Tara Langley Evidence Table Topic: Children with Autism and the effects of Sensory Processing deficits

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1 Tara Langley Evidence Table Topic: Children with Autism and the effects of Sensory Processing deficits Hall, L., & Case-Smith, J. (2007) Ashburner, J., Ziviani, J., & Rodger, S. (2008) The purpose of this study was to investigate the effectiveness of a therapeuticlistening home program in combination with a sensory diet on children with sensoryprocessing disorders (SPDs) and visual motor delays. This study aimed to confirm previous research findings that the responses of children with ASD to sensory input differed from those of typically developing children and explore the associations between the sensory-processing patterns of children with and without ASD and their respective classroom emotional, behavioral, and educational outcomes. This was a convenience sample of children who were referred to occupational therapy at an outpatient clinic associated with a children s hospital. / There was 10 participants ages 5-11 years old with visual-motor delays and sensory processing disorders. This was a Level IV it being a correlation study between the children with ASD and those of typically developing in the classroom./ There were 28 children with ASD and 51 with typically developing children. There were four standardized The participants demonstrated The author used the same pre and assessments given to measure outstanding improvement in post test, the Sensory Profile, but sensory responsiveness and behaviors that reflected sensory it was completed by the parents visual-motor performance. The processing. rather than the participants. The ETCH for handwriting, the VMI other tests, the VMI, DAP, and for visual-motor integration, the the ETCH were all administered Sensory Profile for sensory by the author but scored by other processing, and the DAP for the occupational therapists. integration of visual-motor skills. The participants parents filled out the Sensory Profile before and after the 12 week phase. The participants performed the DAP, VMI, and the ETCH before and after. There were five standardized tests/questionnaires that were performed in this study. The Short Sensory Profile (SSP) measures the sensory sensitivity of the children in which the parent or caregiver rates. The GARS is a caregiver questionnaire that determines the likelihood of people age 3-22 years having autism. The GADS is a caregiver questionnaire that determines the likelihood of people ages 3-22 of having Asperger s syndrome. The K_BIT is a measure of verbal and nonverbal intelligence of people ages 4-90 years. The CTRS-R:L describes the attention, social, and emotional behaviors of children in the classroom that the teacher fills out. The ASEBA:TRF describes the There were significant group differences in the SSP factors. In the SSP, the sensory processing of tactile sensitivity was the most prominent difference. There were also differences in children with ASD and typically developing children in the groups of movement sensitivity, underresponsive/seek sensation, and auditory filtering. The results were significant to OT intervention because it is not because of a child s IQ that they are performing poorly academically, they have sensory needs that are overstimulating to prevent from learning in the classroom. There indeed needs to be more information and more studies on this topic to help those children with ASD be better accommodated to in the classroom to enable their unique traits of learning. There needs to be more study in if the environment is modified, does it enhance their ability for learning. The SSP identifies many other atypical sensory responses, and those need to be considered also when significant. This table is based on a template created by the Evidence-Based Practice Project of the American Occupational Therapy Association. The template is used with permission of AOTA.

2 children s school function as seen by teachers. Watling, R. L., Deitz, J., & White, O. (2001) Watling, R. L., & Dietz, J. (2007). The present study sought to describe the Sensory Profile factor scores of 3-year-old through 6-year-old children with and without autism and to compare the factor score patterns of the two groups. The primary purpose of this study was 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 This was a Level IV it being a correlation study between the children with Autism and those without Autism and the differences in sensory processing. / There were 40 children with Autism, and 40 children without Autism. This was a level II, being it is a randomized control trial/ There were four male children with the diagnoses of ASD. The Sensory Profile was the only assessment used in this study. This assessment was used to identify the sensory processing factors and how they are different among those with Autism. Children with Autism with faulty processing can have a negative impact on the performance of daily activities. There were 10 factors tested and in eight of the ten, the children with Autism s scores were significantly different which verifies how important sensory processing is with children with Autism. Ayre s sensory integration enhances nervous system processing of sensation to provide a stable foundation for the formulation and execution of appropriate behavior (Dietz, 575). Ayre believes that tactile sensations, vestibular, and proprioception are used to facilitate production of adaptive behavior, therefore she uses enhanced sensory experiences that are thought to be meaningful, and self-directed activity to support the person s ability to meet the contextual demands of daily occupations. There are still The results reported that those children with Autism had a significant difference in a majority of the sensory processing factors, some more than others. This is not a diagnostic tool being there are many differences in each child, but it shows the many factors that inhibit sensory processing in those with Autism. This is very important in OT practice because it shows every child is different. There may be a child without Autism but they may have one or two sensory processing factors that are significantly different. During practice, we need to remain objective when assessing children with Autism because there is such a wide spectrum. The results involved within the undesired behavior cannot be drawn due to the overlap of scores across the A and B phases. Although, with the rate of engagement from baseline to intervention, all four boys had the highest rate of engagement with no overlaps. As well, the subjective data along with the scored data, the boys changed behaviors in the home environment, and new behaviors appeared. This is very useful in OT interventions, because although the clinical data does not show substantial changes, the The sample size could have been larger for a more effective result, and the lack of a control group to strengthen the study. The current use of clinical observation, informal questionnaires, and parent interviews lack standardization and normative data for establishing consistent interpretation of sensory processing abilities. With this study, there were only four boys who were participants, which is a small sample size. Also, a big threat to validity is the constraints imposed by the operational definition of engagement because it is so subjective. 2

