Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.
Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger’s, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.
Understanding the individual meaning of daily activities for children with developmental disabilities such as autism is both important and challenging for researchers and practitioners. Rigorous participant observation offers a method for developing this knowledge base by including the child's perspective. Through literature and examples from an ethnography of young children with autism, this article illustrates the application of participant observation to children with developmental disabilities. Specific strategies can promote valid interpretations despite developmental, linguistic, and perceptual differences between adult researchers and child participants.
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