Yu-Wei Chen

Background and Objectives: Self-regulation is important for children’s learning, social participation and everyday functioning, yet intervention evidence for autistic children and young people is fragmented across intervention approaches and regulatory constructs. This systematic review and meta-analysis aimed to characterise and critically evaluate non-pharmacological randomised controlled trials targeting self-regulation in autistic children and young people and to quantify effects on both self-regulation and separate child functional outcomes. Methods: MEDLINE, PubMed, PsycINFO, CINAHL and ERIC were searched to 24 May 2026. Eligible studies were randomised controlled trials involving autistic children and young people aged 0–18 years that targeted at least one domain of self-regulation and assessed both self-regulation and child function. Risk of bias was assessed using RoB-2. Random-effects meta-analyses were conducted for self-regulation and functional outcomes, with moderator, meta-regression and sensitivity analyses examining sources of variation. Functional proximity and intervention-mechanism moderator analyses were exploratory and were not prespecified in the registered protocol. Results: Twenty-five studies involving 1655 randomised participants were included. Self-regulation improved significantly across 27 intervention–comparator effects from 25 studies (Hedges’ g = 0.605, 95% CI 0.454–0.756; 95% prediction interval 0.027–1.183). Functional outcomes also improved across 25 effects from 23 studies (g = 0.527, 95% CI 0.356–0.698; 95% prediction interval −0.158–1.212). Functional effects were substantially larger for direct/target-aligned outcomes (g = 0.761) than for distal/generalisation outcomes (g = 0.250; Q_β = 11.034, p < .001). The direct–distal contrast attenuated when restricted to active-comparator studies (Q_β = 3.770, p = .052), although distal effects remained positive. Comparator type moderated both outcome streams, whereas self-regulation construct coverage, age, intervention duration, target-skill application and explicit generalisation support did not significantly moderate effects. Conclusions: Self-regulation-focused interventions produce beneficial average effects on both regulatory and functional outcomes. Functional improvement is strongest when outcomes align closely with intervention targets, although smaller positive effects also extend to distal outcomes. Future trials should distinguish proximal regulatory change from target-aligned and distal functional outcomes and explicitly test pathways of generalisation.

Children with neurodevelopmental or mental health diagnoses often face barriers to their successful psychosocial functioning at school. This study aimed to systematically review the key characteristics and quality of primary school‐based interventions that evaluate psychosocial functioning and to conduct a meta‐analysis of the interventions' effectiveness and moderators. The review was registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Four databases were searched in July 2024. Eligible randomised controlled trials (RCTs) needed to evaluate school‐based interventions for primary school children with neurodevelopmental or mental health diagnoses. The first author screened all abstracts, with a second reviewer screening 50% of randomly selected abstracts. The same authors appraised the methodological quality of all studies using the Cochrane Risk of Bias 2 Tool and the QualSyst Appraisal Tool. Twenty‐four studies were included, including 11 RCTs and six cluster RCTs involving 17 interventions. Twelve interventions targeted autistic children, and five interventions targeted children with ADHD. Fifteen studies involving children with mental health conditions were screened at the full‐text stage; however, all were excluded because the study design ( n = 8), outcome measures ( n = 3) or intervention design ( n = 4) did not meet the inclusion criteria. Seven studies analysed moderating variables impacting the interventions' psychosocial outcomes. Individualised interventions were the most common ( n = 12), with a range of intervention techniques and outcome measures assessing sub‐constructs of psychosocial functioning. The meta‐analysis showed small, significant treatment effects from the between‐group analysis favouring the intervention groups. Findings from the subgroup analysis revealed that school‐based interventions were more effective for children with ADHD when they were single‐tiered and included children, teachers and parents. Although the review intended to include both neurodevelopmental and mental health diagnoses, all eligible studies involved neurodevelopmental conditions; therefore, conclusions are restricted to autistic children and children with ADHD. Context and implications: Rationale for this study: Fostering a supportive school environment is key to supporting children's psychosocial development. Successful psychosocial functioning can enable children to participate academically and socially. We aimed to explore the available school‐based interventions to support children with a neurodevelopmental or mental health diagnosis and improve their psychosocial functioning at school. Why the new findings matter: Overall, we found evidence supporting the effectiveness of school‐based interventions in enhancing the psychosocial functioning of autistic children and children with ADHD in this review. Implications for educational researchers and policy makers: Our findings highlight the ongoing necessity for evidence‐based tier‐two and tier‐three interventions for neurodiverse children to support their psychosocial functioning, whether embedded within a multitiered intervention or as a standalone approach. Psychosocial functioning encapsulates the interrelationship between the person and their environment. Thus, as most interventions focused solely on upskilling neurodiverse children, we encourage future researchers and clinicians to intervene at the environmental level to foster an inclusive and supportive environment for the child.

