ArticlePDF AvailableLiterature Review

Efficacy of Sensory and Motor Interventions for Children with Autism

November 2002
Journal of Autism and Developmental Disorders 32(5):397-422

November 2002
32(5):397-422

DOI:10.1023/A:1020541906063

Source
PubMed

Authors:

Grace T Baranek

University of Southern California

Idiosyncratic responses to sensory stimuli and unusual motor patterns have been reported clinically in young children with autism. The etiology of these behavioral features is the subject of much speculation. Myriad sensory- and motor-based interventions have evolved for use with children with autism to address such issues; however, much controversy exists about the efficacy of such therapies. This review paper summarizes the sensory and motor difficulties often manifested in autism, and evaluates the scientific basis of various sensory and motor interventions used with this population. Implications for education and further research are described.

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lish language for the past 30 years with a focus on the

past 10 years. Also, manual searches of key references

from articles were completed. In a few noted cases,

studies of individuals with related disorders (e.g., men-

tal retardation), or slightly older children (over 8 years)

were included provided the results had implications for

young children with autism.

LITERATURE REVIEW OF SENSORY AND

MOTOR DEVELOPMENT

Empirical studies about sensory and motor devel-

opment in children with autism are limited compared to

studies of other aspects of development. Those that exist

often suffer from a variety of methodological limitations;

however, these studies provide both a foundation of sci-

entific knowledge critical for understanding the early

development of children with autism and guidance for

intervention planning. Empirical evidence converges to

confirm the existence of sensory and motor difficulties

for many children with autism at some point in their early

development (Adrien et al., 1987; 1992; 1993; Baranek,

1999; Dahlgren & Gilberg, 1989; Hoshino et al., 1982;

Ohta, Nagai, Hara, & Sasaki, 1987; Ornitz, Guthrie, &

Farley, 1977; Scharre & Creedon, 1992), although much

PURPOSE, SEARCH PROCEDURES, AND

SCOPE

The purpose of this paper is threefold: (1) briefly

summarize the empirical literature with respect to sen-

sory and motor development/abnormalities in children

with autism, (2) evaluate the scientific basis of sensory

and motor interventions used with children with autism,

and (3) describe implications of these findings for edu-

cation and further research. Subject headings and key-

words were searched for terms related to sensory and

motor deficits (e.g., arousal, sensory reactivity/pro-

cessing, habituation, posture, praxis, gross/fine/oral

motor development, etc.), and categorical terms spe-

cific to sensory and motor interventions (e.g., sensory

integration, prism lenses, etc.). Searches were con-

ducted using MEDLINE, CINAHL, & PSYCINFO data-

bases to find empirical studies specific to children with

autism spectrum disorders (i.e., autistic disorder, per-

vasive developmental disorder) available in the Eng-

Efﬁcacy of Sensory and Motor Interventions

for Children with Autism

Grace T. Baranek

Idiosyncratic responses to sensory stimuli and unusual motor patterns have been reported clin-

ically in young children with autism. The etiology of these behavioral features is the subject

of much speculation. Myriad sensory- and motor-based interventions have evolved for use

with children with autism to address such issues; however, much controversy exists about the

efficacy of such therapies. This review paper summarizes the sensory and motor difficulties

often manifested in autism, and evaluates the scientific basis of various sensory and motor

interventions used with this population. Implications for education and further research are

described.

KEY WORDS: Sensorimotor therapies; evidence-based treatments; sensory integration.

397

The Clinical Center for the Study of Development and Learning,

Room 111 Medical School Wing E—CB # 7120 University of North

Carolina at Chapel Hill, Chapel Hill, NC 27599-7120; e-mail:

gbaranek@med.unc.edu

variability is present in specific symptoms or patterns

expressed. These types of behaviors appear neither uni-

versal nor specific to the disorder of autism; however,

qualitative aspects of these patterns have not been well

studied, and prospective, longitudinal investigations that

systematically document developmental trajectories from

infancy through childhood are yet to be accomplished.

The majority of evidence stems from parental reports,

which themselves are prone to some biases and method-

ological weaknesses. Empirical data from retrospective

video studies (Adrien et al., 1992; Baranek, 1999) and

clinical evaluations (Gillberg et al., 1990) are emerging

to suggest that patterns of sensory and motor features

in autism may differ qualitatively from those in other de-

velopmental disorders. Furthermore, unusual sensory-

perceptual features appear to be manifest quite early in

the development of children with autism (i.e., by 9 to

12 months of age). Though not well understood, sensory

processing and motor patterns may be related to core fea-

tures, development of other aberrant behaviors, and later

prognosis; thus these patterns have implications for early

diagnosis and intervention.

Unusual sensory responses (e.g., hypo- and hyper-

responses; preoccupations with sensory features of ob-

jects, perceptual distortions; paradoxical responses to

sensory stimuli) have been reported in 42 to 88% of

older children with autism in various studies (Kientz &

Dunn, 1997; LeCouteur et al., 1989; Ornitz et al., 1977;

Volkmar, Cohen, & Paul, 1986), indicating that these

are common concerns in this population. Percentages

vary depending on how specifically items were sam-

pled. Auditory processing problems are particularly

noted, with one study (Greenspan & Weider, 1997) pur-

porting that 100% of subjects demonstrated these dif-

ficulties. Visual spatial skills are often more advanced

than other areas of development, although individual

differences are noted. Sensory processing abilities also

appear to be uneven and of a fluctuating nature in

autism, such that both hyper- and hypo-responses are

evident in the same child. These aberrant sensory re-

actions are thought to reflect poor sensory integration

and/or arousal modulation in the central nervous sys-

tem, although the underlying nature of these symptoms

remains speculative (e.g., neurological structures and

systems involving the cerebellum, limbic system, cor-

tical mechanisms, etc). Both patterns of under- and

over-arousal have been reported (Hutt, Hutt, Lee, &

Ounsted, 1964; James & Barry, 1984; Kinsbourne,

1987; Kootz & Cohen, 1981; Kootz, Marinelli, &

Cohen, 1982; Rimland, 1964; Zentall & Zentall, 1983).

Children with autism tend to show these abnormal sen-

sory responses to both social and nonsocial stimuli and

398 Baranek

in the absence of known peripheral dysfunction (e.g.,

hearing acuity, visual defect) per se. Thus some re-

searchers have suggested shifting toward the investi-

gation of more complex levels of information

processing including attentional control mechanisms

and executive functions to help explain some of these

unusual sensory features or motor deficits (e.g., Lin-

coln et al., 1995; Minshew, Goldstein, & Seigel, 1997;

Wainwright & Bryson, 1996). Given that many con-

ventional educational environments are sensorily com-

plicated and unpredictable, interventions likely need to

consider the individualized sensory processing needs

of children demonstrating such difficulties to optimize

successful participation in such programs.

With respect to developmental milestones, uneven-

ness between domains is often reported, indicating a rel-

ative sparing of general motor skills compared to

language or social skills in children with autism (Klin,

Volkmar, & Sparrow, 1992; Stone et al., 1999). How-

ever, not all children with autism demonstrate prowess

in motor skills and considerable variability exists (Amato

& Slavin, 1998; DeMyer et al., 1972; Jones & Prior,

1985; Johnson, Siddons, Frith, & Morton, 1992; Ohta

et al., 1987; Ornitz et al., 1977; Rapin, 1997; Rinehart,

Bradshaw, Brereton, & Tonge, 2001). Many demonstrate

atypical features (e.g., low muscle tone, oral-motor prob-

lems, repetitive motor movements, dyspraxia) or test in

the delayed ranges on standardized motor assessments

particularly as the complexity of tasks increases.

Whether or not these difficulties are purely motoric is

unclear, because other areas also affect test-taking abil-

ities. Furthermore, delayed motor development is not

a unique characteristic of children with autism, because

it is often associated with the level of mental retarda-

tion in general. However, because more than 75% of

children with autism have concomitant mental retarda-

tion, the presence of motoric concerns, regardless of

whether they are primary or secondary to autism, still

has substantial implications for individualized educa-

tional interventions. Developmental motor delays, al-

though only minimally different during infancy, may

become magnified with progressive age (e.g., Ohta

et al., 1987). Especially during early foundational years,

motor skills provide a means for learning important

skills in other domains (e.g., social skills, academics)

and thus motor-related difficulties may need to be ad-

dressed in the educational curricula or through related

therapy services. At least one study (Perez & Sevilla,

1993) demonstrates a predictive relationship between

motor skills in children with autism to functional out-

comes in other domains such as vocational and leisure

skills 5 years later.

Motor planning deficits are an area of particular in-

terest, given that several studies point out that both

younger and older children with autism may demonstrate

difficulties with aspects of praxis (Adams, 1998; Jones

& Prior, 1985; Rinehart et al., 2001; Rogers et al., 1996;

Smith & Bryson, 1998; Stone et al., 1990). These diffi-

culties are certainly exaggerated in tasks that require ex-

ecution of a social imitation, either motor or object

related, but may also be present in nonimitated simple

goal-directed motor tasks (e.g., reaching, grasping, and

placing) (Hughes & Russell, 1993). Motor planning

deficits are sometimes mistaken for general clumsiness;

however, Rinehart et al. (2001) separated out two com-

ponents of action and found that highly functioning chil-

dren with autism spectrum disorders, ages 5 to 19 years,

had intact movement execution but atypical movement

preparation during a simple motor reprogramming task

compared with typical, IQ-matched controls. Specifi-

cally, children with autistic disorder were characterized

by a lack of anticipation during movement preparation

phases, ﬁndings suggestive of difﬁculties in motivational

aspects of behavior or attention for action. Children with

Asperger’s disorder showed slower preparations for

movement at phases in which movement should be

optimal—implicating additional dysfunction in the

frontal-striatal system, according to the authors.

Although it is possible that the formulation of motor

plans is deficient, it is also possible that simple motor

planning is intact but that the use of externally guided vi-

sual feedback is diminished, affecting the quality of motor

performance, postural stability, and the lack of effective

sequencing of actions (Masterton & Biederman, 1983;

Gepner, Mestre, Masson, & de Schonen, 1995; Smith &

Bryson, 1998; Stone et al., 1990; Kohen-Raz, Volkmar,

& Cohen, 1992). Thus, perceptually challenging tasks

that require smooth integration of visual with vestibular-

proprioceptive information, for example, may be partic-

ularly difﬁcult to perform and could result in poor quality

of motor performance on complex tasks. These ﬁndings

taken together with evidence that motor imitation skills

in young children with autism predict later expressive

language skills and play skills (Stone et al., 1997), have

signiﬁcant implications for educational interventions and

future research.

EFFICACY OF SENSORY AND MOTOR

INTERVENTIONS

Because “interventions for sensory and motor

deficits” are not synonymous with “sensory and motor

interventions,” the following inclusion criteria were

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 399

used to define the parameters for the review: (a) re-

medial interventions that target specific sensory or

motor components per se, broader performance out-

comes that are thought to be the result of the sensory-

motor treatment, or both; (b) compensatory skills

training approaches; and/or (c) task/environmental

modifications targeted for sensory and motor difficul-

ties. A variety of other interventions exist that may be

at least partially aimed at improving sensory and motor

skills; however, only those interventions that have a

primary basis in sensory processing or motor theories

were included. Traditional behavioral interventions and

psychopharmacological treatments were excluded.

Likewise, comprehensive educational models (e.g.,

Greenspan—DIR Model; TEACCH) were excluded,

even though these programs frequently include a sen-

sory processing or motor development component. Al-

though a variety of professionals (e.g., occupational

therapists, adaptive physical educators, physical ther-

apists, speech pathologists, etc.) may utilize various

sensory-motor strategies listed within the context of

any given child’s individualized educational plan, this

paper is not intended to be a critique of the efficacy of

those related services. Sensory-motor interventions are

not presumed to represent the full scope of therapeutic/

educational services offered by specialized profes-

sionals. Sensory or motor treatments often are used as

an adjunct to a more holistic intervention plan. For

example, the occupational therapist provides therapeu-

tic interventions aimed at improving a child’s occupa-

tional performance (e.g., play, school functional skills,

self-care) within the educational context. Remediation

of sensory or motor deficits (as well as other compo-

nents including cognitive or psychosocial functions)

may occur if indicated, but only within the larger con-

text of occupational performance problems within the

learning environment. Compensatory interventions and

environmental adaptations are also utilized and often

preferred because of the more immediate effects on

meaningful participation.

To judge the validity of each category of inter-

ventions, first a description of each intervention ap-

proach is provided that includes the underlying

assumptions of the intervention, proposed mechanisms

thought to be responsible for the therapeutic changes

purported, and the service delivery model utilized to

provide the intervention. In addition, the scientific evi-

dence (i.e., efficacy research from peer-reviewed

sources) of each intervention category is reviewed.

