Research in Autism Spectrum Disorders 3 (2009) 783–796

Contents lists available at ScienceDirect

Research in Autism Spectrum

Disorders
Journal homepage: http://ees.elsevier.com/RASD/default.asp

The effect of sensory activities on correct responding for

children with autism spectrum disorders
Ginny L. Van Rie *, L. Juane Heflin
Dept. EPSE, Georgia State University, P.O. Box 3979, Atlanta, GA 30302-3979, United States

A R T I C L E I N F O A B S T R A C T

Article history: Sensory-based activities are commonly recommended for students

Received 23 February 2009 with ASD, even in the absence of empirical data to substantiate their
Accepted 3 March 2009 effectiveness. A single subject alternating treatment design was
used to assess functional relations between sensory-based ante-
Keywords: cedent interventions and correct responding in four students with
Autism autism. As individuals with autism constitute a heterogeneous
Sensory interventions population, it is not surprising that a functional relation was found
Learning outcomes
for only two of the four students. Results of this study lead to the
conclusion that sensory-based interventions may be effective for
some but not all students with autism. Implications for evaluating
aptitude by treatment interactions and suggestions for future
research are discussed.
ß 2009 Published by Elsevier Ltd.

Adherents to the optimal stimulation theory posit that individuals strive to maintain ideal levels of
arousal in order to function effectively and efficiently (Zentall & Zentall, 1983). According to this
theory, individuals adjust their activity levels depending on whether they are over or under aroused in
order to achieve an optimal level of stimulation conducive to navigating daily life. Therefore, an
individual’s activity level may be a good indicator as to his or her level of arousal. Based on
observations of their activity levels, children with ASD react in typical environments the way typically
developing peers respond in stressful environments (Zentall & Zentall, 1983). Unfortunately, the
repetitive and stereotyped behaviors children with ASD employ to achieve their optimal level of
arousal in environments they perceive as stressful (Fisher & Murray, 1991; O’Brien & Pearson, 2004)
interfere with their ability to engage with instructional materials and learning activities. Engagement
in academic tasks and educational activities is vital for learning. Students who are not engaged are less

* Corresponding author. Tel.: +1 404 413 8040; fax: +1 404 413 8043.
E-mail address: gvanrie@yahoo.com (G.L. Van Rie).

1750-9467/$ – see front matter ß 2009 Published by Elsevier Ltd.

doi:10.1016/j.rasd.2009.03.001
784 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

likely to learn the material and thus less likely to make academic gains (Logan, Bakeman, & Keefe,
1997).
Individuals with ASD may have difficulty reaching the optimal level of arousal required for learning
because they do not process or respond to sensory stimuli in the same manner as typically developing
peers (Rogers, Hepburn, & Wehner, 2003; Volkmar, Cohen, & Paul, 1986). Ayres (1972) articulated a
theory of sensory integration that posits the importance of appropriate responses to sensory input and
modulation of output for effective functioning. Individuals who have difficulty responding to sensory
stimuli will over or under react in the presence of the stimuli (Yack, Aquilla, & Sutton, 2002). These
extreme reactions reflect an individual’s attempt to regain optimal levels of arousal.
Since Ayres proposed the theory of sensory integration, several techniques and methods have
evolved to help individuals with sensory processing difficulties. Although none of the techniques are
empirically validated, the theory is that they help individuals register and modulate responses to
sensory stimuli (Dunn, 2001). Sensory integration requires participation in activities such as swinging,
jumping, and bouncing which are designed to strengthen sensory processing abilities. The
aforementioned activities rely on vestibular and proprioceptive sensory input to allow individuals
with sensory dysfunction to regulate these systems and overcome some of their hyper or hypo
responses to sensory stimulation (Heflin & Alaimo, 2007; Yack et al., 2002).
Authors of physiology texts and theoretical guides describe the roles of the vestibular and
proprioceptive systems in humans. The vestibular system provides information from the semicircular
canals of the inner ear to the brain which gives an individual a sense of balance and center of gravity
(Berthoz, 2000). The vestibular system is the foundation for the functioning of other systems and is
closely tied to auditory functioning (Kashman & Mora, 2005). Difficulty processing vestibular
stimulation negatively affects the ability to communicate or process auditory stimulation (Kranowitz,
2005). The proprioceptive system relies on feedback from muscles, joints, and tendons and enables
determination of how much effort is needed to perform movements such as grasping and lifting and to
modulate tension for walking, writing, chewing, and so forth (Zigmond, Bloom, Landic, Roberts, &
Squire, 1999). Individuals who have problems processing proprioceptive stimulation may have
difficulty controlling their body movements (i.e., motor planning; Bundy, Lane, & Murray, 2002). Many
of the stereotyped behaviors commonly seen in individuals with ASD engage the vestibular and
proprioceptive systems to either increase or decrease stimulation to these systems in order to reach
their optimal level of arousal (Heflin & Alaimo, 2007). Unfortunately, these stereotyped and repetitive
behaviors may impede a student’s ability to engage in learning activities and materials.
Individuals with difficulty processing vestibular and proprioceptive stimulation can be either
hyper-reactive or hypo-reactive. According to Yack et al. (2002), individuals with hyper-reactivity
may try to escape from or protest bright lights or loud sounds, express discomfort with certain
clothing textures, dislike certain smells or tastes and appear overly fearful of heights and movement.
In contrast, individuals who are hypo-reactive may not respond to loud noises or painful stimuli, may
not acknowledge other people or things in the environment, may not get dizzy with excessive
spinning and may have delayed responses. Different sensory activities are theorized to help
individuals modulate their sensory systems depending on if they are hypo-reactive or hyper-reactive
(Kranowitz, 2005). The impact of the activities are modulated by not only the type of input (e.g.,
proprioceptive or vestibular) but also by the quality of the input (e.g., fast vs. slow, loud vs. soft). Slow
linear swinging, sucking, white noise, bear hugs, and playing with fidget toys are a few sensory
activities that are supposed to help an individual with hyper-reactivity calm down and reach an
optimal level of arousal. Bouncing, jumping, listening to loud fast music, and playing in cold water are
theorized to be alerting activities to an individual who is hypo-reactive to sensory input.
Although there is limited empirical research supporting the use of sensory activities to improve
task engagement for individuals with ASD, it is a common practice within school, occupational
therapy, and speech therapy settings (Baranek, 2002; Heflin & Alaimo, 2007; Schreibman, 2005) with
over 92% of occupational therapists surveyed reporting the use of sensory-based interventions (Olson
& Moulton, 2004). A few researchers suggest sensory based therapies may produce positive outcomes
in the areas of communication, play skills, and academic functioning for individuals with sensory
processing difficulties (Case-Smith & Bryan, 1999; Fertel-Daly, Bedell, & Hinojosa, 2001; Schilling &
Schwartz, 2004; Schilling, Washington, Billingsley, & Deitz, 2003; VandenBerg, 2001). However, these
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 785

