La revue American journal of occupational therapy consacre son numéro de mars-avril 2023 au besoins en santé mentale des personnes avec TSA.

1. Bagatell N, Lamarche E, Klinger L. Roles of Caregivers of Autistic Adults: A Qualitative Study. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Understanding the roles of caregivers of autistic adults is important given the increasing number of autistic adults and their ongoing need for various supports. OBJECTIVE: To address the following question: What roles do caregivers enact to support autistic adults? DESIGN: This study had a descriptive qualitative design. Caregivers completed a two-part interview. Data analyses included extracting narratives and a multiple-step coding process that resulted in the identification of three main caregiving themes. PARTICIPANTS: Thirty-one caregivers of autistic adults. FINDINGS: Three main themes that reflected caregiving roles were identified: (1) managing daily living needs, (2) obtaining services and supports, and (3) providing invisible supports. Each theme comprised three subthemes. The roles were enacted regardless of the autistic adults’ age, gender, adaptive behavior scores, employment status, or residential status. CONCLUSIONS AND RELEVANCE: Caregivers enacted many roles to support their autistic adult to participate in meaningful occupation. Occupational therapy practitioners can support autistic people across the lifespan in areas such as daily living, leisure, and executive function strategies to decrease the need for caregiving or services. They can also support caregivers as they manage the present and plan for the future. What This Article Adds: This study provides descriptions that illustrate the complexity of caregiving for autistic adults. With an understanding of the many roles that caregivers enact, occupational therapy practitioners can provide services that support both autistic people and their caregivers. Positionality Statement: We recognize that use of person-first versus identity-first language is a source of debate and controversy. We have chosen to use identity-first language, for two reasons. First, studies indicate that person with autism is the term least preferred by autistic people (e.g., Botha et al., 2021). Second, autistic is the term used by the majority of our participants during interviews.

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2. Campi E, Sideris J, Wiles A, Phillips A, Carrasquero VV, Ausderau K, Baranek G. Associations Among Clinical Factors and Occupational Therapy Service Utilization in Children With Autism Spectrum Disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Limited research has elucidated factors predicting occupational therapy-specific service utilization by children with autism. Such research is needed to inform reasons for receipt of services. OBJECTIVE: To examine factors associated with occupational therapy service utilization by children with autism. We hypothesized that elevated sensory hyperresponsiveness; greater sensory interests, repetitions, and seeking; and lower adaptive behavior would predict more service utilization. DESIGN: Analysis of extant data from a prospective, longitudinal survey study about autism symptom severity, adaptive behavior, sensory features, and demographic and service utilization information of children with autism ages 3 to 13 yr. SETTING: Online parent survey regarding child behaviors during daily activities and contexts. PARTICIPANTS: 892 parents of children with autism from 50 U.S. states. OUTCOMES AND MEASURES: We used scores on the Vineland Adaptive Behavior Scale-Second Edition, the Social Responsiveness Scale, and the Sensory Experiences Questionnaire Version 3.0 and responses to a demographic questionnaire. We formulated hypotheses after data collection but before analysis. RESULTS: Predictors of higher occupational therapy service utilization were lower enhanced perception; lower adaptive behavior; elevated sensory interests, repetitions, and seeking behaviors; younger child age; and higher household income. CONCLUSION AND RELEVANCE: Results partially support our hypotheses. Sensory interests, repetitions, and seeking behavior predicted occupational therapy service utilization, whereas other sensory response patterns did not, suggesting a possible referral bias for certain sensory response patterns. Occupational therapy practitioners can educate parents and teachers about the scope of practice, which includes addressing sensory features beyond sensory interests, repetitions, and seeking behaviors. What This Article Adds: Children with autism who have impairments in adaptive functioning and high levels of sensory interests, repetitions, and seeking behaviors receive more occupational therapy services. Occupational therapy practitioners should be well trained to address such concerns and advocate for the profession’s role in mitigating the impact of sensory features on daily life.

