Sensory Integration Therapy for Children with Autism.

Sensory Integration Therapy Sensory Integration Therapy for Children with Autismfor Children with Autism

What is Sensory Integration What is Sensory Integration Therapy? Therapy?

Sensory Integration Therapy (SIT) is a Sensory Integration Therapy (SIT) is a sensory-motor treatment sensory-motor treatment

SIT looks like play, because play is a SIT looks like play, because play is a child’s way of learning and developingchild’s way of learning and developing

SIT is designed to restore effective SIT is designed to restore effective neurological processing by enhancing the neurological processing by enhancing the vestibular, proprioceptive, and tactile vestibular, proprioceptive, and tactile systems systems

Vestibular SystemVestibular System

Involves inner ear responses to movement Involves inner ear responses to movement and gravityand gravity

Influences balance, emotions, muscle Influences balance, emotions, muscle tone, and eye movementtone, and eye movement

Vestibular processing may be under-Vestibular processing may be under-responsive or over-responsiveresponsive or over-responsive

Proprioceptive SystemProprioceptive System

Receives input from joints and musclesReceives input from joints and muscles

This input helps us to locate our bodies in This input helps us to locate our bodies in spacespace

Movement is often slow and clumsyMovement is often slow and clumsy

Trouble learning new skills Trouble learning new skills

Tactile SystemTactile System

Involve increased or decreased reaction to Involve increased or decreased reaction to touchtouch

Or difficulty receiving information by touchOr difficulty receiving information by touch

May experience under-responsive tactile May experience under-responsive tactile processing processing

May experience over-responsive tactile May experience over-responsive tactile processing processing

History of Sensory Integration History of Sensory Integration TherapyTherapy

Ayres developed a theoretical model, the Ayres developed a theoretical model, the theory of Sensory Integrationtheory of Sensory Integration

Based on principles from neuroscience, Based on principles from neuroscience, biology, psychology and education biology, psychology and education

Faulty integration of sensory informationFaulty integration of sensory information

Inability of higher centers to modulate and Inability of higher centers to modulate and regulate lower brain sensory-motor regulate lower brain sensory-motor centers centers

History of Sensory Integration History of Sensory Integration Therapy (con’t)Therapy (con’t)

Sensorimotor development is an Sensorimotor development is an important substrate for learningimportant substrate for learning

The interaction of the individual with the The interaction of the individual with the environment shapes brain developmentenvironment shapes brain development

The nervous system is capable of change The nervous system is capable of change (plasticity)(plasticity)

Meaningful sensory-motor activity is a Meaningful sensory-motor activity is a powerful mediator of plasticitypowerful mediator of plasticity

Meet Dr. A Jean AyresMeet Dr. A Jean Ayres

Born in 1920 and grew up on a farm in Born in 1920 and grew up on a farm in Visalia, CaliforniaVisalia, California

As a child, she struggled with learning As a child, she struggled with learning problemsproblems

Masters Degree in Occupational TherapyMasters Degree in Occupational Therapy

Doctorate in Education Psychology Doctorate in Education Psychology

Postdoctoral work at UCLA’s Brain Postdoctoral work at UCLA’s Brain Research InstitutionResearch Institution

Meet Dr. A Jean Ayres (con’t)Meet Dr. A Jean Ayres (con’t)

Developed diagnostic tools for identifying Developed diagnostic tools for identifying the disorderthe disorder

Proposed a therapeutic approach that Proposed a therapeutic approach that transformed pediatric occupational therapytransformed pediatric occupational therapy

1972, Sensory Integration International 1972, Sensory Integration International was establishedwas established

The Ayres ClinicThe Ayres Clinic

Founded in 1976 by A. Jean AyresFounded in 1976 by A. Jean Ayres

Was Dr. Ayres private practiceWas Dr. Ayres private practice

Today, it is part of Sensory Integration Today, it is part of Sensory Integration InternationalInternational

The Ayres ClinicThe Ayres Clinic

AssessmentAssessment

TreatmentTreatment

EducationEducation

ResearchResearch

Sensory Integration: The TheorySensory Integration: The Theory

Ayres (1972) hypothesized that…Ayres (1972) hypothesized that…– “ “learning is a function of the brain [and] learning learning is a function of the brain [and] learning

disorders reflect some deviation in neural functions” disorders reflect some deviation in neural functions” – Since some individuals with learning disorders have Since some individuals with learning disorders have

motor or sensory problems, they have difficulty motor or sensory problems, they have difficulty processing and integrating sensory information processing and integrating sensory information

– This inability to integrate sensory information causes This inability to integrate sensory information causes behavior and learning problemsbehavior and learning problems

