Current Practice of
The purpose of this study was to examine the
Occupational Therapy
for Children With
Autism
Renee Watling, Jean Deitz, Elizabeth M.
Kanny, John F. McLaughlin
Key Words: assessment process, occupation-
al therapy • child development disorders,
pervasive • developmental therapy
Renee Watling, MS, OTR/L, is Doctoral Student, Department of
Rehabilitation Medicine, University of Washington, Box 356490,
Seattle, Washington 98195; rwatling@u.washington.edu.
Jean Deitz, PhD, OTR/L, FAOTA, is Professor and Graduate
Program Coordinator, Department of Rehabilitation Medicine,
University of Washington, Seattle, Washington.
Elizabeth M. Kanny, PhD, OTR/L, FAOTA, is Associate Professor
and Head, Division of Occupational Therapy, Department of
Rehabilitation Medicine, University of Washington, Seattle,
Washington.
John F. McLaughlin, MD, is Professor, Department of Pediatrics
and Director, Clinical Training Unit Center on Human
Development and Disability, University of Washington, Seattle,
Washington.
This article was accepted for publication February 18, 1999.
498
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Objective.
current practice patterns of occupational therapists experi-
enced in working with children with autism spectrum dis-
orders.
Method. Occupational therapists experienced in pro-
viding services to 2-year-old to 12-year-old children with
autism completed a mail questionnaire describing practice
patterns, theoretical approaches, intervention techniques,
and preferred methods of preparation for work with chil-
dren with autism.
Results. Of those contacted, 72 occupational therapists
met the study criteria and returned completed question-
naires. Practice patterns included frequent collaboration
with other professionals during assessment and intervention.
Intervention services were typically provided in a one-to-one
format with the most common techniques being sensory inte-
gration (99%) and positive reinforcement (93%). Theoret-
ical approaches included sensory integration (99%), develop-
mental (88%), and behavioral (73%). Evaluations relied
heavily on nonstandardized tools and clinical observations.
Educational methods identified as most helpful were week-
end workshops (56%) and on-the-job training (52%).
Conclusion. This study clarified the nature of current
occupational therapy practice patterns for 2-year-old to 12-
year-old children with autism. Additional studies are need-
ed to examine the efficacy of current evaluation and inter-
vention methods, as well as to explore the relevance of
available standardized assessments for this population.
Watling, R., Deitz, J., Kanny, E. M., & McLaughlin, J. F. (1999).
Current practice of occupational therapy for children with autism.
American Journal of Occupational Therapy, 53, 498–505.
A
utism is a neurobiological disorder occurring in
approximately 1 per 1,000 children (Bristol et al.,
1996; Bryson, 1996). Children with autism spec-
trum disorders typically demonstrate dysfunction in per-
ceptual and sensory processing, as well as in communica-
tion and neurological functioning, resulting in a variety of
functional skill limitations in communication, social inter-
action, behavioral regulation, and play (Freeman, 1993;
Ramm, 1988; Rapin, 1997). The etiology of this puzzling
disability is unknown; however, hypotheses include both
genetic and environmental causes (Bristol et al., 1996).
Children with autism may participate in an assortment
of intervention services, including early intervention, dis-
crete trial training and other behavioral procedures, speech
therapy, dietary modifications, and craniosacral therapy.
The importance of occupational therapy services for chil-
dren with autism has been supported by professionals in
the fields of medicine (Coleman, 1989; Mays & Gillon,
1993; Rapin, 1997), psychology (Dawson & Osterling,
1996), special education (Hulme, 1995), and occupational
September/October 1999, Volume 53, Number 5
 therapy (Clark, 1983; Huebner, 1992). However, in the
professional literature, no current description of the
breadth of occupational therapy services for children with
autism spectrum disorders can be found.
