Interventions That Foster Self-Determination in Autistic Individuals (2013–2021)

Full Systematic Review Question

This systematic review addressed the question “What interventions in the scope of occupational therapy support or improve self-determination for autistic individuals?”

Current Theme Reported

The main theme of the studies included in this systematic review brief is interventions to develop and enhance self-determination for persons on the autism spectrum.

Clinical Scenario

The development of self-determination and advocacy skills are critical for students and adults with and without disabilities. Self-determination is the process by which individuals demonstrate control over their own lives, make choices, and demonstrate mastery and competence (Deci & Ryan, 1985; Patten Koenig & Shore, 2018). For autistic adolescents, there is a need to specifically teach self-determination and advocacy skills as they transition to adulthood, as their access to accommodations and parental advocacy is restricted or changes after high school (Hotez et al., 2018). These skills allow autistic individuals to achieve competency, become aware of their strengths, and master their interest areas, augmenting their self-efficacy and self-determination (Gordon et al., 2015; Martin et al., 2020). As more autistic students are in inclusive classrooms, they often are required to advocate for their sensory, academic, and social needs as they study alongside their nonautistic peers in these inclusive spaces (Onwumere et al., 2021). There is a need for creating spaces and evidence-informed programs where self-determination and advocacy skills can flourish, enhancing social competence and executive functioning, and potentially reducing mental health challenges. The focus on self-determination is often secondary to sensory and motor needs but is critical to successful participation in meaningful occupations. This systematic review brief presents the strength of evidence of interventions that focus on improving self-determination with subthemes on developing self-advocacy skills and autistic individuals gaining mastery and competence.

Summary of Key Findings

Of the 30 studies included in a larger review with additional mental health outcomes, five studies (16%) met the inclusion criteria and had self-determination as their primary outcome. The five articles were further divided into two subthemes: self-advocacy and competence and mastery. The risk of bias ranged from low to high in the five studies. We used the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence for this review. The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018). Subthemes are synthesized and reported in Table 1.

Bottom Line for Occupational Therapy Practice

When working with autistic adolescents, occupational therapy practitioners should consider the importance of the acquisition of self-determination and self-advocacy not only during transition planning but in other contexts (i.e., interest-based clubs, university programs). Interest-based activities can be introduced for younger children as well, with elementary (Onwumere et al., 2021) and middle-school students (Martin et al., 2020). Studies highlighted the need to develop self-advocacy and self-determination skills through developing curricula that focus on positive mental health skills and self- determination. Additional studies showed moderate evidence highlighting the efficacy of developing interventions that enhance and use the strengths of autistic individuals to achieve mastery in their interest areas, thus building the self-advocacy of their participants. Studies are also beginning to include authentic autistic involvement where collaboration and partnership are centered on creating a self-advocacy curriculum through authentic, collaborative partnerships with autistic students (Gillespie-Lynch et al., 2017).

There is a need to move away from deficit-focused interventions and build interventions that organically develop and enhance autistic individuals’ self-advocacy by building opportunities within interventions where they can practice these skills and gain competence and mastery. Environments that are safe spaces for autistic individuals to develop self-advocacy will prepare them to advocate for themselves in real-world scenarios.