A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study.

IMPORTANCE: There is a paucity of research that explores the effectiveness of sensory integration interventions in the school setting. OBJECTIVE: To test the effectiveness of a sensory integration intervention paired with teacher consultation, aligned with the principles of Ayres Sensory Integration® and the Sensory Therapies and Research Frame of Reference, to improve functional regulation and active participation in school for students with sensory integration and processing differences. DESIGN: Concurrent, multiple-baseline, single-subject design. SETTING: Public elementary school in the United States. PARTICIPANTS: Students (N = 3; ages 5-8 yr) whose sensory integration and processing differences were affecting their school occupational performance and were not remediated by integrated support. INTERVENTION: For 15 wk, each student had one-to-one sensory integration intervention 2×/wk for 30 min and a consultation between the occupational therapist and teacher weekly for 10 min. OUTCOMES AND MEASURES: The dependent variables, functional regulation and active participation, were measured weekly. The Short Child Occupational Profile and Behavior Assessment System for Children, Third Edition, were given before and after intervention. Goal Attainment Scaling and semistructured interviews with the teachers and participants were completed after intervention. RESULTS: All 3 students showed meaningful improvement in functional regulation and active participation in the classroom during the intervention period as demonstrated by a 2-SD band method or celeration line analysis. All additional measures noted positive change. CONCLUSIONS AND RELEVANCE: Findings suggest that sensory integration intervention with consultation in the education setting can improve school performance and participation for children with sensory integration and processing challenges. What This Article Adds: This study offers an evidence-based model of service delivery for the school setting that is effective in improving the functional regulation and active participation of students whose sensory integration and processing challenges interfere with occupational engagement and are not mitigated by embedded supports.

Adolescents' and Adults' Perceptions of Sensory-Based Interventions: A Qualitative Analysis.

IMPORTANCE: Adolescents and adults report that their sensory integration and processing differences affect their occupational performance and quality of life, thus requiring effective sensory-focused interventions. Researchers have yet to investigate this population's experience of occupational therapy interventions designed to remediate these challenges. OBJECTIVE: To explore the perceived experience of adolescents and adults with respect to (1) response to intervention, (2) strategies offered to manage sensory differences, and (3) need for services on completion of an intervention. DESIGN: Retrospective, qualitative study. SETTING: Zoom or phone call. PARTICIPANTS: Eleven adolescents and adults with sensory integration and processing differences who had previously completed occupational therapy interventions. INTERVENTION: Sensory-based intervention based on the principles of Ayres Sensory Integration® (ASI) and the Sensory Therapies and Research Frame of Reference. OUTCOMES AND MEASURES: A semistructured interview to obtain data, followed by an in-depth analysis using an inductive coding process to group initial open codes into themes and common subthemes Results: Open codes were grouped into three core themes: (1) therapist-related factors (what the therapist did in treatment); (2) client-related factors (what the client experienced); and (3) follow-up (future needs of the clients). Four main subthemes of the client-therapist relationship emerged: (1) therapeutic alliance; (2) education and knowledge; (3) strategies, tools, and resources; and (4) future needs. CONCLUSIONS AND RELEVANCE: This study provides a perspective on the experience of adolescents and adults specific to the impact of a sensory-focused occupational therapy intervention on their daily lives. This will help occupational therapists when designing interventions for current and future clients. What This Article Adds: This study highlights the need for further research addressing effective sensory-based interventions for adolescents and adults. It also captures which components of intervention clients deemed helpful and identifies potential targets for future intervention.

A Pilot Study of Idiopathic Toe Walking: Measures and Outcomes.

This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.

Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure.

IMPORTANCE: The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. OBJECTIVE: To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. DESIGN: Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. SETTING: Three outpatient clinic sites in the United States. PARTICIPANTS: Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. OUTCOMES AND MEASURES: The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. RESULTS: Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. CONCLUSIONS AND RELEVANCE: The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. WHAT THIS ARTICLE ADDS: This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.

State of the Science: A Roadmap for Research in Sensory Integration.

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.

Measurement in Sensory Modulation: the Sensory Processing Scale Assessment.

OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups and for clinical work in guiding treatment planning. We thus evaluated the new Sensory Processing Scale (SPS) Assessment. METHOD. Research included item development, behavioral scoring system development, test administration, and item analyses to evaluate reliability and validity across sensory domains. RESULTS. Items with adequate reliability (internal reliability >.4) and discriminant validity (p < .01) were retained. Feedback from the expert panel also contributed to decisions about retaining items in the scale. CONCLUSION. The SPS Assessment appears to be a reliable and valid measure of sensory modulation (scale reliability >.90; discrimination between group effect sizes >1.00). This scale has the potential to aid in differential diagnosis of sensory modulation issues.

State of measurement in occupational therapy using sensory integration.

This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.

It's Not Just about Bicycle Riding: Sensory-Motor, Social and Emotional Benefits for Children with and without Developmental Disabilities.

