Abigail Brown

Hosted by Abigail Matthews - Occupational Therapist, UK Aims and issues addressed This article seeks to explore the evidence behind Sensory Integration Intervention for Children with Autism, in order to ensure quality of practice. Intervention takes place within a context of play, involving a collaborative relationship between therapist and child - and focusing on participation-oriented outcomes, that are collected at regular intervals throughout the duration of the intervention. The focus is on developing sensory motor skills, due to evidence that some people with autism have difficulty processing everyday sensory information and can experience a lack of, or sensory overload. Too much information can cause stress, anxiety and possibly physical pain. Abstract Sensory integration is one of the most highly utilised interventions in autism; however, a lack of consensus exists regarding its evidence base. An increasing number of studies are investigating the effectiveness of this approach. This study used the Council for Exceptional Children (CEC) Standards for Evidence-based Practices in Special Education, to evaluate the effectiveness of research, from 2006 to 2017, on Ayres Sensory Integration (ASI) intervention for children with autism. What is already known how can it help solve important problems for practice? ASI is an individualized intervention designed to address the specific underlying sensory-motor issues that may be affecting children’s performance during daily routines and activities, including participation within the classroom and in other contexts of the school. Consequently, occupational therapists play a key role in developing sensory motor skills in schools, due to their role in enhancing daily living skills, through meaningful occupation. However, the evidence behind such practice has been criticised, which is problematic when implementing evidence based practice. This systematic review is critical of past systematic reviews and meta-analyses of studies, claiming to evaluate sensory integration intervention. Concerns are based around inconsistence use of ASI principles (Case-Smith et al., 2015) and lack of participant engagement and outcomes in the interventions (Lang et al., 2012 and Barton et al., 2015). Outcome measures in existing studies also vary widely, meaning that it is difficult to synthesise the findings of these systematic reviews to identify a useful outcome measure (Case-Smith & Arbesman, 2008; Case-Smith et al., 2015; May-Benson & Koomar, 2010; Watling & Hauer, 2015). Research Design To answer this question, we conducted a systematic review of available research studies: The first stage involved a series of electronic database searches, to locate potentially relevant studies. The second stage involved selection of studies using specific inclusion criteria related to methodology and description of the intervention. The third stage involved evaluation of the quality of each included study, to explore the reliability of findings and remain evidence based. The diagram below shows the search strategy. Data was analysed using the CEC Criteria, to ensure that interventions were based on similar outcomes. Three of the six reviewed papers were excluded from further analysis, because the intervention description was inconsistent or insufficient to be confidently considered ASI intervention, or because of significant methodological issues. Main findings ASI has strong evidence for positive outcomes on individual goals, moderate evidence supporting improvements in autistic behaviors and caregiver assistance for self-care activities - and emerging but insufficient evidence for outcomes related to play, sensory-motor skills, language, and social skills. Reliability and validity The diagram above shows the PRISM diagram used to show the search strategy, detailing the search process can improve the reliability of the study, as it can be replicated at a later date to consider any new research. This study also demonstrates that it has sought knowledge from a number of different electronic databases, in order to give a valid representation of ASI from the literature. Limitations The lack of relevant studies identified of a good quality mean that conclusions were formed based on three articles; findings may have lost quality as well as reliability. It could be argued that, while this article has achieved rigour, validity and reliability due to its focus on reducing bias, the paper lacks exploration around the role of occupational therapy using a sensory integration approach. It would be necessary to explore the literature to understand the core principles and focus under study. Facilitator’s comments Across my career, I have worked in learning disabilities and mental health, as a mental health practitioner. I found a passion for supporting this client group, focusing on skill development and increasing independent living. I valued the challenge of weaving my OT skills into my generic role, to promote the value of OT across healthcare roles. I choose this article because I wanted to understand more about autism, due to the differences between learning disabilities and those on the autistic spectrum. I was inspired to choose this article after reading the last Journal Club article on autism. I learnt a lot from this and wanted to explore the evidence behind the use of sensory integration as a well-known approach, when working with clients with autism. Given the level of scrutiny the authors undertook, the recommendations around future practice appear valid and reliable. It provides a good base for development of further research, in line with principles of AI, ASI and CEC standards of practice as an outcome measure. Open-access link to the journal article: www.researchgate.net/publication/329613236_A_Systematic_Review_of_Ayres_Sensory_Integration_Intervention_for_Children_with_Autism/fulltext/5c1251c5299bf139c755a8d6/329613236_A_Systematic_Review_of_Ayres_Sensory_Integration_Intervention_for_Children_with_Autism.pdf?origin=publication_detail A note from the Hub Team Thank you to @Abi Matthews for an excellent contribution to The Journal Club! What are your thoughts on this article? Do you have comments or feedback on host Abigail's critique? Members: Get involved in the conversation - and print off your input for your CPD/CEU files!