1-07-08
Autism Research Comments to IACC from AOTA
January 4, 2008
Interagency Autism Coordinating Committee
Re: Request for Information: Research Priorities for the IACC Strategic Plan for ASD
The American Occupational Therapy Association (AOTA) represents more than 37,000 occupational therapists, occupational therapy assistants and students of occupational therapy. We appreciate the opportunity to provide information to the Interagency Autism Coordinating Committee (IACC) regarding the development of a strategic plan for Autism Spectrum Disorders (ASD).
AOTA conducted an evidence-based review of research related to occupational therapy that examined the effectiveness of occupational therapy interventions in the areas of play, self-care, social participation, and education for children with ASD. The results indicate that many of the comprehensive interventions employed by occupational therapists have positive effects on the performance of children with ASD across developmental domains and on socially appropriate behavior. In addition, clinical trials have demonstrated that specific interventions used by occupational therapists are effective in promoting adaptive behaviors, social communication and other functional outcomes. This research must be built upon and AOTA acknowledges the need for further research into determining more efficient and effective interventions occupational therapy professionals may offer individuals with ASD to enhance their overall functioning and quality of life.
In response to the request for information (RFI), AOTA suggests several important areas of research that will greatly improve outcomes for people with ASD across the lifespan.
Although occupational therapy has unique contributions in each of the areas discussed in the RFI, our comments will focus mainly in the areas of treatment and biology related to ASD.
Treatment of ASD
- Research with older children, adolescents and adults is critically necessary to ensure effective intervention strategies and to more completely understand the long term effects associated with ASD as children move to adulthood. Such research should focus on transition into work and independent living, particularly for higher functioning individuals with ASD
- Longitudinal studies are needed to develop a clear picture of the trajectory of the disorder and to evaluate the ultimate outcomes for individuals with ASD. Such research could inform the development of systems of care and support for people with ASD across the lifespan.
- Early intervention is one of the areas in which occupational therapists are most active in providing autism interventions. Randomized comprehensive early intervention studies should be given high priority and occupational therapy interventions and researchers should be included in such efforts.
- Trials of interventions such as intensive behavioral intervention and relationship-based intervention have shown positive effects. But additional research is needed to demonstrate how these interventions can be applied in real world settings such as schools and day care facilities. This translational research will help practitioners and caregivers apply effective practices in daily life. In some ways, this research is needed as much if not more than research to develop additional innovations in treatment.
- Research on how to better develop and implement comprehensive and holistic interventions may require research methods other than randomized clinical trials (RCT). While RCT’s are essential to advancing research on ASD, RCT should not be the only research method consider for funding by the IACC.
Biology of ASD
- Occupational therapists are valuable in autism intervention because of their expertise in how physiological factors such as sensory processing (referred to as biological in the RFI) and contextual factors of the environment affect every day function. In individuals with ASD, the biological issues and contextual issues are critical and occupational therapy interventions address both. Occupational therapy research should be linked with biological investigations.
Additional Comments
AOTA has significant concerns related to the number of researchers our profession is able to develop. We need the support of the IACC to improve training of new investigators. An area of emphasis we would like the Committee to consider is capacity building. Such an emphasis is necessary to improve research related to each of the areas that are the focus of the RFI. The best way for ASD research to be improved, both in terms of quality and volume is to increase the number of trained professionals, from multiple disciplines, capable and willing to conduct scientific research. This process will require the coordinated effort of professional associations like AOTA to emphasize the importance of such roles and the financial and technical assistance of many of the IACC member organizations to enable occupational therapists and other health care professionals to pursue these careers. Fostering the development of scientists and socializing clinicians into the research environment is a key aspect of improving and promoting Autism research and a top priority of AOTA. To meet this goal AOTA suggests:
- The Committee can direct resources to sponsor training conferences to promote the development of clinician/scientists who will increase research capacity in all the disciplines involved in Autism research.
- The Committee can provide faculty development support to meet increased demand for occupational therapy and other core services for people with ASD. Given the increasing focus on recovery and chronic issues in health care research, occupational therapy’s approach will be of increasing importance.
Again, we thank you for this opportunity to share our thoughts related to the development of the IACC’s Strategic Plan for ASD and look forward to continuing to work with the committee and member organizations in support of our common research agenda.
Christina A. Metzler
Chief Public Affairs Officer
The American Occupational Therapy Association