Table I provides a comparative summary of the empir-

ical studies reviewed for children with autism spectrum

disorders.

Table 1. Sensory and Motor Intervention Studies

Treatment Int. Ext. Intervention Outcomes

Study category

n Subjects val.

val.

Gen

Design elements speciﬁcations measured Findings

Ayres &

Tickle (1980)

Case-Smith &

Bryan (1999)

Linderman &

Steward

(1999)

Larrington

(1987)

Reilly et al.

(1983)

Stagnitti,

Raison, &

Ryan

(1999)

Edelson et al.

(1999)

SI-classical

SI-based

(Sensory

Diet)

SS-touch

pressure

Mild-severe

autism;

3–13 yr

Autism/MR;

4–5 yr

Autism; 3–4 yr

Autism/severe

MR; 15-yr-

old boy

Autism 6–11 yr

Sensory Defen-

siveness and

Possible

Autism spec-

trum; 5-yr-old

boy

Autism 4–13 yr

III

Retrospective case-control

of treatment responders

versus nonresponders

Single-subject AB design;

3 wk baseline, 10 wk

treatment

Single-subject AB design;

2 wk baseline, 7 or

11 wk treatment

Descriptive case study

Counter-balanced alternating

treatments design; random

assignment to activity

order

Descrriptive case study

RCT with placebo; Pre- and

post-treatment measures

2!wk for one year

30 min treatment

sessions plus

teacher consulta-

tion

1 hr/wk in clinic

Varied sensory treat-

ment (vest./prop/

oral motor) treat-

ment in school and

group home; 2 yr

2 sessions 30 min

vestibular treat-

ment versus 2 ses-

sions 30 min ﬁne

motor treatment

(alternating); pro-

vided within a 3

Brushing, joint com-

pression 3–5!/day

for 2 wk (other

techniques were

also used); re-

peated again at 5

mo post treatment

Hug Machine (pres-

sure) versus

placebo (no pres-

sure) 2!20-min

sessions per week;

6 wk total

Language, awareness of en-

vironment, purposeful ac-

tivities, self-stimulation.,

social and emotional

behavior

Mastery play, engaged be-

haviors, peer and adult

interactions

Functional behavior

measures varied between

subjects (e.g., social

interactions,

communication)

Variety of behaviors (e.g.,

SIB, play skills, social

interactions)

Quantity and quality of

vocalizations measured

during treatment only.

(No pre-post measures).

Anecdotal reports of tactile

tolerance, affect, activity

level, temper tantrums at

home, school/community

Behavioral (tension, anxi-

ety, hyperactivity) and

physiological (galvanic

skin response)

Subjects with hyper-

responsivity to tactile

and vestibular stimuli

had better outcomes

than hypo-responsive

subjects

General improvements in

mastery play, engaged

behaviors, and adult

interactions. No signif-

icant changes in peer

interactions

Increase in social inter-

actions, response to

movement and affec-

tion, and approach to

new activities

Positive effects reported

in many domains of

behavior

Fine motor activities

elicited more variety

of speech and mean

length of vocalizations

and decreased autistic

speech than the

vestibular treatment

Improvements in all areas

following treatment;

beneﬁts faded by

5 months post-treat-

ment; 6- and 9-mo as-

sessments (following

2nd phase of treatment)

showed sensory defen-

siveness cured

Decreased tension and

anxiety for treatment

group. Subjects with

initially higher anxiety

level had better out-

comes

Field et al.

(1997)

McClure &

Holtz-Yotz

(1990)

Ray et al.

(1988)

Zisserman

(1991)

Bettison (1996)

Brown (1999)

Gillberg et al.

(1997)

Link (1997)

SS-touch

therapy

SS-touch

pressure

SS-vestibular

SS-touch

pressure

AIT (Berard)

Autism; mean

age 4.5 yr

Autism/MR;

13-yr-old boy

in psychiatric

unit

Autism; 9-yr-

old male

Autism; 8-yr-

old female

Autism or As-

perger (sound

hypersensi-

tivity), ages

3–17 yr

Autism; 3.5 and

5 yr

Autism (all

with MR);

3–16 yr

Autism; ages 6,

7, and 15 yr;

2 nonverbal

III

RCT with alternative treat-

ment; Pre- and post-treat-

ment measures

Descriptive case report

Descriptive case report;

Pre-, mid-, and post-treat-

ment measurement

Descriptive case report

RCT with alternative treat-

ment; pre- and post mea-

sures at 1, 3, 6, 12 mo

Descriptive case reports

Pre- and post-design

(parents/raters aware

of treatment)

Descriptive case reports

(pre- and post-measures)

Touch therapy ver-

sus one-to-one

quiet play (read)

2!15-min ses-

sions per week;

4 wk total

Elastic (pressure)

wrappings ad-

ministered over 4

treatment ses-

sions

Self-initiated

vestibular stimu-

lation; 5-min ses-

sions 2!week

over 4 wk

Pressure garments

(vest and gloves)

worn in class-

room

Treatment group

had AIT

(ﬁltered/modu-

lated music);

control group had

structured listen-

ing treatment

(unprocessed

music), 2 !30

min per day,

10 days

AIT 2 !30 min

per day, 10 days

AIT 30 min daily,

10 days

AIT 30 min daily,

10 days

Touch aversions, off-task

behaviors, orientation to

sounds, stereotypic be-

havior, teacher report

Self-stimulatory behaviors,

self-abuse, social inter-

actions

Time spent vocalizing

Self-stimulatory behavior

(e.g., hand slapping)

Aberrant behavior (ABC),

sensory problems, sound

sensitivity, IQ, language,

audiometric tests.

Descriptions of sensory,

motor, and functional

behaviors

Pre and post-tests of autism

symptoms on CARS and

ABC

Descriptions of hearing acu-

ity, sound sensitivity, and

behavior at home/school

reported by caregivers

Both groups showed

positive changes;

treatment group im-

proved in response to

sounds, stereotypic be-

havior, and social be-

haviors

Generally positive out-

comes in all areas

during treatment

Increased vocalizations

during treatment; most

prominent in ﬁrst

week

Decrease in self-stimula-

tory behaviors with

gloves, slight (non-

signiﬁcant) decrease

with vest

Similar gains noted in

both groups. 75% of

subjects improved in

1st month. Much vari-

ability and attenuation

of improvements over

course of 12-mo fol-

low-up. Two subjects

had signiﬁcant adverse

effects

General improvements

noted in a variety of

domains (e.g., atten-

tion and speech)

No signiﬁcant differ-

ences on CARS and

ABC; sensory prob-

lems declined slightly

One child improved; one

child had mixed re-

sults; one child deteri-

orated following a

seizure during AIT

and was D/C on day 5

continued

Table 1. Sensory and Motor Intervention Studies (Continued)

Treatment Int. Ext. Intervention Outcomes

Study category

n Subjects val.

val.

Gen

Design elements speciﬁcations measured Findings

AIT (Berard)

AIT (Toma-

tis)

AIT (Berard)

AIT

Mudford et al.

(2000)

Neysmith-

Roy (2001)

Rimland &

Edelson

(1994)

Rimland &

Edelson

(1995)

445

Autism (low

functioning);

ages

5–14 yr

(M "9.4)

Severe Autism;

ages 4–11 yr

Autism; pri-

mary or sec-

ondary dx;

4 – 41 yr

(M "10.7)

Autism;

4– 21 yr

III

Balanced cross-over experi-

mental design (parents

blind to treatment condi-

tions)

Pre- and post-design with

independent evluation

(repeated across subjects)

[Part 1: Compared 3 AIT

devices using RCT.] Part

2: Retrospective case

control (treatment group

compared to no treat-

ment, control group of 9

subject from a previous

pilot study). Follow-up

from 1 to 9 mo in 191

subjects.

RCT w/ alt. treatment; Pre-,

mid-, and post-treatment

measures at 2 wk and at

1, 2, 3 mo post-treatment.

(raters and parents blind

to conditions)

AIT versus placebo

(disengaged

headphones),

30 min 2!/day,

10 days; 3–5 mo

baseline; treat-

ment and control

phases in random

order for all sub-

jects

20 (30-min) ses-

sions repeated

for 4– 8 blocks.

Treatment phases

followed by 3–8

weeks of no

treatment/evalua-

tion phases

AIT 2!30 min per

day for 10 days;

one of three AIT

device conditions

(EERS, Audio-

kinetron, or

Audio Tone En-

hancer).

AIT versus alter-

native treatment

(unprocessed

music) 2!30

min per day for

10 days

Aberrant behavior (ABC,

Nisonger; observational

recordings), IQ, adaptive

behavior (Vineland), lan-

guage measure (Reynell)

CARS scores (from inde-

pendent ratings of video-

taped play observations

and teacher/parent inter-

views)

Audiograms, behavioral re-

actions to sound, parent

reports of sound sensitiv-

ity, aberrant behavior,

and behavior problems

checklists

Audiograms; parental re-

ports of hypersensitivity

to sound and aberrant be-

havior (stereotypy, hyper-

activity, speech, etc)

Several drop-outs due to

problems tolerating

treatment; placebo

slightly more beneﬁ-

cial (less aberrant be-

havior) than AIT for

subjects that com-

pleted treatment

Pre-treatment, all sub-

jects were “severely

autistic” on CARS;

After treatment 3

(younger) children had

reduced severity of

autism; 3 older chil-

dren had few changes

No signiﬁcant differ-

ences among 3 AIT

devices. Slightly im-

proved sound sensitiv-

ity & acuity. Decreased

audiogram variability

associated with im-

proved behavior.

Age and degree of

sound sensitivity not

related to behavioral

improvement.

Treatment group had de-

creased auditory prob-

lem behaviors and

aberrant behaviors 3

months post-treatment.

No signiﬁcant changes

in sound sensitivity;

however, subjects

were not necessarily

hyper-sensitive pre-

treatment

Zollweg, Palm,

& Vance

(1997)

Carmody et al.

(2001)

Kaplan et al.

(1996)

Kaplan et al.

(1998)

AIT

Prisms

Autism/MR;

ages 7–24 yr;

M "14 yr, 5

mo (included

1 AUT

#8 yr)

Autism; Ages

3–18 yr.;

(Median "8)

Autism; ages

4–15 yr;

(Mean "

8 yr)

Autism/PDD;

ages 7–18 yr;

(Mean "

11.5 yr)

(39% with

strabismus)

III

RCT w/ alt. treatment; pre-

and post-treatment at 1

wk, and at 1, 3, 6, and 9

mo post-treatment (dou-

ble blind)

Cross-over design (within

subjects) with three con-

ditions.

[Independent ratings from

video used to validate ini-

tial optometric ratings.]

Cross-over design (within

subjects) with three con-

ditions.

[Independent ratings by two

authors made later from

video to validate initial

optometric ratings.]

Double-blind cross-over de-

sign with placebo control

AIT vs. alt. treat-

ment. (un-

processed music)

2!/day for 10

days, 30 min/

session

Three brief opto-

metric assess-

ment conditions

for each subject:

no lens (baseline)

versus base-up or

base-down lenses

(randomly or-

dered treatment)

for each subject

Performance de-

scribed under

three assessment

conditions: no

lens (baseline)

versus base-up or

base-down lenses

(randomly or-

dered treatment)

for each subject

Subjects matched/

randomly as-

signed;

⁄

re-

ceived placebo

(clear lens);

⁄

got treatment

(ambient prism

lens) conditions

for 3–4 mo; then

conditions were

reversed

Audiograms, sensitivity and

loudness tolerance; aber-

rant behaviors (ABC)

A single session assessment

period with 60–90 sec

trials for each task:

Recorded spatial orient-

ing behaviors (i.e., head

and body posture, facial

expression) while seated

watching TV and ball

catching performance

while standing

A single-session assessment

period with 60–90 sec

trials for each task.

Recorded ratings on vi-

sual-spatial orientation

behaviors (i.e., head posi-

tion, body posture, facial

expression) during vari-

ous lab tasks (i.e., watch

TV seated and standing

on balance board; ball

catch game).

Measured behavior prob-

lems (Aberrant Behavior

Checklist); visual-spatial

orientation and attention

pre-, mid, and post-treat-

ment for both treatment

and control conditions.

No signiﬁcant difference

in audiological or be-

havioral outcomes be-

tween the groups;

control group showed

slightly less aberrant

behavior at 6 mo

post-treatment

Head posture, body pos-

ture, facial expression,

and ball catching in-

creased with correct

(facilitating) prism

lenses as compared to

incorrect and habitual

lenses

Overall posture and per-

formance was better

with correct prism

lenses for group as a

whole

Improved behavior in

treatment condition

(short term). No sig-

niﬁcant differences be-

tween tx and control

conditions for postural

orientation and atten-

tion. No signiﬁcant

differences between

children with and

without strabismus;

trend for more behav-

ior problems with

placebo lenses.

continued

Table 1. Sensory and Motor Intervention Studies (Continued)

Treatment Int. Ext. Intervention Outcomes

Study category

n Subjects val.

val.