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3. Hilton CL, Ratcliff K, Hong I. Predictors of Participation Difficulties in Autistic Children. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Participation in meaningful occupations supports quality of life and health. Because quality of life is lower in autistic children than in children without this diagnosis, it is important to consider aspects contributing to the participation difficulties this population experiences. OBJECTIVE: To identify predictors of participation difficulties in a large data set from autistic children to inform professionals about potential intervention targets. DESIGN: Retrospective cross-sectional design using a large data set with multivariate regression models for home life, friendships, classroom learning, and leisure activities. SETTING: 2011 Survey of Pathways to Diagnosis and Services data set. PARTICIPANTS: Parents or caregivers of 834 autistic children with co-occurring intellectual disability (ID) and 227 autistic children with no ID. RESULTS: The strongest participation predictors within the scope of occupational therapy practice were sensory processing, emotional regulation, behavioral variables, and social variables. Our results are consistent with those of smaller previous studies and indicate the importance of addressing these areas in occupational therapy intervention in line with client priorities. CONCLUSION AND RELEVANCE: Focusing interventions with autistic children on sensory processing, emotional regulation, behavioral skills, and social skills to address their underlying neurological processing can support their increased participation in home life, friendships, classroom learning, and leisure activities. What This Article Adds: Our findings support a focus in occupational therapy interventions on sensory processing and social skills to increase activity participation in autistic children with and without ID. Emotional regulation and behavioral skills can be supported by interventions that target cognitive flexibility. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

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4. Holmes LG, Goebel RJ, Hollingue C, Zhu S, Zhang H, Shan W, Wang S, Caplan R, Sanchez A, Wharmby P, Chiang M, Person M, Rothman EF. Reductions in Depression and Anxiety Among Autistic Adults Participating in an Intervention to Promote Healthy Relationships. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Some autistic adults experience depression and anxiety related to their social relationships. There is a need for evidence-based occupational therapy interventions that decrease depression and anxiety and improve the health of social relationships for autistic adults. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Relationships on the Autism Spectrum (HEARTS) intervention, a six-session, group-based psychoeducational intervention for the improvement of relationship health. DESIGN: One-group pretest-posttest design with a 3-mo follow-up after baseline. SETTING: United States; online intervention through community organization. PARTICIPANTS: Fifty-five adults, ages 20 to 43 yr, with a professional or self-diagnosis of autism and the capacity to independently participate in an online, group-based, participatory class. INTERVENTION: Participants received 6 90-min weekly sessions that addressed healthy relationship topics, including recognizing abuse, meeting people, maintaining relationships, setting interpersonal boundaries, neurohealth for relationships, and ending relationships. A psychoeducational approach that provided education and involved guided discovery and strategy acquisition was used. OUTCOMES AND MEASURES: All measures were self-administered through an online survey. Depression and anxiety were assessed using instruments from the Patient-Reported Outcomes Measurement Information System. RESULTS: Fifty-five participants completed the intervention. Postintervention scores revealed statistically significant improvements in depression and anxiety. CONCLUSIONS AND RELEVANCE: HEARTS is a promising intervention for improving depression and anxiety among autistic adults and should be investigated further. What This Article Adds: HEARTS offers a potentially effective, nonpharmacological, psychoeducational group-based intervention option to promote healthy relationships for autistic adults. Positionality Statement: This article uses identity-first language (autistic person) in accordance with the preference of autistic self-advocates (Autistic Self Advocacy Network, 2020; Kenny et al., 2016; Lord et al., 2022).

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5. Kirby AV, Morgan L, Hilton C. Autism and Mental Health: The Role of Occupational Therapy. The American Journal of Occupational Therapy. 2022; 77(2).

