**3. Treatment approaches for autism spectrum disorders utilized by occupational therapists**

With the increase in awareness and identification of children on the autism spectrum, teachers, researchers, clinicians, and families have worked diligently to create programming that can meet the varied and unique needs of this population. Often these approaches are developed for use across all aspects of a child's life, and as such, are intertwined in all services provided. While some approaches are utilized primarily in occupational and physical therapy (e.g. Ayres Sensory Integration), others are used across all disciplines (e.g. Applied Behavior Analysis). Whatever approach is selected, it is important to remember to communicate with the interprofessional team in order to determine best practices with each individual child and that the interventions provide purposeful activity [13, 14]. Occupational therapy professionals place significant value on the individual with autism's community participation and that it can be increased through their participation in meaningful and purposeful activities [15, 16]. The following sections review some of the more commonly used approaches in therapy.

#### **3.1. Sensory processing treatment approaches**

engagement in occupations related to health, well-being, and participation [1]. The intervention process includes a plan, implementation, and review [9]. The aim of the intervention is to improve the client's desired and expected participation and performance in occupations through the implementation of techniques and procedures that are directed towards the client or towards his or her environment and/or activities [1]. A unique aspect of the intervention process is the standard procedure of practitioners using the collective influence of the client's context and environment, demands of the activity at hand, and the individual characteristics

In order to practice occupational therapy, practitioners must first gain an understanding of the domain, process, and intervention utilized in OT while completing their higher education at a school that is accredited by the Accreditation Council for Occupational Therapy

The current degree required for entry-level occupational therapists is a master's degree. The Occupational Therapy Doctorate (OTD) is also available as an entry level-degree, but is not currently required by ACOTE. Obtaining graduate degree assures that practitioners have the knowledge and skills necessary to fully implement evaluation and intervention to remediate

In addition to occupational therapists, OT personnel are also comprised of occupational therapy assistants (OTAs). OTAs must minimally obtain an associate's degree from an ACOTE accredited institution. OTAs must work under the supervision of an occupational therapist and are generally tasked with implementing intervention and performing other tasks in support of the OT plan of care, which vary depending on the state in which the OTA practices.

After completing their formal education, both occupational therapists and OTAs are required to pass a national registration exam offered by the National Board for Certification in Occupational Therapy. OTs and OTAs who pass the registration exam are then eligible to

Occupational therapists can assume a variety of roles in clinical practice. These roles include, but are not limited to: clinician, manager, case coordinator, policy maker, educator, and advocate. Roles cross a variety of practice settings, such as acute care, subacute care, outpatient care, home care, early intervention, and school-based practice. In a survey study completed by the AOTA, approximately 24% of OT practitioners provide services in school and early intervention based settings while many additional therapists work in freestanding commu-

In the evaluation and treatment of individuals with ASD, OT professionals tend to address ADLs, IADLs, adaptive behavior, rest and sleep, employment/pre-employment, and social

nity-based clinics and hospital-based settings that include pediatric services [11, 12].

**2.7. Occupational therapy and the treatment of autism spectrum disorders**

apply for state licensure and to assume a practice role.

**2.6. Occupational therapy roles**

of the client [1]. This procedure is formally characterized as a task analysis [9].

6 Occupational Therapy - Therapeutic and Creative Use of Activity

Education (ACOTE).

**2.5. Education**

functional deficits.

Difficulty processing sensory information has been identified as a common feature of ASD. The current best estimates demonstrate that up to 96% of children with ASD demonstrate difficulty with processing sensory information as a part of their daily routines [13, 15, 17]. Restricted, Repetitive Patterns of Behavior, Interest, of Activities" and that one of those 4 has something to do with "sensory features" [18]. The inability to accurately process sensory information impacts all areas of child development, so approaches directed towards remediation of sensory processing deficits are often used by both occupational therapists.

were assigned to a control group focused on fine motor intervention and 20 participants were assigned to the experimental group who received ASII. The study reported no significant differences in the subjective perception of sensory processing difficulties via the Sensory Processing Measure and objective ratings on the Quick Neurological Screening Test, 2nd Edition, between the control and experimental groups. Yet the authors reported a significant difference between groups in the reduction of autistic mannerisms and social responsiveness as measured by the Social Responsiveness Scale. Both groups demonstrated statistically significant improvement with Goal Attainment Scaling (focused on sensory processing, motor skills, & social functioning). However, there was a higher effect size in the ASII group than in the fine motor group.

Occupational Therapy's Role in the Treatment of Children with Autism Spectrum Disorders

http://dx.doi.org/10.5772/intechopen.78696

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Another randomized-control trial evaluated the efficacy of ASII among 32 children aged 4–8 years old, diagnosed with ASD [27]. In this trial, the experimental group using ASII (*n* = 17) scored significantly higher at posttest in the areas of self-help skills and socialization, than did the control group (*n* = 15) who received standard care. Additionally, the authors reported that children in the ASII group were better able to reach specific goals than the control group when measured using Goal Attainment Scaling. Children in the ASII group also experienced greater

Iwanaga et al. utilized a quasi-experimental design to explore the use of ASII on 20 preschool aged children with high functioning autism [28]. It was reported that the children in the experimental group, who received ASII, demonstrated significantly higher total post test scores on the Miller Assessment of Preschoolers when compared to the control group. Significant improvements were noted specifically in the areas of motor coordination, nonver-

Case-Smith et al. conducted a systematic review on sensory integration with standardized administration protocols that occurred in clinics that used sensory-rich, child directed activities to improve a child's adaptive responses to sensory experiences [15]. They found and reviewed two randomized controlled trials, which reported positive effects for ASII on the participants (children with ASD) using Goal Attainment Scaling (with reported effect sizes ranging from .72 to 1.62); the additional studies analyzed included Level III–IV research studies, that reported positive effects on reducing challenging behaviors linked to sensory

Kashefimehr et al. reported improvement in a sensory integration intervention group (*n* = 16) over a control group (*n* = 15) among children with ASD. The authors reported that the participants in the intervention group demonstrated significant improvements in the subjective measures of the Short Child Occupational Profile and the Sensory Profile. Of significant note the authors reported improvements not only in sensory processing domains (tactile processing, vestibular processing, etc.) but also in occupational performance based upon the Model

It is important to make a clear distinction between ASII and other sensory-based interventions, as ASII has strict implementation protocol that may not always be followed accurately. In a review of more than 70 published research articles examining the efficacy of ASII, it was found that only three adhered to the theory and intervention protocols [25, 29, 30]. The reason for this disparity is that research conducted (in occupational and speech therapy, special education and psychology) generally did not report if the researchers designed the

decreases in sensory related behaviors than the control group.

processing difficulties.

of Human Occupation [29, 30].

bal cognitive abilities, and sensory motor abilities following ASII treatment.
