Occupational Therapy

Research Paper

Malaysian occupational therapists practiceswith children and adolescents with autismspectrum disorder

Masne Kadar1, Rachael McDonald2 and Primrose Lentin2

AbstractIntroduction: Occupational therapy is one of the health care professions that provides assessments and interventions for childrenand adolescents with autism spectrum disorder. However, to date, there is no information available regarding occupational therapypractices in Malaysia for this population. The purpose of this study is to describe the occupational therapy services for children andadolescents with autism spectrum disorder in Malaysia, including the perceived training needs of practitioners.

Method: We surveyed the registered members of the Malaysian Occupational Therapy Association using a mailed questionnaire.Results: A response rate of 15.5% was obtained. The majority of the responses were from those working in hospital settings whohad less than 5 years experience working as occupational therapists with children and adolescents with autism spectrumdisorder. The theories, assessments, interventions, and training that related to respondents practices mainly revolved aroundsensory-based approaches. Encouragingly, more than 70% of the respondents claimed that they performed assessments of dailyliving activities in their service. Client-centred practice was a further feature of occupational therapist respondents involved in thisstudy.

Conclusion: Future study is needed, especially to engage more respondents and thereby produce more generalizable results andan in-depth exploration of the continuing education needs of occupational therapists in Malaysia.

KeywordsTheory, interventions, professional development

Received: 18 July 2013; accepted: 2 September 2014

Introduction

The recently published Diagnostic and Statistical Manual

of Mental Disorders 5th Edition (DSM-V) (American

Psychiatric Association (APA), 2013) specied two

major characteristics of impairment in autism spectrum

disorder (ASD).

1. Decits in social interaction and social communication.

2. Restricted, repetitive patterns of behaviour, interests, or

activities.

The DSM-V recognizes that the four previously separ-

ate disorders under the Diagnostic and Statistical Manual

of Mental Disorders-IV Text Revision (DSM-IV-TR)

classication (APA, 2000) that is: (a) autistic disorder;

(b) Aspergers disorder; (c) childhood disintegrative dis-

order; and (d) pervasive developmental disorders not

otherwise specied are actually a single condition with

dierent levels of symptom severity in the two core decits

mentioned earlier. In this study, the ASD criteria, as stated

under the DSM-IV-TR (APA, 2000), were used because

the DSM-V (APA, 2013) was only published after the

research data had been collected. Internationally, it has

been reported that the prevalence of this condition is

increasing (Baron-Cohen et al., 2009; MacDermott et al.,

2006), with boys diagnosed more frequently than girls at a

ratio of 4:1 (Fombonne, 2003).

This article reports the results of a survey examining the

practice of occupational therapists in Malaysia with chil-

dren and adolescents with ASD. The prevalence of ASD in

Malaysia is estimated at 1.6 per 1000 (Mohd Kassim et al.,

2009). Malaysia is divided into two regions separated by

the South China Sea: Peninsular Malaysia to the west and

East Malaysia on the island of Borneo. National manage-

ment and administrative tasks (including matters regard-

ing children with special needs) are governed federally

from central Peninsular Malaysia. Occupational therapy

services in Malaysia have been available for over 50 years;

1Lecturer, Universiti Kebangsaan, Kuala Lumpur, Malaysia2Senior Lecturer, Monash University, Melbourne, Australia

Corresponding author:Masne Kadar, Lecturer, Universiti Kebangsaan Malaysia (UKM), Department

of Occupational Therapy, School of Rehabilitation Sciences, Faculty of

Health Sciences, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300,

Malaysia.

Email: [email protected]

The British Journal of Occupational

Therapy

2015, Vol. 78(1) 3341

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though rst introduced by Barbara Tyldesley, member of

the British Association of Occupational Therapists

(BAOT), in 1958, information about occupational therapy

practices with children and adolescents with ASD in

Malaysia is still limited.

Globally, occupational therapy practitioners form one

of the professional groups involved in providing services to

children and adolescents with ASD (Provost et al., 2007),

and they have begun to do so in Malaysia as well (Amar,

2008). However, we have very little evidence to guide best

practice approaches with this group (Jasmin et al., 2009;

Wallen and Imms, 2006). Concern has also been expressed

that the interventions we do use have not been well docu-

mented for evidence-based practice, and that we risk losing

our occupational focus if we do not mindfully attend to

this, in addition to other approaches (Rodger et al., 2010).

