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Occupational Therapy

What is Occupational Therapy?
Occupational therapy “is a health care service concerned with an individual’s ability to function in everyday life activities and occupations that provide meaning to the individual’s life.”1 Occupational therapists work to enhance participation in daily living activities (eating, dressing, etc.), education, work, leisure, play, and social life.2 According to the Interactive Autism Network (IAN), nearly 2,400 IAN families are using occupational therapy, which makes it the 3rd most popular treatment among this population.3 Occupational therapy can be implemented at any age, but, like most treatments for ASD, early intervention is encouraged. A certified occupational therapist (OT) can diagnose under/over activity of sensory stimulation, help to improve the quality of daily living activities, including learning, socializing, motor, and basic life skills, and can help all individuals regardless of where they are diagnosed on the autism spectrum or their age.

How does Occupational Therapy make a Difference for Individuals on the Autism Spectrum?
An individual using occupational therapy will first undergo an evaluation that will establish a baseline for data collection and help the occupational therapist to plan intervention strategies.4 This evaluation becomes the basis for the occupational therapy evaluation which is “individualized to include a variety of strategies and techniques that help clients maximize their ability to participate in daily activities at home, school (if relevant), work, and in the community environment.”2 The results of this evaluation, and all future updates, should be shared with family, caregivers, teachers, and other supporters who influence the individual’s day-to-day life. OTs collaborate with anybody involved in the child’s life from parents to school counselors to develop programs and strategies that can help the child by supporting current medical interventions, and to understand how the child’s social, sensory, and cognitive difficulties interfere with the child’s participation in play, daily living activities, and social activities.5 By conducting an initial evaluation and speaking with all those involved in the child’s life, an OT can create a customized intervention program that can improve their client’s ability to accomplish daily living tasks. For school-aged children, occupational therapy can be requested as a related service as part of the child’s IEP. Adults who require OT services should contact developmental disability programs, social services agencies, or state occupational therapy associations.

Who is Qualified to be an Occupational Therapist?
There are several educational milestones one must reach to become certified in the field of occupational therapy. Students interested in a career as an occupational therapist must attend an accredited post baccalaureate entry-level program to attain either a master’s or doctoral degree.6 Students may enter into these programs with any variety of undergraduate degrees or as undergraduates in a combined undergraduate/graduate program. Upon completion of an entry-level program, an individual can take the national certification examination administered by the National Board for Certification in Occupational Therapy (NBCOT). Specifics concerning eligibility requirements, the application process, and preparing for the exam can be found in the 2012 version of the NBCOT Handbook (note this handbook is intended specifically for students applying to take the NBCOT Certification Exam in 2012).

Where do Occupational Therapists Work?
In addition to working with individuals in a school setting, occupational therapists may help individuals on the autism spectrum at home, in the workplace, adult daycare, and other residential settings.2 For school-aged children, occupational therapy can be requested as a related service as part of the child’s IEP and adults who require OT services should contact developmental disability programs, social services agencies, or state occupational therapy associations. Unlike some other interventions for developmental disorders, occupational therapy is not solely centered around individuals on the autism spectrum.

What Should you Expect from an Occupational Therapist?
What do occupational therapists mean when they refer to “daily living tasks”? That answer is dependent on the types of individuals the occupational therapist is working with. Besides working with individuals with developmental disorders, occupational therapists can assist the elderly, individuals recovering from serious injuries, individuals living with cancer, stroke, or a myriad of other maladies, or simply help an individual to achieve a more ergonomically sound workspace.7 The following are some of the daily living activities that individuals on the autism spectrum can acquire with an occupational therapist’s assistance:

  • Driving/Community Mobility: Having a reliable form of transportation is necessary for grocery shopping, banking, and a number of other independent daily living tasks. Many individuals on the autism spectrum can learn to drive along with their high school peers. Occupational therapy can enhance and individual’s potential to safely get behind the wheel by “addressing predriving skills that promote independence, such as coordination and quick use of extremities, crossing streets, managing social interactions, managing time, managing money, handling an emergency, and self-care when alone.”8 Since driving isn’t suitable for everybody, other “community mobility skills addressed by occupational therapy within this population include reading maps or using a GPS, obtaining a first driver’s license, and using public transportation.”8

  • School: The education a child receives at school is both academic and social. School is an environment for children to keep and make friends, manage stress, define social groups, and learn about respect for authority figures and their peers. Occupational therapists help children in school to succeed in their daily routines in the classroom, playground, and extracurricular activities with an analysis of sensory, motor, cognitive, and social tasks, assistive technology, and environmental modifications.9

  • Employment: Occupational therapists do not only work with children, but can help individuals of all ages with returning to work after a disability, make an office environment more productive and efficient, and even advise an individual on proper computing skills designed to reduce eyestrain and neck/back pain. A 2008 article about integrating disabled individuals into society found that “over 40 percent of disabled persons ages 18 to 64 whose disabilities would permit gainful employment with available accommodations are unemployed.”10 Occupational therapists trained in ergonomics can evaluate an individual on the autism spectrum to find a job that meets his/her physical, cognitive, and behavioral/emotional needs. Some of the supports an OT can provide include addressing sensory, motor, and perceptual abilities and how they relate to specific work tasks, create supports that match the client’s abilities to perform certain job requirements, create programs for skill development (typing, etc.), and recommend assistive technology if needed.11

What Research is there to Support Occupational Therapy?
For an intervention to be considered effective by the medical community it must be backed by evidence-based research. Knowing that an intervention is evidence-based should influence parents and caregivers to choose that treatment option over one that does not have that distinction. A 2008 review of 49 studies relating to autism and occupational therapy focuses on the topics of sensory-based interventions, relationship-based intervention, developmental skill-based programs, social-cognitive skill training, parent-directed approaches, and intensive behavioral intervention.12 Although there were positive and negatives for each category and several studies were burdened with various limitations, the review found the “research literature offers strong positive evidence for occupational therapists to use comprehensive, individualized analysis of child’s performance to develop the intervention strategies. The research evidence also supports the use of family-centered, interdisciplinary approaches.”12

Where can I find more information about Occupational Therapy?
Occupational therapy can be implemented in different ways throughout an individual’s lifetime. Individuals on the autism spectrum can benefit from occupational therapy services in school, in the workplace, and in residential settings. For more information about occupational therapy’s role in autism, or in any other area of mental and physical health, visit The American Occupational Therapy Association (AOTA). To find an occupational therapist in your area, please visit the National Autism Network’s Resource Guide.