Title:A Review of Sensory Integration Therapy as a Treatment For Autism
Description:
Dancing (with head and trunk movement) Sit n' Spin. Rolling. Rocking ... Weighted lap bag or vest. Massaging hands before the sensitive material is handled ... – PowerPoint PPT presentation
Title: A Review of Sensory Integration Therapy as a Treatment For Autism
1 A Review of Sensory Integration Therapy as a Treatment For Autism
Elizabeth Kraljic
Evelyn Agrusti
Joanne Tasy
Caldwell College Graduate Program In Applied Behavioral Analysis
2 What Is Sensory Integration
Founder of Sensory Integration Theory
A. Jean Ayres Ph.D OTR FAOTA
Credited with having first identified sensory integrative dysfunction.
Author of three major standardized tests.
Occupational therapys foremost leader in theory development
3 A. Jean Ayres
Other Accomplishments
Educator at University of Southern California 1955-1984
Wrote books journal articles and training videos
Founder of Sensory Integration International
Licensed Psychologist
Credentials
BS and MA in Occupational Therapy
Ph.D in Educational Psychology
Post-Doctoral Traineeship at UCLA Brain Research Institute
4 A. Jean Ayres and Theory of Sensory Integration
Systematically investigated the brains processing of sensory information
She developed a theory to explain the relationship between the behavior and brain functioning
Sensory Integration
A Neurobiological process that organizes sensations from ones own body and environment and makes it possible to use the body effectively within that environment.
5 What is Sensory Integration
The senses are the primary building blocks of the central nervous system
External senses-all five senses
Internal senses
Tactile System- sense of touch through skin
Vesticular System- balance and weight
Proprioceptive System- sensory data from tendons muscles and joints
The three systems are interconnected but are also connected with other systems in the brain
Critical for basic survival
Allow us to experience interpret and respond to different stimuli in the environment.
6 Continued
Sensory impact nourishes the brain
Raw material for brain development and learning
Sensory stimulation produces brain tone which is responsible for basic brain waves of the conscious state
They provide the input that stimulates the Reticular Activation System of the brainstem to arousal
Regulates alertness coordination focus and the regulation of input and output
7
Multi-various sensations
Stimulated simultaneously and must be organized quickly and accurately
Sensory Integration (S.I.)
Provides the foundation for complex learning and behavior.
All skills are complex processes based on a strong foundation of sensory integration
S.I. is information processing.
Praxis and perception are the resulting products.
8 Theory Of S.I.
Sensory Integration is an automatic process.
Natural outcomes include
Motor planning
Adaptive ability to incoming sensations
When S.I. does not efficiently the process is disordered
Learning problems
Developmental lags
Behavioral or emotional issues
9 Continued
The young brain is malleable
Structure and function become set with age
Formative- allows person- environment interaction to promote and enhance neuro-integrative efficiency
A deficiency in effective interaction at critical periods interferes with optimal brain development and overall brain ability
Early detection and therapeutic interaction can enhance individual opportunity for normal development
10 Signs of Sensory Integrative Dysfunction
Sensory Integration focuss on three basic senses or systems
Tactile Vesticular and proprioceptive
Tactile System- nerves under skin that send information to brain (light touch pain temperature and pressure)
Important for perceiving environment and for protective reactions for survival
Misperception of touch or pain (hypo or hyper sensitivity)
Self imposed isolation irritability distractibility and hyperactivity
Tactile Defensiveness
Is a condition where individuals are extremely sensitive to light touch.
Abnormal signals to the cortex in the brain interfere with other brain processes.
12 Sensory Integration Dysfunction
Vestibular System
Refers to structure within the inner ear called the semi-circular canals. These structures detect movement and the position of the head.
Dysfunction-Hypersensitivity
Hypersensitive to vestibular stimulation and have fearful reactions to ordinary movement. They may have trouble learning to climb or descend stairs or hills. They may be apprehensive walking or crawling on uneven or unstable surfaces.
Dysfunction- Hypo-Reactive Vestibular System
Actively seeks very intense sensory experiences.
Whirling jumping spinning
13
Proprioceptive System
Components of muscles joints and tendons that provide the subconscious awareness of body position.
Praxis or motor planning
The ability to plan and execute different motor tasks
Dysfunction
Clumsinesstendency to fall lack of body position in space odd body posturing difficulty manipulating small objects eating in a sloppy manner resistance to new motor movement activities
14 S.I.D. Implications
Implications
Dysfunction in the three previously mentioned systems can be manifested in many ways.