– This is referred to as Sensory Integrative DysfunctionThis is referred to as Sensory Integrative Dysfunction


Later, Ayres and Tickle (1980) applied the theory Later, Ayres and Tickle (1980) applied the theory to children with autism and further hypothesized to children with autism and further hypothesized that…that…– SI helped decrease tactile and other sensitivities to SI helped decrease tactile and other sensitivities to

stimuli that interfere with these individuals’ ability to stimuli that interfere with these individuals’ ability to play, learn, and interactplay, learn, and interact

– Poor sensory processing among individuals with Poor sensory processing among individuals with autism may contribute to maladaptive behaviors of autism may contribute to maladaptive behaviors of these children and impact their ability to participate in these children and impact their ability to participate in social, school, and home activities social, school, and home activities

– Autism is said to be a factor contributing to Sensory Autism is said to be a factor contributing to Sensory Integrative DysfunctionIntegrative Dysfunction


According to Ayres, According to Ayres, ““A sensory integrative approach to treating A sensory integrative approach to treating learning disorders differs from many other learning disorders differs from many other approaches in that it does not teach approaches in that it does not teach specific skills. Rather, the objective is to specific skills. Rather, the objective is to enhance the brain’s . . . capacity to enhance the brain’s . . . capacity to perceive, remember, and motor plan. perceive, remember, and motor plan. Therapy is considered a supplement, not a Therapy is considered a supplement, not a substitute to formal classroom instruction.”substitute to formal classroom instruction.”

Sensory Integration: The Theory Sensory Integration: The Theory

The focus is on 3 sensory systems: Tactile, The focus is on 3 sensory systems: Tactile, Vestibular, and ProprioceptiveVestibular, and Proprioceptive

The interrelationship among these sensory The interrelationship among these sensory systems is critical to one’s basic survival (most systems is critical to one’s basic survival (most people can integrate and interpret sensory people can integrate and interpret sensory information automatically)information automatically)

These systems interact with each other, allowing These systems interact with each other, allowing us to experience, interpret, and respond to us to experience, interpret, and respond to different stimuli in our environmentdifferent stimuli in our environment

Sensory Integration: The TherapySensory Integration: The Therapy

SI therapy provides opportunities for SI therapy provides opportunities for engagement in sensory motor activities that are engagement in sensory motor activities that are rich in tactile, vestibular, and proprioceptive rich in tactile, vestibular, and proprioceptive sensationssensations

The child is guided through challenging and fun The child is guided through challenging and fun activities designed to stimulate and integrate activities designed to stimulate and integrate sensory systems, challenge his or her motor sensory systems, challenge his or her motor systems, and facilitate integration of sensory, systems, and facilitate integration of sensory, motor, cognitive, and perceptual skillsmotor, cognitive, and perceptual skills

Sensory Integration: Key Principles Sensory Integration: Key Principles of Therapy of Therapy

PrinciplePrinciple DescriptionDescription

Just Right Just Right ChallengeChallenge

Therapist creates playful activities with achievable Therapist creates playful activities with achievable challengeschallenges

The Adaptive The Adaptive ResponseResponse

In response to challenge, the child adapts his or her In response to challenge, the child adapts his or her behavior with new and useful strategies, furthering behavior with new and useful strategies, furthering developmentdevelopment

Active Active Engagement Engagement

The methods of play incorporate new and advanced The methods of play incorporate new and advanced abilities that increase the child’s repertoire of skills abilities that increase the child’s repertoire of skills and processingand processing

Child DirectedChild Directed Therapist constantly observes the child’s behavior Therapist constantly observes the child’s behavior and reads behavioral cues, follows the child’s lead or and reads behavioral cues, follows the child’s lead or suggestions, and uses these cues to create enticing, suggestions, and uses these cues to create enticing, sensory rich activitiessensory rich activities

Sensory Integration: The TherapySensory Integration: The TherapyTactile SystemTactile System

Processes information taken in by touchProcesses information taken in by touch

Some deficits may include:Some deficits may include:– sensitivity to touchsensitivity to touch– difficulty in discriminating texturesdifficulty in discriminating textures– avoiding getting wet or dirtyavoiding getting wet or dirty– food selectivity based on texture or food selectivity based on texture or

temperaturetemperature

Sensory Integration: The TherapySensory Integration: The TherapyTactile SystemTactile System

Some tactile activities include:Some tactile activities include:– Koosh ball gamesKoosh ball games– Feely bagsFeely bags– Hiding objects in rice, beans, kitty litter, and Hiding objects in rice, beans, kitty litter, and

sandsand– Shaving cream painting and drawingShaving cream painting and drawing– Drawing shapes on the child’s backDrawing shapes on the child’s back– Brushing, interspersed with joint compressionBrushing, interspersed with joint compression– Deep pressure massagesDeep pressure massages

