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A Review of Sensory Integration Therapy as a Treatment For Autism . Elizabeth Kraljic Evelyn Agrusti Joanne Tasy Caldwell College Graduate Program In Applied Behavioral Analysis . What Is Sensory Integration?. Founder of Sensory Integration Theory: A. Jean Ayres Ph.D, OTR, FAOTA

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a review of sensory integration therapy as a treatment for autism

A Review of Sensory Integration Therapy as a Treatment For Autism

Elizabeth Kraljic

Evelyn Agrusti

Joanne Tasy

Caldwell College Graduate Program In Applied Behavioral Analysis

what is sensory integration
What Is Sensory Integration?
  • Founder of Sensory Integration Theory:
    • A. Jean Ayres Ph.D, OTR, FAOTA
      • Credited with having first identified sensory integrative dysfunction.
      • Author of three major standardized tests.
      • Occupational therapy’s foremost leader in theory development
a jean ayres
A. Jean Ayres
  • Other Accomplishments:
    • Educator at University of Southern California 1955-1984
    • Wrote books, journal articles, and training videos
    • Founder of Sensory Integration International
    • Licensed Psychologist
  • Credentials
    • BS and MA in Occupational Therapy
    • Ph.D in Educational Psychology
    • Post-Doctoral Traineeship at UCLA Brain Research Institute
a jean ayres and theory of sensory integration
A. Jean Ayres and Theory of Sensory Integration
  • Systematically investigated the brains processing of sensory information
  • She developed a theory to explain the relationship between the behavior and brain functioning
  • Sensory Integration:
    • A Neurobiological process that organizes sensations from one’s own body and environment and makes it possible to use the body effectively within that environment.
what is sensory integration5
What is Sensory Integration
  • The senses are the primary building blocks of the central nervous system
    • External senses-all five senses
    • Internal senses
      • Tactile System- sense of touch through skin
      • Vesticular System- balance and weight
      • Proprioceptive System- sensory data from tendons, muscles and joints
    • The three systems are interconnected but are also connected with other systems in the brain
      • Critical for basic survival
      • Allow us to experience, interpret and respond to different stimuli in the environment.
continued
…Continued
  • Sensory impact nourishes the brain
    • Raw material for brain development and learning
  • Sensory stimulation produces “ brain tone” which is responsible for basic brain waves of the conscious state
  • They provide the input that stimulates the Reticular Activation System of the brainstem to arousal
    • Regulates alertness, coordination, focus, and the regulation of input and output
slide7
Multi-various sensations
    • Stimulated simultaneously, and must be organized quickly and accurately
  • Sensory Integration (S.I.)
    • Provides the foundation for complex learning and behavior.
      • All skills are complex processes based on a strong foundation of sensory integration
  • S.I. is information processing.
    • Praxis and perception are the resulting products.
theory of s i
Theory Of S.I.
  • Sensory Integration is an automatic process.
    • Natural outcomes include:
      • Motor planning
      • Adaptive ability to incoming sensations
    • When S.I. does not efficiently the process is disordered
      • Learning problems
      • Developmental lags
      • Behavioral or emotional issues
continued9
…Continued
  • The young brain is malleable
    • Structure and function become set with age
      • Formative- allows person- environment interaction to promote and enhance neuro-integrative efficiency
      • A deficiency in effective interaction at critical periods interferes with optimal brain development and overall brain ability
    • Early detection and therapeutic interaction can enhance individual opportunity for normal development
signs of sensory integrative dysfunction
Signs of Sensory Integrative Dysfunction
  • Sensory Integration focus’s on three basic senses or systems:
    • Tactile, Vesticular, and proprioceptive
      • Tactile System- nerves under skin that send information to brain (light touch, pain, temperature, and pressure)
        • Important for perceiving environment and for protective reactions for survival
      • Dysfunctions:
        • Withdrawal from touch
        • Food texture avoidance
        • Sensitivity to types of clothing
        • Reaction to washing face or hair
slide11
Dysfunctions continued:
    • Avoiding getting hands dirty (glue, sand, mud, paint)
    • Using fingertips rather than full hand
    • Misperception of touch or pain (hypo or hyper sensitivity)
    • Self imposed isolation, irritability, distractibility and hyperactivity
  • Tactile Defensiveness:
    • Is a condition where individuals are extremely sensitive to light touch.
    • Abnormal signals to the cortex in the brain interfere with other brain processes.
sensory integration dysfunction
Sensory Integration Dysfunction
  • Vestibular System
    • Refers to structure within the inner ear called the semi-circular canals. These structures detect movement and the position of the head.
  • Dysfunction-Hypersensitivity
    • Hypersensitive to vestibular stimulation and have fearful reactions to ordinary movement. They may have trouble learning to climb or descend stairs or hills. They may be apprehensive walking or crawling on uneven or unstable surfaces.
  • Dysfunction- Hypo-Reactive Vestibular System:
    • Actively seeks very intense sensory experiences.
      • Whirling, jumping, spinning
slide13
Proprioceptive System:
    • Components of muscles, joints, and tendons that provide the subconscious awareness of body position.
    • Praxis or motor planning
      • The ability to plan and execute different motor tasks
    • Dysfunction
      • Clumsiness,tendency to fall, lack of body position in space, odd body posturing, difficulty manipulating small objects, eating in a sloppy manner, resistance to new motor movement activities
s i d implications
S.I.D. Implications
  • Implications:
    • Dysfunction in the three previously mentioned systems can be manifested in many ways.
      • Over or under responsiveness to sensory input
      • Deficiencies in gross and fine motor coordination, speech/language delays and learning issues
      • Behaviorally, the child is frequently impulsive, easily distractible, and shows a general lack of planning.
      • Tendency towards difficulty in adjusting to new situations, easily frustrated, aggressive, or withdrawn