Over or under responsiveness to sensory input
Deficiencies in gross and fine motor coordination speech/language delays and learning issues
Behaviorally the child is frequently impulsive easily distractible and shows a general lack of planning.
Tendency towards difficulty in adjusting to new situations easily frustrated aggressive or withdrawn
15 S.I.D. Resulting Problems
Attention and Regulatory
The ability to attend to a task depends on screening out nonessential sensory information background noises or visual information.
Can produce distractibility hyperactivity or uninhibited output.
Sensory Defensiveness
Individual has highly aroused nervous system which prepares the body for survival.
Individual does not recognize input as non threatening
16 Continued
Activity Level
The child may appear disorganized or lacking purpose in their activity
Does not explore the environment or lacks variety in play activities
May appear clumsy or have poor balance
Behavior
The child exhibit negative behaviors
They lack flexibility may be explosive or have difficulty transitioning
Sensory Modulation
The childs inability to regulate sensory input and maintain a situation-appropriate state.
17 Patterns of S.I.D.
Research identified factors that highly correlate with each other
Patterns of sensory integration dysfunction examples
Visual construction and praxis deficits and Tactile discrimination and praxis
Developmental coordination disorder (fine and gross motor balance and coordination deficits)
Developmental regulatory disorder
Under over or fluctuating response to sensations
18 Evaluating S.I.D.
Assessment-- First step of the treatment process
Individualized- Identify the specific learning motor and behavior difficulty of a child
Tests observations interviews of neuromotor function and sensory modulation abilities
Standardized Tests Ayres developed seventeen standardized tests and many non standardized observations to identify and understand the multiple patterns of S.I.D. Her tests and others are currently used to test for sensory issues.
19 Evaluation continued
Examples
Sensory Integration and Praxis Tests (SIPT) for children 4-8 years and 11 months
Test for Sensory Integration (TSI) for children 3-5 years of age
Bruininks Osteretsky Test for Motor Proficiency for ages 5-15 years
Peeramid ages 6-14
20 Evaluating S.I.D.
Evaluation and treatment of the basic sensory integrative processes is preformed by trained SI occupational therapists and or physical therapists or speech and language pathologists
Goals
Provide the child with sensory information which helps organize the central nervous system
Assist the child in inhibiting and or modulating sensory input
Assist the child in processing a more organized response to sensory stimuli
21 Validation of S.I. Treatment
In 2002 occupational therapy experts defined the core principles of sensory integration as used in professional practice such as occupational therapy.
This was done to validate methods reported as sensory integration in research.
These principles are deemed essential to providing sensory integration intervention
22 Intervention Principles Based on Sensory Integration Theory
Qualified professional occupational therapist physical therapist or speech and language pathologist.
Intervention plan is family-centered based on a complete assessment and interpretation based on the patterns of sensory integrative dysfunction collaboration with significant people in the individuals life adherence to ethical and professional standards of practice.
23
Safe environment that includes equipment that will provide vestibular proprioceptive and tactile sensations and opportunities for praxis.
Activities rich in sensation especially those that provide vestibular tactile and proprioceptive sensations and opportunities for integrating that information with other sensations such as visual and auditory.
Activities that promote regulation of affect and alertness and provide the basis for attending to salient learning opportunities.
24
Activities that promote optimal postural control in the body oral-motor ocular motor areas and bilateral motor control sustaining control while holding against gravity and maintaining control while moving through space.
Activities that promote praxis including organization of activities and self in time and space.
Intervention strategies that provide the just-right challenge
25
Opportunities for the client to make adaptive responses to changing and increasingly complex environmental demands. Highlighted in Ayres Sensory Integration intervention principles is the Somato-motor adaptive response which means that the individual is adaptive with the whole body moving and interacting with people and things in the 3-dimensional space.
Intrinsic motivation and drive to interact through pleasurable activities in other words play.
26
Therapist engenders an atmosphere of trust and respect through contingent interactions with the client. That is the activities are negotiated not pre-planned and the therapist is responsive to altering the task interaction and environment based on the clients responses.
The activities are their own reward and the therapist ensures the childs success in whatever activities are attempted by altering them to meet the childs abilities.
