What does the evidence say?
Whilst there is a lot of research on the use of sensory strategies, the design of much of it is poor. A recent review considering the use of sensory strategies with pre-schoolers (Bodison & Parnham, 2018) found 11426 potential articles. However, only 24 were suitable to review, and only eight were used in the report. These numbers show that, although there is a huge amount of information written about sensory strategies, there are very few studies with a good research design.
The authors found that “insufficient evidence supports the effectiveness of regularly incorporating specific sensory techniques into classroom routines for pre-schoolers with ASD” (p.9). Their recommendation was to use the interventions cautiously. They found insufficient evidence for using weighted vests with children on the autism spectrum. It is felt that this study supports the AJOT recommendation for documentation and review when using sensory strategies.
There are two small case studies looking at sensory movement breaks. One case study (Mills & Chapparo, 2016) showed a drop in the number of daily behaviour incidents of a child with ASD after participating in sensory activity programme. The incidents dropped from 83 incidents prior to 14 incidents per day after the programme was used. Perez, Wong and Perryman (2019) were able to demonstrate that off task behaviour decreased in the three children that participated in their sensory activity schedule. It is important to note that in both of these studies the sensory programmes were created by an OT to support the children’s specific needs.
Ayres® Sensory Integration (ASI) treatment is very different to the use of sensory strategies, such as wobble cushions, fidget toys or weighted vests, commonly used in schools. One essential criteria of ASI treatment is that it is child led. A second essential criterion is that the child must be actively engaging in sensory experiences. There is a fidelity measure which aims to ensure that there is consistency with therapists using the ASI treatment approach (Parnham et al 2007).
Schaff et al completed a review of research looking at using ASI with children with autism in 2018. The authors only included studies where the sensory integration treatment met this fidelity measure. They reviewed five studies. Their results indicated strong evidence that ASI treatment provides positive outcomes for improving function and participation goals in children with autism. These goals were individualised for each child’s needs. They also found a moderate degree of evidence to support the use of ASI to help to improve behaviours, and increase independence with self-care activities. There was only emerging but insufficient evidence to support the use of ASI to improve play, sensory motor and language skills.
An exciting piece of new sensory integration research in the UK
Whilst results are not yet available, an exciting piece of research is currently being completed at Cardiff University. Radell et al (2019) are running a trial comparing ASI to usual care in children with autism. They aim to recruit 216 children within the UK to participate in the trial. Half of the children will receive two sessions of ASI therapy a week for ten weeks. The other half, a control group, will receive the usual care provided. All sensory integration therapy will be scored against the fidelity measure. The study aims to provide high quality evidence on the clinical and cost effectiveness of ASI. The results should give clear data on the true effectiveness of ASI for children with autism.
Where to Next?
Next you might want to ready about more common sensory differences which present in autism. We recommend these articles
To learn even more about the senses we recommend our Free Introduction to Sensory Processing.
* Atwood, T., Evans, C., & Lesko, A. (2014). Been There. Done That. Try This! Philadelphia: Jessica Kingsley Publishers
Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72, 7201190040. https://doi.org/10.5014/ajot.2018.029413
** Hazen, E. et al (2014) Sensory Symptoms in Autism Spectrum Disorders Harvard Review of Psychiatry Volume 22 Number 2 March/April 2014
Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration practice intervention research. American Journal of Occupational Therapy, 61, 216–227
Pfeiffer, B. A. (2012, June). Sensory hypersensitivity and anxiety: The chicken or the egg? Sensory Integration Special Interest Section Quarterly, 35(2), 1–4
Randell, R. et al (2019) Sensory integration therapy vs usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised control trial. BMC Trials. https://doi.org/10.1186/s13063-019-3205-y
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of occupational therapy using ASI: A systematic review. American Journal of Occupational Therapy, 72, https://doi.org/10.5014/ajot.2018.028431