3 additional studied that need to be performed to show the reliability of the intervention. changes are still an improvement in each child. Fodstad, J., Hess, J., Matson, J., & Neal, D. Bedell, G., Fertel-Daly, D., & Hinojosa, J. (2001). Bodfish, J.W., Boyd, B. A.,Khan, F., McDonough, S. G., & Rupp, B. Challenging behaviours are a commonly co-occuring problem in children with ASD and are often present during the toddler years. The relationship that these challenging behaviours have with core features of ASD, specifically social behaviours, was examined in this study. Data were compared based this study systematically examined the effects of wearing a weighted vest on attention to task and selfstimulatory behaviors of 5 preschool children with PDD. The purpose of this article is to present clinical outcome data on the FITBI treatment approach using experimental, single case design methodology. This was a Level II, being it was a randomized control trial. / There were 153 toddlers between the ages of months, being that 75.8% were male. Of the participants, 57.5% had a diagnosis of autism and 42.5% had a diagnosis of PPDNOS, and the 77.8% of the sample reported no additional diagnoses. level- III, due to this being a prepost test due to the effect of a weighted vest and attention to task. / There were five children (2 girls and 3 boys) ranging from the ages 2-4 diagnosed with PDD, who reported having difficulties in attention to task, and were not currently wearing a weighted vest. Participant 1 had been treated with a weighted vest one year from this study. Level II: randomized control trial with five children with ASD./ There are five pre-school aged children 2-6 years old presenting with a diagnoses of autism spectrum disorder who present with repetitive behaviors in The importance of treatment for every child along the ASD spectrum is early diagnosis, and the understanding of the correlation of challenging behaviors to developmental milestones is desired. Every child is presented with interaction among adults and peers their own age as they learn to grow, those with ASD require the same interaction and if it isn t available then who is to say it isn t a correlation to challenging behaviors. Children with PDD exhibit selfstimulating behaviors that are thought to be a child s attempt to calm and modulate his or her arousal level during times of overarrousal. Past studies have found that the children s attention problems are worse when they self-stimulate. The thought of this study is to find a way to decrease these self-stimulating behaviors that decrease attention. The Family- Implemented Treatment for Behavioral Inflexibility (FITBI) uses both direct instruction and naturalistic behavioral teaching methods to treat the range of repetitive behaviors in autism. Also used The results to this study show a correlation in lower levels of adult interaction and peer interaction were associated with higher levels of stereotypic behavior, aggressive/destructive behavior, and to a lesser extent self-injury. (Neal, pg.167). The first canonical variate was found to be significant between social behavior and problem behavior. The subscales of adult interaction and peer interaction were significantly correlated. As a result of the weighted vest during a 5 minute fine motor activity, by visual analysis, showed a positive effect on at least two measures of attention for all 5 participants. The children appeared less distractible and demonstrated less behaviors than before while increasing their attention to task with the weighted vest on. Meanwhile, there were the positive effects and once the weighted vest was removed, the duration of focused attention was not sustained. Overall, there were reductions in the occurrence of repetitive behaviors for all of the participants involved. It was also found that children s engagement in alternative activities increased which in turn decreases With this study, it is thought the internal consistency was found to be excellent as well as the interrater reliability. The test-retest reliability, content validity, and criterion validity were all at acceptable levels. In this study, there were five children who were observed, which is a small sample size. Also another limitation would be that the study used ABA instead of a multiple baseline design due to some behaviors not exhibiting reversibility or did not return to baseline after intervention phase. The internal validity has strengths with it being a single case design under the guidance of a skilled therapist to verify parents following a standard treatment protocol. Due to Autism being such a wide 3

