A Review of Sensory Integration Therapy as a Treatment For Autism

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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

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
Dysfunctions
Withdrawal from touch
Food texture avoidance
Sensitivity to types of clothing
Reaction to washing face or hair

Dysfunctions continued
Avoiding getting hands dirty (glue sand mud
paint)
Using fingertips rather than full hand
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

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.

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.

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

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.

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)

(http//www.pdm1.org/toc.htm)
57
Sensory Processing Disorder

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
4 boys had less nonengaged play
1 boy had improvements with adult interactions
None changed in level of peer interactions

(Baranek 2002 Watling Dietz 2007) )
65
Case-Smith and Bryan (1999)

Limitations
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.

Questions

80
References

Aetna. (2007). Clinical Policy BulletinSensory
and Auditory Integration Therapy. Retrieved on
June 10 2008 from
http//autism.about.com/gi/dynamic/offsite.htmzi
1/XJsdnautismcdnhealthtm6gps122_189_1020_
592f00tt12bt0bts1zuhttp3A//www.aetna.co
m/cpb/medical/data/200_299/0256.html .
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
http//www.anthem.com/medicalpolicies/policies/mp
_pw_a053279.htm.
Autism/Sensory Integration Therapy for Children
with Autism. Healing Thresholds Co. Retrieved on
May 29 2008
http//autism/healingthresholds.com/therapy/senso
ry-integration
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
http//www.empireblue.com/provider/noapplication/f
2/s5/t9/pw_ad084948.pdf.
(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
http//www.healthlink.com/provider/medpolicy/polic
ies/BEH/treatment_autism.html.

82
References (continued)

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
http//www.doh.gov.uk/nsf/children/nationalautist
icfrsec.pdf.
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/

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.