Little Hands Blog

Article, News, Events and More...

An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial

December 23, 2014

Source:  Journal of Autism and Developmental Disorders (Read Full Article)


This study evaluated a manualized intervention for sensory difficulties for children with autism, ages 4–8 years, using a randomized trial design. Diagnosis of autism was confirmed using gold standard measures. Results show that the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) than the Usual Care control group (n = 15). The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol, and provides support for the use of this intervention for children with autism. Findings are discussed in terms of their implications for practice and future research.


Difficulty processing, integrating and responding to sensory stimuli has been described as a feature of autism spectrum disorders (ASD) since the disorder was first identified. Current estimates show that between 45 and 96 % of children with ASD demonstrate these sensory difficulties (Ben-Sasson et al. 2009; Lane et al. 2010) and sensory features (i.e.: hyper- or hypo reactivity to sensory input or unusual interest in the sensory aspects of the environment) are now included as one of four possible manifestations of ‘Restricted, Repetitive Patterns of Behavior, Interests, or Activities’ (American Psychiatric Association 2013). Families report that behaviors associated with difficulty processing and integrating sensory information create social isolation for them and their child, restrict participation in daily living activities (Schaaf et al.2011) and impact social engagement (Hilton et al. 2007, 2010; Baker et al. 2008; Ashburner et al. 2008; Reynolds et al. 2011; Watson et al. 2011; Hochhauser and Engel-Yeger 2010). Consequently, interventions to address problems associated with difficulty processing sensory information, such as occupational therapy using sensory integration (OT/SI), (Ayres 1972, 1979, 1989) are among the most often requested services by parents of children with ASD (Mandell et al. 2005; Green et al. 2006; Goin-Kochel et al. 2009). There is emerging evidence regarding positive outcomes of OT/SI for children with ASD (Pfeiffer et al. 2011; Fazlioglu and Baran 2008; and see Schaaf 2011for a review), however, methodological limitations preclude definitive conclusions. Hence, there is the need for a rigorous study of OT/SI that includes a manualized protocol and measurement of treatment adherence (Case-Smith and Arbesman 2008; Watling et al. 2011). Fortunately, a validated measure of treatment fidelity that describes the key principles of the sensory integrative approach and provides guidelines for best practice is now available (Parham et al. 2011, 2007; May-Benson et al., in press). Importantly, this measure provides a means to evaluate the fidelity of OT/SI in a clinical trial while assuring internal and external validity; a standard that is followed in the current study.

A second advancement that enhances the testing of this intervention is data showing that Goal Attainment Scaling (GAS) is a useful outcome measure for studies of interventions for ASD (Ruble et al. 2012). GAS is used to measure functional and meaningful aspects of an individual’s progress (Mailloux et al. 2007; Kiresuk et al. 1994). In autism, inherent heterogeneity often confounds findings, and thus, it is important to utilize outcome measures that are sensitive to individual outcomes. GAS has been shown to be a substantive and sensitive approach to evaluate progress on individualized goals in randomized controlled trials of psychosocial interventions for children with autism provided that specific quality indicators are present. These include that goals are independently rated, evaluated for equivalence between groups (comparability), scaled with equidistance, have measurable criteria, and clear, identifiable benchmarks (Ruble et al. 2012), recommendations that we followed in this study. A further strength of using GAS is that it provides a means to identify and measure outcomes that are parent-chosen and thus, meaningful to family. Given the increased emphasis on measurement of outcomes that are meaningful to the client or family (PCORI, http://​www.​pcori.​org), the use of GAS provides a model for best practice.

(Read Full Article)


Winter Holiday Feeding Intensive

3 Weeks - Every Wednesday (Nov. 29th to December 13th)

We are pleased to offer a 3-week Winter Holiday Feeding Intensive this year!  Over the years many of our families have expressed that the holidays can bring added stress and chaos to mealtimes, as many kids are being offered foods they only see a few times per year.  Many approaches from well-intended relatives such as “try a bite,” “everyone is eating it, so you need to as well,”  “you can have dessert if you try a bite,” etc. aren’t effective and can cause meal time avoidance, meltdowns, or increase picky eating.

Our Holiday Food School will be inclusive of all winter-holidays our families at Little Hands celebrate and we will be asking families to share any traditional dishes or foods that they would like their child to explore in food school.  We are looking forward to sharing so many exciting new dishes with the kids this holiday season.

Details:  Wednesdays from 12:45pm – 1:45pm (3-5.11 years old) and 4:15pm – 5:15pm (6-10 years old)

  • First Session: Wednesday November 29, 2023
  • Last Session: Wednesday December 13, 2023

Is Feeding Therapy Right For My Kiddo?…

  • My child eats a restricted range or variety of foods (typically less than 20)
  • My child refuses entire categories of foods
  • My child cries, screams, or is easily distressed when new foods are presented
  • My child usually eats entirely different foods than the rest of the family at meal times
  • Mealtimes are an ongoing challenge
  • I would characterize my child’s feeding habits as extremely “picky”
  • My child is over-reactive to smells or tastes to the point of gagging or vomiting
  • My child has a history of sensory-processing difficulties
  • My child has motor development challenges 

How to sign up:

  • Space is limited, sign up early to reserve a spot for your child!
  • Food School sessions will be prepaid and given the nature of the feeding intervention and pacing of therapy activities in a group setting, we will not be offering make-ups for any missed food school sessions.

How Can We Join…

  • Space is limited, sign up early to reserve a spot for your child!
  • For families who are currently receiving OT feeding therapy OR have participated in a previous OT Feeding group: Please respond to this email with your interest and complete an updated food list & update any food allergies or dietary restrictions.
  • For new families who have not received OT feeding services: To ensure appropriate peer pairings and group treatment goals, we require an initial evaluation to assess group readiness and appropriate fit for our sensory-based intervention approach to feeding. Please email our clinic coordinator, Emily at to schedule an initial screening and submit our initial OT Intake and Feeding History Questionnaire forms that can be downloaded directly from our website.

Should you have additional questions about billing, please contact Emily!

Emily O’Brien |  (415)-758-2767  |