Classroom based sensory intervention for children with autism spectrum disorders (ASD): A pilot study using single system design

Transcription

1 Classroom based sensory intervention for children with autism spectrum disorders (ASD): A pilot study using single system design Caroline Mills Occupational Therapist, PhD Candidate Dr Christine Chapparo Senior Lecturer

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3 Literature Review Extensive reporting presence of sensory difficulties in ASD (Iarocci & McDonald, 2006; Ben-Sasson, Hen, Fluss, Cermak et al, 2009, Ashburner, Bennet, Rodger & Ziviani, 2013; Tomcheck & Dunn, 2007) Difficulties in occupational performance resulting from sensory issues (Ashburner, Ziviani & Rodger, 2008) Limited studies on classroom based sensory intervention (Case- Smith, Weaver & Fristad, 2014; Lang et al 2012) Children with ASD have ID up to 70% of the time, different needs to those with ASD alone (Matson & Goldin, 2013; Matson & Shoemaker, 2009)

4 Background Special school based research Children with ASD, ID, autism specific special school in Sydney Research Question: What is the impact of a Sensory Activity Schedule (SAS) on task performance and cognitive behaviours in children with ASD in a classroom setting?

5 Meet the Participants Name Age Sex Diagnosis M 7 y 10 mo Male Autistic Disorder, moderate intellectual disability, severe language delay B 5 y 7 mo Male Autism spectrum disorder, intellectual disability L 6 y 3 mo Male Autistic disorder, moderate intellectual disability C 6 y 8 mo Male Autistic disorder, moderate intellectual disability

6 Referral and Assessment Referred to School OT for reduced participation Teacher reported: Off task behaviour- sensory seeking or sensory avoiding function, frustrated, fixed in routine Short Sensory Profile (McIntosh, Miller & Shyu, 1999) findings summary: All total scores showed definite difference (underresponsive/seeks sensation, auditory filtering, visual/auditory sensitivity, tactile sensitivity)

7 Method Single System AB design: non-concurrent, multiple baseline Phase A (Baseline) Best practice teaching for ASD (Curriculum, structure, routine, visual supports) Phase B (Intervention) Best practice teaching for ASD + Sensory Activity Schedule (SAS) Teacher designed desk work tasks were rated including cutting, sticking, put in tasks, puzzles and matching. Sampling of class task performance was videotaped by school staff

8 Method Between 11 and 18 videos were rated using Perceive, Recall, Plan and Perform (PRPP) Stage One and Two Analysis for each student (Chapparo & Ranka, 2005) Videos were randomly ordered and scored by researchers For each student, Phase A (Baseline) and Phase B (Intervention) performances were compared. Students were not compared to each other.

9 Intervention- Sensory Activity Schedule (SAS) Intervention Administered by Bouncing on a therapy ball, tight lycra, teacher s aide and deep touch pressure teacher. Jumping on a mini-tramp, deep touch Morning session- after pressure morning circle, before Squashing with a bean bag desk work. Rolled over a therapy ball, Used classroom based Jumping on a mini tramp and crashing equipment into cushions, shoulder squeezing, tight mins lycra

10 Intervention- Sensory Activity Schedule (SAS) Queensland DET Guidelines (QLD DET, 2011): Based on the sensory diet (Wilbarger & Wilbarger, 1991) Activities are encouraged at specific times Enable occupational performance Terminology should be clarified Brushing (Deep Pressure Proprioceptive Technique) was not used (Wilbarger & Wilbarger, 1991) Participants were not targeted for sensory defensiveness

11 Perceive, Recall, Plan, Perform (PRPP) Two stage standardised criterion referenced assessment Stage One uses procedural task analysis to determine level of expected skill (Chapparo & Ranka, 2005) Stage Two uses cognitive task analysis and measures cognitive strategy application in the context of task performance

12 Data Analysis- PRPP Stage One Outcome Measure- PRPP Stage One: Procedural task analysis for teacher designated desk work tasks in the classroom. Steps containing errors were recorded Percentage of error free performance was calculated PRPP Stage One Put in Task Sit down Take plastic bottle Take bottle cap Place in bottle Take bottle cap Place in bottle Put bottle in finish tray Errors X X ERROR FREE- 5/7 71.4%

13 Percentage Score Results: M Performance Mastery Phase A- Baseline Phase B- SAS Intervention Task Performances p=0.038, p<0.05 Two band standard deviation method (Ottenbacher, 1986)

14 Percentage Score B Performance Mastery Phase A Baseline Phase B SAS Intervention Task Performances p=0.01, p<0.05

15 Percentage Score L Performance Mastery % 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% 55.00% 50.00% Phase A Baseline Phase B SAS Intervention Task Performance p=0.502, p>0.05

