Autism Spectrum Disorder (ASD) is one of the most frequently occurring childhood-onset
neurodevelopmental disorders affecting 1 in every 54 children1. As a lifelong condition,
individuals with ASD experience a range of intellectual, behavioral, sensory, motor, and
functional challenges that impact successful participation in daily life activities and
tasks. As a result, occupational therapy (OT) intervention is a frequently requested and
utilized service in ASD, and clinically validated OT approaches are needed. In a series of
studies funded by the NIH and autism foundations, our team manualized and studied an OT
intervention that targets the sensory and motor factors impacting participation in daily life
activities and tasks and showed significant improvements in those that received the
intervention in comparison to controls 2-4. In this project, the investigators plan to adapt
our existing protocol to a telehealth model of service delivery, and evaluate its feasibility
and preliminary effectiveness.
The COVID-19 global pandemic created a call to action for healthcare providers to design
unique and innovative methods for therapeutic service delivery. This shift creates an urgent
need for remote solutions so that therapeutic services can be delivered in safely and
effectively. Since the onset of the COVID-19 pandemic, families have reported regression in
adaptive functioning in addition to a negative impact on social skills and increased anxiety,
and an impact to daily routines of children with ASD5. In a recent survey of families with
children with ASD, 95% of the parents reported that disruptions in services/therapies
negatively impacted their child's behaviors and only 35% of families were receiving
telehealth services/therapies6. To address these increased needs for children with ASD and to
meet the need of manualized telehealth intervention, the investigators propose to adapt the
existing intervention to a telehealth delivery model. This intervention, termed occupational
therapy for children with Autism Spectrum Disorder (OT4ASD) targets the sensory motor factors
that impact behavior and participation in life activities and tasks. This project is
significant in that it will address the need for evidence-based OT services for children with
ASD using an innovative telehealth model. Given that many children with ASD require treatment
for the sensory and motor symptoms that impact their optimal participation in a range of
daily life activities and tasks, and that the current COVID 19 pandemic has compromised
access to this therapy, this project is urgently needed.
Innovation: Telehealth offers an emerging and innovative approach for OT intervention.
Research shows that children with ASD require intensive intervention to assure best outcomes
and telehealth offers an innovative solution for providing therapy during a pandemic. To the
investigator's knowledge, this will be the first telehealth manualized protocol to address
the sensory motor symptoms of ASD and measure outcomes at the activity and participation
levels of the ICF framework. Importantly, the investigators will adapt an evidence-based,
manualized intervention with solid data on outcomes to a telehealth model. The protocol will
operationalize the data-driven decision making (DDDM) approach into an on-line format. DDDM
is innovative in that it explicitly guides the therapist to contextualize intervention within
the child and family's real life participation challenges and use data from assessment to
individualize the intervention. DDDM measures outcomes at the proximal (sensory and motor
factors) and distal (functional/participation-based goals) levels facilitating an
intervention that is context-specific and participation-oriented.
Methods: The project will first adapt the existing protocol into a telehealth delivery model
using a formative approach that includes a modified Delphi process to obtain input and
consensus from experts in telehealth and autism interventions and key stakeholders (parents
and clinical interventionists). Next, the investigators will conduct a feasibility trial to
assess the acceptability, satisfaction and implementation fidelity as well as gather data on
clinically meaningful outcomes. Outcomes will be measured at the proximal and distal levels
using validated outcome measures to assure information gained is relevant and scientifically
rigorous. Data from the feasibility trial will be used to support an R01 application to
conduct a randomized trial of OT4ASD.
To implement the project, the investigators utilize a highly skilled team of clinicians and
scientists with experience in conducting randomized trials in autism who will work
collaboratively to translate knowledge gained into useful information that will impact the
lives of families and children with ASD. Our approach is consistent with contemporary models
of evidence-based practice and rehabilitation science promoting promote high integrity,
evidence-based information from research that targets relevant and meaningful areas for each
child and family. The timeline is ambitious and the investigators feel well-equipped to meet
it given past experiences and expertise.
In summary, this project addresses an urgent need to provide rehabilitation services to
children with ASD using remote technology. It will operationalize best practices in
telehealth to adapt an existing evidence-based OT intervention and utilize a skilled and
experienced team of investigators. As such, this project is consistent with the AACPDM
mission to promote excellence in research and services for persons with childhood-onset
disabilities.