Sensory Integration: The TherapySensory Integration: The TherapyVestibular SystemVestibular System

Processes information based on balance Processes information based on balance and gravity and gravity

Some deficits include:Some deficits include:– lack of awareness of body in spacelack of awareness of body in space– intolerance of movementintolerance of movement– avoiding physical activitiesavoiding physical activities– constant movement, spinningconstant movement, spinning

Sensory Integration: The TherapySensory Integration: The TherapyVestibular SystemVestibular System

Some vestibular activities include:Some vestibular activities include:– Teaching children to spinTeaching children to spin– Rolling in a barrelRolling in a barrel– Sitting or bouncing on an exercise ballSitting or bouncing on an exercise ball– Swinging on a hammockSwinging on a hammock– Scooter board relay racesScooter board relay races– Walking on a balance beamWalking on a balance beam– Stair climbingStair climbing

Sensory Integration: The TherapySensory Integration: The TherapyProprioceptive SystemProprioceptive System

Processes information based in muscles Processes information based in muscles and jointsand joints

Some deficits include:Some deficits include:– difficulty with motor skillsdifficulty with motor skills– lack of coordinationlack of coordination– difficulty holding a writing utensildifficulty holding a writing utensil– falls or walks into objects oftenfalls or walks into objects often

Sensory Integration: The TherapySensory Integration: The TherapyProprioceptive SystemProprioceptive System

Some proprioceptive activities include:Some proprioceptive activities include:– Tug-of-warTug-of-war– Backpack hikingBackpack hiking– Jumping over obstaclesJumping over obstacles– Crab walking relay racesCrab walking relay races– Crawling under a parachuteCrawling under a parachute

Sensory Integration: OutcomesSensory Integration: Outcomes

According to Ayres, some outcomes from SI According to Ayres, some outcomes from SI therapy include:therapy include:– Ability to concentrateAbility to concentrate– Ability to organizeAbility to organize– Increase in self-esteemIncrease in self-esteem– Increase in self-controlIncrease in self-control– Increase in self-confidenceIncrease in self-confidence– Improvement in academic learning abilityImprovement in academic learning ability– Capacity for abstract thought and reasoningCapacity for abstract thought and reasoning– Specialization of each side of the body and the brainSpecialization of each side of the body and the brain

What does the research tells us?What does the research tells us?

THE ARGUMENT:THE ARGUMENT:– Howard Goldstein, in 2000, wrote a Howard Goldstein, in 2000, wrote a

commentary to research studies conducted by commentary to research studies conducted by Edelson, Rimland and Grandin.Edelson, Rimland and Grandin.

– Commentary entitled, Commentary entitled, Interventions to Interventions to Facilitate Auditory, Visual and Motor Facilitate Auditory, Visual and Motor Integration: “Show Me the Data”Integration: “Show Me the Data”

The Argument cont.The Argument cont.

Goldstein dissected the research done in these Goldstein dissected the research done in these fields. His conclusion was that there was no fields. His conclusion was that there was no substantial evidence to conclude the substantial evidence to conclude the effectiveness of such treatments. effectiveness of such treatments. Most of the data was unreliable due to lack of Most of the data was unreliable due to lack of experimental control, subject selection, research experimental control, subject selection, research design (or lack there of), and subjective design (or lack there of), and subjective measurement tools.measurement tools.Since there was no data to support claims made Since there was no data to support claims made by such therapies, it is not justifiable nor ethical by such therapies, it is not justifiable nor ethical to promote such therapies to parents using such to promote such therapies to parents using such claims. claims.


THE REBUTAL:THE REBUTAL:– Edelson, Rimland and Grandin in 2003 discuss the Edelson, Rimland and Grandin in 2003 discuss the

false accusations made by Goldstein that their false accusations made by Goldstein that their research was lacking such data.research was lacking such data.

– The researchers claim that statistically significant data The researchers claim that statistically significant data was found in conclusion to their research studies and was found in conclusion to their research studies and that with such a large number of participants their that with such a large number of participants their claims were justified.claims were justified.

– This article does not include how these claims are This article does not include how these claims are justified but instead uses numbers to explain effects. justified but instead uses numbers to explain effects. The numbers are arbitrary in that they do not explain The numbers are arbitrary in that they do not explain how participants were selected, the research method, how participants were selected, the research method, and the measurement tool.and the measurement tool.


THE COUNTER ARGUMENT:THE COUNTER ARGUMENT:– Goldstein comments again in 2003 to the Goldstein comments again in 2003 to the

claims made by his opponents. He justifies claims made by his opponents. He justifies his claims of his want for data.his claims of his want for data.

