Schaaf, R., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., & Kelly, D. (2014). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44(7), 1493-1506. doi: 10.1007/s10803-013-1983-8.
Reviewed by
Sunita Chhatwani, MSc, MEd, ABA, ASAT Extern
and
Karen Fried, PsyD, BCBA-D, ASAT Board Member
Why research this topic?
Occupational therapy using sensory integration (OT/SI) is an intervention based on the premise that children with autism spectrum disorder (ASD) have trouble processing information received from the senses. OT/SI aims to overcome sensory dysfunction in children with ASD through activities that provide sensory input to the brain about the body’s movement through space or about movement of muscles and joints. Examples of OT/SI activities include swinging, riding a scooter board, or brushing the child’s body.
Though OT/SI has been used for quite some time with children with ASD, there is not yet a body of evidence supporting its effectiveness for this population. The research to date has had methodological limitations. The current study set out to examine OT/SI using a more rigorous design.
What did the researcher do?
Researchers randomly assigned 32 children with ASD, ages four to eight years, to one of two groups, the control and experimental group. Over 10 weeks, the control group received only “usual care” which was defined as the non-study related services the children were already receiving, including school-based occupational therapy, school- or home-based behavioral intervention, and/or pharmacological treatment. The experimental group received the same “usual care” plus three hours per week of an OT/SI intervention that followed procedures in a manual and measured the degree to which providers were sticking to those procedures. The experimental OT/SI intervention also used a systematic method for defining each child’s goal priorities and attainment, using assessment data and parent input. Before and after the 10-week study period, all children were assessed by independent evaluators who were unaware of the group assignments. The children’s individual goal attainment, sensory behaviors, functional and adaptive behaviors were evaluated. The two groups were compared to see if there were any differences.
What did the researchers find?
At the end of treatment, compared to the control group, the experimental group obtained significantly higher scores on the parent-reported measures of individual goal attainment and functional behaviors, as well as marginally significantly better scores on a parent-reported measure of sensory behaviors. However, there was no significant group difference on a parent-reported measure of adaptive behaviors.
What are the strengths and limitations of the study?
A strength of the study is that the OT/SI intervention followed a manualized protocol and measured the therapists’ adherence to that protocol. A manualized protocol can be replicated by other therapists and researchers. Measuring adherence helps establish that therapists are consistently providing the intended service, rather than drifting. Another strength is that the experimental OT/SI intervention used a systematic method for defining each child’s goal priorities, emphasizing assessment data, parent input and measurable objectives.
The researchers identified some of the main limitations of their study. To judge the children’s progress, they relied on parent interview and parent-report measures rather than on direct observation. While parent-report measures have value, they are prone to bias and are best used in combination with direct observational measures. The parents in the current study were not blind to the intervention, and so parent report measures need to be interpreted with caution.
The researchers noted that the OT/SI intervention is not meant to be a comprehensive treatment for ASD but rather part of a comprehensive program. With that in mind, it might be valuable for a future investigation to compare the current manualized OT/SI intervention (with measurable objectives and adherence checks), when combined with another well-specified treatment, to the other treatment alone.
What do the results mean?
Because of the exclusive reliance on reports from parents who were aware of whether or not their children were receiving OT/SI, results of this study are inconclusive regarding the effects of OT/SI on individual goal attainment, sensory behaviors, and functional and adaptive behaviors in children with ASD. Nevertheless, this study illustrates greater rigor in examining OT/SI by using a manualized protocol for the OT/SI intervention, measuring therapist adherence to the protocol, and using a systematic method for defining each child’s goal priorities and attainment, including measurable objectives. OT/SI needs more research to be termed an evidence-based intervention.
Citation for this article:
Chhatwani, S., & Fried, K. (2016). Research review: An intervention for sensory difficulties in children with autism: a randomized trial. Science in Autism Treatment, 13(1), 26-27.
