinating inventory for the weekly auction. T.J. was able to self-advocate for accommodations while at work to help him focus and produce accurate work. Interpersonal interaction improved, although T.J. decided he preferred to not interact with people at the auction organization and instead supported the auction behind the scenes. On campus, however, he has built stronger friendships and started an antique car social media page to connect with others.
Research Evidence and Related Resources to Guide Practice	▪ Occupational Self-Assessment (OSA; Baron et al., 2006)

Exhibit 5.

Sanjaya, Age 34 Yr

Occupational Therapy Process	Clinician’s Findings
Client Description	Sanjaya, age 34 yr, has ASD. He lives in an apartment with his wife, Maria. He primarily works from home, coordinating an online business to deploy ads for websites. His wife works outside the home at a local bookstore 3 days/wk. Sanjaya prefers working from home over going to the office, but recent changes will require him to work in the office weekly. He reports work is generally stressful, but the thought of having to go to the office is creating significant anxiety. Sanjaya feels he makes fewer errors and is more efficient when working alone at home. When Maria is home, he is more distractible, has difficulty with time management, and takes longer to accomplish tasks. This frustrates him and often leads to arguments with Maria. Sanjaya and Maria also experience challenges with intimacy. The couple’s LMFT requested that an OT evaluate self-regulation and work modifications that could help Sanjaya be more successful and support a healthy marriage.
Occupational Profile	The OT interviewed Sanjaya and Maria and confirmed that Sanjaya is aware of his differences that affect daily occupations. Occupational roles were discussed, with a focus on social participation, ADLs, and work. The COPM was used to identify Sanjaya’s priorities for intervention. He wants to “feel less stressed” and be able to be productive when he has to work in the office. He also wants to stop “snapping” at Maria when she is home and he is trying to work. Sanjaya also wants to have intimacy “like neurotypicals do.”
Analysis of Occupational Performance	The OT conducted a structured interview with Sanjaya to dive deeper into his social participation with Maria and his work-related stressors (time management, organization challenges). Together, they concluded that he has challenges with arousal regulation and coping skills. He also has difficulty with body space awareness and with reading and sending body language signals during social events. Sensory preferences and differences were noted when discussing both social participation and work. The AASP revealed tactile and auditory sensitivity. Sanjaya seeks deep pressure and reports he likes clothing with Spandex, multiple pillows, and a heavy comforter at night. He also prefers rhythmic movement.
Goal Setting	Sanjaya’s self-determined goals included ▪ Be able to work at home or at the office without experiencing a stress rating over 5 on a self- reported 10-point scale ▪ Reduce his lashing out at Maria when frustrated with work to 0 ▪ Experience some intimacy with Maria weekly
Intervention Approach	Occupational therapy coaching was initially provided in the OT’s office to increase Sanjaya’s awareness of his sensory processing preferences and reflect on opportunities to support arousal regulation. Collaboratively, they conducted environmental scans so Sanjaya could consistently identify aspects he would change to reduce his feelings of anxiety. Reflective questions allowed Sanjaya to identify potential modifications and supports (i.e., dimming the lights; positioning his desk away from others, with a window behind it to use natural light; noise-canceling headphones; alternate seating to allow rhythmic movement). Sensory-based interventions were scaffolded with self-awareness and monitoring interventions to further develop sensory and stress reduction supports for Sanjaya to implement, when necessary, in his natural environments. A cell phone app was used to cue Sanjaya to monitor his stress level and to take a break from work to reduce cumulative stress when he has not moved for a period of time. Video modeling of essential steps in his workflow and additional organizational aids were used to reduce errors and the amount of time to finish tasks. The OT conducted a video analysis of Sanjaya’s interactions with coworkers. They reviewed the video together and role played to help develop awareness of nonverbal communication of facial expression and body language and then practice pragmatic skills. The OT explored opportunities for Sanjaya and Maria to engage in deep tactile pressure and rhythmic input to diminish the impact of tactile sensitivity.
Outcomes	Sensory and self-monitoring supports allowed Sanjaya to report a more even temperament and arousal level regardless of whether he was working from his home or in the office. He had self-advocated with Maria and his boss to make modifications to his work areas at home and in the office. He was working in both environments close to a window to use natural light. Noise-canceling headphones were used as necessary when the noise level was too high for him to focus. Sanjaya was able to interact with coworkers when in the office to request assistance or provide input to job-related activities. He was working toward engaging in conversations not related to work with his coworkers. At the time of discharge from OT, he had not experienced a stress rating above 4 in more than a month. He and Maria had also not argued at home while working. Sanjaya and Maria were experiencing intimate moments periodically throughout the week. They used a hammock or spooned tightly to nap. Deep pressure massage was also used.
Research Evidence and Related Resources to Guide Practice	▪ Canadian Occupational Performance Measure (COPM; Law et al., 2014) ▪ Adolescent/Adult Sensory Profile (AASP; Brown & Dunn, 2002)

Exhibit 6.

