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Interventions enhancing daily living
skills for children with Autism
Spectrum Disorder
A systematic Literature Review from 2010-2020
Nikolopoulos Marios
One-year master thesis 15 credits Supervisor: Ingallill Gimbler
Berglund
Interventions in Childhood
Examinator
Spring Semester 2020 Name: Lilly Augustine
SCHOOL OF EDUCATION
AND COMMUNICATION (HLK)
Jönköping University
Master Thesis 15 credits
Interventions in Childhood
Spring Semester 2020
ABSTRACT
Author: Nikolopoulos Marios
Interventions enhancing daily living skills for children with Autism Spectrum Disorder.
A systematic Literature Review from 2010-2020.
Pages: 29
Activities of daily living (ADL) are fundamental to participation in daily life. Even if participation is
necessary for person’s well-being and development, individuals with disabilities often are not par-
ticipating in basic life domains. Children with autism spectrum disorder (ASD) can have an impact
on many basic functional areas such as daily living skills. The daily living skills (DLS) contain the
ability of children to participate in activities such as personal hygiene, dressing, household chores
and money management that are important prerequisites for self-sufficiency and autonomy. The
aim of this systematic literature review was to investigate the existence and the outcomes of inter-
vention programs which can enhance daily living skills for children with autism spectrum disorder.
A search for peer-reviewed articles evaluating such intervention programs and published between
2010 and 2020 was performed. The search in several databases resulted in eight articles. The findings
were grouped based on the kind and the target activity of each intervention program. Most of the
identified studies have reported effective outcomes using various intervention programs for the
improvement of DLS such as picture prompting, video prompting, video-game training, self-mon-
itoring, behavioural training and therapeutic horseback riding aiming in activities such as hygiene,
clothing, cooking and money management. The International Classification of Functioning, Disa-
bility and Health, version for Children and Youth (ICF-CY) and the Occupational Therapy practice
framework were used as a base for the discussion after the analysis. Despite the number of studies
found, not enough research has been done to describe and evaluate interventions enhancing the
performance in ADL. The findings of this review may serve as a resource for future researchers,
who are working with children in need of special support.
Keywords: autism spectrum disorder, activities of daily living, children and adolescents, occupational ther-
apy, systematic literature review
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Table of Contents
1 Introduction .............................................................................................................................................................................. 1
2 Background ............................................................................................................................................................................... 2
2.1 Autism Spectrum Disorder and Quality of life ...................................................................................... 2
2.2 Activities of Daily living ............................................................................................................................. 3
2.2.1 Daily living skills ................................................................................................................................ 3
2.3 ICF-CY Framework.................................................................................................................................... 4
2.4 Occupational Therapy Practice Framework: Domain and Process .................................................... 5
2.5 Intervention programmes .......................................................................................................................... 7
2.6 Rationale ....................................................................................................................................................... 8
3 Purpose of the systematic review and research questions ................................................................................................ 8
4 Method ...................................................................................................................................................................................... 8
4.1 Search procedure ......................................................................................................................................... 9
4.2 Inclusion/exclusion criteria ....................................................................................................................... 9
4.3 Selection process .......................................................................................................................................11
4.4 Ethics ..........................................................................................................................................................12
4.5 Data analysis ..............................................................................................................................................13
5 Results ...................................................................................................................................................................................... 13
5.1 Overview ....................................................................................................................................................13
5.2 Intervention activities ...............................................................................................................................14
5.3 Content of interventions ..........................................................................................................................15
5.3.1 Body functions/ Body structures ..................................................................................................18
5.3.2 Activities/ Participation ..................................................................................................................18
5.4 Outcomes of intervention .......................................................................................................................19
5.4.1 Pre and post-test assessment tools score .....................................................................................19
5.4.2 Pre and post-intervention percentages of correct independent performance .......................20
5.4.3 Effect sizes ........................................................................................................................................21
6 Discussion ............................................................................................................................................................................... 21
6.1 The role of parents ...................................................................................................................................22
6.2 Activity-centered or skill-centered intervention? .................................................................................23
6.3 Methodological issues ...............................................................................................................................24
6.4 Strenghts and Limitations ........................................................................................................................25
6.5 Future research ..........................................................................................................................................26
7 Conclusion .............................................................................................................................................................................. 26
8 References ............................................................................................................................................................................... 21
9 Appendices ............................................................................................................................................................................. 29
1
1 Introduction
Children with autism spectrum disorder (ASD) often face difficulties in multiple areas of occu-
pation. They struggle to cope with the demands of daily life and complete activities of daily
living in many contexts (Liss et al., 2006). According to Jasmin et al. (2009), both parents and
professionals have reported that children with ASD have delayed performance of self-care and
face difficulties with feeding and toileting. Two theoretical frameworks will be used in order to
clarify the relationship between theory and practice: “The Occupational Therapy Practice
Framework” and the “ICF-CY”.
Within the Occupational Therapy Practice Framework, occupational therapy is defined
“as the therapeutic use of everyday life activities (occupations) with individuals or groups for
the purpose of enhance or enabling participation in roles, habits, and routines in home, school,
workplace, community, and other settings” (American Occupational Therapy Association,
2014). Occupational therapists use their knowledge to design the appropriate occupation-based
intervention plans. This combination consists of the transactional relationship among the per-
son, the engagement in valuable occupations and the context. According to American Occupa-
tional Therapy Association (2014), the intervention plans aim to facilitate change or growth in
client factors (body functions, body structures, values, beliefs, and spirituality) and skills (mo-
tor, process, and social interaction) needed for successful participation.
The ICF-CY (International Classification of Functioning, Disability and Health Chil-
dren & Youth Version) provides a framework for health that demonstrates relationships among
the six core domains: the presence of a health condition, body structures and functions, activity
performance, participation, environmental factors and personal factors (World Health Organi-
zation, 2007). The everyday life participation of individuals with a need of special support is
directly connected with the outcomes of education and health services. Even if participation is
necessary for person’s well-being and development, individuals with disabilities are not partic-
ipating in essential life domains such as in leisure activities, domestic life and school to the
extent that their typically functioning peers do (United Nations Convention on the Rights of
Persons with Disabilities, 2006). ICF-CY provides an approach for understanding children’s
functioning as a complex relationship between the health condition, environmental and personal
factors in order to find the activity limitations and participation restrictions, which may have
been experienced. Several factors are ranging from personal and environmental factors that can
work as barriers for a child in need of special support. Therefore, the focus of outcomes of
2
education and health services for individuals with a need of special support is strongly related
to their engagement in everyday life situations (UNCRPD, 2006).
2 Background
The theoretical frameworks of this study constitute the ICF-CY (WHO, 2007) and the Occupa-
tional Therapy practice framework (American Occupational Therapy Association, 2014) as
have been mentioned above. The key concepts within this paper will focus on interventions
related to functioning-quality of life, Activities of Daily Living (ADL) and children- adoles-
cents with Autism Spectrum Disorder.
2.1 Autism Spectrum Disorder and Quality of life
Recent studies indicated that an estimated 1 in 76 children has autism spectrum disorder (Cen-
ters for Disease Control and Prevention, 2015). According to the Diagnostic and Statistical
Manual of Mental Disorders (DSM–5) criteria, an individual must show significant deficits in
social skills and interaction within multiple contexts to be diagnosed with ASD (American Psy-
chiatric Association, 2013). There are several levels of ASD, depending on the type and func-
tional impacts. The social communication deficits and the restrictive and repetitive patterns of
behaviour are the core factors of diagnosis. Additionally, many people with ASD also show
comorbid disabilities, such as intellectual disability, sensory processing disorders and psychi-
atric diseases (Ben-Sasson et al., 2007). Because of these issues, ASD is associated with limi-
tations in occupational domains such as activities of daily living (ADLs), instrumental activities
of daily living (IADLs), education, work, and sleep (APA, 2013).
Participation of children with ASD is assessed using different assessments, for example,
the Child Assessment of Participation and Enjoyment (CAPE) and Activities Card. Preschool
and school-aged children with ASD participate in fewer daily activities across all participation
domains, such as self-care, leisure, play, social interaction, and education, compared to their
peers (LaVesser & Berg, 2011). Interestingly, among a population of High Functional ASD,
differences were found in some aspects of participation, such as diversity, social aspects, and
location of activities. In contrast, no differences were found in other aspects of participation,
such as enjoyment and preferences between them and their peers without developmental disa-
bilities (Potvin et al., 2013). To broaden understanding of participation in daily life activities of
children with ASD, various child characteristics and their associations with participation were
3
studied. Gender, age, and autism severity predict participation, diversity and intensity (Little et
al., 2014). A child’s behaviour difficulties were reported as the main reason for non-participa-
tion among preschoolers (LaVesser & Berg, 2011). Sensory processing issues and executive
functions also limit participation (Reynolds et al. 2011).
2.2 Activities of Daily living
Throughout developmental process for children with ASD, health professionals evaluate ADL
skills and try to promote autonomy in these occupations. Because the impairments can influence
many functional areas, skills development for Activities of daily living (ADLs) and Instrumen-
tal Activities of daily living (IADL) is needed. Interventions involve the improvement in ADLs
such as feeding, dressing, and personal hygiene. These activities are often priorities for parents
of children with ASD because they increase independent living of a child and decrease the need
for personal assistance in the home and community. ADLs are essential in daily life participa-
tion (AOTA, 2014), however, IADLs can promote participation in more complicated tasks and
activities in the home and community (AOTA, 2014). IADLs comprise occupations which are
necessary for independent living in the future. It includes activities such as meal preparation,
shopping, home maintenance, and communication management, for example, cell phones.
These skills promote opportunities for increased autonomy and self-efficacy for youth with
ASD, as well as allow them to further participate in educational process (Weaver, L., 2015).