s i d resulting problems
S.I.D. Resulting Problems
  • Attention and Regulatory:
    • The ability to attend to a task depends on screening out nonessential sensory information, background noises, or visual information.
    • Can produce distractibility, hyperactivity, or uninhibited output.
  • Sensory Defensiveness:
    • Individual has highly aroused nervous system, which prepares the body for survival.
    • Individual does not recognize input as non threatening
continued16
…Continued
  • Activity Level:
    • The child may appear disorganized or lacking purpose in their activity
    • Does not explore the environment or lacks variety in play activities
    • May appear clumsy or have poor balance
  • Behavior:
    • The child exhibit negative behaviors
    • They lack flexibility, may be explosive, or have difficulty transitioning
  • Sensory Modulation:
    • The child’s inability to regulate sensory input and maintain a situation-appropriate state.
patterns of s i d
Patterns of S.I.D.
  • Research identified factors that highly correlate with each other,
    • Patterns of sensory integration dysfunction examples:
      • Visual construction and praxis deficits, and Tactile discrimination and praxis
      • Developmental coordination disorder (fine and gross motor, balance, and coordination deficits)
      • Developmental regulatory disorder
        • Under, over, or fluctuating response to sensations
evaluating s i d
Evaluating S.I.D.
  • Assessment-- First step of the treatment process
    • Individualized- Identify the specific learning motor and behavior difficulty of a child
    • Tests, observations, interviews of neuromotor function and sensory modulation abilities
  • Standardized Tests: Ayres developed seventeen standardized tests and many non standardized observations to identify and understand the multiple patterns of S.I.D. Her tests and others are currently used to test for sensory issues.
evaluation continued
Evaluation continued
  • Examples:
    • Sensory Integration and Praxis Tests (SIPT) for children 4-8 years and 11 months
    • Test for Sensory Integration (TSI) for children 3-5 years of age
    • Bruininks Osteretsky Test for Motor Proficiency for ages 5-15 years
    • Peeramid ages 6-14
evaluating s i d20
Evaluating S.I.D.
  • Evaluation and treatment of the basic sensory integrative processes is preformed by trained SI occupational therapists and or physical therapists or speech and language pathologists
    • Goals
      • Provide the child with sensory information which helps organize the central nervous system
      • Assist the child in inhibiting and or modulating sensory input
      • Assist the child in processing a more organized response to sensory stimuli
validation of s i treatment
Validation of S.I. Treatment
  • In 2002 occupational therapy experts defined the core principles of sensory integration as used in professional practice such as occupational therapy.
  • This was done to validate methods reported as sensory integration in research.
  • These principles are deemed essential to providing sensory integration intervention
intervention principles based on sensory integration theory
Intervention Principles Based on Sensory Integration Theory
  • Qualified professional, occupational therapist, physical therapist or speech and language pathologist.
  • Intervention plan is family-centered, based on a complete assessment and interpretation based on the patterns of sensory integrative dysfunction, collaboration with significant people in the individual’s life, adherence to ethical and professional standards of practice.
slide23
Safe environment that includes equipment that will provide vestibular, proprioceptive and tactile sensations and opportunities for praxis.
  • Activities rich in sensation especially those that provide vestibular, tactile and proprioceptive sensations and opportunities for integrating that information with other sensations such as visual and auditory.
  • Activities that promote regulation of affect and alertness and provide the basis for attending to salient learning opportunities.
slide24
Activities that promote optimal postural control in the body, oral-motor, ocular motor areas and bilateral motor control sustaining control while holding against gravity and maintaining control while moving through space.
  • Activities that promote praxis including organization of activities and self in time and space.
  • Intervention strategies that provide the “just-right challenge”
slide25
Opportunities for the client to make adaptive responses to changing and increasingly complex environmental demands. Highlighted in Ayres Sensory Integration  intervention principles is the “Somato-motor adaptive response” which means that the individual is adaptive with the whole body, moving and interacting with people and things in the 3-dimensional space.
  • Intrinsic motivation and drive to interact through pleasurable activities, in other words, play.
slide26
Therapist engenders an atmosphere of trust and respect through contingent interactions with the client. That is the activities are negotiated, not pre-planned, and the therapist is responsive to altering the task, interaction and environment based on the client’s responses.
  • The activities are their own reward and the therapist ensures the child’s success in whatever activities are attempted by altering them to meet the child’s abilities.
guidelines for competency in application of s i theory
Guidelines for Competency in Application of S.I. Theory
  • Restricted to professionals qualified occupational therapists, physical therapists, speech and language pathologists
  • Competencies developed through post graduate continuing education, mentoring in clinical experience
  • Advanced training is through the same means
  • Certification in S.I. should include administering and interpreting the Sensory Integration and Praxis Tests (SIPT) when used in O.T.
maintaining competency
Maintaining Competency
  • Applying clinical application of S.I. for a maximum of two years
  • Mentorship through supervision and professional guidance by a therapist certified in S.I.
  • Ongoing study and review of literature
  • Ongoing feedback from professional peers as a check and balance for best practice.
maintaining competency29
Maintaining Competency
  • Essential Knowledge for Occupational Therapist’s using Sensory Integration
    • Sensory Integration Theory
    • Assessment of Sensory Integration and Praxis
    • Interpretation of Assessment Data for Intervention Planning
    • Occupational Therapy Intervention using Sensory Integration Strategies.
part ii
Part II:

TREATMENTS

&

SPECIFIC

BEHAVIORS

3 keys to treatment

3 Keys to Treatment

Frequency

2. Duration

3. Intensity

sensory diet
Sensory Diet
  • Is a specifically designed plan of biochemical and neurological input to promote and facilitate function
biochemical
Biochemical
  • Consists of two components
  • 1. Sleep
  • 2. Nutrition
neurological
Neurological

Consists of 3 things:

  • 1. Vestibular
  • 2. Proprioceptive
  • 3. Tactile
    • Auditory
    • Visual
vestibular system
Vestibular System
  • The sensory system that responds to changes in head position and to body movement through space.
  • It coordinates movements of the head, body, and eyes
  • The receptors are in the inner ear
vestibular activities
Vestibular Activities*
  • Hokey Pokey with “big” movements
  • Head, Shoulders, Knees and Toes
  • Dancing (with head and trunk movement)
  • Sit ‘n’ Spin
  • Rolling
  • Rocking Chair
proprioceptive system
Proprioceptive System
  • Unconscious awareness of sensation coming through the muscles, joints, and tendons that tells you what position you are in
proprioceptive activities
Proprioceptive Activities
  • Stair climbing and/or sliding
  • Playing tug of war
  • Pulling or Pushing
  • Big Ball activities
  • Being squished between pillows
  • Scooter activities
  • Hitting a punching bag
tactile system
Tactile System
  • The sensory system that receives sensations of pressure, vibration, movement, pain, and temperature through connections in the skin
  • This system helps to tell the difference between threatening and non-threatenting sensations
tactile activities
Tactile Activities
  • Finger painting
  • Making things with foam soap
  • Clay/Play-Doh/Putty
  • Walking on the grass with no shoes
  • “swim” and “dry off” with towel
  • Texture adventure bins
  • Lotions
  • Glue projects
sensory seeking behaviors

