A systematic review of sensory processing interventions for children with autism spectrum disorders

A systematic review of ayres sensory integration intervention for children with autism

Sensory integration is one of the most highly utilized interventions in autism, however, a lack of consensus exists regarding its evidence base. An increasing number of studies are investigating the effectiveness of this approach. This study used the Council for Exceptional Children (CEC) Standards for Evidence-based Practices in Special Education to evaluate the effectiveness research from 2006 to 2017 on Ayres Sensory Integration (ASI) intervention for children with autism. A systematic review was conducted in three stages. Stage 1 involved an extensive database search for relevant studies using search terms related to sensory integration and autism, interventions suggesting a sensory integration approach, and high-quality study designs. Searches yielded 19 studies that were evaluated in Stage 2. Six of these met inclusion criteria of being peer-reviewed, written in English, description of intervention this is consistent with ASI intervention, and comparison group design or single subject method employed. Prior to analysis using CEC standards, three articles were excluded because intervention details were not consistent with the core principles of ASI, or because of major methodological flaws. In Stage 3, the remaining three studies were rated using the CEC quality indicators and standards for an evidence-based practice. Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items. One additional study met more than 50% of the criteria. Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4-12 years old. Autism Research 2019, 12: 6-19. © 2018 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY: Ayres Sensory Integration intervention is one of the most frequently requested and highly utilized interventions in autism. This intervention has specific requirements for therapist qualifications and the process of therapy. This systematic review of studies providing Ayres Sensory Integration therapy to children with autism indicates that it is an evidence-based practice according to the criteria of the Council for Exceptional Children.

Longitudinal assessment of stability of sensory features in children with autism spectrum disorder or other developmental disabilities

Prior research on the stability of sensory processing problems in children with autism spectrum disorder (ASD) or other developmental disabilities (DD) has produced inconsistent results. We employed a longitudinal study design to assess the stability of three clinical sensory response patterns: hyporesponsiveness; hyperresponsiveness; and sensory interests, repetitions, and seeking behaviors (SIRS). Parents of children with ASD (n = 55) or DD (n = 35) responded to sensory questionnaires at two time points (T1 and T2) separated by 3.3 years on average, with the children aged 2-12 years (M = 5.69 ± 2.46) at the first assessment. For each sensory response pattern, regression analysis revealed that, for both ASD and DD groups, scores at T1 were strong predictors of scores at T2. Over the longitudinal assessment interval, there was a significant mean decline in severity for SIRS in both groups and for hyporesponsiveness in the ASD group. Parental estimates of the amount of therapy services received were positively associated with the severity of sensory features at T2, an outcome that may result from increased intervention dosages being administered to children who fail to improve over time. The results are discussed in terms of person-centered and environmental considerations, which, in combination, have the capacity to affect stability outcomes for sensory features. Autism Research 2019, 12: 100-111. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) and other developmental disabilities (DD) may process sensory information differently from those who do not have ASD. For example, some children may be over-responsive or under-responsive to sound or touch. In this study, we showed that sensory features in preschool/school-aged children with ASD and DD tend to decrease on average over a several year period. However, individual children tend to retain their ranking (low or high in sensory features) in comparison to other children over time.

Staff awareness training: improving knowledge and confidence of autism spectrum disorders and intellectual disabilities in a locked rehabilitation unit

Purpose

The purpose of this paper is to present a training package which was delivered to improve staff members’ knowledge and confidence of autism spectrum disorders (ASD) and intellectual disabilities (ID).

Design/methodology/approach

The training was facilitated in a locked rehabilitation unit for adult males, many of whom had diagnoses of ASD and/or ID. With all staff receiving an invite, 25 attended which was the majority of the staff team. This included staff from housekeeping, nursing and catering.

Findings

To evaluate the effectiveness of the training, a survey and short assessment was administered before and after training. This revealed an improvement in both perceived knowledge and confidence of ASD and ID, as well as actual knowledge. Follow-up interviews also revealed some evidence of sustained learning and practice changes.

Research limitations/implications

Based on these findings, it is recommended that further face-to-face training is delivered at this locked rehabilitation unit to further improve professional practice.