Introduction: Understanding the form, function, and meaning of occupations is essential for effective occupational therapy practice. Parenting is widely recognised as a meaningful and valued occupation. The Parenting Occupations and Purposes (POP) Framework conceptualises parenting occupations and their underlying purposes, but its validity in real‐world contexts has not been tested. This study aimed to evaluate the applicability of the POP Framework among parents in Ireland. Methods: An exploratory descriptive design using Experience Sampling Methodology captured real‐time data on parenting occupations and purposes via the Participation In Everyday Life mobile application. Data were analysed using descriptive and inferential statistics as well as deductive and inductive content analysis to assess the framework's applicability to the sample. Consumer and Community Involvement: Collaboration with the POP Framework developers ensured accurate application of its concepts. Partnership with the developer of the Participation In Everyday Life mobile application supported correct setup and usability. Results: Forty‐four parents completed 1150 surveys over 7 days. All categories in the POP Framework were represented. The most frequent occupation was attending to the child's basic needs (223 occurrences) while seeking help appeared only once. Among purposes, having the child's basic needs met dominated (571 occurrences), whereas purposes related to continuous parental development were least frequent. New examples of occupations emerged, including faith‐based activities, purchasing discretionary goods, and technology‐mediated monitoring (e.g., texting a spouse to check on a child), suggesting areas for framework expansion. Conclusion: Findings support the validity of the POP Framework in a real‐world context while highlighting opportunities for refinement to capture cultural and technological dimensions of parenting. Enhancing the framework may improve understanding of parenting occupations and inform more comprehensive occupational therapy services for parents.

Autistic adolescents often report lower social and overall quality of life (QoL) associated with limited social skills and behavioral challenges. Awareness of social limitations and social anxiety can worsen QoL, yet the specific roles of these factors remain underexplored. This study examined how social skills, challenging behaviors, social anxiety, and self‐perceived social competence influence QoL in autistic adolescents. A total of 117 autistic participants (age = 12.6 ± 2.2 years; female = 13.7%, male = 86.3%) completed measures including the Pediatric Quality of Life Inventory, the Social Anxiety Scale for Adolescents, and the Self‐Perception Profile for Children/Adolescents Social Competence Subscale. Caregivers assessed social skills and challenging behaviors using the Social Skills Improvement System Rating Scales. Linear regressions, controlling for age, sex, and autistic characteristics, revealed that lower overall QoL was significantly associated with higher social anxiety ( β = −0.48, p < 0.001), lower perceived social competence ( β = 0.21, p < 0.05), and more challenging behaviors ( β = −0.24, p < 0.01) among autistic adolescents. Furthermore, lower social QoL was associated with social anxiety ( β = −0.52, p < 0.001) and perceived social competence ( β = 0.28, p < 0.01). These factors accounted for 45.5% of overall and 51.6% of social QoL variance. The findings highlighted the importance of supporting self‐perception, addressing emotional distress, and managing behavioral challenges to improve QoL in autistic adolescents.

Inconsistent terminology and the selection of measurement tools create challenges in assessing self-regulation in children and adolescents. Available measures often result in incomplete evaluations, hindering a full understanding of children’s self-regulation. This systematic review examined tools used to assess self-regulation in individuals aged 1–18, aiming to identify key components within cognitive, behavioural and emotional domains of self-regulation. Following PRISMA guidelines, we searched six databases and grey literature for studies examining the psychometric properties of self-regulation measures that capture three domains. Thematic analysis identified key components within each domain, and mapped measures to these components to assess coverage. A total of 26 measures spanning all three domains were identified. Cognitive regulation included six components, with ‘flexibility,’ ‘attention,’ and ‘planning’ most frequently assessed, while ‘understanding others’ states’ was least examined. Behavioural regulation commonly captured ‘intrinsically initiated action’ but less often ‘extrinsically prompted inhibition.’ Emotional regulation was the most comprehensively assessed, with at least 14 measures covering its components. No single measure fully captured all self-regulation components, although the Emotional Competence Assessment Questionnaire emerged as the most comprehensive. This review highlights the need for a “gold standard” tool that addresses all components of self-regulation, along with further research to refine its conceptualisation and assessment.