– Goldstein takes apart studies done in:Goldstein takes apart studies done in:AITAIT

SITSIT


Goldstein claims that research is lacking in Goldstein claims that research is lacking in AIT but mostly in SIT (especially Grandin’s AIT but mostly in SIT (especially Grandin’s hug machine)hug machine)Goldstein explains the lack of data using Goldstein explains the lack of data using four criteria:four criteria:– The lack of randomization of participantsThe lack of randomization of participants– The choice of variablesThe choice of variables– Statistically Significant data that is NOTStatistically Significant data that is NOT– Replication is lackingReplication is lacking

SIT on SIBSIT on SIB

Iwata and Mason, 1990 study:Iwata and Mason, 1990 study:– Investigated three types of SIB:Investigated three types of SIB:

Attention-getting SIBAttention-getting SIB

Stereotypic SIBStereotypic SIB

SIB that functioned as escape behaviorSIB that functioned as escape behavior

– Study used previous research of SIT and its Study used previous research of SIT and its affects on decreasing SIB in individuals.affects on decreasing SIB in individuals.

Iwata and Mason cont.Iwata and Mason cont.

Participants:Participants:– Sally, 6 years old, severely mentally retarded with no Sally, 6 years old, severely mentally retarded with no

language skills. She also had very few independent language skills. She also had very few independent skills.skills.

– Kathy, 3 years old, profoundly mentally retarded with Kathy, 3 years old, profoundly mentally retarded with cerebral palsy and scoliosis and no language skills cerebral palsy and scoliosis and no language skills and no independent skills.and no independent skills.

– Mort, an 18-year-old male, profoundly retarded, with Mort, an 18-year-old male, profoundly retarded, with microcephaly and scoliosis. He had minimal skills microcephaly and scoliosis. He had minimal skills and no language skills.and no language skills.

– All participants displayed SIB producing tissue All participants displayed SIB producing tissue damage that was at a moderate risk level.damage that was at a moderate risk level.


3 phases to study:3 phases to study:– 1- observation/baseline condition to determine 1- observation/baseline condition to determine

function of SIBfunction of SIB– 2- exposure to SIT2- exposure to SIT

A variety of techniques were utilized:A variety of techniques were utilized:– Auditory, kinesthetic, tactile, vestibular, and visual Auditory, kinesthetic, tactile, vestibular, and visual

stimulation. stimulation. – Used three types of settings to utilize these techniques. Used three types of settings to utilize these techniques.

Each subject exposed to all three during each 15- minute Each subject exposed to all three during each 15- minute session.session.

– 3- using behavioral interventions3- using behavioral interventions


Results:Results:– All participants SIB decreased significantly and at near All participants SIB decreased significantly and at near

zero levels only during the behavioral intervention phase.zero levels only during the behavioral intervention phase.– During the SIT phase SIB was variable and SIB only During the SIT phase SIB was variable and SIB only

decreased during therapy sessions.decreased during therapy sessions.– Parents were trained in implementing the behavioral Parents were trained in implementing the behavioral

interventions to reduce SIB after the conclusion of the interventions to reduce SIB after the conclusion of the study.study.

– During a 6-month follow-up Mort’s and Sally’s SIB During a 6-month follow-up Mort’s and Sally’s SIB remained at 0% and Kathy’s SIB was similar to that in remained at 0% and Kathy’s SIB was similar to that in phase 3 of the experiment at 8%.phase 3 of the experiment at 8%.

– The data show that behavioral interventions show a The data show that behavioral interventions show a maintained effect on decreasing SIB.maintained effect on decreasing SIB.

More ResearchMore Research

Fertel-Daly, Bedell and Hinojosa in 2001 Fertel-Daly, Bedell and Hinojosa in 2001 conducted a research study on the effects of a conducted a research study on the effects of a weighted vest on attention to task and self-weighted vest on attention to task and self-stimulatory behavior.stimulatory behavior. Five participants for this study:Five participants for this study:– Ranged in age from 2-4 years old.Ranged in age from 2-4 years old.– All were diagnosed with PDD.All were diagnosed with PDD.– Not currently treated with a weighted vestNot currently treated with a weighted vest– Reported to have difficulties in attending to tasks.Reported to have difficulties in attending to tasks.– Enrolled in a 5 day a week preschool program (3 hrs Enrolled in a 5 day a week preschool program (3 hrs

daily)daily)– Program used principles of ABAProgram used principles of ABA

More Research cont.More Research cont.

Followed an ABA reversal design. Followed an ABA reversal design. – Allowed for comparison between wearing and not Allowed for comparison between wearing and not

wearing the vest and effects on attending.wearing the vest and effects on attending.