studies contain methodological weaknesses that make it impossible to document functional relations
between the interventions and the behavioral outcomes. For example, Case-Smith and Bryan (1999)
claim that 32 min sensory-based occupational therapy sessions a week were the reason 5 preschool
age boys with ASD improved in the areas of play and engagement. However, the researchers do not
give details of the activities involved in the therapy sessions nor do they account for confounding
variables that may have contributed to the gains made by the students over the course of the study. In
recognition of the fact that optimal levels of arousal are necessary for learning and the current lack of
empirical research documenting the link between strategies to improve arousal and learning
outcomes, the purpose of this study is to determine if there is a functional relation between sensory
activities, such as slow linear swinging and fast bouncing on an exercise ball, and correct responding
for four children with autism in elementary school.

1. Method

1.1. Participants

Participants for this study were recruited from the first author’s classroom. The study was approved
by Institutional Review Boards at the authors’ University and first authors’ school district. There were six
students in the classroom; only the four students with autism were invited to participate in the study.
The four participants were diagnosed with autism by a psychologist employed by the school system
using to DSM-IV-TR criteria (APA, 2000). The Childhood Autism Rating Scale (CARS; Schopler, Reichler, &
Renner, 1988) completed by the first author at the time of each student’s evaluation for consideration of
special education eligibility in the school system was used as an indication of severity. District
procedures were followed in determining that each child was eligible for special education services
under the category of autism. All of the participants received special education services in a self-
contained classroom in a public elementary school outside a major metropolitan area in the
southeastern US. The parents of the four students with autism gave permission for their children to
participate and child assent procedures were followed prior to the start of each session to ensure
voluntary participation. Information about the participants is provided in Table 1.
Joey was an active and alert child. He enjoyed drawing his favorite movie production logos and
singing Christmas carols. He communicated verbally, but often had to be cued when to respond or how
to respond to questions. He expressed his wants and needs using three to five word phrases. Joey sat in
his chair during academic tasks but, he was often bouncing around, singing, or looking away from
instructional materials. He required multiple verbal, gestural, and physical prompts to answer
academic questions. Joey was not taking prescription medications during the study.
Troy was energetic and ran or jumped around the classroom on his tiptoes. He liked to draw his
favorite store logos, watch cartoons aired on public television, and build with blocks. Troy used three
to five word phrases to express his wants and needs, but required prompting to answer questions. He
had difficulty sitting in his chair and often jumped up out of his chair or ran away from his chair during
academic tasks. During instruction, Troy engaged in delayed echolalia and started repeating phrases
from cartoons and computer games and thus required multiple prompts to engage in academic
instruction. Troy did not take prescription medications during the study.

Table 1
Participant information.