Gen

Design elements speciﬁcations measured Findings

Patterning

Exercise

Institutionalized

subjects with

MR; (M "

15 yr)

Various DD—

CP, MR,

autism/

seizure (M "

8 yr)

Autism 4–14 yr

Autism 7–11 yr

III

RCT with alt treatment

(physical activities with

sensory stimulation and

attention) and no-treat-

ment control group

Prospective cohort design

(nonrandom group as-

signments); pre, mid-

(3 and 6 mo) and post-

treatment measurements

(at 10 mo)

Repeated reversal design

(ABAB); 45 reversals;

Multiple pre- and post-

treatment measures

Counter-balanced, alternat-

ing treatments design.

Baseline and multiple

post-treatment measures

Doman-Delcato

method patterning

treatment 2

hr/day 5!per

week for 2.5 mo,

then 7!per wk

for 4 mo

Doman-Delcato

method patterning

8 hr per day; con-

trol group re-

ceived Special

Education ser-

vices; 10 mo

5–20 min structured

individual jog-

ging sessions;

variable settings

(e.g., clinic and

home) and vari-

able duration of

treatment 4 –17

days

15 min vigorous ac-

tivity (jogging)

followed by 15

min mild activity

(ball playing) and

return to 1st con-

dition; condition

order reversed on

second day

Cognitive performance,

developmental tests for

vocabulary, visual-

perceptual, and motor

skills

Developmental proﬁle, IQ

with Bayley mental scale

or Stanford-Binet (mea-

surements not uniformly

applied)

Percent of self-stimulation

as well as number of cor-

rect responses on acade-

mic (matching task) and

ball playing (catching

task).

Time sampling of stereo-

typed behaviors

No dramatic changes in

individuals; no signiﬁ-

cant changes in IQ or

motor skills. Signiﬁ-

cant increases for

treatment group in two

categories most related

to treatment skills

taught; visual compe-

tence and mobility. No

treatment control fared

worst on most mea-

sures

Treatment group slightly

better in language and

socialization at 3 mo

but ﬁndings were

short-lived and no sig-

niﬁcant differences

found at 10 mo.

Consistent decrease in

self-stimulatory behav-

iors and improvements

in academic and play

responses following

treatment

Reduction in self-stimu-

latory behaviors after

vigorous jogging

exercise.

Neman et al.

(1974)

Bridgman et al.

(1985)

Kern et al.

(1982)

Kern et al.

(1984)

KEY:

Treatment Category Codes

●SI, Sensory Integration Therapy (classical)

●SI-based, Sensory-Integration Based Approach

●SS, Sensory Stimulation Technique

●Patterning, Sensorimotor Patterning

●AIT, Auditory Integration Training

●Prism, Ambient Prism Lenses (Visual Therapy)

●Exercise, Exercise Therapy

Internal Validity Classification Criteria:

●I: Prospective study comparing treatment to alternative or placebo (e.g., RCT) where evaluators are blind to treatment status.

●II: Multiple baseline, ABAB, reversal/withdrawal with measurement of outcome blind to treatment conditions, or prepost design with indep. evaluation.

●III: Prepost or historical designs or multiple baseline, ABAB, reversal/withdrawal (not “blind”).

●IV: Other (e.g., single subject [AB or ABA] designs without multiple baselines; case study reports).

External Validity Classification Criteria:

●I: Random assignment of well-defined cohorts and adequate sample size for comparisons.

●II: Nonrandom assignment, but well-defined cohorts with inclusion/exclusion criteria and documentation of attrition/failures. In addition, adequate sample size for group designs or repli-

cation across three or more single subjects.

●III: Well-defined population of three or more subjects in single-subject designs or sample of adequate size in group designs.

●IV: Other.

Generalization Classification Criteria:

●I: Documented changes (i.e., generalization) in at least one natural setting outside of treatment setting.

●II: Generalization to one other setting or maintenance beyond experimental intervention in natural setting in which intervention took place.

●III: Intervention occurred in natural setting or use of outcome measures with documented relationship to functional outcome.

●IV: Not addressed or other.

Levinson &

Reid

(1993)

Watters &

Watters

(1980)

Exercise

Autism (low

functioning)

11 yr

Autism; ages

9–11 yr

Counterbalanced, alternat-

ing treatments design;

multiple pre-, during,

post-treatment measure-

ments

Alternating treatments de-

sign with three pre-task

conditions in randomized

order. Pre- and post-treat-

ment measures

15 min group

walking (mild

exercise) for

5 sessions versus

15 min individual

jogging (vigorous

exercise) !4 ses-

sions across 9 wk

Compared three

conditions: 8–10

min jogging ver-

sus 15 min TV

viewing versus

varied academic

tasks; given

1 session per day,

1–4 !per week

(total weeks var-

ied)

Heart rates, individualized

measures of self-stimula-

tory behaviors

Rates of self-stimulatory

behaviors and academic

performance during a lan-

guage training session

post treatment

Reduction in self-stimu-

latory behaviors after

vigorous exercise

treatment. Effects wear

off after 90 min

Decrease in self-stimula-

tory behaviors follow-

ing exercise condition

Sensory Integration Therapy

Description and Assumptions

Sensory integration (SI) therapy, based on the

work of Dr. A. Jean Ayres, is intended to focus directly

on the neurological processing of sensory information

as a foundation for learning of higher-level (motor or

academic) skills. Some of the neurological assumptions

upon which this model is based (i.e., hierarchically or-

ganized nervous system) have received criticism as

being outdated; recent theorists are reconceptualizing

this theory (Bundy & Murray, 2002). The assumption

that sensory experiences have an effect on learning is

less controversial, although the mechanisms through

which this occurs are somewhat ambiguous and often

debated. Disruptions in subcortical (sensory integra-

tive) functions are treated by providing controlled ther-

apeutically designed sensory experiences for a child to

respond to with adaptive motor actions. Through so-

matosensory and vestibular activities actively con-

trolled/sought out by the child, the nervous system is

thought to be able to better modulate, organize, and in-

tegrate information from the environment, which in turn

provides a foundation for further adaptive responses

and higher-order learning. Other necessary components

of the classical SI model include a child-centered ap-

proach, providing a just-right challenge (scaffolding),

facilitating progressively more sophisticated adaptive

motor responses, and engaging the child in affectively

meaningful and developmentally appropriate play in-

teractions. The child’s focus is intended to be placed

on the occupation of play (intrinsically motivated) and

not on cognitive-behavioral strategies or repetitive

drills—as is the focus of other sensorimotor and be-

havioral approaches. Treatment goals may center on

improving sensory processing to either (a) develop bet-

ter sensory modulation as related to attention and be-

havioral control, or (b) integrate sensory information

to form better perceptual schemas and practic abilities

as a precursor for academic skills, social interactions,

or more independent functioning.

Service Delivery Model and Approach

SI therapy is classically provided utilizing a direct

one-on-one intervention model in a clinic environment

that requires specialized equipment (e.g., suspended

swings). Treatment plans are designed individually and

carried out by a trained therapist (OT) approximately

1 to 3 times per week, 1-hour sessions. Duration typi-

cally entails several months and in some cases years.

Consultative services, home/school programs, or task/

406 Baranek

environmental adaptations are often provided in tan-

dem with the direct intervention. Cost varies depend-

ing on the location, frequency, and duration of the

treatment, but it is comparable to hourly rates of other

therapy services. Equipment is generally low-tech, but

can be moderately expensive. The feasibility of doing

classical SI in a school setting is low because of the

need for specialized equipment and the “pull-out”

model that may conflict with inclusionary principles.

Empirical Studies

Three studies investigated interventions that

matched the criteria of classical SI therapy. Two utilized

prospective AB designs with several subjects and ade-

quate controls to look at SI treatment efficacy (Case-

Smith & Bryan, 1999; Linderman & Steward, 1999); one

utilized a retrospective design to identify predictors of

positive outcomes within a group of children with autism

receiving SI (Ayres & Tickle, 1980). Although outcome

measures included aspects of proximate (sensory pro-

cessing/modulation) functions and/or broader outcomes

(e.g., play skills, social interactions), none of the studies

directly attempted to remediate deficits in praxis.

Case-Smith & Bryan (1999) studied five boys

across a 3-week baseline phase and a 10-week inter-

vention that consisted of a combination of classical SI

treatment and consultation with teachers. Independent

coding of videotaped observations of free play indi-

cated that three of the five boys demonstrated signi-

ficant improvements in mastery play, and four of five

demonstrated less “nonengaged” play. Only 1 subject

had significant improvements with adult interactions,

and none changed in level of peer interaction. Outcome

measures more directly related to intrinsic features of

the intervention (e.g., individual mastery play) ap-

peared more improved than measures that were not

directly addressed in treatment (e.g., peer interaction).

Although it is possible that the positive results could

be attributed to factors other than the intervention it-

self (i.e., maturation, caregiving effects), the authors

note that the behaviors did not change systematically

across all outcome measures. However, because sen-

sory processing variables were not directly assessed, it

is not known whether the positive outcomes are directly

due to improvements in sensory processing mechanisms

per se, as would be purported by sensory integration

theory. It is also possible that the improvements evi-

denced are a function of other components of the in-

tervention (e.g., play coaching, motivational strategies).

Linderman & Steward (1999) also utilized a sin-

gle subjects AB design with two 3-year-olds with per-

vasive developmental disorder (mild autism) to track

the functional behavioral changes in the home envi-

ronment associated with classical SI (clinic-based

1 hour per week for 7 to 11 weeks). Subject 1 (who was

noted to have tactile hypersensitivity) demonstrated

gains in all intended outcomes (social interactions, ap-

proach to new activities, response to holding). Subject

2 (who had both hypo-responsiveness to vestibular and

hyper-responsiveness to tactile sensations) made gains

in activity level and social interaction, but not in func-

tional communication. This study purports that SI may

result in some functional gains that generalize to natu-

ralistic contexts. However, given the limitations inher-

ent in this single subject design, it is also possible that

other co-occurring interventions (e.g., education), mat-

urational effects, and parent participation in evaluation

procedures may have also contributed to the positive

outcomes, thus limiting definitive conclusions about

the efficacy of the treatment.

The last study by Ayres and Tickle (1980) utilized

a retrospective (within group) design to explore variables

that predicted positive or negative outcomes following

one year of SI therapy in 10 children (mean age 7.4 years)

with autism. They found that subjects who tended to

have average to hyper-responsive patterns to the vari-

ous stimuli (e.g., touch, movement, gravity, and air

puff) showed better outcomes than those with a hypo-

responsive pattern. Numerous limitations (i.e., small sam-

ple size, variability of the outcome measures used, lack

of control over maturational effects, retrospective nature

of the study) make conclusive statements difﬁcult; how-

ever, the study raises the possibility that differences in

outcomes may be partially dependent on speciﬁc subject

attributes including patterns of sensory processing.

Numerous efficacy studies of SI exist with other

populations (e.g., children with MR or LD) (e.g., Arendt,

Maclean, & Baumeister, 1988; Ayres, 1972; Clark et al.,

1978; Hoehn & Baumeister, 1994; Humphries et al.,

1990; 1992; 1993; Kanter, Kanter, & Clark, 1982; Po-

latajko et al., 1991; 1992; Wilson et al., 1992). Although

these are excluded from this review, it is noteworthy

that these studies have sparked much controversy, given

the lack of consistent empirical support. Some difficult

issues surround the nature of the intervention and

whether or not these studies were truly representative

of SI therapy versus some other variation of sensori-

motor or perceptual-motor treatments. Several meta-

analyses (Ottenbacher, 1982; Vargas & Camilli, 1999)

are also available; these report that effect sizes vary from

low to moderately high depending on the populations

studied, recency of the studies, and specific parameters

measured. Outcomes in psychoeducational and motor

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 407

categories are stronger than in other areas, at least for

SI studies compared to no treatment conditions; how-

ever, effects appeared to be equivocal when compared

with alternative treatments.

Other Sensory Integration-Based Approaches

Description and Assumptions

This section groups several types of approaches

that are based on the foundations of SI theory, but de-

viate from classical SI in one or more criteria: (a) so-

matosensory and vestibular activities are provided but

suspended equipment is not used; (b) treatment is more

adult-structured or passively applied (i.e., not con-

ducive to child-directed play), and/or (c) treatment is

more cognitively focused than found in classical SI.

For example, structured perceptual-motor training ap-

proaches may fall into this category. Although these

were popular 10 to 30 years ago, they are less often

used today with children with autism.