Measurement procedure recorded the duration Measurement procedure recorded the duration of focused attention to task, number of of focused attention to task, number of distractions, and duration and type of self-distractions, and duration and type of self-stimulatory behaviors during 5-min intervals.stimulatory behaviors during 5-min intervals.

Vests were worn for 2 hours and then off for 2 Vests were worn for 2 hours and then off for 2 hours to follow previous research.hours to follow previous research.


Results:Results:– Duration of attention and duration of self Duration of attention and duration of self

stimulatory behavior were depicted on graphs stimulatory behavior were depicted on graphs in seconds for each participant. The number in seconds for each participant. The number of distractions was also depicted per of distractions was also depicted per participant. participant.

– Each participant therefore had three Each participant therefore had three categories graphed.categories graphed.


Results cont:Results cont:– Results showed that there was a positive effect on at least two Results showed that there was a positive effect on at least two

measures for the 5 participants. (less distractable and less self measures for the 5 participants. (less distractable and less self stimulatory behaviors occurred)stimulatory behaviors occurred)

– All increased in focused attention but the extent to which the All increased in focused attention but the extent to which the increase occurred, varied.increase occurred, varied.

All participants also showed an increase in this category when the All participants also showed an increase in this category when the vest was not worn during the withdrawl phase. What does this say vest was not worn during the withdrawl phase. What does this say about the functional relationship between the weighted vest and about the functional relationship between the weighted vest and attending?attending?After removing the weighted vest 4 participants had an abrupt After removing the weighted vest 4 participants had an abrupt decrease in duration of focused attention. Therefore, demonstrating decrease in duration of focused attention. Therefore, demonstrating that effects are short lived.that effects are short lived.

– No return to baseline between interventions could this effect No return to baseline between interventions could this effect results?results?

Conclusions and Conclusions and Recommendations:Recommendations:

Current research based on scientific criteria Current research based on scientific criteria does notdoes not support Sensory Integration Therapy as an effective support Sensory Integration Therapy as an effective treatment for improving behavior and learning of individuals treatment for improving behavior and learning of individuals with autism.with autism.

However, some studies have been published indicating However, some studies have been published indicating specific sensory intervention strategies have improved some specific sensory intervention strategies have improved some specific aspects of behavior.specific aspects of behavior.

Many studies, either “proving” or “disproving” the effects of Many studies, either “proving” or “disproving” the effects of SIT have not clearly defined terms and have not followed SIT have not clearly defined terms and have not followed rigorous research procedures.rigorous research procedures.

After a review of the literature, the appropriate After a review of the literature, the appropriate scientific conclusion is that:scientific conclusion is that:

The effect of Sensory Integration The effect of Sensory Integration

Therapy is neither proven nor Therapy is neither proven nor

unproven at this point.unproven at this point.

More research is needed!More research is needed!

Specifically:Specifically:

Terms must be clearly defined.Terms must be clearly defined.More objective criteria must be used to More objective criteria must be used to characterize and diagnose individuals with characterize and diagnose individuals with sensory processing deficitssensory processing deficitsClinical trials must be administered in a Clinical trials must be administered in a replicable fashion using specific sensory replicable fashion using specific sensory integration techniques to address specific integration techniques to address specific observable behaviors.observable behaviors.Autism practitioners must keep informed Autism practitioners must keep informed on current research in the field.on current research in the field.

Research must depend on clear Research must depend on clear definition of terms:definition of terms: Classical “Sensory Integration Therapy” Classical “Sensory Integration Therapy”

based on A. Jean Ayres model based on A. Jean Ayres model specifically: specifically: – Is based on inference that tactile, vestibular and Is based on inference that tactile, vestibular and

kinesthetic experiences treat disruptions in subcortical kinesthetic experiences treat disruptions in subcortical functions of CNS.functions of CNS.

– Utilizes activities chosen/controlled by childUtilizes activities chosen/controlled by child– Always involves use of specialized equipment such as Always involves use of specialized equipment such as

swing, usually in clinical settingswing, usually in clinical setting

Current “best practice” in field of occupational Current “best practice” in field of occupational

therapy uses “Sensory-Based O. T.” model: therapy uses “Sensory-Based O. T.” model:– Assessment and intervention imbedded in activities Assessment and intervention imbedded in activities

that are part of individual’s daily routine/instructional that are part of individual’s daily routine/instructional program program

– Goal is not to “cure” individual but to use purposeful Goal is not to “cure” individual but to use purposeful and meaningful activities to maximize potential.and meaningful activities to maximize potential.

– Intervention at impairment level (e.g., to address Intervention at impairment level (e.g., to address specific sensory problems in processing tactile, specific sensory problems in processing tactile, proprioceptive, or other sensory stimuli), but proprioceptive, or other sensory stimuli), but imbedded in occupational functioning. imbedded in occupational functioning.

