Milestone 3: Literature Review 1

Milestone 3: Literature Review

Ajaybir Singh Kalket and Joshua Robert Wilson

Master of Occupational Therapy, Pacific Northwest University

OTH 540: Foundation of Inquiry II

Dr. Malcolm Cutchin

February 27, 2024

 Milestone 3: Literature Review 2

Background of the Problem

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by diagnostic

criteria that include deficits in social communication and social interaction and the presence of

restricted, repetitive patterns of behavior, interests, or activities that can persist throughout life.

According to the Centers for Disease Control and Prevention [CDC], 2022), about 1 in 36

children have been identified with autism spectrum disorder (ASD). ASD affects children of all

racial, ethnic, and socioeconomic groups, and it is approximately 4 times more likely in boys

than in girls (Manner et al., 2023). Autism incurs substantial expenses for society in the United

States, with the total financial burden, including direct (medical and non-medical) and indirect

costs for the lifelong care of individuals diagnosed each year, exceeding $35 billion (Ganz,

2006).

Significance

Current research categorizes diagnostic symptoms of autism spectrum disorder (ASD)

into two fundamental areas: social communication/interaction skills and restricted/repetitive

behaviors, significantly impacting young teens’ occupational performance. Both fundamental

areas are foundational skills to learn for social participation. Studies highlight a notable decline

in social/motor skills within executive function (EF) among young teens with ASD, suggesting

that targeted training in these areas could markedly enhance their occupational engagement

(Kilroy, 2022; Spence, 2003; Tomchek et al., 2017).

The relationship between social participation and the holistic development of young

teens, especially those facing mental health challenges, holds immense significance in pediatric

occupational therapy. Cahill et al. (2020) delved into interventions rooted in activities and

occupations, aiming to enhance well-being, foster positive behaviors, and promote social
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engagement among young individuals. Their research underscores the substantial benefits of

these interventions on mental health and overall activity involvement. Building upon this

foundation, Beisber and Laverdure (2020) explore the intricate dimensions of well-being and

mental health. Their work emphasizes the active role parents, schools, and communities play in

interventions that facilitate more meaningful participation by individuals aged 5 to 21 years. A

robust social network emerges as a critical factor in supporting their developmental journey.

Scientific Knowledge

Social Participation

It is important to bring light to young teen deficits at early development stages as they

transition to adolescence and how social participation contributes to development. This focus

aligns with the World Health Organization’s 2002 framework, which views disability outcomes

through the lens of individual and contextual factors (Shattuck, 2011), emphasizing the

importance of social participation for adolescents with ASD. The significance of social

participation is profound in ASD individuals having elevated anxiety levels, leading to

heightened stress and exclusion from participating in environments requiring social interaction

relationships (Kaat & Lecavalier, 2013). People with ASD also face difficulty understanding and

engaging in social norms and cues, leading to social withdrawal (Bauminger et al., 2010).

Research in specific interventions focuses on improving communication abilities and addressing

the social participation challenges of ASD adolescents (Kasari et al., 2006; Shattuck et al., 2011).

Occupational therapy (OT) interventions aimed at enhancing social participation could notably

improve skills related to independent living activities (IADLs), with meal preparation being a

primary area of impact (Bedell et al., 2013; Spence, 2003). The research emphasizes the vital
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role of social engagement in improving the lives of individuals with ASD, promoting better

social interactions and participation in occupation performance.

Executive Functioning

Individuals with EF development deficits show significant implications throughout their

lifespan on cognitive flexibility, working memory, and inhibitory control (Van Nieuwenhuijzen,

2017). Genetic and environmental influences shape the development of executive function (EF)

skills throughout childhood and adolescence. According to Zelazo et al. (2016), self-regulation is

a key component of EF, reflecting the capacity to manage one’s behavior and emotions,

particularly under stress in home or school environments. This perspective emphasizes the

importance of EF skills to support adaptive responses to stress and challenges. Young teens with

or without a diagnosis of ASD could be affected by internalizing behaviors from not

understanding how to self-regulate stress from environmental effects (Ashburn et al., 2008;

Bauminger et al., 2010). The impact of sensory processing difficulties contributes to young teens

with ASD having difficulties in sensory modulating themselves at home or in school. Their

inability to sensory modulate causes exclusion from social participation or partake in meal

preparation activities socially (Tomchek & Dunn, (2007).

