Abstract
Systematic review briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings to support social participation for autistic 1 children and adolescents (birth to 18 yr) in homes and communities.
Full Systematic Review Question
This systematic review addressed the question “What are the interventions within the scope of occupational therapy to address participation in activities of daily living, instrumental activities of daily living, rest and sleep, work, education, play, leisure, social participation, health management among autistic people under the age of 18?”
Current Theme Reported
The themes presented in this systematic review brief include interventions to support social participation for autistic children and adolescents in homes and communities.
Clinical Scenario
Autistic children and adolescents often experience difficulties with social participation (Tobin et al., 2014) as well as limited opportunities to enhance social participation (Bedell et al., 2013; Potvin et al., 2013). Social participation refers to activities that involve social interaction with others and support social independence and may include community participation, family participation, friendships, intimate partner relationships, and peer group participation (American Occupational Therapy Association, 2020). For young autistic children, social participation primarily occurs within the context of everyday activities with adult caregivers (e.g., family and service providers), while school-age autistic children begin to experience socialization opportunities with peers. While systematic reviews have previously investigated methods to increase discrete skills that may contribute to social participation (e.g., joint attention, eye gaze, and expressive vocabulary), occupational therapy practitioners consider how autistic children participate in social situations with caregivers and peers. Therefore, this systematic review brief presents evidence on the efficacy of interventions to support social participation for autistic children and adolescents in homes and communities.
Summary of Key Findings
Nine articles were included in the review related to interventions that support young and school-aged autistic children in social participation in homes and communities. These articles were divided into three themes: 1) Web-based parent education and coaching interventions, 2) community-based interventions, and 3) recreation-focused social interaction interventions (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).
Evidence Table for Interventions to Support Social Participation for Autistic Children and Adolescents in Homes and Communities
Note. EBI = early behavioral intervention; PRT = pivotal response treatment; RCT = randomized clinical trial; SCERTS = Social Communication, Emotional Regulation, and Transactional Supports; SD = standard deviation.
Bottom Line for Occupational Therapy Practice
Social interaction difficulties among young and school-aged autistic children are well documented and accompany the diagnostic criteria (APA, 2013). Therefore, occupational therapy practitioners must consider intervention strategies to promote social interaction and social participation when working with this group. Findings in this systematic review brief showed that practitioners may use a variety of approaches to support social participation among autistic children. First, occupational therapy practitioners may consider web-based interventions to educate and support caregivers of young autistic children to enhance social participation within everyday routines. Ibañez et al. (2018) found that a 6-hr web-based tutorial significantly increased children’s engagement and social relating as compared with services as usual. Ingersoll et al. (2016) found that a therapist-assisted web-based training did not significantly differ from the web-based training alone for children’s socialization, because both groups made significant gains in socialization. Second, three studies (Brian et al., 2017; Rivard et al., 2017; Vernon et al., 2019) showed that parent education interventions did not significantly influence children’s socialization skills as compared with services as usual or a waitlist control. The variability in services as usual control groups is problematic and conflate findings related to the efficacy of specific parent mediated intervention approaches. In one study (Wetherby et al., 2014), however, the individual-SCERTS model was found to be more effective than a group-SCERTS delivered model, suggesting that individualized support in families’ everyday contexts may support children’s social participation. Finally, recreation-focused programs presented mixed effects on child social participation. Corbett and colleagues (2019) found that school-aged autistic youth, when paired with neurotypical peers, demonstrated increased social participation following a theater training program. However, a soccer program (i.e., Australian football; Howells et al., 2020) and an outdoor playground program (Zachor et al., 2017) showed no effects on child social participation as compared with control groups. Notably, neither of these programs included neurotypical peers. The variability in dosage of intervention programs ranged in length (1–9 mo), time (30 min to 20 hr/wk), and sessions (30 min to 4 hr), which limits specific recommendations. Together, these studies guide practitioners to use instruction via web-based delivery and the inclusion of neurotypical peers in interventions designed to increase social participation.
Footnotes
1
This paper will use the identity-first language, “autistic individuals.” This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by healthcare professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).
*
Indicates articles included in the brief systematic review.