EBP Compendium: Summary of Systematic Review
Evidence-Based Review of Interventions for Autism Used in or of Relevance to Occupational Therapy
Case-Smith, J., & Arbesman, M.
American Journal of Occupational Therapy, 62(4), 416–429.
Indicators of Review Quality:
The review addresses a clearly focused question
Criteria for inclusion of studies are provided
Search strategy is described in sufficient detail for replication
Included studies are assessed for study quality
Quality assessments are reproducible
Description: This is a review of Level I (i.e., randomized controlled trials, systematic reviews, meta-analyses), Level II (nonrandomized clinical trials, cohort studies), and Level III evidence (before-after studies and one group designs) that pertain to interventions conducted by occupational therapists for children and adolescents with autism. Although the intended audience is occupational therapists, the interventions target cognitive communication outcomes.
"What is the evidence for the effect of interventions used in or of relevance to occupational therapy in children and adolescents with autism spectrum disorder?" (p. 417).
Population: Children and adolescents with autism spectrum disorder (ASD). In this review ASD includes autism, Asperger’s disorder, and pervasive developmental disorder.
Intervention/Assessment: Occupational, engagement, and performance-based interventions of relevance to occupational therapy.
Number of Studies Included: 49
Years Included: 1986 to 2007
- General Findings
- Developmental play-based approaches that emphasize “positive affect, nonverbal communication play, social relationships, and classroom structure have small positive effects" (p. 421).
- Developmental “interventions that use visual cueing and visual learning are effective in promoting communication and learning” (p. 421). Because only Level II or III studies support these interventions, “the evidence for effectiveness is weak” (p. 421)…”however all of the studies found positive effects across multiple developmental domains” (p. 422).
- Relationship-based interventions (RBIs) had small but positive effects for improving social-emotional growth in children (p. 419). RBIs that incorporate adult imitation of the child’s actions, “implement high levels of positive responsiveness, apply prompting and cueing, facilitate peer interactions, establish environments that support social interaction, and demonstrate positive effects on social engagement in children with ASD" (p. 419).
- Activities incorporating "cueing, prompting, and reinforcement, are effective interventions to enhance turn-taking, sharing, communication, and social interaction in children with ASD" (p. 420).
- "Interventions emphasizing responsive, supportive relationships, and social-emotional development in young children can facilitate the child’s social-emotional growth and promote development of pivotal behaviors essential for learning" (p. 420).
- Applied Behavioral Analysis/Discrete Trial/Lovaas – Discrete trial training "has evidence of moderate to strong effects" (p. 423).
- Auditory Integration/Sensory Integration – "Sensory integration intervention appears to enhance the child's ability to modulate behavior and participate in social interaction; however, findings are inconclusive at this time” (p. 418). Approaches that use the auditory system, such as therapeutic listening and auditory integration training, have "inconclusive evidence for their effectiveness" (p. 419).
- Parent Mediated/Implemented – "…[T]raining parents to implement skill-based interventions has mixed evidence for its effectiveness in promoting the child's performance and does not lower parent stress" (p. 423).
- Pragmatics/Social Skills
- Social skills training in groups yielded "limited gains in social interaction of adolescents" (p. 422).
- Cognitive-based social skills training incorporating simple discrete steps of social skills which are "explained, modeled, and practiced appears to have modest, positive effects" (p. 422).
- Social Stories – Social Stories demonstrated small positive effects on teaching appropriate behavior to children with ASD.
Keywords: Autism Spectrum Disorders, Sensory Integration, Relationship-Based Intervention, Social Skills, Parent-Mediated Intervention, Behavioral Treatments
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Added to Compendium: April 2012