One example of a popular modernized version of an

SI-based program is the “Sensory Diet” (or sometimes

referred to as a sensory summation approach), in which

the child is provided with a home or classroom program

of sensory-based activities aimed at fulfilling the child’s

sensory needs. A schedule of frequent and systematically

applied somatosensory stimulation (i.e., brushing with a

surgical brush and joint compressions) is followed by a

prescribed set of activities designed to meet the child’s

sensory needs are integrated into the child’s daily rou-

tine. Another example that melds together aspects of sen-

sory integration theory with a cognitive-behavioral

approach is the “Alert Program,” in which a child (usu-

ally with a higher functioning level and verbal abilities)

is given additional cognitive strategies to assist with

his/her arousal modulation.

Service Delivery Model and Approach

These models often utilize a direct intervention (one-

on-one or group). Consultative/collaborative models are

common; caregivers under the supervision of a thera-

pist may carry out school programs. Treatments gen-

erally require less equipment than classical SI and can

often be provided in an inclusive setting. Cost is com-

parable to SI, depending on the length and duration of

intervention.

Empirical Studies

No studies of specific perceptual-motor treatments

for autism were found. Two studies (Larrington, 1987;

Reilly, Nelson, & Bundy, 1983) using structured

sensorimotor interventions based on SI principles were

found. Despite documenting numerous positive out-

comes, the descriptive case study by Larrington (1987)

provides limited internal validity as a result of multi-

ple methodological weaknesses, probable maturation

effects, and a focus on an older age-group (teenager)

that has limited generalizability to young children. The

more rigorous study by Reilly et al., (1983) utilized a

counter-balanced alternating treatments design with

18 children diagnosed with autism (ages 6 to 11 years)

to measure the comparative effects of two interventions

on production of vocalizations. The authors expected

that structured vestibular-based activities would facil-

itate higher amounts of language in their subjects during

the intervention than the table-top ﬁne motor activities.

Order of the two treatment conditions was randomly

assigned, and each subject received two 30-minute ses-

sions of each type. No significant differences were

found with respect to function of speech, articulation,

total language, or rate of vocalizations during the in-

tervention sessions. In contrast to the hypotheses, sig-

nificant differences in favor of the fine motor group

were found for variety of speech, length of vocaliza-

tions, and amount of autistic speech. Limitations of

these findings included: (a) the children’s vocalizations

had been previously reinforced by teachers during fine

motor activities in the classroom—which may have

proved in favor of the alternative therapy; (b) a short

duration of the intervention period may not have been

sufficient to provide an adequate sampling of behav-

iors, and (c) outcome measures outside of the treatment

sessions were not provided, thus it is not known if the

vocalizations generalized to other contexts.

Although the Sensory Diet interventions are com-

monly used, only one study of a child suspected of hav-

ing an autistic spectrum disorder was found (Stagnitti,

Raison, & Ryan, 1999). This case report described a

5-year-old boy with severe sensory defensiveness who

underwent a treatment program consisting of brushing

(i.e., sensory summation) followed by joint compres-

sions an average of 3 to 5 times daily for 2 weeks. The

program included integration of appropriate sensory ac-

tivities interspersed throughout the child’s daily activ-

ities and routines (i.e., sensory diet) and was carried out

by the parents at home under the supervision of a thera-

pist trained in these methods. Following initial im-

provements, the treatment program was repeated several

months later when the child’s behaviors seemed to again

deteriorate. Post-treatment parental reports suggested

improvements in tolerance of tactile stimulation, fewer

temper tantrums, an increase in activity level, and bet-

ter coordination. The authors concluded that the child

408 Baranek

was cured of his sensory defensiveness, and autistic

symptoms appeared to resolve. These anecdotal claims

appear unfounded given that no systematic data were

collected and that adequate methodological controls

were not instituted (e.g., a variety of competing treat-

ments were implemented during the 9-month period).

No empirical studies on the Alert Program were

found for children with autism or related populations. It

may be that some of these programs have been too re-

cently developed to have been subjected to empirical

tests; more likely they are utilized by clinicians who re-

port outcomes via individualized education plans (IEPs)

and not through the peer-reviewed research literature.

Sensory Stimulation Techniques

Description and Assumptions

These approaches are varied and usually involve

passively providing one type of sensory stimulation

through a circumscribed modality (e.g., touch pressure,

vestibular stimulation) with a prescribed regimen. Some-

times these techniques are incorporated within the

broader sensory-integration–based programs described

above; other times they are used in isolation. The as-

sumptions vary with the treatment, but most are based

on neurophysiological principles stipulating that a given

sensory experience may provide facilitatory or inhibitory

influences on the nervous system that result in behav-

ioral changes such as arousal modulation. An example

of a commonly used technique is “deep pressure” (i.e.,

firm touch pressure providing calming input), which can

be applied via therapeutic touch (e.g., massage; joint

compression), or an apparatus (e.g., Hug Machine, pres-

sure garments, weighted vests). Vestibular stimulation,

another example, is often used to modulate arousal, fa-

cilitate postural tone, or increase vocalizations. Auditory

integration training and visual therapies will be discussed

in separate sections.

Service Delivery Model and Approach

The service delivery models vary, depending on

the intervention provided. Both direct and consultative

approaches are used, although the direct intervention

approach is more often described in research. Cost

varies depending on the equipment used (e.g., minimal

cost of brushes vs. moderate to significant costs of Hug

Machine) and staff time allocated.

Empirical Studies

Five studies specific to children with autism were

found in this category. Three of the studies utilized case

study descriptions (McClure & Holtz-Yotz, 1990;

Ray, King, & Grandin, 1988; Zisserman, 1991), and

two provided more rigorous and controlled methodo-

logies with randomization of subjects to two alterna-

tive treatment conditions (Edelson, Goldberg, Edelson,

Kerr, & Grandin, 1999; Field et al., 1997). One study

reviewed the effects of vestibular stimulation (Ray

et al., 1988), and four studies investigated the effects

of somatosensory stimulation on a variety of behaviors.

All of these studies report effects of some type of touch

pressure/deep pressure.

Although several limitations (e.g., a tendency to

use numerous measures with small sample sizes) exist

in the majority of these studies, they yield some useful

information that may guide educational planning. The

two prospective controlled studies provide preliminary

evidence that touch pressure may have a calming ef-

fect on children with autism (Edelson et al., 1999; Field

et al., 1997). Field et al. (1997) measured the effects

of touch therapy (massage) on attentiveness and re-

sponsivity in 22 preschool children with autism. Mas-

sage was provided for 15 minutes per day, 2 days per

week for 4 weeks (i.e., eight sessions). Results indi-

cated that both groups showed positive changes with

respect to all the observational variables (i.e., touch

aversion, off-task behavior, orienting to sounds; stereo-

typies) post-treatment; the touch therapy group demon-

strated significantly greater changes in responsiveness

to sound and stereotypies and significant improvements

on measures of social communication. Although hy-

pothetically links were made to changes in autonomic

(vagal) activity, these claims are unsubstantiated, be-

cause no physiological measures were taken.

Edelson et al., (1999) investigated the efficacy of

the Hug Machine—a touch pressure device designed

by Temple Grandin to decrease arousal and anxiety by

self-administration of lateral body pressure—in 12 chil-

dren with autism that had varying levels of anxiety. The

treatment group (Hug Machine twice for 20 minutes

per week for 6 weeks) showed a significant reduction

on a tension scale and a marginally significant change

on anxiety. Physiological measures (galvanic skin re-

sponses) were not significantly different between

groups overall; however, variability in the experimen-

tal group increased over the course of treatment. The

authors concluded that children in the treatment group

with higher initial levels of arousal/anxiety were more

likely to benefit from the intervention. Although the

small sample size and marginally significant findings

limit the conclusions in this study, there is some con-

vergence of findings with the Ayres and Tickle (1980)

study that children with hyper-responsive patterns may

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 409

benefit more from these types of sensory-based inter-

ventions than those who are under-responsive.

Both McClure and Holtz-Yotz (1990) and Zisser-

man (1991) provide interesting but methodologically

weak case reports using variations of touch pressure

garments to diminish self-stimulatory behaviors.

Neither study provided a functional analysis of the self-

stimulatory behaviors prior to the interventions, but both

assumed the function of the behaviors was sensation

seeking and/or arousal modulation based and hypo-

thesized that providing a sensory substitute would yield

calming effects and decreased stereotypy. Zisserman

(1991) described clinical improvements using pressure

gloves (overall 46% decrease) but not for pressure vest

(11.8% decrease). Additionally, no carry-over effects

could be demonstrated once the gloves were removed.

Similarly, McClure & Holtz-Yotz (1990) using elastic

wraps to effect behavioral changes (i.e., social inter-

actions, self-stimulation) reported some positive effects

in an institutionalized 13-year-old boy with autism/

mental retardation; however, investigator biases, co-

interventions (medication, physical agent modalities),

and poor reliability/validity for the measures used sig-

nificantly limited conclusive statements. The final case

study by Ray et al. (1988) describes the effects of

vestibular stimulation on speech sounds in a 9-year-old

low-functioning boy with autism and dyspraxia. Self-

controlled vestibular stimulation (i.e., spinning in circles

5 minutes for 17 days across a 4-week period). Speech

sounds were greater in the treatment (17% time) than the

pre- (2% time) or post-intervention (1.3% time) phases.

Because no measures of vestibular processing were di-

rectly collected, it is unclear whether the increased

speech production was directly linked to vestibular pro-

cessing changes. The child was simultaneously receiv-

ing other SI treatments in school, which may have

confounded results.

Auditory Integration Training (AIT) and Related

Acoustic Interventions

Description and Assumptions

AIT is based on the concept that electronically

modulated/filtered music provided through earphones

may be helpful in remediating hypersensitivities and

overall auditory processing ability that is thought to be

problematic in children with autism. Although exact neu-

rological mechanisms underlying AIT and other listen-

ing therapies are not known, various hypotheses have

been proposed (e.g., improved functioning of the retic-

ular activating system, reorganization of the cerebellar-

vestibular system, modiﬁcation of brain serotonin levels).

AIT is said to “massage” the middle ear (hair cells in the

cochlea) and enhance auditory perception. Methods and

equipment vary depending on the specific philosophical

approach (i.e., Tomatis or Berard); the most commonly

used approach for children with autism in the United

States is the Berard method, developed by the French

otolaryngologist during the 1960s–1990s. In the Berard

method, a modulating and filtering device (e.g., Ears Ed-

ucation & Retraining System [EERS], Audiokinetron or

Audio Tone Enhancer [ATE]) accepts music input from

CDs and transforms sounds by (a) randomly modulating

high and low frequencies and (b) filtering out selected

frequencies in accordance with the child’s performance

on an audiogram (test of auditory thresholds to a series

of frequencies that measures hearing ability). Sound fre-

quencies that are 5 to 10 dB different from their adjacent

frequencies (i.e., “peaks”) are filtered out for the listen-

ing sessions. Volume level for the left ear is sometimes

reduced in order to stimulate language development in

the left hemisphere. Although improved sound modula-

tion is one goal of treatment, other goals include en-

hancement of generalized behaviors (attention, arousal,

language, social skills, etc.).

The Tomatis method is similar, but integrates a

psychodynamic with a psychophysiological perspec-

tive. In the passive phase, the individual listens to fil-

tered sounds of the maternal voice, as well as prepared

music through a modulating apparatus (i.e., Electronic

Ear that attenuates low frequencies and amplifies higher

frequencies). The earphones have an attached bone con-

ductor to facilitate sounds through vibration and air

conduction methods. Later, in the active phase, the sub-

ject is introduced to language and audio vocal exercises

that provide feedback of his/her own voice through

headphones to reinforce more normal auditory percep-

tion and overall quality of life.

Variations of listening programs applied to chil-

dren with autism include Stephen Porges’ Acoustic

Intervention. This treatment is based on Porges’ (1998)

Polyvagal Theory—a phylogenetic theory of autonomic

nervous system control that is the substrate for emo-

tional and affective experiences. By providing filtered

sounds of the human voice (as opposed to any filtered

music), the listening stimulation is designed to alter-

natively challenge and relax the middle ear muscles to

enhance speech perception.

Service Delivery Model and Approach

The Berard AIT treatments are usually provided

individually in a small sound-quiet room for 30 min-

utes 2 times per day for 10 to 20 days (i.e., minimum

410 Baranek

of 10 hours) by a professional trained in the techniques.

Fees can range from $1000 to $3000 for the 2-week

treatment. The equipment itself is highly technical and

expensive. The Tomatis method is performed in simi-

lar ways but often with repeated blocks of intervention

with longer overall durations, sometimes spanning

years of treatment. The Porges acoustic intervention

uses five sessions at 45 minutes each. Occasionally,

such auditory treatments are provided within a school

setting if the trainer brings the equipment to the school.

