A Clinical Trial of Occupational Therapy for Sensory Dysfunction in ASD

Background: This paper reports on a study of the effectiveness of occupational therapy strategies to reduce sensory dysfunction and enhance adaptive behaviors and participation for children with ASD and their family. Unusual responses to sensation or sensory dysfunction (SD) are extremely prevalent (80-90%) in individuals with Autism Spectrum Disorders (ASD), contributing to the maladaptive behavioral profile of these disorders and limiting participation in daily life activities. Children with ASD exhibit SD in many ways including self stimulating behaviors, avoiding behaviors (such as placing hands over ears in response to typical levels of auditory input), sensory seeking behaviors (twirling, chewing, etc) and/or “tuning out” behaviors such as not responding to their name or other environmental sensory cues. Families report that SD significantly restricts full participation in daily activities and consequently, interventions to address SD are among the most often requested services (Mandell, et al, 2005; Green, et al, 2006). Despite this, data supporting interventions to specifically address SD are sparse and lack evidence to support their efficacy. This study presents preliminary data on the feasibility, acceptability, safety and efficacy of a manualized occupational therapy intervention for SD for children with ASD ages 5-8 years.

Objectives: Evaluate the feasibility of an intervention protocol that utilizes evidence-based, theory- driven occupational therapy strategies designed to address SD in ASD.

Methods: We follow Smith, et al’s (2007) model for systematically validating and disseminating an intervention for ASD in a sequence of steps beginning first with case studies to determine the feasibility of the protocol and its acceptability by families, then moving to fidelity testing and outcome validity in a small controlled trial, and finally a randomized clinical trials to test efficacy under controlled conditions. This paper reports on phase 1:  descriptive case studies to address questions of feasibility, acceptability and safety. Quantitative and qualitative data are obtained pre, mid and post intervention from parents and therapists; and the child’s progress toward individual goals is obtained using goal attainment scaling.  Other outcome measures include the Sensory Profile to evaluate change in SD; the Vineland to measure change in adaptive behaviors, and participation and quality of life scales. 

Results: Qualitative and quantitative data are reported on a range of important and clinically relevant questions such as: Is the manualized intervention viable for children with ASD and SD (feasibility)? Is it acceptable to parents? Is it practical and acceptable to offer the intervention at the stated frequency with supplemental parent education? Which measures best detect meaningful outcomes? Are therapists able to deliver the intervention in a way that is in keeping with its principles (fidelity)? Does the intervention decrease maladaptive sensory behavior, improve adaptive behaviors, improve the family quality of life, and result in greater participation in self care routines, play, and community activities by the child and family?

Conclusions: Data to guide “best practice” for children with ASD and SD are shared and implications for phase 2 and 3 of this project are discussed.