27 Guidelines for Competency in Application of S.I. Theory
Restricted to professionals qualified occupational therapists physical therapists speech and language pathologists
Competencies developed through post graduate continuing education mentoring in clinical experience
Advanced training is through the same means
Certification in S.I. should include administering and interpreting the Sensory Integration and Praxis Tests (SIPT) when used in O.T.
28 Maintaining Competency
Applying clinical application of S.I. for a maximum of two years
Mentorship through supervision and professional guidance by a therapist certified in S.I.
Ongoing study and review of literature
Ongoing feedback from professional peers as a check and balance for best practice.
29 Maintaining Competency
Essential Knowledge for Occupational Therapists using Sensory Integration
Sensory Integration Theory
Assessment of Sensory Integration and Praxis
Interpretation of Assessment Data for Intervention Planning
Occupational Therapy Intervention using Sensory Integration Strategies.
30 Part II
TREATMENTS
SPECIFIC
BEHAVIORS
31 3 Keys to Treatment
Frequency
2. Duration
3. Intensity
32 Sensory Diet
Is a specifically designed plan of biochemical and neurological input to promote and facilitate function
33 Biochemical
Consists of two components
1. Sleep
2. Nutrition
34 Neurological
Consists of 3 things
1. Vestibular
2. Proprioceptive
3. Tactile
Auditory
Visual
35 Vestibular System
The sensory system that responds to changes in head position and to body movement through space.
It coordinates movements of the head body and eyes
The receptors are in the inner ear
36 Vestibular Activities
Hokey Pokey with big movements
Head Shoulders Knees and Toes
Dancing (with head and trunk movement)
Sit n Spin
Rolling
Rocking Chair
37 Proprioceptive System
Unconscious awareness of sensation coming through the muscles joints and tendons that tells you what position you are in
38 Proprioceptive Activities
Stair climbing and/or sliding
Playing tug of war
Pulling or Pushing
Big Ball activities
Being squished between pillows
Scooter activities
Hitting a punching bag
39 Tactile System
The sensory system that receives sensations of pressure vibration movement pain and temperature through connections in the skin
This system helps to tell the difference between threatening and non-threatenting sensations
40 Tactile Activities
Finger painting
Making things with foam soap
Clay/Play-Doh/Putty
Walking on the grass with no shoes
swim and dry off with towel
Texture adventure bins
Lotions
Glue projects
41 Sensory Seeking Behaviors
Running Spinning or other movements
Provides vestibular and proprioceptive stimulation
Treatments to try
Movement games like tag or relay races
Bouncing on large therapy balls
Rocking chair
Jumping
42 More Sensory Seeking Behaviors
Pinching Squeezing or Grabbing
A students hand may be extremely sensitive compared to other body parts and sensory input in the palm may help to override the painful response to a light touch
Treatments to try
Deep pressure massages
Hand massages or pressing hands together
Wristbands that provide pressure
Vibration toys
43 More Sensory Seeking Behaviors
Flapping
This movement of the bodys joints and muscles provides proprioceptive sensation to the muscles and joints in the wrists arms and shoulders. (could signal sensory overload)
Treatments to try
Wheelbarrow walks
Push-ups
Jumps with hands being held
Fidget toy
44 More Sensory Seeking Behaviors
Pica (mouthing or eating non-food substances)
Provides strong tactile and proprioceptive input for a child who is not registering the sensation. It could also transmit vibration to the jaw which can stimulate the vestibular system
Treatments to try
Vibrating toys for the mouth
Crunchy foods throughout the day
Listerine to be swabbed inside the childs mouth
with parental permission
45 Sensory Avoidant Behaviors
Takes off clothing
Clue to the fact that the clothings touch is uncomfortable to the childs skin
Treatments to try
Calming techniques
Soft fabrics
Washing new clothes several times before use
Allow child to choose their clothes
46 More Sensory Avoidant Behaviors
Avoids eye contact
Peripheral vision could be less stressful or processing visual and auditory input could be difficult looking away allows the child to process the auditory input better
Treatments to try
Look into a mirror and gradually increase to someones eyes
Teach a child body positions that indicate listening
Using quiet hands
47 More Sensory Avoidant Behaviors
Avoids handling sensory material
This is a common sign of tactile defensiveness because the hands have a lot of touch receptors. Also the temperature and wetness affect the childs tolerance.