Through the educational procedure, youth can follow pathways to develop life skills
and become active members of society. It is necessary to enrich therapists’ knowledge with
supports and strategies which are effective in achieving those outcomes, in order to find the
appropriate interventions to facilitate a purposeful and effective academic experience (Dunn et
al. 2012). The successful educational experiences could make youth with ASD gain functional
skills for employment in the future. Many professionals have tried to develop interventions
aiming to increase participation and independent functioning in daily occupations applying a
variety of methods. The understanding of the effectiveness of interventions aimed at improving
performance in ADLs, can be used as a guide for treatment of people with ASD and lead to
increased application of evidence-based practice (Weaver, L., 2015).
2.2.1 Daily living skills
The most vital prerequisites for self-sufficiency and autonomy are related to the daily living
skills (DLS) in activities such as personal hygiene, dressing, meal preparation, completing
household chores, following safety rules and money management (Sparrow, Cicchetti, & Balla,
4
2005). The existing evidence has shown that adolescents with disabilities who can inde-
pendently perform feeding and dressing skills have more possibilities to be engaged in higher
education, work, or preparation for work, after high school than adolescents with limited skills
(Wagner et al. 2003). Likewise, enhanced DLS are associated with increased independence and
sustained community employment for individuals with ASD (Chan et al., 2017). One of the
major concerns for parents of children with disabilities is the promotion of a safe and productive
life (Bilgin & Kucuk, 2010), and the ability to independently perform Daily Living Skills
(DLS). These two factors can contribute to a person’s inclusion, meaningful participation in
society and to an overall better quality of life (Carnahan et al., 2009).
Additionally, children and adolescents with limited DLS express the need to rely on oth-
ers for support, which usually comes from their family members. As a consequence, this need
becomes a significant predictor of both lower levels of family quality of life (Gardiner &
Iarocci, 2015) and higher levels of parental distress (Tomanik, Harris, & Hawkins, 2004). Evi-
dence supports that the DLS of children are associated with a reduction in parenting stress,
regardless of children’s developmental level, autism symptom severity and problem behaviours
(Green & Carter, 2014). However, excluding very few cases, research on adaptive functioning
and DLS in ASD has mostly been performed in the USA or other western countries, and very
little is known regarding other parts of the world (Valenti et al., 2010).
2.3 ICF-CY Framework
Participation constitutes an important part of functioning. According to the biopsychosocial
model and as the ICF-CY defines, the functioning of children is a complex relationship with a
health condition, environmental and personal factors (Figure 1). This relationship can lead pro-
fessionals to find the activity limitations and participation restrictions, which children may have
experienced (WHO, 2007). A possible diagnosis of Autism Spectrum Disorder (ASD) requires
that the difficulties in social communication and interaction have an important clinical role, and
they influence social, occupational and other important areas of functioning. In addition, stere-
otyped, repetitive and restricted behaviour patterns that present in the early developmental pe-
riod are crucial. Researchers have proved that the professionals use the ICF-CY ( WHO, 2007)
in ASD and they consider ICF-CY (WHO, 2017) categories from all areas of the biopsychoso-
cial model in the assessment and intervention process when they work with young children with
ASD (Castro & Pinto, 2013).
5
The ICF and ICF-CY provide methods for classifying functioning within four key com-
ponents of the biopsychosocial model, that is body functions, body structures, activities and
participation, and environmental factors. These components are structured in categories with
up to four levels of increasing detail. Basically, the first level provides only a general overview
of the areas of functioning that are included in the classification model. The total number of the
categories that ICF and the ICF-CY contain is over 1400. That means that together provide a
holistic classification of functioning. However, the content, in its current, complete form, can-
not apply for daily clinical use or research purposes. For example, many categories are irrele-
vant if applied to any health condition.
Figure 1. The framework of the International Classification of Functioning, Disability – Child
and Youth version (ICF-CY) (WHO, 2007).
2.4 Occupational Therapy Practice Framework: Domain and Process
The purpose of a framework is to provide a theoretical base on which to build a system or a
concept (American Heritage Dictionary of the English Language, 2003). The Occupational
Therapy Practice Framework: Domain and Process describes the ground theory of occupational
Health Condition
(disorder or disease)
Activity Body functions /
Body structures
Participation
Environmental
Factors
Personal Factors
6
therapy practice and make clear the basic concepts for a common understanding of the profes-
sion. The engagement in occupation aims to achieve health, well-being, and participation in life
and that statement describes the domain and process of occupational therapy in its fullest sense.
In addition, this process determines the profession’s belief that active engagement in occupation
promotes and maintains health and participation. The term occupation refers to the daily life
activities in which people engage. Occupations are meaningful, purposeful and they occur in a
context. They are influenced by the interaction between individual’s factors, performance skills,
and performance patterns. Occupations can engage the performance of multiple activities for
integration and can lead to various results. The Framework identifies a wide range of occupa-
tions categorized as ADLS, IADLs, rest and sleep, education, work, play, leisure, and social
participation (AOTA, 2014). (Figure 2). All aspects of the domain, including occupations, client
factors, performance skills, performance patterns, and context and environment, are equally
valued and they interact together in order to affect the client’s occupational identity, health,
well-being, and participation in life.
Figure 2. Aspects of the domain of occupational therapy: All aspects of the domain transact to
support engagement, participation, and health (AOTA, 2014).
Occupations Client factors Performance skills Performance
patterns
Contexts and
environments
Activities of daily liv-
ing (ADLs)
Values, beliefs and
spirituality
Motor skills Habits Cultural
Instrumental activities
of daily living
(IADLs)
Body functions Process skills Routines Personal
Rest and sleep Body structures Social interaction
skills
Rituals Physical
Education Roles Social
Work Temporal
Play Virtual
Leisure
Social participation
7
2.5 Intervention programmes
Given this breadth and depth of performance limitations, professionals need to utilize a range
of interventions and educational programmes to children and adolescents with ASD. In early
interventions of these children, occupational therapists often focus on enhancing children’s sen-
sory processing, sensorimotor performance, social–behavioral performance, self-care and play-
ing participation. In older children and adolescents, occupational therapy goals mainly focus on
independence in the community through the improvement of social and behavioral perfor-
mance. In most occasions, occupational therapists work as members of a multidisciplinary team
of professionals who assess, plan, and implement the child’s program (Case-Smith &
Arbesman, 2008). Previous research recognizes the importance of an individualized approach
and has shown the efficacy of a range of different approaches, differing both theoretically and
practically. However, a clear superiority of one approach over another has not been shown
(Greenspan, Wieder & Simons, 1998). The treatment procedure its vital to start as earlier as
possible and should be as completed and intensive as possible. Intervention follows a reliable
assessment of child’s characteristics and skills in different fields. The social isolation and the
limitation of cognitive function and behaviour is very common in children with ASD. Early
intervention is fundamental to prevent situations like these, planning intervention for develop-
ment (Magiati, Charman, & Howlin, 2007).
Special autism services are increasingly provided by American governments. However,
community mental health centres in America serve a low percentage of the children with ASD
(Bryson et al., 2008). It’s basic to be mentioned that health service conditions may differ not
only across countries but within the same country. The older age of diagnosis and the inacces-
sibility to treatment can cause a delay in developmental process. Because of the unavailability
of daily-accessible services, the beginning of the intervention comes in second place. As a mat-
ter of fact, children are often taken in for treatment in late infancy or adolescence or not treated
at all, although the early intervention should be the rule. Facing this scenario, the parents’ as-
sociations are playing a growing role in promoting local initiative to implement special autism
treatment centres (Valenti et al., 2010).
8
2.6 Rationale
Occupational Therapists focus on the ability of children with ASD to function within a variety
of contexts, like home, school, and community environments. The support on the development
of their daily living skills is essential because as children develop, the parents gradually transfer
the responsibility for managing the tasks of daily life to them (Kao et al., 2014). The result of
this responsibility shift is that the child manages to cope with all these components of important
daily life tasks. The basic features of autism such as poor socializing, inadequate awareness of
others’ perceptions and difficulties in generalizing of skills from one context to another, may
make it more difficult for these people to take responsibility for vital tasks. Additionally, there
is no sufficient evidence regarding the way that impairments and functional skills change over
time and the relationship of those changes to independent living outcomes for individuals with
ASD (Kao et al., 2014). Better daily living skills (DLS) are associated with increased independ-
ence and positive functional outcomes in ASD (Kilincaslan et al., 2019).
3 Purpose of the systematic review and research questions
The purpose of this systematic literature review is to describe the intervention programs which
can enhance daily living skills, for children with ASD in school age. The research questions
are:
- What kind of intervention programs aim to support daily living skills?
- What are the outcomes of those intervention programs?
4 Method
To identify research on the purpose of this study, a systematic literature review was performed.
Systematic reviews are a type of literature review that are designed to provide a complete,
comprehensive summary of current evidence relevant to a research question. It is characterized
by clearly stated questions, uses systematic methods to collect data and synthesize findings
qualitatively or quantitatively. Through the search and collection method, researcher also de-
fine inclusion/ exclusion criteria and quality assessment criteria (Jesson, Matheson, & Lacey,
2011).