BACKGROUND: A developing area for therapy is teaching children to ride a bicycle. Little has been written about the effectiveness of these programs. This study explored outcomes from participation in a novel bicycle riding program for children with a wide array of developmental challenges. METHOD: Two studies were conducted; a nonconcurrent, multiple baseline design with four participants and a pretest-posttest single group with 15 children. RESULTS: Study 1 participants improved on broad jump. Balance positions showed variable responses. Study 2 participants showed significant improvement on broad jump, and a trend toward significance walking forwards and backwards. Parents reported improvement in following rules, participating in daily routines, interacting with peers, and feeling good about him/herself and a change in child's participation in community and extracurricular activities. All children improved in glide time or achieved independent riding. CONCLUSIONS: Preliminary evidence was found for the effectiveness of one approach for developing motor and social skills within the context of learning to ride a bicycle. Children over the age of 6 years were able to ride a two-wheeled bicycle at the end of the program. Participation suggested improvement in motor coordination and dynamic balance as well as changes in measures of social interaction and self-esteem.

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 Children's 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.

Preparing Advanced Clinicians and Practitioners: A Model for Mentorship in Occupational Therapy Practice.

Mentoring is essential at all stages of a professional career. However, little has been written about the effectiveness of programs for practicing clinicians. This study was designed to address the need for evidence about the effectiveness of formal mentorship programs by describing the impact of the STAR mentorship program on a group of clinicians specializing in sensory integration and processing challenges. This study utilized an exploratory, retrospective, survey research design. Course evaluations were examined from 240 subjects following participation in a one-week, small group mentorship training program. Qualitative methods were adapted for use in this study. Sixteen codes, with operational definitions, were developed to analyze the surveys. Ninety-six percent indicated that the program met or exceeded their expectations; only 12.5% had a negative comment. Impact on psychosocial function was reflected by 22% of the participants. Comments related to impact on career function were indicated by 45% of the participants. Ninety-four percent provided positive comments about the program structure, and 74% responded with positive comments regarding content of the program. Positive outcomes were associated with this one mentorship program, suggesting a need for more in-person, structured mentored learning experiences. Mentorship is recommended as a method to address the growing need within the profession to support career development, build knowledge, skill and attitudes, and aspirations/commitment as well as enhance professionalism/professional development.

Wireless Measurement of Sympathetic Arousal During in vivo Occupational Therapy Sessions.

PURPOSE: One goal of occupational therapists working with children who have sensory processing challenges is the regulation of arousal. Regulation strategies have not been evaluated using an empirical measure of physiological arousal. OBJECTIVE: To establish the feasibility of using an objective physiologic measure of sympathetic arousal in therapeutic settings and explore the relation between therapeutic activities and sympathetic arousal. To evaluate changes in electrodermal activity (EDA) during occupational therapy sessions. METHODS: Twenty-two children identified with sensory modulation dysfunction (SMD) wore a wireless EDA sensor during 50 min occupational therapy sessions (n = 77 sessions). RESULTS: All children were able to wear the sensor on the lower calf without being distracted by the device. The five insights below are based on a comparison of EDA recordings in relation to therapists' reflections describing how sympathetic arousal might correspond to therapeutic activities. CONCLUSION: Objective physiological assessment of a child's sympathetic arousal during therapy is possible using a wireless EDA measurement system. Changes in EDA may correspond directly with therapeutic activities. The article provides a foundation for designing future therapeutic studies that include continuous measures of EDA.

A systematic review of ayres sensory integration intervention for children with autism.

Sensory integration is one of the most highly utilized interventions in autism, however, a lack of consensus exists regarding its evidence base. An increasing number of studies are investigating the effectiveness of this approach. This study used the Council for Exceptional Children (CEC) Standards for Evidence-based Practices in Special Education to evaluate the effectiveness research from 2006 to 2017 on Ayres Sensory Integration (ASI) intervention for children with autism. A systematic review was conducted in three stages. Stage 1 involved an extensive database search for relevant studies using search terms related to sensory integration and autism, interventions suggesting a sensory integration approach, and high-quality study designs. Searches yielded 19 studies that were evaluated in Stage 2. Six of these met inclusion criteria of being peer-reviewed, written in English, description of intervention this is consistent with ASI intervention, and comparison group design or single subject method employed. Prior to analysis using CEC standards, three articles were excluded because intervention details were not consistent with the core principles of ASI, or because of major methodological flaws. In Stage 3, the remaining three studies were rated using the CEC quality indicators and standards for an evidence-based practice. Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items. One additional study met more than 50% of the criteria. Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4-12 years old. Autism Research 2019, 12: 6-19. © 2018 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY: Ayres Sensory Integration intervention is one of the most frequently requested and highly utilized interventions in autism. This intervention has specific requirements for therapist qualifications and the process of therapy. This systematic review of studies providing Ayres Sensory Integration therapy to children with autism indicates that it is an evidence-based practice according to the criteria of the Council for Exceptional Children.

Pilot study of the Sensory Over-Responsivity Scales: assessment and inventory.