Treatments to try
Deep pressure touching
Weighted lap bag or vest
Massaging hands before the sensitive material is handled
48 Calming Techniques
These are especially helpful for children with sensory defensiveness.
They help to relax the nervous system
They can reduce exaggerated responses to sensory input
Techniques
Help with heavy work
Ripping paper
Joint compression
Lap snake
Lavender vanilla or banana scents
Reduced noise or light levels
Sucking through a straw
Bear hugs
49 Organizing Techniques
Can help a child who is either over or under reactive become more focused and attentive
Techniques
Hard candy
Catching/throwing heavy balls
Pulling apart toys (Legos etc)
Adding rhythm to the activity
50 Altering Techniques
Help a child who is under reactive to sensory input
Need to be closely monitored
Techniques
Jump up down (10x)
The Airplane Activity (hand out)
Fast swinging
Quick unpredictable movements
Running games
Loud fast music
51 Part 3
Evelyn Agrusti
52 Sensory Integration Therapy and Insurance
Many Insurance companies will not pay for Sensory Integration Therapy (SIT)
Aetna Empire BC/BS and Healthlink consider sensory and auditory integration therapies experimental and investigational for the management of persons with various communication behavioral emotional and learning disorders and for all other indications. The effectiveness of these therapies is unproven.
(Aetna 2007 Empire BC/BS 2006 Healthlink2007 ) 53 SIT is Experimental and Unproven
Aetna references numerous studies that support their view on sensory integration
National Initiative for Autism (UK) (2003)
Kaplan et al. (1993)
Hoehn and Baumeister (1994)
National Academy of Sciences (NAS) (2001)
American Association of Pediatrics (2001)
Tochel (2003)
Vargas and Camilli (1999)
Parham et al. (2007)
Parr (2006)
(Aetna 2007) 54 Investigational and Not Medically Necessary
Cognitive rehabilitation
Elimination diets (e.g. gluten and milk elimination)
Facilitated communication
Immune globulin infusion
Lovaas therapy (also known as applied behavior analysis (ABA) intensive behavioral intervention (IBI) discrete trial training early intensive behavioral intervention (EIBI) or intensive intervention programs)
Music therapy pet therapy (e.g. Hippotherapy)
Nutritional supplements (e.g. megavitamins)
Secretin infusion
Sensory integration therapy
Vision therapy
(Anthem BC/ BS 2008) 55 A LOOP HOLE
Current ICD diagnostic manual and DSM-IV
no recognized procedural codes for Sensory Processing Disorder (Sensory Integration Dysfunction Dysfunction of Sensory Integration.)
SPD of the Bay Area tells people The child must be billed with a diagnosis other than Sensory Processing Disorder or Autism.
315.4 coordination disorder
728.9 disorder of muscle ligament/muscle hypotonicity
781.3 motor incoordination
781.92 abnormal posture
(http//www.spdbayarea.org/SPD_diagnosis.htm) 56 Make Your Own Manual
The Psychodynamic Diagnostic Manual (PDM) (2006)
Psychoanalytic groups involved
American Psychoanalytic Association
International Psychoanalytical Association
Division of Psychoanalysis (39) of the American Psychological Association
American Academy of Psychoanalysis and Dynamic Psychiatry
National Membership Committee on Psychoanalysis in Clinical Social Work
Developmental Disorders include
SCA321. Regulatory Disorders
IEC200 Series - Regulatory-Sensory Processing Disorders (RSPD)
Recognized in the new Diagnostic Manual for Infancy and Early Childhood (DMIC)
The formal diagnostic category is Regulatory Sensory Processing Disorder (code 200). http//www.spdbayarea.org/SPD_diagnostic_codes.pdf
Published by Interdisciplinary Council on Developmental and Learning Disorders (ICDL) in 2005.
Dr. Stanley I. Greenspan is Chair of ICDL.
(http//www.spdbayarea.org/SPD_diagnosis.htm) 58 False Claims of Recovery
SPD Bay Area Resource Group Hope and Recovery!
In our international SPD Parent Resource Network we believe and have experienced that recovering children from Sensory Processing Disorder is absolutely possible!
Parents in our Groups use a variety of occupational medical auditory homeopathic and other alternative therapies that help a child recover from Sensory Processing Disorder.
