Date Presented 04/05/19
This systematic review evaluates the effectiveness of interventions at improving activities of daily living (ADLs) in children and adolescents with autism spectrum disorders. Overall, moderated evidence supported family-based interventions and strong evidence supported individual, therapist-led interventions targeting ADLs. However, specific intervention approaches and ADL outcomes were heterogeneous, making cross-study comparisons difficult.
Primary Author and Speaker: Matthew Walczak
Additional Authors and Speakers: Michele Severson, Jessica Muesbeck, Shannon Kant, Karla Ausdreau
PURPOSE: Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by persistent deficits in social communication as well as restrictive or repetitive behaviors. Core (e.g., sensory) and commonly associated (e.g., motor) characteristics can affect the level of function in activities of daily living (ADLs). Deficits in ADL skills can lead to a lower level of independence, increased caregiver dependence, and difficulty transitioning to post-secondary education and employment. Interventions can target these skills and support increased independence and participation for individuals with ASD. However, the specific types of interventions being implemented and their effectiveness for individuals with ASD is unclear. The purpose of this systematic review was to evaluate the effectiveness of interventions on improving ADLs in children and adolescents with ASD.
DESIGN: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to conduct this systematic review.
METHODS: Following the PRISMA guidelines, a systematic review was conducted using a systematic search of relevant academic databases and relevant reference lists using terms such as ASD, ADLs, and interventions. Academic databases searched included PubMed, CINAHL Plus, PsychINFO and Web of Science. Inclusion criteria included child diagnosis of ASD and between birth to 25 years old. Studies were excluded if the intervention focused on drug trials only or oral motor skills interventions relating to only speech production outcomes. The search resulted in 1,529 articles. After screening titles and abstracts, 67 articles were selected for full-text review. Fourteen studies were included in the final analysis.
RESULTS: Levels and strength of evidence were identified based on the AOTA guidelines and U.S. Preventive Services Task Force levels of certainty. The 14 studies included three with Level I, three with Level II, and eight with Level III evidence. Studies were categorized into either family-centered or individual intervention approaches. Family-centered therapy approach was defined as interventions that included parent or caregiver involvement during sessions, including but not limited to, participation in parent training and/or parent delivery of intervention. Individual therapy approaches were defined as interventions involving only the child and the therapist implementing the intervention. Moderate evidence supported family-centered intervention approaches. Strong evidence supported the individual intervention approaches. Thirteen out of the fourteen studies showed improvement in ADLs.Interventions addressed a range of ADL outcomes.
CONCLUSION: While this systematic review suggests moderate to strong evidence to support intervention for children with ASD to improve their ADL skills, interventions were heterogeneous and included a range of outcomes. Future research should examine if specific types of interventions may be more effective for certain outcomes or possibly different approaches (family-centered or individual) may be more effective for different age ranges. In addition, few studies provided long-term follow-up to determine if ADL skills were maintained overtime or supported increased independence in occupational performance. Occupational therapy practitioners should evaluate the specific needs of their clients to determine which intervention and approach may best support participation in meaningful occupations for children with ASD.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing
Green, S. A., & Carter, A. S. (2014). Predictors and course of daily living skills development in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(2), 256-26. doi:http://dx.doi.org/10.1007/s10803-011-1275-0
Jasmin, E., Couture, M., McKinley, P., Reid, G., Fombonne, E., & Gisel, E. (2009). Sensori-motor and daily living skills of preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(2), 231-241. doi:http://dx.doi.org/10.1007/s10803-008-0617-z
Smith, L. E., Maenner, M. J., & Seltzer, M. M. (2012). Developmental trajectories in adolescents and adults with autism: The case of daily living skills. Journal of the American Academy of Child and Adolescent Psychiatry, 51(6), 622–631. https://doi.org/10.1016/j.jaac.2012.03.001