Sensory Seeking Behaviors

Running, Spinning, or other movements

Provides vestibular and proprioceptive stimulation

Treatments to try:

Movement games like tag or relay races

Bouncing on large therapy balls

Rocking chair

Jumping

more sensory seeking behaviors
More Sensory Seeking Behaviors
  • Pinching, Squeezing, or Grabbing
    • A students hand may be extremely sensitive compared to other body parts and sensory input in the palm may help to override the painful response to a light touch
      • Treatments to try:
        • Deep pressure massages
        • Hand massages or pressing hands together
        • Wristbands that provide pressure
        • Vibration toys
more sensory seeking behaviors43
More Sensory Seeking Behaviors
  • Flapping
    • This movement of the body’s joints and muscles provides proprioceptive sensation to the muscles and joints in the wrists, arms, and shoulders. (could signal sensory overload)
    • Treatments to try:
      • Wheelbarrow walks
      • Push-ups
      • Jumps with hands being held
      • Fidget toy
more sensory seeking behaviors44
More Sensory Seeking Behaviors
  • Pica (mouthing or eating non-food substances)
  • Provides strong tactile and proprioceptive input for a child who is not registering the sensation. It could also transmit vibration to the jaw which can stimulate the vestibular system
    • Treatments to try:
      • Vibrating toys for the mouth
      • Crunchy foods throughout the day
      • Listerine to be swabbed inside the child’s mouth*
        • *with parental permission
sensory avoidant behaviors
Sensory Avoidant Behaviors
  • Takes off clothing
    • Clue to the fact that the clothing’s touch is uncomfortable to the child’s skin
  • Treatments to try:
      • Calming techniques
      • Soft fabrics
      • Washing new clothes several times before use
      • Allow child to choose their clothes
more sensory avoidant behaviors
More Sensory Avoidant Behaviors
  • Avoids eye contact
  • Peripheral vision could be less stressful or processing visual and auditory input could be difficult, looking away allows the child to process the auditory input better
    • Treatments to try:
      • Look into a mirror and gradually increase to someone’s eyes
      • Teach a child body positions that indicate listening
        • Using quiet hands
more sensory avoidant behaviors47
More Sensory Avoidant Behaviors
  • Avoids handling sensory material
  • This is a common sign of tactile defensiveness because the hands have a lot of touch receptors. Also, the temperature and wetness affect the child’s tolerance.
    • Treatments to try:
      • Deep pressure touching
      • Weighted lap bag or vest
      • Massaging hands before the sensitive material is handled
calming techniques
Calming Techniques
  • These are especially helpful for children with sensory defensiveness.
  • They help to relax the nervous system
  • They can reduce exaggerated responses to sensory input
  • Techniques:
    • Help with heavy work
    • Ripping paper
    • Joint compression
    • Lap “snake”
    • Lavender, vanilla, or banana scents
    • Reduced noise or light levels
    • Sucking through a straw
    • Bear hugs
organizing techniques
Organizing Techniques
  • Can help a child who is either over or under reactive become more focused and attentive
  • Techniques:
    • Hard candy
    • Catching/throwing heavy balls
    • Pulling apart toys (Legos, etc)
    • Adding rhythm to the activity
altering techniques
Altering Techniques
  • Help a child who is under reactive to sensory input
  • Need to be closely monitored
  • Techniques:
    • Jump up & down (10x)
    • The Airplane Activity (hand out)
    • Fast swinging
    • Quick unpredictable movements
    • Running games
    • Loud, fast music
part 3

Part 3

Evelyn Agrusti

sensory integration therapy and insurance
Sensory Integration Therapy and Insurance
  • Many Insurance companies will not pay for Sensory Integration Therapy (SIT)
  • Aetna, Empire BC/BS, and Healthlink consider “sensory and auditory integration therapies experimental and investigational for the management of persons with various communication, behavioral, emotional, and learning disorders and for all other indications. The effectiveness of these therapies is unproven.”