Research has indicated a high prevalence of mental health problems among autistic people, with elevated rates of depression, anxiety, and suicidality. The profession of occupational therapy has its roots in mental health and can offer a unique focus on occupation to support the mental health needs of autistic clients. In this Guest Editorial we introduce articles for this special issue of the American Journal of Occupational Therapy related to autism and mental health and use the Person–Environment–Occupation Model. The articles offer insights into how interactions among person, environment, and occupation factors affect the mental health of autistic populations and demonstrate ways that mental health can be supported through occupational engagement. Opportunities to support the mental health of autistic people include promoting engagement in meaningful activities, supporting individual strengths, and bolstering clients’ sense of self and identification with their autistic identity. Future research is needed to uncover and test interventions to support autistic clients and should reflect cultural humility and participatory approaches. We chose to use identity-first language (rather than person-first language) to describe the autistic community in this Guest Editorial out of respect for common community member preferences and in accordance with recommendations for anti-ableist language use (Bottema-Beutel et al., 2021). Decisions about language for each article in this special issue were made by the respective authors.

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6. Kuhaneck HM, Watling R, Glennon TJ. Ayres Sensory Integration® for Addressing Play in Autistic Children: A Multiple-Baseline Examination. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Play is an area of difficulty for autistic children, and occupational therapy practitioners need evidence to guide interventions to improve play for this population. Ayres Sensory Integration® (ASI) intervention has not yet been studied for its impact on play outcomes. OBJECTIVE: To examine the impact of ASI intervention on play types in autistic children. DESIGN: Nonconcurrent, multiple-baseline design across subjects. SETTING: Outpatient occupational therapy clinic in New England. PARTICIPANTS: Three autistic children, ages 5, 6, and 6 yr. INTERVENTION: Twenty-four ASI sessions. OUTCOMES AND MEASURES: Frequency of play type was coded using partial interval coding. Progress monitoring used Goal Attainment Scaling. RESULTS: All three participants demonstrated changes in the frequency of specific types of play, but changes varied among them. CONCLUSIONS AND RELEVANCE: Findings suggest that ASI intervention may alter a child’s patterns of play. What This Article Adds: This study is the first to examine the impact of ASI on play and the third that documents the feasibility of single-subject research for studying ASI. If confirmed in future studies, ASI could become an evidence-based intervention for improving play, an important outcome for autistic children and the profession of occupational therapy. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

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7. Levi MK, Schreuer N, Granovsky Y, Bar-Shalita T, Fogel IW, Hoffman T, Gal E. « Feeling Unwanted, When Nobody Wants You Around »: Perceptions of Social Pain Among People With Autism. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: A paucity of studies have focused on pain experiences among people with autism spectrum disorder, particularly those addressing social pain in daily life contexts or learning from the perspective of autistic people. OBJECTIVE: To explore the social pain experience of autistic people. DESIGN: A descriptive qualitative design followed by deductive thematic analysis. Interviews were semistructured to capture the social pain experience, coping strategies, and implications for the participation of autistic people. SETTING: Online interviews using Zoom videoconferencing software. PARTICIPANTS: Fifteen autistic people were recruited for the study using purposeful and criterion sampling. RESULTS: Four primary themes emerged from the data analysis: (1) a definition of social pain and the distinction between social pain and other types of pain; (2) the sources-internal, external, and combined-of social pain; (3) the loneliness outcome, which echoes the gap between the desire for and lack of social contacts; and (4) coping strategies pertaining to the continuum between inward and outward coping strategies to deal with social pain. CONCLUSION AND RELEVANCE: The study indicates the existence of a discrepancy between autistic people’s need for social interactions and the social pain they experience. It calls for intervention programs for autistic people to improve their coping strategies and promote their self-acceptance and better inclusion in the community. What This Article Adds: Promoting social functioning is a prime role of occupational therapists, and this article adds a novel theoretical model that contributes to that role. The model represents the social pain experiences of autistic people and their strategies to overcome this phenomenon. Firsthand accounts of autistic people regarding social pain enable a better understanding of their desire to be involved in the social context. This study suggests directions for further intervention programs to assist autistic people in fulfilling their wish for social relationships and enabling their enhanced integration into society. Positionality Statement: We recognize that use of person-first versus identity-first language is a source of debate and controversy. We have chosen to use identity-first language for two reasons. First, studies indicate person with autism is the term least preferred by autistic people (Botha et al., 2021). Second, autistic is the term used by the majority of our participants during interviews.

