classroom based sensory intervention for children with ... · classroom based sensory intervention...
TRANSCRIPT
Classroom based sensory intervention
for children with autism spectrum
disorders (ASD): A pilot study using
single system design Caroline Mills
Occupational Therapist , PhD Candidate
Dr Christine Chapparo
Senior Lecturer
• Extensive reporting presence of sensory difficulties in ASD
(Iarocci & McDonald, 2006; Ben-Sasson, Hen, Fluss, Cermak et al, 2009, Ashburner,
Bennet, Rodger & Ziviani, 2013; Tomcheck & Dunn, 2007)
• Difficulties in occupational performance resulting from sensory
issues (Ashburner, Ziviani & Rodger, 2008)
• Limited studies on classroom based sensory intervention (Case-
Smith, Weaver & Fristad, 2014; Lang et al 2012)
• Children with ASD have ID up to 70% of the time, different
needs to those with ASD alone (Matson & Goldin, 2013; Matson &
Shoemaker, 2009)
Literature Review
• Special school based research
• Children with ASD, ID, autism specific special school in
Sydney
Research Question:
What is the impact of a Sensory Activity Schedule
(SAS) on task performance and cognitive behaviours in
children with ASD in a classroom setting?
Background
Meet the Participants
Name Age Sex Diagnosis
M 7 y 10 mo Male Autistic Disorder, moderate intellectual
disability, severe language delay
B 5 y 7 mo Male Autism spectrum disorder, intellectual disability
L 6 y 3 mo Male Autistic disorder, moderate intellectual disability
C 6 y 8 mo Male Autistic disorder, moderate intellectual disability
Referral and Assessment
• Referred to School OT for reduced participation
• Teacher reported: ‘Off task’ behaviour- sensory seeking
or sensory avoiding function, frustrated, fixed in routine
• Short Sensory Profile (McIntosh, Miller & Shyu, 1999) findings
summary: All total scores showed definite difference
(underresponsive/seeks sensation, auditory filtering, visual/auditory
sensitivity, tactile sensitivity)
Method
• Single System AB design: non-concurrent, multiple baseline
• Teacher designed desk work tasks were rated including
cutting, sticking, put in tasks, puzzles and matching.
• Sampling of class task performance was videotaped by
school staff
Phase A (Baseline) Phase B (Intervention)
Best practice teaching for ASD
(Curriculum, structure, routine,
visual supports)
Best practice teaching for ASD +
Sensory Activity Schedule (SAS)
Method
• Between 11 and 18 videos were rated using Perceive,
Recall, Plan and Perform (PRPP) Stage One and Two
Analysis for each student (Chapparo & Ranka, 2005)
• Videos were randomly ordered and scored by researchers
• For each student, Phase A (Baseline) and Phase B
(Intervention) performances were compared.
• Students were not compared to each other.
Intervention- Sensory Activity Schedule
(SAS)
• Administered by
teacher’s aide and
teacher.
• Morning session- after
morning circle, before
desk work.
• Used classroom based
equipment
• 10-15 mins
Intervention
Bouncing on a therapy ball, tight lycra,
deep touch pressure
Jumping on a mini-tramp, deep touch
pressure
Squashing with a bean bag
Rolled over a therapy ball,
Jumping on a mini tramp and crashing
into cushions, shoulder squeezing, tight
lycra
Intervention- Sensory Activity Schedule
(SAS)
Queensland DET Guidelines (QLD DET, 2011):
• Based on the ‘sensory diet’ (Wilbarger & Wilbarger, 1991)
• Activities are encouraged at specific times
• Enable occupational performance
• Terminology should be clarified
• Brushing (Deep Pressure Proprioceptive Technique) was
not used (Wilbarger & Wilbarger, 1991)
• Participants were not targeted for sensory defensiveness
• Two stage standardised
criterion referenced
assessment
• Stage One uses
procedural task analysis
to determine level of
expected skill
• Stage Two uses cognitive
task analysis and
measures cognitive
strategy application in the
context of task
performance
Perceive, Recall, Plan, Perform
(PRPP)
(Chapparo & Ranka, 2005)
• Outcome Measure- PRPP
Stage One: Procedural
task analysis for teacher
designated desk work
tasks in the classroom.