4 Rayner, C. S. The present case study extends this line of research by using video modelling to improve completion of two daily living tasks by a 12-year-old child with autism. which hinder social participation and in learning abilities. Level II being a randomized control trial/ A 12 year old boy with the age equivalence of 2 years and 7 months going through steps of packing/unpacking a bag, and also for teeth brushing. Children with Autism often times go through a routine daily, and have difficulty with task completion, with a visual example for visual processing, it can increase their awareness of a task, and go through the many steps to complete it. are the Response Interruption and behavioral inflexibility and spectrum, there may be other Redirection (RIR) and the allows them to have more children who have repetitive Differential Reinforcement of opportunities to explore and behaviors in which they may not Variability (DVR) for the two learn. effect learning or social behavior intervention strategies. participation. Or there may be a The goal of treatment is for the situation in which the parents child to immediately begin to aren t following the protocol as engage in the should be and end up with alternative/appropriate behavior different results that may not taught instead of the habitual increase the validity of this study. repetitive behavior inhibited when presented with a evocative stimulus. The child is presented with items or situations that trigger the repetitive behavior followed by a prompt that the child not contact the item and/or engage in repetitive behavior with the item. Regan was tested on the Childhood Autism Rating Scale (CARS) and on the Vineland Adaptive Behaviour Scales (VABS) which was done in Regan s classroom. First there was an assessment to correctly imitate acts (facial expressions, gestures, actions with objects) which he correctly imitated 63% of the modeled acts. Next, were the target behaviors to focus on during the experiment, which were unpacking his bag upon arrival at school without repetition, and brushing his teeth. The intervention led to a rapid increase in percentage of steps Regan performed for both tasks. He performed 8% of steps in the baseline and 92% during the intervention phases, although at the followu-up stage he completed 44% of the steps. The completion of teeth brushing was consistent from intervention stage to follow-up stage, at 55%. This being a one-person study, there are many things that are limited. This study could have been done with more children at different times to see if it had an effect on age, severity of Autism, and/or gender. There are many factors that can be involved in the lapse of performance, and the carry over in the home environment. 4

5 Key Points Cap 1: Sound-based interventions such as therapeutic listening can be used as a tool for calming and organizing in a child s body Cap 2: -Children may be misdiagnosed as ASD or ADHD when it could be Sensory Processing disorders. Which is very difficult for children to function in the environment with all of its distractions. - Children in classrooms with SPD may have a very difficult time with the bright lights, loud noises, tapping of one s foot, loudness of the air conditioner, or the hardness of the chair they may be sitting in - There may need to be modifications to the lights, sounds, or even use some tools such as a weighted blanket etc. Cap 3: The Sensory Profile points out where specifically the child is having difficulty. What effects them most to what effects them least, and it is a very important tool in finding out what specifically in the environment is hindering them from living functionally. Cap 4: Jean Ayre developed the idea of sensory processing, and all of the important components in understanding how it can affect a child. The five senses are broken down to how a child can be over sensitive or under sensitive to certain sensory stimuli. Cap 5: When children with Autism have difficulty controlling their bodies due to sensory concerns, they act out in a way to try to moderate their body in space. These actions and behaviors sometimes hinder these children from having peer interaction and socialization, which is a huge component in the growing process. Parents have a hard time coming up with a ways to integrate their child in with their peers due to their behaviors and actions. Figuring out what the child may need sensory wise will be a huge indicator to lessening the behaviors and increasing peer interaction. Cap #6: Have you ever seen a child who cannot sit still in a chair? Or have you seen a child that cannot focus or attend to something someone is saying to them? This may not be ADHD or Autism, many children have Sensory Processing Disorder and are misdiagnosed. If your child is a wiggle worm there is a way to help them sit down in a chair and focus their attention to a task at hand. The weighted vest has been found to be effective for those children, and their attention increases, and their grades are higher from retaining learned information. Cap 7: We often focus so much on the child that we forget about the families experiencing this every day. Family-implemented treatment on repetitive behaviors may help the child to react to a certain stimuli correctly instead of with repetitive nonfunctional behaviors. By a family working with their child on things outside of the classroom or therapy it is a big help and families tend to see more improvement in their children. Cap 8: Children often have difficulty with completing tasks, and with socialization so therefore it is hard for them to learn tasks by listening to others. Video modeling may be able to fix the gap between non-socialization and difficulty completing tasks. It is a way for children to watch other children, or someone they may know complete a task step by step so they may understand it. 5