Lifestyle Documentation in Therapy Evaluations for Autistic Children: A Lexicon-Based Analysis of Electronic Health Records

Background Whole person health (WPH) is a multidimensional construct encompassing, physical, and mental health along with relational constructs such as social health that are deeply tied to well-being. Autistic individuals report an overall lower quality of life, but the extent to which these issues are addressed during therapy evaluations has not been examined systematically. Methodology In this retrospective, cross-sectional study, we employ a rule-based NLP/lexicon-based approach to examine the areas of focus of therapy evaluations documented by occupational therapy, physical therapy (PT), and speech-language pathology (SLP) professionals. Using electronic health records for children aged 2 to 18 diagnosed with autism spectrum disorder (ASD) (n = 5619 evaluation reports of n = 2021 unique patients), we classified health records based on the domains addressed. Results Across notes, nutrition had the highest average degree of documentation ( M = 2.14), compared to activity ( M = 0.91), followed by wellness ( M = 0.66), and sleep ( M = 0.39). In occupational therapy, wellness was the most common (77.62% of notes), followed by physical activity (76.49% of notes), nutrition management (73.33% of notes), and sleep (34.97% of notes). The overall area under the curve (AUC) from the receiver operating characteristic analysis is 0.89. Conclusions While it is encouraging that most evaluations addressed nutrition or physical activity, the near absence of attention to sleep represents a critical gap in care. Given sleep's foundational role in overall health and daily functioning, its omission is particularly concerning. Occupational therapists and interdisciplinary rehabilitation teams should more deliberately integrate WPH frameworks into their evaluations.