Clinic-Based Interventions to Support Social Participation for Autistic Children and Adolescents (2013–2021)

Full Systematic Review Question

This systematic review addressed the question “What is the evidence related to interventions within the scope of occupational therapy practice for supporting social participation among autistic children and adolescents (birth to 18 yr)?”

Current Theme Reported

The main themes of the studies presented in this systematic review brief include interventions implemented in clinics to support social participation among autistic children and adolescents.

Clinical Scenario

Autistic children and adolescents experience difficulties with social participation (Tobin et al., 2014), which includes friendships, participation in recess, and other social opportunities in homes, communities, and schools (American Occupational Therapy Association, 2020). As occupational therapy practitioners, we must consider ways to support autistic children and adolescents’ social participation. Therefore, this systematic review brief presents evidence on the efficacy of clinic-based interventions to support social participation for autistic children and adolescents.

Summary of Key Findings

Sixteen articles were included in the review related to clinic-based interventions that support autistic children in social participation. These articles were divided into three themes: (1) social participation interventions for early childhood aged autistic children; (2) social participation interventions for school-aged autistic children; and (3) social participation interventions for autistic adolescents (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Bottom Line for Occupational Therapy Practice

Social interaction difficulties among autistic children are included in the diagnostic criteria (American Psychiatric Association, 2013), and these social difficulties present in early childhood in parent–child interactions as well as interactions with peers during school age and adolescent years. Occupational therapy practitioners must consider intervention strategies to support social participation among autistic toddlers, children, and adolescents. Findings in this systematic review brief showed that early childhood (i.e., toddlers, preschool age children) autistic children showed increased social participation following parent education and behavior management interventions. For example, Blackman et al. (2020) found that both in-person and online parent training about behavior management resulted in increased parent–child interaction. In addition, Tonge et al. (2014) found that parent education about behavior management resulted in increased child communication skills as compared with a general parent education approach alone. Taken together, findings suggest that parent education that includes information about managing children’s behavior is key to supporting the social participation of very young autistic children. It is likely that when parents are able to better understand their children’s behavior, they are providing and structuring increased opportunities for social participation.

Next, practitioners should provide multifaceted intervention approaches for school-aged autistic children focused on opportunities for socialization with neurotypical peers, robot-assisted therapy, parent education, and supporting child self-regulation. For example, Thomeer et al. (2019) found that a 5-wk SummerMAX program (see Lopata et al., 2013), which targeted social communication and offered education to school-aged children about socialization, resulted in increased child social skills as compared with a waitlist control. In another study, De Korte et al. (2020) found that robot-assisted sessions resulted in increased child socialization skills.

Lastly, practitioners may support the social participation of autistic adolescents by providing opportunities to socialize with neurotypical peers and education about social skills. Two studies (Ko et al., 2019; Vernon et al., 2018) found that the Social Tools and Rules for Teens (START) program, which integrates neurotypical teens with autistic adolescents, resulted in increased parent-reported and observed socialization as compared with a waitlist control. Schohl et al. (2014) found that the Program for the Education and Enrichment of Relational Skills (PEERS), which provides education about social skills to autistic adolescents, resulted in increased knowledge and decreased social anxiety.

The variability in dosage of intervention programs ranged in length (5 wk to 3 yr), time per week (20–120 min), and sessions (15–156), which limits specific recommendations. Overall, practitioners can use parent education, interaction with neurotypical peers, and supports for child self-regulation in practice.