9
4.1 Search procedure
The database search for this systematic literature review took place in January 2020. All the
searches were limited to scholarly articles published in English language. The search words
that were used in the database PsycINFO were ("children" OR "kids" OR "youth" OR "teen-
agers" OR "adolescents" OR "child") AND ("activities of daily living" OR "Adl" OR "Iadl")
AND ("Autism" OR "Asd" OR "Autism spectrum disorder") AND "Effect*". This search re-
sulted with 20 articles. The search words that were used in the database ERIC were ("children"
OR "kids" OR "youth" OR "teenagers" OR "adolescents" OR "child") AND ("activities of daily
living" OR "Adl" OR "Iadl") AND ("Autism" OR "Asd" OR "Autism spectrum disorder")
AND "Effect*". In this search, 17 articles were found. The search words were used in database
Pubmed were ("children" OR "kids" OR "youth" OR "teenagers" OR "adolescents" OR
"child") AND ("activities of daily living" OR "Adl" OR "Iadl") AND ("Autism" OR "Asd" OR
"Autism spectrum disorder") AND "Effect*". This search result in 43 articles. The search
words that were used in database CINAHL ("children" OR "kids" OR "youth" OR "teenagers"
OR "adolescents" OR "child") AND ("activities of daily living" OR "Adl" OR "Iadl") AND
("Autism" OR "Asd" OR "Autism spectrum disorder") AND "Effect*". This search yielded 37
articles see flowchart 1.
4.2 Inclusion/exclusion criteria
Inclusion and the exclusion criteria which was used for the screening were established based
on the research questions. The participant, interest, comparison and outcome (PICO) frame-
work was used in order to determine the exact components necessary for the aim of this review.
The PICO formulation is an accepted mechanism used in systematic reviews to frame a review
question about an intervention programme and outline inclusion and exclusion criteria. The
PICO format helps to operationalise systematic and consistent approaches to selection of items
for inclusion independent of either the direction or nature of results or factors empirically
known to influence the direction or interpretation of results (Booth, Cantrell, Preston, Cham-
bers & Goyder, 2015).
10
Table 1. Inclusion/ Exclusion criteria
Inclusion Exclusion
Population
Children with Autism Spectrum Disorder
aged 5-18, Parents, Health Professionals
Infants 0-5, Adults 18+
Interest
Autism spectrum disorder with or without in-
tellectual disability
ADHD, Down Syndrome, DCD, Dyspraxia,
Learning disabilities, Developmental Delays,
Cerebral Palsy
Comparators
Typically development children or no com-
parators
Non-typically development children
Outcome
Activities of Daily Living, daily living skills,
everyday functioning, task performance
Social engagement, Motor skills, Cognitive
skills
Publication
Research articles published in peer-reviewed
journals
Documents that are not peer-reviewed, book
chapters, systematic reviews
Year
2010-2020 Older research
The participants included were children or adolescents diagnosed with Autism Spectrum
Disorder within the age range 5-18 years. The topic of interest included the diagnoses of autism
spectrum disorder with or without intellectual disability. Other possible diagnoses or comor-
bidities (ADHD, Down Syndrome, DCD, Dyspraxia, learning disabilities, Developmental De-
lays, Cerebral Palsy) were not included within this research review because the mentioned di-
agnosis can importantly differ if there are additional difficulties. The optional comparison group
are children or adolescents who are typically functioning without any diagnosis. The outcome
11
criteria included interventions and relations about Occupational engagement, functioning, de-
velopment, independency, quality of life, task performance, Activities of Daily Living. The
publication type of inclusion criteria were research articles which were published in peer-re-
viewed journals. Articles which were published between 2010-2020 were only included in order
to have the most recent information concerning the topic. An extraction form with inclusion
and exclusion criteria is shown in the Table 1 above.
4.3 Selection process
A detailed overview of the search process and article selection can be observed in the flow
chart below (Flowchart 1).
Iden
tifi
cati
on
Scr
een
ing
Elig
ibili
ty
Incl
uded
Eric 17 PubMed 43
20
Total number of records
from combined databases
(n= 118)
Records screened by title
and abstract (n= 118)
Records excluded following
the exclusion criteria (n=68)
Records screened by in-
clusion criteria (n= 50)
Number of duplicates removed
(n=31)
Full text articles assessed
for eligibility (n=19)
Records exluded (n=11)
Total number of records
included (n=8)
CINAHL 37 PsycINFO 20
Manual search (n=1)
12
Articles collected in databases ERIC, PsycINFO, CINAHL and Pubmed were imported to
Zotero, a reference management software to manage bibliographic data and related research
materials and facilitate the screening process in systematic literature review. Then, the articles
(n=118) were screened through title and abstract contents based on inclusion and exclusion
criteria. A total of 68 articles were excluded based on the exclusion criteria. Next, duplicate
articles were exluded (n=31). Duplicate articles consisted of articles which were found more
than once in databases searching. The rest of the articles (n=19) were then assessed through
full text readings for eligibility based also on the inclusion criteria (Table 1) and the quality
assessment protocol (Appendix 1 and 2). When the articles were deemed to be low quality or
not did adhere to the inclusion criteria, they were excluded (n= 11) leaving a total of 8 articles
in the study. A total of 8 articles were finally included in this research.
In order to assess the quality of the articles, two assessment protocols were used. The
quality assessments for this study was taken from the CASP (Critical Appraisal Skills Pro-
gramme, 2018). These checklists were designed to be used as educational pedagogic tools, as
part of a workshop setting, therefore we do not suggest a scoring system. The core CASP check-
lists (randomised controlled trial & systematic review) piloted from health care professionals
in 1994 and a group of experts gathered to develop and pilot the checklist which it would be
used. Over the years overall adjustments have been made to the format, but a recent survey of
checklist users reiterated that the basic format continues to be useful and appropriate. Due to
the existence of both qualitative and quantitative design, two different checklists were used for
each type of study. The articles which used mixed methods were assessed from both quality
assessment checklists. Five of the articles were considered to have good quality (>70% of the
quality criteria fulfilled) and three articles were of moderate quality (>50% and <70% of the
quality criteria fulfilled). None of the final included articles was of low quality (<50% of the
quality criteria fulfilled) (Appendix 3).
4.4 Ethics
Systematic reviews are frequently read and cited in documents that influence educational policy
and practice. Hence, ethical issues associated with what and how systematic reviews are pro-
duced and used have serious implications. According to Zawacki-Richter et al. (2019) there are
guiding principles which were followed in the particular systematic review and consisted of six
13
phases: an appropriate epistemological orientation, identifying an appropriate purpose search-
ing for relevant literature, evaluating, interpreting and distilling evidence from selected reports
and constructing connected understandings for the reader.
4.5 Data analysis
After data extraction, the last step of methodology was the data analysis. The studies assigned
with an identification number (see Table 2.), to be used as a reference for the continuing of
review. General information about studies and intervention programs were described first, men-
tioning the country of conducting and the methodology design. A narrative synthesis was then
undertaken to report the findings. To answer the first research question, descriptions of inter-
vention programs and the activities of daily living which each program focuses were analysed.
Then, a categorization of intervention’s content for children with ASD was considered with
respect to the domains of function on the International Classification of Functioning, Disability
and Health (WHO, 2007). The term “content” describes the means of intervention, the fre-
quency and the sample. To answer the second research question, outcomes of the intervention
programs were analysed in different groups. Contents that were recognized as covering similar
constructs and topics were grouped in the same group, as well as outcomes that were recognized
as similar constructs. The outcomes of chosen interventions were analysed divided into three
groups depending on the methods and measurements were used to assess the outcomes.
5 Results
5.1 Overview
Eight articles were identified that answered the research questions according to the inclusion
criteria. They evaluated interventions supporting daily living skills, such as cooking, dressing,
laundry, either by observing a change in outcomes from pre- to post- intervention. These articles
were published between 2010 and 2020 in journals related to health, education and science. A
short overview of the studies can be found in Table 2, while some additional information about
the studies, is included in Appendix. Most of the studies which are included in this systematic
literature review, were set in USA. Only one of the eight studies conducted in Taiwan and one
in China. Six studies evaluated individual interventions aimed at adolescents and children (1,
3, 4, 5, 6, 7), one study evaluated group intervention aimed at adolescents (2) and one study
14
evaluated interventions aimed at children with the implication of parents in educational process
(8).
Two studies were quantitative studies (2, 3) and six were mixed methods studies (1, 4,
5, 6, 7, 8). Four studies (1, 3, 4, 5) had an experimental group enrolled in an intervention from
the beginning- baseline phase until the end of the intervention phase with pre-tests and post-
tests. The other four studies (2, 6, 7, 8) had also an experimental group with baseline condition,
intervention condition but they also evaluated the follow-up condition to investigate the sus-
tainability of the effect. The results are categorized based on the daily living skill and the activ-
ity which is examined, the content of intervention and the outcomes of each intervention.
The sample was diverse. Firstly, because there is a wide variation in the type and sever-
ity of symptoms people with autism experience and secondly because the range of age (5-18)
was also wide. In three studies (5, 6, 7) the intervention programs were focused on young chil-
dren (6-12 years old), in one study (1) the intervention programs were focused on elementary
school aged children (12-15 years old) and two studies (2, 4) focused on adolescents (15-18
years old). Furthermore, two studies (3, 8) included ages from various levels. Regarding the
severity of autism spectrum disorder and the functional level of the sample, there were different
levels too. Five studies (1, 4, 5, 6, 7) included participants with mild-moderate autism disorder,
one study (2) included participants with high functioning autism disorder, while 2 studies (3, 8)
included various levels of autism disorder. Six out of eight studies (1, 3, 4, 5, 6, 7) applied
interventions on children directly, one study (2) combined children and parents, while one study
(8) did the intervention to the parents training them in relation with their children DLS.
5.2 Intervention activities
In most of the studies researchers used interventions focused on a specific task/activity. The
studies are listed in the Table 2. The basic activities which were described can be divided in
three basic categories such as Hygiene: morning routine (which includes making a bed, wash-
ing hands, washing face, washing teeth and toileting) and shower training, Clothing: dressing,
laundry, folding clothes, tying shoes, Cooking: cooking a pasta with or without microwave,
dishwashing and Social skills: money management.
15
Table 2. Focused ADL of each intervention.
Two out of eight studies (3,4), did not focused on a specific activity but they described inter-
ventions to improve skills which can be useful for many activities of daily living. These skills
were the adaptive skills through horse-riding (3) and on-task behavior using activity schedule
on the iPod touch (4).
