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EVIDENCE TABLE
Name: Marissa Elder and Marissa Stendel
Date: 09/16/15
Focus Question: Does Ayres' sensory integration (SI) treatment increase engagement and improve play skills in children with
autism/PDD and sensory deficits?
Rationale for inclusion/exclusion criteria applied to determine which articles should be included in the evidence table: Include
articles beginning from 1999-2015, in English, must have diagnosis of Autism Spectrum Disorder, Pervasive Developmental Disorder
with sensory deficits.
Author/
Year
Study
Objectives
Level/Design/
Subjects
Intervention and
Outcome Measures
Results
Study
Limitations
Implications for OT
- Effects of OT
intervention
emphasizing SI
(sensory
integration) with
five pre-school
children with
Autism
Spectrum
Disorder (ASD).
- Mastery play
revealed
significance for four
out of five children.
- One child received
significant score in
adult interaction.
-None of the
children received
significant scores in
- Author of study
was providing
treatment to
participants.
- Small sample size
- All same sex
participants.
- ABA therapy was
provided to one
participant for 40
baseline measured.
- Intervention was provided
by second author certified
in SI and praxis tests and
with extensive training in
SI. One to one services
were provided in adjacent
classroom for 30 minutes.
peer interaction.
- Study was too
small to be applied
to a more general
population.
hours a week
concurrent with SI
treatment.
- Comorbidities in
participants such as
bipolar disorder, and
hearing impairment.
- Dunbar, S.,
Carr-Hertel,
J.,
Lieberman,
H., Perez,
B., Ricks, K.
(2012).
- Differences
between
traditional
individualized SI
treatment and
integrated
sensorimotor
activities for
preschool
children with
ASD.
Outcome measures:
Evaluation of Sensory
Processing and the Knox
Preschool Play Scale
- Evaluation of sensory
processing completed by
parents.
- Knox Preschool Play
Scale completed by an
occupational therapist (OT)
before and after
interventions.
Outcome areas: Play along
with the individual
components of sensory
systems including, tactile,
vestibular, proprioception,
- Knox Preschool
Play Scale pre- test
treatment mean
score was 28.5 and
post control mean
score was 32.62.
- Knox Preschool
Play Scale post-test
treatment mean
score was 39.37 and
post control mean
score was 47.40.
- Results indicated
an improvement for
both treatment and
control groups in
their overall play
visual, auditory,
olfactory/taste.
- Intervention was
conducted over 12 weeks in
collaboration with teachers
and OTs.
- Activities included table
tasks, circle, story, art,
sensory, play, computer,
teacher time, independent
work, nap, mealtime, gym,
and playground time.
-The amount of time in
sensorimotor-related
activities was intended to
match the time of the one
hour pull out sessions.
- Four students who
received pull out therapy
were provided with
individualized intervention
to meet needs. Occurred
twice a week for 30
minutes.
increase program
outcomes like this across
the nation.
Societal Needs
-The high rate of incidence
for ASD in this country is
in need for further services
like these where an OT
and teacher combine
forces to help these
children with their needs.
Healthcare delivery and
policy
-Creating policy to better
implement OTs into
classrooms could help to
decrease deficits like these
in children.
Education and training
of OT students
-Gaining hands on
experience in the
classroom with children
and organizing SI
treatment can better help
train students for the work
force.
Refinement, revision, and
advancement of factual
knowledge or theory
-This study advances
typical SI treatment by
moving the application of
its principles from the
setting of an outpatient
-Linderman,
T. M., &
Stewart, K.
B. (1999).
- Explore the
effects of SI OT
treatment on the
performance of
two pre-school
children with
Pervasive
Developmental
Disorder (PDD)
in social
interaction,
communication
during mealtime,
approaches to
new activities,
response to
holding, and
response to
movement.
- Outcome measures:
Functional Behavior
Assessment for Children
with Sensory Integrative
Dysfunction was used for
duration, quality, and
frequency of behaviors.
- Outcome areas: Social
interaction skills, approach
to new activities, and
response to holding and
hugging for Participant 1
and social interaction skills,
functional communication
during mealtime, and
response to movement for
Participant 2.
- For intervention a wide
range of materials were
used depending on need of
child.
- Each child encouraged to
participate in multimodality
input and movement
through space.
- Novel experiences and
graded sequence of
activities.
- Significant
improvements were
noted in the areas of
social interaction,
approach to new
activities, response
to holding and
hugging, and
response to
movement.
Participants
demonstrated
significant gains in
all functional
behaviors observed
in context of home.
- Tables provided
with more detail.
- Future research
needed to replicated
and extend findings.
- One of participants
had been receiving
SI treatment prior to
study.
- Presence of video
in home of
Participant 2 could
have altered
behavior and thus
the validity of data.
- Authors collected
interrater reliability
of the study.
Miller, L.J.,
Coll, J.R., &
Schoen. S.A.
(2007).
- To find how SI
can better
ameliorate
attention,
cognitive/social,
sensory, or
behavioral
problems
-Level I, RCT.
-24 children
participates total.
-Seven were in the OTSI group, 10 in the
Alternate Placebo
Group, and seven in the
Passive placebo or no
compared to an
active/ Alternate
Placebo
treatment or a
passive placebo.
treatment group.
- Of the 24 children
with diagnosis of
sensory modulation
disorder (SMD), five
had attention deficit
disorder (ADHD), three
with learning
disabilities (LD), and
one with anxiety. 15
had no other diagnosis.
