Occupational Therapy Interventions Using New Technologies in Children and Adolescents with Autism Spectrum Disorder: A Scoping Review

We performed a systematic literature search on the databases MEDLINE (PubMed), EMBASE, Scopus and Web of Science (WOS) on November 16, 2020. We performed an additional manual search of several OT journals indexed in the Journal Citation Reports (JCR) including those with the highest impact (indexed in the first quartile): American Journal of Occupational Therapy (AJOT); Australian Occupational Therapy Journal (AOJT); British Journal of Occupational Therapy (BJOT); Canadian Journal of Occupational Therapy (CJOT); Hong Kong Journal of Occupational Therapy (HKJOT); Journal of Occupational Rehabilitation (JOR); Occupational Therapy International (OTI); Occupation, Participation and Health (OTJR); Physical and Occupational Therapy in Pediatrics (POTP); Scandinavian Journal of Occupational Therapy (SJOT). We used the same search strategy in all the sources consulted, including all ASD disorders, ‘occupational therapy’, and different terms included in NT as search terms, combined with the Boolean operators AND and OR. Search strategies used in all databases can be found in Table 1.

In this review, we included all articles that met the following inclusion criteria: (a) Studies with experimental design: non-randomized controlled trials, randomized controlled trials, quasi-experimental studies, pilot studies, case report and exploratory studies; these types of studies are included in the levels of evidence 2,3,4 established by the Oxford Centre for Evidence-Based Medicine (Centre for Evidence-Based Medicine (CEBM) n.d.); (b) children or adolescent population (under 18 years old); (c) study population with a diagnosis of ASD: Asperger's Syndrome, Rett Syndrome, Disintegrative Disorder, Classic Autistic Disorder, and Pervasive Developmental Disorder, (d) OT intervention using NT: app, tablet, iPad, mobile, virtual reality, computer, laptop, technology device, internet, video game or software. We excluded the following: (a) studies not published in English and/or Spanish; and (b) with no full-text available.

No filters by time or type of study were applied during the literature search in any of the databases and journals consulted.

We downloaded and compiled all the article titles obtained from all the searches using Microsoft Excel for further review and screening. One researcher (SDL) carried out a preliminary screening which consisted of removing duplicates. Two researchers (SDL and LMCG) then reviewed and screened the articles independently. We performed three comprehensive, successive and screenings: by title, by abstract and by full text. In each screening, articles that did not meet the inclusion criteria were discarded. A third review research (MGDH) resolved discrepancies between SDL and LMCG regarding study inclusion at the end of each of the three screenings.

Before the data extraction, all researchers designed the tables and defined the items to be included in them, in order to reduce subjectivity in the synthesis of the data. We elaborated three tables based on the Cochrane Handbook (Higgins & Thomas, 2021). Table 2, which provides information on the main characteristics of the studies included in this review through the following items: author/year, study design, sample/country, participants, intervention/comparator, evaluation, and study outcomes (Page et al., 2021). Table 3, which provides information on the main characteristics of the interventions conducted in the studies included in this review through the following items: author/year, participants, intervention, duration of intervention, sessions, intervention manager and main results (Page et al., 2021). And finally, Table 4, which provides information regarding aspects related to the risk of bias in the articles included in this review through the following items: author/year, main limitations, funding sources and declarations of interest (Boutron et al., 2021). Two researchers (SDL and LMCG) performed the data extraction independently, LTC resolved discrepancies about data extraction.

We made a descriptive synthesis of the results and used tables and figures as far as possible to present the flow of the study selection process and the characteristics of the included studies. In addition, as a multidisciplinary research team, we discussed categories to classify the different types of OT interventions using NT in children and/or adolescents with ASD used in the included studies in the results section.

The quality of the included studies was not assessed as this is not a mandatory requirement of scoping reviews (Arksey & O’Malley, 2005; Levac et al., 2010; Peters et al., 2020; Tricco et al., 2016, 2018). However, we have included a table about risk bias, as recommended in the Cochrane Handbook (Higgins & Thomas, 2021), which includes information on the main limitations reported in the included articles, funding sources and declarations of interest (Table 4) to make readers aware of these characteristics and to enable them to assess the results presented in this scoping review more critically. The main limitations reported by the authors of each included study are also discussed in the results section.

