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.