Written by:
Kristina Gasiewski, MOTR/L, M.Ed., BCBA
Melmark

Description:

Autism Treatments SummaryWeighted vests are a Sensory Based Intervention (SBI) often used by occupational therapists and educators to target problem behaviors (e.g., inattentiveness or repetitive/stereotypical behaviors that interfere with an individual’s ability to engage in on-task behavior). The weighted vest is intended to help the individual modulate their sensory processing needs and produce a calming and organizing effect by providing deep pressure (Morrison, 2007; Olson & Moulton, 2004; Stephenson & Carter, 2009; Taylor et al., 2017).

The weighted vest is a garment that evenly distributes weight. It generally is 10% of one’s own body weight (Taylor et al., 2017; Olson & Moulton, 2004); however, there is not an exact protocol, as this varies in both research and clinical studies. In research, there are studies reporting the use of vests that are between 4% – 10% of a person’s body weight (Stephenson & Carter, 2009; Tam et al., 2023). Additional conventions include instructions that the weighted vest should be worn on a schedule to avoid habituation, but the set amount of wear time is also not consistent through the literature (i.e., 10-30 minutes or more per trial; Taylor et al., 2017). Specific parameters regarding frequency and duration of vest wearing are not currently available and vary across the literature.

Research Summary:

In general, the literature has historically lumped SBIs into one broad classification of sensory integration (e.g., sensory diets, therapy balls, Wilbarger brushing protocol). Watling and Hauer (2015) completed a systematic review concluding mixed results for SBIs overall. It was further discussed that SBIs for children with autism have limited or inconclusive empirical evidence and should be utilized with caution (Thompson-Hodgetts & Magill-Evans, 2018; Watling & Hauer, 2015).

Regarding weighted vests, Watling and Hauer (2015) noted that the evidence does not support the use of weighted vests for children with autism due to the limited use of rigorous research designs and study results that do not indicate positive outcomes. Additionally, Bodison and Parham (2018) found, during their systematic review, that there is limited and insufficient evidence for weighted vests with children with autism spectrum disorder.

In a more recent publication, Grajo, and colleagues (2020) examined the effectiveness of school-based occupational therapy interventions for children and adults between the ages of 5 to 21 years old. They reviewed articles from 2000 to 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From this analysis, the authors note that weighted vests had low evidence as an intervention to target educational participation.

Additionally, Cahill and Beisbier (2020) synthesized the results of three systematic reviews of activity and occupation-based interventions for children and adults between the ages of 5 to 21 years old. They translated these findings into recommendations for occupational therapists. The authors recommended that weighted vests should be used with caution and therapists should closely monitor for any behavioral changes due to insufficient evidence.

Battin and colleagues (2020) also completed a systematic review of the literature. They reviewed studies from 2010 to2019 for people between the ages of 2 to 21 years old with sensory processing challenges. The researchers graded the evidence based on strength and quality by utilizing the Evidence Alert Traffic Light System. Based on eleven studies, the authors determined that there was strong and sufficient evidence against the use of weighted vests for children with sensory processing challenges. The authors suggest that therapists should not utilize a weighted vest as a form of intervention for children with sensory processing challenges; in fact, the authors designated vests as “a red-light procedure.”

Recommendations:

Overall, there is currently limited and insufficient evidence for SBIs in general. The research for weighted vests, specifically, indicates that there is no evidence to support their use for individuals with autism. Overall, there is limited to no evidence to support weighted vests as an intervention to target educational participation or as an activity/occupation-based intervention for children broadly. For children experiencing sensory processing challenges, there is insufficient evidence for weighted vests.

While it may seem tempting to consider a weighted vest as a therapeutic intervention due to its ease of use, accessibility, and relative low cost, consumers should use caution based on the extensive research confirming a lack of evidence for effectiveness. It is imperative for individuals with autism to be provided with interventions that are evidence-based to promote effective change and avoid wasting time, effort, and hope. Utilizing interventions that are empirically validated can help to ensure effective treatment and best outcomes (Zane et al., 2016).