(http//www.spdbayarea.org/) 59 Research on Sensory Integration Theory (SIT)
As of 2007 only 3 published studies existed that used methods consistent with Ayress sensory integration therapy that included people with ASD
Ayres and Tickle (1980)
Linderman and Stewart (1999)
Case-Smith and Bryan (1999)
(Watling Dietz 2007)
60 Ayres and Tickle (1980)
Purpose explore variables that predict positive or negative outcomes after 1-yr of SIT
Participants 10 children (mean age of 7.4 yrs)
Participants with ASD who had average or hyper-responsive reactions to tactile and vestibular sensations showed better outcomes than those with hypo-responsive patterns
After 11 months of Ayress sensory integration reported improvements in interaction initiation environmental awareness and activity selection
(Baranek 2002 Watling Dietz 2007) 61 Ayres and Tickle (1980)
Researchers suggest that differences in outcomes may be due to specific subject attributes including patterns of sensory processing.
Limitations
Small sample size (10 children)
variability of the outcome measures used
lack of control over maturational effects
No control group (within group design)
(Baranek 2002) 62 Linderman and Stewart (1999)
Purpose Track functional behavioral changes in the home associated with SIT
Participants 2 children (3 yrs) with PDD (mild autism)
Method therapy in clinic for 1 hr/wk for 7 to 11 wks
Results
Subject 1 (tactile hypersensitivity) demonstrated gains in all intended outcomes
social interaction response to movement approach to new activities and response to holding and hugging
Subject 2 (hypo-responsive to vestibular and hyper-responsive to tactile) made gains in activity level and social interaction but not in functional communication
(Baranek 2002 Watling Dietz 2007) 63 Linderman and Stewart (1999)
Limitations
No control group (single- subject design)
Small sample size (only 2 participants)
Confounding variables
Other possible interventions (e.g. education)
Maturation of participants
Parent participation in evaluation procedures
(Baranek 2002) 64 Case-Smith and Bryan (1999)
Purpose to examine affect SIT has on play and interaction with others
Participants 5 preschool boys with ASD
Method 3-week baseline and 10-week Ayress sensory integration
Results
3 boys had significant improvements in mastery play
Results could have been a product of other confounding variables
(e.g. maturation caregiving effects other interventions)
Sensory processing variables could not be assessed directly so it is not known if positive results are due to improvements in sensory processing mechanisms
Improvements could also have resulted from other components of intervention
(e.g. play coaching motivational strategies)
66 Watling Dietz (2007)
Purpose
to examine the effectiveness of Ayress sensory integration compared to a play scenario for (a) reducing undesirable behaviors and (b) increasing engagement in purposeful activities for young children with ASD.
Method
single-subject study
ABAB design to compare the immediate effect of SIT and a play scenario on the undesired behavior and task engagement of 4 children with ASD.
Familiarity phase also included to reduce effect of novelty of dependent variables and therapists
This study had three phases familiarization baseline and treatment. Each phase of the study included three 40-min intervention sessions per week followed by a 10-min tabletop activity segment that served as the data collection period.
67 Watling Dietz (2007)
The research questions
Does participation in Ayress sensory integration immediately before tabletop tasks affect the occurrence of undesired behaviors during the tabletop activities
Does participation in Ayress sensory integration immediately before tabletop tasks affect engagement in tabletop activities
Tabletop paradigm
frequently encountered by children in education setting
Provided standardized environment for data collection
68 Watling Dietz (2007)
Materials for the treatment phases included items that commonly are used in Ayress sensory integration
suspended equipment such as swings trapeze bar and rope ladder
a small trampoline
scooterboard and ramp
plastic rings
Tunnel
balance beam
toys with various textures
toys that challenge bilateral coordination and manipulation skills
69 Watling Dietz (2007)
Tabletop activities had to meet 2 criteria
(a) the activity demands matched the cognitive and fine motor skills of the child
(b) the activity had the tendency to elicit focused attention and purposeful engagement.
Examples of activities were puzzles stickers figurines beads and string and blocks. None of the toys used in the tabletop segments were the same as those used in baseline or treatment sessions for any child.
70 Watling Dietz (2007)
Undesired behavior was defined as those behaviors that interfere with task engagement and participation in daily activities
Identified through caregiver report and observation by the primary investigator during the familiarity period of the study
For 42 of data collection forms interobserver agreement for undesired behavior was calculated using the point-by-point method (Kazdin 1982)
Agreement for undesired behavior ranged from 85 to 100 (mean of 91)
71 Watling Dietz (2007)
Engaged behavior was defined as intentional persistent active and focused interaction with the environment including people and objects.
did not require typical use of the tabletop materials to capture all interactions that held meaning for each child.