Martina, Age 47 Yr, Group Home

Occupational Therapy Process	Clinician’s Findings
Client Description	Martina, age 47 yr, has ASD and has recently transitioned from her parents’ home to assisted living, with available 24-hour supervision, due to her parents’ declining ability to care for her. Martina works part time at a local library, where she sorts books. She has supports for community living funding through the department of developmental disabilities and a small amount of private resources. Martina becomes anxious when her routine is disturbed, demands are placed on her, or her desires are not granted. She enjoys leisure activities with her parents but has limited social participation with peers. Her parents are worried about her making friends and joining activities with peers at her new living facility. Given these concerns, Martina’s parents have arranged for short-term, contract OT services to facilitate her transition to the group home.
Occupational Profile	The OT interviewed Martina, her parents, and group home staff to develop an occupational profile focused on new occupations since her transition to the group home. The COPM was used to identify Martina’s goals for intervention. She identified ADL independence, IADLs, and leisure. She was struggling to complete self-care tasks without reminders from her parents. In addition, Martina noted that her parents performed many of the IADL tasks for her when she lived in their home. Now that she had moved into assisted living, she wanted to learn how to prepare snacks and small meals, do laundry, and take care of her space in the home. She also wanted to be more comfortable with moving around the community on her own. Martina also reported that she sometimes gets lonely without her parents around. She wanted to find ways to do some things with others.
Analysis of Occupational Performance	The OT conducted clinical observations of participation during self-care, cooking, laundry, and cleaning tasks. She also traveled with Martina from her new home to the library to assess navigation awareness and skills in using public transportation. Responses to the AASP items were gathered via interview. In general, Martina’s sensory preferences were consistent with the registration/bystander pattern.
Goal Setting	With group home staff input, Martina’s collaborative goals included ▪ Establish routines to independently accomplish self-care and household chores ▪ Demonstrate a better understanding of and independence in use of transportation services to and from work ▪ Identify at least one self-determined leisure activity to engage with peers (from work or the group home) on a weekly basis
Intervention Approach	Direct OT services were provided in the group home using supported decision making and coaching as primary interaction styles. Visual supports supplemented task analysis and problem-solving interventions for Martina to organize her environment and belongings; establish a routine for daily self-care and weekly home management tasks; and ensure her functional independence in using the available microwave oven, washer, dryer, and vacuum. The OT used technology-aided instruction with Martina to help her learn how to use public transportation to get to and from work each day. She coached Martina to use an app on her smartphone to follow her walking route, identify where to get off the bus, and problem-solve what to do if the bus is late. A family locator app was also used to ease Martina’s parents’ initial anxiety about her use of public transportation. The OT consulted with residential program staff to teach modeling, prompting, and visual supports within an environmental structure to support continued success after discharge from intervention and during everyday interactions. Staff training regarding environmental accommodations, as well as behavioral and environmental supports, was also included. Martina and the OT collaborated with group home staff to identify leisure activity options that matched the self-determined interests Martina identified during the occupational profile. Coaching strategies were used with Martina to help her learn how to engage with peers during leisure activities. The OT also provided social skills training, naturalistic intervention, social narratives, and scripts to support peer-mediated instruction opportunities resulting in engagement in preferred interests with peers.
Outcomes	After a month of twice-weekly occupational therapy, Martina reported improvements in IADL goal area performance and satisfaction with her new living situation. She was following her daily self-care routine and recognized the differences between days she worked and those she did not (e.g., time constraints on workdays). She was also able to prepare a small meal or snack when she missed the home’s prepared meal. Martina did her own laundry and maintained her room with developed supports. Martina rode public transportation most days to work. Her parents still had some anxiety with her use of public transportation, and so they often tried to connect with her for a meal, and they offered to give her a ride on workdays. Martina was still developing her comfort with participating in the leisure activities available at the home. She reported she was most comfortable with bowling because the demands were not as great as on game night. She was engaging most days with other residents in the common area to watch TV and had developed a fondness for one particular resident. Overall, Martina was satisfied with her progress in this goal area.
Research Evidence and Related Resources to Guide Practice	▪ Canadian Occupational Performance Measure (COPM; Law et al., 2014) ▪ Adolescent/Adult Sensory Profile (AASP; Brown & Dunn, 2002)

Exhibit 7.