16 Percentage Scores C Performance Mastery % 95.00% 90.00% 85.00% 80.00% 75.00% 70.00% 65.00% 60.00% 55.00% Phase A Phase B 50.00% Task Performances p<0.001

17 Results Summary PRPP Stage One Child Stage One Task Mastery Result Statistics* Phase A (Baseline) Phase B (Intervention) M 69.5% 82.64% p=0.038** B 86.67% 95.88% p=0.01*** L 81.32% 84.39% p=0.502 C 85.2% 98.18% p<0.001*** *Two tailed, Independent Samples T test (confirmed by Mann Whitney U statistic) ** Significance at the 0.05 level, *** Significance at the 0.01 level

18 Discussion 3 out of 4 showed improved task mastery following a classroom based SAS as measured by Stage One PRPP Why was intervention effective for 3 out of 4 children? A targeted opportunity to meet a child s sensory needs contributed to better self regulation prior to completion of work tasks in the classroom. L s results were not significant- baseline not stable, trend lines showed improvements L needed a longer baseline

19 Discussion Teachers can be trained to do the intervention Intervention designed with teachers Qualitative feedback from teachers confirmed statistical results PRPP is a suitable tool to use to measure task mastery in context Ecologically suitable- teacher set tasks Small pilot study, many limitations Real life research

20 Where to from here? Results support further research Randomised Control Trial (RCT) At least 50 children Sensory Activity Schedule intervention for least one school term (9 weeks) Quantitative and qualitative measures of task mastery and occupational performance in the classroom Aspect Elizabeth Hoyles Fellowship

21 References Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, p Ashburner, J., Bennett, L., Rodger, S. & Ziviani, J. (2013) 'Understanding the sensory experiences of young people with autism spectrum disorder: A preliminary investigation.' Australian Journal of Occupational Therapy 60, pp Ben-Sasson, A., Hen, L., Fluss, R. Cermak, S.A., Engel-Yeger, B. & Gal, E. (2009) 'A Meta-Analysis of Sensory Modulation Symptoms in Individuals with Autism Spectrum Disorders' Journal of autism and developmental disorders, 39, p.1 11 Case-Smith, J., Weaver, L.L. & Fristad, M.A. (2014) 'A systematic review of sensory processing interventions for children with autism spectrum disorders Autism pp Chapparo C. & Ranka, J. (2005) PRPP Task Analysis Research User s Training Manual- Research Edition. Sydney: The University of Sydney. DET QLD (2011) Best Practice Guidelines for Department of Education and Training Occupational Therapists: Supporting Students with Sensory Processing Challenges. Department of Education and Training, Queensland, Australia. Iarocci G. & McDonald, J. (2006) 'Sensory integration and the perceptual experiences of persons with autism.' Journal of Autism and Developmental Disorders, 36 (1) p

22 References Lang, R., O'Reilly, M., Healy, O., Rispoli, M., Lydon, H. et al (2012) 'Sensory integration therapy for autism spectrum disorders: A systematic review' Research in Autism Spectrum Disorders 6, pp Matson, J.L. & Goldin, R.L. (2013) Review: Comorbidity and autism: Trends, Topics and future directions. Research in Autism Spectrum Disorders 7 pp Matson, J.L. & Shoemaker, M. (2009) 'Review: Intellectual disability and its relationship to autism spectrum disorders.' Research in Developmental Disabilities 30, pp McIntosh DN, Miller LJ, Shyu V (1999) Development and validation of the Short Sensory Profile. In: W Dunn, ed. The Sensory Profile examiner s manual. San Antonio, TX: Psychological Corporation, p Ottenbacher, K. (1986) 'Evaluating Clinical Change: Strategies for occupational and physical therapists' USA: Williams & Wilkins. Tomchek, S.D. & Dunn, W. (2007) Sensory processing in children with and without autism: A comparitive study using the short sensory profile. American Journal of Occupational Therapy, 61, p Wilbarger, P. & Wilbarger, J. (1991) Sensory Defensiveness in Children ages 1-12: an intervention guide for parents and other caretakers. Santa Barbara California: Avanti Educational Programs.

23 Acknowledgments Lara Cheney, Allyce Cunningham, Lydia Griffiths, Jamie Togle, Rebecca Fitzroy, Nala Simmons, Yasmina Adamson, Ashwini Reddy, Dr Debra Costley, Dr Trevor Clark, Dr Susan Bruck, Dr Joanne Hinitt Participating students and families

24 Thank you Contact: Caroline Mills Dr Chris Chapparo