Date Presented 04/22/2023

This study aimed to develop a preliminary list of active ingredients of standard OT for children on the autism spectrum using the Delphi method. Our results have the potential to serve as a framework for clinical research in autism.

Primary Author and Speaker: Meredith Kromalic

Contributing Authors: Jewel Elias Crasta, Joseph E. Martis, Shannon E. Jarrott

PURPOSE: Occupational Therapy (OT) is one of the most utilized interventions for autistic children and OT practitioners often use a variety of treatment approaches (Kuhaneck & Watling, 2015). There is a need to identify the active ingredients of routine OT in autism. Active ingredients are defined as the specific elements of an intervention thought to facilitate change. This study aimed to identify and develop consensus on definitions and examples of active ingredients in standard OT for autistic children (ages 6 – 13 years).

DESIGN: The Delphi method, a process of acquiring feedback from a panel of experts via multiple surveys, was used to acquire consensus on treatment ingredients. A preliminary list of treatment ingredients with definitions and examples was derived from an extensive literature review. Through four Delphi rounds, 16 expert OT practitioners rated the definitions and examples of treatment ingredients.

METHOD: In round 1, panelists rated the criteria rating form that would be used in the following rounds. In rounds 2-4, panelists rated and provided feedback on each ingredient’s definition, example, and relevance to OT, and provided general comments on current or missing ingredients. After each round, revisions were made based on panelist feedback. Consensus was established when an ingredient’s definition and example reached greater than 80% agreement (Van Stan et al., 2021).

RESULTS: Based on the panelists’ feedback on Delphi round 1, the criteria rating form was revised to include four Likert-scale questions for the definition and example of each treatment ingredient. We identified 20 active ingredients that incorporated elements of commonly used OT treatment frameworks regardless of evidence level. Conclusion and Impact: The operationalized list of treatment ingredient definitions and examples have the potential to serve as a foundational framework to improve education, practice, and research of OT intervention for children on the autism spectrum.


Kuhaneck, H. M., & Watling, R. (2015). Occupational Therapy: Meeting the Needs of Families of People With Autism Spectrum Disorder. The American Journal of Occupational Therapy, 69(5), 6905170010p1-6905170010p5.

Van Stan, J. H., Whyte, J., Duffy, J. R., Barkmeier-Kraemer, J. M., Doyle, P. B., Gherson, S., Kelchner, L., Muise, J., Petty, B., Roy, N., Stemple, J., Thibeault, S., & Tolejano, C. J. (2021a). Rehabilitation Treatment Specification System: Methodology to Identify and Describe Unique Targets and Ingredients. Archives of Physical Medicine and Rehabilitation, 102(3), 521–531.

Stahmer, A. C., Suhrheinrich, J., & Mandell, D. S. (2016). The importance of characterizing intervention for individuals with autism. Autism, 20(4), 386-387.

Stahmer, A. C., Suhrheinrich, J., Roesch, S., Zeedyk, S. M., Wang, T., Chan, N., & Lee, H. S. (2019). Examining relationships between child skills and potential key components of an evidence-based practice in ASD. Research in Developmental Disabilities, 90, 101–112.