Name Age CARSa Cognitive assessments

Al 6 years 3 months 34.5 42b

Carl 6 years 3 months 37.5 48c
Joey 7 years 4 months 51 48b
Troy 6 years 6 months 46.5 58d
a
Childhood Autism Rating Scales.
b
Stanford-Binet Intelligence Scale – Fifth Edition (full scale score).
c
Wechsler Preschool and Primary Scale of Intelligence – Third Edition (full scale score).
d
Battelle Developmental Inventory, Second Edition (standard score).
786 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

Al was an energetic and happy child. He ran around the classroom pretending to be a superhero or
flew planes he built out of interlocking blocks. He loved to play outside and requested the opportunity
multiple times during the day. Al communicated his wants and needs with two to three word phrases
and required prompting to respond to questions. He had difficulty remaining seated during academic
instruction and engaged in constant verbal stimming. Often his verbal stims were unintelligible and
included nonsense words. Engaging Al in academic tasks was very difficult because of his activity level
and verbal stimming. Al was not on prescription medication until he was removed from the study
during the replication phase.
Carl was a calm and lethargic child. He often sat quietly in his chair, smiling. He liked to hold small,
soft items in his hands such as cotton balls, tissues, or balls. He enjoyed sitting in an adult’s lap or
getting hugs. Carl communicated his wants and needs using one to two word phrases but required
modeling to use the correct words and phrases. When presented with academic tasks, Carl would
avert his eyes from the stimulus and required multiple verbal, gestural, and physical prompts to
respond. Carl did not take prescription medications during the study.

1.2. Setting

All four participants were in the same classroom which was approximately 24 ft.  31 ft. The room
was divided into a calendar activity area, a 1:1 work area, a small group work area, a large group work
area, a play area, an area for sensory activities, and an area for the teacher’s and paraprofessional’s
desks and materials (one full-time paraprofessional was assigned to the classroom). The pre-academic
instruction activities were implemented in the sensory area of the classroom. The academic
instruction was conducted in a 1:1 work area set up in the back of the classroom that consisted of one
small table and two chairs. The students were familiar with the 1:1 work area and received instruction
in this area throughout the day. The study was conducted between 9:00 and 10:00 daily. Each student
engaged in the intervention and instructional activities with the first author for 15 min daily. The
order in which the students participated varied daily based on child availability (e.g., due to related
service provision, assessments, arrival time).

1.3. Design

An alternating treatment design with replication of the most effective intervention (Barlow &
Hayes, 1979) was used to demonstrate a functional relation between the intervention and
behavioral outcomes. Baseline data on correct responses were collected for three sessions or until
the data were stable. Stability was determined by 50% or less variability around the baseline mean
(Alberto & Troutman, 2009). Each student was randomly assigned an intervention or the control
activity for each session, ensuring that each intervention and the control activity were
implemented an equal number of times and counterbalanced during the intervention phase.
Randomization was accomplished by assigning each condition a number (1 for swinging, 2 for
bouncing, and 3 for listening). Two sets of numbers were placed in a hat. Monday morning, the first
author drew five numbers out of the hat for a student. The first number drawn was the condition
implemented on Monday, the second Tuesday, and so forth. The procedure was repeated for each
student. After the first week, the condition that was implemented twice the week before was
removed from the selection. Three sets of instructional materials for two different categories
(community helpers and safety signs) were used to guard against practice effect across
interventions and the control activity.
Horner, Carr, and Halle (2005) substantiate the need to augment visual analysis of single-subject
data with more objective outcome measures. In this study, percentage of non-overlapping data (PND;
Scruggs, Mastropieri, & Casto, 1987) was calculated to provide an indication of magnitude of change
during intervention. Although the most commonly used metric for calculating effect size in single-
subject research, PND has been criticized as being overly sensitive to outliers and phase length
(Marquis et al., 2000). Therefore, an additional metric, the pairwise data overlap (PDO) procedure was
calculated to document intervention effectiveness. PDO has been described as the most reliable of the
non-parametric approaches (Wendt & Scholsser, in press) and requires comparison of overlap for each
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 787

baseline data point against all data points in intervention (Parker & Vannest, in press). Only data from
the intervention phase (excluding replication) were used to calculate PDO.

1.4. Independent variable

The independent variable was the sensory or control activity implemented for 5 min immediately
preceding academic instruction. The two sensory interventions included slow linear swinging and fast
bouncing on an exercise ball. Slow linear swinging was conducted using a sling-seat swing mounted in
the ceiling of the classroom. The first author, who was also the children’s teacher, pushed the student in
slow linear patterns for 5 min. Fast bouncing on a ball involved the student sitting on a 65-cm exercise
ball while the first author held the student’s hands or waist and helped the student quickly bounce up
and down on his bottom on the ball for 5 min. A control activity served as a contrast to the two sensory
activities. During the control activity, the student chose a story book and listened to a reading by the first
author. The control activity was conducted in the same area as the swinging and bouncing activities.

