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People with autism spectrum disorder (ASD) commonly experience difficulties with social participation, play, and leisure along with restricted and repetitive behaviors that can interfere with occupational performance. The objective of this systematic review was to evaluate current evidence for interventions within the occupational therapy scope of practice that address these difficulties. Strong evidence was found that social skills groups, the Picture Exchange Communication System, joint attention interventions, and parent-mediated strategies can improve social participation. The findings were less conclusive for interventions to improve play and leisure performance and to decrease restricted and repetitive behaviors, but several strategies showed promise with moderately strong supporting evidence. Occupational therapists should be guided by evidence when considering interventions to improve social participation, play, leisure, and restricted and repetitive behaviors in people with ASD. Additional research using more robust scientific methods is needed for many of the currently available strategies.
People with autism spectrum disorder (ASD) experience lifelong barriers to full participation in social, play, and leisure activities and contexts. Many of these barriers can be attributed to core difficulties in social communication and restricted and repetitive behaviors, including sensory features (American Psychiatric Association, 2013). The costs of nonparticipation in these areas of occupation are immense. The World Health Organization (2001) considers full participation in daily activities and routines as the ultimate indicator of health and functioning. Moreover, the achievement of intellectual, physical, social, emotional, and communicative potential in childhood is dependent on full occupational engagement (King et al., 2003; Law, 2002).
Recent estimates of the prevalence of childhood ASD in the United States stand at 1 in 68, a 30% increase since 2008 (Autism and Developmental Disabilities Monitoring Network, 2012). Thus, occupational therapists are increasingly required to provide comprehensive evaluation and treatment of occupational performance issues associated with ASD. Participation in social, play, and leisure pursuits is clearly within the domain of occupational therapy (American Occupational Therapy Association [AOTA], 2014) and is a particular issue for people with ASD. In a large study of the social participation patterns of adolescents in special education, Shattuck, Orsmond, Wagner, and Cooper (2011) reported that adolescents with ASD were significantly more likely to never see friends outside of school, be called by friends, or be invited to social activities than adolescents with...