**10. Vocational rehabilitation**

participation in recreational activities, strong cooperation of families and professionals are required in the planning and implementation of intervention [208]. Occupational therapists are important both with their expertise in occupational participation and their knowledge on sensory integration interventions for participation of individuals with autism in recreational activities. Occupational therapists point out exploration and participation in leisure activities, which are one of the occupational areas. Leisure exploration refers to identifying interests, skills, opportunities, and appropriate leisure activities. Leisure participation is planning and participating in appropriate leisure activities; maintaining a balance of leisure activities with other areas of occupation; and obtaining, using, and maintaining equipment and supplies as

Occupational therapy assessment with an occupation-based, family-centred and top-down approach starts with an interview with the family and self-report. Family's perspective on interests and skills of child, life style, economical status, their access to social and community resources should be recorded. Ideally, leisure assessments should be made in the natural settings of the child whenever possible. Interview and observation made in this setting are important to assess physical, social, cultural, attitudinal or organizational environment factors which affect leisure participation of the child and to evaluate child's performance skills. It is important for the therapist to observe motor, process and social interaction skills and attitudes

Paediatric Activity Cart Shorting (PACS), Children's Assessment of Participation and Enjoy‐ ment (CAPE), Canadian Occupational Performance Measure (COPM) are some of the exam‐ ples of standardized methods that can be used in the assessment of recreational interests and skills of the child [85, 216, 217]. It is important to assess the sensory integration skills of the child and impact of these skills on activities, to define strategies to meet the needs of the child and to create sensory friendly settings. Therefore Sensory Profile (SP) is a standardized scale

Occupational therapists give trainings to families, friends and teachers on how to facilitate participation of individual besides teaching the most needed skills for participation of children in selected leisure activity. Additionally they give training on use of adaptive equipment required for activities and make environmental modifications.Participation of children with deficits in activities together with their peers without deficits is important for both groups. Some of the study results show that peer support programs are useful for both groups. Structuring recreational activities where children with autism can be together with children with typical development can be an effective for proper modeling and social integration of

One of the most important highlight of recreation and leisure activities is that they are "intrinsically motivated". Neurobiological studies show that limbic system which orchestrates

children with autism and for the positive attitude changes in others [218, 219].

of the child against others during activities with peers [185].

used in defining sensory difficulties of child [29].

appropriate [65].

184 Autism Spectrum Disorder - Recent Advances

**9.1. Assessment**

**9.2. Intervention**

Many people diagnosed with autism experience difficulties in finding and sustaining jobs. 50-75% of this population is estimated to be unemployed [223]. One of the basic problems of individuals with autism in finding jobs is the deficit in social and communication areas, which require advanced support in the workplace [224]. In addition to these personal features, availability and accessibility of services that support employment and existence of social supports are considered as significant environmental factors that affect employment rates [81]. Studies show that individuals with autism may be successful in business life and are consid‐ ered as important by their employers together with proper vocational interventions [225-227].

Employment opportunities for individuals with autism may be based on two main categories; a) integrated, competition-based employment with supportive employment opportunities and b) separate, non-competitive opportunities including daily therapy, work activity centres and protected businesses. Supportive employment is a system where individuals are supported in the workplace, long term support is given with work coaching system and the support is reduced as the individual becomes more independent. This approach is based on the assump‐ tion that all people can work and argues that we should create long-term support mechanism nationally to support this assumption. So the actual question is not whether or not an indi‐ vidual with autism will work but whether or not there is support services required for the individual's success in work performance [228].

Studies show that supportive employment opportunities is the effective way for the partici‐ pation of individuals with autism in work life [229, 230]. Supportive employment programs have a team consisting of different professions and who work together for common goals in the evaluation of work process, its referral, work analysis, work skills training and follow up of the working individual. This team includes occupational rehabilitation consultant, work coach, occupational therapist, physiotherapist, speech therapist, special trainer, psychologist, individual himself/herself, individual's family and other profession members who may contribute in employment process. Occupational therapists have different roles in assessment, recruitment and training, work development and supportive employment process stages of employment process of individuals with autism. During assessment stage occupational therapists assess sensory and motor skills, professional interests, communication and trans‐ portation, daily living activities, cognitive, social and community skills, emergency response and safety in workplace and self-assessment skills. During recruitment and training stage occupational therapist work on training and adaptations about work task and settings, identification and training on auxiliary equipment and technology, training on or compensa‐ tion of basic cognitive skills like attention, visual perception etc., training of work coaches and supporters on use of auxiliary technologies. During work development stage occupational therapist work for increasing environmental support and reducing barriers, doing work analysis, adjusting improvement of conformity between skills of the individual and expecta‐ tions of the employer and work development in line with interests and skills of individual. In the supportive employment process stage occupational therapist interested in training of work coaches, training on complex cognitive skills such as problem solving, time management, advocating rights of the individual against the employer and other colleagues and cooperation with interdisciplinary team [231].

#### **10.1. Assessment**

Vocational assessment starts with interview, self-report and behavioural observation. Occupational profile is defined for the occupation and occupational performance analysis is made. It's important to assess strengths, interests and needs of the individual as well as environmental supports and barriers during the interviews [233]. Observation of the individual during occupational performance would provide important information for occupational performance analysis. Other assessments specific to occupational therapy may include sensory-motor skills, socialization skills, cognitive skills and participation in activities of daily living. The Vocational Index, The Autism Work Skills Questionnaire (AWSQ), Vineland Adaptive Behavioural Scale, Adult/Adolescent Sensory Profile, Wais‐ man Activities of Daily Living Scale are examples for standardized assessments that can be used [80, 83, 234-236].

#### **10.2. Intervention**

Occupational therapists can train the person about skills required for occupation and train his/her natural supports, such as co-workers, supervisors, or family members in the use of adaptive equipment or techniques, environmental adaptations, sensory needs of the person, and compensatory strategies to help the person perform job tasks. Also teaching and compensating for complex cognitive skills such as problem solving, time management, and sequencing to higher functioning persons with autism is within the scope of occupational therapy [232].

Wilczynski, Trammell and Clarke describes forms of technology that can help individuals with autism acquire and maintain employment. According study assistive technology like com‐ puter-based systems, personal computers, video recorders, tablets, iPods, iPads, and other devices; video based instruction like video self-modeling, and video games to teach social interaction, covert audio coaching like video modeling instruction initially and follows with audio prompting and alternative support includes personal digital assistants, smartphones, and other mobile devices that can be used for auditory and visual reminders, time manage‐ ment, organizational skills, and daily living tasks can enhance the natural support available for individuals with autism in the workplace [237]. Occupational therapists can compensate sensory needs through sensory stimulation or inhibition using techniques such as fidget toys, chewing gum, music, weighted clothing, lighting changes, and increases or decreases in environmental stimuli in workplaces.These changes in the sensory environment may lead to improvement in motor processes, which enable the person to be more productive on the job site [232].