5.3 Content of interventions
The content of interventions includes the description of the aim, the sample and the materials
that the professionals used to intervene. What did they do and how? The ICF-CY (WHO, 2007)
was used to divide the content into two themes: Activity/Participation and Body functions/
Body structures.
Reference
no.
Activity of Daily living Intervention
1 Fold clothes and Cook microwave pasta Vivo picture prompting and video
prompting strategies
2 Morning Routine, cooking, laundry, money
management
STRW (Surviving and Thriving in the
Real World)
3 Adaptive skills Therapeutic horseback riding
4 Activity schedule and On-task behavior Self- reinforcement on the iPod touch
5 Tying shoes Video prompt-models and backward
chaining
6 Shower training Kinect-based training videogame
7 Dishwashing Self- monitoring intervention
8 Making a bed, cooking a pasta, tying shoes Parent delivery video prompting
16
Table 3.
Reference Aim Intervention Duration
1. Enhance independent functioning skills
and learn DLS.
Picture prompts: Children follow a power point presentation with pictures
which describe each step they have to do in a specific task.
Video prompts: Children follow a power point presentation with filmed vid-
eos which describe each step they have to do in a specific task.
10-12
Sessions for
6 weeks
2. Explore and evaluate the feasibility of
STRW group intervention on the acquisi-
tion of DLS (morning routine,
kitchen/cooking, laundry and money man-
agement).
Group intervention to adolescents and parents:
Adolescents: Each week, one DLS was targeted through didactics, discus-
sion, demonstration, and in vivo practice using empirically based strategies
(e.g. behavioural, technology, video modelling)
Parents: Each week, parents were taught how to utilize strategies (e.g. visual
strategies, technology, modelling, prompt fading, and incorporating special
interests) to both promote practice of DLS by their adolescent and generalize
the DLS to home and community environments.
90 min.
sessions for
10 weeks
3. Evaluate the effects of Therapeutic horse-
back riding (THR) in core areas of func-
tioning.
Every THR lesson followed the same routine: put riding helmet on, sit and
wait on the bench, mount horse, teaching a new skill, game or activity to
practice the new skill, dismount horse, groom horse, and put away equip-
ment.
10/1-h
weekly ses-
sions
17
4. Assess the independent on-task remaining
and completion when using self-reinforce-
ment compared to teacher-delivered rein-
forcement.
The intervention includes activity schedules and the use of portable technol-
ogy by presenting schedules on an iPod touch, which was used to teach vo-
cational, leisure, and functional living skills
6 weekly
sessions
5. Integrate video segments as prompt model
with backward chaining to teach children
shoe tying.
A series of video recordings were prepared to provide prompt models as part
of the backward chaining procedure. The number of steps needed increased
as training moved back through the chain. Each child observed a cartoon
selected based on their preference.
3 x 10–15
min. learn-
ing sessions
6. Examine if game technology is effective
to teach independently shower.
The game-based training is an interactive technology approach between hu-
man and computer, in which a Kinect gesture recognition technology en-
gages the child in a play procedure in order to promote his or her target be-
haviors.
25-40 min./
21 sessions
(11 weeks)
7. Evaluate the independent completion of
dishwashing in home setting.
The intervention condition consisted of two main phases: (a) dishwashing
instruction: washing bowls and (b) self-monitoring instruction: self-record-
ing of the individual’s dishwashing from video tapings.
1 month /
daily basis
8. Teach parents to deliver VP to their chil-
dren with ASD using an iPad.
A Microsoft Power-Point presentation described the purpose and rationale
of the training, outlined intervention procedures, and guided the instruction.
Parents were given this presentation in the form of a guide. Video prompting
segments used in the children’s intervention were created using an iPad 3G
and transferred to the Picture Scheduler application on the same iPad.
3 times per
week / 5-7
weeks
18
As has been already mentioned, various functional levels and age were existed in the
sample. However, apart from differences, some important similarities were found. Most of the
interventions (1, 2, 4, 5, 6, 7, 8) used technology to accomplish their goals. Four studies (1, 2,
5, 7, 8) used video prompting combined with other techniques such as backward chaining and
self-monitoring. One study (6) used game technology and one used activity schedules in iPod
touch. Interestingly, one study (1) conducted a comparison between the effectiveness of video
and picture prompts when used for teaching daily living skills in adolescents with ASD. Visu-
alized pictured programmes were used in two other studies (4, 7).
5.3.1 Body functions/ Body structures
Methods were used to improve DLS for children and adolescents with ASD focus on the body
functions and structures. The horseback riding (3) was focused on development in three core
areas functioning: self-regulation behaviors, adaptive skills, and motor skills in school-age chil-
dren and adolescents. The sessions consisted of activities and exercises that addressed physical,
psychological, cognitive, and social skills. Additionally, the self-reinforcement (4) was one of
the intervention methods that was focused on body functions and structures. Self-reinforcement
is an important part of self-development and self-management training, although it has received
little attention in the literature. The purpose of this study was to assess whether individuals with
ASD remained on-task for longer durations and completed tasks independently when using self-
reinforcement compared to teacher-delivered reinforcement
5.3.2 Activities/ Participation
The technology methods which have been described above as well as The Surviving and Thriv-
ing in the Real World (STRW) (2) method of intervention aiming to improve DLS for children
and adolescents with ASD focused on activities/ participation. The STRW was a group inter-
vention to adolescents and parents which was combined behavioural and technology strategies
in order to achieve the acquisition of DLS. The strategies included: didactics, discussion,
demonstration, and in vivo practice using empirically based strategies (e.g. behavioural, tech-
nology, video modelling) for the adolescents and for the parents there was a teaching on how
to utilize strategies (e.g. visual strategies, technology, modelling, prompt fading, and incorpo-
rating special interests) to promote the improvement of DLS. More specifically, the intervention
targeted four areas: morning routine, kitchen/cooking, laundry and money management.
.
19
5.4 Outcomes of intervention
Intervention outcomes were operationalized as a change from pre-intervention (baseline condi-
tion) to post intervention (intervention condition) and follow-up (maintenance) condition, if it
was existed. Different methods and various measurement instruments were used to assess the
outcomes. A brief description of the different measurements and results in relation to the target
activity has been presented in Table 4. The fact of different methods and measurement made it
challenging to categorize and compare them, however, three groups have been created based
on the type of each study’s results. The first includes the studies which compare the perfor-
mance scores of the assessment tools through the different intervention conditions (2,3). The
second includes the studies which compare the percentage of the correct independent perfor-
mance through the different intervention conditions (1, 4, 6, 7) and the third includes the studies
which estimate the efficacy, presenting the effect sizes (5, 8).
5.4.1 Pre and post-test assessment tools score
The Vineland Adaptive Behavior Scales, Second Edition (Vineland -II), Goal Attainment Scal-
ing (GAS) and Vineland Adaptive Behavioral Scales II- Interview edition (VABS-II) are the
assessment tools which were used in the studies which compared the performance scores in
ADL (2,3). A more detailed description of these assessment tools can be found in the Appendix
5. In study no. 2, the Vineland-II was used and the raw scores on the three Vineland-II DLS
subdomains corresponding to the targeted skills taught in STRW and the results were the fol-
lowing: from baseline to post-treatment, the paired sample t tests revealed statistically signifi-
cant improvement in the raw scores on the Domestic subdomain (t(6) = 2.85, p = 0.03, d = 1.1)
and DLS domain (t(6) = 2.86, p = 0.03; d = −1.3), from baseline to follow-up, the paired sample
t tests revealed statistically significant improvement in the raw scores on the Community sub-
domain (t(6) = 4.41, p = 0.005; d = 1.7) and DLS domain (t(6) = 3.880, p = 0.01; d = 1.5), while
from post-treatment to follow-up, there were no significant changes in the raw scores on the
Vineland-II DLS domain and subdomains. The GAS also was used in study no. 2 and the results
were the following: from baseline to post-treatment, paired sample t tests revealed statistically
significant improvement in the mean item score in all four areas and in the total score, from
baseline to post-treatment, paired sample t tests revealed statistically significant improvement
in the mean item score in all four areas, from baseline to follow-up, paired sample t tests re-
vealed statistically significant improvement in the mean item score in all four areas and in the
total score, while from post-treatment to follow-up, there were no significant changes in the
mean item scores in the four areas and total score of the GAS. Overall, the results of STRW
20
intervention were promising, especially given that high-functioning adolescents with ASD have
significant DLS deficits (e.g. Duncan and Bishop, 2013) that are not typically addressed through
school or clinical services. The VABS-II was used in study no. 3. The results comparing base-
line and post-THR assessments for the VABS-II, significant improvements were observed for
the Adaptive Total score (p = 0.001) and the Daily Living raw score (p = 0.011).
5.4.2 Pre and post-intervention percentages of correct independent performance
Regarding the second category which includes the studies (1, 4, 6, 7) which compare the per-
centage of the correct independent performance through the different intervention conditions,
the study no. 1 compared the effects of Video prompting and Picture prompting interventions
and they concluded that both prompting systems were effective in developing independent re-
sponding for participants with ASD. However, the video prompting was more effective than
picture prompting and more specifically the one of the two participants engaged in more inde-
pendent correct responding when the video prompting condition was used (M = 91%) than with
the picture prompting condition (M = 83%). The second participant also had higher independent
correct responding when the video prompting materials were used (M = 90%) than in the picture
prompting condition (M = 76%). In study no. 4, the researchers tried to assess whether individ-
uals remained on task longer durations and completed tasks independently when they use self-
reinforcement compared to teacher-delivered reinforcement. Results of this study demonstrated
high percentages of on-task behavior and schedule completion in both self-reinforcement and
teacher-delivered reinforcement. More specifically, the percentage of intervals with on-task be-
haviour of the three participants increased from 14%, 13% and 11% (baseline condition) to
100% for all of them (intervention condition) and they maintained the same on task behaviour
through the follow-up condition.