(Aetna, 2007; Empire BC/BS, 2006; Healthlink,2007 )

sit is experimental and unproven
SIT is Experimental and Unproven
  • Aetna references numerous studies that support their view on sensory integration
    • National Initiative for Autism (UK) (2003)
    • Kaplan et al. (1993)
    • Hoehn and Baumeister (1994)
    • National Academy of Sciences (NAS) (2001)
    • American Association of Pediatrics (2001)
    • Tochel (2003)
    • Vargas and Camilli (1999)
    • Parham et al. (2007)
    • Parr, (2006)

(Aetna, 2007)

investigational and not medically necessary
Cognitive rehabilitation

Elimination diets (e.g., gluten and milk elimination)

Facilitated communication

Immune globulin infusion

Lovaas therapy (also known as applied behavior analysis (ABA), intensive behavioral intervention (IBI), discrete trial training, early intensive behavioral intervention (EIBI), or intensive intervention programs)

Music therapy, pet therapy (e.g., Hippotherapy)

Nutritional supplements (e.g., megavitamins)

Secretin infusion

Sensory integration therapy

Vision therapy

Investigational and Not Medically Necessary

(Anthem BC/ BS, 2008)

a loop hole
A LOOP HOLE?
  • Current ICD diagnostic manual and DSM-IV:
    • no recognized procedural codes for Sensory Processing Disorder (Sensory Integration Dysfunction, Dysfunction of Sensory Integration.)
  • SPD of the Bay Area tells people: “The child must be billed with a diagnosis other than Sensory Processing Disorder or Autism.”
    • 315.4 coordination disorder
    • 728.9 disorder of muscle ligament/muscle hypotonicity
    • 781.3 motor incoordination
    • 781.92 abnormal posture

(http://www.spdbayarea.org/SPD_diagnosis.htm)

make your own manual
Make Your Own Manual

The Psychodynamic Diagnostic Manual (PDM) (2006)

  • Psychoanalytic groups involved:
    • American Psychoanalytic Association
    • International Psychoanalytical Association
    • Division of Psychoanalysis (39) of the American Psychological Association
    • American Academy of Psychoanalysis and Dynamic Psychiatry
    • National Membership Committee on Psychoanalysis in Clinical Social Work
  • Developmental Disorders include:
      • SCA321. Regulatory Disorders
      • IEC200 Series - Regulatory-Sensory Processing Disorders (RSPD)

(http://www.pdm1.org/toc.htm)

sensory processing disorder
Sensory Processing Disorder
  • Recognized in the new Diagnostic Manual for Infancy and Early Childhood (DMIC)
  • The formal diagnostic category is "Regulatory Sensory Processing Disorder," (code #200). http://www.spdbayarea.org/SPD_diagnostic_codes.pdf
  • Published by Interdisciplinary Council on Developmental and Learning Disorders (ICDL) in 2005.
  • Dr. Stanley I. Greenspan is Chair of ICDL.

(http://www.spdbayarea.org/SPD_diagnosis.htm)

false claims of recovery
False Claims of Recovery
  • SPD Bay Area Resource Group: “Hope and Recovery!”
    • “In our international SPD Parent Resource Network, we believe and have experienced that recovering children from Sensory Processing Disorder is absolutely possible!”
  • “Parents in our Groups use a variety of occupational, medical,auditory,homeopathic and other alternative therapies that help a child recover from Sensory Processing Disorder.”

(http://www.spdbayarea.org/)

research on sensory integration theory sit
Research on Sensory Integration Theory (SIT)
  • As of 2007, only 3 published studies existed that used methods consistent with Ayres‘s sensory integration therapy that included people with ASD
    • Ayres and Tickle (1980)
    • Linderman and Stewart (1999)
    • Case-Smith and Bryan (1999)

(Watling & Dietz, 2007)

ayres and tickle 1980
Ayres and Tickle (1980)
  • Purpose: explore variables that predict positive or negative outcomes after 1-yr of SIT
  • Participants: 10 children (mean age of 7.4 yrs)
  • Participants with ASD who had average or hyper-responsive reactions to tactile and vestibular sensations showed better outcomes than those with hypo-responsive patterns
    • After 11 months of Ayres's sensory integration reported improvements in interaction, initiation, environmental awareness, and activity selection