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8. Mahoney WJ, Abraham G, Villacrusis M. Many Hands Working Together: Adapting Hospital Care to Support Autistic Children’s Mental Health. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Hospitals pose a threat to autistic children’s mental health. Adapting hospitals to meet children’s needs can address this issue. OBJECTIVE: To determine the impact of an interprofessional program (Adaptive Care) to support autistic children’s mental health on nursing staff’s knowledge, efficacy, and confidence. DESIGN: Pretest-posttest, quasi-experimental design. SETTING: Large pediatric hospital. PARTICIPANTS: Nursing staff were the first participants in the program implementation. Approximately 300 nursing staff received training through the program, and 107 completed program evaluation surveys. Of these, 18 nursing staff completed both the pretest and posttest surveys approximately 1 yr apart. INTERVENTION: Occupational therapy practitioners and other professionals developed and implemented the program, which consists of staff training and resources to adapt hospital physical and social environments and to ultimately improve patients’ hospital experiences. OUTCOMES AND MEASURES: Researcher-developed, pilot-tested, online survey to assess knowledge, perceived effectiveness, confidence, and strategies that staff used while caring for autistic children in the hospital. RESULTS: Respondents had increased effectiveness and confidence working with autistic children in the hospital after program implementation. Respondents reported significantly more strategies to care for autistic children. CONCLUSIONS AND RELEVANCE: Interprofessional collaboration and programming can positively affect social environments in the hospital by enhancing nursing staff’s self-efficacy, confidence, and strategies to support mental health and to enhance health care for autistic children. What This Article Adds: The Adaptive Care program is an example of occupational therapy practitioners and other interprofessional team members adapting physical and social health care environments to support autistic children’s mental health. This program was effective at increasing nursing staff’s self-efficacy, confidence, and strategies while caring for autistic children in the hospital. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

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9. Murthi K, Patten K. Improving Executive Functions Using the Engineering Design Process: A Peer-Mediated Problem-Solving Approach for Autistic Adolescents. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

Executive functions-specifically, problem-solving skills-are crucial for school success. Challenges in these functions faced by autistic adolescents are often unrecognized or viewed through a behavioral lens that requires correction or normalization. A lack of development of higher order problem-solving skills leads to increased instances of secondary mental health issues, creating further behavioral and social challenges. We propose using the Engineering Design Process (EDP), a flexible, cyclical, top-down, self-sustaining approach that uses peer mediation to teach group problem-solving skills. We then position this cycle within existing occupational therapy models to demonstrate its adaptability and flexibility, describe the distinct features of this problem-solving strategy, and present a real-world case study in which the EDP is used as a problem-solving approach in an after-school program. The EDP develops crucial social and interpersonal skills using interest-driven occupations and can be organically used as a group strategy. This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021, Kenny et al., 2016).

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10. Ortiz Rubio A, de María Romero Ayuso DN, Torres Sánchez I, Cabrera Martos I, Rodríguez Torres J, López López L, Valenza MC. Pain Experiences of People Diagnosed With Autism Spectrum Disorder: A Systematic Review of Case-Control Studies. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders and is characterized by compromised social interactions, reduced verbal communication, stereotyped repetitive behaviors, restricted interests, and sensory abnormalities. Yet absent from the knowledge base is information about sensory abnormalities related to pain experiences. Exploring the pain experiences of people with ASD may provide occupational therapy practitioners with a baseline to determine areas of need and effective interventions. OBJECTIVE: To conduct a systematic review of the literature to summarize current evidence from case-control studies comparing sensory abnormalities with regard to pain experiences of people diagnosed and not diagnosed with ASD. DATA SOURCES: A systematic literature search of the CINAHL, Cochrane, MEDLINE (PubMed), OTseeker, and Web of Science databases, using MeSH terms and broad keywords. STUDY SELECTION AND DATA COLLECTION: A search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of the included studies. FINDINGS: A total of 27 case-control studies involving 865 people with ASD and 864 control participants were included. Several methods were used to explore pain experiences, such as threshold detection or pain threshold. CONCLUSION AND RELEVANCE: The results indicate that people with ASD may have an abnormal sensory experience with regard to pain sensitivity. Occupational therapy practitioners should develop an intervention to focus on pain. What This Article Adds: This study adds to the body of literature indicating that people with ASD have sensory abnormalities with regard to pain experiences. Results highlight the need for occupational therapy interventions to focus on pain experiences.

