The Research Behind OT for Social Participation in Persons with Autism

The Research Behind OT for Social Participation in People Autism. Getty Images

If you have a child on the autistic spectrum receiving occupational therapy for social participation and communication, it is beneficial to know the latest research backing particular treatments, so that you can advocate that your child receives the best care possible.

As a consumer of occupational therapy, you should never hesitate to ask about the research that guides your practitioner’s decision making.

Particularly in a rapidly changing field like care of individuals with Autism, your therapist should be versed in the new research coming out and be able to provide you with related information.

If the particular treatment your occupational therapist is using doesn’t have a strong evidence backing, it doesn’t necessarily mean the care is bad. New techniques take years to build solid research to back them up. But, as a consumer you have a right to know that your therapist is using techniques that have not yet been well studied.

The American Journal of Occupational Therapy released an article in the Sept/Oct 2015 issue reviewing the effectiveness of interventions to improve social participation and communication in people with Autism. The remainder of this article summarizes those findings. For a more in-depth look at the research, you can find the article here.

How Articles Were Chosen to Be Reviewed

The articles chosen for this review had to meet the following criteria:

  • From peer-reviewed scientific literature
  • Published in English
  • Published between 2006 and 2013
  • The interventions had to be deliverable by an occupational therapist, not a team
  • The participants had to present with autism spectrum disorder (ASD)

In the end, 66 articles were selected for review.

The Effectiveness of Social Skills Interventions

The evidence is strong for group-based social skills training programs.

In group-based training programs, a therapist leads a group of people with ASD through a set curriculum to improve social skills. These can take place either in a clinic or school or camp setting. The amount of time spent in these programs varied significantly, but the ones that yielded the best results met regularly for 60 minutes or more for a total of 8 hours or more.

The evidence is moderate for activity-based interventions.

Activity based interventions involved participation in group tasks such as LEGO or Topobo with the guidance of a therapist.

The evidence is moderate for computer-based interventions

Computer-based interventions are programs in which individuals with ASD learn social skills from computer programs, virtual reality modeling, or video modeling. Many of these programs are new and still developing.

The evidence is mixed for peer-mediated interventions.

While a therapist is still involved in conducting these treatments, a peer is responsible for providing feedback and assistance.

There was some success demonstrated by this strategy, but several articles reported that the social skills gained did not carry-over to real world situations.

The evidence for social stories is mixed.

This intervention uses stories about social skills to increase positive behaviors in social settings. Half of the studies regarding this treatment showed low or highly variable effectiveness.

The Effectiveness of Social Communication Interventions

The evidence is strong for the Picture Exchange Communication System (PECS)

This treatment includes the exchange of pictures and icons for functional communication.

The evidence for joint attention training is strong.

Joint attention is when two individuals focus their attention on the same object. This is a foundational skill for social communication.  One study found that gains were still demonstrated six months following therapy.

The evidence is moderate for naturalistic behavioral interventions

These treatments include milieu therapy, functional communication training, and pivotal response training.

The strength of evidence is moderate for parent-mediated interventions

While facilitated by the therapist, these treatments include the parent as a key player in the therapeutic social interaction. Of note, one strong study showed improvement in the child-parent relationship.

The evidence is insufficient for classroom-based interventions

These interventions are developed for use in the classroom and may be used by other professionals, for example the Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH).

The evidence for sensory-motor intervention is insufficient.

This technique uses movement and sensory input to improve social communication skills. There were two reviews of articles examining this technique, but the studies included in reviews were of low quality.


Tanner, K., Hand, B. N., O'Toole, G., & Lane, A. E. (2015). Effectiveness of interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with autism spectrum disorder: A systematic review..Sept/Oct(69)

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