American Occupational Therapy Association, Inc.
View all recommendations from this societyJuly 27, 2021
Don’t provide interventions for autistic persons to reduce or eliminate “restricted and repetitive patterns of behavior, activities, or interests” without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.
Occupational therapy practitioners should provide person-centered, strengths-based interventions, and advocate for autistic persons on individual and societal levels by providing information to promote inclusivity and belonging, and to decrease stigma. Actions that are considered “restricted and repetitive behaviors” by the DSM-5 (American Psychiatric Association, 2013) may serve as meaningful activities for self-regulation, communication, or self-expression. Attempting to change or extinguish these behaviors without direct request from the individual, without understanding and incorporating the underlying meanings, or substituting other actions to meet self-regulatory reasons for the behavior commonly results in camouflaging (e.g., masking or hiding behaviors), that can result in negative self-image, depression, and an increased risk of suicidality.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.
How The List Was Created
(1–5) The American Occupational Therapy Association (AOTA) conducted a three-phase project to develop the final Choosing Wisely recommendations of services that occupational therapy practitioners should not provide. The phases of the project included Phase I—building member awareness and support, Phase II—soliciting member input, and Phase III—dissemination of the final items. Phase I was accomplished through presentations to AOTA member and volunteer groups, a Town Hall session at AOTA Annual Conference, an online webinar and related materials, and coverage in AOTA publications. Phase I was completed with an online member survey that resulted in 328 responses. Following the elimination of duplicate responses and items outside the scope of occupational therapy practice, the list was narrowed down to 62 items. Additional input was received from AOTA Special Interest Section volunteer leaders to rank the items based on established criteria. An extensive literature search was conducted on the highest ranked strategies. Phase II involved an online member survey presenting 12 items for evaluation with a goal of picking the top 5. This survey resulted in 4,860 responses that were analyzed, resulting in the final 5 items. These items were reviewed by the AOTA Board of Directors. Phase III included the development of a communication and dissemination plan.
AOTA’s disclosure and conflict of interest policy can be found at www.aota.org.
(6-10) In 2018, The American Occupational Therapy Association (AOTA) published its first set of Choosing Wisely recommendations. Between 2018 and 2020, numerous
practice articles, clinical resources, and webinars were created to promote the recommendations and assist AOTA members with implementation efforts. In 2019,
AOTA selected two members as Choosing Wisely Champions, based on their implementation efforts in practice and education. The initial recommendations are
reviewed annually.
In 2020, AOTA initiated the process to develop additional recommendations. The process to select and refine the recommendations followed the same member
survey and selection process that was used for the initial recommendations. Interventions identified, but not selected for a final recommendation in the 2018 survey,
were included in an online member survey. Respondents were to select 5 out of 10 items for development of additional recommendations. This survey resulted in
999 responses that were analyzed, resulting in 7 highly ranked selections. These selections, along with a write-in suggestion identified in multiple surveys, were
then ranked by AOTA Special Interest Section (SIS) steering committees. Results from the member survey and SIS rankings were compared, and the top 5 items
were selected. A final literature review was conducted for each item, and recommendations were developed in collaboration with AOTA staff members and member
content experts.
AOTA’s disclosure and conflict of interest policy can be found at www.aota.org.
Sources
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Benevides, T. W., Shore, S. M., Palmer, K., Duncan, P., Plank, A., Andresen, M.-L., …Coughlin, S. S. (2020). Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism, 24(4), 822–833. https://doi.org/10.1177/1362361320908410
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018). Risk markers for suicidality in autistic adults. Molecular Autism, 9(1), 42. https://doi.org/10.1186/s13229-018-0226-4.
Cage, E., Di Monaco, J., & Newell, V. (2018). Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473-484.
https://pubmed.ncbi.nlm.nih.gov/29071566/
Hull, L., Petrides, K. V., Allison, C., Smith, P., Baron-Cohen, S., Lai, M. C., & Mandy, W. (2017). “Putting on my best normal”: Social camouflaging in adults with autism spectrum conditions. Journal of Autism and Developmental Disorders, 47(8), 2519–2534. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509825
Patten Koenig, K. (2019). A strength-based frame of reference for autistic individuals. In P. Kramer, J. Hinojosa, & T. Howe (Eds.). Frames of reference for pediatric occupational therapy (4th edition).
Philadelphia: Lippincott Williams & Wilkins.