(Baranek, 2002; Watling & Dietz, 2007)

ayres and tickle 198061
Ayres and Tickle (1980)
  • Researchers suggest that differences in outcomes may be due to specific subject attributes including patterns of sensory processing.
  • Limitations:
    • Small sample size (10 children)
    • variability of the outcome measures used
    • lack of control over maturational effects
    • No control group (within group design)

(Baranek, 2002)

linderman and stewart 1999
Linderman and Stewart (1999)
  • Purpose: Track functional behavioral changes in the home associated with SIT
  • Participants: 2 children (3 yrs) with PDD (mild autism)
  • Method: therapy in clinic for 1 hr/wk for 7 to 11 wks
  • Results:
    • Subject 1 (tactile hypersensitivity) demonstrated gains in all intended outcomes:
      • social interaction, response to movement, approach to new activities, and response to holding and hugging
    • Subject 2 (hypo-responsive to vestibular and hyper-responsive to tactile) made gains in activity level and social interaction, but not in functional communication

(Baranek, 2002; Watling & Dietz, 2007)

linderman and stewart 199963
Linderman and Stewart (1999)
  • Limitations:
    • No control group (single- subject design)
    • Small sample size (only 2 participants)
    • Confounding variables:
      • Other possible interventions (e.g. education)
      • Maturation of participants
      • Parent participation in evaluation procedures

(Baranek, 2002)

case smith and bryan 1999
Case-Smith and Bryan (1999)
  • Purpose: to examine affect SIT has on play and interaction with others
  • Participants: 5 preschool boys with ASD
  • Method: 3-week baseline and 10-week Ayres's sensory integration
  • Results:
    • 3 boys had significant improvements in mastery play
    • 4 boys had less “nonengaged” play
    • 1 boy had improvements with adult interactions
    • None changed in level of peer interactions

(Baranek, 2002; Watling & Dietz, 2007)

)

case smith and bryan 199965
Case-Smith and Bryan (1999)
  • Limitations:
    • Results could have been a product of other confounding variables
      • (e.g., maturation, caregiving effects, other interventions)
    • Sensory processing variables could not be assessed directly, so it is not known if positive results are due to improvements in sensory processing mechanisms
    • Improvements could also have resulted from other components of intervention
      • (e.g., play coaching, motivational strategies)
watling dietz 2007
Watling & Dietz (2007)
  • Purpose
    • to examine the effectiveness of Ayres's sensory integration compared to a play scenario for (a) reducing undesirable behaviors and (b) increasing engagement in purposeful activities for young children with ASD.
  • Method
    • single-subject study
    • ABAB design to compare the immediate effect of SIT and a play scenario on the undesired behavior and task engagement of 4 children with ASD.
    • Familiarity phase also included to reduce effect of novelty of dependent variables and therapists
    • This study had three phases: familiarization, baseline, and treatment. Each phase of the study included three 40-min intervention sessions per week followed by a 10-min tabletop activity segment that served as the data collection period.
watling dietz 200767
Watling & Dietz (2007)
  • The research questions
    • Does participation in Ayres's sensory integration immediately before tabletop tasks affect the occurrence of undesired behaviors during the tabletop activities
    • Does participation in Ayres's sensory integration immediately before tabletop tasks affect engagement in tabletop activities?
  • Tabletop paradigm
    • frequently encountered by children in education setting
    • Provided standardized environment for data collection
watling dietz 200768
Watling & Dietz (2007)
  • Materials for the treatment phases included items that commonly are used in Ayres's sensory integration
    • suspended equipment such as swings, trapeze bar, and rope ladder;
    • a small trampoline
    • scooterboard and ramp
    • plastic rings
    • Tunnel
    • balance beam
    • toys with various textures
    • toys that challenge bilateral coordination and manipulation skills
watling dietz 200769
Watling & Dietz (2007)
  • Tabletop activities had to meet 2 criteria
    • (a) the activity demands matched the cognitive and fine motor skills of the child
    • (b) the activity had the tendency to elicit focused attention and purposeful engagement.
    • Examples of activities were puzzles, stickers, figurines, beads and string, and blocks. None of the toys used in the tabletop segments were the same as those used in baseline or treatment sessions for any child.
watling dietz 200770
Watling & Dietz (2007)
  • Undesired behavior was defined as those behaviors that interfere with task engagement and participation in daily activities
    • Identified through caregiver report and observation by the primary investigator during the familiarity period of the study
    • For 42% of data collection forms, interobserver agreement for undesired behavior was calculated using the point-by-point method (Kazdin, 1982)
    • Agreement for undesired behavior ranged from 85% to 100% (mean of 91%)
watling dietz 200771
Watling & Dietz (2007)
  • Engaged behavior was defined as intentional, persistent, active, and focused interaction with the environment, including people and objects.
    • did not require typical use of the tabletop materials to capture all interactions that held meaning for each child.
    • Engaged behavior: object was used in a manner that was clearly playful or imaginative and that appeared to have meaning to the child.
      • For example: when a child used a marker to color on his hand and directed his gaze toward his coloring, his behavior was coded as engaged.
      • When a child bit or chewed on a marker while looking across the room, his behavior was coded as not engaged.