Adult Group

Occupational Therapy Process	Clinician’s Findings
Client Description	Four adult males, ages 40–56, live in a privately funded group home for autistic adults. The mission of the home is to create community as the residents live together. The home is staffed by two assistants, whose roles are to support resident independence, develop relationships, and manage the household. All residents are responsible for managing their personal space and belongings, contributing to maintenance of common spaces, participating in meal preparation, working in the home’s vegetable garden, and engaging in Friday evening group leisure activities. A private-practice OT is contracted to visit the residence annually for evaluation and every other month throughout the year.
Occupational Profile	Upon becoming a resident, and annually thereafter, each resident is evaluated by the OT, and individual occupational profiles are developed. In addition, a collective occupational profile is developed for the group of residents. Note: This case example presents the group occupational profile and occupational therapy service delivery. To develop the group occupational profile, the OT conducted skilled analyses of residents during group meal preparation and cleanup, daily chore hour, gardening responsibilities, and Friday night leisure activities. She noted each resident’s social interaction skills, motor and praxis abilities, and role and interactions of the staff assistants. The OT then used the COPM to scaffold a group interview with the residents to understand their history as a group and to facilitate group identification of goals for enhanced satisfaction with the living arrangements. The informal LIS tool was used to scaffold discussion and identification of preferred activities for Friday night leisure. Each resident completed the FPI to gather information about individual food preferences and aversions.
Analysis of Occupational Performance	Skilled observations revealed the strengths and challenges of each resident during the collective group activities, including social interaction habits and patterns, individual self-regulatory strategies, and individual capabilities for the motor and praxis demands of the various tasks. Notes from the LIS discussion revealed a range of shared leisure interests. The therapist analyzed these and took into consideration her observations of residents’ motor and praxis skills. The FPI results were reviewed to identify a range of foods enjoyed by all residents and those that are aversive to any resident.
Goal Setting	Through shared decision making, the residents agreed on the following goals: ▪ Use each resident’s strengths to assign meal preparation and gardening responsibilities ▪ Adopt a schedule system for the house that identifies each resident’s daily and weekly responsibilities for house maintenance ▪ Rotate Friday evening leisure activities in accord with resident interests ▪ Meet once a month for collective menu planning
Intervention Approach	A total of 8 hr of direct OT services were delivered to the residents of the home over a 4-wk period to promote collaborative group decision making and enact processes to achieve goals. The OT facilitated group recognition of each resident’s strengths and scaffolded discussions about matching those strengths to required house tasks, helping the group to arrive at collective agreement on each resident’s house maintenance and gardening assignments. The OT established a schedule system for home maintenance assignments and gardening tasks. The OT led discussion and promoted shared decision making for resident selection of Friday evening leisure activities, helping them consider the results of the LIS and matching activities to the strengths and motor and praxis abilities of the residents. She provided guidance on how to compromise. She then established the schedule system depicting the group’s agreed-on schedule for Friday evening leisure activities. The OT facilitated collective group processing of the results from the individual FPIs to promote recognition of which foods were collectively preferred by all residents and which foods were identified as aversive to any resident. Building from the earlier guidance on compromise, she aided the group in establishing a process for working together each month to plan menus that take into consideration the food preferences and aversions. Two hr of indirect service delivery were provided to train assistants in how to support the residents during the planning times for Friday evening leisure and menu development. They implemented group-focused interventions to support collective and collaborative participation in household chores, farm work, and Friday night leisure activities.
Outcomes	After 4 wk of twice-weekly occupational therapy visits, all residents demonstrated competence in consulting the visual chore charts to identify their weekly meal preparation responsibilities and weekly gardening responsibilities. They were able to initiate, persist in, and conclude these activities appropriately with minimal cueing from the staff assistants for when to get started or for thoroughness. On Fridays, all residents joined together at 7:00 p.m. for their leisure activity. Each resident was able to consult the chart depicting the activity for the evening and to engage for a minimum of 30 min, after which they were able to choose whether to continue with the activity or to do something else. Over a period of four Fridays, the resident identified to lead the activity rotated. Each resident was able to take the leadership responsibility when it was his turn, utilizing support from the staff assistants as needed. Residents demonstrated active participation in the monthly menu planning, including consulting the list of foods to include based on the shared food preferences of the group and list of foods to avoid based on each resident’s food aversions. With scaffolding by the staff assistants, the residents were able to complete the monthly menu planning in 90 min, with each resident satisfied with the plan. Assistants were skilled at facilitating resident participation in collaborative leisure activity and menu planning, providing a least-to-most cueing procedure with residents for chore and garden task completion and to provide verbal assistance as needed during Friday evening leisure activities.
Research Evidence and Related Resources to Guide Practice	▪ Canadian Occupational Performance Measure (COPM; Law et al., 2014) ▪ Leisure Interest Survey (LIS; Cincinnati Recreation Commission, n.d.) ▪ Food Preference Inventory (FPI; Goldsmith, 1997)