Engaged behavior object was used in a manner that was clearly playful or imaginative and that appeared to have meaning to the child.
For example when a child used a marker to color on his hand and directed his gaze toward his coloring his behavior was coded as engaged.
When a child bit or chewed on a marker while looking across the room his behavior was coded as not engaged.
Interobserver Agreements for engagement ranged from 81 to 100 (mean of 95).
72 Watling Dietz (2007)
Results
No clear patterns of change in undesired behavior or task management emerged through objective measurement.
Subjective data suggested that each child exhibited positive changes during and after intervention.
Conclusion
immediately after intervention short-term Ayress sensory integration does not have a substantially different effect than a play scenario on undesired behavior or engagement of young children with ASD.
subjective data suggest that Ayress sensory integration may produce an effect that is evident during treatment sessions and in home environments.
73 Research
More studies examining SIT for children with ASD are needed.
Conclusions regarding the effectiveness of the intervention cannot be drawn.
Well-controlled studies with relevant and reliable outcome measures are needed to expand knowledge of the effectiveness of Ayress sensory integration. (Dawson Watling 2000 Goldstein 2000)
Ayress sensory integration remains under development and efficacy studies should include well-controlled single-subject design experiments with a few subjects (Goldstein 2000)
74 Possible Benefit
Although therapies do not appear to work as intended there is some evidence that they serve as reinforcement (Mason Iwata 1990) and they may have other benefits such as promoting healthy and physical exercise.
(Jacobson Foxx and Mulick2005)
75 Temple University Study (2007)
Pfieffer Kinnealey from OT Dept in Temple Uniersitys College of Health Professions
American Occupational Therapy Associations 2008 conference
Children with ASD who underwent SIT exhibited fewer autistic mannerisms compared to children who received standard treatments.
71 percent of parents who pursued alternatives to traditional treatment used sensory integration methods
91 percent found these methods helpful.
(http//www.temple.edu/newsroom/2007_2008/04/stori es/aota.htm) 76 Temple University Study (2007)
Participants and setting
summer camp near Allentown Pa. for children with autism.
Participants were between the ages of 6 and 12 years old and diagnosed with autism or PDD-NOS.
Method
One group (17) received traditional fine motor therapy and the other group (20) received sensory integration therapy.
Each child received 18 treatment sessions over a period of six weeks.
A statistician randomly assigned the participants to groups this information was provided to the project coordinator at the site.
Primary researchers were blinded to group assignment and served as evaluators before and after the study.
Parents were blinded to the interventions assigned and were not on site.
77 Temple University Study (2007)
Results
Researchers used a series of scales that measure behavior.
While both groups showed significant improvements the children in the sensory integration group showed more progress in specific areas at the end of the study.
Conclusion
Sensory integration intervention group
reached more goals specified by their parents and therapists
Progressed toward goals in areas of
sensory processing/regulation
social-emotional and functional motor tasks.
78 Temple University Study (2007)
Need for research such as randomized control trials to validate sensory integration
Provided a foundation for designing randomized control trials for sensory integration interventions with larger sample sizes in the future
It identified issues with measurement such as the sensitivity of evaluation tools to measure changes in this population
Develop accurate ways of measuring sensorimotor abilities before and after treatment to evaluate the therapys outcome with scientific quantitative data.
79
Questions
80 References
Aetna. (2007). Clinical Policy BulletinSensory and Auditory Integration Therapy. Retrieved on June 10 2008 from
American Psychoanalytic Association. (2006). The Psychodynamic Diagnostic Manual (PDM). Retrieved on June 10 2008 from http//www.pdm1.org/toc.htm
American Association of Pediatrics (AAP). (2001). Technical Report The Pediatricians Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children. Pediatrics 107(5)85.
Anthem Blue Cross and Blue Shield. (2008). Medical Policy. Retrieved on June 10 2008 from
Ayres A. J. Tickle L. S. (1980). Hyper-responsivity to touch and vestibular stimuli as a predictor of positive response to sensory integration procedures by autistic children. American Journal of Occupational Therapy 34 375381.
81 References (continued)
Baranek GT. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Developmental Disorders 32 397-422.