• Steps containing errors
were recorded
• Percentage of error free
performance was
calculated
Data Analysis- PRPP Stage One
PRPP Stage One Put in Task
Errors
Sit down
Take plastic bottle
Take bottle cap
Place in bottle
Take bottle cap
Place in bottle
Put bottle in finish tray
ERROR FREE- 5/7 71.4%
X
X
Results: M Performance Mastery
50.00
55.00
60.00
65.00
70.00
75.00
80.00
85.00
90.00
95.00
100.00
1 2 3 4 5 6 7 8 9 10 11
Pe
rce
nta
ge S
core
Task Performances
Phase A- Baseline
p=0.038, p<0.05
Two band standard deviation method (Ottenbacher, 1986)
Phase B- SAS Intervention
B Performance Mastery
Phase A Baseline Phase B SAS Intervention
p=0.01, p<0.05
50.00
55.00
60.00
65.00
70.00
75.00
80.00
85.00
90.00
95.00
100.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Pe
rce
nta
ge S
core
Task Performances
L Performance Mastery
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
1 2 3 4 5 6 7 8 9 10 11 12
Pe
rce
nta
ge S
core
Task Performance
Phase A Baseline Phase B SAS Intervention
p=0.502, p>0.05
C Performance Mastery
50.00%
55.00%
60.00%
65.00%
70.00%
75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Pe
rce
nta
ge S
core
s
Task Performances
Phase A Phase B
p<0.001
Results Summary PRPP Stage One
Child Stage One Task Mastery Result Statistics*
Phase A (Baseline) Phase B (Intervention)
M 69.5% 82.64% p=0.038**
B 86.67% 95.88% p=0.01***
L 81.32% 84.39% p=0.502
C 85.2% 98.18% p<0.001***
*Two tailed, Independent Samples T test (confirmed by Mann
Whitney U statistic)
** Significance at the 0.05 level, *** Significance at the 0.01 level
• 3 out of 4 showed improved task mastery following a
classroom based SAS as measured by Stage One
PRPP
• Why was intervention effective for 3 out of 4 children?
• A targeted opportunity to meet a child’s sensory needs
contributed to better self regulation prior to completion of
work tasks in the classroom.
• L’s results were not significant- baseline not stable, trend
lines showed improvements
• L needed a longer baseline
Discussion
Discussion
• Teachers can be trained to do the intervention
• Intervention designed with teachers
• Qualitative feedback from teachers confirmed statistical
results
• PRPP is a suitable tool to use to measure task mastery
in context
• Ecologically suitable- teacher set tasks
• Small pilot study, many limitations
• Real life research
Where to from here?
• Results support further research
• Randomised Control Trial (RCT)
• At least 50 children
• Sensory Activity Schedule intervention for least one
school term (9 weeks)
• Quantitative and qualitative measures of task
mastery and occupational performance in the
classroom
• Aspect Elizabeth Hoyles Fellowship
References
Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62, p.564–573.
Ashburner, J., Bennett, L., Rodger, S. & Ziviani, J. (2013) 'Understanding the sensory experiences of young people with autism spectrum disorder: A preliminary investigation.' Australian Journal of Occupational Therapy 60, pp. 171-180.
Ben-Sasson, A., Hen, L., Fluss, R. Cermak, S.A., Engel-Yeger, B. & Gal, E. (2009) 'A Meta-Analysis of Sensory Modulation Symptoms in Individuals with Autism Spectrum Disorders' Journal of autism and developmental disorders, 39, p.1–11
Case-Smith, J., Weaver, L.L. & Fristad, M.A. (2014) 'A systematic review of sensory processing interventions for children with autism spectrum disorders‘ Autism pp. 1 –16
Chapparo C. & Ranka, J. (2005) ‘PRPP Task Analysis Research User’s Training Manual- Research Edition’. Sydney: The University of Sydney.
DET QLD (2011) Best Practice Guidelines for Department of Education and Training Occupational Therapists: Supporting Students with Sensory Processing Challenges. Department of Education and Training, Queensland, Australia.
Iarocci G. & McDonald, J. (2006) 'Sensory integration and the perceptual experiences of persons with autism.' Journal of Autism and Developmental Disorders, 36 (1) p. 77-90
References
Lang, R., O'Reilly, M., Healy, O., Rispoli, M., Lydon, H. et al (2012) 'Sensory integration therapy for
autism spectrum disorders: A systematic review' Research in Autism Spectrum Disorders 6, pp.1004-
1018.
Matson, J.L. & Goldin, R.L. (2013) Review: Comorbidity and autism: Trends, Topics and future
directions. Research in Autism Spectrum Disorders 7 pp.1228-1233
Matson, J.L. & Shoemaker, M. (2009) 'Review: Intellectual disability and its relationship to autism
spectrum disorders.' Research in Developmental Disabilities 30, pp.1107–1114.
McIntosh DN, Miller LJ, Shyu V (1999) Development and validation of the Short Sensory Profile. In: W
Dunn, ed. The Sensory Profile examiner’s manual. San Antonio, TX: Psychological Corporation, p.59-
73.
Ottenbacher, K. (1986) 'Evaluating Clinical Change: Strategies for occupational and physical therapists'
USA: Williams & Wilkins.
Tomchek, S.D. & Dunn, W. (2007) Sensory processing in children with and without autism: A comparitive
study using the short sensory profile. American Journal of Occupational Therapy, 61, p.190-200.
Wilbarger, P. & Wilbarger, J. (1991) ‘Sensory Defensiveness in Children ages 1-12: an intervention
guide for parents and other caretakers.’ Santa Barbara California: Avanti Educational Programs.
Acknowledgments
Lara Cheney, Allyce Cunningham, Lydia Griffiths, Jamie
Togle, Rebecca Fitzroy, Nala Simmons, Yasmina Adamson,
Ashwini Reddy, Dr Debra Costley, Dr Trevor Clark,
Dr Susan Bruck, Dr Joanne Hinitt
Participating students and families