Sensory Processing role in Executive functions

Research shows sensory information processing (SIP) interrelates to EF and relates to

impaired focused attention within cognitive flexibility and impaired inhibitory control, leading to

aggressive response selection and behavior problems. Focused attention is necessary to evaluate

the outcomes of different response options and to select a matching response to environmental

stimuli, while inhibition is needed to suppress the urge to react impulsively and draw immediate

conclusions. (Van Nieuwenhuijzen et al., 2017)

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Social Participation

Their research underscores the substantial benefits of these interventions on mental health

and overall activity involvement. Building upon this foundation, Beisber and Laverdure (2020)

explore the intricate dimensions of well-being and mental health. Their work emphasizes the

active role parents, schools, and communities play in interventions that facilitate more

meaningful participation by individuals aged 5 to 21 years. A robust social network emerges as a

critical factor in supporting their developmental journey.

Executive Functions

Karst and Van Hecke (2012) provide a compelling comparative analysis of children with

ASD, shedding light on the adverse effects of disengagement from religion, school, and

organized activities on family dynamics. The negative emotions may also cause future avoidance

of social functions. It shows social engagement and family dynamics are interrelated.

EF development for individuals with or without diagnosis is instrumental in one’s ability to

engage in social participation. EF plays a key role in planning and organizing skills. Executive

function significantly impacts social interaction, communication, repetitive behaviors, and

restricted interests in individuals with ASD (Kenworthy et al., 2009; Lee, 2021). For adolescents

with ASD, especially in low-income environments, deficits in conversational and social

communication skills, coupled with cognitive impairments, contribute to reduced social

participation. This emphasizes the need for targeted interventions that address EF to improve

social outcomes for this population, underscoring the complex interplay between cognitive

abilities and social integration. The lack of social participation impacts these individuals’ ability

to establish and maintain social relationships, affecting their well-being and quality of life
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(Shattuck et al., 2011; Bedell et al., 2013; Kenworthy et al., 2009; Lee, 2021). EF contributes to

deficits in planning and organization skills for individuals with ASD. This deficit in EF inhibits

cognitive flexibility and information integration among individuals who have not developed EF

(Hill et al., 2004). Impairments in executive functions EF can increase social withdrawal among

peers or family members. Stress within the family environment affects EF, impacting individuals

regardless of their diagnosis. It obstructs their ability to regulate emotions across different

environments, hindering their development in emotionally regulating themselves across various

environments (Bauminger et al., 2010).

OT Involvement

The model of Human Occupation (MOHO) provides a comprehensive framework for

understanding the intricate dynamics between individuals, their activities, and the environment.

The MOHO emphasizes the integral roles of motivation, habits, and performance in activity

engagement. From the perspective of the Model of Human Occupation (MOHO), meal

preparation holds significance beyond the mere act of cooking. It plays a vital role in an

(cognitive abilities and considers individual’s social and cultural context, contributing to overall

well-being and enhancing occupational performance. (Kielhofner & Burke, 2020; Larsson-Lund

& Nyman, 2017). Additionally, the value of incorporating children into meal preparation and

family meals promotes healthy dietary habits and improves food literacy, increasing the process

of engagement in meaningful daily activities (Slater and Mudryj 2016). The International

Classification of Functioning (ICF) highlights the essence of participation as inclusion,

acceptance, and access to necessary resources. It suggests that participation is not merely about

the ability to perform a task but also encompasses being welcomed and supported within one’s

community and environment (Larsson-Lund & Nyman, 2017). Research by Bedell et al. (2013)
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further emphasizes the importance of fostering community participation for these children,

pointing out the critical role of environmental modifications and support in facilitating

occupational engagement.

Gaps

These findings reveal a gap in our understanding of how changes in social environments

impact activities that can build EF and social participation, highlighting the need for targeted

research and intervention efforts that address not only the physical and cognitive demands of the

task but also the social inclusivity and accessibility of the environments in which these tasks are

performed (Bedell et al., 2013).

