Interventions to Support Participation in Education for Autistic Students (2013–2021)

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 main themes of the studies included in this systematic review brief are classroom engagement and secondary transitions.

Clinical Scenario

Autistic children and adolescents frequently experience barriers to fully participating in educational and transition occupations. Barriers are often attributed to person factors of the student (e.g., social communication, social interaction, behavior regulation, and sensory processing patterns; American Psychiatric Association, 2013). Accordingly, previous systematic reviews have often focused on the efficacy of specific intervention approaches and contexts (e.g., peer-mediated interventions, parent training, early intervention, physical activity and sensory integration) to reduce symptom severity and skill deficits at the cost of considering if the outcome measures are performance-based or align with the aims of the study (Lami et al., 2018; McConachie et al., 2015; Schaaf et al., 2021). Occupational therapy practitioners are well equipped to work collaboratively with autistic children and their families using multidimensional interventions to adapt activities and environments; however, they need more information on the efficacy of interventions to promote participation in meaningful activities of daily life (American Occupational Therapy Association [AOTA], 2020).

Summary of Key Findings

Five articles were included in the review related to interventions that support participation in education. These five articles were divided into two categories (classroom engagement and secondary transition) based on target outcomes (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

The intentional focus on participation in occupations often differentiates occupational therapy from other providers on a care team with autistic persons (AOTA, 2020). Occupational therapy services start by considering function and participation in authentic contexts. Participation- focused interventions with both students and teachers significantly improved autistic students’ educational participation. Student-focused social narrative (Hanrahan, 2020) and executive function (Kenworthy et al., 2014) interventions facilitated classroom engagement (e.g., turn taking, following directions, and daily transitions). Teacher training paired with coaching during implementation of social communication and emotional regulation strategies also yielded significantly greater classroom engagement and social interaction (Morgan, 2018). Teacher coaching for implementation of behavioral strategies in another study, however, did not yield improvements in academic achievement or adaptive behavior (Iadarola et al., 2018). These studies do not provide clear intervention guidance for practitioners given variability in intervention recipient (student, teacher), type (individualized, manualized), delivery (group, individual), study length (2 wk to full school year), and participants (kindergarten–fifth grade). Together, the evidence does highlight student- and teacher-focused interventions in the natural school context that support participation in classroom engagement of elementary school aged autistic students. Future investigations can build upon this evidence to elucidate optimal dosage and delivery methods that support educational participation of autistic students.

The one additional study included in this review provides low strength of evidence to support secondary transitions. Self-guided online education targeting self-determination and career planning completed asynchronously by autistic adolescents (Hatfield et al., 2017) yielded greater capacity for self-determination, opportunity to be self-determined, and participation in career exploration. The moderate risk of bias limits implications.