As children with autism spectrum disorder become adults, social participation continues to be an area of need. Within creative arts, there is a growing body of literature about the use of theatre arts, improvisational theatre, and improvisational techniques as a way to address social participation for individuals with autism spectrum disorder. The purpose of this article is to discuss current literature related to the use of improvisation for individuals with ASD and how improvisation techniques can address social participation within occupational therapy practice. Recommendations for research-based strategies using improvisational theatre are described for occupational therapy practice in various contexts, as well as future areas of research.