Originality/value

This paper provides value to other inpatient settings as it highlights to practitioners how face-to-face training can significantly improve staff members knowledge and confidence of developmental disorders.

Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor

Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD.

Sensory abnormalities in children with autism spectrum disorder

OBJECTIVE

The clinical picture of children with autism spectrum disorder is characterized by deficits of social interaction and communication, as well as by repetitive interests and activities. Sensory abnormalities are a very frequent feature that often go unnoticed due to the communication difficulties of these patients. This narrative review summarizes the main features of sensory abnormalities and the respective implications for the interpretation of several signs and symptoms of autism spectrum disorder, and therefore for its management.

SOURCES

A search was performed in PubMed (United States National Library of Medicine) about the sensory abnormalities in subjects (particularly children) with autism spectrum disorder.

SUMMARY OF THE FINDINGS

Sensory symptoms are common and often disabling in children with autism spectrum disorder, but are not specific for autism, being a feature frequently described also in subjects with intellectual disability. Three main sensory patterns have been described in autism spectrum disorder: hypo-responsiveness, hyper-responsiveness, and sensory seeking; to these, some authors have added a fourth pattern: enhanced perception. Sensory abnormalities may negatively impact the life of these individuals and their families. An impairment not only of unisensory modalities but also of multisensory integration is hypothesized.

CONCLUSIONS

Atypical sensory reactivity of subjects with autism spectrum disorder may be the key to understand many of their abnormal behaviors, and thus it is a relevant aspect to be taken into account in their daily management in all the contexts in which they live. A formal evaluation of sensory function should be always performed in these children.

Use of Props During Mealtime for Children With Autism Spectrum Disorders: Self-Regulation and Reinforcement

Mealtime is an important family routine commonly affected for families with children with autism spectrum disorders (ASD). Limited research is available regarding strategies families incorporate to support mealtime engagement. The purpose of this study was to explore the frequency and characterize the purpose of Props used during mealtimes with children with ASD. A total of 12 families with a child(ren), N = 14, aged 2 to 7 years, with ASD and mealtime challenges or eating difficulties participated in video-recorded mealtimes in their home. Independent coders analyzed mealtimes for the frequency and purpose of Props (items used to support child participation during mealtime). Props were used by 75% of families ( n = 9); common Props included toys, electronics, and books. Props were used primarily as a self-regulation tool for the child and occasionally as positive reinforcement for specific behaviors. Overall, Props were used to support child engagement in mealtime. Occupational therapists should consider using Props as individualized, accessible, and supportive mealtime interventions for families and children.

Efficacy of Occupational Therapy Using Ayres Sensory Integration®: A Systematic Review

This systematic review addresses the question "What is the efficacy of occupational therapy using Ayres Sensory Integration^® (ASI) to support functioning and participation as defined by the International Classification of Functioning, Disability and Health for persons with challenges in processing and integrating sensory information that interfere with everyday life participation?" Three randomized controlled trials, 1 retroactive analysis, and 1 single-subject ABA design published from 2007 to 2015, all of which happened to study children with autism, met inclusion criteria. The evidence is strong that ASI intervention demonstrates positive outcomes for improving individually generated goals of functioning and participation as measured by Goal Attainment Scaling for children with autism. Moderate evidence supported improvements in impairment-level outcomes of improvement in autistic behaviors and skills-based outcomes of reduction in caregiver assistance with self-care activities. Child outcomes in play, sensory-motor, and language skills and reduced caregiver assistance with social skills had emerging but insufficient evidence.

Sensory Behaviors in Minimally Verbal Children With Autism Spectrum Disorder: How and When Do Caregivers Respond?

Sensory behaviors are widely reported in autism spectrum disorder (ASD). However, the impact of these behaviors on families remains largely unknown. This study explored how caregivers of minimally verbal children with ASD responded to their child's sensory behaviors. Using a mixed-methods approach, we examined two variables for each endorsed child behavior: (1) Did the caregiver respond/try to change the behavior? and (2) What response did they employ? Caregivers did not differ in the frequency of responses to hypo- or hyper-responsive behaviors but employed different responses. Caregivers responded to more social sensory behaviors and predominately changed their own behavior in response to their child's. Our findings demonstrate how extensively caregivers adapt to their child's behaviors and vary their response dependent on behavior exhibited.

