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

Abstract

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.

Introduction

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.

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