1.5. Dependent variable

The dependent variable was the percent of correct responses the student achieved for two different
sets of instructional tasks during academic instruction after each sensory intervention or control
activity. Three sets of instructional materials for two different categories (community helpers and
safety signs) were created by reviewing the Individual Education Plans of the four participating
students. All of the students had objectives to identify community helpers and safety signs. The
students knew a few signs from previous instruction (e.g. stop sign, traffic light, enter, exit), so these
signs were eliminated from the pool. Fifteen novel signs and community helpers were selected from a
list of common community helpers and safety signs in the curriculum.
Three sets of five flash cards were created for each category. The flash cards were approximately
3.75 in.  3.75 in. and were created using the Mayer–Johnson Boardmaker program. The pictures were
in color and the word labels at the top of the flashcards were deleted. The flash cards were printed on
cardstock, cut out in squares and laminated. Joey knew six safety signs and one community helper.
Troy knew two community helpers and five safety signs. Carl knew one community helper and no
safety signs. Al did not know any community helpers or safety signs. The first author divided the
flashcards into sets that equally dispersed the number of known flashcards. Baseline data are reported
based on the subsequent division; analysis of responses during baseline substantiates the equivalence
of the sets of flash cards.
One set of flash cards for each category was designated for a specific intervention (i.e. every time a
student bounced on the exercise ball prior to instruction he used the same five flash cards from each of
the two categories, every time a student was swung prior to instruction he used a different but
equivalent set of five flashcards from each of the two categories, and every time a student listened to a
story he used a different but equivalent set of five flashcards from each of the two categories). Baseline
data were collected by presenting all 15 community helpers and 15 safety signs to the students while
sitting 1:1 at the same table that would later be used for intervention. The flashcards were presented
one time each in random order and the students were given 5 s to respond by labeling them verbally.
The students did not receive corrective feedback during the baseline phase. During intervention the
participants were presented three trials for each set of five flash cards from the two categories. Thus
the total number of opportunities to respond after each sensory intervention or control activity was
thirty. The number of correct responses was measured using event recording on a data sheet. Correct
responses were indicated using a plus sign and incorrect responses were indicated using a minus sign.
The percentage was calculated by taking the total number of correct responses and dividing it by the
total number of opportunities to respond within each set of academic tasks.

1.6. Procedures

The teacher followed the IRB-approved assent procedure before every session for each student to
ensure that the students voluntarily participated in the study. According to the pre-determined
788 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

randomization schedule, the students were assisted to swing slowly in a linear motion, rapidly bounce
on a ball, or to listen to a story for 5 min prior to instruction. A visual timer was set to indicate the end
of the pre-instruction activity at which point the first author would announce ‘‘It is time to work.’’ The
first author and the student went to the 1:1 work area and the student was presented with two sets of
academic tasks, one immediately after the other. The first task was to expressively identify five
community helpers and the second task was to identify five community safety signs. The flash cards
were presented randomly with all five community helpers first followed by all five safety signs. This
was repeated until the student was presented with three trials of all 10 flash cards for a total of thirty
responses per session.
After 12 intervention sessions it was determined that Al and Carl needed to respond receptively
instead of expressively because they were having difficulty pronouncing the names of the community
helpers and safety signs. Starting on the twelfth intervention session they were given a field of three
flashcards from the same category for every trial and the location of the correct flashcard was
randomized for every response. The first author requested the target safety sign or community helper
for the student to select. The student then picked up the flashcard and placed it in the first author’s
open hand.
The instructional procedure consisted of a system of least prompts and the students received
intermittent secondary reinforcement in the form of praise, tickles, or access to a preferred item such a
toy car or figurine while sitting at the 1:1 work table during instruction. The system of least prompts
involved the first author presenting the flashcard and allowing the student 5 s to respond. After 5 s, if
the student did not respond, the first author gave a verbal prompt of the initial sound of the target item
to the students responding expressively and a gestural prompt to the students responding receptively.
If the student did not respond after 5 s then the first author stated the whole name of the target item
for students responding expressively and physically guiding the hands of the students responding
receptively to the target item. Only the students’ responses that were give correctly and
independently after the initial presentation of the flashcard were counted as correct.
The students were considered to have met mastery when they achieved three consecutive sessions
with 80% correct in one condition. Once a student achieved mastery for one condition, the results were
replicated using the instructional materials of the least successful intervention.

1.7. Reliability data

For the purpose of calculating interobserver agreement and treatment fidelity, an independent
observer was trained to collect data on videotaped sessions. An average of 33.6% of sessions were
videotaped across all phases and students (25.6% of the sessions for Joey, 38% of the sessions for Troy,
32.3% of the sessions for Al, and 35.7% of the sessions for Carl). Joey had the lowest average of
videotaped sessions because he participated in the study for the fewest number of sessions.
The independent observer was working on her doctoral degree in special education and was
trained by the first author to determine if the sensory interventions and the control activity were
implemented with fidelity as well as to take data on correct and incorrect responses during academic
instruction. The second observer recorded data on a data sheet identical to the one the first author
used during instruction and reached 85% agreement for three consecutive sessions at the start of the
study. During the study interobserver agreement (IOA) was calculated using point-by-point
agreement between the first author and the independent observer. The results of IOA and ranges
are presented in Table 2.

