Effect of MOHO-based occupational therapy techniques on stress, anxiety, depression, self-esteem, and occupational performance among mothers of children with autism spectrum disorder

Background: Caring for a child with autism spectrum disorder (ASD) places mothers at heightened risk of stress, anxiety, depression, diminished self-esteem, and impaired occupational performance. The Model of Human Occupation (MOHO) offers a holistic, client-centered framework that promotes well-being through meaningful occupational engagement. Objectives: This study evaluated the effectiveness of MOHO-based occupational therapy techniques in reducing stress, anxiety, and depression while improving self-esteem and occupational performance among mothers of children with ASD. Materials and methods: In this randomized controlled trial, 107 mothers of children with ASD were recruited from six rehabilitation centers in Chennai after screening 246 candidates. Participants were randomly allocated to an experimental group (N=54) or control group (N=53). Outcomes were assessed using the Depression Anxiety Stress Scales (DASS-21), Model of Human Occupation Screening Tool (MOHOST), and Rosenberg Self-Esteem Scale (RSES) before and after the 12-week intervention. The experimental group received 36 sessions (three 45-minute sessions weekly) of structured MOHO-based techniques targeting volition, habituation, and performance capacity. The control group attended a parental education program. Data were analyzed with SPSS version 23.0 using paired and independent t-tests. Results: Both groups showed significant within-group improvements; however, the experimental group showed markedly greater gains across all variables (p<0.001). Between-group comparisons confirmed significantly superior post-intervention outcomes in the experimental group (p<0.001). Conclusion: MOHO-based interventions proved highly effective in enhancing occupational performance and self-esteem while reducing psychological distress. These findings support the integration of MOHO approaches into caregiver support programs for mothers of children with ASD.