Exhibit 8.

Organization

Occupational Therapy Process	Clinician’s Findings
Client Description	The local museum of science is interested in making the museum more accessible to individuals on the autism spectrum. The museum hosts school classes daily and specialized weekend learning programs. The city where the museum is located has embarked on an autism-friendly business community initiative.
Occupational Profile	The OT developed an occupational profile of supports for and inhibitors of engagement in museum activities by museum patrons.
Analysis of Occupational Performance	The OT initially completed an environmental scan with an activity analysis as museum patrons of various ages interacted with museum exhibits. Structured analyses were made of behavioral, sensory, and social demands of the museum, including structure, timing, and transitions of docent-led groups; signage; “way-finding” materials; universal design features of physical space; and parking/transportation transitions to the museum. A dedicated time was scheduled for children on the autism spectrum and their families to explore the museum and further inform structured observations. The OT also conducted focus groups at the museum with employees and parents who have children on the autism spectrum to elicit their recommendations for improving accessibility.
Goal Setting	The ultimate goals of the consultation service were to make the museum more accessible. Specifically, museum leadership sought to ▪ Increase the knowledge of museum staff about ASD ▪ Recognize opportunities to alter current exhibits and the environment to make it more accessible ▪ Have supports available for families to guide them when planning to attend and participate in museum exhibits
Intervention Approach	The OT provided an educational presentation to museum education staff highlighting the characteristics associated with ASD, sensory preferences, environmental considerations, and strategies for supporting informal engagement learning. The OT consulted with museum staff to ▪ Ensure the museum website was accessible ▪ Develop a social narrative to be placed on the museum website for families to use before visiting the museum ▪ Create quiet spaces and explore opportunities to alter exhibits to make them sensory friendly and allow both sensory-rich exploration and quiet spaces ▪ Develop an after-school program for adolescents with preferred interests in science to support potential vocational pursuits.
Outcomes	In response to the supports developed through the consultation, the museum leadership reported positive reviews on social media and on their internal satisfaction program from families with children on the autism spectrum. There was recognition in these reviews that the museum staff had become better equipped to support their participation in exhibits and their general enjoyment in the museum and to respond to challenges. Follow-up with the focus group participants validated these positive outcomes.
Research Evidence and Related Resources to Guide Practice	▪ Pfeiffer et al. (2017) ▪ Fletcher et al. (2018) ▪ Silverman & Bartley (2013)

Note. ADLs = activities of daily living; ASD = autism spectrum disorder; EI = early intervention; IADLs = instrumental activities of daily living; IEP = individual education plan; IFSP = individualized family service plan; LMFT = licensed marriage and family therapist; OT = occupational therapist/occupational therapy; SLP = speech–language pathologist.

Evaluation

Evaluation is comprehensive and tailored to the concerns of the specific person, group, organization, or population. Information is collected through records review, interviews, structured observations, and standardized assessments. The evaluation process is designed to provide an understanding of the client’s individual occupational profile and performance. At the group level, evaluation processes may focus on analyzing a program structure, resources, and services that support engagement of people on the autism spectrum in desired occupations. At the population level, practitioners may focus the evaluation process on collaborating with groups who work with or on behalf of people with ASD, or groups of people with ASD, to identify their capacities and needs to support participation in occupations.

