Person-Centered Interventions for Autistic Adolescents Ages 13–19 Years (2013–2021)

Full Systematic Review Question

This systematic review addressed the question “What are the effects of person-centered, student-centered, or family-centered planning approaches on outcomes within the scope of occupational therapy?”

Current Theme Reported

The main themes of the studies presented in this systematic review brief include person-centered planning (PCP) interventions for autistic adolescents aged 13–19 yr.

Clinical Scenario

Collaborative partnerships between occupational therapy practitioners (OTPs) and clients drive the practice of occupational therapy (American Occupational Therapy Association, 2020). These partnerships depend upon client-centered care, which “incorporates respect for and partnership with clients as active participants in the therapy process” and “emphasizes clients’ knowledge and experience, strengths, capacity for choice, and overall autonomy” (Schell & Gillen, 2019, p. 1194). PCP is defined as a way to offer a “facilitated, individual-directed, positive approach to the planning and coordination of a person’s services and supports based on individual aspirations, needs, preferences, and values” (National Quality Forum, 2020, p. 7).

PCP fosters development of self-determination through meaningful exploration and discovery of unique preferences, needs, and wants (Kim, 2019). Further, PCP can support engagement in areas for which autistic people face widespread challenges, such as “health and well-being, relationships, safety, communication, residence, technology, community, resources, and assistance” (National Quality Forum, 2020, p. 7). Notably, autistic adolescents may need scaffolding and structure during their transition from school to adult life, higher education, work, and beyond. PCP bolsters their direct engagement in planning and action steps that use their strengths, talents, and skills to achieve key goals and address major barriers. PCP also aids autistic people in driving their access to needed supports and services to support success and provides a crucial way for autistic adolescents to enhance their self-defined quality of life, choice, and control (Carter et al., 2013; Bernhardt et al., 2020).

Summary of Key Findings

This review included both quantitative evidence (Levels 1B–3B) and qualitative studies which described person-centered planning interventions for autistic individuals and their families. Out of the 22 articles included in the review, six articles (Table 1) (27%) focused on person-centered planning interventions directed at adolescents aged 13 to 19 yr, which this brief describes.

After analyzing these six articles (Level 2B, n = 3; Level 3B, n = 1, qualitative, n = 2), three subthemes emerged:

Coaching or mentoring: Emerging evidence with a low strength of evidence for use of coaching or mentoring (n = 3 articles) for autistic adolescents who use spoken language to help address anxiety, depression, self-esteem, and improvement on self-reported goals.

In this systematic review brief, the evaluation of certainty of available evidence adopts criteria from the National Professional Development Center on Autism Spectrum Disorder (n.d.; Young et al., 2010). Criteria from the NPDC classifies evidence-based practices into “evidence-based,” “emerging evidence,” and “unestablished,” which the field of autism research commonly accepts.

Interventions deemed to be “evidence-based” contained either:

two or more high-quality randomized controlled trials in support of that intervention, or

“Emerging evidence” reflected two or more studies which existed that a) were of lower quality or had less-rigorous study design, and b) had evidence that showed some or no effect and did not produce negative effects on participants (e.g., poor outcomes).

“Unestablished interventions” reflected evidence from available studies that met at least one of these conditions: a) showed negative effects on outcomes of the participants, b) showed no effect for all the available studies on that intervention, or c) presented only one intervention study that that was available for review.

We also provided levels of evidence based on 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). Studies using qualitative methodology were judged using the percent of items reflecting trustworthiness of the data (Letts et al., 2007).

Bottom Line for Occupational Therapy Practice

Weak study designs with limited samples constrained the strength of evidence from these studies. However, the emerging evidence suggests that occupational therapy practitioners (OTPs) who work with adolescents in school settings should collaborate with school personnel from middle and high schools. Working together, they should adopt and implement PCP approaches when working with autistic adolescents. Further, OTPs should collaborate with school personnel to assess whether the use of published school-transition programs that use PCP approaches can result in changes to transition-specific self-determination outcomes.

OTPs working with autistic adolescents in afterschool, outpatient, or community settings should implement the practice of teaching autistic or nonautistic peer-mentors or coaches to focus on person-centered goals, interests, and strengths in a data-centered manner. When using these approaches, they should directly examine student outcomes to determine whether this practice results in improved self-esteem and reduced anxiety and depression as the emerging evidence suggests. Evidence from the literature does not yet support the use of problem-solving approaches to help support autistic adolescents in this area. However, key practices continue to shape emerging research studies and continued growth of the research literature.