Sensory-Based O.T., cont.Sensory-Based O.T., cont.

– Emphasis not on repairing CNS functioning, but on Emphasis not on repairing CNS functioning, but on increasing productive behavior by improving increasing productive behavior by improving processing of sensory stimuli. Specific goals would processing of sensory stimuli. Specific goals would include reduction in rates of aberrant behaviors that include reduction in rates of aberrant behaviors that interfere with learning, enhanced ability to focus on interfere with learning, enhanced ability to focus on relevant materials/activities, and increased ability to relevant materials/activities, and increased ability to self-regulate.self-regulate.

““Sensory Stimulation” programs:Sensory Stimulation” programs:

– Involve providing specific type of sensory stimulation Involve providing specific type of sensory stimulation through circumscribed modality (e.g., touch pressure, through circumscribed modality (e.g., touch pressure, vestibular stimulation, tactile stimulation)vestibular stimulation, tactile stimulation)

– Child is passive recipient of techniquesChild is passive recipient of techniques

– Used to modulate arousal, increase attention, Used to modulate arousal, increase attention, increase self-regulation of behaviorincrease self-regulation of behavior

– Includes techniques such as sensory brushing, Includes techniques such as sensory brushing, weighted vests, sensory diets, or deep pressureweighted vests, sensory diets, or deep pressure

– Used either in isolation, or in conjunction with Used either in isolation, or in conjunction with sensory-based O.T. or other programs (e.g., ABA)sensory-based O.T. or other programs (e.g., ABA)

More objective and direct methods More objective and direct methods must be used to diagnose/characterize must be used to diagnose/characterize individuals with sensory integration individuals with sensory integration deficits:deficits:

Physiological measures currently being Physiological measures currently being studied include:studied include:– Electrodermal Reactivity (EDR)Electrodermal Reactivity (EDR)– Vagal Tone (VT)Vagal Tone (VT)– PosturographyPosturography– Galvanic Skin Response (GSR)Galvanic Skin Response (GSR)– EEGEEG– Brain studies Brain studies

Standardized behavioral measures currently Standardized behavioral measures currently being used to diagnose sensory integrative being used to diagnose sensory integrative dysfunction include:dysfunction include:

Sensory Integration and Praxis Test (SIPT)Sensory Integration and Praxis Test (SIPT)– Reported to measure visual, tactile, and kinesthetic Reported to measure visual, tactile, and kinesthetic

perception and motor coordination using direct perception and motor coordination using direct administration of 17 testsadministration of 17 tests

– Standardized on national sample of more than 2000 Standardized on national sample of more than 2000 children. Provides norms for each test.children. Provides norms for each test.

– Must be administered by O.T. who has completed Must be administered by O.T. who has completed post-graduate courses and certification specifically in post-graduate courses and certification specifically in Sensory Integration and test administrationSensory Integration and test administration

– Developed by AyresDeveloped by Ayres– Research indicates that about 1/3 of tests are Research indicates that about 1/3 of tests are

unstable. unstable. – Children with ASD not included in normative sample. Children with ASD not included in normative sample.

•Sensory ProfileSensory Profile

– Behavioral questionnaire completed by parentBehavioral questionnaire completed by parent– Contains 125 items grouped into categories of Contains 125 items grouped into categories of

Sensory Processing, Modulation, and Behavioral and Sensory Processing, Modulation, and Behavioral and Emotional ResponsesEmotional Responses

– Standardized on more than 1200 children.Standardized on more than 1200 children.– High internal reliability, validity measures vary High internal reliability, validity measures vary

between sectionsbetween sections– Has been used to correctly distinguish between Has been used to correctly distinguish between

children with ASD, ADHD, and typically developing children with ASD, ADHD, and typically developing childrenchildren

– Results are correlated with physiologic measures Results are correlated with physiologic measures (EDR) of sensory reactivity (p < .01)(EDR) of sensory reactivity (p < .01)

Additional clinical research must be Additional clinical research must be administered in a replicable administered in a replicable fashion:fashion:Research must:Research must:

– utilize subjects identified by licensed professionals as utilize subjects identified by licensed professionals as demonstrating sensory integration deficits using demonstrating sensory integration deficits using standardized behavioral and/or physiological standardized behavioral and/or physiological assessmentsassessments

– target specific observable behaviors and/or target specific observable behaviors and/or physiological measures and incorporate specifically physiological measures and incorporate specifically defined SI techniquesdefined SI techniques

– use randomized assignment of subjects to treatment use randomized assignment of subjects to treatment groups, non-treatment groups, and/or alternative groups, non-treatment groups, and/or alternative treatment groupstreatment groups

Research must:Research must:

use blind assessments of specific behaviors pre- use blind assessments of specific behaviors pre- and post-treatmentand post-treatment

Utilize research design which will increase Utilize research design which will increase validity of study (e.g., alternating treatment validity of study (e.g., alternating treatment design vs. pre-post-treatment design).design vs. pre-post-treatment design).

