Shifting Focus From Impairment to Inclusion: Expanding Occupational Therapy for Neurodivergent Students to Address School Environments

Abstract

Social participation in schools is critical to student academic and psychosocial outcomes. Neurodivergent students, however, often experience environmental barriers to social participation, such as lack of awareness and negative attitudes among peers and school staff, including teachers. Although authentic social participation is composed of dynamic interactions between a person and the external environments, occupational therapy’s role in addressing student social participation primarily focuses on internal social characteristics. Barriers within school environments often remain unaddressed, with no clear role for occupational therapy practitioners. We advocate an expansion of occupational therapy’s role to address school environments, especially the social, physical, and policy aspects, to promote social participation and inclusion. We also discuss the need for change and present a framework guiding intervention in school environments.

Autistic Adult Perspectives on Occupational Therapy for Autistic Children and Youth

“…Autism is characterized by a lack of empathy and social awareness (Centers for Disease Control and Prevention, 2020), therefore, a common goal occupational therapists focus on with their Autistic and neurodivergent clients is “improving social skills.” However, building off research on double empathy and differing communication styles between and among neurotypes (Crompton, Ropar, et al, 2020; Milton, 2012), interest-based groups that support Autistic identity and communication among Autistic children may be more appropriate than groups that purport to teach neurotypical social interactions (Chen & Patten, 2021; Koenig, 2020) which can increase masking leading to burnout and suicidal ideation (Miller et al, 2021). Autistic children do not need to be taught neurotypical social skills.…”

“…However, many interventions for Autistic children continue to focus on skill development and remediating perceived deficits (O'Brien & Kuhaneck, 2020) rather than changing environments or tasks. Skill development has a place in occupational therapy intervention if it is individualized, aligns with the Autistic community's values, and is developed in collaboration with an Autistic client (Chen & Patten, 2021). For example, many participants valued learning about how to accommodate sensory differences, including interoception.…”

“…For example, many participants valued learning about how to accommodate sensory differences, including interoception. Autism in and of itself, does not need to be “treated.” Instead, occupational therapists can work with Autistic individuals to identify occupational performance challenges in their everyday lives, and determine changes or modifications to the environments and tasks (Chen & Patten, 2021). Focusing on the “why” of the task, rather than the task itself may support therapists, parents, and educators to let go of neurotypical standards and allow children to do tasks the way that works best for them (e.g., moving around the room to complete a writing task).…”