The main characteristics of the included studies are summarized in Table 2. Nine studies were conducted in Asian countries, seven in the United States, three in Australia and one in Europe. The study population of all the included articles consisted of children or adolescents with a diagnosis of ASD but nine of them, (Campbell et al., 2015; Cosper et al., 2009; Gal et al., 2016; Henning et al., 2016; Janeslätt et al., 2014; Josman et al., 2008; Lo et al., 2009; Lorah et al., 2014; Palsbo & Hood-Szivek, 2012) in addition to children and adolescents diagnosed with ASD, also included other diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD), Intellectual Disability, Infantile Cerebral Palsy, Spina Bifida, Cerebellar Hypoplasia, Auditory Processing Disorder and undiagnosed population. The sample size varied greatly between included studies, two being the lowest number of participants (Lee et al., 2013), and ninety-four the highest (Hatfield et al., 2017).

Six of the included articles are pilot studies (two of them were randomized controlled clinical trials and four of them were quasi-experimental studies), (Henning et al., 2016; Ikuta et al., 2016; Josman et al., 2008; Lo et al., 2009; Meister & Salls, 2015; Palsbo & Hood-Szivek, 2012), five are quasi-experimental studies (Cosper et al., 2009; Gal et al., 2016; Gentry et al., 2010; Lee et al., 2016; Wuang et al., 2010), four are non-randomized clinical trials (Campbell et al., 2015; Hatfield et al., 2017; Lamash & Josman, 2021; Lee et al., 2013), three are randomized controlled clinical trials (Hochhauser et al., 2018; Janeslätt et al., 2014; Parsons et al., 2019), and two are case reports (Chen et al., 2015; Lorah et al., 2014). Only six of all included studies included a control group (Hatfield et al., 2017; Hochhauser et al., 2018; Janeslätt et al., 2014; Josman et al., 2008; Lamash & Josman, 2021; Parsons et al., 2019). In four of them (Hatfield et al., 2017; Hochhauser et al., 2018; Lamash & Josman, 2021; Parsons et al., 2019) the control group received either the usual therapy or received no intervention. In one study (Josman et al., 2008) both groups received the same intervention, the only difference being the number of sessions. Finally, in one study (Janeslätt et al., 2014) both groups received the same intervention, although the intervention group was treated before the control group, while the control group received a usual therapy. Two studies (Ikuta et al., 2016; Wuang et al., 2010) had two intervention groups, both of whom received the same intervention, although in different phases of the study or in a different order (Table 2).

Activities of daily living (ADLs) and related abilities are the most studied outcome among the included studies (n = 9). Occupational performance was assessed in three studies by using different instruments such as the Child Occupational Self-Assessment (COSA) (Meister & Salls, 2015), the Canadian Occupational Performance Measure (COPM) (Gentry et al., 2010) or video analysis (Campbell et al., 2015). In nine studies, specific ADL such as shopping (Lamash & Josman, 2021), mobility in the community (crossing street) (Josman et al., 2008), mealtime (Lo et al., 2009), toothbrushing (Lo et al., 2009) and play skills (Henning et al., 2016), were assessed with the Test of grocery shopping skills (TOGSS), the Pedestrian safety scale (PSS), duration of meals and % of non-feeding behaviors through video recording, the number of brushing strokes through video recording and plaque-revealing dye, and the Test of Playfulness (ToP), respectively (Table 2).

Social skills are the second most frequent study outcome among the included studies (n = 6). Two studies (Chen et al., 2015; Lee et al., 2016) assessed emotion recognition with non-standardized assessments such as video recording observation and questions regarding video-stories. Among the rest of the studies investigating social skills, several different measurement instruments were used. One study (Henning et al., 2016) used the Conners' Comprehensive Behaviour Rating Scales-Parent (CCBRS-P) to assess social and behavioral problems. One study (Gal et al., 2016) investigated social interaction assessing it with the Friendship Observation Scale (FOS). One study (Hochhauser et al., 2018) measured conflict management and negotiation attitude using the Five Factor Negotiation Scale (FFNS) and The ConflictTalk questionnaire. Another (Parsons et al., 2019), assessed social imitation with the Communication and Symbolic Behavior Scales (CSBS) (Table 2).