The occupational therapy literature surrounding the
topic of autism is varied. Areas that have been studied
include play and adaptive abilities (Gralewicz, 1973;
Restall & Magill-Evans, 1994), the impact of vestibular
function on verbalizations (Ray, King, & Grandin, 1989;
Reilly, Nelson, & Bundy, 1984), postrotary nystagmus as
an indicator of change (Nelson, Nitzberg, & Hollander,
1980), and empathic ability (Davidson, Short, & Nelson,
1984). There are also descriptive reports (Stancliff, 1996a;
1996b), theoretical works (Bloomer & Rose, 1989; King,
1987; Llorens, 1974; Nelson, 1982), literature reviews
(Cammisa, & Hobbs, 1993; Clark, 1983; Ottenbacher,
1982; Peterson, 1986), and studies citing the application of
sensory integrative techniques for children with autism
(Ayres & Mailloux, 1983; Ayres & Tickle, 1980; Baranek,
Foster, & Berkson, 1997; King, 1987).
Despite a plethora of publications regarding areas of
interest to occupational therapists, empirical studies regard-
ing the nature of occupational therapy services for children
with autism are rare. A search of the professional literature
since 1967 produced only six data-based studies relating to
occupational therapy and autism. None described evaluation
or intervention techniques or identified the nature of occu-
pational therapy services for this population. In order to val-
idate the importance of occupational therapy intervention
for children with autism, initial efforts must be made to
describe and define the responsibilities of occupational ther-
apists, the relevant training that is needed, and the tools and
techniques used to provide services for this population.
This study was designed to examine the practice pat-
terns currently used by occupational therapists when work-
ing with children with autism spectrum disorders. A survey
of practitioners was conducted to answer the following
questions:
1.How do occupational therapists experienced in
serving children with autism describe their current
practice?
2.What assessments and intervention techniques are
used by occupational therapists who are experi-
enced in serving children with autism?
3.What education and training do occupational ther-
apists who are experienced in serving children with
autism consider most important to their practice?
Method
Participants
The target population for this study was occupational
therapists who were experienced in providing services to
children with autism. Inclusion criteria for occupational
The American Journal of Occupational Therapy
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therapists to be considered experienced were defined as the
following: (a) the therapist worked at least 10 hr per week
in a program that provided services to 2-year-old to 12-
year-old children with autism, (b) the therapist worked as
an occupational therapist at the time of the survey, and (c)
the therapist considered himself or herself to be competent
in providing services to children with autism.
The survey questionnaire was initially sent to 158 pro-
grams in the United States identified by the Autism
Research Institute. Twenty-five of these programs indicated
that (a) they did not provide occupational therapy services
or did not serve the identified population, or (b) they had
a part-time occupational therapist who had already com-
pleted the questionnaire at his or her other place of
employment. Another 6 were unreachable. Thus, the total
sample was 127. The response rate was calculated by divid-
ing the number of surveys returned and completed (87) by
the sample size (127), and then multiplying by 100
(Dillman, 1978) which yielded a 68.5% response rate. Of
the 87 returned questionnaires, 15 did not meet the speci-
fied inclusion criteria; the remaining 72 were usable for
data analysis.
Instrument
A mail questionnaire designed specifically for this study
was used to increase the probability of reaching qualified
pediatric occupational therapists from diverse geographic
locales. The questionnaire was comprised of four sections
intended to address the study questions: (a) description of
current practice; (b) evaluation and intervention methods;
(c) continuing education, training, and experience; and (d)
demographics. Questionnaire items were developed from a
comprehensive review of the occupational therapy, educa-
tion, and psychology literature and through consultation
with two pediatric experts and one survey research expert.
Face and content validity were examined through
review and pretesting of the questionnaire by three expert
consultants, each of whom had published research in the
area of occupational therapy and autism. In addition, a
pretest of the questionnaire was conducted with a conve-
nience sample of three occupational therapists who regu-
larly worked with children with autism. The questionnaire
was modified according to verbal and written feedback.
Data Collection and Analysis
A survey technique with structured follow-up mailings was
used to optimize the response rate (Dillman, 1978).
