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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

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

11
  • 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

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
  • Clumsiness,tendency 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 Healthlink,2007
)
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 Ayres's 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 Ayres's
    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 Ayres's 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 Ayres's sensory integration
    immediately before tabletop tasks affect the
    occurrence of undesired behaviors during the
    tabletop activities
  • Does participation in Ayres's 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 Ayres's 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
    Ayres's 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 Ayres's 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 Ayres's sensory
    integration. (Dawson Watling, 2000 Goldstein,
    2000)
  • Ayres's 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 Mulick,2005)

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
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