In study no. 6, the purpose was to examine whether game technology is an effective way
to teach adolescents with ASD to take a shower independently. The results indicated that the
proposed system, in conjunction with operant conditioning strategies, can facilitate the progress
of children with ASD taking a shower independently. For the six participants, the rate of im-
provement in taking a shower independently was 33%, 62%, 72%, 88%, 191% and 193%. Fi-
nally, in study no.7 the researchers utilized a self-monitoring intervention to increase independ-
ent task completion of dishwashing at home for three elementary-aged children with ASD. The
results indicated that all three children acquired self-monitoring, improved dishwashing skills
and maintained both skills at a high level without supervision one week after the completion of
21
the intervention. More precisely, during baseline and without the use of the self-recording, the
first participant completed the dishwashing task with 25% (two steps), the second with 0–12%
(one step) accurate, while the third did not complete any steps accurately during baseline probe
trials. The mastery criterion for dishwashing was 100% accuracy in probe trials for three con-
secutive days. The three children achieved the mastery criterion on dishwashing in 23, 12, and
11 days.
5.4.3 Effect sizes
The third category includes the studies which present effect sizes (5,8). In study no. 5, the re-
searchers tried to extend the prior research by integrating video prompting with backward
chaining and evaluating the treatment in an experimental design. The study demonstrated the
successful application of video prompt-modelling with backward chaining to teach the complex
skill of shoe tying, nevertheless the data of baseline and treatment conditions indicated medium
effects for all the three participants. The effect size calculations for the first participant shown
NAP= .7841, p= .0044, for the second participant NAP= .7500, p= .0007 and the third NAP=
.8571, p= .0000. Lastly, the study no. 8 included both parents and children. The purpose of that
study was to evaluate the effects of behaviour skills training with follow-along coaching to
teach parents to deliver video prompting using an iPad to teach DLS to their children with ASD.
The study indicates that behaviour skills training packages can be used to teach parents to de-
liver evidence-based practices effectively and efficiently to the children, since the Tau-U scores
for the three participants were 1.00, 0.83, and 1.00 and the omnibus Tau-U score was 0.95.
These individual data indicate that the parent-delivered intervention ranged from effective to
very effective.
Table 4. Description of each intervention’s measurements and results.
20
References Intervention Outcome
Target Measurement Results
1 Vivo picture prompting and
video prompting strategies
Fold clothes and Cook
microwave pasta
Task analytic data sheet with
correct and incorrect perfor-
mance
Both strategies were effective.
Effectiveness: Video prompting > Picture prompting
2 STRW (Surviving and Thriving
in the Real World)
Morning Routine, cook-
ing, laundry, money man-
agement
Vineland II, GAS Vineland- II and GAS: Significant improvement from baseline to post-
treatment, but no significant changes from post-treatment to follow-up.
3 Therapeutic horseback riding Adaptive skills
VABS-II VABS-II: Significant improvements in Adaptive, Communication, So-
cial and Daily Living raw score.
4 Self- reinforcement on the iPod
touch and Teacher delivered re-
inforcement
Activity schedule and
On-task behaviour
Independent schedule comple-
tion, 30s momentary time sam-
pling procedure
High percentages of on-task behavior and schedule completion in both
self-reinforcement and teacher-delivered reinforcement.
5 Video prompt-models and back-
ward chaining
Tying shoes
Checklist based on the research
protocol
Medium effect sizes. Good treatment in promoting skills acquition but
extensive number of teaching trials.
6 Kinect-based training video-
game
Shower training
Data sheet designed to record the
task chain
The rate of improvement in taking shower independently was raised for
all the participants.
7 Self- monitoring intervention Dishwashing
Checklist based on the research All three children improved dishwashing, acquired self-monitoring and
maintained both skills without supervision after one week. Their parents
also very satisfied.
8 Parent delivery video prompting Making a bed, cooking a
pasta, tying shoes
Checklist based on the research
protocol
Τhe parents implemented consequence strategies inconsistently. How-
ever, they were successful with the implementation of the VP prepara-
tion and intervention. Children completed the steps of their DLS with
high accuracy, and these skills maintained following the removal of the
intervention.
21
6 Discussion
The findings of this systematic review indicate the existence of evidence which support the
feasibility and effectiveness of daily living skills intervention programs. The common target of
the studies was to enable children and adolescents with ASD to participate in activities of daily
living in a home as well as school setting. Although previous evidence has documented the
important relation between DLS and functional independence (Katsiana, Sinodinou and Strim-
pakos, 2019) this review found limited number of studies with interventions with goal to im-
prove daily living skills in an effective way in this specific population. However, most of the
existing treatment procedures were medium or high effective in promoting skill or activity ac-
quisition for the participants in a short or long space.
Previous studies have also examined various approaches to improve skills for children
with ASD and the results about interventions that are most frequently used are common with
the results of this study. Hong et al. (2013) identified video modelling, behavioural in vivo
procedures, visual cues, and audio cuing. Video modelling involves the children watching vid-
eos of behaviours either from others or from themselves engaging in the target behaviours
(Charlop-Christy et al. 2000), behavioural in vivo procedures which include prompting, rein-
forcement, modelling, chaining, and shaping (Mayer, Sulzer-Azaroff & Wallace, 2012)., visual
cues include visually based strategies, such as visual activity schedules (Ganz et al. 2008) and
audio cueing which providing verbal prompts from the instructor to the individual (Allen et al.
2012). The interventions mentioned are also included in this study with an emphasis on video
prompts-video modelling and visual cues, showing a high effectiveness. Research indicates that
individuals with autism have difficulties to receive information that is presented only vocally,
while the visual stimuli tends to be stronger in learning procedure (Van Laarhoven et al. 2010).
The use of visual seems to enhance instruction and has brought in positive outcomes for these
individuals when completing multi-step tasks independently (Wong et al. 2013).
22
6.1 The role of parents
As can been seen, two out of the eight studies (2, 8) which are included in this systematic review
used the parents as a basic or complementary part in the therapy process, pointing to positive
outcomes in both studies. Parents seems to be the most important people in the life of a child
with ASD. They have a direct influence from the crucial first few years until the whole child-
hood and teenage years. Their role in the social setting of the child and therefore in the support,
relationships, stimulation and services that are accessed is significant (Viljoen et al., 2019).
An important number of studies have been conducted to examine the effects of parent-
implemented intervention and they indicated a positive effect for most parents regarding the
increasing of the parental knowledge, skills, and performance (Koegel, Bimbela and Schreib-
man, 1996; Schreibman, Kaneko, Koegel, 1991). Furthermore, one way parents can contribute
to their children’s development is to help them gain DLS by becoming fluent in the application
of parent-implemented interventions (PII). PII are practices in which therapists teach the parents
intervention procedures in order to deliver part, or all, of the given intervention to their own
children (Wong et al. 2013). The use of PII has been reported to promote successful outcomes
such as effective communication, joint attention and appropriate mealtime behaviors (Naj-
dowski et al. 2010) among children with ASD (Cruz‑Torres et al. 2019). The PII practice in-
cludes mainly instructions, modeling, coaching and performance feedback from the profession-
als. In total, these instructional methods are known as Behavior Skills Training and they are
considered as a successful way for teaching parents of children with ASD and other develop-
mental disabilities, how to promote appropriate behaviors (Mueller et al. 2003). Interestingly,
research suggest that the achievement of the desired outcomes for the child’s participation and
performance provide benefits in parents’ life too (Osborne et al. 2008, Schwichtenberg and
Poehlmann 2007).
According to ICF, the environmental factor, which include the social and physical struc-
ture, affects the person directly as well as indirectly. For example, the impact of the medication
that targets body function is a direct affect, while our perceptions of the activity context are an
indirect effect. However, the person also affects the environment through engagement in activ-
ities within places (Batorowicz, King, Mishra and Missiuna, 2015). This phenomenon can be
described by the transactional relationships between the person and the context in which people
are involved causing changes to both the individual and the environment over time (Mallinson
& Hammel, 2010). Therefore, effective approaches to support parents and families of children
23
with ASD and factors associated with positive parent and family outcomes need to be identified
to improve the quality of life for families, parents, and children with ASD (Estes et al. 2013).
6.2 Activity-centered or skill-centered intervention?
Most of the intervention programs included in this review are based on occupation-focused
practices, rather than skill-focused intervention. More specifically, out of the eight studies with
intervention programs, only one focused on skill-centered strategies (3). This study included
therapeutic horse-riding lessons to teach or practice new skills for children with ASD and the
outcomes indicated significant improvements for the adaptive, the communication, the social
and the daily living raw score. Research suggests adaptive behavior as a very closely related
factor for social functioning and independent living (Farley et al. 2009, Kanne et al. 2011).
Adaptive behavior characterizes the individual’s ability to convert cognitive functions to typical
performance skills of daily activities (Sparrow et al. 1984). These skills are developing inde-
pendently, and they include everyday skills, such as the effective communication and partici-
pation in community activities. Well-developed adaptive skills are necessary to independent
functioning (Klin et al. 2007). The measure of adaptive behaviour skills with the most common
use is the Vineland Adaptive Behavior Scales (Sparrow et al. 2005) and can been detected in
the current review, too.