Be published in peer-reviewed journalBe published in peer-reviewed journal

Stand up to replication and analysis by other Stand up to replication and analysis by other professionals in the fieldprofessionals in the field

As professionals/parents in the As professionals/parents in the autism field, we should:autism field, we should:

Keep current on research in the field of Sensory Keep current on research in the field of Sensory Integration, analyzing all information presented Integration, analyzing all information presented in terms of scientific criteria in terms of scientific criteria

If sensory integration therapy is recommended If sensory integration therapy is recommended for a particular child, share research findings for a particular child, share research findings with parents/other professionalswith parents/other professionals

Make sure all parties have clearly defined Make sure all parties have clearly defined specific type of therapy being proposed and specific type of therapy being proposed and specific observable outcomes expected.specific observable outcomes expected.

We should:We should:

If SIT is already part of child’s program, use If SIT is already part of child’s program, use principles of ABA to attempt to establish principles of ABA to attempt to establish functional relationship between treatment and functional relationship between treatment and observable outcomes in terms of specific and observable outcomes in terms of specific and observable behaviors.observable behaviors.

Collect data: baseline, during treatment, post-Collect data: baseline, during treatment, post-treatment, generalization.treatment, generalization.

Investigate possible antecedent or consequent Investigate possible antecedent or consequent effects of intervention (e.g., adult attention, effects of intervention (e.g., adult attention, engagement in preferred activity, etc.)engagement in preferred activity, etc.)

We should:We should:

If possible, incorporate aspects of single-subject If possible, incorporate aspects of single-subject research design to further establish whether or research design to further establish whether or not treatment affected behavior: ABAB design, not treatment affected behavior: ABAB design, alternating treatment design, or multiple baseline alternating treatment design, or multiple baseline design.design.

Share results with parents/other professionals in Share results with parents/other professionals in order to make better informed program decisionsorder to make better informed program decisions

It is simplistic to say that “Sensory IntegrationIt is simplistic to say that “Sensory Integration Therapy does not work.” Therapy does not work.”

While Ayres’ underlying “theory” does not While Ayres’ underlying “theory” does not appear to be based on scientific data and has appear to be based on scientific data and has not been supported by current research, there is not been supported by current research, there is increasing research in the area of physiological increasing research in the area of physiological evidence for differences in sensory processingevidence for differences in sensory processing

Current research may be used to create Current research may be used to create hypotheses for further, more scientifically valid hypotheses for further, more scientifically valid research in the field of sensory integration.research in the field of sensory integration.

ReferencesReferencesBaranek, G.T. (2002). Efficacy of sensory and motor interventions for children with autism. Baranek, G.T. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Journal of Autism and

DevelopmentalDevelopmental DisordersDisorders, 32,397-422., 32,397-422.Baron-Cohen, S. (2004). The cognitive neuroscience of autism. Baron-Cohen, S. (2004). The cognitive neuroscience of autism. Journal of Neurology, Neurosurgery and PsychiatryJournal of Neurology, Neurosurgery and Psychiatry , ,

75, 945-948.75, 945-948.Bundy, A.C. & Murray, E.A. (2002). Sensory Integration: A. Jean Ayre’s Theory Revisited. In A.C. Bundy, E.A. Murray Bundy, A.C. & Murray, E.A. (2002). Sensory Integration: A. Jean Ayre’s Theory Revisited. In A.C. Bundy, E.A. Murray

& S. Lane (Eds.), & S. Lane (Eds.), Sensory Integration: Theory and PracticeSensory Integration: Theory and Practice . Philadelphia: F.A. Davis.. Philadelphia: F.A. Davis.Dunn, E.J. (1998). The sensory profile: a discriminant analysis of children with and without disabilitiesDunn, E.J. (1998). The sensory profile: a discriminant analysis of children with and without disabilities . American . American

Journal of Occupational TherapyJournal of Occupational Therapy, 52, 283-290., 52, 283-290.Edelson, S.M., Rimland, B., & Grandin, T. (2003). Response to Goldstein’s Commentary: Interventions, to Facilitate Edelson, S.M., Rimland, B., & Grandin, T. (2003). Response to Goldstein’s Commentary: Interventions, to Facilitate

Auditory, Visual, and Motor Integration: “Show Me the Data”. Auditory, Visual, and Motor Integration: “Show Me the Data”. Journal of Autism and Developmental DisordersJournal of Autism and Developmental Disorders , , 33, 551-552.33, 551-552.