Surveys were coded with an identification number to
ensure confidentiality while allowing for tracking of nonre-
spondents. A cover letter describing the purpose of the
study and inclusion criteria, the survey questionnaire, and
a postage-paid business reply envelope comprised the initial
mailing that was sent to each of the 158 programs. Follow-
up included a postcard reminder at 1 week, and mailings of
499
 the questionnaire at 3 and 7 weeks to nonrespondents.
Data were analyzed using Microsoft Excel Version 5.0
(Microsoft Corporation, 1995) and Data Desk Version 6.0
(Data Description, 1997). Descriptive statistics, frequency
counts, and percentages were calculated to describe practice
patterns and demographic characteristics.
Results
Demographics
The 158 programs to which questionnaires were sent were
distributed fairly evenly across the United States with 28%
in the Midwest, 24% in the South, 30% in the Northeast,
and 18% in the West. The 72 respondents in the final sam-
ple represented the four regions of the United States
according to the following percentages: 32% from the
Midwest, 21% from the South, 29% from the Northeast,
and 18% from the West. This distribution roughly corre-
sponds to the geographic distribution of the original 158
programs. The ineligible respondents were distributed as
follows: 4 from the West, 4 from the Midwest, 6 from the
South, and 1 from the Northeast.
Although 72 eligible surveys were returned, not all
respondents completed the questionnaire in its entirety;
therefore, the number of responses varies for some questions.
Respondents’ (n = 71) levels of education were reported as
follows: 61% had a bachelor’s degree, 34% had a postprofes-
sional master’s degree, 4% had a professional master’s degree,
and 1% were certified occupational therapy assistants.
The level of experience working both in pediatrics and
with children with autism was assessed by each respondent
indicating the category that best matched the number of
years worked in each area. As a group, respondents (n = 71)
reported more general pediatric experience than experience
with children with autism. The median category for num-
ber of years worked as a pediatric occupational therapist
was 11 to 15 years, with 73% of respondents having 6 or
more years of experience. Both the mode and the median
category for number of years worked with children with
autism was 6 to 10 years, with 65% of respondents having
6 or more years of experience with this population.
Respondents’ (n = 70) reports of their perceived level
of competence in providing services to children with
autism yielded ratings of competent by 39%; proficient by
49%; and expert by 13%.
Current Practice Patterns
The mean number of hours worked per week by respon-
dents (n = 72) was 34, with a low of 12 and a high of 60.
Of those hours, the mean percentage of time spent on work
related to services for children with autism was 50%, with
a median of 40%.
The ages of children with autism who were receiving
occupational therapy services were reported by all 72 eligi-
ble respondents. A substantial number (88%) of respon-
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Table 1
Percentage of Time Occupational Therapists Reported
Providing Each Service When Providing Care for
Children With Autism
Service na M (%) Median (%) Low–High (%)
Consultation 61 15 10 1–70
Evaluation 60 14 10 1–50
Family training 47 11 10 2–40
Group intervention 36 20 10 1–70
One-to-one intervention 68 55 60 4–100
Other 15 21 15 3–65
Note. n = 71. Percentages of time are calculated based on the total number of
hours spent on care related to children with autism.
an represents the number of respondents providing percentages of time for
each service.
dents worked with 2-year-olds through 5-year-olds, 71%
worked with 6-year-olds through 8-year-olds, 58% worked
with 9-year-olds and 10-year-olds, and 39% worked with
11-year-olds and 12-year-olds. At the time of the survey,
the respondents provided services to a total of 184 children
with autism spectrum disorders.
In response to a question regarding the distribution of
hours worked per week, respondents (n = 71) recorded the
percentage of time spent in each of six service models as
related to the total number of hours spent on care related
to children with autism. As a group, respondents reported
spending the greatest percentage of their time in one-to-
one intervention. Many occupational therapists also pro-
vided consultation services. The complete results are dis-
played in Table 1.
