Predictors of Participation Difficulties in Autistic Children

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.