Sensory Processing Disorders: Phenotypic Characterization Pre and Post Intensive Occupational Therapy Based Model (STAR Model)

Background:

Sensory processing challenges negatively effect an individual’s functioning in daily life. However, debate continues to exist in the literature as to the effectiveness of many sensory-based interventions. The literature is rampant with descriptions of many protocolized approaches or equipment specific sensory strategies (such as brushing, sitting on a ball or wearing a weighted vest) that are misrepresented as individualized occupational therapy, which relies on a broader clinical reasoning approach. Problems exist in previous studies because the intervention is poorly defined, lacks a manualized approach, and reports no method for maintaining fidelity to the intervention.

Objectives:

The present study aims to determine whether there are sensory and behavioral changes, which can be reliably measured after the administration of a manualized OT intervention, the STAR Approach, which combines regulation and relationship-based OT with principles of sensory integration and mental health consultation (Miller, 2014: chapter 4).

Methods:

This study used a retrospective pretest and posttest design. All referrals to STAR Center between 2007 and 2013 were included if they met criteria for a Sensory Processing Disorder.  Children with ASD, known brain injury or genetic conditions, and movement disorders were excluded. The final dataset included 179 children ranging from 2 to 13 years of age (mean = 6.1 years, SD = 2.3), 139 males.  All children engaged in the  STAR approach, which is a short term, intensive program with 50-minute sessions, scheduled 3-5 times a week for a total of 20-40 sessions. Each family participates in all direct treatment sessions with their child as well as 5-6 parent-only, education sessions.  The model includes pre and post testing for all participants using standardized scales, parent report measures and individualized goals. Post testing is conducted within 2 weeks of completing the program.

Results:

In this study, we noted significant improvement over the course of the intervention on all sensory and motor measures as well as standardized behavioral measures.  Specifically, using the MFUN and GOAL scales, we noted significant improvement on visual motor control, fine motor control, and gross motor control/coordination (effect sizes (ES) > 0.52).  Using the SPD3, a standardized parent report measure of sensory related behaviors, we found a reduction in sensory craving, sensory-over and under-responsivity.  Using the ABAS-II and BASC, two commonly used standardized parent report measures of function and behavior, we again saw significant changes in many composite scores including general adaptive function, social function, internalizing behaviors and externalizing behaviors with moderate to large effect sizes ( r>0.41).

Conclusions:

This study provides preliminary support for the effectiveness of a novel treatment, the STAR Approach that combines short-term intensive occupational therapy using principles from DIR/Floortime ™, and sensory integration, with extensive parent education and training. Children improved on standardized measures of adaptive behavior, emotional functioning, sensory processing and motor skills, thus suggesting that these measures are sensitive to change. Prospective studies may benefit from using these outcome measures.