Understanding multi-party communication in therapy sessions for autistic children

Autism spectrum disorder (ASD) affects approximately 1-2% of children displaying difficulties in social interaction and restricted, repetitive and/or sensory behaviours. Therapeutic approaches are common in ASD including sensory integration therapy (SIT), which uses play-based sensory activities to support autistic children to process and integrate sensory input. Studies on healthcare communication focus mainly on interactions between adults; even when the focus of research is on children. Greater understanding on how to facilitate therapeutic encounters with autistic children, consistent with health equity goals, is needed. In this study, I explore the communication and relationship evolution between the autistic child, Occupational Therapist (OT) and parent(s). Data from the Sensory Integration Therapy in Autism Randomised Controlled Trial (ISRCTN: 14716440) dataset of video-recorded SIT sessions were used, following two autistic children throughout their therapeutic journey over 26 weeks (=50 videos). A qualitative theme-oriented discourse analysis of full annotated extracts from the 37 therapy sessions was conducted. Drawing on sociological and linguistic concepts, I explored what is or is not actually said and how it is said. In this thesis, I focused on different interactional strategies (e.g., invitations, social rewarding) used by OTs to achieve and maintain rapport with the children, and sometimes their parent, throughout the SIT sessions (Chapter Five). I also identified ‘playfulness’ as a key element that can further support the OT to maintain a successful relationship with the child throughout the therapeutic journey (Chapter Six). Finally, I examined how participants use collaboration and negotiation during SIT task transitions in which the group’s power dynamics might change (Chapter Seven).The results are used to identify ways in which rapport can be optimised and maintained during child interventions, encourage effective communication with autistic children in OT encounters and explore the potential impact of findings for different play-based therapy sessions (e.g., physiotherapy)