SENSORY INTEGRATION AND THE IMPROVEMENT OF PLAY SKILLS IN CHILDREN WITH AUTISM

SPECTRUM DISORDER AND PERVASIVE DEVELOPMENTAL DISORDER

Marissa Elder, OTS & Marissa Stendel, OTS
Touro University Nevada, School of Occupational Therapy
RESEARCH QUESTION
Does Ayres' sensory integration (SI) treatment increase engagement
and improve play skills in children with Autism Spectrum Disorder
(ASD) and Pervasive Developmental Disorders (PDD) and sensory
deficits?

SEARCH METHODS

IMPLICATIONS FOR OT

Databases utilized:
CINHAL, SAGE Publications (SAGE), OT Search, OTDbase, Google Scholar, AOTA, and additional hand searching of
bibliographies was performed.

The clinical and community-based practice of OT

Evidence has shown that mastery play can be an area of focus during OT/SI
interventions (Case - Smith & Bryan, 1999).
The research illustrates how attentional deficits in children with ASD could
be addressed within the confines of SI treatment (Miller, Coll, & Schoen,
2007).
Program development
This program would need to be expanded and researched with a larger
population for generalizability. Because it is known novel experiences for
each child will be different, sensory gyms and various therapeutic tools will
necessary to start a sensory integration program that will successful
address the needs of individual children (Linderman & Stewart, 1999).
Provided ten core principles of SI that could be used to structure an SI
program for children with ASD and ADHD (Schaaf, Hunt, & Benevides,
2012).
Societal Needs
The research attempts to provide justification for the implementation of SI
treatment throughout various clinical settings, particularly hospital-based
settings (Miller, Coll, & Schoen, 2007).
The creation of programs that address needs of children with all types of SI
deficits is essential (Watling & Dietz, 2007).
Healthcare delivery and policy
Demonstrates how the GAS can be used to assess a childs goals in
relation to SI treatment plans and how the process can then be documented
(Miller, Coll, & Schoen, 2007).
Further delivery of these services and use of assessments with children
demonstrates the process of refinement and need for these OT services
within the community and home setting (Linderman & Stewart, 1999).
Education and training of OT students
Educate on task engagement for children with ASD using multimodal means
of intervention (Watling & Dietz, 2007, Level IV).
Gaining hands on experience in the classroom with children and organizing
SI treatment can better help train students for the work force (Dunbar, CarrHertel, Lieberman, Perez & Ricks, 2012).
Refinement, revision, and advancement of factual knowledge or theory
The research examines how SI treatment can be utilized to influence the
occupation of play versus ADLs, which are what is typically examined. By
examining occupations outside of ADLs, the study refines the
implementation of SI treatment (Case - Smith & Bryan, 1999).
The research provides information to guide future higher level research
studies on SI, specifically a model of how SI treatment studies involving
RCTs should be conducted (Pfeiffer, Koenig, Kinnealey, Sheppard &
Henderson, 2011).

BACKGROUND & CLINICAL SCENERIO

What are Autism Spectrum Disorder (ASD) and Pervasive

Developmental Disorders (PDD)?
The Center for Disease Control (CDC) (2015) estimates that 1 out of 68
children living in the United States has some form of ASD.
Researchers for the CDC also speculate that ASD is found five times
more in males than females (2015).
Another condition related to ASD is Pervasive Developmental DisorderNot Otherwise Specified (PDD-NOS) (CDC, 2015).
Children with ASD and PDD-NOS typically experience deficits in a wide
variety of skills, such as social, behavioral, executive, and sensory
integration skills (CDC, 2015).
Because children with ASD and PDD-NOS experience difficulty with
socializing, behaving appropriately, executive functioning and sensoryintegrative skills, many of their meaningful occupations can be
compromised (Watling & Dietz, 2007).
The impairments in engagement experienced by children with ASD and
PDD-NOS impact activities of daily living (ADL), instrumental activities
of daily living (IADL), education, and play (Watling & Dietz, 2007).
Play, or lack thereof, is also the primary occupation that can serve as a
catalyst for behavioral outbursts (Case-Smith & Bryan, 1999).
What is sensory integration (SI) treatment?
Sensory integration (SI) treatment is based on the assumption that
neurological processes associated with sensation can be disrupted,
causing abnormal behavioral responses (Pfeiffer, Koenig, Kinnealey,
Sheppard & Henderson, 2011).
The goal of this treatment tool is to elicit an adaptive motor response
through the use of controlled sensory experiences (Pfeiffer, Koenig,
Kinnealey, Sheppard & Henderson, 2011).
By decreasing undesirable behaviors and encouraging engagement,
treatments rooted in sensory integration theory may improve
meaningful, occupational participation in children with ASD or PDD-NOS
(Pfeiffer, Koenig, Kinnealey, Sheppard & Henderson, 2011).

