*3.8.3. Review of the evidence*

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 approaches.

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 session plan of care.

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 pre and post-intervention assessment [78]. Specifically, moderate to significant improvement was noted on the caregiver subjective scale using the Canadian Occupational Performance Measure, Performance Quality Rating Scales and the Vineland Adaptive Behavior Scales.

Overall, the CO-OP approach for children and adolescents with ASD has yielded positive findings, enhancing function and participation in meaningful activities as a part of activities of daily living and instrumental activities of daily living and supports its use in clinical practice, yet more research needs to be conducted using more robust designs.