Neural Correlates of Sensory Abnormalities Across Developmental Disabilities

Abnormalities in sensory processing are a common feature of many developmental disabilities (DDs). Sensory dysfunction can contribute to deficits in brain maturation, as well as many vital functions. Unfortunately, while some patients with DD benefit from the currently available treatments for sensory dysfunction, many do not. Deficiencies in clinical practice surrounding sensory dysfunction may be related to lack of understanding of the neural mechanisms that underlie sensory abnormalities. Evidence of overlap in sensory symptoms between diagnoses suggests that there may be common neural mechanisms that mediate many aspects of sensory dysfunction. Thus, the current manuscript aims to review the extant literature regarding the neural correlates of sensory dysfunction across DD in order to identify patterns of abnormality that span diagnostic categories. Such anomalies in brain structure, function, and connectivity may eventually serve as targets for treatment.

Sensory Reduction on the General Milieu of a High-Acuity Inpatient Psychiatric Unit to Prevent Use of Physical Restraints: A Successful Open Quality Improvement Trial

BACKGROUND

Impaired sensory gating in patients with acute mental illness predisposes to overstimulation and behavioral dyscontrol.

OBJECTIVE

Explore use of sensory reduction interventions on a high-acuity inpatient milieu to reduce high assault/restraint rates.

DESIGN

A multidisciplinary team using failure mode and effect analysis to explore high restraint use between 4:00 p.m. and 7:00 p.m. observed patient/staff overstimulation contributed to behavioral escalations. The team implemented sensory reduction/integration improvements over a 5-month period to prevent excessive restraint use.

RESULTS

Restraint rates dropped immediately following light and sound reduction interventions and by 72% at 11 months postimplementation. Mann-Whitney statistics for unpaired 6-month comparisons, 1-year pre- and postintervention showed significant reductions: Assault rates (median pre = 1.37, post = 0.18, U = 4, p = .02); Restraint rates (median pre = 0.50, post = 0.06, U = 0, p = .002).

CONCLUSION

Sensory reduction during a high-stress time period on a high-acuity psychiatric unit was associated with a reduction in assaults and restraints.

The Effect of Sensory Integration Therapy on Occupational Performance in Children With Autism

Sensory processing problems and related dysfunctions are among the most common conditions in children with autism spectrum disorder (ASD). This study examined the effect of sensory integration therapy (SIT) on different aspects of occupational performance in children with ASD. The study was conducted on an intervention group ( n = 16) receiving SIT and a control group ( n = 15) with 3- to 8-year-old children with ASD. The Short Child Occupational Profile (SCOPE) was used to compare the two groups in terms of the changes in their occupational performance and the Sensory Profile (SP) was used to assess sensory problems. The intervention group showed significantly greater improvement in all the SCOPE domains, as well as in all the SP domains, except for the "emotional reactions" and "emotional/social responses" domains, ( p < .05). The effectiveness of SIT in improving occupational performance in children with ASD as a health-related factor is supported by our findings.

A microfluidic device for partial immobilization, chemical exposure and behavioural screening of zebrafish larvae

The zebrafish larva is an important vertebrate model for sensory-motor integration studies, genetic screening, and drug discovery because of its excellent characteristics such as optical transparency, genetic manipulability, and genetic similarity to humans. Operations such as precise manipulation of zebrafish larvae, controlled exposure to chemicals, and behavioural monitoring are of utmost importance to the abovementioned studies. In this work, a novel microfluidic device is presented to easily stabilize an individual larva's head using a microfluidic trap while leaving the majority of the body and the tail unhindered to move freely in a downstream chamber. The device is equipped with a microvalve to prevent the larva's escape from the trap and a microchannel beside the larva's head to expose it to chemicals at desired concentrations and times, while investigating multiple behaviours such as the tail, eye, and mouth movement frequencies. An in situ air bubble removal module was also incorporated to increase the yield of experiments. The functionality of our device in comparison to a conventional droplet-based technique was tested using l-arginine exposure and viability assays. We found that the larvae in the device and the droplet exhibit similar tail and eye response trends to nM-mM concentrations of l-arginine, and that the survival of the larvae is not affected by the device. However, the tail responses in the device were numerically higher than the droplet-tested larvae at nM-mM l-arginine concentrations. In the future, our device has the potential to be used for conducting simultaneous whole-brain functional imaging, upon optimized immobilization of the brain, and behavioural analysis to uncover differences between diseased and healthy states in zebrafish.

