If you’re working with autistic adolescents in schools, you’ll be acutely aware that parents face unique caregiving responsibilities and significant stress. These parents often experience mental and physical exhaustion, feelings of being overwhelmed, and increased anxiety regarding their adolescent’s achievements. Existing interventions primarily emphasise child-focused outcomes—reducing behaviour problems or improving specific skills—whilst often neglecting critical parental outcomes such as resilience, daily functioning, and family dynamics.

This study aimed to investigate the effectiveness of the OT-Parentship intervention on the parents of autistic adolescents. It specifically looked at the impact on parental occupational performance, self-determination and resilience and the occupational performance of the adolescents.

Methods

The study used a two-group randomised control trial design with participant recruitment occurring between March 2021 and July 2023.

The study recruited parents of adolescents aged 12 to 18 years with an ASD diagnosis and documented IQ scores of 85 or above. These parents needed to report that their children had unmet functional needs, such as showering independently, managing finances, completing homework, or initiating conversations, and provide signed consent to attend all intervention sessions.

The study evaluated parental resilience using the Autism: Parenting Questionnaire, self-determination using the Basic Psychological Need Satisfaction in Relationships scale, and occupational performance using the COPM for both parents and adolescents. Participants in both groups were assessed at three time points: pre-intervention, post-intervention, and follow-up 3 months post-intervention.

There were 36 parents who completed the intervention (20 families in the experimental group and 16 in the control group). The sample included parents of a near-even split of male and female autistic adolescents, who had a mean age of 14.1 years. Most adolescents were diagnosed between ages 10 and 15 years and attended various educational settings including regular classes, special education, and home-schooling.

In the intervention group, each parent or couple participated in 11 weekly individual 90-minute sessions, followed by an additional session 3 months post-intervention. Sessions were conducted either at the university or a local child development centre. Five occupational therapists with over 5 years clinical experience, who had completed a training course, delivered the protocol.

Throughout the sessions, parents and therapists collaboratively explored the adolescent’s multidimensional profile and its daily impact. Parents identified three primary challenges across occupational areas, and both parents and adolescents set goals. Parents aligned their own goals to support their adolescent’s occupational performance. For instance, if an adolescent’s goal was to manage time effectively for homework, the parent might set a goal to provide structured prompts and establish routines. The parent and therapist continuously analysed daily life situations, with the therapist guiding parents in understanding how their individual coping strategies affected situations. In later sessions, action plans were created, and by the 11th session, parents set an additional “transfer goal” to work independently for the next 3 months.

In the control group, each family viewed six psychoeducational videos explaining the multidimensional profile of autistic adolescents generally, along with guidance on interpreting their child’s personal profile. During the third video session, parents identified a challenging occupational domain and set a goal using the Canadian Occupational Performance Measure.

The Results

No significant differences were observed at baseline between the two groups in demographic and clinical characteristics. This is important to note, as I have spoken about in previous episodes, if the groups are different at the start, it can make it harder to determine the true impact of the intervention. Following the intervention, the experimental group demonstrated greater gains in outcomes compared with the control group.

Parental Resilience

A significant Group × Time interaction was found for the total parental resilience score, indicating that the experimental group experienced greater improvements from pre- to post-intervention compared with the control group.

Parent Self-Determination

A significant Group × Time interaction was identified for the competence aspect of self-determination, but no significant Group × Time interaction was observed for autonomy and relatedness scores on the measure. However, the experimental group showed a improvement trend from pre- to post-intervention in both autonomy and relatedness.

Parent and Adolescent Occupational Performance

Statistically significant Group × Time interactions were found for COPM scores of both parents and adolescents—for both performance and satisfaction scores. This interaction indicates that the intervention led to greater improvements in both performance and satisfaction of occupational goals for the experimental group compared with the control group.

Sustained Improvements

The second analysis examining the experimental group across all three time points indicated no significant differences in mean scores for all measures between post-intervention and follow-up, indicating maintained results. This is particularly important as it demonstrates the intervention’s potential for lasting positive changes.

Transfer Goals

Regarding the transfer goal that parents set at the 11th session to work on independently for 3 months, COPM scores showed significant improvement between post-intervention and follow-up assessments for both parents and adolescents. For parents, performance improved from a mean of 1.9 to 5.6, and satisfaction from 1.9 to 5.7. Similar improvements were observed for adolescents. This suggests the intervention equipped families with skills and strategies applicable to new goals and contexts beyond the immediate intervention period.

Practical Takeaways

For school-based occupational therapists, this research provides evidence for the value of parent-centred interventions. The researchers introduce the concept of continuous parental development—the ongoing process of growth, learning, and adaptation that parents undergo as they raise their children. The OT-Parentship approached effectively supported parents by increasing their resilience and some areas of self-determination. I did have a look for the programme itself, but it doesn’t seem to be available outside of the research yet.

This approach recognises that supporting parents is crucial for fostering positive family outcomes. The results highlight how parents’ occupational performance goals are inherently tied to their adolescent’s occupational performance. This reciprocal relationship means advancements in one reinforce the other—when we equip parents with strategies to align their goals with their adolescent’s needs, we promote progress for both.

What I found interesting was that the researchers didn’t discuss the difference between pre-recorded video-based support and direct therapy support as this was also measured in the study. The control group received the light touch, video-based support whereas the intervention group had direct input from occupational therapists. This was probably the biggest take away for me, direct therapy had a bigger impact than a self-led approach. The tables however do show that families using the video-based support still did make a two-point gain in their COPM scores, so even though it was less than the direct therapy group which had an almost 5-point increase, it did help them to make progress with their goals. The study provide evidence that direct support is more impactful than video alone and I think we need to be mindful of this as services move towards offering more universal self-directed support to families. It helps, but it helps less than direct support from an occupational therapist.

This qualitative phenomenological study explored caregivers’ perceptions of how sensory integration therapy impacts families of children receiving this intervention. Three themes emerged. The first was family routines which discussed families structuring their daily routines around their child’s sensory needs, and how sensory integration therapy helped them develop these routines more effectively. Secondly, parent response/ reaction to sensory issues which explored how parents found education around sensory needs and learning strategies made a positive difference for their child. Theme three was Modified Participation in Family Activities, here caregivers discussed how they frequently avoided places, events, or outings they anticipated would be difficult due to their child’s sensory needs. This aligns with the results from Ben Sasson’s work that I discussed in episode four. The final theme discussed how Improved Regulation Led to Increased Family Participation Outside the Home.

This evidence-based occupational therapy project implemented a coaching service delivery model with 10 caregiver-toddler dyads over six sessions, showing increases in caregiver self-efficacy and decreases in toddler dysregulation. This is another piece of work that indicates coaching can be an effective service delivery model to promote co-regulation between caregivers and their toddlers in early intervention.

This study developed the Applied Coaching Tool (ACT) and training protocol to build coaching competency in therapists supporting parents of young children. The ACT framework includes five coaching events to support therapists to implement coaching practices these are: self-directed goals, learner-focused interventions with meaningful reflection, practice and feedback. Here’s the link to the tool.

This cross-sectional study of 466 parents and their typically developing children ages 3-7 years found that global sensory reactivity differences were associated with increased parental stress in both fathers and mothers. Associations were observed across multiple sensory domains, underscoring the need for family-centred support when children experience sensory processing differences. I think this is probably something we all observe in practice, so it’s useful to have the data to back it up.