1.8. Procedural fidelity

A detailed task analysis (see Appendix A) was used to determine treatment fidelity for every
session IOA data were collected. The independent observer reviewed the sessions and took data on the
number of steps for the task analyses that were completed correctly as well as the steps that were
completed incorrectly. Procedural fidelity is reported as the percentage of steps completed correctly
for each intervention and control session videotaped for each participant. The mean treatment fidelity
for Joey and Troy was 100% and the mean for Al and Carl was 99%. The reason treatment fidelity was
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 789

Table 2
IOA and treatment fidelity results.

Joey Troy Al Carl

Baseline
% of sessions taped 20 33.3 33.3 33.3
% Agreement 86.6 90 100 100
Range 86.6–86.6 90–90 100–100 100–100

Intervention phase expressive

% of sessions taped 31.2 25 33.3 33.3
% Agreement 91 96.7 94.2 97.5
Range 86.6–100 90–100 80–100 90–100

Intervention phase receptive

% of sessions taped N/A N/A 29.2 33.3
% agreement N/A N/A 96.9 97.7
Range N/A N/A 93.3–100 90–100

Replication
% of sessions taped N/A 55.6 33.3 42.9
% Agreement N/A 99.3 97.8 96.7
Range N/A 96.7–100 96.7–100 93.3–100
Procedural Fidelity 100% 100% 99% 99%

99% for Al and Carl was because there were two times for each of them that more than three trials of a
particular flashcard was presented during the receptive intervention phase. The overall treatment
fidelity percentage for this study was 99%.

2. Results

The results of the two sensory and the one control activity on academic performance for the
students are presented in Figs. 1–4. Since Joey’s data were undifferentiated between the conditions, he
participated in only a baseline and an intervention phase. Troy participated in three phases: baseline,
the alternating treatment intervention phase with expressive responses, and replication of the most
effective intervention when he reached mastery with one intervention during the second phase. Al
and Carl participated in four phases. The first two phases were the same as the phases for Joey and
Troy. The third phase was the alternating treatment intervention with receptive responses and the
fourth phase was replication of the most effective intervention.
Joey had five sessions in baseline before his data stabilized. He knew a few of the community
helpers and safety signs during the baseline phase. His responses ranged from 10% to 30% correct with
a mean of 21%. During the intervention phase he had 100% non-overlapping data points between the
baseline and intervention data for swinging, 100% for bouncing, and 83% for the control (listening to a
story) so that all three interventions would be considered ‘‘highly effective’’ (Scruggs & Mastropieri,
1998). The effect size calculated through PDO was 1.0 for bouncing and swinging and .97 for listening,
leading to the conclusion that the interventions were indistinguishable in terms of behavioral change.
The data were undifferentiated between the three interventions and Joey reached mastery criteria
in all three conditions; in four sessions for swinging, bouncing in five sessions and listening in six
sessions. The mean percentage of correct responses in the swinging condition was 79%, in the
bouncing condition was 82%, and in the listening condition was 77%. It took Joey six sessions to reach
mastery criteria in the listening condition because he had 1 day at 83% and then dropped back to 77%
which was below the mastery criteria. Thus he had to reach 80% or higher again and then have three
consecutive sessions at 80% correct before he reached the mastery criteria. The swinging intervention
was the most efficient intervention for Joey because he reached mastery criteria in only four sessions.
Since the data paths did not fractionate there was no replication phase and thus no functional relation
between the independent and dependent variables for Joey.
Troy had three sessions in the baseline condition. He knew a few safety signs and community
helpers prior to the intervention, but his baseline data were stable. His data ranged from 20% to 27%
790 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

Fig. 1. Percentage of correct responses for community helpers and safety signs for Joey.

Fig. 2. Percentage of correct responses for community helpers and safety signs for Troy.

Fig. 3. Percentage of correct responses for community helpers and safety signs for Al.
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 791

Fig. 4. Percentage of correct responses for community helpers and safety signs for Carl.