Hence, the main aim of occupational therapy to provide

occupation-based intervention should always be the

focus of every clinician dealing with children with ASD

(Arbesman and Lieberman, 2010; Rodger et al., 2010;

Wagenfeld and Kaldenberg, 2005).

The majority of the occupational therapy services for

children and adolescents with ASD in Malaysia are pro-

vided in the hospital/clinic-based setting (Muthuraman

Sellathurai Pathar, President of Malaysian Occupational

Therapy Association, 2011, personal communication). A

minimum of a diploma/certicate in occupational therapy

is required to practise in Malaysia. The training of local

occupational therapists at certication level in Malaysia

was started over 30 years ago under the Malaysian

Ministry of Health (MOH), with the primary objective

being to full the requirements of government hospitals

and clinics. However, over the past 15 years, training of

occupational therapists at diploma and degree levels has

increased, with courses oered by the Ministry of Higher

Education (MOHE) and other private educational pro-

viders (Mohd Suleiman Murad, Occupational Therapy

Lecturer, 2012, personal communication). Occupational

therapy practitioners in Malaysia are reported to be

receiving an increasing number of referrals for children

and adolescents with ASD, for both assessments and inter-

ventions (Rohana Mukahar, Head of Occupational

Therapy Department, Universiti Kebangsaan Malaysia

Medical Centre, 2009, personal communication).

To date, there is no information available regarding the

theories, assessments, and interventions utilized, or the

further education needs of Malaysian occupational ther-

apists working with children and adolescents with ASD.

Database searches including CINAHL Plus, Medline,

ProQuest, PsycINFO, and ERIC, on the keywords of

occupational therapy and Malaysia and service/practice

and autism/autistic, returned no results for literature

published between 1992 and 2012. Hence, the aim of this

study was to describe the occupational therapy practices

in Malaysia provided to children and adolescents with

ASD aged between 3 and 18 years, in terms of theories,

assessment, intervention, and professional development

needs. Occupational therapists working throughout

Malaysia were surveyed in this study. Thus, this is the

rst published study reporting on the occupational

therapy services for children with ASD in Malaysia.

Literature review

Occupational therapy is one of the most common services

received by children with ASD and their families

(McLennan et al., 2008). In the United Kingdom (UK),

the prevalence of ASD was reported at 1% of the total

population of school-aged children between 5 and 9 years

of age (Baron-Cohen et al., 2009). In the United States

(US), the overall estimated prevalence of ASD was

reported at one in 50 children a signicant increase

from that previously reported (Blumberg et al., 2013).

Occupational therapy within the US, for example, pro-

vides various interventions, including early intervention

programmes, social skills training, and educational inter-

vention programmes (Case-Smith and Arbesman, 2008).

Although much is now known about the characteristics

of children who have ASD, the underlying occupational

performance issues and eective interventions for children

with ASD remain poorly understood (Wallen and Imms,

2006). Furthermore, explicit information regarding the

interventions and services received by children with ASD

and their families is limited (McLennan et al., 2008). It was

reported that children with ASD experienced diculties in

personal care activities (Allik et al., 2006; Cermak et al.,

2010; Flynn and Healy, 2012; Twachtman-Reilly et al.,

2008), poor engagement in school or classroom activities

and with peers (Falkmer et al., 2012), and motor dicul-

ties that can cause occupational performance problems for

those children (Green et al., 2009; Liu, 2013; Rinehart and

McGinley, 2010; Shetreat-Klein et al., 2012).

To date, there have been three studies reporting on

occupational therapy services provided specically for

children and adults with ASD: Watling et al. (1999a) per-

formed a study in the US; Ashburner et al. (2010, unpub-

lished report) in Queensland, Australia; and Kadar et al.

(2012) in Victoria, Australia. Despite a gap of a decade,

there are strong similarities in the ndings of these studies.

They relate to the emphasis given by the occupational

therapy participants in managing issues and providing

interventions related to sensory processing diculties

exhibited by people with ASD, as well as the need for

knowledge related to sensory-based approaches in the

areas of assessment, intervention, and training in their ser-

vice for this population. Despite the therapists emphasis

on working with sensory processing diculties in these

reports of their practice, there is currently little evidence

of the eectiveness of the sensory-based interventions or

approaches for children and adolescents with ASD (Hyatt

et al., 2009).

It is also important for occupational therapists to con-

sider the use of other related approaches and/or useful

strategies in their interventions for children and adoles-

cents with ASD (Arbesman and Lieberman, 2010).