The Immediate Effects of Deep Pressure on Young People with Autism and Severe Intellectual Difficulties: Demonstrating Individual Differences

Background

Deep pressure is widely used by occupational therapists for people with autism spectrum disorders. There is limited research evaluating deep pressure.

Objective

To evaluate the immediate effects of deep pressure on young people with autism and severe intellectual disabilities.

Methods

Mood and behaviour were rated for 13 pupils with ASD and severe ID before and after deep pressure sessions.

Results

Sufficient data was available from 8 participants to be analysed using Tau-U, a nonparametric technique that allows for serial dependence in data. Six showed benefits statistically. Five of these showed benefits across all domains, and one showed benefits on three out of five domains.

Relevance to Clinical Practice

Deep pressure appears to be of immediate benefit to this population with autism and severe ID, but the heterogeneity of response suggests that careful monitoring of response should be used and deep pressure discontinued when it is no longer of benefit.

Limitations

This is an open label evaluation study using rating scales.

Recommendations for Future Research

Future studies of the use of deep pressure should use physiological response measures, in addition to blinded raters for aspects of behaviours such as attitude to learning psychological health not captured physiologically.

Behavior in CHARGE syndrome

Unusual behavior is often associated with genetic syndromes, and may constitute a behavioral phenotype. In contrast to providing a psychiatric diagnosis, a behavioral phenotype describes what is unique to the behavior associated with different syndromes. While behaviors in CHARGE are as complex and variable as other aspects of the syndrome, there are some commonalities that raise the question of common sources for these behaviors. This article addresses how pain, sensory issues, and anxiety may impact the behavior of individuals with CHARGE syndrome, and how the development of self-regulation skills might help to mitigate some of the behaviors.

Listening to teachers: Views on delivery of a classroom based sensory intervention for students with autism

BACKGROUND/AIM

Occupational therapists consider the impact of autism spectrum disorder on occupational performance at school. Occupational therapists work with teachers to support student participation. Atypical sensory processing is common in children with autism. Therefore, collaborating with teachers to enable students with autism to appropriately process sensory information within classrooms may be necessary. This qualitative pilot study aimed to capture teachers' perceptions of using a Sensory Activity Schedule, a sensory based intervention, in the classroom.

METHODS

A qualitative descriptive approach was used to analyse semi-structured interview responses from 19 qualified teachers who taught children with autism from seven different autism specific special schools in NSW. Teachers were asked about their motivation to complete the intervention as well as helpful and difficult aspects of the intervention.

FINDINGS

Three main categories and eight sub-categories were identified from the 19 respondents who reported that helping their students was an important motivation for using a Sensory Activity Schedule as well as the opportunity to evaluate whether sensory based intervention was beneficial. Teachers reported that learning new ideas, working with an occupational therapist and seeing an increase in concentration and a reduction in undesired behaviours were positive aspects of utilising the intervention. Timing, staffing and fidelity of the intervention were areas of concern.

CONCLUSION

Collaboration with classroom teachers is an essential part of school-based occupational therapy. Insights from teachers who implemented a sensory based intervention in the classroom assist occupational therapists to better support students with autism spectrum disorder in schools.

