**3.9. Behavioral treatment approaches**

Missuana and associates identified that the three main objectives addressed by CO-OP are: (1) skill acquisition in client-chosen goals/tasks, (2) cognitive strategy development, and (3) generalization of subsequently learned skills and strategies to a variety of contexts. Specifically, in the CO-OP process the client is learning a new motor skill or improving performance on

In CO-OP, a client-centered approach is used to encourage clients to select their own goals for the intervention plan. The CO-OP cognitive strategies are used to influence skill acquisition. Generalization and transfer of skills is supported through the use of an executive, or problem-solving, strategy that trains the child to monitor his performance and self-evaluate

Rodger et al. have argued that in order for clients with ASD to be successful in taking part in CO-OP, therapists need to ensure they have accommodated the language and communication needs of the clients, given that the technique relies heavily on language and communication [71]. The goal of CO-OP is to create a process to teach clients how to think, instead of what

According to Polatajko and Mandich, during CO-OP, clients are instructed on a global cognitive strategy and are then guided in the process of discovering other cognitive strategies that are relevant to their chosen goals. The global strategy used in CO-OP is "the goal, plan, do, check" [70]. Specifically, this foundational strategy involves working with the client to identify "what needs to be done, planning how to achieve this, carrying out the plan and then

Domain specific strategies (DSS) are specific cognitive strategies that are task, child or situation specific and focus on facilitating or improving performance [69]. The child is guided to

CO-OP has been evaluated across diverse populations (pediatric and adult) and conditions (ASD, cerebral palsy, developmental coordination disorder, cerebral vascular accident, traumatic brain injury) [73–76]. The current research of CO-OP among children and adolescents diagnosed with high functioning and/or mild ASD have emerged using case studies/series

Several case studies (Level IV-V) have been conducted among diverse segments of the spectrum of children/adolescents with autism. Phelan and associates reported general improvement on the Canadian Occupational Performance Measure and the Performance Quality Rating Scale among two children with ASD [77]. Visual analysis indicated consistent increase in performance on both subjective scales and across the three client-centered goals across a 10

In another case study of two participants with ASD, Rodger and Brandenburg found that after 10 weekly sessions using CO-OP, the participants demonstrated improvements on the

develop his/her own strategies based on the problems encountered during tasks [72].

one that has not yet developed sufficiently to be functional [69].

16 Occupational Therapy - Therapeutic and Creative Use of Activity

the outcome [69].

*3.8.2. Overview of the technique*

*3.8.3. Review of the evidence*

approaches.

session plan of care.

evaluating its effectiveness" ([72], p. 184).

to think.

Behavioral treatment approaches to ASD incorporate components of operant conditioning in order to manipulate behavior to create positive outcomes. When considering ASD, the primary behavioral treatment approach used is Applied Behavior Analysis (ABA), which is applied in a variety of forms (school-based, clinic-based, home-based, discrete trial training, Lovaas therapy, inclusive programs). Generally, occupational and physical therapists will follow an ABA approach if the child is currently enrolled in a program that specifically uses ABA, or if the child is learning a discrete skill that would benefit from an ABA approach (e.g. toileting, shoe-tying).