Increasingly, studies that investigate the improvement of

occupational performance of children and adolescents

with ASD are being performed (Rodger and

34 The British Journal of Occupational Therapy 78(1)


Brandenburg, 2009), such as the cognitive orientation for

daily occupational performance (CO-OP). CO-OP is a

task-orientated problem-solving approach that utilizes

cognitive skills to improve occupational performance

(Rodger, 2004). Other than that, the use of physical stra-

tegies which are more occupation- and activity-focused,

such as leisure and recreation activities, in interventions

among children and adolescent with ASD, have also been

observed (OBrien, 2010).

Method

Design

A self-administered questionnaire was mailed to occupa-

tional therapists in Malaysia. The questionnaire used in

this study was adapted from a questionnaire entitled

Current Practice of Occupational Therapy for Children

with Autism: A National Survey of Practitioners, developed

by Watling et al. (1999b) for their survey of occupational

therapists in the US. This questionnaire was selected as the

basis for the questionnaire used in this study. Considerable

modication was required as the original questionnaire

was: (a) designed for therapists based in the US; and

(b) designed and carried out prior to 1999 (Renee

Watling, 2009, personal communication). Permission to

do so was granted by the rst author. The questionnaire

was modied to include more current information relating

to occupational therapy and ASD by reviewing relevant

occupational therapy textbooks and literature (Case-

Smith, 2005; Case-Smith and Arbesman, 2008; Kramer

and Hinojosa, 2010; Miller-Kuhaneck, 2004; Mulligan,

2003; Watling et al., 1999a) and was also based on a ques-

tionnaire entitled The Paediatric Occupational Therapy

Practitioner Survey (Brown and Rodger, 2001, unpub-

lished tool) (permission to modify the questionnaire was

granted by the author). The modied questionnaire

includes more current assessment tools and interventions

provided to children with ASD compared with the original

questionnaires. To ensure its face and content validity, the

questionnaire was sent to 12 experts in the occupational

therapy and/or ASD eld internationally (including

experts from the US, Australia, Malaysia, and Taiwan).

The purpose of sending the initial questionnaire to the

experts was to ensure that the questionnaire design works

in practice, to identify and amend problematic questions,

rene the questionnaire, and identify problems

relating to the content, wording, layout, length, and

instructions included in the questionnaire. The question-

naire was further tested by six Malaysian occupational

therapists who had experience of working with children

with ASD, in order to ensure that the English language

used in the survey was applicable to Malaysian occupa-

tional therapists. None of the six therapists tested sug-

gested that the questionnaire should either be in Malay

language or be in two languages (that is, English and

Malay) because English is used in most of the teaching

delivery and training activities of the occupational therap-

ists in Malaysia. The feedback received was used to

produce the nal version of the questionnaire entitled

Occupational Therapy Practice Survey for Children with

Autistic Spectrum Disorders that was used in this study

(the questionnaire can be obtained from the corresponding

author).

The nal questionnaire was divided into six sections.

. Section A: the frame(s) of reference and model(s) of prac-tice utilized with children with ASD.

. Section B: the assessments or outcome measures adminis-tered to children with ASD.

. Section C: the interventions utilized in occupational ther-apy services for children with ASD.

. Section D: the areas of adaptive behaviours addressed inoccupational therapy services for children with ASD.

. Section E: the issues of professional development needsamong occupational therapists.

. Section F: the respondents demographic information,including personal and professional information.

The developed questionnaire was also used to collect data

from occupational therapists in Victoria, Australia, and

these results have been reported elsewhere (Kadar et al.,

2012).

Research ethics

Ethics approval was gained from the Monash University

HumanResearchEthical Committee (MUHREC) project

number CF09/3131 2009001710. In order to conduct

research in Malaysia, another ethical approval was also

requested from The Research Promotion and Co-

Ordination Committee, Economic Planning Unit (EPU),

Prime Ministers Department, Malaysia reference

number UPE: 40/200/19/2505.

Respondents

The respondents in this survey were Malaysian qualied

non-international occupational therapists who were mem-

bers of the Malaysian Occupational Therapy Association

(MOTA). To be included in the study, respondents must

work or have worked with children and adolescents with

ASD in occupational therapy services, either in Peninsular

or East Malaysia. MOTA were consulted for their help in

identifying potential respondents for the survey.

