IMPACT OF OCCUPATIONAL THERAPY INTERVENTIONS ON QUALITY OF LIFE IN SCHOOL-AGED CHILDREN WITH AUTISM SPECTRUM DISORDER

Abstract

Autism spectrum disorder (ASD) is a major medical and social challenge worldwide. According to WHO estimates, approximately 1 in 160 children has ASD, while surveillance data from the United States demonstrate a rising prevalence, reaching 1 in 36 among 8-year-old children in 2020 and 1 in 31 in 2022. In Ukraine, official statistics remain limited and incomplete; however, available data indicate a steady increase in ASD diagnoses since 2006. By 2017, the number of newly identified cases had grown 8.5-fold, reaching 27.8 per 100 000 children. Experts suggest that the real prevalence is substantially higher. Although more than 75 000 children in Ukraine were estimated to have ASD in 2019, electronic health-record data from 2023 list only 20 936 children with a confirmed diagnosis. The increase in reporting is associated with broader diagnostic criteria, improved awareness, and greater accessibility of assessment tools. Under wartime conditions, disruptions of routines, environmental instability, and limited access to services negatively affect children’s emotional well-being, learning, and participation in daily activities, highlighting the relevance of occupational therapy interventions. Occupational therapy is a key component of comprehensive rehabilitation for children with ASD, as the primary goals for both families and professionals involve the development of independence and functional participation. Aim. The aim of the study was to evaluate changes in the overall PedsQL quality-of-life score in school-aged children with ASD during wartime and to compare the effectiveness of three approaches to occupational therapy interventions. Methods. The study included children with ASD aged 8–12 years. Three groups of 20 participants each were formed (total n = 60): the first group (CG; 18 boys, 2 girls) received occupational therapy consultations; the second group (EG1; 17 boys, 3 girls) received clinic-based occupational therapy sessions; and the third group (EG2; 18 boys, 2 girls) received clinic-based occupational therapy sessions combined with school-environment adaptations. Quality of life was assessed using the parent-proxy version of the PedsQL. Pre-post differences were analyzed using the Wilcoxon signed-rank test (p). Results. All groups showed statistically significant improvements in total PedsQL scores (p<0.001). The greatest absolute improvement was observed in OG2: +34.7 percentage points (mean 44.5±1.8 → 79.2±2.9). OG1 demonstrated a +21.2-point increase (43.4±0.9 → 64.6±1.2), while the CG showed a smaller improvement of +6.7 points (40.3±1.7 → 47.0±1.6). Conclusions. The findings confirm that the magnitude of quality-of-life improvement is dependent on the intensity and ecological relevance of occupational therapy interventions. The combination of clinical occupational therapy with school-environment adaptations was associated with the most substantial growth in PedsQL scores. These results align with existing evidence on the importance of sensory regulation and school-based supports for academic and behavioral outcomes in children with ASD.