Empirical Studies

Nine studies were found using various methods of

AIT with children with autism. Eight of these studies

were utilized the Berard AIT method (Bettison, 1996;

Brown, 1999; Gillberg, Johansson, Steffenburg, &

Berlin, 1997; Link, 1997; Mudford, et al., 2000; Rim-

land & Edelson, 1994; 1995; Zollweg, Palm, & Vance,

1997). The Tomatis AIT approach was used in one

study (Neysmith-Roy, 2001) for the population of in-

terest. An additional study of the Tomatis AIT method

demonstrating no positive benefits for children with

significant learning disabilities is also published (Ker-

shner et al., 1990) but is not included in this review.

Although Porges’ acoustic intervention is currently un-

dergoing some scientific experiments with children

with autism, no published studies in peer-reviewed

journals were found.

Of the nine AIT studies reviewed in total, three

used randomized, controlled methods with either no

treatment or an alternate treatment/placebo, (Bettison,

1996; Rimland & Edelson, 1995; Zollweg et al., 1997),

two utilized other methodological designs with various

levels of control (Neysmith-Roy, 2001; Mudford, et al.,

2000), one was a pre-post open trial (Gillberg et al.,

1997), two were descriptive case reports (Brown, 1999;

Link, 1997), and one compared various types of AIT

devices (Rimland & Edelson, 1994). These are sum-

marized below.

Bettison (1996) utilized a randomized controlled

trials design with AIT as the treatment condition and

an alternative structured listening task for the control

condition for 80 children with autism (ages 3 to 17 years)

with concomitant sound sensitivities. At 1 month post-

treatment, both groups demonstrated significant but

equal amounts of improvement for all measures show-

ing nonspecific treatment effects. Significant improve-

ments were maintained for the audiogram scores only;

patterns of change across other behavioral measures

(behavior checklist; development, sensory checklist,

and sound sensitivity questionnaire) was so variable

that it is difﬁcult to interpret clinically, even though some

of the changes were positive. By 12 months, most of

the improvements seen reverted to initial post-treatment

levels taken at 1 month. It is not clear what aspect of

the interventions was responsible for the outcomes—

maturation, practice effects, or other aspects of the

treatment may have also influenced the results. More-

over, this study documents negative side effects for two

subjects who had documented psychiatric problems.

Rimland & Edelson (1995) present some positive

effects with 18 subjects (4 to 21 yrs of age) in a ran-

domized controlled trial using AIT (EERS) versus un-

filtered music. Results indicated that the treatment

group demonstrated fewer auditory problem behaviors

and aberrant behaviors than the control; these im-

provements were maintained across 3 months. How-

ever, neither the pure tone discomfort test nor the

hearing sensitivity questionnaire provided evidence of

reduction in sound sensitivity post-treatment. Treat-

ment and control groups did not significantly differ in

their hearing acuity at any of the six points tested. Posi-

tive results were not limited to those with hyper-

sensitive hearing. In a large scale study, these same

authors (Rimland & Edelson, 1994) investigated the

differential effectiveness of three types of auditory

filtering devices for 445 subjects with primary or

secondary diagnoses of autism (CA "4 to 41 years;

M"10.73 years). Because no differences were found

across the three devices, data were collapsed across treat-

ment conditions. Results indicated a signiﬁcant but small

improvement in hearing sensitivity, as well as decreased

variability in audiograms for some subjects, mostly

during the first 3 months. Lower-functioning individu-

als seemed to make greater gains. However, there was

no significant relationship between level of sensitivity

pre-AIT and the behavioral outcomes post-treatment.

Zollweg, Palm, & Vance (1997) used a well-

controlled, double-blind design with an alternative treat-

ment to study the effects of AIT on 30 low-functioning,

multihandicapped, institutionalized residents. Nine of

the 30 residents had autism; only 1 of the 9 with autism

was a child under the age of 8 years. Participants were

assigned randomly to treatment (filtered/modulated

music) or control (unﬁltered/unmodulated music) groups

and provided with twenty 30-minute sessions by trained

practitioners who were blind to the treatment conditions.

Participants were allowed to engage in other activities

(e.g., eating, toy play, magazine browsing) simultane-

ously with treatment to facilitate cooperation. Subjects

were assessed for hearing sensitivity and tolerance

for loud sounds pre- and post-treatment (1- 3-, 6-, and

9-month time periods) by a licensed audiologist, also

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 411

blind to treatment conditions. Results of audiological as-

sessments demonstrated that there was a small magni-

tude change of 200 Hz on pure tone thresholds between

the two groups at only one of seven frequencies tested.

This finding was likely spurious given the number of

comparisons and was not deemed clinically significant

by the authors. No significant group differences were

found with respect to loudness discomfort levels at any

frequency for any of the follow-up time points; in fact,

only one subject demonstrated an increased tolerance be-

tween the pre-AIT and the 9 month, post-AIT condition.

Behavioral data indicated that both groups were reported

to improve over time; slight differences favored the con-

trol group at 6 months post-treatment for overall scores

on the Aberrant Behavior Checklist (ABC), but groups

had similar levels of improvement on this measure at

9-months after treatment. No significant differences be-

tween groups were noted for any of the subscales of the

ABC at any of the post-treatment time points. Although

both groups were reported to improve over time, notable

fluctuations across the subscales of aberrant behavior on

post-treatment assessment phases were not easily inter-

pretable. These findings are similar to those of Bettison

(1996) suggesting that factors other than AIT (e.g., extra

attention; caregiver expectations, etc.) could be respon-

sible for reductions in aberrant behaviors.

Mudford et al. (2000) used a balanced cross-over

design to assess the effects of AIT (twenty 30-minute

sessions) with 16 children with autism ages 5 to 14

years. Four were girls; all of the subjects were low-

functioning. Parents and AIT practitioners were blind

to the treatment conditions that included either AIT

(modulated music) without the filtering component, or

the placebo control (headphones disengaged, music

playing in background of room). Baseline and follow-

up assessments were used for each condition, includ-

ing standardized measures of aberrant behavior,

cognitive functioning, adaptive levels, language levels,

and observational data. Notably, several children

dropped out of the study as a result of inability to tol-

erate the procedures and/or severe behavioral difficul-

ties. Of the 16 children completing the study, there were

no positive findings in favor of the AIT condition, de-

spite a liberal alpha level used in the statistical tests.

In fact, small but significant differences on measures

of aberrant behavior favored the control condition for

this low-functioning group.

Neysmith-Roy (2001) describes outcomes of the

Tomatis AIT method with six children with severe

autism ranging from 4 to 11 years. Several blocks of

“Intensives” (i.e., twenty 30-minute sessions repeated

from four to eight times) were each followed by a 3- to

8-week unsystematic evaluation period spanning 6 to

21 months, depending on the individual child’s pro-

gram. Pre- and post-measures of autistic symptoms on

the Childhood Autism Rating Scale (CARS) were

recorded on videotapes of two separate play conditions

and parent/teacher reports during both the intervention

and evaluation phases. Videos were randomized and

coded by two raters who were blind to the conditions

of the study for each subject. Reductions in autistic

symptoms overall including an improvement in pre-

linguistic behaviors were noted in three of the six boys

(50%), who also happened to be among the youngest

subjects, but no improvements were seen in the other

three (older) boys. Audiological/physiological mea-

sures were not employed because the boys were unable

to cooperate for the testing.

A case report by Brown (1999) on two preschool-

age siblings with autism describes improvements in

sensory-motor functions, attention, social interest, praxis,

eye control, and speech for two children who underwent

AIT for two 30-minute sessions for 10 days. Similary,

Link (1997) presented a case report for three children

with autism, documenting mixed findings. Sound sen-

sitivity (using unvalidated measures) was noted to be

unchanged for two of the three children and inconclu-

sive for the third. Informal behavioral observations

were found to be improved for one child (across par-

ent and teacher ratings) and mixed a second child. One

child unfortunately suffered a psychomotor seizure dur-

ing the AIT procedure and was removed from the pro-

tocol on day 5. Parent and teacher reports on day 5

indicated deterioration in behaviors possibly related to

the seizure. Both studies were weak methodologically

such that no systematic data was collected and pre- and

post-measures lacked independence, as well as valid-

ity and reliability data; thus findings are speculative.

In summary, the nine available studies using var-

ious methods of AIT with children with autism demon-

strate mixed results. Studies with sample selection

biases and unmasked evaluation processes would tend

to favor outcomes for the treatment groups; however,

this was not always the case. Some studies, using var-

ious types of methodologies, reported improvements in

either behavior or audiological measures (e.g., Brown,

1999; Link, 1997; Neysmith-Roy, 2001; Rimland,

1994; 1995) at some points in time for some children.

However, it is important to note that if changes are seen

in behaviors without concomitant changes in hearing

sensitivity, an alternative mechanism than that pro-

posed by AIT theory may be responsible for the im-

provements. Furthermore, significant fluctuations of

behavior over time, and inconsistency of performance

412 Baranek

across measures seen in several studies (e.g., Bettison,

1996; Zollweg et al., 1997) are difficult to interpret.

Adverse effects (i.e., seizures, behavioral problems)

and drop-out rates require special attention given that

these are reported in several AIT studies.

Methodologically stronger studies (Bettison; 1996;

Mudford et al., 2000; Zollweg et al., 1997) demon-

strated that improvements in behavior often were not

significantly different between treatment (AIT) and

control (unfiltered/unmodulated music) conditions

(Bettison, 1996; Zollweg et al., 1997). In two studies

(Mudford et al., 2000; Zollweg et al., 1997) the con-

trol group showed a subtle advantage in reduction of

aberrant behaviors at at least one point in time. Simi-

lar improvements for subjects in both treatment and

control conditions suggest that effects are due to fac-

tors that are peripheral to the treatment (e.g., extra at-

tention; caregiver expectations; compliance training)

and/or other co-occurring treatments (i.e., behavioral

and educational interventions) may be influencing out-

comes. Future replication studies need to better control

for such effects. Although the hypothesis that music in

general (filtered or unfiltered) may have a beneficial

effect on behavior is plausible, it is yet to be tested em-

pirically. Gravel (1994) provided a detailed critique of

AIT studies, stressing the importance of distinguishing

between statistical and clinical significance. She states

that small differences between frequencies (i.e., 5 dB)

or fluctuations in hearing sensitivity in some children

with autism may be attributable to attentional/behavioral

difficulties that preclude reliable responses on behav-

ioral audiometry. Furthermore, electrophysiological

measures (ABRs) fail to demonstrate differences in

hearing sensitivity between children with autism and

controls—a finding that may challenge the overall

premise of AIT.

Visual Therapies

Description and Assumptions

A variety of visual therapies including but not lim-

ited to oculomotor exercises, ambient prism lenses, and

colored filters (i.e., Irlen lenses) have been applied to

children with autism. These visual or behavioral opto-

metric therapies and are aimed at improving visual pro-

cessing or visual-spatial perception that may be related

to autistic symptomatology (e.g., unusual visual stereo-

typies, coordination problems, strabismus, attention,

etc.). In particular, the ambient (i.e., visual-spatial sys-

tem) as opposed to the focal (i.e., visual acuity system)

is hypothesized to be dysfunctional in children with

autism. Thus prism lenses transform the light through

an angular displacement of 1 to 5 degrees (base up or

base down), producing a shift in the field of vision.

These are thought to lead to more stable perception and

improved behavior or performance.

Service Delivery Model and Approach

Visual therapies and corrective lenses are pre-

scribed individually through a licensed optometrist. In

some cases, programs are carried out by parents or other

professionals. Various visual treatments may also be

combined, as in the case of ambient lenses and oculo-

motor exercises. Costs may be moderate and include

the optometrist’s fees for the initial and follow-up eval-

uations and cost of prescriptive eyewear.

Empirical Studies

Anecdotal data are plentiful; however, empirical

studies regarding the efficacy of visual therapies specific

to children with autism are limited. No published stud-

ies were found on the use of Irlen lenses or independent

use of oculomotor therapies for children with autism.

Three studies (all by the same group of researchers) in-

vestigating prism lenses were found (Carmody, Kaplan,

& Gaydos, 2001; Kaplan, Carmody, & Gaydos, 1996;

Kaplan, Edelson, & Seip, 1998).

The study by Kaplan et al. (1998) used the most

rigorous methodological design (double-blind cross-

over). It was an extension of the earlier pilot investi-

gation (Kaplan et al., 1996) and used 18 children with

autism (CA "7 to 18 years; M "11.53 yrs). Thirty-

nine percent had strabismus. All subjects were pre-

scribed prism lenses with modification determined

individually for the visual direction (base up or base

down) and angular displacement. Five subjects were lost

as a result of non-compliance with the eyewear. The re-

maining 18 were matched and randomly assigned to one

of the two conditions (placebo lenses or treatment with

prism lenses) for 3 months; then treatment conditions

were switched for the second phase (4 months). Pre-,

mid-, and post-treatment measures were taken for pos-

tural orientation, attention, and visual-spatial perfor-

mance tasks, as well as ratings of behavioral problems.