The rst author was given access to the MOTA

member information database in order to source addresses

to which the survey could be mailed. However, out of 459

ordinary members listed (December 2009), only 362 mem-

bers had their full names and addresses recorded in the

database. The remaining 97 members had incomplete

names or addresses. It was not known whether the com-

plete details of members were current. There was also no

indication on the database of the members service areas

or specialties (such as whether they are working in the

paediatrics area or in any other specialized areas) to

enable the researchers to select and mail the surveys only

to those in the target group for the purpose of this study;

Kadar et al. 35


hence, the survey was mailed to the 362 Malaysian occu-

pational therapists whose full names and addresses were in

the MOTA database.

Procedures

Ethical approval was granted by the Monash University

Human Research Ethical Committee (MUHREC) and

The Research Promotion and Co-Ordination Committee,

Economic Planning Unit (EPU), Prime Ministers

Department, Malaysia. The self-administered survey was

mailed to members on the MOTA database, together with

an introductory letter, explanatory statement, and

stamped, self-addressed envelope. In order to encourage

the response rate, reminders were sent out at two and four

weeks after the survey was sent (Salant and Dilman, 1994).

Return of the anonymous surveys by the respondents was

considered as their consent to take part in the study. To

ensure the privacy and condentiality of the respondents,

no identifying information was kept or recorded by the

researchers. No incentive was provided for participating

in the survey.

Data analysis

Numerical data were entered into the SPSS 18.0 and ana-

lysed to generate descriptive statistics such as frequencies

and percentages. The answers given to open-ended ques-

tions were categorized following the content analysis pro-

cess described by Liamputtong (2009: 281). Firstly, all

responses to open-ended questions were read entirely to

gain an understanding of their meaning. Codes were then

assigned to all answers for each question by the rst

author. These codes were then grouped together into cate-

gories and the replies for each code and category were then

counted (Liamputtong, 2009). However, to prevent bias,

an audit trail was performed by the third author to ensure

the coding and categorizing was accurate. Where discre-

pancies arose, the responses to the open-ended questions

were referred to in order to ascertain the correct coding

and categorizing.

Results

Response rates

A total of 78 respondents returned their survey during the

3-month data collection period. However, 26 were

excluded, because they indicated that they had never

worked with children with ASD. These 26 negative

responses were excluded from the survey sample total of

362, making the valid response rate 15.5% for a total of

52 respondents. According to Weisberg et al. (1996), the

response rate for postal surveys tends to fall between 10%

and 50%. The response rate for this study is at the lower

end of this range. Due to the limitations of the MOTA

database, we cannot be sure if this is a valid response rate

representative of Malaysian occupational therapists who

have worked with children and adolescents with ASD.

Characteristics of the participants

Results show that 82.7% of the respondents were from

Peninsular Malaysia and 17.3% were from East

Malaysia. In terms of the respondents academic quali-

cations, 71.0% held diplomas/certicates in occupational

therapy and all of them were qualied general occupa-

tional therapy practitioners, as none reported that they

had received any certication or specialized training in

certain areas, such as certication in sensory integration.

The majority of the respondents worked in hospital set-

tings (82.7%). More than half (57.7%) of the respondents

reported having 1 to 5 years experience working as an

occupational therapist. Table 1 details the participants

characteristics.

Occupational therapy practice

Frames of reference and models of practice

Results showed that 98.1% of the respondents indicated

that they used frames of reference (FOR) and 92.3%

models of practice (MOP) to guide their service delivery

with children and adolescents with ASD. The most

common FOR in use were the sensory integration FOR

(92.3%) (Kimball, 1999) and the psychosocial FOR

(63.5%) (Olson, 1999). In terms of MOPs, the Model of

Human Occupation (MOHO) (Kielhofner, 2008;

Kielhofner and Burke, 1980) was used by the majority of

the respondents (73.1%).

Interventions

The six interventions/programmes indicated as being

often and always used were: (1) play therapy (86.6%);

Table 1. Participants experiences working as occupational ther-apists, working with children with ASD, and their academic

qualification.

Participants working experiences Frequency Percentage

Years of practising as an occupational therapistLess than 1 year 6 11.5%

15 years 30 57.7%

610 years 9 17.3%

1115 years 6 11.5%

1620 years 1 2.0%

Total 52 100.0%

Years of working with children with autism spectrum disorderLess than 1 year 31 59.6%

15 years 18 34.6%

610 years 3 5.8%

Total 52 100.0%

Highest academic qualificationDiploma/certification in occupational therapy 37 71.0%

Bachelors degree in occupational therapy 14 27.0%

Coursework/research masters 1 2.0%

Total 52 100.0%



(2) sensory integration training (79.2%); (3) sensorimotor

stimulation (78.8%); (4) pre-school training (77.0%); (5)

early intervention (65.4%); and (6) Snoezelen therapy

(60.8%).