Typical occupational therapy treatment sessions. To further
describe occupational therapy services, each respondent (n =
72) was asked to report the primary format that he or she
used to provide direct intervention services. Eighty-two per-
cent reported primary use of a 1:1 format, 10% worked
mainly in small groups (3 to 5 children), 4% in large groups
(6 or more children), 3% in a 1:2 format, and 1% indicat-
ed that this question was not applicable. The typical length
of a treatment session reported by 43% of respondents (n =
72) was 30 min. Four percent reported a treatment session
less than 30 min, 31% reported 45 min, 15% reported 60
min, 3% reported more than 60 min, and 4% reported that
this question was not applicable.
Site of occupational therapy service delivery. In describing
the context of occupational therapy services for children
with autism, respondents (n = 72) reported all of the set-
tings in which they provided services to this population.
Fifty percent reported working in an outpatient clinic,
39% worked in a private school, 38% worked in public
schools, 26% traveled to the child’s home, 22% worked in
unspecified community settings, 8% worked in early inter-
vention programs, 7% worked in residential facilities, and
7% worked elsewhere. Because therapists were asked to
indicate all appropriate responses, the sum exceeds the total
number of respondents.
Frequency of collaboration with other professionals.
Respondents reported the frequency with which they worked
September/October 1999, Volume 53, Number 5
 Table 2 their workplaces. Of these, 10 respondents indicated that
Frequency With Which Factors Determining Discharge
Were Reported
this question was not applicable because all children in their
Not Applicable Rarely Sometimes Frequently workplace had autism. Responses from the remaining 58
Factor n (%) (%) (%) (%) therapists clustered around several themes. Comments by 27
Child’s skill level/ respondents suggested that intervention sessions included a
goals attained 70 7 19 34 40
End of school year 63 24 46 13 17 substantial emphasis on sensory processing. Qualifying
Transition to new school 65 12 22 38 28 remarks indicated that sensory-based techniques often were
Exhausted funding 63 38 27 24 11
Parent request 63 13 59 25 3
used to affect the child’s state of arousal. Fourteen comments
Other 13 0 8 38 54 suggested that occupational therapists worked more closely
with other professionals when working with children with
with other professionals during both evaluation (n = 45) and autism than when working with children with other disabil-
treatment (n = 40) processes. Twenty-seven respondents did ities. More than 5 respondents noted that their practice with
not report collaboration during evaluation and 32 did not children with autism emphasized behavioral regulation, con-
report collaboration during intervention. Frequency was trol of environmental demands, provision of parent training
reported on a 3-point scale ranging from sometimes to always. and education, and high levels of structure during the inter-
For both evaluation and intervention, speech pathologists vention process. Seven therapists reported that there was no
and schoolteachers received the highest frequency ratings. difference in the delivery of services for children with and
Collaboration during the evaluation phase with speech without autism.
pathologists was reported by 98% and with schoolteachers by
84%. Collaboration during evaluation also was reported with Evaluation and Intervention Practices
psychologists (64%), neurologists (47%), developmental Table 3 displays responses to questions regarding the skill
pediatricians (47%), psychiatrists (33%), physical therapists areas assessed by occupational therapists when providing
(29%), and other professionals (29%). Of the collaborating evaluation and intervention services for children with
respondents, 100% reported collaboration during the inter- autism. Skill areas written-in by therapists (n = 8) as being
vention phase with speech pathologists, and 78% reported addressed during evaluation included praxis, self-regula-
collaboration with schoolteachers. Physical therapists (33%), tion, language and communication, oral motor/feeding,
psychologists (18%), other professionals (18%), neurologists and interaction style. Skill areas written-in by therapists (n
(8%), developmental pediatricians (5%), and psychiatrists = 9) as being addressed during intervention included self-
(5%) also were identified. No respondents indicated collabo- regulation, language and communication, oral motor, and
rating with the child’s primary physician during either the interaction style.