On the other hand, from a top-down perspective, the daily living skills enhancement can
be focused through participation in occupation-focused practices, coaching parents and other
similar approaches (Gillen & Greber, 2014, Palisano et al. 2012). Some of the previous evidence
suggest the use of the term activity- or occupation-based intervention to describe this approach,
presenting the common points as below: “Choosing activities according to the child’s interests,
Teaching individual goals embedded in routines and planned activities, Teaching functional
and generalizable skills, Using before and after behaviour stimuli which have natural and mean-
ingful relations with behaviours and environment” (Pretti-Frontczak and Bricker, 2004). The
term occupation, as it is used in the Occupational Therapy practice framework (AOTA, 2014),
refers to the daily life activities in which people engage. Occupations have purpose, meaning,
and perceived utility to the individuals. Therefore, they are influenced by the interaction among
client factors, performance skills, and performance patterns. The child’s interests consist one
of the basic components, so there is a need for involving them in multiple occupations-activities
of their preference. Besides, the occupational therapy process is the client-centered delivery of
occupational therapy services and the practitioners use the collaboration with clients when they
24
engage in clinical reasoning (AOTA, 2014). In addition, the occupational outcome, except from
the terms of occupational performance and occupational engagement are connected to occupa-
tional rights that encompass inclusive participation in everyday occupations, too. The concept
of occupational rights (Hammell 2008) is complementary to the concept of occupational science
which supports that humans are occupational beings who need and want to engage in doing,
being, becoming, and belonging.
Nevertheless, focusing on the participation of children in everyday life from a system
theoretical perspective, the ICF-CY defines participation as ‘involvement in a life situation’,
therefore the intervention process might include both occupation performance and skill’s de-
velopment. Taking into consideration the diagnoses of ASD as a health condition and the ac-
tivity limitations and participation restrictions as the deficits in daily living skills, an interven-
tion plan should include changes in both activities and skills regarding personal factors. The
individual’s deficit is classified as a result of many different aspects, therefore ICF suggests
interventions which can be used in a more holistic way in order to enhance participation (WHO,
2007).
6.3 Methodological issues
In this section, the most important methodological issues of the included studies will be high-
lighted. Although positive results have been reported, the quality of research designs and quality
of the evidence of studies on those interventions focusing on daily living skills for individuals
with ASD have not been investigated in depth. Most of the intervention programs included in
this review have not described in detail some interventions. Furthermore, there are several
thoughts about the generalizing of the results from studies identified in this review to broader
contexts, because of the sample. The size of the sample was small in most of the studies and as
it can been observed, it was only consisted of participants with medium to high functioning
autism. Thus, there is a difficulty to evaluate the daily living skills intervention programs for
children with low functioning autism.
In general, most of the existing studies comprised children with high functioning autism
spectrum disorder (HFASD) and did not control for the severity of symptoms of autism (Ros-
enberg, Moran and Bart, 2017). Because of their severe communicative and cognitive limita-
tions, these children are a hard-to-research population (King, 2013), and the feasibility of stand-
ardized tests for these children is limited compared to children with HFASD. However, Little,
25
Sideris, Ausderau and Baranek (2014) have identified that autism severity is one of the most
important factors which predict participation diversity and intensity. Children with low func-
tioning autism spectrum disorder (LFASD) present motor dysfunction which is a barrier for the
performance and generalization of routine daily activities such as dressing, eating, drawing,
playing (Fabbri-Destro et al., 2013).
6.4 Strenghts and Limitations
The research literature offers strong positive evidence for occupational therapists to use com-
prehensive, individualized analysis of the child’s performance to develop the intervention strat-
egies. The research evidence also supports the use of family-centered and the interdisciplinary
approaches. Many of the studies used skill-based or activity-based interventions such as those
implemented by health care therapists. The results of this analysis will assist readers in evalu-
ating intervention effectiveness in a more clear and accurate way.
The limitations of this systematic review are based on the design and methods of this
systematic review, including a small number of studies. The particular review shows that stud-
ies about enhancing daily living skills are carried out basically in developed countries, which it
follows the inclusion criteria but could have been influenced by the choice to restrict the search
to empirical English-language articles published in peer-reviewed journals. Consequently, the
identified intervention strategies could be applied to only developed countries. Furthermore,
another limitation has to do with the criterion that only studies involving samples without any
comorbidities except intellectual disability are selected. That means that children and adoles-
cents with some usual comorbidities, such as sensory processing disorders were excluded. Alt-
hough relations between sensory responses and DLS remain to be explored, the DLS require
sensory interaction and the effects of sensory sensitivity, or sensory avoiding could be interest-
ing to be explored (Jasmin et al., 2009). Mental health issues also consist a very common char-
acteristic of the children and adolesents with ASD, as have been demonstrated by evidence
(Hofvander et al., 2009, Leyfer et al, 2006, Simonoff et al. 2008), but they were also excluded
from the study sample.
26
6.5 Future research
Every profession makes use of theories to underlie and explain its practice. However, there is a
need of testing these explanations through research. Research is the primary tool by which the-
ory can be corrected and refined so that can be improved and provide useful explanations for
practice. As experts in childhood occupations, one of the suggestions for future research is to
critical examine and make assumptions regarding the mechanisms of development. There is
still a debate between skill-based and activity-based interventions which is important to be ad-
dressed in order to approach the needs of children with developmental challenges in an evi-
dence-based manner. Moreover, it would be useful for the future researches to include a larger
sample for various countries using ADL measurements in different contexts and environments
of the children themselves. The cognitive level measurements or IQ scores of participants also
are essential in order to explore the relationship between DLS and cognitive level. Finally, sen-
sory integration approaches should be the focus of future research evidence considering that
sensory-based techniques have moderate to strong evidence of effectiveness but minimal re-
search evidence.
7 Conclusion
To conclude, as it becomes apparent the necessity of research regarding the enhancing of DLS
for children with ASD is a very important issue in order to improve the clinical training and the
impact on practice. There is a need to take into consideration all the factors which may influence
everyday life. Most of the identified studies have reported effective results using various inter-
vention programmes for the improvement of DLS such as picture prompting, video prompting,
videogame training, self-monitoring, behavioural training and therapeutic horseback riding.
The ICF-CY while analyzing the most important components, highlighted the environ-
mental factor as crucial. All professionals involved within pediatric rehabilitation should have
an up-to-date and realistic view of a family’s needs in order to provide an effective service
provision to the child and as an extension to the whole family. The Occupational Therapy prac-
tice framework focuses on the ability of children with ASD to function within a variety of con-
texts, like home, school, and community environments through the provision of purposeful and
meaningful occupations, such as personal hygiene, dressing and feeding.
Most existing studies comprised children with moderate and high functioning autism
spectrum disorder (HFASD) and did not control children with a more severe levels of symptoms
27
even if the severity is a vital feature which predict participation diversity and intensity. This
systematic review has certain limitations and not enough research has been done generally to
evaluate the intervention strategies in a holistic way, however, provides a useful overview of
interventions aimed at enhancing DLS and can offer guidance in planning such intervention
programs.
21
References
Allen, K. D., Burke, R. V., Howard, M. R., Wallace, D. P., & Bowen, S. L. (2012). Use of audio
cuing to expand employment opportunities for adolescents with autism spectrum disorders and
intellectual disabilities. Journal of Autism and Developmental Disorders, 42, 2410–2419.
American Heritage dictionary of the English language (4th ed.). (2003). Retrieved from
http://www.thefreedictionary.com/framework.
American Occupational Therapy Association (2014). Occupational therapy practice frame-
work: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.1),
S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders
(2013). 5th ed. Arlington, VA: American Psychiatric Association.
Azad, G., & Mandell, D. S. (2016). Concerns of parents and teachers of children with autism
in elementary school. Autism, 20, 435–441.
Batorowicz, B., King, G., Mishra, L., & Missiuna, C. (2015). An integrated model of social
environment and social context for pediatric rehabilitation. Disability And Rehabilitation,
38(12), 1204-1215.
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Carter, A. S., Kadlec, M. B., & Dunn, W.
(2007). Extreme sensory modulationbehaviors in toddlers with autism. American Journal of
Occupational Therapy, 61(5), 584–59.
Bilgin, H. & Kucuk, L. (2010). Raising an Autistic Child: Perspectives From Turkish Mothers.
Journal of Child and Adolescent Psychiatric Nursing, 23(2), 92–99.
Booth A, Cantrell A, Preston L, Chambers D, Goyder E. (2015). What is the evidence for the
effectiveness, appropriateness and feasibility of group clinics for patients with chronic condi-
tions? A systematic review. Health Service Delivery Research, 3(46), 1-194.
Bryson, S. A., Corrigan S. K., McDonald T. P. & Holmes C (2008). Characteristics of chil-
dren with autism disorders who received services through community mental health centers.
Autism, 12(1), 65-82.
22
Carnahan, C., Hume, K., Clarke, L., & Borders, C. (2009). Using structured work systems to
promote independence and engagement for students with Autism Spectrum Disorders. Teach-
ing Exceptional Children, 41(4), 6–14.
Case-Smith, J., & Arbesman, M. (2008). Evidence-based review of interventions for autism
used in or of relevance to occupational therapy. American Journal of Occupational Therapy,
62, 416–429.
Castro, S. & Pinto, A.I. (2013). Identification of core functioning features for assessment and
intervention in autism spectrum disorders. Disability & Rehabilitation, 35, 125–133.
Centers for Disease Control and Prevention, 2015. Autism and Developmental Disabilities
Monitoring (ADDM) Network. Retrieved from: http://www.cdc.gov/ncbddd/autism/addm.html
Chan, W., Smith, L., Hong, J., Greenberg, J., Lounds Taylor, J., & Mailick, M. (2017). Factors
associated with sustained community employment among adults with autism and co-occurring
intellectual disability. Autism, 22(7), 794-803.
Charlop-Christy, M. H., Le, L., & Freeman, K. A. (2000). A comparison of video modeling
with in vivo modeling for teaching children with autism. Journal of Autism and Developmental
Disorders, 30, 537–552.