Cognitive skills are the third most frequent study outcome among the included studies (n = 5). General cognitive functioning was assessed in two studies by the use of WebNeuro software (Lamash & Josman, 2021) and the Mullen Scales of Early Learning (MSEL) (Parsons et al., 2019). Specific cognitive aspects such as sustained attention (Cosper et al., 2009), time management (Janeslätt et al., 2014) and self-determination (Hatfield et al., 2017) were assessed with the Gordon Diagnostic Systems, the Kit for assessing Time-processing ability in children (KaTid-Child), and the AIR Self-Determination Scale (AIR), respectively (Table 2).

Motor skills were assessed less frequently than cognitive skills in the included studies (n = 3). Among the motor skills assessed, we found: motor control (Cosper et al., 2009; Palsbo & Hood-Szivek, 2012; Wuang et al., 2010) assessed with the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (Cosper et al., 2009), the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) (Palsbo & Hood-Szivek, 2012), and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) (Wuang et al., 2010); motor coordination assessed with the Bruininks-Oseretsky Test of Motor Proficiency-Short Form (Cosper et al., 2009), and handwriting, assessed with the Test of Handwriting Skills-Revised (THS-R) and the Evaluation Tool of Children’s Handwriting (ETCH) (Palsbo & Hood-Szivek, 2012) (Table 2).

Other outcomes and questionnaires were studied to a lesser extent in the included studies. Sensory integration was assessed (Wuang et al., 2010) with the Test of Sensory Integration Function (TSIF); visual-spatial skills were assessed with the Developmental test of visual-perceptual skills-2 (DTVP-2) (Lee et al., 2013), speech generation was assessed using the Proloquo2Go trial score (Lorah et al., 2014), and intervention effectiveness was assessed using the Goal Attainment Scaling (GAS) (Ikuta et al., 2016) (Table 2).

NT used in the OT interventions in the included studies can be categorized into three clear types: OT interventions using computers (n = 12), OT interventions using iPad™ (n = 3) and OT interventions using another NT (n = 5) such as Personal Digital Assistant (PDA) (n = 2), assistive robot (n = 1), simulated Developmental Horse-Riding Program (SDHRP) (n = 1) and earmuffs and Noise-cancelling Headphones (n = 1).

The specific characteristics of these interventions are summarized in Table 3. All interventions described in the included studies were exclusively carried out by occupational therapists (n = 20) (Campbell et al., 2015; Chen et al., 2015; Cosper et al., 2009; Gal et al., 2016; Gentry et al., 2010; Hatfield et al., 2017; Henning et al., 2016; Hochhauser et al., 2018; Ikuta et al., 2016; Janeslätt et al., 2014; Josman et al., 2008; Lamash & Josman, 2021; Lee et al., 2013, 2016; Lo et al., 2009; Lorah et al., 2014; Meister & Salls, 2015; Palsbo & Hood-Szivek, 2012; Parsons et al., 2019; Wuang et al., 2010), psychologists, teachers and research professors formed part of the intervention team in only three of them (Janeslätt et al., 2014; Palsbo & Hood-Szivek, 2012; Parsons et al., 2019). Computers were the most used NT in the included studies (n = 12). In general, intervention programs lasted between 1 and 15 weeks, although in two studies the intervention lasted 40 (Wuang et al., 2010) and 48 weeks (Hatfield et al., 2017). The intervention programs consisted of between 1 and 5 weekly sessions, but in one study there were 9 weekly sessions (Henning et al., 2016). Only two interventions carried out daily sessions (Lorah et al., 2014; Parsons et al., 2019). In general, the sessions lasted 45–60 min, except for one study (Janeslätt et al., 2014), which lasted 120 min. Some studies, did not state the duration of the intervention programs (Janeslätt et al., 2014; Josman et al., 2008; Lorah et al., 2014) or that of sessions performed (Ikuta et al., 2016).

The most frequently used device in OT interventions is the computer (n = 12) (Campbell et al., 2015; Chen et al., 2015; Cosper et al., 2009; Gal et al., 2016; Hatfield et al., 2017; Henning et al., 2016; Hochhauser et al., 2018; Josman et al., 2008; Lamash & Josman, 2021; Lee et al., 2013, 2016; Lo et al., 2009). It is a highly versatile device with different intervention options that can be differentiated as follows:

The second most used device was the iPad™ (n = 3) (Lorah et al., 2014; Meister & Salls, 2015; Parsons et al., 2019). This device was used to improve social, visuo-motor, imitation, language and ADL skills. The interventions were performed exclusively by an occupational therapist, except in one study (Parsons et al., 2019), in which a psychologist collaborated. The duration of the intervention varied from to 6 weeks to 3 months with two 25 min weekly sessions (Meister & Salls, 2015) or daily sessions (Lorah et al., 2014; Parsons et al., 2019).