Sensory Processing in Children with Autism Spectrum Disorder and/or Attention Deficit Hyperactivity Disorder in the Home and Classroom Contexts

Children with neurodevelopmental disorders often show impairments in sensory processing (SP) and higher functions. The main objective of this study was to compare SP, praxis and social participation (SOC) in four groups of children: ASD Group (n = 21), ADHD Group (n = 21), ASD+ADHD Group (n = 21), and Comparison Group (n = 27). Participants were the parents and teachers of these children who were 5-8 years old (M = 6.32). They completed the Sensory Processing Measure (SPM) to evaluate the sensory profile, praxis and SOC of the children in both the home and classroom contexts. In the home context, the most affected was the ASD+ADHD group. The ADHD group obtained higher scores than the ASD group on the Body Awareness (BOD) subscale, indicating a higher level of dysfunction. The ASD group, however, did not obtain higher scores than the ADHD group on any subscale. In the classroom context, the most affected were the two ASD groups: the ASD+ADHD group obtained higher scores than the ADHD group on the Hearing (HEA) and Social Participation (SOC) subscales, and the ASD group obtained higher scores than the ADHD group on the SOC subscale. Regarding sensory modalities, difficulties in proprioception seem to be more characteristic to the ADHD condition. As for higher-level functioning, social difficulties seem to be more characteristic to the ASD condition. Differences between the two contexts were only found in the ASD group, which could be related to contextual hyperselectivity, an inherent autistic feature. Despite possible individual differences, specific intervention programs should be developed to improve the sensory challenges faced by children with different diagnoses.

Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.

Interventions Targeting Sensory Challenges in Autism Spectrum Disorder: A Systematic Review

CONTEXT

Sensory challenges are common among children with autism spectrum disorder (ASD).

OBJECTIVE

To evaluate the effectiveness and safety of interventions targeting sensory challenges in ASD.

DATA SOURCES

Databases, including Medline and PsycINFO.

STUDY SELECTION

Two investigators independently screened studies against predetermined criteria.

DATA EXTRACTION

One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE), or confidence in the estimate of effects.

RESULTS

Twenty-four studies, including 20 randomized controlled trials (RCTs), were included. Only 3 studies had low risk of bias. Populations, interventions, and outcomes varied. Limited, short-term studies reported potential positive effects of several approaches in discrete skill domains. Specifically, sensory integration-based approaches improved sensory and motor skills-related measures (low SOE). Environmental enrichment improved nonverbal cognitive skills (low SOE). Studies of auditory integration-based approaches did not improve language (low SOE). Massage improved symptom severity and sensory challenges in studies with likely overlapping participants (low SOE). Music therapy studies evaluated different protocols and outcomes, precluding synthesis (insufficient SOE). Some positive effects were reported for other approaches, but findings were inconsistent (insufficient SOE).

LIMITATIONS

Studies were small and short-term, and few fully categorized populations.

CONCLUSIONS

Some interventions may yield modest short-term (<6 months) improvements in sensory- and ASD symptom severity-related outcomes; the evidence base is small, and the durability of the effects is unclear. Although some therapies may hold promise, substantial needs exist for continuing improvements in methodologic rigor.

Noise and autism spectrum disorder in children: An exploratory survey

BACKGROUND

With more students being educated in schools for Autism Spectrum Disorder (ASD) than ever before, architects and interior designers need to consider the environmental features that may be modified to enhance the academic and social success of autistic students in school.

AIM

This study explored existing empirical research on the impact of noise on children with ASD and provides recommendations regarding design features that can contribute to noise reduction.

METHODS AND PROCEDURES

A survey, which addressed the impact of architectural design elements on autism-related behavior, was developed for teachers of children with ASD and distributed to three schools.

OUTCOMES AND RESULTS

Most teachers found noise control to be an important issue for students with autism and many observed children using ear defenders. In terms of managing issues related to noise, most teachers agreed that thick or soundproof walls and carpet in the classroom were the most important issues for children with ASD.

CONCLUSIONS

Suggested future research should address architectural considerations for building an acoustically friendly environment for children with autism, identifying patterns of problematic behaviors in response to acoustical features of the built environment of the classroom setting, and ways to manage maladaptive behaviors in acoustically unfriendly environments.