Age group of children with ASD served mostfrequently

A total of 69.2% of the respondents reported that they

mainly see children with ASD aged below 5 years (pre-

school), 36.5% reported they mainly see those aged

between 6 and 18 years, and 9.6% of the respondents

reported seeing both age groups.

Methods of assessment and outcome measures

The following methods of assessments were reported by

the majority of the respondents as often and always

utilized: performing interviews with parents/caregivers

(90% of respondents), utilizing informal assessment/

screening tools (70.8%), utilizing standardized assess-

ment/screening tools (56.3%), and observation in multiple

environments (46%). Two methods of assessment were

reported by the majority of the respondents as seldom

and sometimes used; namely, interviews with teachers/

education sta (70%) and interviews with other health

professionals (67.3%). Four types of standardized assess-

ments were administered by the majority of the respond-

ents. These assessments and the tools frequently used

were: (1) developmental screenings and evaluations

(76.9%) (Denver developmental screening test); (2) activ-

ities of daily living skill assessments (76.9%) (modied

Barthel index of activities of daily living); (3) gross or

ne motor skill assessments (69.2%) (Denver developmen-

tal screening test); and (4) sensory processing or sensory

integration assessments (67.3%) (sensory prole/sensory

prole school companion).

Short-term occupational therapy interventiongoals

The answers to the open-ended question, where the

respondents were asked about their top ve most

common short-term occupational therapy intervention

goals when working with children and adolescents with

ASD, showed that the top ve most common were:

(1) improving attention and concentration skills (n 26);(2) improving communication and social skills (n 26);(3) managing issues related to sensory diculties

(n 18); (4) improving self-care skills (n 16); and (5)improving physical functions (for example, motor skills,

muscle strength) (n 15).

Collaboration with other people or professionalsand level of confidence

All respondents had collaborated with parents/caregivers

in the provision of services for children and adolescents

with ASD. The majority of the respondents (67.3%)

reported that they always worked with parents/care-

givers, 51% reported they sometimes worked with tea-

chers/education sta, and 38% reported they worked with

speech therapists/speech pathologists. Furthermore, the

majority of the respondents felt moderately condent

when working with children and adolescents with ASD

(59.6%), 38.3% felt high or very high condence, and

2.1% felt low condence.

Professional development

Training/certification/continuing education courses eitherattended or listed as desirable to attend. The three mostfrequently attended courses for professional development

related to the provision of services for children and ado-

lescents with ASD were:

1. sensory-based interventions/trainings (n 12);2. knowledge/understanding about ASD (n 9); and3. behavioural skills training (n 4).

The three courses that the respondents most frequently

stated they would like to attend were:

1. sensory-based interventions/training (n 22);2. behavioural skills training (n 15); and3. social skills training (n 8).

Preferred methods for obtaining knowledge andskills. Table 2 lists the respondents preferred methodsfor obtaining knowledge and skills. The two methods

most preferred by Malaysian occupational therapists in

obtaining knowledge and skills were hands-on mentoring

by experts/experienced therapists and attending short

courses of specialized certication on certain techniques/

programmes; these were reported by 43.1% and 33.3% of

the respondents, respectively. Only 4% of the respondents

gave top preference to literature reviews as a method of

obtaining knowledge and skills.

Discussion

Descriptions of the occupational therapypractices in Malaysia with children andadolescents with ASD

The fact that the majority of the respondents in this study

worked in hospital-based settings is consistent with the

statement made by Muthuraman Sellathurai Pathar, the

President of the Malaysian Occupational Therapy

Association (2011, personal communication). The data

gathered in this study were largely from respondents

who have worked as occupational therapists and with chil-

dren and adolescents with ASD for less than 5 years.

Most respondents were from Peninsular Malaysia; thus,

generalization of the results obtained in this study to the

practices of all Malaysian occupational therapists working

with children and adolescents with ASD is limited.

Kadar et al. 37


Further study is needed in order to get a more repre-

sentative description of the occupational therapy practices

in Malaysia with children and adolescents with ASD.

