Creating Evidence: Sensory Integration and Children With Autism
By Ashley Opp Hofmann
Through their recent research on sensory integration and autism, Beth Pfeiffer, PhD, OTR/L, BCP, and Moya Kinnealey, PhD, OTR/L, of Temple University in Philadelphia, and Kristie Koenig, PhD, OTR/L of New York University, have generated lots of buzz for the occupational therapy profession and the sensory integration intervention approach. Although their research yielded important results, they have also insisted that stakeholders act very carefully when making claims based on their research.
At AOTA’s 2008 Annual Conference and Expo in Long Beach, Koenig, Pfeiffer, and Kinnealey presented their study, the results of which indicated that children with autism who received sensory integration therapy had a significant yet modest decrease in displaying autistic mannerisms, and improvement toward individual goals. “Both of us were using the sensory integration approach pretty heavily, and found a need for more evidence and stronger evidence for such a widely used approach,” Pfeiffer says.
Funded by Autism Speaks, Pfeiffer and Kinnealey worked with a summer program for children with autism that didn’t already offer any occupational therapy. Occupational therapists provided fine motor training for 17 participants and sensory integration therapy for 20 participants. It was a double blind study, in which neither the parents nor the researchers were aware of the children’s group assignment.
Using the Goal Attainment Scale, which involves individualized goals for the children, Pfeiffer and Kinnealey examined three areas: sensory integration processing and regulation; social-emotional functioning; and functional motor skills. Pfeiffer and Kinnealey’s analysis thus far has examined those combined scores. “The results indicate that the sensory integration group made more progress than the fine motor group, but both groups made progress,” Pfeiffer says. Their subsequent analyses will examine the three separate areas to see if there is a difference in which area the children improved.
Although children in the sensory integration group made more progress, Pfeiffer and Kinnealey warn that practitioners and other stakeholders should not make any sweeping conclusions. “I think it would be a disservice to pit one clinical approach within the occupational therapy framework against another approach. Both might be perfectly appropriate and very effective at different stages of the treatment process,” Kinnealey says. “An occupational therapist makes clinical judgments based on the presenting needs of the child.”
Some of the study’s most important results have provided guidance on where research should go next. “The significant results were important, but one of the things we really realized was that we need to find more individualized measures for this particular population,” Pfeiffer says. “One of our most significant findings was that the Goal Attainment Scale might be a really useful tool in measuring progress for some occupational therapy interventions, especially for children with autism and especially in the area of sensory processing and integration.”
The individualized nature of the scale makes it an ideal measurement tool within highly individualized occupational therapy interventions. “There’s such diversity in the [children with autism] population that what might work for one child might not work for another one,” Kinnealey says. Measuring progress constitutes a major challenge when studying interventions for children with autism. “Most standardized tests are not sensitive enough to pick up the types of qualitative changes that we see as improvement,” Kinnealey explains. Goal attainment scaling is an excellent way to measure because it’s sensitive enough to see some changes that occur, whereas a standardized test might not be.”
The participant pool that Pfeiffer and Kinnealey used is indeed diverse. Many children had secondary diagnoses, such as attention deficit hyperactivity disorder, anxiety disorders, or depression. These particular participants underscore the fact that children with autism often have secondary problems and diagnoses.
Keeping Expectations Realistic
The interest that Pfeiffer and Kinnealey’s study stirred up has been huge. “We received a ton of e-mails, and some of them made me nervous,” Pfeiffer said, because they didn’t necessarily take into account the full range of results. In addition, many media outlets reported on the study. “They saw the significance of the results, but they kind of disregarded that there were areas where we didn’t see changes. They weren’t looking at the whole picture.”
“I think some people want to say, ‘based on a study, I can justify why my child needs to get sensory integration.’ As this is a pilot study, it does not provide that evidence,” Kinnealey says.
“People need to be realistic about the results. Both inside and outside of the profession, people are so looking for support for sensory integration,” Pfeiffer says. Nonetheless, the study makes a major contribution to the already existing body of sensory integration and measurement knowledge, in addition to providing preliminary support and guidance for future researchers. “We need more research in this area,” Pfeiffer says. “It’s essential that we provide evidence for the interventions we use.”