Evidence-Based Sensory Interventions for Children with Autism Spectrum Disorder

Today we look at Evidence-Based Sensory Interventions for Children with Autism Spectrum Disorder. People who work with kids who have autism spectrum disorder (ASD) often use sensory integration (SI) treatment. However, even though SI therapy can be helpful, occupational therapists should think about using a more complete, top-down method to therapy. A bottom-up approach to SI looks at how the senses work, while a top-down method looks at bigger functional goals and client needs.

How Sensory Integration Therapy Works

Sensory integration treatment is all about helping kids understand and react to the things they sense around them. The goal of therapy is to help people pay more attention, control themselves, and take part in daily tasks. Many people use SI treatment, but not all of them work the same way, and not all sensory interventions can help everyone. So, it’s very important for OTs to look at the evidence behind these interventions to make sure they’re using the best methods possible.

• Morals

Making clients and their families aware of how well certain strategies work is very important. Not every technique that occupational therapists learn will lead to useful results. Practitioners should be honest with parents about the research that supports the treatments they choose, especially if new research suggests that one intervention is more effective than another.

• Population

The main group of people who benefit from sensory integration (SI) interventions are children with autism spectrum disorder (ASD). These children often have difficulties processing sensory information, which can impact their daily lives, including activities at school, playtime, and self-care.

• Key Research Articles

Many studies have looked into the effectiveness of different sensory techniques and how changing the environment can help children with sensory issues. Here are some important ones:

1. Miller-Kuhaneck, H., & Watling, R. (2018): This study reviewed how educating and coaching parents or teachers can support children with sensory processing challenges.
2. Pfeiffer, B., Frolek Clark, G., & Arbesman, M. (2018): This research focused on cognitive and occupation-based interventions, which are methods aimed at improving thinking skills and daily activities for children with sensory issues.
3. Schaaf, R. C., et al. (2018): This study looked at the effectiveness of Ayres Sensory Integration®, a specific method of SI therapy.
4. Tanner, K., et al. (2015): This review focused on interventions to improve social participation and behaviors in individuals with ASD.
5. Watling, R., & Hauer, S. (2015): This research assessed both Ayres Sensory Integration® and other sensory-based interventions for children with ASD.
6. Weaver, L. L. (2015): This study analyzed interventions for work, daily living activities, education, and sleep for people with ASD.

In 2012, the American Academy of Pediatrics (AAP) recommended that sensory processing disorder should not be used as a diagnosis. This suggests that more evidence is needed to support SI as a distinct condition.

• Outcome Measures

When researchers study how effective sensory interventions are, they use specific tools to measure outcomes. Some of the common ones include:

1. Social Responsiveness Scale-2 (SRS-2): Measures social behavior and communication.
2. Children Sensory Profile-2 (CSP2): Assesses how children respond to sensory experiences.
3. Canadian Occupational Performance Measure (COPM): Evaluates a child’s ability to perform daily activities.
4. Goal Attainment Scaling (GAS): Tracks progress towards specific goals set for the child.
5. Parent Stress Index-Short Form (PSI-SF): Measures the level of stress parents feel.
6. Parent Sense of Competence Scale (PSOC): Assesses how competent and confident parents feel in managing their child’s needs.

These tools help researchers and therapists understand if the sensory interventions are making a positive difference in the child’s life.

Evidence-Based Sensory Interventions

• Qigong Massage

1. Effectiveness: Qigong massage has shown strong evidence of effectiveness. It helps improve various aspects of autism, including sensory processing, behavior, language skills, self-control, sociability, sensory and cognitive awareness, and physical health.
2. Quality of Evidence: Although Qigong massage shows positive outcomes, many studies have insufficient quality and high risks of bias. Therefore, it is recommended to use Qigong massage as a complementary therapy alongside other treatments rather than relying on it as the sole treatment.

• Weighted Vests

1. Effectiveness: The use of weighted vests has limited evidence supporting their effectiveness for improving attention and calming behaviors in children with ADHD and ASD. Any positive effects are generally minimal.
2. Quality of Evidence: Studies on weighted vests show high variability and small positive effects. Some positive reports are based on therapist surveys rather than rigorous scientific research, reducing the reliability of these findings.

• Slow Linear Swinging

1. Effectiveness: There is insufficient evidence to support the use of slow linear swinging for improving on-task behavior in children with ASD.
2. Quality of Evidence: Research indicates no significant differences in behavior between children who experienced swinging and those who did not, suggesting that this intervention may not be effective.

• Sensory Enrichment in Preschool

1. Effectiveness: There is insufficient evidence to support the use of tactile, proprioceptive, and vestibular activities in daily preschool routines for improving sensory processing.
2. Quality of Evidence: Studies in this area often lack robust methodologies, making it difficult to draw definitive conclusions about the effectiveness of these activities.

Other Techniques 

1. Effectiveness: Techniques such as the Wilbarger brushing protocol, therapy ball chairs, sensory diets, Sensory Gym and auditory stimulation programs (e.g., therapeutic listening) have low levels of evidence supporting their effectiveness.
2. Quality of Evidence: Research designs for these techniques often face internal validity threats, making it hard to draw concrete conclusions about their effectiveness. The lack of rigorous studies further diminishes the reliability of these interventions.

you may also like: https://advantagetherapy.com.au/auditory-processing-disorder/

Effective Sensory Interventions

While many traditional sensory interventions have limited evidence supporting their effectiveness, some environmental and holistic approaches have been shown to yield better outcomes. Here are some examples:

Sensory Environmental Modifications

• Effectiveness:

  Changing the environment to reduce sensory overload can greatly improve participation and comfort for children with autism spectrum disorder (ASD). For instance, a study in a dental office found that making sensory modifications, such as reducing noise and bright lights, along with using a weighted wrap, led to moderate improvements in pain intensity, sensory discomfort, and participation for children with ASD.

Holistic Techniques

• Effectiveness:

  Approaches that combine sensory interventions with broader functional goals have higher levels of evidence supporting their effectiveness. Examples include:

• CO-OP (Cognitive Orientation to daily Occupational Performance): A method that helps children develop problem-solving skills to achieve their goals.
• Behavioral Interventions: Strategies to modify behavior through reinforcement and other techniques.
• Coaching: Guiding children and their families to develop skills and strategies for recreational activities.
• Problem-Solving: Teaching children how to tackle challenges in a structured way.
• Mindfulness: Techniques that help children become more aware of their thoughts and feelings in the present moment.
• Joint Attention: Activities that encourage children to share focus on objects or events with others.
• Social Skills Training: Programs that help children learn and practice appropriate social interactions.

Conclusion

However, sensory integration therapy should only be utilized by occupational therapists in cases when strong data is available to back it up. Occupational therapists treating children on the autism spectrum need to employ a thorough, evidence-based approach to address each child’s unique requirements, since different sensory therapies have different effects. Advantage therapy greatly benefits their clients by prioritizing open communication, making necessary environmental adjustments, and setting attainable goals.

Sources : https://research.aota.org/ajot/article/76/Supplement_1/7610510189p1/23413/A-Systematic-Review-of-Sensory-Interventions-for

https://www.otdude.com/ot-practice/evidence-based-supported-sensory-integration-interventions-for-autism-occupational-therapy-practice/