evaluation or intervention phase of service delivery. Use of assessments. Respondents (n = 70) rated the fre-
Discontinuation of services. Respondents (n = 70) rated quency with which each of 13 assessments, including infor-
the frequency of six factors in determining when to dis- mal questionnaires, checklists, and observational tools, were
charge a child from services. The factor rated the highest used during the evaluation. Because of restrictions of each
was child’s skill level/goals attained. The factor rated as the assessment, none was appropriate for the entire age range of
least frequent reason for discharge was parent request. See children represented by respondents (see Table 4). Some
Table 2 for details. respondents (n = 22) reported occasional to frequent use of
Service differences. Sixty-eight therapists responded to the assessments not listed on the questionnaire. Among these
open-ended question regarding how the delivery of occupa- were the Developmental Test of Visual-Motor Integration
tional therapy services for children with autism differed from (Beery, 1982), Early Intervention Developmental Profile
services provided to children with other disabilities within (Rogers & D’Eugenio, 1981), Hawaii Early Learning Pro-

Table 3
Skill Areas Addressed by Occupational Therapists During Evaluation and Treatment of Children With Autism
Evaluation (%) Treatment (%)
Skill Area na 1 2 3 4 na 1 2 3 4
Activities of daily living 72 1 4 21 74 69 1 20 39 39
Attention 72 0 6 15 79 71 0 10 28 62
Behavior 72 0 6 14 81 71 0 14 35 51
Coordination 72 0 1 22 76 72 0 19 39 42
Fine motor 72 0 4 18 78 72 0 21 32 47
General development 72 3 18 24 56 70 3 37 27 33
Gross motor 72 1 8 35 56 70 1 27 33 39
Play 71 0 8 31 61 71 1 13 25 61
Sensory processing 72 0 0 4 96 72 0 0 18 82
Social skills 69 1 17 26 55 71 1 21 34 44
Note. 1 = never, 2 = occasionally, 3 = frequently, 4 = always. Because of rounding, all row totals do not equal 100.
a n represents number of respondents providing ratings for each skill area during evaluation and treatment, respectively.

The American Journal of Occupational Therapy 501

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 Table 4
Reported Use of Specific Assessments With Children With Autism
Frequency of Use (%)
Assessment na NA 1 2 3 4
Ayres Clinical Observations (Ayers, 1981) 64 13 13 13 25 38
Bayley Scales of Infant Development (Bayley, 1993) 66 33 44 14 6 3
Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978) 65 9 34 40 14 3
Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1988) 66 44 20 15 11 11
Coping Scale (Zeitlin, 1985) 64 58 36 0 3 3
Informal Sensory Processing History (Beery, 1982) 68 3 4 6 18 69
Peabody Developmental Motor Scales (Folio & Fewell, 1983) 70 9 16 24 40 11
Pediatric Evaluation of Disability Inventory (Haley, Coster, Ludlow, Haltiwanger, & Andrellos, 1992) 63 51 24 13 11 2
Scales of Independent Behavior—Revised (Bruininks, Woodcock, & Weatherman, 1996) 61 66 30 2 3 0
Self-Care Checklist (Rogers & D’Eugenio, 1981) 68 4 12 16 31 37
Sensory Integration and Praxis Tests (Ayers, 1989) 65 20 31 35 14 0
Sensory Profile (Dunn & Westman, 1995) 68 6 3 10 31 50
Vineland Adaptive Behavior Scales (Sparrow, Ball, & Cicchetti, 1984) 60 48 33 8 10 0
Note. NA = assessment not available, 1 = never, 2 = occasionally, 3 = frequently, 4 = always. Because of rounding, all row totals do not equal 100.
a n represents number of respondents providing ratings for each assessment listed.