Manualization of Occupational Therapy Using Ayres Sensory Integration® for Autism

This article reports on the development of a Stage 3 manual (following pilot effectiveness study) for implementing occupational therapy using Ayres Sensory Integration® (OT/ASI) for children with autism spectrum disorders to enhance participation in daily occupations. Three stakeholder groups were surveyed to aid in translation of manual from research to practice (i.e., Stage 3 manual) and an expert consensus meeting was held to finalize recommendations. Data indicated that the manuals usability could be improved by including a section on frequently encountered problems and solutions, and by including video case examples. Also recommended were greater chapter uniformity, improved clarity of forms and charts, and inclusion of a glossary. Changes were made and subject to expert review and consensus using modified Delphi process. The Stage 3 manual has been rigorously vetted and is ready for practice and research replication.

The Relationship Between Intolerance of Uncertainty, Sensory Sensitivities, and Anxiety in Autistic and Typically Developing Children

Guided by a recent theory that proposes fundamental differences in how autistic individuals deal with uncertainty, we investigated the extent to which the cognitive construct ‘intolerance of uncertainty’ and anxiety were related to parental reports of sensory sensitivities in 64 autistic and 85 typically developing children aged 6–14 years. Intolerance of uncertainty and anxiety explained approximately half the variance in autistic children’s sensory sensitivities, but only around a fifth of the variance in typical children’s sensory sensitivities. In children with autism only, intolerance of uncertainty remained a significant predictor of children’s sensory sensitivities once the effects of anxiety were adjusted for. Our results suggest intolerance of uncertainty is a relevant construct to sensory sensitivities in children with and without autism.

The Efficiency of Sensory Integration Interventions in Preterm Infants

This study aimed to explore the effects of individualized sensory integration interventions on the sensory processing functions of preterm infants. Thirty-four preterm infants (intervention group) at a corrected age of seven months and 34 term infants (control group) were included. The preterm infants underwent an eight-week sensory integration intervention. Before and after the intervention, the preterm infants' sensory processing functions were evaluated using the Test of Sensory Functions in Infants and compared with those of term infants. Preterm infants had significantly poorer sensory processing function preintervention when compared with term infants. There was a significant improvement in preterm infants' sensory processing functions after the sensory integration intervention. In conclusion, preterm infants should be evaluated for sensory processing disorders and individualized sensory integration interventions should be implemented.

Effectiveness of a Sensory-Enriched Early Intervention Group Program for Children With Developmental Disabilities

OBJECTIVE. The study’s objective was to evaluate the effectiveness of the Interdisciplinary Sensory-Enriched Early Intervention (ISEEI) group program for children with developmental delays.

METHOD. We conducted a retrospective chart review of 63 children ages 18–36 mo who participated in ISEEI. We evaluated participants with the Bayley Scales of Infant and Toddler Development III (Bayley–III) and the Infant/Toddler Sensory Profile (ITSP) at enrollment and after 3–9 mo. We conducted a paired t test to examine changes in the Bayley–III between pre- and posttests.

RESULTS. At enrollment, 70% of children presented atypical scores in two or more areas of sensory processing in the ITSP. Results revealed that children with sensory processing difficulties demonstrated significant improvement in all areas of development except fine motor skills; children without sensory processing difficulties showed significant improvement in language and cognition.

CONCLUSION. The ISEEI group program is an effective method to ameliorate developmental delays.

The impact of an in-class sensory activity schedule on task performance of children with autism and intellectual disability: A pilot study

Introduction

There is limited evidence to support use of sensory interventions by teachers in the classroom. The purpose of this pilot study is to determine the effectiveness of sensory activity schedule intervention in supporting participation and increasing classroom task performance in students with autism.

Method

A non-concurrent, AB single system research design across multiple baselines was used with four students with autism who attended an autism-specific school. Students demonstrated atypical sensory processing, which negatively affected their school performance. Repeated baseline and intervention data were collected by school staff using video recording during classroom tasks. Tasks performed were designated by the child’s teacher. Stage one of the Perceive, Recall, Plan, Perform System of Task Analysis was used as a repeated measure of student performance. Ratings were carried out by independent raters who were blinded to the condition of performance.

Results

Results revealed three out of four students achieved significant improvements in classroom task performance following the use of sensory activity schedule intervention developed in consultation with an occupational therapist as measured by the task analysis.

Conclusion

This study provides emerging evidence for the use of sensory activity schedule intervention in the classroom for students with autism.