There is limited exploration regarding the effectiveness of occupational-based social

interventions to address EF and associated issues of young teens with ASD. A case example of

young individual Jimmy’s participation in a culinary club, from a mere 25% attendance in the

previous semester to an impressive 90% in the current semester (Tomchek et al., 2017). It

showcases the potential impact of occupation-focused, client-centered occupational therapy

interventions on enhancing participation in meaningful activities. This occupation-based

intervention can be optimized to improve engagement and outcomes in activities like meal

preparation. Yet there is little literature on such interventions for this population.

Aims

Our first aim will be to identify the potential role of environmental modifications and

support systems in facilitating improved social participation and independence in meal

preparation activity in a small group setting. Our question is: What happens during a social OT

intervention focused on meal preparation with young teens with ASD in a small group setting?
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The research will focus on a “supper club” (meal preparation) occupational therapy

session for young teens with ASD. This pilot session could enhance social participation,

motivation, EF skills in meal preparation activity contributing significantly to OT knowledge and

practice. By investigating the various key elements of the intervention and how they are

experienced by clients, such as environmental modifications, EF skills, and motivation, the study

would provide initial evidence of how such an intervention may work to improve the quality of

life for individuals with ASD. Our research will expand understanding of how tailored OT

interventions can address specific challenges faced by young teens with ASD, contributing to

more effective, personalized care strategies. This research would also fill gaps in current

knowledge regarding integrating EF development within OT practices, offering insights into

innovative approaches to therapy that prioritize social participation, motivation, satisfaction,

independence in daily living activities, and quality of life.

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References

American Occupation Therapy Association. (2014). Occupational therapy practice framework:

Domain and Process-Fourth Edition. The American Journal of Occupational Therapy,

2020, Vol. 74(Supplement_2).

https://doi.org/10.5014/ajot.2020.74S2001

Bauminger, N., Solomon, M., & Rogers, S. J. (2010). Externalizing and internalizing behaviors

in ASD. Autism Research, 3(3), 101–112.

https://doi.org/10.1002/aur.131

Bedell, G., Coster, W., Law, M., Liljenquist, K., Kao, Y-C., Teplicky, R., Anaby, D., & Khetani,

M. A. (2013). Community participation, support, and barriers of school-age children with

and without disabilities. Archives of Physical Medicine and Rehabilitation, 94, 315-323.

https://dx.doi.org/10.1016/j.apmr.2012.09.024

Beisbier, S., & Laverdure, P. (2020). Occupation- and activity-based interventions to improve

performance of instrumental activities of daily living and rest and sleep for children and

youth ages 5–21: A systematic review. American Journal of Occupational Therapy, 74,

1–32.

https://doi.org/10.5014/ajot.2020.039636

Cahill, S. M., Egan, B. E., & Seber, J. (2020). Activity- and occupation-based interventions to

support mental health, positive behavior, and social participation for children and youth:

A systematic review. American Journal of Occupational Therapy, 74, Article

7402180020.

https://doi.org/10.5014/ajot.2020.038687
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CDC. (2022, April 27). Signs and symptoms of autism spectrum disorders.

https://www.cdc.gov/ncbddd/autism/signs.html

Ganz, M. L. (2006). The costs of autism. In S. O. Moldin & J. L. R. Rubenstein

(Eds.), Understanding autism: From basic neuroscience to treatment (pp. 495–522).

https://doi.org/10.1201/9781420004205-25

Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental

Review, 24(2), 189–233.

https://doi.org/10.1016/j.dr.2004.01.001

Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents

with autism spectrum disorders: A review of the prevalence, presentation, and

treatment. Research in Autism Spectrum Disorders, 7(12), 1579–1594.

https://doi.org/10.1016/j.rasd.2013.08.012

Karst, J. S., & Van Hecke, A. V. (2012). Parent and family impact of autism spectrum disorders:

A review and proposed model for intervention evaluation. Clinical Child and Family

Psychology Review, 15(3), 247–277.

https://doi.org/10.1007/s10567-012-0119-6

Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young

children with autism: A randomized controlled intervention study. Journal of Child

Psychology and Psychiatry, 47(6), 611-620.

https://doi.org/10.1111/j.1469-7610.2005.01567

Kenworthy, L., Black, D. O., Harrison, B., Della Rosa, A., & Wallace, G. L. (2009). Are

executive control functions related to autism symptoms in high-functioning children?