Critical Appraisal Skills Programme. (2018). CASP qualitative checklist. Retrieved from:
https://pingpong.hj.se/courseId/21193/courseDocsAndFiles.do?nodeTreeToggle-
Folder=16492329
Cruz-Torres, E., Duffy, M., Brady, M., Bennett, K., & Goldstein, P. (2019). Promoting Daily
Living Skills for Adolescents with Autism Spectrum Disorder via Parent Delivery of Video
Prompting. Journal of Autism and Developmental Disorders, 50(1), 212-223.
Dunn,W., Cox, J., Foster, L.,Mische-Lawson, L., & Tanquary, J. (2012). Impact of a contextual
intervention on child participation and parent competence among children with autism spectrum
disorders: A pretest–post test repeated measures design. American Journal of Occupational
Therapy, 66, 520–528.
Duncan, A., & Bishop, S. (2013). Understanding the gap between cognitive abilities and daily
living skills in adolescents with autism spectrum disorders with average intelligence. Autism,
19(1), 64-72.
23
Estes, A., Vismara, L., Mercado, C., Fitzpatrick, A., Elder, L., Greenson, J., Lord, C., Mun-
son, J., Winter, J., Young, G., Dawson, G., Rogers, S. (2014). The Impact of Parent-Delivered
Intervention on Parents of Very Young Children with Autism. Journal of Autism and Devel-
opmental Disorders, 44(2), 353–365. https://doi.org/10.1007/s10803-013-1874-z
Fabbri-Destro, M., Gizzonio, V., & Avanzini, P. (2013). Autism, motor dysfunctions and mirror
mechanism. Clinical Neuropsychiatry, 10(5), 177–187.
Farley, M. A., McMahon, W. M., Fombonne, E., Jenson, W. R., Miller, J., Gardner, M., et al.
(2009). Twenty-year outcome for individuals with autism and average or near-average cogni-
tive abilities. Autism Research, 2(2), 109–118.
Ganz, J. B., Kaylor, M., Bourgeois, B., & Hadden, K. (2008). The impact of social scripts and
visual cues on verbal communication in three children with autism spectrum disorders. Focus
on Autism and Other Developmental Disabilities, 23, 79–94.
Gardiner, E., & Iarocci, G. (2015). Family Quality of Life and ASD: The Role of Child Adap-
tive Functioning and Behavior Problems. Autism Research, 8(2), 199-213.
Gillen A. & Greber C (2014). Occupation-focused practice: challenges and choices. British
Journal of Occupational Therapy, 77(1), 39–41.
Green S.A. & Carter A., S. (2014). Predictors and course of daily living skills development in
toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders.
44(2), 256–263.
Greenspan, S., Wieder, S., & Simons, R. (1998). The child with special needs. Reading,
Mass.: Addison-Wesley.
Hammell, K., W. (2008). Reflections on well-being and occupational rights. Canadian Jour-
nal of Occupational Therapy, 75, 61–64.
Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., Herbrecht, E.,
Stopin, A., Anckarsäter, H., Gillberg, C., Råstam, M., Leboyer, M. (2009). Psychiatric and
24
psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC
Psychiatry, 35(1), 1-9.
Hong, E. R., Ganz, J. B., Ninci, J., Neely, L., Gilliland, W., & Boles, M. (2015). An evalua-
tion of the quality of research on evidence-based practices for daily living skills for individu-
als with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(9),
2792-2815.
Jasmin, E., Couture, M., McKinley, P., Reid, G., Fombonne, E., & Gisel, E. (2009). Sensori-
motor and Daily Living Skills of Preschool Children with Autism Spectrum Disorders. Jour-
nal Of Autism And Developmental Disorders, 39(2), 231-241.
Jesson, J., Matheson, L., & Lacey, F. M. (2011). Doing your literature review. Traditional and
Systematic Techniques. London: SAGE.
Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier,
C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for
functional outcome. Journal of Autism and Developmental Disorders, 41(8), 1007–1018.
Kao, Y., Kramer, J., Liljenquist, K., & Coster, W. (2014). Association between impairment,
function, and daily life task management in children and adolescents with autism. Developmen-
tal Medicine & Child Neurology, 57(1), 68-74.
Katsiana K., Sinodinou K., Strimpakos N. (2019). Daily living skills in children with autism
spectrum disorder and down syndrome and their relationship to health-related quality of life.
Interdisciplinary healthcare, 11(3), 24-38.
Kilincaslan, A., Kocas, S., Bozkurt, S., Kaya, I., Derin, S., & Aydin, R. (2019). Daily living
skills in children with autism spectrum disorder and intellectual disability: A comparative study
from Turkey. Research In Developmental Disabilities, 85, 187-196.
King, G. (2013). Perspectives on measuring participation: Going forward. Child: Care, Health
and Development, 39(4), 466–469.
25
Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007).
Social and communication abilities and disabilities in higher functioning individuals with au-
tism spectrum disorders: The Vineland and the ADOS. Journal of Autism and Developmental
Disorders, 37(4), 748–759.
Koegel, R., L., Bimbela, A. & Schreibman L (1996). Collateral effects of parent training on
family interactions. Journal of Autism and Developmental Disorders, 26(3), 347–359.
Lavesser, P. & Berg, C. (2011) Participation patterns in preschool children with an autism spec-
trum disorder. OTJR: Occupation, Participation and Health, 31, 33-39.
Leyfer, O.T., Folstein, S.E., Bacalman, S., Davis, N.O., Dinh, E., Morgan, J., Tager-Flusberg,
H. & Lainhard, J. (2006). Journal of Autism and Developmental Disorders, 36 (7), 849– 861.
Liss, M., Saulnier, C., Fein, D., & Kinsbourne, M. (2006). Sensory and attention abnormalities
in autistic spectrum disorders. Autism, 10, 155–172.
Little, L. M., Ausderau, K., Sideris, J. & Baranek, G. (2015) Activity participaton and sensory
features among children with autism spectrum disorders. Journal of Autism and Developmental
Disorders, 45, 2981-2990.
Little, L. M., Sideris, J., Ausderau, K. & Baranek, G. T. (2014) Activity participation among
children with autism spectrum disorder. American Journal of Occupational Therapy, 68, 177-
185.
Magiati, I., Charman, T., & Howlin, P. (2007). A two-year prospective follow-up study of com-
munity-based early intensive behavioural intervention and specialist nursery provision for chil-
dren with autism spectrum disorders. Journal Of Child Psychology And Psychiatry, 48(8), 803-
812.
Mallinson, T., & Hammel, J. (2010). Measurement of Participation: Intersecting Person, Task,
and Environment. Archives Of Physical Medicine And Rehabilitation, 91(9), 29-33.
Mayer, G. R., Sulzer-Azaroff, B., & Wallace, M. (2012). Behavior analysis for lasting change.
Hudson, NY: Sloan Pub.
26
Mueller, M. M., Piazza, C. C., Moore, J. W., Kelley, M. E., Bethke, S. A., Pruett, A. E., et al.
(2003). Training parents to implement pediatric feeding protocols. Journal of Applied Behavior
Analysis, 36, 545–562. https ://doi.org/10.1901/jaba.2003.36-545.
Najdowski, A. C., Wallace, M. D., Reagon, K., Penrod, B., Higbee, T. S., & Tarbox, J. (2010).
Utilizing a home-based parent training approach in the treatment of food selectivity. Behavioral
Interventions, 41, 90–107.
Osborne, L. A., McHugh, L., Saunders, J., & Reed, P. (2008). A possible contra-indication for
early diagnosis of Autism Spectrum Conditions: Impact on parenting stress. Research in Autism
Spectrum Disorders, 2(4), 707–715.
Palisano, R., Chiarello, L., King, G., Novak, I., Stoner, T., & Fiss, A. (2012). Participation-
based therapy for children with physical disabilities. Disability & Rehabilitation, 34(12), 1041-
1052.
Pianta, R. C. & Stuhlman, M. W. (2004). Teacher-Child Relationships and Children's Success
in the First Years of School. School Psychology Review, 33(3), 444-458.
Potvin, M. C., Snider, L., Prelock, P., Kehayia, E., & Wood-Dauphinee, S. (2013a). Children’s
Assessment of Participation and Enjoyment/Preference for activities of children: Psychometric
properties in a population with high-functioning autism. The American Journal of Occupational
Therapy, 67, 209-217. http://dx.doi.org/10.5014/ajot.2013.006288
Pretti-Frontczak, K. & Bricker, D. (2004). An activity-based approach to early intervention.
Baltimore, Md.: P.H. Brookes Pub.
Reynolds, S., Bendixen, R., Lawrence, T., & Lane, S. (2011). A pilot study examining activity
participation, sensory responsiveness, and competence in children with 182 high functioning
autism spectrum disorder. Journal of Autism & Developmental Disorders, 47(11), 1496-1506.
https://doi.org/10.1007/s10803-010-1173-x
Rosenberg, L., Moran, A., & Bart, O. (2017). The associations among motor ability, social-
communication skills, and participation in daily life activities in children with low-functioning
autism spectrum disorder. Journal Of Occupational Therapy, Schools, & Early Intervention,
10(2), 137-146.
27
Schreibman, L., Kaneko, W.M. & Koegel, R.L. (1991). Positive affect of parents of autistic
children: A comparison across two teaching techniques. Behavior Therapy, 22(4), 479–490.
Schwichtenberg, A., & Poehlmann, J. (2007). Applied behavior analysis: Does intervention
intensity relate to family stressors and maternal well-being? Journal of Intellectual Disability
Research, 51(8), 598–605.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T. & Baird, G. (2008). Psychiatric
disorders in children with autism spectrum disorders: prevalence, comorbidity and associated
factors. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921– 929.
Sparrow, S.S., Balla, D.A. & Cicchetti, D.V. (1984). Vineland adaptive behavior scales. Amer-
ican Guidance Service. Circle Pines, MN.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2008). Vineland adaptive behavior scales:
Second edition (Vineland II), The expanded interview form, Livonia, MN: Pearson Assess-
ments.