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11. Simpson K, Adams D, Malone S, Tucker M, Rapee RM, Rodgers J. A Parent-Mediated Anxiety Intervention Specifically Tailored for Autistic Preschoolers: A Pilot Study. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Autistic children experience reduced participation in life activities. One factor that may contribute to their reduced levels of participation is anxiety, which is identified at higher rates among young autistic children than among their neurotypical peers. Anxiety is also strongly associated with sensory overresponsivity and has a considerable impact on daily functioning. OBJECTIVE: To determine the feasibility, acceptability, and usefulness of a small-group, parent-mediated intervention to prevent and reduce anxiety. DESIGN: Pre-post. SETTING: University research center. PARTICIPANTS: Three parents of autistic children (ages 4-7 yr). OUTCOMES AND MEASURES: Parents completed a six-session group training program. Parents completed an anxiety scale for their child before and after parent training. At the end of training, parents participated in a focus group and were interviewed 4 mo after training. RESULTS: Positively received aspects of the intervention were the benefits of a small group, composed of parents of autistic children, run by a facilitator with expertise in autism and anxiety. Parents gained knowledge, resulting in « taking a different approach » with their child and « seeing an interplay between anxiety and autism. » After the intervention, parents reported a reduction in children’s reported anxiety levels. CONCLUSIONS AND RELEVANCE: Knowledge of autism and anxiety acquired during a parent-mediated group increased parents’ understanding of their child’s behaviors and assisted them in supporting their child’s participation. Further research, including larger studies, is required to determine the effectiveness of this intervention. What This Article Adds: The findings from this research provide preliminary support for the adaptation of an existing parent intervention (Cool Little Kids) to reduce anxiety among autistic children. Parents reported an increased awareness and understanding of anxiety and of the interplay between anxiety and autistic traits. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016).

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12. Smith J, Halliwell N, Laurent A, Tsotsoros J, Harris K, DeGrace B. Social Participation Experiences of Families Raising a Young Child With Autism Spectrum Disorder: Implications for Mental Health and Well-Being. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Social participation (SP) is an important facilitator of positive mental health for children and families. Children are dependent on their families to mediate SP, yet families of children with autism spectrum disorder (C-ASD) seemingly limit SP because of behavioral and functional challenges in community environments. The resulting isolation can affect the child’s and the family’s mental health. OBJECTIVE: To distill the essence of everyday SP experiences in the community of families raising C-ASD. DESIGN: Data collected via in-depth, semistructured interviews with a purposive sample and analyzed in the phenomenological tradition. SETTING: Community. PARTICIPANTS: We recruited seven families with English-speaking parents (ages 18-64 yr) raising one C-ASD (age 2-8 yr). Families with more than one C-ASD or those whose C-ASD was diagnosed with complex medical condition or a neurological or genetic disorder were excluded. RESULTS: The essence of experiences of SP emerged in the form of three themes depicting the mismatch between societal expectations for SP and families’ experience: (1) « the struggle, » (2) « it’s hard to feel like you belong, » and (3) what we « have to do. » CONCLUSIONS AND RELEVANCE: As a collective, families expressed desire for everyday community SP and could do so only in select environments with core groups. The findings, as interpreted through the lens of mental health promotion, reveal opportunities to reduce barriers and to promote meaningful family SP so as to facilitate positive mental health and well-being through the transactional intersecting characteristics of the child with ASD, the family, and the community. What This Article Adds: This study illuminates the experience of SP of families raising a young C-ASD, highlighting both supports and barriers. Practitioners can use this information to potentially prevent isolation and promote both child and family mental health and well-being.