correct responses with a mean of 25% correct for community helper and safety sign identification
during the baseline phase. There was fractionation between the data paths during the intervention
phase. The swinging intervention data path separated from the other two data paths immediately and
crossed only once during session 20. Troy had 92% non-overlapping data points between the baseline
and the swinging intervention data, indicating a ‘‘highly effective’’ intervention (Scruggs &
Mastropieri, 1998). The PND for bouncing was 22% and PND for listening to a story was 0%,
indicating an ‘‘ineffective’’ intervention (Scruggs & Mastropieri, 1998). Troy reached mastery under
the swinging condition in 12 sessions with a range of 27–90% with a mean of 57% correct. The effect
sizes calculated for each of the interventions using PDO were .97 for swinging, .52 for bouncing, and
.00 for listening to a story.
The instructional tasks from the listening condition were used in the replication phase for Troy
using the swinging intervention. During the replication phase, Troy reached mastery in nine
sessions with percentages ranging from 40% to 87% with a mean of 63%. There were no overlapping
data points between the listening data path in the intervention phase and the use of the same
materials with the swinging intervention in the replication phase. Since Troy reached mastery in
the replication phase as well, there was a functional relation between swinging and percentage of
correct responses for Troy.
Al and Carl had three sessions each during the baseline phase. All three data points for Al were 0%
for each of the 10 flashcards used in the three conditions (difficult to distinguish on the graph). Carl’s
data ranged from 0% to 3% with a mean of 2% correct responses for community helpers and safety
signs. During the first intervention phase, Al and Carl were asked to expressively identify community
helpers and safety signs following the three interventions. After twelve intervention sessions both
students were having very limited success under all three conditions. Thus another phase was added
in which their response mode was changed to receptively identifying a requested card from a field of
three. Their percentage of correct responses increased immediately. Since baseline data were not
collected on the receptive task, the control condition (listening to a story) was used to contrast the
effects of the two interventions (Richards, Taylor, Ramasamy, & Richards, 1999).
Al’s data paths fractionated between the three conditions during the receptive phase. Swinging
was more effective than listening or bouncing. Al reached mastery criteria in the swinging
condition in 14 sessions. His data ranged from 23% to 83% with a mean of 60%. The swinging data
path did cross the bouncing and listening data paths in the middle of the phase, but the swinging
data path fractionated during the last 10 sessions of the phase. Using the listening condition as the
control (Richards et al., 1999), PND was 93% for swinging and 39% for bouncing, leading to the
conclusion that swinging was ‘‘highly effective’’ while bouncing was ‘‘ineffective’’ (Scruggs &
Mastropieri, 1998). PDO was .93 for swinging and .54 for bouncing, corroborating the conclusions
drawn from the PND analysis.
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Given the clear fractionation and results of the nonparametric calculations, Al began the replication
phase using the instructional materials from the listening activity while using the swinging
intervention. However, a major medication change was instituted at the same time and he did not
reach mastery during the replication phase. Thus there was no functional relation between swinging
and percentage of correct responses for Al.
Although Carl’s data paths crossed at the beginning of the receptive phase, there is clear data
fractionation during the last 19 sessions. Carl reached mastery criteria under the bouncing condition
in 15 sessions. His data ranged from 30% to 87% with a mean of 56%. Using the listening condition as
the control (Richards et al., 1999), PND was 0% for swinging and 60% for bouncing, leading to the
conclusion that swinging was ‘‘ineffective’’ while bouncing was ‘‘questionable’’ (Scruggs &
Mastropieri, 1998). PDO was .3 for swinging and .84 for bouncing, providing stronger support for
the effect of the bouncing intervention.
Given the clear fractionation and results of the PDO calculations, the instructional materials from
the swinging condition (being the condition with the poorest performance) were used during the
replication phase with the bouncing intervention. Carl reached mastery in the replication phase in
seven sessions with data ranging from 53% to 83% with a mean of 59%. There were no overlapping data
points between the swinging data path in the receptive phase and the use of the same materials with
the bouncing intervention in the replication phase. There was a functional relation for Carl between
bouncing on an exercise ball and percentage of correct responses.

2.1. Social validity

Social validity was measured using a subjective survey created by the authors. Ten items were
generated based on previous experience conducting research and tailored to solicit perceptions of the
ease and benefit of the two sensory-based interventions and to ascertain if the adults would use
sensory-based interventions in the future. The surveys were completed by the paraprofessional who
worked in the classroom as well as the speech and occupational therapists who worked with the
students. Each question was answered using a Likert scale of 1–5 with one representing ‘‘strongly
disagree’’ and five indicating ‘‘strongly agree.’’
The occupational therapist responded with fives for every item, which indicates that she used
sensory interventions prior to the study, thought the interventions used for the study would be easy to
implement and planned to continue to use sensory interventions with students in the future. The
mean score for the paraprofessional was 4.5. The lowest score on her survey was for the question
involving the use of sensory interventions prior to the study; however she marked a five for the last
question which indicates she intends to use sensory interventions in the future. The speech therapist
had a mean score of 4.8. She indicated that she used sensory interventions with students prior to the
study, thought the interventions were easy to implement, and intended to continue to use sensory
interventions with students in the future.
Parents were not queried to assess social validity as they did not observe their children’s
participation; by the time they saw their children at the end of the day, any effects of the interventions
would have faded. Students were not questioned as they all participated willingly in each of the pre-
instruction activities and their cognitive functioning would preclude the ability to differentiate subtle
preferences.

