What Does Occupational Therapy Actually Look Like for Autistic Children?

A review of: Crasta, J. E., Martis, J., Kromalic, M., Jarrott, S., Wengerd, L., & Darragh, A. (2024). Characterizing occupational therapy intervention for children

on the autism spectrum. American Journal of Occupational Therapy, 78, 7805205210. https://doi.org/10.5014/ajot.2024.050734

Occupational therapy (OT) is one of the most commonly accessed supports for autistic children. Yet parents, educators, and even professionals often ask the same question:

“What actually happens in OT sessions?”

A recent research study by Crasta, et al (2025) set out to answer this question—not by testing a new program, but by carefully describing what everyday, real-world OT practice for autistic children actually involves.

The findings are validating, reassuring, and important.

Why was this study needed?

Despite OT being widely used, it’s often described as a “black box.” Sessions can look very different from one therapist or child to another, which can lead to confusion or unrealistic expectations for parents.

This study aimed to:

• Clearly describe the core components of usual OT practice for autistic children

• Capture what experienced occupational therapists really do in sessions

• Create shared language that supports evidence-based, ethical, and individualised practice

How was the study done?

The researchers used a Delphi method, a well-established way of reaching expert consensus (otherwise known as agreement).

• 17 experienced paediatric occupational therapists participated

• Therapists completed four rounds of structured surveys

• They reviewed, refined, and agreed on OT intervention components

• Agreement was reached when 80% or more of participants endorsed a component

This approach ensured the findings reflected collective clinical wisdom, not one therapist’s opinion.

What did the study find?

The study identified 20 core components that commonly make up occupational therapy for autistic children aged 6–13 years.

Rather than following a rigid program, therapists use a flexible blend of approaches, tailored to each child and family.

Key themes included:

• Play-based and child-led practice

Play wasn’t just a tool—it was central to practice. Therapists followed the child’s interests, motivations, and cues to support engagement, learning, and regulation.

• Supporting regulation and participation

OT focused on helping children participate more comfortably in daily life by supporting emotional regulation, sensory needs, and coping strategies.

• Real-life relevance

Therapy targeted everyday activities: self-care, school participation, routines, and social engagement—not isolated skills.

• Partnering with families

Parent education and coaching were core components. Families were supported to understand their child’s needs and make meaningful changes in daily environments.

• The therapeutic relationship matters

The relationship between the therapist and child was recognised as an active part of intervention—not just a backdrop.

What this means for parents

If your child’s OT sessions don’t look like a strict program or worksheet-based therapy, this research offers reassurance.

Good OT:

• Is individualised, not standardised

• Looks different depending on the child, family, and context

• Focuses on participation, wellbeing, and quality of life

• Works with families, not just on the child

There is no single “correct” way OT should look - responsiveness and flexibility are strengths, not weaknesses.

Your child and family situation is unique, and we believe that your therapy should be too! At Enable Me Occupational Therapy we aim to tailor each session to your child's interests and goals, rather than completing a "cookie cutter" approach, where we do the same thing for every child.

What this means for occupational therapists

For OTs, this study provides something powerful: shared language.

It:

• Validates eclectic, child-centred, occupation-focused practice

• Supports clearer documentation and communication with families and funders

• Strengthens advocacy for play-based and relational approaches

• Bridges the gap between research and real-world clinical reasoning

Importantly, it reinforces that OT is not about delivering a protocol—it’s about thoughtful decision-making in context of the things the child (and their family) want and need to do, and the environments that they exist in.

Why this research matters

By clearly describing what occupational therapists do in practice, this study helps:

• Demystify OT for families and educators

• Strengthen evidence-informed practice without sacrificing individuality

• Protect ethical, neuro-affirming, and occupation-centred care

In a service system that often demands standardisation, this research reminds us that meaningful therapy is relational, flexible, and human.

Final takeaway

Occupational therapy for autistic children isn’t one thing—and it shouldn’t be.

This study confirms what many families and therapists already know:

Effective OT meets children where they are and supports them to participate more fully in their own lives.