file (Furuno et al., 1985), Motor-Free Visual-Perceptual Test Education, Training, and Experience
(Colarusso & Hammil, 1972), and Test of Visual-
The final section of the questionnaire addressed the educa-
Perceptual Skills (Gardner, 1988).
tion, training, and experience that respondents believed
Respondents rated the frequency with which they used
had been most important in preparing them for work with
specific theories and intervention techniques to guide ser-
children with autism. Respondents (n = 63) reported a
vices provided to children with autism. In addition to the
mean of three continuing education activities per year. The
theories listed on the questionnaire, 4% of respondents
majority gave the highest rating available to both weekend
reported frequent use of other approaches including
workshops (63%) and on-the-job training (59%).
humanism, dynamic systems theory, and a gestalt perspec-
Continuing education courses. Five types of courses were
tive of learning. Details of respondents’ ratings related to
rated on a scale from 1 (least helpful) to 5 (most helpful) in
frames of reference are displayed in Table 5.
preparing therapists for work with children with autism.
When describing the use of direct intervention tech-
Ratings of most helpful were given to courses in sensory
niques, respondents (n = 70) reported frequently or always
integration treatment by 63% of respondents; occupation-
using proprioceptive input (100%), vestibular input
al therapy intervention by 61%; sensory integration theory
(99%), tactile media (100%), and positive reinforcement
by 57%; behavior management by 24%; and augmentative
(93%). No respondents indicated that they never used
communication by 10%. Twenty (28%) respondents listed
these techniques. The majority of respondents indicated
other courses as helpful, including auditory integration
that they never or only occasionally used discrete trial
training, craniosacral therapy methods, Project TEACCH
training (82%) and computer technology (75%).
methods, and sensory defensiveness.
Movement facilitation or inhibition techniques were never
Preferred method of obtaining knowledge and skills. Four
used by 22% of respondents, occasionally by 36%, fre-
themes were identified from responses (n = 47) to the open-
quently by 29%, and always by 13%. Twenty-three per-
ended question regarding preferred method of obtaining
cent of respondents reported either frequently or always
using other intervention techniques. Listed among these training specific to working with children with autism.
were auditory integration training, oral motor techniques, Sixteen respondents reported a preference for hands-on
Project TEACCH methods, and craniosacral techniques. mentoring opportunities in which experienced therapists
provided specific feedback after observing the therapist in
Table 5 an intervention session. Thirteen respondents cited an inter-
Reported Use of Theories or Frames of Reference When est in case presentations that demonstrated intervention
Working With Children With Autism methods and techniques. Nine respondents described mul-
Frequency Rating
Theory or Frame Never Occasionally Frequently Always
tidisciplinary workshops that offered opportunities for dis-
of Reference na (%) (%) (%) (%) cussion and problem solving, and nine others cited a pref-
Behavioral 70 6 21 47 26 erence for courses on the topic of sensory integration.
Biomechanical 69 41 30 26 3
Coping 65 28 22 35 15
Developmental 71 3 8 42 46 Discussion
Model of Human 67 24 33 30 13
Occupation This study clarified the nature of current practice patterns
Neurodevelopmental 71 7 38 31 24 for providing occupational therapy services to 2-year-old to
Sensory integration 72 0 1 17 82
12-year-old children with autism. Results showed frequent
Note. Because of rounding, all row totals do not equal 100.
an represents number of respondents providing ratings for each theory or collaboration between occupational therapists and other
frame of reference listed. professionals; consistency in theory and treatment modali-
502 September/October 1999, Volume 53, Number 5

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 ties used; and a need to examine the use of standardized
assessments with this population. In addition, findings
showed that occupational therapists preferred experiential
opportunities for obtaining knowledge and skills relevant
to providing services to children with autism.
Current Practice Patterns
The finding that a direct 1:1 intervention format was the
most prevalent service model for providing occupational
therapy services was consistent with Dawson and Osterling’s
(1996) recommendation for ratios of 1:1 or 1:2 adults to
children, especially in the early stages of intervention and
when working on skills such as attention, toy play, and imi-
tation. These ratios have been shown to be the most effec-
tive format for early intervention programs (Dawson &
Osterling, 1996; Rogers, 1996) and behavioral programs
(Lovaas, 1987). However, efficacy of this model within
occupational therapy has not been studied systematically.