Personal digital assistant (PDA): Two studies (Gentry et al., 2010; Janeslätt et al., 2014) used a PDA to train time management in daily life. One intervention was performed by an occupational therapist and the other by an occupational therapist and a special educator. In one study the duration of the intervention program was 40 days (Gentry et al., 2010) and in the other the duration was not stated (Janeslätt et al., 2014). Three ninety-minute sessions (Gentry et al., 2010) and an undisclosed number of 2-h sessions (Janeslätt et al., 2014) were performed.

The specific results of each study are shown in Table 3. The effect of the interventions was positive in most of the articles, expressed as significant differences in the results either pre-post intervention or between the intervention group and control group. Seven studies (Campbell et al., 2015; Gentry et al., 2010; Janeslätt et al., 2014; Josman et al., 2008; Lamash & Josman, 2021; Lo et al., 2009; Meister & Salls, 2015) showed significant improvements in the performance of basic and instrumental ADLs, such as eating, personal hygiene, shopping, mobility in the community and time management in these activities. Five studies (Chen et al., 2015; Gal et al., 2016; Henning et al., 2016; Hochhauser et al., 2018; Lee et al., 2016) showed significant improvements in social skills, including collaboration, emotion recognition and conflict resolution. Two studies (Palsbo & Hood-Szivek, 2012; Wuang et al., 2010) reported significant improvements in motor skills, such as graphomotor skills and balance, and in sensory integration skills. One study (Lorah et al., 2014) showed significant improvements in communication and one study (Lee et al., 2013) found significant improvements in visual-spatial skills.

However, in some articles no significant results were reported. In two articles (Hatfield et al., 2017; Parsons et al., 2019), no significant results were reported when the groups were compared. In addition, one article (Cosper et al., 2009) only showed significant improvements in motor control, but not in the other study outcomes, sustained attention and motor coordination. In one study (Ikuta et al., 2016), of the two tools used in the intervention, only the results obtained by earmuffs were significant.

In Table 4 we show the main limitations reported by the authors of included studies, as well as other ethical aspects that could influence the interpretations of the obtained results, such as conflict of interest and funding sources.

The main limitation in included articles is small sample size, which was reported in twelve of them (Campbell et al., 2015; Gal et al., 2016; Gentry et al., 2010; Hatfield et al., 2017; Henning et al., 2016; Ikuta et al., 2016; Janeslätt et al., 2014; Josman et al., 2008; Lamash & Josman, 2021; Lee et al., 2013, 2016; Palsbo & Hood-Szivek, 2012). In seven studies, authors reported the absence of a control group (Cosper et al., 2009; Gentry et al., 2010; Henning et al., 2016; Ikuta et al., 2016; Janeslätt et al., 2014; Meister & Salls, 2015; Wuang et al., 2010), in six studies, authors reported the lack of monitoring and/or evaluation of the transference of results to the natural context was reported (Hatfield et al., 2017; Hochhauser et al., 2018; Ikuta et al., 2016; Lamash & Josman, 2021; Lorah et al., 2014; Meister & Salls, 2015), in four studies, authors reported a limited duration of the intervention (Campbell et al., 2015; Janeslätt et al., 2014; Lee et al., 2016; Meister & Salls, 2015), in three studies, authors reported a non-randomized and non-representative sample (Gal et al., 2016; Gentry et al., 2010; Hatfield et al., 2017), in three studies, authors reported a high withdrawal rate (Hatfield et al., 2017; Janeslätt et al., 2014; Lamash & Josman, 2021), in one study the dose and fidelity of treatment was lower than prescribed (Parsons et al., 2019), and in another, 43% of the sample refused to use any of the interventions (Ikuta et al., 2016). Finally, with regard to measurement instruments, one article highlights the absence of a valid instrument (Palsbo & Hood-Szivek, 2012), one used KaTid-Child and Time Parent scales, which have not previously been used to assess long-term effects (Janeslätt et al., 2014), and one used the Five Factory Negotiation Scale, which has a low internal consistency (Hochhauser et al., 2018).

