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Evidence Synthesis Based on Fieldwork Experience

Chris Gutierrez, Sotheavy Moeung, & Ian Sande
Touro University Nevada
School of Occupational Therapy









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Evidence Synthesis Based on Fieldwork Experience
How does this study relate to your research question?
Based on our level 1 fieldwork experience, we decided on researching the clinical
question, what kind of feeding issues do children with ASD have? As future occupational
therapists we will have to work with children with ASD who have feeding complications, food-
related difficulties, and problematic family dynamics during meal time. The article Parent
Reports of Sensory Experiences of Preschool Children With or Without Autism: A Qualitative
Study conveyed both positive and negative experiences for caregivers when it comes to
preschool children with ASD during mealtime.
What is the purpose of the study?
The purpose of the study was to describe the sensory experiences of children with
and without ASD during their daily routines in order to generate information about how the
caregivers perceived and explained these sensory experiences. The descriptions were
then compared among the children with autism as well as the typically developing children.
Additionally, this study seeks to analyze the potential of relatively unstructured caregiver
experiences to add to other research-based knowledge of the sensory experiences of children
with ASD.
Were research questions asked? If so, what are the research questions?
The main research questioned address in the article was how do children with autism
experience sensory differences in the context of their daily lives, specifically mealtime?
What is the study design/ type of qualitative research?
This was a narrative design qualitative study using parent descriptions of their childrens
sensory experiences. Data was collected using focused interviews emphasizing stories and
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historical descriptions with parents to aid relevant interventions for children with ASD. One or
both parents (of children with and without ASD) were interviewed, using open-ended interview
based on Flanagans Critical Incident Technique (CIT).
What is the theoretical perspective of the researcher for this study?
n/a
How were the participants recruited and selected?
The study utilized convenience sampling with participants with ASD who were recruited
for a larger study using a university-based state-wide research registry. Typically developing
children were recruited through a convenience style sampling method from local day cares,
university list-serves, and through word of mouth.
How many participants were in the study?
The participants included 66 preschoolers with 29 typical children and 37 children with
ASD.
How are the participants described?
The participants included varying maternal educational backgrounds, chronological age,
and mental age.
What is the relationship of the researcher to the participants?
The researchers served as interviewers communicating with the participants on the phone
as well as face-to-face. Interviews were conducted by the project coordinator, graduate student
assistant, and other graduate students trained in the process. Analysis was done by one of the
authors of the research article who did not have any experience with ASD. This author was also
blind to the data and findings from the larger study, helping to eliminate any biases.

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What are the sources for data?
Face-to-face and phone interviews were audio taped and then transcribed for analysis.
Separate researchers developed themes and codes from the transcribed interviews. Two sets of
questions were asked to interviewees during the interview. The first question asked the
caregivers to describe when the child had a positive sensory experience, specifically, why he/she
believed it was a good experience, and explain how it made them feel. The same question was
posed for a negative or unpleasant sensory experience.
How are the findings reported?
The analytical process included reading and rereading the interview transcripts and
coding positive and negative sensory experiences. The findings were reported under two major
themes: sensory-related experiences of children as described by their caregiver, and the
caregivers understandings of the concept of sensory experiences including the manner in which
the children responded to such experiences. The sensory modalities included experiences with
sound, visual, touch, movement, food-related, oral but not related to food, issues related to self-
care, and unusual sensory experiences.
What are the findings?
Children in both groups responded negatively to sounds such as loud and unexpected
ones, responded positively to movement, and they disliked certain foods and/or sensory
components related to food. The parents with children with ASD recognize the sensory related
elements in their childrens experiences, correlating it to their childs diagnosis. Although
parents of both groups reported strong reactions to the sensory input, more extreme responses
were reported by parents with children with ASD.

