A recent study, using a randomised controlled trial design, has provided the first research evidence that sensory integration therapy can provide measurable improvements in daily function in children with autism. Sensory integration is widely used in practice but has previously lacked support from the existing research.
Funded by an Autism Speaks treatment research grant, this small study is the first to use a randomised control design (often seen as the ‘gold standard’ of research designs) to support positive anecdotal reports from parents and educators. The research was carried out by occupational therapists at Philadelphia’s Jefferson School of Health Professions and is published in the Journal of Autism and Developmental Disorders. Autism’s symptoms often include difficulty processing sensory information such as textures, sounds, smells, tastes, brightness and movement. These difficulties can make ordinary situations feel overwhelming. As such, they can interfere significantly with daily function and contribute to social or community isolation for some individuals and their families.
Differences with processing, integrating and responding to certain sensory stimuli have been described as one of the features of autism since the disorder was first identified. Studies suggest that between 45 and 96 % of children with ASD demonstrate sensory processing differences, and sensory features including hyper- or hypo-reactivity to sensory input, are now included as one of four possible manifestations of ‘Restricted, Repetitive Patterns of Behavior, Interests, or Activities’ (according to the DSM-V).
Describing the study, lead researcher Roseann Schaaf noted that “the rationale is that by changing how sensations are processed by the brain, we help children with autism make better sense of the information they receive and use it to better participate in everyday tasks”.
The findings of this study will, however, need to be replicated before the efficacy of sensory integration is fully established. The study involved only a small sample size of 32 participants, and future studies will need to follow children for longer periods to see if improvements remain over time.
The TEACCH Autism Program started in 1972 as part of the University of North Carolina. TEACCH stands for Treatment and Education of Autistic and Communication Handicapped Children. It was developed as a system of university-based regional centers to serve children, adolescents and adults with Autism Spectrum Disorder and their families and consists of active clinical, teaching, and research programmes.
Across the state of North Carolina, TEACCH operates 7 community regional clinics as well as a vocational/residential facility for adults with ASD. Each of the centres provides core services and unique demonstration programmes meeting the needs of individuals with ASD, their families, and professionals. TEACCH additionally supports student and professional training activities within the state, the US, and around the world.
In the UK many aspects of the TEACCH approach are adapted and used in both specialist and mainstream schools, as well as by parents at home. One of the 4 major components of structured teaching widely used in the UK is the individual work system used for developing independence in school (The other 3 major components are: physical organisation; schedules; and learning task organisation – Schopler & Mesibov, 1995). Typically, young people using the work system to support their learning will have a work station set up within the classroom that allows their work activities to be structured using trays or folders which the young person can then work through with minimal adult support.
The structured work station provides a prosthetic that allows the young person to make sense of how to understand and proceed with the activities, and reduces the need for adult direction and support. It’s important to remember to be creative with how these structured approaches are used – what works well for one young person may not work well for another, but the idea of making the task more easily understood and developing independence is an important one!
Parents and teachers can often feel overwhelmed when considering which approaches to use to support young people with autism. There are numerous intervention strategies and approaches advocated within the literature. Research Autism list a bewildering 978 different interventions which are used in practice. The NAS lists strategies and approaches ranging from visual supports and social stories to more ‘complete’ packages like TEACCH.
However, the evidence base for many of the approaches that are widely used is not entirely convincing. Many experts in the field would agree that no single approach can be useful for all individuals with autism, and that no approach is likely to be suitable even for the same individual over time. So just how do parents and professionals know that they are ‘doing the right thing’?
A research study published in November 2012 suggests that more evidence is urgently needed to support the use of autism interventions. The report, published in the journal Pediatrics, and comissioned by the RAND corporation concludes that the evidence for the efficacy of the most widely used interventions ranges from moderate to insufficient.
The study indicates that there is moderate evidence that Auditory Integration Training is not effective, and that there is insufficient evidence regarding the efficacy of augmentative and alternative communication devices. Also, the expert panel was unable to reach consensus about the evidence for Sensory Integration or Deep Pressure Brushing.
The researchers agreed that there was enough evidence to endorse the following approaches:
The study also concludes that what is needed is higher quality, longitudinal research studies which are large enough to be able to tease out important details such as which interventions are best suited to different types of difficulties and also able to distinguish the effects of different components of interventions.