Similar to the ndings from Ashburner et al. (2010,

unpublished report), Kadar et al. (2012), and Watling

et al. (1999a), respondents from Malaysia also reported

the use of theories, assessments, and interventions asso-

ciated with sensory-based approaches for children and

adolescents with ASD. These are evident in the high

reported use of the sensory integration FOR (Kimball,

1999) to guide their practice and also in the choice of sen-

sory integration training (Kimball, 1999) and sensori-

motor stimulation (Huebner and Lane, 2001) in their

interventions. However, this is quite concerning as, while

none of the respondents in this study reported that they

have received specialized training or are certied in sen-

sory integration, some of them are using sensory integra-

tion intervention approaches in their services for children

and adolescents with ASD. Unlike users of sensory-based

stimulation, therapists who want to provide sensory inte-

gration therapy should undergo extensive training and be

certied in that therapy.

It is interesting to note that, besides assessments and

interventions based on sensory integration and sensory-

based stimulations, the majority of respondents also

indicated performing activities of daily living skills assess-

ments, developmental screenings and evaluations, and

gross or ne motor skills assessments. This is an encoura-

ging result to see, especially the fact that 76.9% of the

respondents stated that they performed activities of daily

living skills assessments in their practices with children and

adolescents with ASD. According to Green et al. (2009),

motor impairments are found to be common in children

with ASD, which might explain why the majority of the

respondents reported performing gross or ne motor skill

assessments in their services for children with ASD.

Occupational therapists perspectives on occupation-

based practice can be varied (Estes and Pierce, 2012;

Mullersdorf and Ivarsson, 2011); however, interventions

based on daily occupation in order to achieve independ-

ence, such as self-care activities, should be the main focus

in occupational therapy services with this population

(Arbesman and Lieberman, 2010; Diamantis, 2010;

Rodger et al., 2010). According to Drysdale et al. (2008),

training on daily activities, such as shopping and tele-

phone tasks, in community-based training for children

with intellectual disabilities might be more eective

than classroom-based training. Studies show that children

with ASD experience diculties managing their daily

occupation, regardless of their level of cognitive function;

for example, children with high-functioning autism (Perry

et al., 2009; Schatz and Hamdan-Allen, 1995). Moreover,

the gap between the ability to function independently in

daily living skills has been reported to widen as the chil-

dren with ASD grow older (Kanne et al., 2011). In order

to enhance occupational performance in children with

ASD, no single approach or therapy might be eective

to achieve this. Best practices may be the combination of

those interventions that use or modulate sensory experi-

ences among those children, which may be achieved

through play to enhance their skills in daily living

activities.

It is important for occupational therapy practitioners

to implement evidence-based interventions in their service

with children with ASD, as reports show that parents are

highly likely to abandon interventions which were either

ineective or not based on sucient evidence (Bowker

et al., 2011). In a setting such as Malaysia, where resources

for interventions are much less available than in more

developed countries, this becomes even more essential.

Lyons et al. (2010) suggested that additional education

in conducting research activities might be benecial to

occupational therapy practitioners in order to improve

their ability to guide their practice based on strong

evidence. However, the very low preference for acquiring

knowledge and skills through reviewing literature indi-

cated by the respondents in this study is quite concerning.

This decision could be due to the heavy workloads faced

by occupational therapy practitioners that make it dicult

for them to implement evidence-based practices, as

reported by occupational therapists from across seven

acute National Health Service (NHS) Trusts in the UK

Table 2. Preferred method of obtaining knowledge and skills.

Methods of obtaining knowledge and skills n

Notpreferred(%)

Lowpreferences(%)

Moderatepreferences(%)

Highpreferences(%)

Preferred themost (%)

Hands-on mentoring by experts/experienced therapists 51 0.0% 3.9% 21.6% 31.4% 43.1%

Case presentation of intervention and technique 51 0.0% 3.9% 31.4% 49.0% 15.7%

Multidisciplinary workshop with discussionand problem-solving

51 2.0% 0.0% 21.6% 49.0% 27.5%

Short courses of specialized certification on a certaintechnique/programme

51 2.0% 3.9% 29.4% 31.4% 33.3%

Online courses 49 10.2% 30.6% 44.9% 8.2% 6.1%

Conferences or seminars 50 6.0% 6.0% 30.0% 50.0% 8.0%

Literature reviews 50 10.0% 20.0% 38.0% 28.0% 4.0%

Advanced post-professional academic degrees 47 14.9% 14.9% 27.7% 23.4% 19.1%

n number of participants providing rating. In a five-point Likert scale: 1 (not preferred), 2 (low preference), 3 (moderate), 4 (high preference),and 5 (preferred the most).