This article describes 3 stages of construction of the Sensory Over-Responsivity (SensOR) Scales: instrument development, reliability and validity analyses, and cross-validation on a new sample. The SensOR Scales include the SensOR Assessment, an examiner-administered performance evaluation, and the SensOR Inventory, a caregiver self-rating scale. Both scales measure sensory overresponsivity in 7 sensory domains. Data were collected from 2 samples consisting of participants who were typically developing (ns = 60 and 44, respectively) and participants with sensory overresponsivity (ns = 65 and 48, respectively), ages 3 to 55. In developing the research edition, items on the pilot version were reviewed for their internal consistency reliability, discriminant validity, and construct validity. Data from both samples on the research edition revealed high internal consistency reliability for domains and the total test and significant discrimination between the overresponsive and the typically responsive groups (p < .05). The preliminary psychometric integrity of the scales, along with continued research efforts, is an important contribution to evidence-based practice.

Sensory reactivity, empathizing and systemizing in autism spectrum conditions and sensory processing disorder.

Although the DSM-5 added sensory symptoms as a criterion for ASC, there is a group of children who display sensory symptoms but do not have ASC; children with sensory processing disorder (SPD). To be able to differentiate these two disorders, our aim was to evaluate whether children with ASC show more sensory symptomatology and/or different cognitive styles in empathy and systemizing compared to children with SPD and typically developing (TD) children. The study included 210 participants: 68 children with ASC, 79 with SPD and 63 TD children. The Sensory Processing Scale Inventory was used to measure sensory symptoms, the Autism Spectrum Quotient (AQ) to measure autistic traits, and the Empathy Quotient (EQ) and Systemizing Quotient (SQ) to measure cognitive styles. Across groups, a greater sensory symptomatology was associated with lower empathy. Further, both the ASC and SPD groups showed more sensory symptoms than TD children. Children with ASC and SPD only differed on sensory under-reactivity. The ASD group did, however, show lower empathy and higher systemizing scores than the SPD group. Together, this suggest that sensory symptoms alone may not be adequate to differentiate children with ASC and SPD but that cognitive style measures could be used for differential diagnosis.

A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder.

OBJECTIVE: A pilot randomized controlled trial (RCT) of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) was conducted with children who had sensory modulation disorders (SMDs). This study evaluated the effectiveness of three treatment groups. In addition, sample size estimates for a large scale, multisite RCT were calculated. METHOD: Twenty-four children with SMD were randomly assigned to one of three treatment conditions; OT-SI, Activity Protocol, and No Treatment. Pretest and posttest measures of behavior, sensory and adaptive functioning, and physiology were administered. RESULTS: The OT-SI group, compared to the other two groups, made significant gains on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised. Compared to the control groups, OT-SI improvement trends on the Short Sensory Profile, Child Behavior Checklist, and electrodermal reactivity were in the hypothesized direction. CONCLUSION: Findings suggest that OT-SI may be effective in ameliorating difficulties of children with SMD.

Lessons learned: a pilot study on occupational therapy effectiveness for children with sensory modulation disorder.

OBJECTIVE: The purpose of this pilot study was to prepare for a randomized controlled study of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) with children who have sensory processing disorders (SPD). METHOD: A one-group pretest, posttest design with 30 children was completed with a subset of children with SPD, those with sensory modulation disorder. RESULTS: Lessons learned relate to (a) identifying a homogeneous sample with quantifiable inclusion criteria, (b) developing an intervention manual for study replication and a fidelity to treatment measure, (c) determining which outcomes are sensitive to change and relate to parents' priorities, and (d) clarifying rigorous methodologies (e.g., blinded examiners, randomization, power). CONCLUSION: A comprehensive program of research is needed, including multiple pilot studies to develop enough knowledge that high-quality effectiveness research in occupational therapy can be completed. Previous effectiveness studies in OT-SI have been single projects not based on a unified long-term program of research.

Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders.

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies.

Fidelity in sensory integration intervention research.

OBJECTIVE: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles). METHOD: We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements. RESULTS: Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration. CONCLUSION: Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.

Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study.

RATIONALE: This study explored subtypes of sensory processing disorder (SPD) by examining the clinical presentations of cluster groups that emerged from scores of children with SPD on the Sensory Processing 3-Dimension (SP-3D) Inventory. METHOD: A nonexperimental design was used involving data extraction from the records of 252 children with SPD. Exploratory cluster analyses were conducted with scores from the SP-3D Inventory which measures sensory overresponsivity (SOR), sensory underresponsivity (SUR), sensory craving (SC), postural disorder, dyspraxia, and sensory discrimination. Scores related to adaptive behavior, social-emotional functioning, and attention among children with different sensory modulation patterns were then examined and compared. RESULTS: Three distinct cluster groups emerged from the data: High SOR only, High SUR with SOR, and High SC with SOR. All groups showed low performance within multiple domains of adaptive behavior. Atypical behaviors associated with social-emotional functioning and attention varied among the groups. IMPLICATIONS: The SP-3D Inventory shows promise as a tool for assisting in identifying patterns of sensory dysfunction and for guiding intervention. Better characterization can guide intervention precision and facilitate homogenous samples for research.