Practitioners collaborate with clients to develop thorough and comprehensive occupational profiles that guide evaluation methods and support intervention planning (AOTA, 2021). In doing so, it is important to identify individual strengths and preferred interests as meaningful occupations for self-determined intervention planning and self-advocacy. Formal preference assessment often accomplishes this goal through a systematic process that identifies a hierarchy of potentially reinforcing items or activities. The evaluation process also includes an analysis of the client’s strengths and challenges related to occupations, performance skills, performance patterns, body functions and body structures, and activity or occupational demands. It is recommended that practitioners conduct comprehensive, individualized assessments of occupations relevant to life roles in natural contexts, when possible, to allow for accurate activity analysis and to clearly identify the impact of ASD features and the environment on occupational performance (Kanne et al., 2009; Tomchek & Koenig, 2016). Moreover, by recognizing the vital role family members, caregivers, and significant others have in the occupational engagement of the person on the autism spectrum, practitioners often consider the needs and desires of the full family system. Relevant barriers to occupational performance are identified through analysis of the complex relationship among occupations, client performance skills and patterns, and contexts, including environmental and personal factors.

Evidence indicates that people on the autism spectrum may have difficulties in areas of occupation (e.g., ADLs, IADLs, health management, rest and sleep, play, leisure pursuits, social participation, education, work) and performance patterns, performance skills, and client factors (e.g., sensory integration and modulation, self-regulation, praxis, and motor skill and imitation); therefore, occupational therapy evaluations conducted at the individual level should assess these areas (Filipek et al., 2000; Hyman et al., 2020; Rodger et al., 2010; Tomchek & Koenig, 2016; Volkmar et al., 2014; Zaks, 2006). When using direct assessment to evaluate these areas, adaptations to the typical testing situation, environment, and materials may be necessary to obtain the most accurate measure of abilities and ensure optimal performance of the individual (Filipek et al., 1999, 2000; Tomchek & Koenig, 2016; Watling & Tomchek, 2018). Possible modifications may include

▪ using a visual schedule to structure the flow of the evaluation process or test items;

▪ adapting the verbal directions or adding nonverbal cues (e.g., gesture, visual, model, picture) to enhance understanding;

▪ recognizing the benefits of using special interests, consistency preferences, positive reinforcement, and priming principles to sustain engagement for item administration;

▪ scheduling additional visits to allow familiarity and comfort with the environment or evaluator to allow for smoother transition into the testing process; and

▪ modifying the testing environment or position.

A key element of the evaluation process is accurate documentation. An occupational therapy practitioner should always refer to assessment manuals for modification and allowances within standardized procedures, or document when they were not completed according to established standardization. Recent book chapters and practice guidelines have been developed to inform the practice of occupational therapy related to ASD. Many of these include comprehensive guidance on the evaluation process (Kuhaneck & Watling, 2019; O’Brien & Kuhaneck, 2019; Schell & Gillen, 2018; Tomchek & Koenig, 2016; Watling & Tomchek, 2018). These additional resources provide more detailed information on the evaluation process for people on the autism spectrum than is included in this document.

Intervention

Occupational therapy intervention is designed collaboratively by the practitioner and client in response to the results of the evaluation and is implemented to address the identified challenges in occupations, performance patterns, performance skills, body functions and body structures, contextual affordances, and activity and occupational demands. Service delivery reflects the occupational demands characteristic of varying life stages. For example, during early childhood, and with newly diagnosed children, occupational therapy intervention emphasizes social communication, engagement, and behavior regulation, as well as parent education and training and establishment of healthy family routines (Little & Wallisch, 2018). During the childhood years, intervention includes family members and other professionals on the service delivery team, such as school personnel (e.g., teachers, instructional assistants, bus drivers), and focuses on the child’s developmental progression in motor, adaptive, emotional, social, and academic domains (Hilton, 2018). In adolescence, intervention emphasizes the growing independence across domains of function as the client transitions from childhood to adulthood and transitions from secondary education to employment or higher education (Orentlicher & Case, 2018).

Throughout the adult years, intervention may vary widely as the individual moves through different life stages. In all cases, intervention is customized to meet the unique needs of each client in accordance with individual living situations, relationships, the ability to obtain and maintain employment, personal desires for leisure, and opportunities for social and community engagement (Pfeiffer, 2018). Needs vary with life stage, severity of symptoms, community supports and available resources, personal priorities and preferences, and development of new skills and strategies for success. Addressing needs related to mental health, social emotional function, behavior regulation, flexibility and adaptability, and health and wellness is considered by occupational therapy practitioners for clients of all ages and throughout the course of service delivery (Lin & Huang, 2019; Tomchek & Koenig, 2016). Individuals of all ages on the autism spectrum and in society as a whole benefit from population-level interventions, which remove disparities in access to and quality of services by advocating for and implementing practices at the macro level, such as models for health promotion or life course approaches (Benevides, et al., 2018).

