Kashefimehr, B., Kayihan, H., & Huri, M. (2018). The effect of sensory integration therapy on occupational performance in children with autism. OTJR: Occupation, Participation, and Health, 38(2), 75-83. https://doi.org/10.1177/1539449217743456
Caitlin Chambers, MEd, BCBA, and Robert LaRue, PhD, BCBA-D, Rutgers, The State University of New Jersey
Why research this topic?
Behaviors such as spinning or rocking, sensitivity to foods, clothing textures, noise, and preoccupation with an object or activity can affect the ability of children with autism to participate in functional daily activities. Some researchers attribute these behaviors to a dysfunction in the ability to process sensory information. Sensory Integration Therapy (SIT) is a commonly used intervention strategy intended to improve an individual’s ability to process and integrate sensory information.
These authors note that some of the commonly used standardized tests to evaluate pediatric occupational therapy may not be as appropriate as assessments that measure “occupation- focused outcome measures.” Occupation-focused outcome measures are those that consider someone’s abilities and difficulties in participating in occupational activities. As there are limited studies that use occupation-focused outcome measures when evaluating the effectiveness of SIT, this study sought to analyze the effects of SIT on occupational performances of children with ASD.
What did the researchers do?
Participants included 35 children, ages 3 to 8, with a diagnosis of autism spectrum disorder (ASD). Four of the participants were excluded from the study since they did not demonstrate sensory processing problems, determined by a Sensory Profile (Dunn, 1999). The Sensory Profile is a standardized assessment of sensory capabilities and is in the format of a questionnaire filled out by parents/caregivers. The remaining participants were randomly divided into control and intervention groups, and the researcher evaluating children was unaware of which groups the children were assigned. The Sensory Profile, in addition to being used as a screening tool, was used as the primary sensory evaluation before intervention began. Additionally, researchers used The Short Child Occupational Profile (SCOPE) to assess occupational skills. Six domains are measured in this assessment, which are volition, habituation, interaction and communication skills, process skills, motor skills, and environment.
Participants in the intervention group received 24 sessions of SIT which included 45 minutes of therapy and 15 minutes of parent training (twice a week). Authors described the therapy as using play activities and sensory-enhanced interactions to challenge the child’s sensory processing and motor planning skills. Equipment in the clinical environment included items such as swings, therapy balls, climbing walls, and trampolines. Therapists also offered strategies to caregivers on how to interact with their child to target the child’s sensory needs. Programs for each child were based on the scores of their SCOPE assessment and their sensory needs. The programs were performed in compliance with principles of SIT and guided by Parham’s 10-item fidelity measure and Ayres’ (1972) theory of using games to provide sensory activities. No specific examples of a sensory-enhanced interaction, a challenge for sensory processing, or a strategy relayed to caregivers were described or defined. Participants in this group also continued their special education program which included occupational therapy, but the procedures of their occupational therapy at school were not described. Participants in the control group only received the occupational therapy delivered as a part of their school’s special education program. Procedures for the control group’s occupational therapy at school were not described. After the 24 intervention sessions were completed for the intervention group, both groups were re-tested using the Sensory Profile and SCOPE assessments.
What did the researchers find?
The improvements that the intervention group made on the SCOPE assessments were greater and statistically significant from the improvements made by the control group. Additionally, the improvements made by the intervention group on the Sensory Profile assessment were greater than the control group and statistically significant in all factors and domains except for the “emotionally reactive” factor and the “emotional and social responses” domain.
What are the strengths and limitations of the study?
This study used occupation-focused outcome measures to assess a portion of the skills they were researching through the SCOPE assessment (volition, habituation, and performance capacity). This is an important strength since it shows that the students made improvements in the areas that researchers intended, suggesting the intervention is valid. Furthermore, the study used an evaluator for the SCOPE assessment that was unaware of which conditions the children were in, to avoid bias.
Although statistically significant results sound promising, there are important limitations that should be considered regarding this study. Researchers did not describe intervention or control procedures in a way for the study to be replicated. Additionally, the fidelity measure (Parham’s 10-item fidelity measure) was only used as a guide, so there were no specific measures of how closely the treatments resembled forms of SIT between participants in the intervention group, or how closely they resembled SIT used outside of this study. Furthermore, the control condition did not account for the effects of an enriched environment that included attention from adults and access to enjoyable items such as swings and trampolines. Researchers did not state if those administering the therapy were occupational therapists, but it should be noted that the study was conducted at an occupational therapy clinic. Because the specific interventions were not described, readers are unable to determine how similar this therapy is to occupational therapy. Lastly, the Sensory Profile assessment is a questionnaire filled out by parents, and parents were aware of the treatment condition that their child was in. Therefore, the results from those measures may be confounded by parents expecting improvement from children in the intervention group, or not expecting improvement from children who received no additional treatment.
What do the results mean?
Further investigation is needed to determine the efficacy of Sensory Integration Therapy for children with ASD. Using outcome-based measures, such as the SCOPE assessment, should be continued in future studies. Additionally, future studies should include control conditions that account for additional enrichment, such as access to the same attention and equipment in an unstructured format, and/or additional occupational therapy, if the procedures are determined to be similar. Furthermore, the intervention and control conditions need to be described in a way that the study can be replicated, as replication is necessary to provide adequate evidence that an intervention is effective.
Citation for this article:
Chambers, C., & LaRue, R. (2021). Research synopsis: The effect of sensory integration therapy on occupational performance in children with autism Science in Autism Treatment, 18(6).
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