Regarding declarations of interest, in seven articles (Campbell et al., 2015; Henning et al., 2016; Ikuta et al., 2016; Janeslätt et al., 2014; Lamash & Josman, 2021; Lee et al., 2016; Parsons et al., 2019) authors declared that they had no conflict of interest. In one article (Hatfield et al., 2017), the authors declare a conflict of interest, based on the fact that the first author of the manuscript that described the efficacy of the BOOST-A program is also the developer of the program. The remaining articles did not include any information regarding conflicts of interest.

Funding sources for the articles were mostly public. Six articles (Gentry et al., 2010; Hatfield et al., 2017; Hochhauser et al., 2018; Ikuta et al., 2016; Lee et al., 2016; Palsbo & Hood-Szivek, 2012) obtained funding through grants, scholarships and support from public institutions. In one article (Campbell et al., 2015), authors stated that they had not received any financial support. The remaining articles did not provide information on funding sources.

The most commonly used device in the interventions described in the included articles was the computer, followed by the iPad™ and, other technologies such as assistive robots, PDA, earmuffs and headphones and simulated developmental horse-riding programs. One clear reason for this is that computers are the most widely owned device in the population, and are present in most ASD children’s homes and schools (Ramdoss et al., 2011). The National Statistics Institute (INE) indicates the presence of computers in 81.4% of households (Instituto Nacional de Estadística, 2021). This popularity has made computers an easy device to implement in rehabilitation centers because children and adolescents with ASD are familiar with their use. In fact, previous studies indicated a clear preference of children with ASD for computers and their screens (Moore & Calvert, 2000).

In contrast, emerging NT such as robotics or augmented reality systems have been less used in the OT interventions described in included studies. This could be partly explained by the fact that OT interventions are mainly focused on the recovery of ADL in children and adolescents with ASD, and the evidence with regard to the use of emerging NT (i.e. robotics) in these children is specially related to social skills in communication (Kumazaki et al., 2020). In fact, the results of the interventions using robots showed that children with ASD achieve a higher level of task engagement when they interact with robots than with humans (Schadenberg et al., 2020). There has been too little research into the adequate necessary conditions of the interventions using emerging NT to generalize these results to human interactions (Pop et al., 2013).

Most of the interventions described in included articles have been carried out exclusively by occupational therapists, without the support of a multidisciplinary team. We are surprised that other professionals collaborated in the interventions in only three studies (Janeslätt et al., 2014; Lorah et al., 2014; Parsons et al., 2019). Most of the OT interventions using NT were mainly focused on increasing ADLs, followed by social, cognitive and motor skills. This was as expected because we searched specifically for OT interventions, and these professionals are responsible for the rehabilitation of ADLs thorough occupation (Kuhaneck et al., 2020). Similarly, the fact that ASD children present several social difficulties, such as persistent impairments in social communication and social interaction in different contexts justifies the researchers' interest in social skills as a study outcome in the included studies [American Psychiatric Association (APA), 2002].

Surprisingly, no article has studied participation, which is a characteristic concept related to OT. A reason for this can be that occupation is closely related to participation. In fact, some authors point out that occupation is the “means” to rehabilitation and participation is the “end” (Larsson-Lund & Nyman, 2017) and this is could lead to confusion between the two terms and to use them indistinctly. Participation is included as a key aspect in a number of practice models in OT and is defined in the International Classification of Functioning, Disability and Health (ICF) as “involvement in a life situation” (WHO, 2001). Children and adolescents with ASD are particularly at risk of presenting restrictions in their participation. Previous studies have shown that children and adolescents with ASD participate in activities less frequently and with less variety than their peers with other disabilities or typical development (Rodger & Umaibalan, 2011; Shattuck et al., 2011). In this sense, the digitalization of society is changing the way OT is carried out as well as people's participation (Larsson-Lund & Nyman, 2019). NT can help occupational therapists to achieve their intervention goals, thanks to the simulation of real contexts and ADLs, in a personalized, interactive and novel way; but in a safe and familiar environment for children and adolescents with ASD, which facilitates and promotes their learning (Valencia et al., 2019) and therefore, in some way, also their participation.

The characteristics of the OT interventions using NT varied greatly among included studies in terms of intervention program duration, number of sessions, duration of the sessions and technology used. It is possible that this was an effect of the inclusion of different experimental studies in our scoping review, because often a case report or exploratory studies have a shorter intervention program duration than controlled trials. The duration of the sessions is the most stable parameter among included studies, and was usually between 45 and 60 min, which is a typical session length.