3. Discussion

Teachers employ sensory activities every day in their classrooms, even in the absence of empirical
support for these practices (Baranek, 2002; Heflin & Alaimo, 2007; Olson & Moulton, 2004;
Schreibman, 2005). The purpose of this study was to investigate the effect of two sensory activities,
slow linear swinging and fast bouncing on an exercise ball, on task engagement as measured by the
percentage of correct responses for identifying community helpers and safety signs for elementary
school aged children with ASD. A control condition, listening to a story for 5 min prior to instruction,
served as a contrast to the sensory activities. The results were somewhat mixed. Joey’s data were
undifferentiated and he reached mastery in all three conditions. There was a functional relation for
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 793

Troy between swinging and percentage of correct responding. Al’s data fractionated to suggest that he
was more successful with the swinging intervention. Unfortunately, as the study progressed Al’s
behavior at school and at home became more erratic and disruptive. His parents chose to put him on
Adderall to help manage his behavior; thus he was removed from the study during his replication
phase before he could reach mastery. Finally, there was a functional relation for Carl between
bouncing on the exercise ball and percentage of correct responding.
The results of this study provide limited support that the use of sensory interventions may help
some students with ASD reach their optimal levels of arousal in order to improve their ability to
learn and engage in academic tasks. Equally important, the results provide support for the belief
that every individual with ASD responds differently to sensory input (Yack et al., 2002) and has
different optimal levels of arousal (Zentall & Zentall, 1983). One of the premises of this study as
outlined in the review of literature was the use of sensory activities to help students achieve an
optimal level of arousal as measured by student learning outcomes. Al and Troy both gave more
correct responses after the swinging intervention, which incorporates vestibular stimulation and
has been theorized to be calming. As described in the methods section they were both very active
students who were easily distracted during academic instruction. Their positive response to the
linear swinging intervention supports the theory that slow linear swinging is calming (Yack et al.,
2002) and thus enabled these active students to reach an optimal level of arousal as measured by
higher percentages of correct responses for indentifying community helpers and safety signs. There
were no improvements in correct responding following the alerting activity (bouncing) or the
control activity (listening).
Carl was a hypoactive child who usually did not respond to visual stimuli prior to the intervention.
After participating in the bouncing intervention, his percentage of correct responding was higher and
he reached mastery criteria during both the receptive intervention and replication phases. His results
support the theory that bouncing increases a hypoactive individual’s attention (Yack et al., 2002) and
helped him achieve an optimal level of arousal by activating both his proprioceptive and vestibular
systems. Carl’s had the lowest percentage of correct responding following linear swinging, possibly
because it exacerbated his lethargy.
The first author, who was also the teacher, anecdotally noted that the latency between the
presentation of the flash cards and the students’ responses were shorter during the swinging condition
for Joey, Troy, and Al. It was easier to gain their attention and engage them in the instruction after the
swinging intervention as compared to bouncing or listening. Whereas the first author and the
paraprofessional both reported that Carl had more success with visual motor activities such as
completing puzzles, shape sorters, and coloring after bouncing on the exercise ball as opposed to the
swinging and listening interventions. The paraprofessional who worked with the students asked if she
could have Carl bounce on a ball prior to engaging him in activities that required him to visually
attend. Thus there were perceptions of positive outcomes for all of the students in regard to specific
sensory interventions.
Individuals with autism constitute a heterogeneous population (Heflin & Alaimo, 2007), often with
as much variability among them as between them and populations without autism (VanMeter, Fein,
Morris, Waterhouse, & Allen, 1997). This variability can result in widely divergent responses to the
same interventions and led to the call to evaluate aptitude by treatment interactions in research
conducted with the population (National Research Council, 2001). In addition to the differences
among the boys’ activity levels, there also are differences in their age, severity of autism, and cognitive
profiles. Joey, who responded favorably to all three conditions, was the oldest participant but had the
highest CARS score, reflecting the most severe level of autism among the boys. However, he could
decode connected text on the 4th grade level with some comprehension so may have had the strongest
visual discrimination abilities; as his teacher, the first author indicated that based on his classroom
performance, his IQ score was probably depressed and inaccurate. Al had the lowest measured IQ and
the most severe behavioral issues, as documented by the family’s decision to initiate medication
therapy after the data fractionated in the intervention phase. However, his CARS score placed him in
the mild-moderate range of autism in contrast to the other three participants whose scores indicated
severe autism. Joey and Troy both knew 7 of the 30 community helpers and safety signs at the outset in
contrast to Carl who knew one community helper and Al who did not recognize any of the stimuli.
794 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