Results indicated short-term positive effects—behavioral

findings were most apparent at the mid-evaluation (1

⁄

or 2 months), with less improvement at follow-up (3 or

4 months). Performance on orientation and visual-

spatial tasks was not significantly different between

conditions. Given these findings, it is unclear what spe-

cific mechanisms were responsible for the behavioral

improvements because the visual performance mea-

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 413

sures were unchanged, at least in the context of the lab-

oratory tasks. Children were not engaged in simulta-

neous visual training tasks that are usually prescribed

in conjunction with prism lenses, which may have lim-

ited long-term effects. Treatment effects did not appear

related to whether or not the children had a prediag-

nosed strabismus; however, a slight trend toward more

behavioral problems during the clear lens (placebo)

condition for the strabismus subgroup was reported.

Unfortunately, the above results were less encour-

aging than those from the original pilot study (Kaplan

et al., 1996) and a more recent study (Carmody et al.

2001), both of which demonstrated significantly bet-

ter performance on orientation and visual-spatial per-

formance when children with autism were wearing

correct (“facilitating”) prism lenses. Carmody et al.

(2001) assessed responses to prism lenses for a conve-

nience sample of 24 children (2 girls, 22 boys) with

autism, ages 3 to 18 years, in Hong Kong. Optometric

evaluations revealed that 18 children had normal visual

acuity, 3 were far-sighted, and 3 were near-sighted. All

children were assessed on measures of spatial orienta-

tion/spatial management abilities with two functional

tasks (i.e., television viewing and ball catching) during

each of three visual assessment conditions: (1) habit-

ual viewing (no lenses), (2) eyeglasses with prisms using

base-up condition, or (3) eyeglasses with prisms using

base-down conditions. Both prism conditions used a mild

displacement of the visual scene (5.6 degrees); however,

one condition was judged to be the child’s favored or

correct condition (facilitating lenses) and one was judged

to be an incorrect condition (interfering lenses) based on

observational measures during the trials by the initial

rater. Assessments were videotaped. The full perfor-

mance assessments were then reviewed by an indepen-

dent rater, and results were analyzed statistically to

validate whether or not the facilitating condition was su-

perior. Results validated the initial rater’s assessment that

head position, body posture, facial expressions, and ball

catching skills significantly improved in the “facilitating

lens” condition as opposed to the habitual or interfering

lens conditions.

Differences in the ages of the samples and the rel-

ative strength of the methodological designs across the

three studies could have contributed to the inconsis-

tent findings. The Kaplan et al. (1996) and the Car-

mody et al. (2001) studies used considerably weaker

designs with relatively short trial periods across the

three assessment conditions (i.e., no lenses, incorrect

prism lenses or correct prism lenses). Replication stud-

ies by independent investigators, using well-controlled

designs and longer-term follow-up are needed. Likewise,

outcome measures used in naturalistic contexts are

needed to demonstrate generalizability of these findings.

Sensorimotor Handling Techniques

Description and Assumptions

Several types of sensorimotor handling techniques

(e.g., reflex integration, neurodevelopmental therapies,

patterning, etc.) have been applied to children with de-

velopmental disabilities. Neurodevelopmental therapy

(NDT) is a specific sensorimotor (physiotherapy)

treatment that originated with the Bobaths in England

in the 1950s–1960s. Its focus is on normalization of

muscle tone, integration of primitive reflexes, and fa-

cilitation of more normal movement patterns through

specific handling techniques. Sensorimotor patterning

is a remedial technique that uses a series of very struc-

tured, passively manipulated exercises to the limbs to

reprogram the central nervous system. Originally de-

signed by Doman and Delcato in the 1950s–1960s, this

treatment is based on an older and simplistic recapitu-

lation theory. Developmental gross motor patterns that

may have been “missed” (e.g., creeping or crawling)

are patterned passively for neurological reorganization.

Although it is not used extensively for children with

autism, there has been a recent resurgence of interest,

particularly as a last-resort therapy. Although cranio-

sacral (C-S) therapy (Upledger, 1996) is not a sensori-

motor treatment per se, it’s similarities to other

handling techniques combined with recent anecdotal

data of its increased use with children with autism war-

ranted inclusion in this paper. This osteopathic treat-

ment involves physical manipulation (e.g, repeated

treatments using gentle and noninvasive traction and

decompressions) to alleviate restrictions in the cranio-

sacral system.

Service Delivery Model and Approach

These interventions are administered individually

by persons trained in the procedures through attendance

in specialized workshops. Contact with the child must

be direct physical contact. Interventions may be short

or long term for NDT or C-S. Home programs for pat-

terning therapies are eventually carried out by families

and tend to be particularly long in duration (8 hours per

day for several months or years). Cost of treatments is

dependent on frequency and duration (therapists’ fees).

Empirical Studies

No empirical studies specific to autism or related

disorders (e.g., mental retardation) were found for NDT.

414 Baranek

From a clinical perspective, it appears that this treat-

ment is rarely applied in any systematic way for use

with children with autism unless other accompanying

and significant neuromotor problems are present (e.g.,

cerebral palsy). No empirical studies were found in peer-

reviewed journals for C-S. No empirical studies of sen-

sorimotor patterning were found specific to autism.

However, two older empirical studies with children with

mental retardation were found (Bridgman, Cushen,

Cooper, & Williams, 1985; Neman et al., 1974). Both

studies provide similar findings and limitations. In the

more rigorous study (Neman et al., 1974), the pattern-

ing group out-performed the other groups in visual com-

petence and mobility. On other measures, the patterning

group out-performed the passive control but not the al-

ternative intervention group; no measurable differences

were found in IQ, and no case made dramatic im-

provement on any measure. Results from methodolog-

ically weaker study (Bridgman et al., 1985) indicated

that the treatment group slightly out-performed the con-

trol group on language and socialization, whereas the

control group fared better in self-help skills. Given that

in both studies improvements were more pronounced in

the earlier assessments, it appears that findings may re-

flect early enthusiasm of participants. High drop-out

rates are particularly noted with this treatment method.

Physical Exercise

Description and Assumptions

Although physical exercise is included in many

regular education curricula, it is not systematically or

consistently utilized with children with autism. Health

benefits of various exercise programs have been touted,

including changes in physical as well as mental well-

being. Researchers have been interested in the appli-

cation of physical exercise particularly as it effects

maladaptive or self-stimulatory behaviors. Assumptions

frequently made are that aerobic exercise would di-

minish stress or modulate self-stimulatory or hyper-

active behavior through physiological changes related

to release of neurotransmitters such as acetylcholine or

beta-endorphins.

Service Delivery Model and Approach

Physical education programs are provided easily

via individual or group methods by teachers within an

educational curriculum given adequate physical space.

Frequency or interventions vary from multiple times

per day to not at all. The majority of research studies

conducted utilize approximately 15 minutes of treat-

ment time per day. The cost of providing services is

usually modest, although larger physical spaces are

often necessitated (e.g., running track or gym) in lieu

of expensive equipment (e.g., exercise bicycle).

Empirical Studies

Four studies of the efficacy of physical exercise

for children with autism were found (Kern, Koegel, &

Dunlap, 1984; Kern et al., 1982; Levinson & Reid,

1993; Watters & Watters, 1980). All of these studied

effects of antecedent exercises on self-stimulatory/

stereotyped behaviors using some variation of single-

subject designs with controls (e.g., alternating treat-

ments designs). Two of these studies also measured

aspects of academic and play tasks in children with

autism (Kern et al., 1982; Watters & Watters, 1980).

All studies found some beneficial, albeit short-lived,

effects of exercise for decreasing self-stimulatory be-

haviors and mixed findings for improving other simple

cognitive/play tasks. Effects were greater for more in-

tensive aerobic activity (relative to mild exertion). A

maximum effect was noted at about 1 to 1

⁄

hours with

attenuation over time. Limitations of these studies in-

cluded relatively small sample sizes, large variability in

the independent measures, and the potential confounds

of extra attention/social interaction that may have con-

tributed to the beneficial effects of the program. The

Watters & Watters (1980) study also concluded that

there was no evidence to support that decreases in self-

stimulatory behavior would automatically generalize to

improved academic performance. Two additional stud-

ies on general physical education effectiveness for chil-

dren with autism were found (Schleien, Heyne, & Berken,

1988; Weber & Thorpe, 1992). Weber & Thorpe (1992)

found that for older children (ages 11 to 15) greater

learning/retention of gross motor skills occurred in a

task variation condition. Schleien et al., (1988) found

that physical education activities in an integrated phys-

ical education class with typical children did not ap-

pear to significantly affect performance of motor or

play skills over a short term (9-week intervention).

Short treatment length or poor sensitivity of motor mea-

sures may have limited the findings. It is also possible

that general physical exercise and recreational activi-

ties do not necessarily generalize to improving social

play without specific play skills being taught within the

context of treatment.

Other Categories of Sensory or Motor

Interventions

Although searches were attempted for many other

specific sensory-motor intervention categories (e.g., de-

velopmental motor therapies, motor skills training,

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 415

compensatory approaches, etc.), no empirical studies

on autism were found. Clinical observation suggests

that providing developmental motor training (i.e., skills

training in hierarchically sequenced developmental

stages) and compensatory teaching strategies are com-

monly utilized approaches in many educational and

therapeutic programs for children with various diag-

noses; thus it was surprising to find so little. However,

it appears that these strategies are being provided as

part of a broader therapeutic consultation program or

via comprehensive educational models; thus empirical

data specific to these components may be obscured in

the literature. Future reviews may wish to address these

components more specifically.

SUMMARY OF EFFICACY OF SENSORY AND

MOTOR INTERVENTIONS

The theoretical strength of many sensory and

motor interventions, particularly sensory integration

(SI), rests on empirical findings that children with

autism indeed have measurable deficits in various sen-

sory processing and motor functions. Some of the treat-

ments reviewed (e.g., sensorimotor handling) provide

a questionable rationale for their use with children with

autism and have no empirical evidence to evaluate their

efficacy with this population. In particular, sensorimo-

tor patterning is based on an older neurological theory

that has been essentially disproven; several other pro-

grams based on sensory integration theory also suffer

from partially outdated assumptions and are being mod-

ernized. Although the sheer volume of studies was low

across categories reviewed, it was encouraging that sev-

eral new studies were conducted in recent years. Find-

ings from these studies were often mixed. Several

studies in the area of SI, sensory stimulation, auditory

integration training, prism lenses, and physical exer-

cise yielded some positive, albeit modest outcomes;

however, methodological constraints (e.g., use of small

and convenience samples, weak/uncontrolled designs,

observer bias, etc.) limit conclusive statements and gen-

eralizability of much of this work. In some areas, such

as AIT, a few well-controlled studies have been re-

cently conducted but with little overwhelming support

for the treatment.

The biggest limiting factor is that many studies

fail to directly link changes in the purported dysfunc-

tional mechanism (e.g., auditory sensitivity, visual dis-

tortions, vestibular dysfunction) to the functional

changes in behavior. Studies either provide outcome

measures of the proximate sensory behaviors (e.g., au-

ditory sensitivity, arousal, tactile defensiveness) or the

broader functional behaviors (e.g., social interactions,

play skills, academic performance), and rarely do they

link both in systematic and measurable ways. A few

preliminary studies of AIT and sensory stimulation

treatments have attempted this; however, the results are

still tenuous and inconsistent across studies, indicating

need for replications. Furthermore, it is still unclear

what specific processes may be responsible for the

gains reported, even in the studies that had reasonable

controls and sample sizes. Are treatment effects truly

reflective of the intervention, or are there other non-

treatment effects (e.g., parent’s expectations, matura-

tion, imposed structure, added attention, practice, etc.)

that influenced the results? Other aspects of the tasks,

not central to the treatment protocol, may also be pro-

ducing beneficial effects. For example, children in one

AIT study (Bettison, 1996) responded favorably under

both the treatment and the alternative condition, thus,

processed (filtered/modulated) music did not appear to

be the critical treatment component. Although music

“in general” may prove to be beneficial, an alternative

explanation could involve the repeated demands for

compliance and structured attention to task that are not

specific to auditory processing. Another AIT study

(Zollweg et al., 1997) demonstrated that both groups

improved but the control group outperformed the treat-

ment group on some measures, further questioning the

efficacy of the treatment. Similarly, one of the core

principles and strengths of classical sensory integration

is that the therapy is child-directed and based in an in-

dividualized play context. Thus, purported gains in en-

gagement and functional play skills may be influenced

by play coaching techniques employed by an expert

therapist as much as they are by improvements in sen-

sory processing per se. Only further research with ad-

equate specificity and controls (e.g., multiple baseline

conditions in single-subject designs) can tease apart the

effective from the noneffective components of these

interventions.