Retrieved from: http://www.sensory-kids.com/

Inclusion
Articles were peer reviewed and written in
English
Articles must be published between 19992015
Must include play as means for intervention
Must include elements of PICO question
Must have diagnosis of Autism Spectrum
Disorder, and/ or Pervasive Developmental
Disorder with sensory deficits.
Level I-V of research

Exclusion
Any articles outside of pre-determined year
range
Non-English written articles
Persons over the age of 21 years
Must not be receiving SI treatment from
other therapy sources while enrolled in
study
Dissertation or master thesis

Level of
Evidence

Study Design/Methodology of
Selected Articles

Number of
Articles
Selected

Systematic reviews, meta-analysis,

randomized controlled trials (RCT)

II

Two groups, nonrandomized studies (e.g.,

cohort, case-control)

III

One group, nonrandomized (e.g., before

and after, pretest, and posttest)

IV

Descriptive studies that include analysis of

outcomes (single subject design, case
series)

Case reports and expert opinion, which

include narrative literature reviews and
consensus statements

Other

Qualitative Studies

TOTAL:

SUMMARY OF KEY FINDINGS

Level I studies
Those who received SI treatment scored significantly higher on the GAS (p value of .003). Children who received SI
treatment also had a decrease in caregiver assistance in self-care and social skills (p value of .039), as defined by the
Pediatric Evaluation of Disability Inventory (PEDI) (Scaaf et al., 2013).
Level II studies
Results indicated an improvement for both the SI treatment and control groups in their overall play skills within the context of
pre-school over a short 12 week period (Dunbar, Carr-Hertel, Lieberman, Perez & Ricks, 2012).
Level IV studies
Significant improvements were noted in the areas of social interaction, approach to new activities, response to holding and
hugging, and response to movement in two children with ASD under the age of three. Participants also demonstrated
significant gains in all functional behaviors observed in context of home. (Linderman & Stewart, 1999).
Level V studies
Researchers used a pre and post t test to determine improvements in occupational performance and sensory integration in a
five-year old male with ASD and ADHD who received SI treatment. None of the data proved significant or generalizable
(Schaaf, Hunt, & Benevides, 2012).
No Level III studies were reviewed.

RESULTS

REFERENCES (PARTIAL LIST)

Case - Smith, J., & Bryan, T. (1999). The effects of occupational therapy with
sensory integration emphasis on preschool-age children with autism.
American Journal of Occupational Therapy, 53, 489-497.
doi:10.5014/ajot.53.5.489
Dunbar S, Carr-Hertel J, Lieberman H, Perez, B., Ricks K. A pilot study
comparison of sensory integration treatment and integrated preschool
activities for children with autism. The Internet Journal of Allied Health
Sciences and Practice, 10(3), 1-8.

OT-SI group also increased significantly more than the other groups on Attention (p = .03 compared to No Treatment; p = .07
compared to Activity Protocol [trend toward significance]) and on the Cognitive/Social Composite of the LeiterR (p = .02
compared to Activity Protocol) (Miller, Coll, & Schoen, 2007).
Mastery play showed statistical significance for three out of five participants (Case - Smith & Bryan, 1999).
Participants in the SI treatment group had a pre-test treatment mean score of 28.5 on the Knox Preschool Play Scale.
Following treatment, the groups scores increased to a post treatment mean score of 47.40, indicating improvement in play
and engagement (Dunbar, Carr-Hertel, Lieberman, Perez & Ricks, 2012).

LIMITATIONS

Small sample sizes led to a lack of generalizability.

Contamination due to participants receiving others modes of therapy during
duration of study.
Homogeneous sample size and lack of diversity.
Lack of detail limits ability to replicate studies in the future.
Lack of appropriate statistical analysis to determine further statistically
significant implications.

CONTACT INFORMATION
Marissa Elder, OTS: ot16.marissa.elder@nv.touro.edu
Marissa Stendel, OTS: ot16.marissa.stendel@nv.touro.edu

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