Sensory Integration - A Randomized Trial for Children with Autism

Background: Sensory hypo and hyper-responsivity have been described in the autism literature since the disorder was first identified.  Current estimates show that between 70-96% of children with Autism Spectrum Disorders (ASD) demonstrate these sensory features (Ben-Sasson, et al 2009), and they are now proposed to be included as a core feature for diagnosis of Autism Spectrum Disorders (ASD) under the Restricted and Stereotypic Behavior criteria in the DSM 5 (APA, 2012).  As such, objective markers of these features have new and important relevance for diagnosis and treatment of ASD.    Our work, to date, shows these sensory differences create social isolation for families and their children, significantly restricting full participation in daily activities.  Consequently, interventions to address sensory differences are among the most often requested services, and, although data on their effectiveness is promising, more rigorous trials are needed. 

Objectives: To determine if occupational therapy using sensory integration (OT/SI) improves adaptive behavior (as measured by individualized goals and standardized assessments) and decreases sensory features.  We previously completed a feasibility study showing that the intervention is safe, feasible to deliver, acceptable to families and that interventionists were able to obtain adequate fidelity (Schaaf, Benevides, Kelly & Mailloux, 2012).  All subjects were well characterized using the ADOS and ADI-R.

Methods: Thirty-two children diagnosed with autism spectrum disorders, between the ages of 4-8 years were enrolled in the study.   Following phenotypic characterization (diagnosis of autism using ADOS-G, ADI-R and a cognitive assessment), subjects were assessed to identify their sensory dysfunction, and if eligible, were enrolled into the study.  Following pre-test assessment, individualized goals were developed using assessment findings and parent-identified goals using Goal Attainment Scaling methodology.  Randomization to either OT/SI or Usual Care (UC) occured using stratified blocks based on ASD severity and cognition.  Children assigned to OT/SI received 30 treatments over a 10 week period.   Intervention followed a manualized protocol that operationalized the principles of sensory integration.  Primary and secondary outcomes were Goal Attainment Scale rating, Pervasive Developmental Disorder Behavioral Inventory (PDDBI) scores, Pediatric Evaluation of Disability Inventory (PEDI), and the Sensory Integration and Praxis Tests obtained at pre and post intervention by independent, blind evaluators.

Results: Parents of children in the treatment group reported significantly higher goal attainment (p = .003) and on the PEDI, children were reported to have significantly greater independence in their in self- care (p = .039) and social functions (p = .008).  In addition, sensory behaviors measured by the PDDBI decreased more in the treatment group in comparison to the controls and approached significance (p = .064).   

Conclusions: The findings from this trial show that occupational therapy using sensory integration principles significantly improves attainment of individually identified functional goals, and has an impact on independence in self-care and socialization.  In addition, this intervention shows a tendency to decrease parent-reported sensory behaviors.