Interobserver Agreements for engagement ranged from 81% to 100% (mean of 95%).

watling dietz 200772
Watling & Dietz (2007)
  • Results
    • No clear patterns of change in undesired behavior or task management emerged through objective measurement.
    • Subjective data suggested that each child exhibited positive changes during and after intervention.
  • Conclusion
    • immediately after intervention, short-term Ayres's sensory integration does not have a substantially different effect than a play scenario on undesired behavior or engagement of young children with ASD.
    • subjective data suggest that Ayres's sensory integration may produce an effect that is evident during treatment sessions and in home environments.
research
Research
  • More studies examining SIT for children with ASD are needed.
  • Conclusions regarding the effectiveness of the intervention cannot be drawn.
  • Well-controlled studies with relevant and reliable outcome measures are needed to expand knowledge of the effectiveness of Ayres's sensory integration. (Dawson & Watling, 2000; Goldstein, 2000)
  • Ayres's sensory integration remains under development and efficacy studies should include "well-controlled single-subject design experiments with a few subjects" (Goldstein, 2000)
possible benefit
Possible Benefit
  • “Although therapies do not appear to work as intended, there is some evidence that they serve as reinforcement (Mason & Iwata, 1990), and they may have other benefits, such as promoting healthy and physical exercise.”
  • (Jacobson, Foxx, and Mulick,2005)
temple university study 2007
Temple University Study (2007)
  • Pfieffer & Kinnealey from OT Dept in Temple Uniersity’s College of Health Professions
  • American Occupational Therapy Association’s 2008 conference
    • Children with ASD who underwent SIT exhibited fewer autistic mannerisms compared to children who received standard treatments.
    • 71 percent of parents who pursued alternatives to traditional treatment used sensory integration methods
    • 91 percent found these methods helpful.

(http://www.temple.edu/newsroom/2007_2008/04/stories/aota.htm)

temple university study 200776
Temple University Study (2007)
  • Participants and setting
    • summer camp near Allentown, Pa., for children with autism.
    • Participants were between the ages of 6 and 12 years old and diagnosed with autism or PDD-NOS.
  • Method
    • One group (17) received traditional fine motor therapy and the other group (20) received sensory integration therapy.
    • Each child received 18 treatment sessions over a period of six weeks.
    • A statistician randomly assigned the participants to groups; this information was provided to the project coordinator at the site.
    • Primary researchers were blinded to group assignment and served as evaluators before and after the study.
    • Parents were blinded to the interventions assigned and were not on site.
temple university study 200777
Temple University Study (2007)
  • Results
    • Researchers used a series of scales that measure behavior.
    • While both groups showed significant improvements, the children in the sensory integration group showed more progress in specific areas at the end of the study.
  • Conclusion
    • Sensory integration intervention group:
      • reached more goals specified by their parents and therapists
      • Progressed toward goals in areas of:
        • sensory processing/regulation
        • social-emotional and functional motor tasks.
temple university study 200778
Temple University Study (2007)
  • Need for research such as randomized control trials to validate sensory integration
  • Provided a foundation for designing randomized control trials for sensory integration interventions with larger sample sizes in the future
  • It identified issues with measurement such as the sensitivity of evaluation tools to measure changes in this population
  • Develop accurate ways of measuring sensorimotor abilities before and after treatment to evaluate the therapy’s outcome with scientific quantitative data.
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