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13. Spielmann V, Burke HK, McCulloch S, Mason A, Lane SJ. Linking Sensory Integration and Processing With Mental Health in Autism: A Retrospective Review of Survey Data. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Although a central tenet of occupational therapy practice, evidence-based practice is at times overrepresented by research and can overlook the contributions of clinical expertise, the lived experience, and context. This survey affords the occupational therapy practitioner the opportunity to understand sensory integration and processing (SI/P) as experienced by autistic adults. OBJECTIVE: To explore the following research question through a retrospective analysis of an internet-based survey: What is the relationship between the SI/P differences and mental health concerns reported by autistic adults? DESIGN: Nonexperimental; retrospective analysis of data collected from September 2018 through June 2019. The analysis team joined the project after the survey had been launched. SETTING: The Grand Sensory Survey (GSS) was available internationally through the websites and social media accounts of the Autistic Empire and STAR Institute for Sensory Processing. PARTICIPANTS: The sample included 440 total responses. Excluding responses from participants ages ≤18 yr (n = 24), 416 responses were included: n = 189 identified as autistic, n = 147 identified as nonautistic, and n = 80 did not provide a response to this query. OUTCOMES AND MEASURES: The GSS included questions about demographics, mental health, and sensory experiences. RESULTS: Both SI/P disruptions and sensory sensitivity predicted anxiety and depression (p < .001). CONCLUSIONS AND RELEVANCE: Differences in SI/P are significant factors in mental health for autistic adults. What This Article Adds: We implicate multiple aspects of SI/P and their influence on mental health among autistic adults. The autistic-led design of the survey ensures representation of issues that are pivotal to the autistic community, broadening the template for aspects of SI/P that should be considered when looking at client factors in autism and influence on function and participation. Positionality Statement: The authors deliberately use identity first language in keeping with requests from the autistic community (see https://autisticadvocacy.org/about-asan/identity-first-language/). This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). This article is written from the perspective of the social model of disability and a neurodiversity affirming frame of reference. Three of the five authors are autistic.

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14. Waldman-Levi A, Kuhaneck H. Father-Child Playfulness: A Secondary Analysis of a Multiple-Baseline Single-Subject Study of Three Children With Autism Spectrum Disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2023; 77(2).

IMPORTANCE: Ayres Sensory Integration® (ASI) is commonly used with children on the autism spectrum to promote sensory processing and improved occupational performance, including play. To date, there has been no explicit effort to examine improvements in playfulness through ASI. OBJECTIVE: To explore whether ASI, coupled with parent training, improves child playfulness and fathers’ support of child playfulness. DESIGN: Single-subject A-B-BC design secondary analysis of a nonconcurrent multiple-baseline study. SETTING: Occupational therapy clinic. PARTICIPANTS: Three father-child dyads; children were ages 3 to 6 yr, with autism spectrum disorder (ASD) and documented sensory processing concerns. INTERVENTION: After a baseline phase, each child received at least 24 sessions of ASI, and fathers received parent training focusing on sensory processing issues and play via an online presentation. OUTCOMES AND MEASURES: The Parent/Caregiver’s Support of Children’s Playfulness and the Test of Playfulness. RESULTS: Visual analysis of the baseline phase, ASI phase, and ASI with parent training phase shows that all 3 fathers demonstrated an increase in the way they supported their child’s playfulness; however, this change was not maintained. Children’s playfulness fluctuated, reaching a peak after fathers received training, but none of the children maintained that change. CONCLUSIONS AND RELEVANCE: Additional support by the therapist is required for fathers to learn and use new strategies to promote consistent change in child playfulness during play. Pilot data can be used to inform future studies. What This Article Adds: Occupation- and family-centered frameworks may be useful in guiding practice when working with families of children with ASD.

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