A Randomized Trial of the Effectiveness of Occupational Therapy to Address Sensory Behaviors in Children with Autism: Phase 1 - Feasibility

Background: This session will present the findings from Phase 1 (Feasiblity) of a 3 year RCT designed to study a manualized protocol of occupational therapy to reduce maladaptive sensory behaviors and enhance participation and quality of life for children with autism and their family. Children with autism exhibit many behaviors that may have a sensory basis 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.  Although it is clear that these behaviors significantly impact the child and families ability to participate in daily activities, and families report that they are among the most debilitating symptoms for their children, data supporting interventions to specifically address the behaviors from a sensory perspective are sparse and lack evidence to support their efficacy and impact on improving adaptive behavior and participation.  Despite the lack of evidence, occupational therapy to address sensory behaviors is among the most often requested services by families of children with autism (Mandell, et al, 2005;  Green, et al 2006).
Objectives: The primary objective of this phase of the RCT is to evaluate the feasibility of a manualized protocol of occupational therapy designed to decrease sensory behaviors and increase participation and quality of life for children with autism and their families. The program, entitled “SMART” Sensory Motor Activities in daily Routines and individually Tailored, follows a set of theoretically-based principles and clinical reasoning strategies. 
Methods: During phase 1 of the study we conducted10 case studies.  After careful characterization of subjects using the ADOS, the ADI-R and IQ testing, and pre-testing, we provided 6 weeks of the SMART intervention and evaluated progress toward individual goals using Goal Attainment Scaling, adaptive behavior (using the Vineland)  and quality of life for the family (using the WHO quality of life scale).  Therapist and families also completed feasibility ratings and parents provided data on changes in sensory behaviors in the home using a systematic rating form.  Therapist’s ability to carry out the intervention was assessed using a “Fidelity to Treatment” measure (Parham, et al, 2007).

Results: We found that it is feasible to carry out the intervention, that parents are satisfied with the intervention protocol and that there were changes in individual goals.  We also noted that the therapists require additional training to develop fidelity on the intervention.  Several additional findings related to outcome measures were of interest.
Conclusions: Our data supports the feasibility of the SMART intervention and supports the initiation of Phase 2 of the RCT. Goal Attainment Scaling is a sensitive outcome measure but the procedure for developing goals will be adapted in the next phase to assure that the goals identified by the parents are feasible and realistic for the treatment period.  Several additional methodological changes will be made for phase 2 based on Phase 1 data.