Methodology: Children with Autism – Sensory Integration

There is plenty of peer review research in the field of special education. You should take advantage of these studies and learn more about how they apply to your child with autism.  IEP teams are required to consider peer-review research when considering program modifications or supports for school personnel that will be provided the child. 20 U.S.C. 1414(d)(A)(I)(IV).

Sensory integration

Sensory Integration Therapy is typically administered by licensed occupational therapist in the public school or in private sector. The purpose of SIT, in part, is to stimulate a child’s skin and vestibular system such as swinging, spinning in circles on specially constructed chairs, brushing parts of a child’s body, and engaging in physical activities that require balance. (Ayers, 1972, 1979). Early studies did not validate the purpose of SIT: Children with autism did not show increased motor development (Jenkins, Fewell & Harris 1983); reduced ritualistic behaviors (Iwasaki & Hohn 1989); or other benefits. (Densom, Nuthall, Bushnell & Horn 1989). More recent studies and research show mixed results: May-Benson and colleagues (2010) evaluated the literature on the effectiveness of SIT on the ability of children with difficulty processing and integrating sensory information to engage in desired occupations and applied these findings to occupational therapy practice.  Results suggested the SIT may result in positive outcomes in sensori-motor skills and motor planning; socialization, attention, and behavioral regulation; reading-related skills; participation in active play; and achievement of individualized goals.  Gross motor skills, self-esteem, and reading gains may be sustained from 3 months to 2 years. These findings are qualified, among other things, for being based upon small sample sizes and lack of fidelity to intervention. Recent studies, however, are more skeptical about the efficacy of sensory integration therapy for children with autism.  A pilot study established a model for randomized controlled trial research, identify appropriate outcome measures, and address the effectiveness of sensory integration (SI) interventions in children with autism spectrum disorders (ASD). Pretests and posttests measured social responsiveness, sensory processing, functional motor skills, and social–emotional factors. Results identified significant positive changes in Goal Attainment Scaling scores for both groups; more significant changes occurred in the SI group, and a significant decrease in autistic mannerisms occurred in the SI group. No other results were significant. Pfeiffer, Koenig, Kinnealey, Sheppard and Henderson 2011).  Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research. Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration intervention research. American Journal of Occupational Therapy, 61, 216–227. Researchers have come to premature conclusions about sensory integration theory and sensory integration procedures. The development of meta-analysis as a statistical tool can be a great stimulus to efficacy research. A major limitation to intervention research is obtaining adequate sample size. Need for studies of the relative efficacy of sensory integration procedures for children with differing diagnoses, differing degrees of disabilities, and different ages. There is a need to develop models to examine of sensory integration treatment effectiveness. Cermak and Henderson (1990).

Auditory Integration

Auditory Integration Therapy consists in part of observations of a therapist to determine frequencies at which child’s hearing appears to be too sensitive. Child spends 10 hours listening to music played through a devise that filters out frequencies identified by an audiogram. Child wears headphones when listening to music.  Behavioral Interventions for Young Children with Autism 1996.  In a 1998 published study, Yencer (1998) found no meaningful changes based on statistical analysis, between the experimental group that received AIT and a placebo group that listened to the same music which was non-altered. The study group was 36 children with auditory processing deficits. Zollweg et al. (1997) reported no improvement for the experimental group compared to placebo, based on pure tone thresholds, the Aberrant Behavior Checklist, and a loudness discomfort test. Both studies show the necessity of using control groups, because without them it would appear that there was significant improvement with the AIT.  Sinha, Y., Silove, N., Wheeler, D., & Williams, K. (2005) concluded that AIT has not been supported by empirical findings. They recommend further research and improved research designs that include long term follow up. However, other studies (e.g., Rimland & Edelson, 1995; Edelson et al., 1999) had different findings and careful review of individual studies seems warranted prior to drawing conclusions about AIT effectiveness. Occupational therapy practitioners should consider the child’s characteristics, the family’s resources, the feasibility of consistent application, and the cost and benefits of AIT prior to recommending it.  Auditory based therapies should be considered experimental in nature and parents should be provided with accurate information about the research evidence for these approaches and the costs involved in pursuing these programs (Sinha et al., 2006).

I know this is pretty heavy duty stuff  to digest. Peer review research can give you the ammunition you may need to improve your child’s IEP and educational programming as well as what methodology might work better for your child.