United Nations Convention on the Rights of Persons with Disabilities (2006). New York:
United Nations.
Valenti, M., Cerbo, R., Masedu, F., De Caris, M., & Sorge, G. (2010). Intensive intervention
for children and adolescents with autism in a community setting in Italy: a single-group longi-
tudinal study. Child And Adolescent Psychiatry And Mental Health, 4(1).
Van Laarhoven, T. V., Kraus, E., Karpman, K., Nizzi, R., & Valentino, J. (2010). A comparison
of picture and video prompts to teach daily living skills to individuals with autism. Focus on
Autism and Other Developmental Disabilities, 25, 195–208.
Viljoen, M., Mahdi, S., Griessel, D., Bölte, S., & de Vries, P. (2019). Parent/caregiver perspec-
tives of functioning in autism spectrum disorders: A comparative study in Sweden and South
Africa. Autism, 23(8), 2112-2130.
Vismara, L. A., & Rogers, S. J. (2010). Behavioral treatments in autism spectrum disorder:
What do we know? Annual Review of Clinical Psychology, 6, 447–468.
Wagner, M., Blackorby, J., Marder, C., & Levine, P. (2003). The functional abilities of youth.
In M. Wagner, C. Marder, P. Levine, R. Cameto, T. W. Cadwallader, & J. Blackorby (with D.
28
Cardoso & L. Newman), The individual and household characteristics of youth with disabilities.
Menlo Park, CA: SRI International.
Weaver, L. L. (2015). Effectiveness of work, activities of daily living, education, and sleep
interventions for people with autism spectrum disorder: A systematic review. American Jour-
nal of Occupational Therapy, 69.
World Health Organization (2007). International Classification of Functioning, Disability and
Health for Children and Youth (ICF-CY). Geneva: World Health Organization. Available from:
http://apps.who.int/iris/handle/10665/43737.
Wong, C., Odom, S. L., Hume, K., Cox, A. W., Fettig, A., Kucharczyk, S., et al. (2013). Evi-
dence-based practices for children, youth, and young adults with Autism Spectrum Disorder.
Chapel Hill, NC: University of North Carolina, Frank Porter Graham Child Development Insti-
tute, Autism Evidence-Based Practice Review Group.
Zawacki-Richter, O., Kerres, M., Bedenlier, S., Bond, M., & Buntins, K. (2019) Systematic
Reviews in Educational Research. Wiesbaden: Springer.
29
8 Appendices
Appendix 1. Quality Assessment for Quantitative studies
Checklist Questions Yes Can’t tell No
1. Did the study address a clearly focused issue?
2. Was the cohort recruited in an acceptable way?
3. Was the exposure accurately measured to minimise bias?
4. Was the outcome accurately measured to minimise bias?
5. (a) Have the authors identified all important confounding factors?
(b) Have they take account of the confounding factors in the design
and/or analysis?
6. (a) Was the follow up of subjects complete enough?
(b) Was the follow up of subjects long enough?
7. What are the results of this study?
8. How precise are the results?
9. Do you believe the results?
10. Can the results be applied to the local population?
11. Do the results of this study fit with other available evidence?
12. What are the implications of this study for practice?
30
Appendix 2. Quality Assessment for Qualitative studies
Checklist Questions Yes Can’t tell No
1. Was there a clear statement of the aims of the research?
2. Is a qualitative methodology appropriate?
3. Was the research design appropriate to address the aims of the re-
search?
4. Was the recruitment strategy appropriate to the aims of the research?
5. Was the data collected in a way that addressed the research issue?
6. Has the relationship between researcher and participants been ade-
quately considered?
7. Have ethical issues been taken into consideration?
8. Was the data analysis sufficiently rigorous?
9. Is there a clear statement of findings?
10. Is the research valuable?
35
Appendix 3. Overview of study characteristics.
No. Author Aim Sample Diagnosis Method
(measures)
Intervention Results QAS
1. Toni Van Laar-hoven, Erika Kraus,
Keri Karpman, Rosemary Nizzi and
Joe Valentino
To compare the picture
and video prompts on
teaching daily living
skills to individuals with
autism
Two male students (13
and 14 years old) with
autism and mild to
moderate intellectual
disabilities
Task analytic data
sheet.
Picture versus video
prompting in
teaching daily living
skills to two adolescents
with ASD
Both effective, video prompt-
ing more than picture prompt-
ing
70%
2. Amie Duncan, Lisa A Ruble, Jareen
Meinzen-Derr, Carrie Thomas and
Lori J Stark
Explore and evaluate the
feasibility of STRW
group intervention on the
acquisition of DLS
7 adolescents (14-18
years old) who had
a diagnosis of ASD
from a medical profes-
sional and IQ >69.
ADOS-2 (verify
diagnosis)
Differential Abil-
ity scales,
Standord- Binet
Intelligence scales
(cognitive abili-
ties)
Vineland-II, GAS
Surviving and Thriving
in the Real World
(STRW).
The adolescents demonstrated
improved DLS on both the
Vineland-II and the DLS GAS
after participating in the
STRW intervention
60%
3. Robin L. Gabriels, John A. Agnew,
Katherine D. Holt, Amy Shoffner, Pan
Zhaoxing, Selga Ruzzano, Gerald H.
Clayton, Gary Mesibov
Evaluate the effects of
Therapeutic horseback
riding (THR) in core ar-
eas of functioning
42 participants (6- 16
years old) diagnosed
with either autistic or
Asperger’s Disorder
ABC, Vineland,
Bruininks, SIPT
Horseback riding Significant improvement on:
self-regulation (Irritability,
Lethargy, Stereotypic Behav-
ior, and Hyperactivity), adap-
tive expressive language skills,
motor skills, and verbal
praxis/motor planning skills.
60%
36
4. Brittany N. Beaver, Sharon A. Reeve,
Kenneth F. Reeve, and Ruth M. DeBar
Assess the independent
on-task remaining and
completion when using
self-reinforcement com-
pared to teacher-delivered
reinforcement
Three individuals (15-
17 years old) diagnosed
with ASD
Independent
schedule comple-
tion, 30s momen-
tary time sampling
procedure
Three text-based activity
schedules were created
across the domains of
vocational, functional
living and leisure skills
High percentages of on-task
behavior and schedule
completion in both self-rein-
forcement and teacher-deliv-
ered reinforcement.
80%
5. Philip R. Richard III & George H. No-
ell
Integrate video segments
as prompt model with
backward chaining to
teach children shoe tying
Three children (5 years
old) with mild-to mod-
erate ASD
Checklist based on
the research proto-
col
Backward chaining and
video prompting
Successful application
of video prompt-modeling
with backward chaining to
teach tie shoes but with me-
dium effects
70%
6. Ya-Shu Kang & Yao-Jen Chang Examine if game tech-
nology is effective to
teach independently
shower
Four male and two fe-
male (9-11 years old)
children with ASD
Data sheet de-
signed to record
the task chain
Using game technology Across all the six participants,
the skill maintained well in
the absence of the video game
50%
7. Gabrielle T. Lee, Jianjun Chen, Sheng
Xu, Hua Feng & Zheqi Guo
Evaluate the independent
completion of dishwash-
ing in home setting
Three boys (6, 7, and 8
years old) with autism
Checklist based on
the research
Self-Monitoring Inter-
vention on Independent
Completion of dishwash-
ing
All three children improved
dishwashing, acquired self-
monitoring, and maintained
both skills at a high level.
70%
8. Elisa Cruz‑Torres, Mary Louise Duffy,
Michael P. Brady, Kyle D. Bennett and
Peggy Goldstein
Teach parents to deliver
VP to their children with
ASD using an iPad
Three parents who ex-
pressed a desire to teach
their children (12, 13
and 17 years old with
ASD to complete a DLS
using VP.
Checklist based on
the research proto-
col
Parent delivery of Video
prompting
Parents were successful in
their delivery of the training
procedures and their children
acquired and maintained the
skills.
80%
37
Appendix 4. Extraction protocol
General Information:
• Author
• Title
• Journal
• Publication year
Method:
• Sampling Strategy
• Basic Design (Qualitative, Quantitative, Mixed)
• Longitudinal (Yes, No)
• Data collection
• Intervention study (Yes, No)
Aim
Research Questions
Hypothesis
Target group:
• Children
• Parents
• Professionals
Intervention programs:
• ADL activity (clothing, food, hygiene)
• Type of intervention
- What intervention?
- How frequent?
- Where?
- Who was involved?
- Specific goal
- Outcome (Positive, Negative)
Participants:
• How recruited
• Where recruited
• Number 1-15, 15-30, 30-45, 45+)
• Gender (Male, Female)
• Age (0-5, 5-12, 12-18, 18+)
• Diagnosis
• Other adult participant
Results/ Outcomes:
• Measure of outcome
• Data analysis
• Results
• Conclusions
• Practical Implications
Quality assessment (Score: /High, Medium, Low Quality)
38
Appendix 5. Assessment tools description.
• The Vineland-II (Sparrow, Cicchetti, & Balla, 2005) is a well-established standardized measure of adaptive behaviour that measures skills
in the Communication, Socialization, and DLS domains. The DLS domain comprised the Personal ( personal hygiene, self-care), Domestic
(cooking, doing laundry), and Community (money management, navigating the community) subdomains.
• Goal Attainment Scale (GAS) is an approach used to measure an individual’s progress on specific goals against their baseline performance.
Change over time is assessed by comparing the individual’s post-treatment and 6-month follow-up GAS scores to their baseline skills, which
are scored as −2.
• The VABS-II is a clinician interview with the parent/legal guardian and measures child adaptive functioning, providing raw and standard
scores in the domains of Communication, Daily Living Skills, and Socialization Skills (Sparrow, Cicchetti, & Balla, 2005)
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