Fertel-Daly, D., Bedell, G. & Hinojosa, J. (2001). Effects of a Weighted Vest on Attention to Task and Self-Stimulatory Fertel-Daly, D., Bedell, G. & Hinojosa, J. (2001). Effects of a Weighted Vest on Attention to Task and Self-Stimulatory Behaviors in Preschoolers with Pervasive Developmental Disorders. Behaviors in Preschoolers with Pervasive Developmental Disorders. The American Journal of Occupational The American Journal of Occupational TherapyTherapy, 55,629-639., 55,629-639.

Goldstein, H. (2003). Response to Edelson, Rimland, and Grandin’s Commentary. Goldstein, H. (2003). Response to Edelson, Rimland, and Grandin’s Commentary. Journal of Autism and Journal of Autism and Developmental DisordersDevelopmental Disorders, 33, 553-555., 33, 553-555.

Goldsetin, H. (2000). Commentary: Interventions to Facilitate Auditory, Visual, and Motor Integration: “Show Me the Goldsetin, H. (2000). Commentary: Interventions to Facilitate Auditory, Visual, and Motor Integration: “Show Me the Data”. Data”. Journal of Autism and Developmental DisordersJournal of Autism and Developmental Disorders , 30, 423-425., 30, 423-425.

Iwata, B. & Mason, S. A. (1990). Artificial Effects of Sensory-Integrative Therapy on Self-Injurious Behavior. Iwata, B. & Mason, S. A. (1990). Artificial Effects of Sensory-Integrative Therapy on Self-Injurious Behavior. Journal Journal of Applied Behavior Analysisof Applied Behavior Analysis, 23, 361-370., 23, 361-370.

Miller, L.J. (2003). Empirical evidence related to therapies for sensory processing impairments. Miller, L.J. (2003). Empirical evidence related to therapies for sensory processing impairments. NASP CommuniquéNASP Communiqué, , 31.31.

Schaaf, Roseann C., & Miller, Lucy Jane. (2005). Occupational Therapy Using A Sensory Integrative Approach for Schaaf, Roseann C., & Miller, Lucy Jane. (2005). Occupational Therapy Using A Sensory Integrative Approach for Children with Developmental Disabilities. Children with Developmental Disabilities. Mental Retardation and Developmental Disabilities Research ReviewsMental Retardation and Developmental Disabilities Research Reviews , , 11, 143-14811, 143-148

Smith, T., Mruzek, D.W., & Mozingo, D. (2005). Sensory Integrative Therapy. In J.W. Jacobson, R.M. Foxx, & J.A. Smith, T., Mruzek, D.W., & Mozingo, D. (2005). Sensory Integrative Therapy. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick, (Eds.), Mulick, (Eds.), Controversial Therapies for DevelopmentalControversial Therapies for Developmental DisabilitiesDisabilities. Mahwah, N.J.: Lawrence Erlbaum . Mahwah, N.J.: Lawrence Erlbaum Associates.Associates.

ResourcesResources

Sensory Integration Disorder. Sensory Integration Disorder. www.geocites.com/Heartland/2085/SENSORY.htm?200613www.geocites.com/Heartland/2085/SENSORY.htm?200613

Sensory Integration International-The Ayres Clinic. Sensory Integration International-The Ayres Clinic. www.sensoryint.com/ayres.htmlwww.sensoryint.com/ayres.html

Sensory Integration Therapy. Sensory Integration Therapy. www.moddrc.com/information-disabilities/fastfacts/sensoryintegratiowww.moddrc.com/information-disabilities/fastfacts/sensoryintegration.comn.com

Sensory Integration and Praxis Tests (SIPT). Sensory Integration and Praxis Tests (SIPT). https://www-secure.earthlink.net/www.wpspublish.com/Inetpub4/cathttps://www-secure.earthlink.net/www.wpspublish.com/Inetpub4/catalog/W-260.htmalog/W-260.htm

Sensory Integration Courses. Sensory Integration Courses. http://www.wpspublish.com/Inetpub4/w0903.htmhttp://www.wpspublish.com/Inetpub4/w0903.htm

Sensory Profile. Sensory Profile. http://http://harcourtassessment.com/haiweb/Cultures/enharcourtassessment.com/haiweb/Cultures/en- US/- US/dotCom/SensoryProfile/About/Sensory+ProfiledotCom/SensoryProfile/About/Sensory+Profile

Sensory Integration Therapy for Children with Autism.

Documents

Transcript of Sensory Integration Therapy for Children with Autism.