Behavioral functioning in cardiofaciocutaneous syndrome: Risk factors and impact on parenting experience

The present study is an investigation of behavioral functioning in children with cardiofaciocutaneous syndrome (CFC). CFC is a rare single-gene disorder associated with cardiac disease, characteristic skin and facial features, intellectual disability, and neurological complications such as seizures and structural brain anomalies. Emotional and behavioral features of CFC have not been systematically investigated. We aimed to identify key variables that contribute to psychopathology during childhood and adolescence, and to examine the impact of challenging behaviors on the caregiving experience. Parents of 34 children and adolescents with CFC completed standardized broadband measures of child emotional and behavioral functioning, as well as measures of sensory modulation, functional communication, and caregiver stress. Results indicate that children with CFC syndrome are at heightened risk for psychopathology, with attention problems, social difficulties, and unusual behaviors (e.g., obsessive thoughts, strange behaviors, repetitive acts) found to be especially prevalent. Behavioral challenges in children with CFC syndrome were significantly associated with a history of obstetric complications and with problems modulating sensory information. With regard to the impact of child neurocognitive and behavioral issues on the caregiving experience, parent self-reported stress was significantly higher among parents of children who engaged in more problem behaviors, and lower among parents whose children could communicate effectively with others. Results of this study suggest avenues to help families cope with CFC-related stressors and enhance overall functioning. In particular, this study highlights the need for educational and treatment interventions aimed at addressing sensory needs, increasing functional communication, and identifying and managing challenging behaviors. © 2016 Wiley Periodicals, Inc.

Toward an interdisciplinary approach to understanding sensory function in autism spectrum disorder

Heightened interest in sensory function in persons with autism spectrum disorder (ASD) presents an unprecedented opportunity for impactful, interdisciplinary work between neuroscientists and clinical practitioners for whom sensory processing is a focus. In spite of this promise, and a number of overlapping perspectives on sensory function in persons with ASD, neuroscientists and clinical practitioners are faced with significant practical barriers to transcending disciplinary silos. These barriers include divergent goals, values, and approaches that shape each discipline, as well as different lexical conventions. This commentary is itself an interdisciplinary effort to describe the shared perspectives, and to conceptualize a framework that may guide future investigation in this area. We summarize progress to date and issue a call for clinical practitioners and neuroscientists to expand cross-disciplinary dialogue and to capitalize on the complementary strengths of each field to unveil the links between neural and behavioral manifestations of sensory differences in persons with ASD. Joining forces to face these challenges in a truly interdisciplinary way will lead to more clinically informed neuroscientific investigation of sensory function, and better translation of those findings to clinical practice. Likewise, a more coordinated effort may shed light not only on how current approaches to treating sensory processing differences affect brain and behavioral responses to sensory stimuli in individuals with ASD, but also on whether such approaches translate to gains in broader characteristics associated with ASD. It is our hope that such interdisciplinary undertakings will ultimately converge to improve assessment and interventions for persons with ASD. Autism Res 2016, 9: 920-925. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Paying It Forward: Honoring Jane Case-Smith for Commitment to Occupational Therapy Education and Research

This issue of AJOT is dedicated to the life and legacy of Jane Case-Smith, an occupational therapy scholar and servant–leader whose broad and diverse work touched the lives of countless children; families; and occupational therapy students, clinicians, and educators.

State of the Science: A Roadmap for Research in Sensory Integration

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.

Systematic Review of Yoga Interventions for Anxiety Reduction Among Children and Adolescents

OBJECTIVE. Anxiety disorders are the most prevalent psychological disorders among children and youths. There is growing interest in intervention options for anxiety. Yoga is widely used in clinical, school, and community settings, but consolidated sources outlining its effectiveness in reducing anxiety are limited.

METHOD. This systematic review examined the evidence base (1990–2014) for yoga interventions addressing anxiety among children and adolescents (ages 3–18 yr).

RESULTS. We identified 2,147 references and found 80 articles that were eligible for full-text review. The final analysis included 16: 6 randomized controlled trials, 2 nonrandomized preintervention–postintervention control-group designs, 7 uncontrolled preintervention–postintervention studies, and 1 case study.

