Occupational Therapy Using Sensory Integration to Improve Functional Skills in Children with Autism Spectrum Disorders – Results of a Randomized Trial

Background:  Sensory features (hyper and hypo-reactivity to sensation and unusual sensory interests) are a common occurrence in children with Autism Spectrum Disorders (ASD) and are now included in the DSM5 as one manifestation of the ‘restricted, repetitive patterns of behavior, interests, or activities’ diagnostic criteria.  Given the recognition of sensory difficulties as a key feature of the autism diagnosis, interventions that address these sensory features may be an important component of a comprehensive treatment program for ASD.  Families indicate that sensory features are among the most debilitating symptoms limiting participation in daily activities for them and their children. Currently, interventions that target these sensory features are controversial and have been criticized due to lack of evidence.  This session reports on a randomized control trial aimed at investigating an occupational therapy intervention that targets these sensory features and measures its outcomes. 

Objectives: The objective of this session is to report on findings of a randomized trial of occupational therapy using sensory integration to improve adaptive behaviors and functional skills in children with ASD.

Methods: Thirty-two children with a confirmed diagnosis of ASD between the ages of 6-9, matched on mental age and autism severity were randomized to either occupational therapy intervention or usual care for 30 sessions over a 10 week period.  The intervention followed a manualized protocol based on the principles of sensory integration that was tested in a previous feasibility study. A random selection of 15% of the sessions was tested for fidelity using a validated measure.  Pre-post scores on Goal Attainment Scales (primary outcome measure) and the Pediatric Evaluation of Disabilities Inventory (PEDI - secondary outcome measure - Haley, et al, 2011) – a measure of the child’s participation in activities of daily living and socialization were compared.

Results: Children in the intervention arm scored significantly higher on Goal Attainment Scales (p = 0.003, d = 1.2) and showed improvements in independence in self-care (p= 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) on the PEDI in comparison to the control group. Average fidelity rating was 82 on a scale of 100 indicating treatment adherence. 

Conclusions: The study provides preliminary data that occupational therapy using sensory integration may be useful for children with ASD whose sensory features are impacting participation activities of daily living and socialization.  The study shows rigor in its use of a manualized protocol, measurement of treatment fidelity, and matching of groups on IQ and severity of ASD. Groups were comparable at pre-treatment on a number of measures and at post treatment on “other services” utilized.  This pilot work set the stage for a comparative effectiveness trial, funded by NIH, that will compare this intervention to behavioral intervention and further elucidate its potential effectiveness and utility.