Tentative and preliminary inferences may include that sensory activities may have less impact on
correct responding for students who already have some academic competence (e.g., Joey’s ability to
decode connected text). The only other aptitude by treatment interaction that seems plausible relates
to the participants’ activity and arousal levels.
According to the results of this study, the swinging intervention may be beneficial for students
with autism who are hyperactive and easily distracted. The bouncing intervention may be helpful
for students with autism who are lethargic and unresponsive to academic stimulation. There may
be some challenges to implementing sensory interventions in other classrooms. The classroom that
was used for this study was equipped with a suspended swing which may not be available in all
classrooms. However, if a suspended swing is not available alternative interventions could include
the use of a rocking chair or going outside to the playground to use a swing. One limitation of using
a swing outside would be other extraneous variables such as transition time, difficulties with
students transitioning from being outside for a brief period of time then returning to academic
instruction, the distractions of other playground equipment, and so forth. There is the potential that
these interventions might be helpful for students prior to other academic tasks such as fine motor
tasks, hand eye coordination tasks, visual tracking tasks, and other academic tasks that require the
students to attend and focus on instructional materials. The swinging intervention may activate the
vestibular system to promote optimal arousal in students who are hyperactive while the bouncing
intervention may incorporate the vestibular and proprioceptive systems to help students who are
hypoactive.
Several limitations were noted during the course of this study. One concern regarding the design of
this study was the amount of time it required for the students to have multiple exposures to the same
set of flashcards. Since this was an alternating treatment design there were three sets of equivalent but
different flashcards. Only one session was conducted every school day and each student was exposed
to each set of flash cards one to two times per week. Therefore it took several weeks for each student to
see each set of flashcards several times and that may have affected how long it took each student to
learn the community helpers and safety signs. This leads to the next limitation which was time
constraints. Due to the breaks in the school schedule for holidays, there were interruptions in the
research and breaks up to 2 weeks between sessions. Another limitation is that two of the students had
to change to receptive responses during the study. The students should have been evaluated at the
beginning of the study to determine if they could pronounce all of the names of the community
helpers and safety signs prior to the start of the study. Finally no formal measures of sensory deficits
were conducted during the study to determine which sensory intervention might be the most
beneficial for each student. This limitation reflects applied practice as few teachers have access to
occupational therapists with the time to conduct formal sensory assessments.
Future research should include measures of sensory deficits of the participants in addition to
teachers’ impressions prior to the interventions to determine which sensory intervention should be most
beneficial for each participant. Yack et al. (2002) suggest it is important to determine if a student with
ASD who exhibits sensory processing difficulties is hyperactive or hypoactive in order to provide the best
sensory activity intervention. Commonly used assessments to determine sensory sensitivity are the
Sensory Integration and Praxis Test (SIPT; Ayres, 1989) and the DeGangi-Berk Test of Sensory Integration
(TSI; DeGangi & Berk, 1983). Although an empirical question for evaluating aptitude by treatment
interactions, it will be important for researchers to adequately describe participants so that practitioners
who cannot secure formal assessment can compare their students to those participating in the studies.
Since this was a single subject design replications of the current study are necessary to provide
support and generalizability to the findings of this study. Five minutes was selected as the length for the
pre-instruction sessions since it was perceived that was enough time to benefit from the activities but
wouldn’t represent too much lost instructional time. The ideal duration for the sensory activities is an
empirical question that should be explored. Future research should evaluate the effect of sensory
activities on task engagement as measured by latency between task demand and response. Additionally,
it would be interesting to determine how long the effects of the sensory activities last. In this study, the
participants were asked to engage in an academic task immediately after the sensory activity and the
instructional session lasted no more than 10 min. Since the paraprofessional asked to have Carl bounce
on a ball prior to other activities later in the day, the effects apparently wore off at some point.
 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796 795

This study is an important addition to the current body of literature regarding sensory
interventions and the learning outcomes of students with autism. Teachers are currently using
sensory interventions with students with autism on a daily basis, but there is limited research to
support the practice (Heflin & Alaimo, 2007; Schreibman, 2005). This study is one of the few
studies available with data-based support for the use of sensory interventions for students
with autism. Three out of four students responded positively to sensory interventions and
increased their percentages of correct responding immediately following the interventions;
however the sensory activities were differentially effective. Future replications of this study and
additional research in the area of sensory interventions and learning outcomes for students with
autism are necessary.

Appendix A. Treatment Fidelity Checklist

Student: _________________________________________ Date: _______________

Number Yes No Step Description

1. Did the teacher ask the student, ‘‘do you want to (swing, bounce, read)?’’

2. If the student responded yes, did the teacher take the student to the correct area? If the
student responded ‘‘no’’ did the teacher stop?

3. Did the student sit correctly to swing, bounce or read?

4. Did the teacher help the student swing/bounce or read for 5 minutes?

5. After five minutes, did the teacher direct the student to the work table?

6. Is the student sitting at the work table?

7. Did the teacher present the student with an academic task?

8. Did the teacher ask the student to verbally label or receptively identify a community helper?

9. Did the teacher repeat the request to identify 4 additional community helpers?

10. Did the teacher ask the student to verbally label or receptively identify a community
safety sign?

11. Did the teacher ask the student to verbally label or receptively identify 4 additional community
safety signs?

12. Did the teacher ask the student to verbally label or receptively identify a community helper?

13. Did the teacher repeat the request to identify 4 additional community helpers?

14. Did the teacher ask the student to verbally label or receptively identify a community
safety sign?

15. Did the teacher ask the student to verbally label or receptively identify 4 additional
community safety signs?

16. Did the teacher ask the student to verbally label or receptively identify a community helper?

17. Did the teacher repeat the request to identify 4 additional community helpers?

18. Did the teacher ask the student to verbally label or receptively identify a community
safety sign?

19. Did the teacher ask the student to verbally label or receptively identify 4 additional
community safety signs?

20. Did the student have a total of 30 opportunities to respond during the academic instruction
session?
796 G.L. Van Rie, L.J. Heflin / Research in Autism Spectrum Disorders 3 (2009) 783–796

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