Roseann C. Schaaf

The everyday routines of families of children with autism: Examining the impact of sensory processing difficulties on the family

The purpose of this qualitative study was to explore the lived experience of how sensory-related behaviors of children with autism affected family routines. In-depth semi-structured interviews were conducted with four primary caregivers regarding the meaning and impact of their child’s sensory-related behaviors on family routines that occurred inside and outside the home. Findings indicated that sensory behaviors are one factor that limited family participation in work, family and leisure activities; and that parents employed specific strategies to manage individual and family routines in light of the child’s sensory-related behaviors. This information has important implications for professionals who work with families of children with autism to decrease caregiver stress and to increase life satisfaction for the child and family.

Parasympathetic Functions in Children with Sensory Processing Disorder

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a childs ability to engage in everyday social, communication, and daily living skills.

Occupational Therapy and Sensory Integration for Children with Autism: A Feasibility, Safety, Acceptability and Fidelity Study.

Objective: To examine the feasibility, safety, and acceptability of a manualized protocol of occupational therapy using sensory integration principles for children with autism. Methods: Ten children diagnosed with autism spectrum disorder ages 4-8 years received intensive occupational therapy intervention using sensory integration principles following a manualized protocol. Measures of feasibility, acceptability and safety were collected from parents and interveners, and fidelity was measured using a valid and reliable fidelity instrument. Results: The intervention is safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocol with adequate fidelity. These data provide support for implementation of a randomized control trial of this intervention and identify specific procedural enhancements to improve study implementation.

Occupational therapy using sensory integration to improve participation of a child with autism: a case report.

In this case report, we describe the changes in adaptive behaviors and participation of 1 child with autism during a 10-wk program of intensive occupational therapy using a sensory integrative approach (OT-SI) following a manualized protocol. This case is part of a larger study examining the efficacy of the OT-SI approach. We found improvement in sensory processing, as measured by the Sensory Integration and Praxis Tests, as well as enhanced participation in home, school, and family activities, as indicated on parent-rated goal attainment scales.

Phenotypes within sensory modulation dysfunction

Sensory modulation disorder (SMD) is a severe inability to regulate responses to everyday sensory stimulation to which most people easily adapt. It is estimated to affect 5% to 16% of the general population of children. Although heterogeneity is seen in the presentation clinically, previous research has not empirically investigated whether the clinical heterogeneity of SMD can be classified into subtypes. This study explores a cohort of 98 children identified with SMD at the Department of Pediatric Rehabilitation by a member of the occupational therapy team at The Childrens Hospital of Denver. Two subtypes of SMD were identified through cluster analysis based on data from 4 parent-report instruments. The first subtype is characterized by sensory seeking/craving, hyperactive, impulsive, externalizing (eg, delinquent, aggressive), unsocial, inadaptive, and impaired cognitive/social behavior. The second subtype is characterized by movement sensitivity, emotionally withdrawal, and low energy/weak behavior. Findings from this study present a step toward understanding and classifying the complexities of children with SMDs.

Toward a Best-Practice Protocol for Assessment of Sensory Features in ASD

Sensory difficulties are a commonly occurring feature of autism spectrum disorders and are now included as one manifestation of the ‘restricted, repetitive patterns of behavior, interests, or activities’ diagnostic criteria of the DSM5 necessitating guidelines for comprehensive assessment of these features. To facilitate the development of such guidelines, this paper provides an overview of the literature on sensory features in autism spectrum disorder. We summarize the literature pertaining to: terminology, current assessment practices, sensory development, and the relationship of sensory features to core symptoms of autism. The paper concludes with recommendations for clinical assessment of sensory features in Autism.

Sensory Integration and Play Behavior

This paper presents a case study describing a developmentally delayed child and examines the changes in environmental interactions that occurred during a study period in occupational therapy in which sensory integration (SI) techniques were applied. Its purpose is to discuss the use of play observation as a means of measuring change in individuals involved in SI treatment and to demonstrate the relevance of qualitative research methodologies to the collection of data on play behavior. The study is a first step in a process of developing methods to evaluate the effectiveness of SI treatment in occupational therapy through collecting qualitative data on play and other behavioral measures of environmental interactions.

Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.

Interrater Reliability and Discriminative Validity of the Structural Elements of the Ayres Sensory Integration® Fidelity Measure©

This study examined the reliability and validity of the structural section of the Ayres Sensory Integration® Fidelity Measure© (ASIFM), which provides a method for monitoring the extent to which an intervention was implemented as conceptualized in studies of occupational therapy using sensory integration intervention methods (OT-SI). We examined the structural elements of the measure, including content of assessment reports, availability of specific equipment and adequate space, safety monitoring, and integration of communication with parents and other team members, such as collaborative goal setting with parents or family and teacher education, into the intervention program. Analysis of self-report ratings by 259 occupational therapists from 185 different facilities indicated that the structural section of the ASIFM has acceptable interrater reliability (r ≥ .82) and significantly differentiates between settings in which therapists reportedly do and do not practice OT-SI (p < .001).

Interventions That Address Sensory Dysfunction for Individuals with Autism Spectrum Disorders: Preliminary Evidence for the Superiority of Sensory Integration Compared to Other Sensory Approaches

It is estimated that 80–90% of individuals with autism spectrum disorders (ASD) demonstrate sensory-related problem behaviors such as self-stimulating behaviors (finger flicking or excessive rocking), avoiding behaviors (such as placing hands over ears in response to typical levels of auditory input), sensory seeking behaviors (twirling, chewing, etc.), “tuning out” behaviors such as not responding to their name or other environmental cues, and difficulty enacting purposeful plans of action (Baranek et al. 2006; Huebner 2001; Kientz and Dunn 1997; O’Neill and Jones 1997; Ornitz 1974, 1989; Rogers et al. 2003; Tomchek and Dunn 2007). These behaviors, which may have a sensory basis, are termed sensory dysfunction (SD) and findings show that they limit participation in play, social, self-care and learning activities (Adrien et al. 1987; Baranek 1999, 2002; Edelson et al. 1999; Grandin 1995; Leekam et al. 2007; McClure and Holtz-Yotz 1991; Leekam et al. 2007, 1997; O’Riordan and Passetti 2006; Ornitz 1974, 1989; Rapin and Katzman 1998; Rogers and Ozonoff 2005; Schaaf et al. 2010; Williams 1992, 1994). Although interventions for SD are among the most requested services for children with ASD (Mandell et al. 2005; Green et al. 2006), there is limited evidence about their efficacy (Baranek et al. 2006; Dawson and Watling 2000; Rogers and Ozonoff 2005). The National Research Council (2001, p. 131) reports that there is a “pressing need for more basic and applied research to address the sensory aspects of behavior problems (in children with ASD).” Baranek (2002) also stressed that “best practice” for children with ASD should include interventions to address SD, but that more research is needed to guide parents, teachers, and other professionals to make informed decisions about intervention. Most studies to date fail to link basic science findings to behavioral or functional changes, and thus, it is not possible to determine the specific processes underlying behavioral gains reported in intervention studies. The purpose of this chapter is to define and describe SD in ASD, evaluate the evidence for current interventions that address SD in ASD, and discuss practice recommendations in light of these data.