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How do the findings relate to previous research as described in the literature review?
The findings in the research article describe sensory experiences between children with
ASD in comparison to their typically-developing peers when it comes to mealtime. Current
literature shows that preschool aged children with ASD have higher rates of sensory processing
deficits when compared to both typically developing children, as well as children with other
disabilities. The qualitative study provided more evidence and understanding in this area of
concern for parents with children who have ASD.
Does the author state any clinical implications for the findings?
The researchers finding were relevant to clinical practice in that children with ASD had
unpleasant meal time experiences when they were exposed to different sound sensory stimuli. A
second clinical finding was that food related experiences were described as negative ones for
children with ASD. Sensory impairments may impact occupational performance, social
participation, and family routines and rituals which all fall under the realm of occupational
therapy. Such impacts on occupational performance will result in more occupational therapy
referrals. However, due to variability in childrens sensory processing profiles, practitioners are
faced with the challenge of determining the extent of impairments affecting these children during
mealtime.
The interview format used in the research study allowed the caregivers the opportunity to
share their own stories about their children without having to compare their child to others. This
invitation to share experiences in ones own terms is usually a rare occasion for caregivers with
children with ASD. Rapport with caregivers was established during the intervention process,
allowing the occupational therapist to better understand the child in the context of the family.
Narrative interviews along with sensory processing evaluations provide a comprehensive
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assessment of the childs sensory experiences in relation to their daily occupations. The findings
may help validate an OTs experience working with children with ASD.
What are the limitations that the author identifies?
Interviews elicited a single good and bad sensory experience which may have extracted
only the most salient experiences and did not achieve an array of frequency, type of sensory
experience, intensity of sensory experience which would have helped further delineate the two
groups. Additionally, the data collected did not portray the extent of differences of sensory
processing functions in children with ASD with that of their typically developing peers. Data
comparisons to the extent of the childs understanding and coping mechanisms were also
lacking. This may affect not only the childs nature of sensory experiences but also the
perceptions of the caregivers of these experiences. Lastly, another limitation included the use of
convenience sampling of typically developing children with parents who were more highly
educated than the parents of the children with ASD. Since the findings were built on the parents
reports rather than the childs, the difference in educational level may cause limitations in the
research.
Does the author discuss implications for future research?
Future qualitative research was discussed involving more participants in the two groups
with the addition of another group with developmental disabilities other than ASD. Also for
future research, direct interviews with older children who can understand and fully participate in
the process will be encouraged to lessen any parental biases.


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What are potential sources of bias on the part of the researcher? Did the researcher
describe methods for avoiding bias?
Observational methods offer a limited scope and ability to generalize to other contexts.
The parent-report methods, although offers good ecological validity, tend to display inherent
subjective biases such as caregivers recall of events.
Is there a rationale for the participant selection? Are the participants credible
(believable)?
Convenience sampling was used and participants were credible, however, there were
limitations due to observations because it was the caregivers opinions of the mealtime
experiences rather than the childs opinion, themselves.
How does the researcher use methods to establish trustworthiness of the data? Do these
methods seem adequate?
Triangulation was utilized to establish trustworthiness and credibility. Additionally,
multiple researchers conducted their own codes and themes and then combined them together.
Are the themes presented consistent with the data presented? Do the conclusions make
sense to you or do you think the researcher was reading into the findings (or trying to find
what he/she wanted to find)?
The themes were consistent with the data. As aforementioned, the themes included:
sensory-related experiences of children as described by their caregiver, and the caregivers
understandings of the concept of sensory experiences including the manner in which the children
responded to such experiences. Modalities were also coded and included experiences with
sound, visual, touch, movement, food-related, oral but not related to food, issues related to self-
care, and unusual sensory experiences. A notable strength of the article would be the amount of
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participants and their agreement in sound being an issue during meal time as well as mealtime
being a negative issue for children with ASD.
Was the researcher flexible in the data collection process? Did he/she allow the data to
guide the process?
The researcher was flexible in the data collection process by allowing the caregivers to
share their childs sensory experiences openly. When asked the two sets of questions the parent
was able to describe positive and negative experience in their own words. If the parent did not
give an answer that was sensory related, then the interviewer would probe the parent for more
details to lead them to giving an answer that would be an answer related to the sensory theme.
How would you use this article as a therapist?
As a therapist, this article helps to reinforce that mealtime is a difficult time for families
that have children with ASD. This can be a parent concern that might not appear in the referral.
Occupational Therapists should serve to advocate for the client and the clients family, and must
address this issue with other interdisciplinary team members as well as during intervention
planning.
How does this article support/not support participation in occupation and the field of
occupational therapy?
This article highlights the importance of the mealtime activity during daily living. It
helps portray the idea that occupation of eating meals is a crucial factor when treating a child
with ASD and that certain component, especially sensory components such as sounds, might
make an already difficult situation for the child, even worse.


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Reference
Dickie, V. A., Baranek, G. T., Schultz, B., Watson, L. R., & McComish, C. S. (2009, May 14).
Parent reports of sensory experiences of preschool children with and without autism: a
qualitative study. American Journal of Occupational Therapy, 63(2), 172-181.