Giving children with autism a voice in their own therapy helps them overcome everyday challenges, new study finds

COLUMBIA, Mo. -- A University of Missouri researcher has used an existing approach in a new way to support children with autism — by including them in therapy planning.

Caregivers, including those who support autistic children, often balance supporting everyday tasks while encouraging independence.

Melanie Tkach is an assistant professor in the University of Missouri College of Health Sciences and an occupational therapist with 10 years of clinical experience. She knows that existing occupational therapy research primarily involves caregivers when brainstorming interventions during coaching sessions. The therapist and caregiver often discuss strategies, which the caregiver then tries to implement.

Tkach’s modified approach? Including the children in those conversations.

In a recent study, Tkach conducted online coaching sessions via telehealth, virtually connecting with children with autism and their families in their homes. The children set personal goals ranging from remembering to bring their iPad to school to brushing their teeth before bedtime and worked alongside caregivers to develop solutions.

“My goal is to help them expand their problem-solving skills, so when they face a challenge at home or at school, they can find their own solutions,” Tkach said. “What we found was that by giving the child a voice in their own therapy, we gave them the opportunity to share their insights and help contribute to the strategies that they might use to help them accomplish their goals.”

One child, for example, wanted to learn how to tie her shoes. Her mom initially tried to walk her through the shoe-tying steps with a popular method where the looped laces become bunny ears. After coaching conversations with Tkach, the daughter decided to personalize the shoe-tying steps by putting them into her own words.

“By the end of the coaching Zoom calls, she was tying her shoes independently, and she was so excited to show me while saying the steps in her own words,” Tkach said. “It is very rewarding to see caregivers and their children work together, achieve goals and be proud of their progress. By empowering kids with autism to set their own path, they are able to thrive.”

By comparing pre-and post-coaching surveys the caregivers completed, Tkach found the intervention helped children with autism accomplish their goals, and she believes the breakthrough came from including the children in the conversation.

“My overall goal is to figure out how to improve occupational therapy services for children with autism, and valuing their self-determination is a big part of that,” Tkach said. “Creating a collaborative environment where both caregivers and their children can practice problem-solving skills is rewarding.”

When deciding how best to deliver the new collaborative intervention, she knew telehealth would provide convenience for both the children and their caregivers by eliminating the need to travel to an in-person clinic.

Conducting the coaching sessions via telehealth offered another benefit: comfort. Children were more comfortable speaking up because they were in familiar surroundings.

“I am so thankful to the families who invited me into their homes virtually,” Tkach said. “In this study, I noticed how enthusiastic the children were to share their favorite toys or show me where they had practiced the activities we had discussed. The virtual format made this possible in a tangible and meaningful way.”

 “The feasibility of occupation-based coaching for autistic children and primary caregivers” was published in Occupational Therapy Journal of Research.