Case-Smith J. Bryan T. (1999). The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy53 489497.
Center for The Study of Autism. (N.D). Sensory Integration. Retrieved May 31 2008 from http//www.autism.org/si.html
Dawson G. Watling R. (2000). Interventions to facilitate auditory visual and motor integration in autism A review of the evidence. Journal of Autism and Developmental Disorders 30 415-421.
Dejean Valerie. (N.D). Sensory Integration theory of Dr. Jean A. Ayres. Retrieved May 28 2008 from http//www.users.nac.net/dejean/sensory. html
Empire Blue Cross and Blue Shield. (2006). Medical Policy. Retrieved on June 10 2008 from
(Gdasi Graves McKena Peopose). 2006. Sensory Strategies for Specific Challenging Behaviors A Hands on Approach. Ridgefield Park Board of Education Staff Development
Goldstein H. (2000). Commentary Interventions to facilitate auditory visual and motor integration Show me the data. Journal of Autism and Developmental Disorders 30 423-425.
Healthlink. (2007) Medical Policy. Retrieved on June 10 2008 from
Hoehn T. P. Baumeister A. A. (1994). A critique of the application of sensory integration therapy to children with learning disabilities. Journal of Learning Disabilities 27(6)338-350.
Jacobson Foxx and Mulick2005
Kaplan B. J. et al. (1993). Reexamination of sensory integration treatment A combination of two efficacy studies. Journal of Learning Disabilities 26(5)342-347.
Kazdin A. E. (1982). Single-case research designs. New York Oxford University Press.
Linderman T. M. Steward K. B. (1999). Sensory integrative-based occupational therapy and functional outcomes in young children with pervasive developmental disorders A single subject study. American Journal of Occupational Therapy 53 207213.
Mason S. A. Iwata B.A. (1990). Artificial effects of sensory-integrative therapy on self-injurious behavior. Journal of Applied Behavior Analysis 23 361-370.
Memorial Hospital Pennsylvania (2005) Sensory Integration Therapy. Retrieved May 31 2008. From http//www.memorialhospital.org/SensoryIntegration .htm
83 References (continued)
National Academy of Sciences (NAS) National Research Council Division of Behavioral and Social Sciences and Education Committee on Educational Interventions for Children with Autism. (2001). Educating Children with Autism. Lord C. McGee J.P. eds. Washington DC National Academics Press.
National Initiative for Autism Screening and Assessment. National autism plan for children (NAPC). London UK National Autistic Society March 2003. Retrieved on June 10 2008 from
Parham L.D. Cohn E.S. Spitzer S. et al. (2007). Fidelity in sensory integration intervention research. American Journal of Occupational Therapy 61 (2)216-227.
Parr J. (2006) Autism. In BMJ Clinical Evidence. London UK BMJ Publishing Group.
Rudy Lisa J. (N.D) What Do Sensory Integration Therapists Do For Children With Autism Retrieved May 31 2008 from http//autism.about.com/od/treat mentoptions/f/sitherapydoes.htm
Sensory Integration Global Network. (N.D) About A Jean Aryes. Retrieved May 28 2008 from http//www.siglobalnetwork.org/about.htm
Sensory Integration Global Network. (N.D). Ayres Sensory Integration. Retrieved May 28 2008 from http//www.siglobalnetwork.org/about.htm
Sensory Integration Dysfunction Signs Symptoms and Background Information. (N.D). Retrieved May 28 2008 from http//www.siglobalnetwork.org/about .htm
Sensory Processing Disorder Bay Area Resource Group Retrieved on June 10 2008 from http//www.spdbayarea.org/
84
Tochel C. (2003). Sensory or auditory integration therapy for children with autistic spectrum disorders. STEER Succint and Timely Evaluated Evidence Reviews. Bazian Ltd. eds. London UK Wessex Institute for Health Research and Development University of Southampton 3(17).
Vargas S. Camilli G. (1999). A meta-analysis of research on sensory integration treatment. American Journal of Occupational Therapy. 53(2)189-198.
Voight Liz. (2004). The Sensory Diet New For 2004. Presentation at Kean University New Jersey
Watling R. L. Dietz J. (2007). Immediate effect of Ayress sensory integration-based occupational therapy intervention on children with autism spectrum disorders. American Journal of Occupational Therapy 61 574-583.
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