Group versus individual occupational therapy for toddlers with autism as a means to improve access to public health-care services. Randomised controlled pilot study

Sivan Hirschmann, Racheli Magnezi, Haim Bassan, Orna Tal

Research output: Contribution to journalArticlepeer-review


Introduction: In recent years, the increasing prevalence of autism-spectrum disorder has resulted in an increased demand for therapies including occupational therapy. In this pilot trial, we aimed to compare the efficacy of group versus individual occupational therapy among toddlers with autism as a means to improve accessibility to care. Methods: Toddlers (2–4 years) undergoing autism evaluation in our public child developmental centre were recruited and randomised to receive 12 weekly sessions of group or individual occupational therapy based on the same mode of intervention: Developmental, Individual-Differences and Relationship-based (DIR). Primary outcomes related to intervention implementation included waiting days, nonattendance, intervention period, number of sessions attended and therapist satisfaction. Secondary outcomes were the Adaptive Behaviour Assessment System questionnaire, the Paediatric Quality of Life Inventory and the Peabody Developmental Motor Scale (PDMS-2). Results: Twenty toddlers with autism were included, 10 in each occupational therapy mode of intervention. Children waited fewer days before beginning group occupational therapy compared to individual therapy (52.4 ± 28.1 vs. 108.8 ± 48.0 days p < 0.01). Mean numbers of nonattendance was similar for both interventions (3.2 ± 2.82 vs. 2 ± 1.76, p > 0.05). Worker satisfaction scores were similar at the beginning and end of the study (6.1 ± 0.4 vs. 6.07 ± 0.49, p > 0.05). There were no significant differences between the percentage changes in individual and group therapy outcomes for adaptive score (6.0 ± 16.0 vs. 4.5 ± 17.9, p > 0.05), quality of life (1.3 ± 20.9 vs. 18.8 ± 24.5, p > 0.05) and fine motor skills (13.7 ± 36.1 vs. 15.1 ± 41.5, p > 0.05). Conclusions: In this pilot study, the group DIR-based occupational therapy for toddlers with autism improved access to services and allowed earlier interventions, with no clinical inferiority to individual therapy. Further research is required to examine group clinical therapy benefit.

Original languageEnglish
Pages (from-to)434-445
Number of pages12
JournalAustralian Occupational Therapy Journal
Issue number4
Early online date20 Feb 2023
StatePublished - Aug 2023

Bibliographical note

Funding Information:
This research was conducted as part of Sivan Hirschmann's studies toward a MSc in the Department of Health Systems Management at Bar-Ilan University, Ramat Gan, Israel. We would like to thank the children and their families for participating in this study, Prof. Diza Zachor, Carmit Netanel, Dr Steven Resnick and Dr Trevor Waner for critically reviewing the manuscript, and the occupational therapy team at the Child Development Center: Dorothy Kramer, Tali Belafonte, Raneen Dibini, Hili Fraimovich, Mor Koptchik-Ovadia, Yael Gutman and Elinor Betzadka.

Publisher Copyright:
© 2023 Occupational Therapy Australia.


  • autism-spectrum disorder
  • group therapy
  • occupational therapy services
  • waiting days


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