Is Sensory Integration Treatment an Evidence-Based Intervention for Children with Autism?
The DSM-5 identifies sensory features (hypo and hyper reactivity, and unusual sensory interests) as a diagnostic characteristic of Autism Spectrum Disorders. These sensory features often interfere with functional skills, socialization and the development of higher-level behaviors. One intervention that is often recommended for addressing sensory features and their related impact on function and behavior is Ayres Sensory Integration© (ASI). ASI consists of principles and practices that provide clear guidelines for appropriate implementation. Despite the literature and guidance for using ASI, controversy continues to exists regarding its effectiveness. This session will present data from an analysis of evidence for ASI using 3 sets of standards designed to evaluate evidence-based practices for ASD. These standards provide specific criteria that are used to evaluate existing research, and are designed to guide educators, therapists, researchers, parents, policy makers, and others to identify effective interventions.
Objectives: To report on findings from a systematic analysis of literature regarding the effectiveness of ASI for children with ASD, 4-12 years old, published from 2006 to 2017; and to extend these finding by subjecting studies to two additional standards for evidence based practices reviews and adding any new data from 2018.
METHOD: An extensive database search was conducted in CINAHL, Cochrane Reviews, Cochrane Trials, Embase, ERIC, Medline, and PsychINFO databases to identify relevant studies using the following search terms: sensory integration, autism, interventions suggesting a sensory integration approach. A total of 4,930 references were retrieved after removing duplicates. Only studies that used a high quality study designs (described below) were included. The iterative process of record reduction resulted in nineteen studies that were identified for further evaluation of fit with inclusion criteria. Only six of those studies met criteria for inclusion: e.g. peer-reviewed, written in English, intervention that is consistent with ASI intervention, provided an assessment of sensory functions prior to intervention, and used a comparison group design or single subject design. Prior to further analyses, three articles were excluded because the study intervention was not consistent with the core principles of ASI, or because of major methodological flaws. The remaining three studies were rated by three independent evaluators using the Council for Exceptional Children's Standards for evidence-based practice in special education (CEC, 2014).
Results: Two randomized controlled trials met 100% and 85% respectively of the CEC criteria with moderate to strong average intervention outcome effect sizes; Cohen’s d equals .93, eta squared equals .21. One additional study met more than 50% of the criteria with an effect size of .23 which was calculated from the data.
This analysis concludes that Ayres Sensory Integration meets the criteria for an evidence-based intervention for children with ASD. Additional data will be added and it will include a recently published(Kashefimehr, Kayihan, & Huri, 2018) and the application of additional review standards using the U.S. Preventive Services Task Force criteria and the National Clearinghouse on Autism Evidence and Practice Standards. Findings will be discussed in light of their implications for practice and research.