Results of this survey indicated that many occupational
therapists provided consultation services. From these find-
ings, questions arise related to format of service delivery.
With rising concerns regarding limited resources and cost
containment, it seems necessary to determine which inter-
vention format is optimal for children with autism in which
situations. It also would be important to examine the impli-
cations of limited resources and the impact of various ser-
vice delivery formats on outcomes for this population.
The high level of collaboration between occupational
therapists and other professionals that was reported during
both evaluation and intervention services conform to the
recommendations of Greenspan (1992) and Huebner
(1992) that occupational therapists work with other profes-
sionals when serving children with autism. These findings
have important implications for the preparation of occupa-
tional therapists at entry levels and postprofessional levels.
Development of skills in teaming and interpersonal com-
munication need to be integrated into occupational therapy
curricula, continuing education, and other professional
development opportunities in order to prepare clinicians for
interdisciplinary collaboration. Additionally, clinicians must
possess sufficient knowledge of occupational therapy and
effective teaching skills to educate other team members as to
the scope of occupational therapy practice and the role of
the occupational therapy practitioner.
Reasons identified by therapists for discontinuing occu-
pational therapy services to children with autism were high-
ly variable. It is likely that this variability reflected both the
broad spectrum of deficits experienced by children with
autism and the inconsistent response to treatment de-
scribed by Coleman (1989), Freeman (1993), and Huebner
(1992). The range of responses suggests that factors affect-
ing discharge may vary according to practice setting or
phase of intervention. Had the questionnaire distinguished
between school-based respondents and non–school-based
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respondents, it is possible that trends could have been iden-
tified that delineated the most common reasons for dis-
charge within these two practice arenas. It is interesting to
note, however, that therapists gave the lowest available fre-
quency rating to parent request. It may be valuable to
explore this issue further and identify the aspects of occupa-
tional therapy intervention that are most valued by parents
of children with autism.
Assessment and Intervention Techniques
Responses to questions regarding evaluation methods
revealed a fairly consistent pattern of measuring fine motor
skills, coordination, attention, behavior, and sensory pro-
cessing. This finding is consistent with Nelson’s (1982) sug-
gestion that occupational therapists evaluate sensory,
motor, perceptual, cognitive, emotional, social, and behav-
ioral performance in their clients with autism.
When asked to rate the frequency with which various
assessments were used to evaluate the skills of children with
autism, respondents gave higher ratings to tools that were
not norm-referenced than they did to norm-referenced or
standardized tools. This finding is not surprising in view of
the fact that many standardized and norm-referenced tools
use verbal instructions and rely heavily on focused atten-
tion, skills that are generally compromised in children with
autism. Perhaps structured observations and criterion-ref-
erenced tests, with their emphasis on ability to perform
skills in natural settings and under natural conditions, are
more relevant for this population.
With respect to intervention, occupational therapists
reported providing services that focused on acquisition of
skills such as attention, behavior, sensory processing, and
play. The scope of skill areas addressed during the inter-
vention phase suggests that occupational therapists provide
comprehensive services that target many of the areas com-
monly identified as deficits for children with autism
(Coleman, 1989; Freeman, 1993; Siegel, 1996). This infor-
mation is relevant to both parents and professionals in
planning and seeking out intervention programs that
directly address an individual child’s areas of delay. This
finding also has implications for the educational prepara-
tion of occupational therapists to work with children with
autism. It suggests that continuing education offerings
should include a host of opportunities for occupational
therapists to gain knowledge in behavior management
techniques as well as in a variety of intervention services
believed to facilitate skill development.