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).
-Improvements in
subtest of the other
measures were
greater for the
treatment group but
not significant.
Program development
-Lays groundwork for a SI
treatment program that
addresses the needs of
children with a wide range
of diagnoses and disorders
(i.e. ADHD, LD, etc.)
Societal Needs
-Attempts to provide
justification for the
implementation of SI
treatment throughout
various clinical settings,
particularly hospital-based
settings.
-This would theoretically
bring needed services to an
underserved portion of
society.
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
Education and training
of OT students
- Can provide a real-life
example for students of the
purpose of the Leiter-R as
well as how it can be
implemented into practice.
-Can be used to teach
Pfeiffer,
B.A.,
Koenig, K.,
Kinnealey,
M.,
Sheppard,
M.,
Henderson,
L. (2011).
-Set up a method
for randomized
controlled trials
dealing with SI,
- Point out ideal
outcome
measures
-Discuss the
efficiency of SI
interventions in
children with
ASD.
-Level I, RCT.
-37 participants, 32
males and five females,
after losing four
participants to drop out.
- Children with PDD
not otherwise specified
(NOS) and children
with ASD (excluding
Aspergers syndrome).
between the ages of 612
- None of the
categories in the
various measures
were significant,
expect for the
attainment of parent
goals in the GAS
and a decrease in
autistic mannerisms
(measured in a
subscale of the
SRS).
Schaaf, R.,
Benevides,
- Evaluate the
efficacy of
- Level I, RCT
- N = 32
- SI treatment provided by
three OT with certification
- Those who
received SI
- Sample size,
sample diversity,
T., Mailloux,
Z., Faller, P.,
Hunt, J.,
Hooydonk,
E., Kelly, D.
(2013).
OT/SI in
comparison to
usual care (UC).
- Two dropouts
Total # - 30
in SI.
- UC treatment defined as
speech, language,
behavioral, and educational
programs that can be
replicated in practice.
-Outcome measures:
Autism Diagnostic
Interview- Revised (ADIR), Autism Diagnostic
Observation Schedule
(ADOS), Stanford-Binet V,
Different Abilities Scale-II,
Weschseler Preschool and
Primary Scale of
Intelligence III, Sensory
Integration and Praxis Tests
(SIPT), Sensory Profile,
Global Assessment Scale
(GAS).
-Secondary measures
comprised of Pediatric
Evaluation of Disability
Inventory (PEDI),
Pervasive Developmental
Disorder Behavior
Inventory (PDDBI), and
Vineland Adaptive
Behavior Scales-III
treatment scored
significantly higher
on the GAS (p value
of .003).
- Children who
received SI
treatment had a
decrease in
caregiver assistance
in self-care and
social skills (p value
of .039), as defined
by the PEDI.
and lack of
additional
assessments to
support the GAS.
practice of OT
-The GAS assessment can
be helpful in evaluating if
SI treatment has been
useful. However, many
other assessments that are
meant to evaluate the same
behaviors did not show
any significant differences
in behaviors.
Program development
-SI care has been identified
to work better for children
than UC. This leads to the
notion that UC should be
improved.
Societal Needs
-UC should be improved in
some areas such as sensory
deficit care in order to
better serve the
community.
Healthcare delivery and
policy
-Increase SI care and
decrease or improve UC
interventions and
implementation among
healthcare professionals.
Education and training
of OT students
-Train OT students how to
incorporate more SI
principles in their UC to
facilitate better outcomes.
Schaaf, R.
C., Hunt, J.,
&
Benevides,
T. (2012).
- Researchers used
manualized protocol based
on SI principles (ten).
-Interventions were
administered by two
registered OTs certified in
SI.
-The therapy was a 10
week, intensive treatment
with 30 sessions per week.
-Outcome measures used
were the Vineland Adaptive
Behavior
Scales, Second Edition, the
Pervasive Developmental
Disorder Behavioral
Inventory (PDD-BI)
Sensory Integration and
Praxis Tests (SIPT), the
Sensory Profile, and
Sensory Experiences
Questionnaire
(SEQ)
-Researchers used a
pre and post t test to
determine
improvements in
performance.
- No p values were
significant at the .05
level.
-The studys results
were an individuals
performance and
cannot be
generalized.
-Limited by small
sample size of only
one child, hindering
generalizability.
-Citing research
conducted by the
authors of the study
indicated bias in
justification
research.
- Lack of statistical
significance limits
implications for
future research and
practice.
Watling, R.
L., & Dietz,
J. (2007).
-Visual inspection
was used to analyze
findings
- No statistical
measures were run
-Leads to lack of
generalizability.
- Limited by a lack
of statistical support
utilized to analyze
the significance of
findings.
- Limited by
subjective testing
bias related to the
questionnaire nature
of the Sensory
Profile.
-Limited by a small
sample size of only
four children.
of OT students
-Teaches students how to
run a pre and post t test to
determine improvements
in performance.
Refinement, revision, and
advancement of factual
knowledge or theory
-Advocated for using the
theoretical background
behind the SIPT in
conjunction with theories
supporting other sensoryrelated outcome measures.
The clinical and
community-based
practice of OT
-OTs could analyze and
find aspects of article that
may emphasize the
importance of finding
subtle nuances in
childrens behavior as
demonstrated in the
context of therapy and
outside the context of
therapy.
Program development
-Design a legitimate study
design that uses statistical
analysis to understand
findings.
Societal Needs
-Create programs that
address needs of children