There is a growing need to examine how Theory of Mind (ToM) abilities impact real‐time social engagement in autistic children. Caregivers of 45 young autistic children (70.7 ± 23.3 months) and those of 36 neurotypical peers (59.2 ± 11.8 months) carried a mobile device for 7 days to repeatedly record their child's social interactions and in‐the‐moment anxiety. They also completed the Social Responsiveness Scale‐2 and the Theory of Mind Inventory‐2 to evaluate their child's severity of autistic symptoms and ToM abilities. Multilevel analyses found that young autistic children with higher ToM abilities were more likely than those with lower abilities to interact with peers (OR = 1.12, 95% CI = 1.01–1.23) but also experienced more anxiety during interactions with both peers and adults (OR = 1.36, 1.28, 95% CI = 1.12–1.67, 1.01–1.63). In contrast, no significant associations between ToM and social interactions or anxiety were found in the neurotypical group. This study highlights the critical role of ToM abilities in the real‐life social engagement of autistic children and emphasizes the importance of understanding real‐time subjective social experiences.

Occupational therapists recognize parenting as within their scope; however, little is known about how this translates to practice with adult clients with disabilities or other challenges. We sought to describe contemporary global occupational therapy practice for parenting with adult clients, including assessment and interventions. A cross-sectional e-survey designed for the study was implemented in eight languages. Participants were recruited using convenience sampling. Responses were received from 1,357 occupational therapists across 42 countries. Of these, 43.1% ( n = 586) frequently ask their clients who are parents about parenting roles and occupations, while 34.2% ( n = 465) frequently or very frequently address parenting concerns. Assessments typically relied on informal approaches or the use of broad measures of occupational performance. The most frequently reported parenting intervention was the provision of education and training in parenting skills. Occupational therapy practice for parenting remains underdeveloped, with limited evidence of comprehensive occupational therapy assessment or intervention.

Individuals who cope well with challenges may engage in social situations more successfully. We examined the association between coping behaviors, self-perceived competence, and social anxiety in everyday social situations. A total of 133 participants between the ages of 10 and 16 years (82 autistic, 51 neurotypical) carried a mobile device that prompted them seven times each day for 7 days to record what they were doing and their perceived competence and social anxiety in that situation. We used the Coping Inventory to measure overall coping abilities (i.e. coping with the self and the environment). Multilevel analyses found that autistic adolescents were more likely than neurotypical peers to experience social anxiety while engaged in maintenance or productive activities with adults. While their ability to cope with the self was positively associated with perceived social competence, it was negatively associated with the ability to cope with environmental challenges. Furthermore, autistic adolescents with poor ability to cope with environmental challenges were more likely than those who coped well to be socially anxious when engaged in leisure activities with peers. Findings from this study can guide evaluation and intervention to improve the social experiences of autistic adolescents by helping them increase coping skills. Lay Individuals who cope well with challenges may engage in social situations more successfully. We examined how well autistic adolescents coped, depending on how competent they felt and how much anxiety they experienced during social activities. We included 133 individuals (82 autistic, 51 neurotypical) between the ages of 10 and 16 years. Participants carried a mobile device that prompted them seven times a day for 7 days to record what they were doing, how competent they felt and how much anxiety they experienced. We used the Coping Inventory to understand how well participants coped with environmental challenges and met their needs for growth. Autistic adolescents were more likely than neurotypical peers to feel anxious while doing activities with adults. Autistic adolescents who had more difficulty coping with challenges were more likely to feel anxious when doing leisure activities with peers. Interestingly, autistic adolescents who coped better with challenges tended to feel less competent in social situations. However, those better able to meet their needs for growth tended to perceive their social competence positively. These findings can help practitioners develop strategies and programs to reduce the negative social experiences of autistic adolescents by helping them cope better.

Background: Children with attention-deficit hyperactivity disorder (ADHD) experience substantial difficulty maintaining meaningful friendships, which has implications for social functioning and mental health. No systematic review has investigated their friendship difficulties. Objectives: To systematically review and methodologically appraise the quality of existing studies reporting on friendships of children with ADHD. To compare their friendships to typically-developing children, and examine associations between friendship and children’s social-emotional wellbeing and mental health. Method: Six databases were searched. The methodological quality of studies was assessed using the QualSyst appraisal tool and the Appraisal tool for Cross-Sectional Studies. Aspects of friendships measured were charted, along with comparisons between children with ADHD and typically-developing children and the associations between friendships and social-emotional wellbeing and mental health. Results: Twenty-three cross-sectional studies and one longitudinal follow-up study were included. Studies included 1509 participants with ADHD, with 1197 typically-developing participants used as a companion in 19 of the 24 studies. Friendship quantity was the most investigated aspect of friendship. Children and youth with ADHD had significantly fewer friends, lower quality friendships and poorer friendship interactions. There were mixed findings from studies investigating the role or impact of friendship on social-emotional wellbeing and mental health. Twenty-two had strong methodological quality. Conclusion: Limited longitudinal studies, small sample sizes and variability in measurement restrict the interpretations of friendship over time and the causal impact of friendship on social and emotional outcomes. Further research should investigate the role and impact of friendships on the social-emotional wellbeing of children and youth with ADHD.