As a whole, responses denoted a strong emphasis on
issues pertaining to sensory processing. This is consistent with
the common mention of sensory processing deficits in reports
by other professionals (Coleman, 1989; Ornitz, 1974; Rapin,
1997; Wing & Wing, 1971), personal accounts (Grandin,
1995; Grandin & Scariano, 1986; McKean, 1994), and the
occupational therapy literature (Ayres, 1979; Baranek et al.,
503
 1997; Cook, 1990; Kwass, 1992; Larrington, 1987; Sanders,
1993). To address sensory processing deficits, respondents
reported using many sensory-based intervention techniques,
most of which have not been definitively supported with
empirical data. This points to the need to examine the effica-
cy of occupational therapy practice methods used with 2-
year-old to 12-year-old children with autism.
Data suggested congruity among the frames of refer-
ence used most frequently, treatment techniques used most
often, and the educational and training experiences per-
ceived to be most helpful. This finding reflects strong con-
sistency among theoretical approaches, intervention meth-
ods, and preferred training experiences. The uniformity in
reported practice patterns of occupational therapists work-
ing with children with autism across the United States
helps to clarify the nature of occupational therapy practice
for children with this condition. This information may be
particularly helpful to those occupational therapists who
lack experience in working with this population. By being
aware of the modalities and approaches used most fre-
quently by occupational therapists who consider them-
selves competent in serving children with autism, novice
occupational therapists may design their services similarly.
Education, Training, and Experience
Extended training or hands-on opportunities were per-
ceived to be most beneficial in preparing occupational ther-
apists for work with children with autism. This information
has implications for continuing education and professional
development opportunities and suggests that courses
intended to prepare clinicians for work with this population
should include experiential learning situations in order to
meet the perceived needs of clinicians working with chil-
dren with autism.
Limitations
The limitations of this study are inherent to the nature of
survey research. The phrasing or terminology used may have
affected responses because participants may have interpret-
ed questions differently than intended, and the general
validity of the findings may have been affected by nonre-
sponse or response error. An effort was made to minimize
the potential impact of these factors through pretesting and
pilot-testing of the questionnaire. Another limitation relat-
ed to the difficulty in locating the desired population of par-
ticipants. However, once located and contacted, a 68.5%
response rate strengthened generalizability of the results.
Directions for Further Research
Although this study successfully described and characterized
current practice patterns of occupational therapists working
with children with autism, additional research is needed.
First, future research should examine practice patterns with
greater depth. For example, studies should be conducted that
504
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delineate practice patterns as they pertain to school-based
and non-school-based practitioners and to explore the col-
laboration between occupational therapists and other service
providers. It is important to understand the differences
between medically relevant and educationally relevant ser-
vices for this population given the specific practice guidelines
established by the American Occupational Therapy Associa-
tion for school system practice as well as the federal and state
laws that govern the delivery of therapy services in the pub-
lic schools. Also, because multiple professionals work with
children with autism and their families, it is important to
understand the nature of the collaborative relationships
between occupational therapists and other service providers.
Second, although the current study identified the interven-
tion strategies that are being used, further research should be
conducted to determine the efficacy of those interventions in
facilitating change in clients with autism. Understanding
what therapists are doing is a first step, but it is not enough
to know what is being done: Occupational therapists also
need to know which of their interventions are effective and
which are not. Increased understanding of the efficacy of
intervention techniques will enable therapists to provide
improved services for children with autism. Through a sys-
tematic program of research, it is hoped that occupational
therapists will come closer to answering the question of how
best to meet the needs of children with autism. ▲
Acknowledgments
This study was funded in part by the American Occupational Therapy
Foundation Student Grant, the Department of Special Education and
Rehabilitation Services (Grant Title, “Preparation of Related Service
Personnel: Preservice Training of Occupational Therapists to Provide
Services to Children with Emotional and Behavioral Disorders”; No.
84.029F), and the Paula M. Carmen Memorial Scholarship Fund
(Grant No. 63-6265).
This study was completed in partial fulfillment of the first author’s
requirements for a Master of Science degree in the Department of
Rehabilitation Medicine, University of Washington, Seattle, Washington.
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