**8. School based occupational therapy**

Occupational therapy in school is quite different from clinic based occupational therapy. School-based occupational therapists focus on learning, developing skills which increase the student's independence in the school environment, and also educating the school personnel about the different considerations required for students to eliminate the barriers from partic‐ ipation [180-183].

Everything the occupational therapist does with student in school must be related to develop educational skills of the student with autism. The occupational therapist evaluates, assesses and accommodates functional abilities of the student with autism in school classrooms, hallways and other related education areas. The occupational therapist works with teachers to help student's acquire functional abilities necessary to access and use educational materials and be independent in the school [183]. Occupational therapists work with the students with autism on adapting or modifying school equipment/materials to help them function better in classrooms, the lunchroom, or restrooms. Other assistance includes helping students with autism to be sensory stable and participate in activities outside of the school through mobility on field trips, sports events, on playgrounds and within the community. Students with autism face a demanding environment at school [183-185]. Presentation methods for educational materials must be modified to meet the challenges of students with autism, such as their ability to communicate, view and manipulate educational materials, and move about the school. Occupational therapists work closely with teachers to promote the highest level of function possible for a child with autism pursuing educational goals like fine and gross motor skills and attention skills [185-188].

#### **8.1. Assessment**

Occupational therapists use screening, assessment, and clinical observation tools and strat‐ egies to analyse why child with autism is having functional and sensory difficulties in educational settings not to establish interventions in school settings. During their interventions occupational therapists use some of the standardized tests like Sensory Profile [189, 190], Bayley Scales of Infant Development-II [191], Peabody Developmental Motor Scale [192], Bruininks-Oseretsky Test of Motor Proficiency [193], and Pediatric Evaluation of Disability Inventory Test [82] in school setting [194].

If the standardized tests are not appropriate, occupational therapist can give descriptive reports without using standardized scales. It is important to compare the child's performance with the previous scores than the normative sample. Occupational therapists can use play based performance profiles like Hawaii Early Learning Profile or Transdisciplinary Play-Based Assessment [194]. Additionally ecological/environment inventories should be used to evaluate child with autism within a variety of educational environments (classroom, garden, sports area etc.), curricular expectations; tools/instruments to help gather relevant information; whether the team needs expansion to obtain needed information [195, 196]. And also to determine and work with the educational team to determine functional strengths and challenges and providing information to design instructional programs of the student with autism. Occupa‐ tional therapist should try to become familiar with the individual education plan [194-196].

#### **8.2. Intervention**

Occupational therapists use direct or indirect services for students with autism in school settings. Occupational therapy interventions purposes are to help students with autism to gain independence in daily living activities, feeding and oral functions, play skills, task organization and completion, written communication skills, hand function, sensory integration (process‐ ing), visual perception, campus/school mobility, participating on a regular and timely basis, using tools and supplies, participating in activities throughout school settings. Also when skill and strength cannot be developed or improved, occupational therapy offers creative modifi‐ cations and adaptations for carrying out development-appropriate activities [195, 196].

In school practice, occupational therapists work with students, teachers, families, classes, schools, and school districts. Occupational therapists are experts at identifying ways to engage students with autism in educational activities and supporting them to develop competence in their roles as students.