CONCLUSION. Nearly all studies indicated reduced anxiety after a yoga intervention. However, because of the wide variety of study populations, limitations in some study designs, and variable outcome measures, further research is needed to enhance the ability to generalize and apply yoga to reduce anxiety.

Sensory modulation disorders in childhood epilepsy

Background

Altered sensory sensitivity is generally linked to seizure-susceptibility in childhood epilepsy but may also be associated to the highly prevalent problems in behavioral adaptation. This association is further suggested by the frequent overlap of childhood epilepsy with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), conditions in which altered behavioral responses to sensory stimuli have been firmly established. A continuum of sensory processing defects due to imbalanced neuronal inhibition and excitation across these disorders has been hypothesizedthat may lead to common symptoms of inadequate modulation of behavioral responses to sensory stimuli. Here, we investigated the prevalence of sensory modulation disorders among children with epilepsy and their relation with symptomatology of neurodevelopmental disorders.

Methods

We used the Sensory Profile questionnaire to assess behavioral responses to sensory stimuli and categorize sensory modulation disorders in children with active epilepsy (aged 4–17 years). We related these outcomes to epilepsy characteristics and tested their association with comorbid symptoms of ASD (Social Responsiveness Scale) and ADHD (Strengths and Difficulties Questionnaire).

Results

Sensory modulation disorders were reported in 49 % of the 158 children. Children with epilepsy reported increased behavioral responses associated with sensory “sensitivity,” “sensory avoidance,” and “poor registration” but not “sensory seeking.” Comorbidity of ASD and ADHD was associated with more severe sensory modulation problems, although 27 % of typically developing children with epilepsy also reported a sensory modulation disorder.

Conclusions

Sensory modulation disorders are an under-recognized problem in children with epilepsy. The extent of the modulation difficulties indicates a substantial burden on daily functioning and may explain an important part of the behavioral distress associated with childhood epilepsy.

Sensory processing in children with Autism Spectrum Disorder: Relationship with non-verbal IQ, autism severity and Attention Deficit/Hyperactivity Disorder symptomatology

The main objective of this study was to analyze in a sample of children with ASD the relationship between sensory processing, social participation and praxis impairments and some of the child's characteristics, such as non-verbal IQ, severity of ASD symptoms and the number of ADHD symptoms (inattention and hyperactivity/impulsivity), both in the home and main-classroom environments. Participants were the parents and teachers of 41 children with ASD from 5 to 8 years old (M=6.09). They completed the Sensory Processing Measure (SPM) to evaluate sensory processing, social participation and praxis; the Gilliam Autism Rating Scale (GARS-2) to evaluate autism severity; and a set of items (the DSM-IV-TR criteria) to evaluate the number of inattention and hyperactivity/impulsivity symptoms in the child. Non-verbal IQ - measured by the Raven's Coloured Progressive Matrices Test - did not show a relationship with any of the SPM variables. The SPM variables were significant predictors of autism severity and had similar weights in the two environments. In the case of ADHD symptoms, the SPM variables had a greater weight in the home than in the classroom environment, and they were significant predictors of both inattention and hyperactivity/impulsivity - especially inattention - only in the family context. The moderate association between inattention and auditory processing found in the main-classroom suggests the possible utility of certain measures aimed to simplify any classroom's acoustic environment.

Effectiveness of Ayres Sensory Integration® and Sensory-Based Interventions for People With Autism Spectrum Disorder: A Systematic Review

This systematic review examines the literature published from January 2006 through April 2013 related to the effectiveness of Ayres Sensory Integration® (ASI) and sensory-based interventions (SBIs) within the scope of occupational therapy for people with autism spectrum disorder to improve performance in daily life activities and occupations. Of the 368 abstracts screened, 23 met the inclusion criteria and were reviewed. Moderate evidence was found to support the use of ASI. The results for sensory-based methods were mixed. Recommendations include performing higher level studies with larger samples, using the Fidelity Measure in studies of ASI, and using carefully operationalized definitions and systematic methods in examination of SBIs.