Bodison and Parham (2018) stated that interventions with limited or no research evidence should only be utilized after initially considering interventions with stronger evidence. Due to this, families may still be considering the weighted vest as a possible strategy. While there is no supporting evidence for weighted vests, the existing research does not report any adverse effects. If families are considering utilizing a weighted vest, they should work closely with their team and determine a means to objectively measure behavioral effects on the individual learner. There should be a plan in place to develop a protocol for various elements of implementation including determining a wearing schedule, identifying target behaviors, and specifying a data collection system. In other words, the vest should be implemented in a manner that enables the systematic evaluation of its effectiveness for the individual. Perhaps most importantly, the team should agree to the continuation or discontinuation of the vest based on the collected data. In this way, the team commits to continued use only if the vest is shown to have a positive impact at the individual level. Finally, teams are urged to consider the negative impact of potentially wasted time allocated to treatments without demonstrated effectiveness, as this may also pose indirect harm.

References

Systematic Reviews of Scientific Studies

Battin, V., Panzone, J., Fish, M., Lorthioir, N. T., Odierna, J., Dow, A., Regimbald, A., Lukovich, G., Heitmann, T., & Eberley, M. (2020). Effectiveness of occupational therapy sensory interventions for children and adolescents: A systematic review. American Journal of Occupational Therapy, 74. https://doi.org/10.5014/ajot.2020.74S1-PO9129

Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. The American Journal of Occupational Therapy: Official publication of the American Occupational Therapy Association, 72(1), https://doi.org/10.5014/ajot.2018.029413

Grajo, L. C., Candler, C., & Sarafian, A. (2020). Interventions within the scope of occupational therapy to improve children’s academic participation: A systematic review. American Journal of Occupational Therapy, 74, 7402180030. https://doi.org/10.5014/ajot.2020.039016

Morrison, A. P. (2007). A review of research on the use of weighted vests with children on the autism spectrum. Education, 127, 323-327.

Stephenson, J., & Carter, M. (2009). The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disorders, 39(1), 105-114. https://doi.org/10.1007/s10803-008-0605-3

Tam, K. T., Philpott-Robinson, K., Johnson, T., & Lane, A. E. (2023). Measurement of School Engagement in Elementary School Students: A Scoping Review. The American Journal Occupational Therapy, 77(3), 7703205150. https://doi.org/10.5014/ajot.2023.050036

Taylor, C. J., Spriggs, A. D., Jones Ault, M., Flanagan, S., & Sartini, E. (2017). A systematic review of weighted vests with individuals with autism spectrum disorder. Research in Autism Spectrum Disorders, 37, 49-60. https://doi.org/10.1016/j.rasd.2017.03.003

Tingler, B., & Fried, K. (2016). Research synopsis: Effects of weighted vests on the engagement of children with developmental delays and autism. Science in Autism Treatment, 13(4), 39-40.

Selected Scientific Studies

Olson, L. J., & Moulton, H. J. (2004). Use of weighted vests in pediatric occupational therapy practice. Physical & Occupational Therapy in Pediatrics, 24(3), 45-60. https://doi.org/10.1300/j006v24n03_04

Reichow, B., Barton, E. E., Sewell, J. N., Good, L., & Wolery, M. (2010). Effects of weighted vests on the engagement of children with developmental delays and autism. Focus on Autism and Other Developmental Disabilities, 25(1), 3-11.

Thompson-Hodgetts, S., & Magill-Evans, J. (2018). Sensory-based approaches in intervention for children with autism spectrum disorder: Influences on occupational therapists’ recommendations and perceived benefits. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 72(3), 7203205020p1-7203205020p8. https://doi.org/10.5014/ajot.2018.024729

Position Statements

Watling, R., Miller Kuhaneck, H., Parham, L. D., & Schaaf, R. (2018). Occupational therapy practice guidelines for children and youth with challenges in sensory integration and sensory processing [E-book]. Bethesda, MD: AOTA Press.

Cahill, S. M., & Beisbeir, S. (2020). Practice Guidelines—Occupational therapy practice guidelines for children and youth ages 5-21 years. American Journal of Occupational Therapy, 74, 7404397010. https://doi.org/10.5014/ajot.2020.744001

Other

Zane, T., Weiss, M. J., Davis, C., & Melton, I. (2016). Evidence-based practices in treatment for autism and intellectual disabilities. In Foxx, R. M. & Mulick, J. A. (Eds.), Controversial Therapies for Autism and Intellectual Disabilities. Routledge.

Citation for this article:

Gasiewski, K. (2024). A treatment summary of the use of weighted vests. Science in Autism Treatment, 21(6).

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