Evidence-Based Occupational Therapy Interventions for Children with Autism: Current Practices and Continuing Education in Minnesota

The purpose of this thesis was to investigate the use of non-evidence-based practices that are often used with children with autism spectrum disorder (ASD) by occupational therapy practitioners, as well as continuing education necessary to better pediatric occupational therapy practice with children with ASD in Minnesota. This mixed-methods project utilized a website content analysis, survey, and focus group data to address the research questions. The study aimed to address: (1) How do pediatric occupational therapy practitioners in Minnesota understand evidence-based practice and apply evidence-based practice principles in their work with children with ASD? (2) How are the twelve specified interventions being used currently in pediatric occupational therapy practice for children with ASD in Minnesota? and (3) What are the next steps for supporting pediatric occupational therapy practitioners in Minnesota in being evidence- based for working with children with ASD? Findings from data analysis elucidated common themes and implications for pediatric occupational therapy practice with children with ASD in Minnesota. The first theme is occupational therapy practitioners are relying more on their clinical experience than evidence- based research when working with children with ASD. The second theme is many of these interventions are used to treat children with ASD without fidelity and by practitioners who haven’t been trained in them. Lastly, practitioners reported barriers to applying evidence-based practices, including lack of time, limited resources, affordability, workplace culture, and difficulty assessing evidence-based information. The majority of occupational therapy practitioners participating were school-based practitioners. If occupational therapy wants to continue to perform a relevant service in MN, occupational therapy practitioners must reflect on the evidence base for the interventions they are selecting as well as the extent their intervention choices address occupational participation in children with ASD. Increasing accessibility to continuing education and resources for evidence-based information is needed as well for occupational therapy practitioners working with children with ASD

Embracing neurodivergent occupations and empowering disabled voices: a knowledge translation tool to support neurodiversity-affirming occupational therapy practice and challenge ableism within the profession

Neurodivergent occupations are ways of living and embodying life that speaks true for their neurotype. Examples include autistic play, ADHDer concepts of attention, and sensory processing differences. Though the neurodiversity movement is beginning to infiltrate health care services, neurodiversity-affirming practices within occupational therapy remains lacking. Neurodivergent occupations continue to be pathologized within occupational therapy, evident within the profession’s education, and all aspects of the occupational therapy process, such as assessment, treatment, and outcomes. Neurotypicality remains to be the benchmark for functioning within occupational therapy, much of which is secondary to the dominating medical model of disability and ableism proliferating the profession. These factors lead to OTPs creating occupational marginalization when attempting to support neurodivergent individuals, with neurodivergent OTPs pleading for the profession to reflect and modify current conceptualizations of occupational therapy. The proposed program, Embracing Neurodivergent Occupations, aims to answer this call. Embracing Neurodivergent Occupations is a knowledge translation tool incorporating tenets of disability justice, community-defined evidence practice, and lived-experience informed practice. The program intends to be an example of community-based participatory research (CBPR), with the program’s creation incorporating neurodivergent OTPs, scholars, and advocates from around the world for a holistic view on neurodivergent ways of living. Components of the Embracing Neurodivergent Occupations will include: (a) the first neurodiversity-affirming occupational therapy model (EMPOWER Model), (b) conversations on models of disablement and rehabilitation, (c) health and well-being priorities designated by autistic individuals, (d) steps for completing neurodiversity-affirming evaluations, (e) neurodiversity-affirming service and practitioner characteristics, and (f) a grading of commonly utilized occupational therapy programs and resources and their level of being neurodiversity-affirming. Embracing Neurodivergent Occupations has three phases: (1) an introductory workshop with OTPs within this author’s current work setting, (2) a website translating the program into a multimedia resource hub, and (3) morphing the introductory workshop into online modules. Embracing Neurodivergent Occupations aspires to support the profession’s ability to be anti-ableist, provide neurodiversity-affirming services through all aspects of the occupational therapy process, and ultimately empower neurodivergent occupational participation and well-being

Auditory Integration Interventions for Children with Autism and Developmental Disabilities: An Evidence-Based Practice Project

After extensive review of select auditory integration interventions including Auditory Integration Therapy (AIT), The Listening Program (TLP), and Therapeutic Listening (TL), we can conclude that many of these interventions have not been examined for use with children and adolescents with autism spectrum disorder (ASD). Although some the research we found showed slight improvements in our investigated outcomes, many of them did not analyze the primary long-term outcomes of interest for occupational therapy including performance, participation, and engagement. Specialized training is required for therapists to facilitate AIT, TLP, and TL with their clients. Courses are costly ranging from $365-$2400, which further detracts the practicality of these interventions. All three of our auditory interventions were either not reviewed by the expert review groups or were investigated but not recommended. Additionally, some insurance companies and the United States Federal Drug Administration do not approve of some of the interventions and equipment required due to safety concerns and lack of evidence (UnitedHealthcare, 2016). Our preliminary recommendations are that these interventions are a Level 5. A Level 5 means that the treatment is designated as an untested/experimental treatment and/or is potentially harmful (WI Department of Health Services, 2014). Additionally, the results may not be a direct outcome of AIT, TLP, and TL due to a variety of limitations and gaps in research. Because of these gaps and limitations we can conclude that the existing research is of poor quality. Given the chosen study design in a majority of these articles, we cannot make definite conclusions that these interventions caused the differences in the outcomes. Also, due to case study designs and small sample sizes, the results cannot be generalized to the larger population. Conflicting recommendations exist for further on these auditory integration interventions. Therefore, individuals interested in conducting research should be aware of these cautions