Child Neuropsychology, 15(5), 425–440.

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https://doi.org/10.1080/09297040802646983

Kielhofner, G., & Burke, J. P. (2020). A Model of Human Occupation, Part 1. Conceptual

Framework and Content. American Journal of Occupational Therapy, 74, 1–32.

https://doi.org/10.5014/ajot.2020.039636

Kilroy, E., Ring, P., Hossain, A., Nalbach, A., Butera, C., Harrison, L., Jayashankar, A., Vigen,

C., Aziz-Zadeh, L., & Cermak, S. A. (2022). Motor performance, praxis, and social skills

in autism spectrum disorder and developmental coordination disorder. Autism Research,

15(9), 1649–1664.

https://doi.org/10.1002/aur.2774

Larsson-Lund, M., & Nyman, A. (2017). Participation and occupation in occupational therapy

models of practice: A discussion of possibilities and challenges. Scandinavian Journal of

Occupational Therapy, 24(6), 393-397.

https://doi.org/10.1080/11038128.2016.1267257

Lee, R. R., Ward, A. R., Lane, D. M., Aman, M. G., Loveland, K. A., Mansour, R., & Pearson,

D. A. (2021). Executive function in autism: association with ADHD and ASD symptoms.

Journal of Autism and Developmental Disorders, 53(688–700).

https://doi.org/10.1007/s10803-020-04852-2

Maenner, M. J., Warren, Z., Williams, A. R., et al. (2023). Prevalence and characteristics of

autism spectrum disorder among children aged 8 years — autism and developmental

disabilities monitoring network, 11 Sites, United States, 2020. MMWR Surveillance

Summaries, 72(No. SS-2), 1–14.

http://dx.doi.org/10.15585/mmwr.ss7202a1
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Shabat, T., Fogel-Grinvald, H., Anaby, D., & Golos, A. (2021). Participation profile of children

and youth aged 6–14, with and without ADHD, and the impact of environmental factors.

International Journal of Environmental Research and Public Health, 18, 537.

https://doi.org/10.3390/ijerph18020537

Shattuck, P.T., Orsmond, G.I., Wagner, M., & Cooper, B.P. (2011). Participation in social

activities among adolescents with an autism spectrum disorder. PLoS ONE, 6(11),

e27176.

https://doi.org/10.1111/1475-3588.00051

Slater, J., & Mudryj, A. N. (2016). Nurturing Future Generations: Household Food Practices of

Canadian Children and Family Meal Participation. Canadian Journal of Dietetic Practice

and Research, 77, 113–118.

https://doi.org/10.3148/cjdpr-2015-050

Spence, S. H. (2003). Social skills training with children and young people: Theory, evidence

and practice. Child and Adolescent Mental Health, 8(2), 84-96.

https://doi.org/10.1111/1475-3588.00051

Tomchek, S. D., & Dunn, W. (2007a). Sensory processing in children with and without autism:

A comparative study using the short sensory profile. The American Journal of

Occupational Therapy, 61(2), 190–200.

https://doi.org/10.5014/ajot.61.2.190

Tomchek, S., Koenig, K. P., Arbesman, M., & Lieberman, D. (2017). Evidence Connection—

Occupational therapy interventions for adolescents with autism spectrum disorder.

American Journal of Occupational Therapy, 71, 7101395010.

https://doi.org/10.5014/ajot.2017.711003
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Van Nieuwenhuijzen, M., Van Rest, M. M., Embregts, P. J. C. M., Vriens, A., Oostermeijer, S.,

Van Bokhoven, I., & Matthys, W. (2017). Executive functions and social information

processing in adolescents with severe behavior problems. Child Neuropsychology, 23(2),

228-241.

https://doi.org/10.1080/09297049.2015.1108396

Zelazo, P. D., Blair, C. B., & Willoughby, M. T. (2016). Executive function: Implications for

education (NCER 2017-2000). National Center for Education Research.

https://doi.org/10.1155/2014/924182