OT interventions using NT described in included studies have shown positive results in different aspects of children and adolescents with ASD, such as ADLs and social skills. These results could be conditioned by the limitations reported in the included studies, such as the small sample size, the absence of a control group, the limited duration of the interventions, the lack of follow-up, the lack of evaluation of the transference of the results to the natural context, and the selection of non-randomized and non-representative samples. However, these positive effects on ADLs and social skills have also appeared in previous published reviews (Becker et al., 2016; Vidal-España et al., 2007). Although not in the OT field, the reviews by Wainer et al. (Wainer & Ingersoll, 2011) and Tanner et al. (Tanner et al., 2015), described the use of NT as adjuvants to conventional intervention to improve facial and emotion recognition, social problem solving and social behaviors in children with ASD. Therefore, NT could be seen as a useful and complementary tool to OT intervention in children and/or adolescents with ASD.

The interventions presented in this review are part of an emerging area of research, and offer occupational therapists a great opportunity for research and clinical practice. This review provides information on outcomes, types of interventions and technologies without focusing on a specific area or variable of intervention, providing a broader view of the use of NT in OT interventions in children and adolescents with ASD. Professionals could use the results to develop intervention programs based on NT, and include the different tools presented in their intervention sessions with children and adolescents with ASD. We also provide a summary of current evidence that can support the performance of evidence-based OT practice. However, occupational therapists should consider the results of this scoping review carefully before determining and developing intervention plans for their patients.

Our scoping review presents some limitations that should be considered when interpreting its results. Although we performed a systematic peer review to ensure scientific rigor, the lack of information reported in included studies, the publication bias which limits null results of the interventions, and the selection bias are limitations for the majority of reviews. Regarding inclusion criteria, we only included articles published in English and/or Spanish and with full text available, so we may have excluded studies that could provide relevant information published in another language. Regarding the search strategy, the terms that define ASD and NT were difficult to define. In recent years ASD classification has been modified and there is no consensus on the terminology used in existing articles. Therefore, we have used the terms included in the DSM-IV [American Psychiatric Association (APA), 2002], which categorizes ASD as: Autistic Disorder, Pervasive Developmental Disorders, Rett Syndrome, Childhood Disintegrative Disorder and Asperger Syndrome. As a result, studies using other terms such as hyperactive disorder associated with mental retardation and stereotyped movements present in the ICD-10 may have been overlooked. Something similar occurred with the included terms in NT. We decided to include different terms that had already been used in previous published reviews (Sandgreen et al., 2020; Strubbia et al., 2020). Moreover, in this review we only included those articles in which occupational therapists were one of the professionals who performed the interventions in ASD. Thus, it is possible that we overlooked articles in which occupational therapists were involved in the intervention, but this was not clearly specified in the study, which favored the selection bias. With regard to included studies, we need to point out that we have only included experimental studies which could contain biases related to this type of study design. In addition, in some of them, measurement instruments which were not validated or standardized were used (Campbell et al., 2015; Chen et al., 2015; Josman et al., 2008; Lee et al., 2013, 2016; Lo et al., 2009; Lorah et al., 2014). Moreover, we have not performed an assessment of the quality of the included studies, which means that some of the articles included in this review may have a low methodological quality. However, we have presented the main reported limitation of every included study in Table 3 and other aspects related to the quality of the results, such as conflicts of interest in Table 4. Finally, the high level of variability in terms of assessment tools, outcomes, sample size and duration of intervention among included articles makes it difficult to compare included studies and to draw conclusions. Thus, the results of this scoping review must be interpreted with caution.

Our scoping review also presents some strengths. We should highlight that we have not found other reviews in the scientific literature aimed at describing OT interventions using NT in children and adolescents with ASD. Thus, our scoping review may provide relevant information in a field that has been investigated very little. In addition, this review provides information regarding current gaps in knowledge from which to begin future lines of research: (i) OT interventions using NT in children and adolescents with ASD have been investigated very little in European countries; (ii) There has been very limited research into OT interventions using smartphones and emerging technologies such as robotics; (iii) Multidisciplinary intervention in children and adolescents with ASD using NT is scarce; (iv) OT interventions using NT in children and adolescents with ASD varied greatly in duration and number of sessions. Moreover, we underline the necessity of performing further studies with a larger sample size, containing a control group, with a representative and random sample, and in which validated assessment tools are used.