Given that autistic symptoms are manifested dif-

ferently across development and that heterogeneity

exists within the autism spectrum, it is likely that indi-

vidualized patterns of reactivity may be associated with

differential treatment outcomes irrespective of the in-

tervention category reviewed. Although outcomes for

individual children have been mixed, it is possible that

significant individual differences in subject character-

istics may be masking significant group effects. That is,

we don’t know which children will benefit the most

from which treatments and under which specific condi-

tions. Several studies in the areas of SI and sensory

stimulation indicated that specific sensory processing

416 Baranek

subtypes (e.g., hyper- versus hypo-responsive) and other

subject variables (e.g., age, developmental levels) may

affect prognosis for treatment outcomes. Though small

sample sizes and retrospective designs limit generaliz-

ability, there appeared to be some converging evidence

to suggest that a hyper-responsive pattern (i.e., high anx-

iety, arousal, or sensitivities) may be more amenable to

sensory techniques aimed at arousal modulation and re-

sultant gains in performance. Physiological studies of

arousal indicate that younger (or less mature) children

may have a higher tendency to display hypersensitive

reactions and reject sensory stimuli that interfere with

other aspects of functioning. If so, one implication of

these findings may be that perhaps beginning some

types of sensory-motor interventions at earlier ages

would be more beneficial. Some studies have only been

conducted with older children and adults (e.g., exercise

treatments), and these results cannot be generalized to

preschool populations. We cannot know the answers to

these types of questions until more systematic research

with increased specificity of subject variables is con-

ducted to help distinguish various levels of response to

treatments; however, these findings indicate that when

provided, sensory and motor interventions need to be

individualized for a given child with autism.

A further concern of this area of intervention is that

most of the studies provide limited follow-up after

intervention, and so it is not known whether positive

effects are sustained in the longterm. A few better-

controlled follow-ups have been included in some of the

AIT studies; however, in those studies in which positive

effects were noted initially, an attenuation of responses

occurred over time (over the course of 9 to 12 months).

These types of findings were also true for one study on

prism lenses and two on exercise treatments. This could

indicate that either the treatments were not useful in the

long term or, conversely, that more frequent application

of treatment is needed to maintain such effects. Repeated

treatments were certainly useful with exercise therapies

where physiological and behavior changes were sus-

tained for approximately 90 minutes following each

treatment. The effects of treatment frequency, duration,

and intensity on both short- and long-term outcomes

need to be further addressed.

Finally, issues of generalizability and feasibility

of sensory and motor interventions need to be addressed

more fully. The majority of studies across sensory and

motor treatment categories, particularly those con-

ducted less recently, have not attempted to investigate

broader issues of generalizability. Two SI studies were

conducted in naturalistic contexts and documented

some functional gains outside of the treatment context.

Others have been unable to prove that the intervention

has substantial effects on academic performance, beyond

the scope or context of the treatment per se. For exam-

ple, several exercise studies have demonstrated positive

effects on primary reduction of aberrant behaviors, but

more limited improvements in secondary effects on

academic skills, play, and recreation. AIT studies

demonstrate much variability across studies and lack of

replication for broader behavioral effects—in some

cases, control treatments produced stronger reductions

in aberrant behaviors. Gains in areas of mastery play and

engagement as a result of SI (i.e., Case-Smith & Bryan,

1999) are interesting to note; however, it is not sur-

prising that behaviors less directly addressed in the con-

text of therapy (e.g., peer interactions and functional

communication) show the least improvement. Without

direct practice in generalizing to functional tasks and

in naturalistic environments, the effects of therapeutic

gains in sensory processing or motor components may

be limited. Studies of motor development in typical

children have demonstrated that behaviors emerge from

the confluence of multiple dynamic systems; thus, task-

relevant information and perceptions of affordances in

the environment can substantially alter movement pat-

terns (Connolly & Elliott, 1989; Thelen & Ulrich,

1991), and motor skills learned in one context may not

automatically generalize to naturalistic functional ac-

tivities (Case-Smith, 1995). In fact, several studies have

found that performance of children with autism on goal-

directed motor and imitation tasks appears to be better

in meaningful and purposeful contexts than in decon-

textualized situations (e.g., Hughes & Russell, 1993;

Rogers, et al., 1996; Stone, et al., 1997). Thus one

would expect that difficulties in applying newly ac-

quired sensory or motor components to functional tasks

and/or generalizing motor skills learned out of context

would be magnified for children with autism.

The feasibility of carrying out specific sensory and

motor interventions varies tremendously and is depen-

dent upon such variables as cost, qualifications of

needed professionals, and congruence with the philo-

sophical orientation of the broader educational pro-

gram. With respect to cost, all treatments require

specialized training and varying amounts of staff time;

however, some require much more technologically so-

phisticated and expensive equipment (e.g., AIT, Hug

Machine, prism lenses) than do others (e.g., massage,

C-S). Some treatments (e.g., exercise therapies, some

SI-based approaches, prism lenses) are certainly more

easily administered within the context of inclusive ed-

ucational programs than other treatments (e.g., senso-

rimotor patterning). Of all the treatments summarized,

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 417

classical SI provides the strongest child-centered and

playful approach; this type of approach is often ap-

pealing to even the most unmotivated or disengaged

child. In the case of sensory stimulation treatments

(e.g., brushing, massage), AIT, patterning, and C-S, the

child must be able to tolerate various sensory applica-

tions or physical manipulations provided by the thera-

pist and usually in a restricted space. For some children

with autism, however, structure and repetition are not

necessarily aversive, although passive application of

stimulation may be; the effects on stress need to be doc-

umented better in future studies. No negative side ef-

fects have been reported in most of the literature

reviewed, with the exception of AIT, in which two stud-

ies documented increased behavior problems and some

adverse health effects with some children. In addition,

compliance has been an issue in several treatments,

such as limited tolerance for eyewear or headphones,

causing drop-outs from treatment.

Feasibility solutions, however, must go beyond

ease of integration and cost effectiveness, they must

also answer questions of best practice within the scope

of educational goals. Because most of these interven-

tions are used to augment comprehensive educational

programs, it is important to know whether or not these

treatments actually facilitate progress or hinder it by

taking away valuable instruction time. The effects of

specific sensory and motor interventions combined with

various types of educational models need to be further

investigated in large outcome studies. At least one case

study report of three preschool children (Schwartz

et al., 1998) indicates that there may be multiple means

to achieving promising outcomes in young children

with autism. Various combinations of specific inter-

vention strategies (including SI in one case) were in-

tegrated into the curriculum and produced positive

effects. Although classical SI therapy originated with

a clinic based, noninclusive model, newer approaches

are attempting to utilize a more naturalistic context with

sensory-based activities integrated into the classroom

routine. However, it will be important to investigate to

what degree specific treatments can be “altered” to fit

an inclusive education model while still retaining their

essential therapeutic elements and purported benefits.

Comparisons of such treatments need to be systemati-

cally investigated in future efficacy research.

As Rogers (1998) eloquently summarized in her re-

view of comprehensive educational programs, we must

keep in mind that a lack of empirical data does not infer

that the treatment is ineffective, but rather that efficacy

has not been objectively demonstrated. Funding will

be critical to this increasingly urgent investigation.

Relying on nonharmful but potentially ineffective treat-

ments can squander valuable time that could be used in

more productive educational or therapeutic ways. Given

that at least some positive findings are noted with re-

spect to the sensory and motor interventions reviewed,

future research must move from the current level of

small-scale, poorly controlled, unsystematic studies of

effectiveness, to a level that demands scientific rigor

and well-controlled large-scale designs. Only such re-

search can provide answers to important questions of

not only what is effective but with whom and under

what conditions.

RECOMMENDATIONS FOR EDUCATION

1. Although not all children with autism display

sensory processing and motor dysfunction,

these types of difficulties are prevalent in the

population and are reported to interfere with

performance in many broader developmental

and functional domains. Therefore, at a mini-

mum, “best practice” guidelines would indicate

that educational programs for young children

with autism need to incorporate appropriately

structured physical and sensory environments

that accommodate these unique sensory pro-

cessing patterns and provide opportunities for

developmentally appropriate sensory-motor

experiences within the context of functional

educational goals.

2. Comprehensive educational programs may ben-

efit from consultation with knowledgeable pro-

fessionals (e.g., occupational therapists, speech

and language therapists, physical therapists,

adaptive physical educators, etc.) to provide

guidance about potential interventions for chil-

dren whose sensory processing or motoric diffi-

culties interfere with educational performance,

as well as to provide support for families strug-

gling with these issues. It is important to note

that related services may provide many mean-

ingful interventions that go well beyond the

scope of this paper. Thus sensory and motor in-

terventions are not synonymous with the terms

for professionals employing these interventions

(e.g, occupational therapy, physical therapy, or

speech pathology); these terms should not be in-

terchanged when making decisions for provision

of therapeutic services.

3. It is important to note that none of the specific

interventions reviewed claim to be a substitute

418 Baranek

for core educational curricula. If and when uti-

lized, these should be viewed as supplementary

interventions integrated at various levels into the

broader individualized educational program.

4. Specific task/environmental modifications for

sensory processing or motoric deficits tend to be

described within the context of broader educa-

tional approaches or in combination with spe-

ciﬁc interventions more so than they are reported

in the empirical literature. For example, adapta-

tions may take the form of changing performance

expectations, modifying classroom activities to

minimize negative sensory reactions, perceptual

distortions or motoric difficulties, teaching com-

pensatory strategies, and/or maximizing the

child’s strengths to bypass sensory and motor

difficulties and facilitate fuller participation.

Such adaptations for sensory processing or motor

difficulties would be feasible in many educa-

tional programs and could be used in tandem

with other interventions.

5. Given the limited scientific basis of many of the

remedial sensory and motor intervention ap-

proaches reviewed in this paper, a conservative

approach is recommended for prescribing spe-

cific sensory or motor treatments. Best practice

would suggest that decisions be made on an in-

dividualized clinical basis by expert profession-

als. If indicated, it behooves the professional to

provide treatments in shorter-term increments

(e.g., 6 to 12 weeks) and document progress in

a systematic manner. Treatments need to be dis-

continued if effects are not apparent within an

expected time frame or if negative reactions are

documented. Certainly, regression in skills fol-

lowing discontinuation of services merits special

attention.

6. With respect to specific interventions, the fol-

lowing points are made:

a. Most categories of sensory and motor inter-

ventions, including SI, sensory stimulation

approaches, AIT, and prism lenses have

shown mixed effects for children with autism

primarily through uncontrolled, descriptive

studies; large-scale experimental studies are

often lacking. Furthermore, beneficial effects

of sensory and motor treatments on atypical

behaviors in some children have been shown

to be short-lived in several studies that fol-

lowed children longitudinally.

b. There is no available empirical evidence to

support the use of sensorimotor handling

therapies for general educational purposes

in young children with autism.

c. Potential risks of AIT (adverse side effects in

some cases, lack of safeguards for hearing

loss) need to be seriously weighed against the

potential benefits for each individual case

undergoing such an intervention.

d. SI and SI-based approaches appear to be rel-

atively safe and anecdotally have shown

some benefits in a few children with autism.

However, given the mixed findings across

uncontrolled, small sample studies, these

treatments need to be individually deter-

mined and carefully monitored until better-

controlled replication studies are completed

with children with autism.

e. Deciding how much to pull a child away from

his or her educational program is a difficult

decision, and thus providing treatments within

the context of an inclusive environment needs

to be addressed.

7. Given the variability in developmental profiles

of children with autism, it should be expected

that not all children benefit equally from sen-

sory or motor interventions. There is not a

“one-size-fits-all” treatment for a diagnosis of

autism. Thus the indiscriminate use of any sen-

sory- or motor-based intervention is unethical.

Comprehensive assessments should be the basis

for service decisions, and, if necessary, sensory

and motor interventions must be prescribed in

an individualized manner consistent with the

functional goals for each child.

8. Although, in general, intervention strategies

need to be developmentally appropriate, reme-

diation of component-level sensory processing

functions or developmental motor skills may not

automatically result in functional gains or gen-

eralize to relevant contexts. Thus, best practice

would suggest that functional activities inte-

grated into daily routines within naturalistic

contexts increase retention and generalization

of skills.

