Initial evaluation of an environment-based intervention for participation of autistic children: a randomized controlled trial

Abstract

Purpose

To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children.

Materials and methods

Twenty-one autistic children 6–10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables.

Results

The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found.

Conclusions

Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research.

IMPLICATIONS FOR REHABILITATION

• Environmental barriers are important attributes to participation restriction in autistic children.

• Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children.

• The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time.

• The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines.

Keywords:

• Autism
• environment
• goal setting
• leisure
• participation

Acknowledgments

The authors thank the enthusiastic participation of the children and parents and the active involvement of the therapists. The authors are grateful to have Dr. Dana Anaby, the developer of the intervention approach used in this study, for her advice.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study implementation and manuscript production were supported by the Chang Gung Memorial Hospital [CMRPD1H0301-02 & CMRPD1L0331] in Taiwan. The funder played no role in the design, conduct, or reporting of this study.