When planning and implementing interventions, occupational therapy practitioners collaborate with clients and persons in their identified support systems (e.g., families, teachers, employers) to customize intervention plans that address clients’ priorities for achieving greater function. The practitioner shares knowledge of theoretical principles, models, and frames of reference; ethical considerations; and available evidence. Collaborative decision-making processes facilitate the collective consideration of client status, client strengths, contextual affordances, opportunities for self-determination, and available resources for occupational engagement, which in turn inform the selection of intervention types and approaches (AOTA, 2020c; Koenig & Shore, 2018). The practitioner then uses professional reasoning in conjunction with ongoing client collaboration to guide clinical decision-making, both in preparation for and throughout intervention delivery. Occupational therapy practitioners use many established interventions as identified by the NAC (2015) and a wide range of the interventions recognized as evidence based by the National Clearinghouse of Autism Evidence and Practice (NCAEP; Steinbrenner et al., 2020), including

▪ antecedent-based interventions,

▪ augmentative and alternative communication,

▪ Ayres’ Sensory Integration^®,

▪ cognitive behavioral and instructional strategies,

▪ exercise and movement,

▪ modeling,

▪ naturalistic and developmental interventions,

▪ parent and teacher implemented interventions,

▪ prompting,

▪ reinforcement,

▪ response interruption and redirection,

▪ self-management,

▪ social skills training and social narratives,

▪ task analysis,

▪ technologically aided instruction and intervention, and

▪ visual supports.

Outcomes

Targeting outcomes of service and transition planning is integral to the occupational therapy process. Outcomes describes what clients aspire to achieve through occupational therapy intervention and encompasses goals that are important to the client within the dynamic physical and social environments and cultural contexts where functioning occurs. Outcomes are important for determining future actions, such as frequency of intervention, progression, and transition out of services. Targeting outcomes involves exploring a client’s priorities, collaborating to design interventions to achieve those priorities, monitoring the client’s responses to intervention, reevaluating and modifying the intervention plan as needed, and measuring intervention success. To facilitate this, occupational therapy practitioners implement data-driven decision-making by regularly collecting and using client-generated data to make clinical decisions regarding intervention implementation, modification, and discontinuation (Schaaf, 2015). Progress is noted through improvement in the client’s occupational performance, adaptation, participation in desired activities, satisfaction, role competence, health and wellness, and quality of life and through prevention of further difficulties and facilitation of effective transitions.

Occupational therapy has been identified by clients and family members as a valuable service that improves understanding and acceptance of ASD characteristics, promotes skill development, reduces interfering behaviors, and fosters functional independence and quality of life (Becerra et al., 2017; Mackintosh et al., 2012; Umeda et al., 2017; Watling & Spitzer, 2018). The interventions provided by occupational therapy practitioners promote positive outcomes in all 13 areas identified by the NCAEP (Steinbrenner et al., 2020) as relevant to people on the autism spectrum:

▪ Academic

▪ Adaptive

▪ Challenging behavior

▪ Cognitive

▪ Communication

▪ Joint attention

▪ Mental health

▪ Motor

▪ Play

▪ School readiness

▪ Self-determination

▪ Social

▪ Vocational

Occupational therapy practitioners are skilled at analyzing the interaction among clients, their engagement in occupations, and the context to support occupational performance and participation. Practitioners collaborate with individuals on the autism spectrum across the life span to understand their unique strengths and challenges, use an array of interventions supported by the evidence to facilitate participation in self-determined occupations, and determine when services are no longer required.

Footnotes

1

The term occupational therapy practitioners includes occupational therapists and occupational therapy assistants.

Authors

Scott D. Tomchek, PhD, OTR/L, FAOTA

Renee Watling, PhD, OTR/L, FAOTA

For The Commission on Practice

Caitlin Synovec, OTD, OTR/L, BCMH, Chairperson

Adopted by the Representative Assembly Coordinating Council (RACC) for the Representative Assembly, 2022.

Note. This revision replaces the 2015 document, “The Scope of Occupational Therapy Services for Individuals with Autism Spectrum Disorder Across the Life Course,” previously published and copyrighted in 2015 by the American Occupational Therapy Association in the American Journal of Occupational Therapy, 69(Suppl. 3), 6913410054.

Citation. American Occupational Therapy Association. (2022). Autism spectrum disorders across the life course and occupational therapy services. American Journal of Occupational Therapy, 76(Suppl. 3), 7613410210. .

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