(Humphris et al., 2000). This highlights an area that needs

to be strengthened in the education of occupational ther-

apists, at least during the student period (Arbesman and

Lieberman, 2010).

It can be seen from the results of this study that a high

percentage of the respondents worked closely with par-

ents/caregivers of children with ASD. A study by Boyd

et al. (2011) showed that parents involvement in the inter-

vention of children with ASD managed to signicantly

reduce repetitive behaviours among such children; other

encouraging results were also achieved.

Regarding professional development needs, the

majority of the respondents in this study indicated that

they had either attended or needed to attend courses

related to sensory-based approaches to improve their

knowledge and skills in their service with children with

ASD. This emphasis on attending and desire to attend

courses related to sensory integration therapy and

sensory-based approaches needs to be explored further

to ascertain the reasons the respondents feel that they

are lacking in this area of intervention compared with

some other areas, such as the occupation-based interven-

tion in daily living; hence why they need to know more

about sensory integration therapy and sensory-based

intervention. It is also essential for occupational therapists

to clearly explain to parents the limited evidence available

on the eectiveness of the use of sensory integration ther-

apy (American Academy of Pediatrics, 2012; Arbesman

and Lieberman, 2010).

Study limitations and future research

A major limitation of this study is the size and repre-

sentativeness of the sample, with the majority of the

responses from respondents coming from Peninsular

Malaysia. For future research, the response rate obtained

could be improved if the membership database kept by

MOTA were updated and completed in terms of its mem-

bers full name, current addresses, and their specialty areas

(if any). A database that contains complete and current

information about its members would be an important

source of information for the further development and

understanding of workforce and service needs, as well as

a useful resource for assisting with research regarding the

future and directions of this profession in Malaysia.

Future research to explore how the practitioners incorp-

orate sensory integration therapy and sensory-based

approaches, as well as other intervention approaches,

into their occupational therapy services for children and

adolescents with ASD in order to improve occupational

performance would be very worthwhile.

Conclusion

This is the rst published study reporting on the occupa-

tional therapy practices in Malaysia with children and

adolescents with ASD. Regardless of dierences in cul-

tural, educational, and health care systems, results from

this study illustrate similarities in occupational therapy

practices with children with ASD in Malaysia to those in

other international studies (Ashburner et al., 2010, unpub-

lished report; Kadar et al., 2012; Watling et al., 1999a).

The majority of the respondents in this study reported

using theories, assessments, and interventions that are

associated with, or based on, sensory integration and/or

processing approaches in their practices with children and

adolescents with ASD. However, it was also encouraging

to see that the majority of the respondents reported that

they performed activities of daily living assessments in

their service, which reected that this area of daily occu-

pation was not being overlooked by them. The element of

client-centred practice was also highly implemented by

occupational therapist respondents involved in this

study, as they reported that they sought to involve

parents/caregivers of children and adolescents with ASD

in their service deliveries.

Key findings

. Occupational therapy practices in Malaysia for childrenand adolescents with ASD highly utilized sensory integra-

tion therapy and sensory-based approaches in their the-

ories, assessments, and interventions.

. An encouraging percentage of participants performed theinterventions of daily living skills in their service for chil-

dren with ASD.

What the study has added

This is the rst published study to describe the prac-

tices of occupational therapy with children and ado-

lescents with ASD in Malaysia. Future study involving

more representative samples from both Peninsular and

East Malaysia will assist in dening the practices

clearly.

Acknowledgements

We would like to extend our gratitude to the occupational therapists

in Malaysia who were willing to spend their valuable time in complet-

ing the questionnaire. We would also like to thank the Malaysia

Occupational Therapy Association (MOTA) for its help in assist-

ing with the addresses for mailing the survey to its members.

Furthermore, we would like to acknowledge Dr Jill Ashburner for

freely sharing her information on a survey of current practices, train-

ing, and professional development needs of occupational therapists who

provide services to people with autism spectrum disorder (Ashburner

et al., 2010, unpublished report) and for her generous help.

Declaration of conflicting interests

None declared.

Funding

This research received no specic grant support from any funding

agency in the public, commercial, or not-for-prot sectors.

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