9. The paucity of available scientific research in

this area leaves many questions yet to be an-

swered. However, these preliminary findings

may provide direction for future studies. The

following are recommended:

a. Cross-sectional and longitudinal studies are

needed to document the developmental pro-

gressions of unusual sensory processing fea-

tures and qualitative motor functions and

Efﬁcacy of Sensory and Motor Interventions for Children with Autism 419

their relationships to broader behavioral and

educational outcomes.

b. Replication studies by independent investi-

gators are needed for all sensory and motor

treatment categories that have shown posi-

tive effects.

c. Methodologically more rigorous designs (e.g,

multiple baseline single-subject designs; ran-

domized controlled trials) with better-defined

intervention components (duration/course,

stimulus type/intensity/frequency, contextual

conditions) and more reliable/valid and sys-

tematic outcome measures are recommended

to directly test effects of a given treatment.

d. Studies that identify specific behavioral and

physiological patterns (individual differ-

ences) that differentiate responders from

nonresponders to specific treatments are

warranted.

e. Studies linking the purported neurological

mechanisms with both proximate measures

of the phenomenon and functional measures

of performance in broader domains (e.g., play

skills, social skills, academic performance,

independent functioning) are needed.

f. Studies providing information on earlier in-

tervention, preventive benefits of sensory

and motor interventions, and/or long-term

impact on educational programming and

functional outcomes of children in natural-

istic contexts should be encouraged.

g. Studies documenting the relative contribu-

tions of sensory or motor interventions

within comprehensive educational curricula

are needed because it is unknown whether

educational goals are facilitated or inhibited

by these various interventions.

ACKNOWLEDGMENTS

I extend my gratitude to Alice Blair, Angela Suratt,

and Lorin McGuire for their assistance in preparation

of this manuscript. I also thank Ruth Humphry, Linn

Wakeford, Cathy Lord, Sally Rogers, and Pauline Fil-

ipek for their helpful reviews. An earlier draft of this

manuscript was commissioned by the National Acad-

emy of Sciences, National Research Council’s Com-

mittee on Educational Interventions for Children with

Autism, and presented at the first committee meeting

in December of 1999.

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1001 Pediatric Treatment Activities: Creative Ideas for Therapy Sessions

Book

May 2024

SENSORY PROCESSING ISSUES AND OCCUPATIONAL ENGAGEMENT AMONG CHILDREN WITH AUTISM SPECTRUM DISORDERS

Article

Sep 2023

Children with Autism Spectrum Disorder (ASD) experience sensory processing issues, affecting their daily behaviour and functional performance. Occupational engagement is viewed as activities a person participates in which involve occupational performance and environmental factors. This study aims to identify impaired sensory processing and occupational engagement, the relationship with demographic profile, and the relationship between impaired sensory processing and occupational engagement among children with ASD. A total of 169 children with ASD from a centre in Sentul were recruited. School Companion Sensory Profile and the Short Child Occupational Profile (SCOPE) were used as the outcome measurements in this study. The research finding yields those children with ASD appear to experience some degree of processing issues in “avoiding” sensory patterns and appear to have significant challenges in “communication and interaction skills” in their occupational engagement. Sensory processing issues and activity engagement are also found to be a minimal to moderate relationship with the demographic profiles of the children. The study also concludes that sensory processing and occupational engagement among children with ASD are interrelated. The correlation coefficients range from r = -0.20 to r = -0.36 indicating a fair to moderate correlation between sensory processing and occupational engagement. These sensory processing issues significantly impact children’s life, which can be seen through their level of engagement in daily life activities. Information on sensory processing issues and occupational engagement allows one to identify successful intervention strategies.

Improved motor skills in autistic children after three weeks of neurologic music therapy via telehealth: a pilot study

Article

Full-text available

May 2024

Background Many autistic children experience motor skill deficits which can impact other areas of functioning, and research on therapeutic interventions for motor skills in autism is in a preliminary stage. Music-based therapies have been used extensively to address motor skills in non-autistic populations. Though a handful of studies exist on the effects of music-based therapies for movement in autistic children, none have investigated the possibility of administering sessions via telehealth. This mixed-methods pilot study investigated whether nine Neurologic Music Therapy (NMT)® sessions via telehealth would improve motor and attention skills in autistic children. Methods Five autistic children between five and 10 years of age participated in the study, with support from their caregivers. Motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency second edition, short form (BOT-2 SF), and a selective attention and sustained attention task were taken from the Test of Everyday Attention for Children, Second Edition (TEA-Ch2). Caregivers and the two neurologic music therapists involved in the study provided qualitative input about the perceived effectiveness of telehealth NMT for the children involved. Their responses were analyzed using qualitative content analysis. Caregivers also filled out a Sensory Profile 2 assessment prior to the onset of sessions so that each child’s sensory profile could be compared to their motor and attention results. Results Statistically significant improvements in motor skills were observed between pre-test assessment and a two-week follow-up assessment. Results from attention test scores were not significant. Caregivers and neurologic music therapists generally perceived sessions positively and noted the importance of having caregivers actively involved. When compared with individual progress on the BOT-2 SF assessment, sensory profile results revealed that children with fewer sensory sensitivities tended to improve the most on motor skills. The improvements in motor skills and positive caregiver and therapist views of telehealth indicate that NMT motor interventions administered via telehealth are a promising avenue of therapeutic support for movement skill development in autistic children.

Parents’ and professionals’ views on autistic motherhood using a participatory research design

Article

Full-text available

Apr 2024
CURR PSYCHOL

Research on autistic women’s experience of parenthood is lacking. In this paper, two studies are presented. Study 1 comprised a small-scale qualitative study with autistic mothers (n = 9) in which their experiences of motherhood were explored using thematic analysis. The findings showed that participants identified a range of strengths, including connection with their children, high knowledge about childhood, a reflective style of parenting, good coping strategies, identifying with their autism diagnosis, and not caring what others thought. They also identified difficulties, including sensory challenges, coping with uncertainty and change, having to socialise, managing exhaustion, and not being taken seriously by professionals involved with their children. Guided by the findings of Study 1, and in collaboration with an advisory panel of autistic mothers, an online survey using mixed methods was completed by education and social professionals (n = 277) to investigate their understanding of, and attitudes towards, autism in women and mothers. Results showed high awareness and positive attitudes towards autism, but low levels of self-efficacy in working with autistic adults. Qualitative content analysis of open-ended questions shed light on challenges and rewards of working with autistic parents. The findings are discussed with reference to the double empathy problem (Milton Disability & Society, 27(6), 883–887, 2012) and implications for training of professionals.

Autism Spectrum Disorder: Learning Environments

Chapter

Full-text available

Feb 2024

Autism spectrum disorder is one of the most strange neuro developmental disorders in which symptoms such as stereotypical habits and behaviors, social skills problems and odd verbal communication skills can be observed. According to the studies and researches, these kind of symptoms also characteristics such as sensory integration problems, empathy problems, odd cognitive and perceptual problems can be the main problems in the family and also the family members will be affected to the secondary psychological problems like anxiety and depression. One of the most problems which can be experienced by the autistic children’s parents and family is the academic problem and the quality of learning environment. Therefore in this chapter, we will discuss about the sensory integration process and the family-based programs which are necessary factors for theses children’s learning environment.

Efficacy of the sensory integration therapy on language development in autism spectrum disorder children

Article

Full-text available

Jan 2024

فاعلية الحمية الحسية في خفض السلوك النمط التكراري لدى الأطفال ذوي اضطراب التوحد " The effectiveness of the sensory diet in reducing repetitive behavior in children with autism disorderr

Article

Apr 2024

ا احمد خليل منصور ا.د عيد عبد الواحد

الحمية الحسية لأطفال التوحد sensory diet for autistic children

Article

Nov 2023

أ أحمد خليل منصور أ.د عيد عبدالواحد

Studying the Specificity of Research Reporting for Ayres Sensory Integration® Interventions in the Published Literature: A Scoping Review

Article

Jan 2024

Importance: A contributing factor to the gap between research publication and clinical implementation is the lack of specificity used when reporting findings. Objective: This scoping review used the Rehabilitation Treatment Specification System (RTSS) to determine which elements of specificity are most often present and omitted from research using Ayres Sensory Integration® (ASI). Data Sources: The following databases were searched: PubMed, CINAHL, PsycINFO, Cochrane Library, and ERIC. Study Selection and Data Collection: Eligible studies used ASI in an outpatient setting with children who had sensory integration or processing difficulties. Studies selected were quantitative (Level 1, 2, 3, or 4), available in full text, peer reviewed, and published in English within the past 20 yr. Findings: Of the 22 studies that met inclusion criteria, 100% included ingredients (actions of the therapist), 63% included mechanisms of action (reasoning behind these actions), 86% included targets, and 23% described client progression. We also found that 49% of all ingredients were listed in conjunction with a target, 15% were listed in conjunction with a mechanism of action, and 11% were listed in conjunction with both a target and a mechanism of action. Conclusions and Relevance: Findings indicate that many studies list ingredients but often omit the mechanism of action. This omission makes replication of the intervention increasingly difficult and prevents a deeper understanding of the clinical reasoning process behind the intervention. Plain-Language Summary: Gaps identified in this scoping review highlight inconsistencies in the reporting of treatment specificity that may affect the replication and translation of Ayres Sensory Integration® (ASI) research into practice.

USING THE SENSORY INTEGRATION TECHNIQUE FOR PEOPLE WITH AUTISM SPECTRUM DISORDERS DURING TRAINING AT THE CLIMBING SECTION

Article

Oct 2023

Aim: To analyze the practical application of the sensory integration technique for individuals with autism spectrum disorder at a climbing section, and to investigate the impact of physical activity on improving their proprioceptive and vestibular systems. Materials and Methods: The method of included participant observation at the climbing classes with constant recording the behavior (desirable and undesirable) was used. The sensory screening (developed by J. Ayres) was applied for recording and determining the sensory systems of the people with ASD before the start of training and again after a month. The scale of Sensory Integration and Praxis Tests (SIPT) was used for assessing certain aspects of participants’ sensory processing or perception according to the goals set during the climbing classes. Results: The results of the research showed that the application of the sensory integration technique for individuals with ACD at a climbing section promoted the dynamics of changes in their sensory system during training considering the characteristics of their sensory system. The positive changes were observed in the way the people with ACD felt about their own bodies and their involvement in sports activities that in its turn made it possible to be active and develop their sensory system. It has been identified that while planning training for the people with ASD it is necessary to take into account sensory modulation (reading sensory signals) and apply exercises for stimulating sensory sensations that will improve the motor activity of persons with ASD, their social interaction, and safety, as well. Conclusions: During training at the climbing section sensory information processing of the individuals with ASD have the impact on their body control, hand-eye coordination, and hand sensitivity during training. The improvement of sensory information processing in its turn enables people with ASD to master climbing.

Optimal stimulation: A model of disordered activity and performance in normal and deviant children

Article

Full-text available

Nov 1983

There is considerable evidence that organisms can moderate incoming sensory stimulation so as to more closely approach optimal levels of arousal. When normal individuals are exposed to unusually high or low sensory input they tend to show "disordered" behavior similar to that of certain chronically disordered populations, for example, hyperactive and autistic children. It is proposed that at least some of the deviant behavior displayed by such disordered children represents a functional set of homeostatic response to condition of abnormal sensory input. Attempts to correct chronic imbalances in arousal through antecedent manipulations of chemical and sensory stimulation have been relatively successful and may provide not only appropriate treatment but also a better understanding of the mechanisms underlying many kinds of disordered behavior.

Integrating Physical Education to Teach Appropriate Play Skills to Learners with Autism: A Pilot Study

Article

Jul 1988

This pilot study attempted to determine the effects of a collaborative sociomotor, adapted physical education/therapeutic recreation curriculum on the social play and motor development of learners with autism and their nonhandicapped peers in an integrated physical education classroom setting. Six students with autism, ages 4-12, participated with 50 nonhandicapped peers in a 9-week, twice weekly, physical education class at a public elementary school. All participants received training as 'Special Friends' as well as instruction in the curriculum which included a variety of lifelong recreation and physical education activities designed to teach social skills and fundamental motor skills. Results of t tests indicated significant reductions in inappropriate play behavior for the younger group at the parallel and cooperative/competitivedyad social levels of play. Although no other significant changes in participants' behaviors occurred, the following observations indicated increased involvement in the activities by the participants: (a) reduced inappropriate play behavior, (b) reduced target inappropriate behaviors, and (c) development of motor proficiency in catching and striking skills.

The evaluation of sensorimotor-patterning and the persistence of belief

Article

Jan 1985

An overview of craniosacral therapy: Its origin and its applications for newborns and infants

Article

Jan 1996

John E. Upledger

CranioSacral Therapy is a gentle and noninvasive, hands-on modality that research has proven effective to identify a number of disorders affecting children, such as dyslexia, hyperkinetic behavior, and motor-control problems. CranioSacral Therapy also is effective in alleviating many of these conditions when they are caused by restrictions to the craniosacral system, which operates as a semiclosed hydraulic system encompassing the brain and spinal cord. The author concludes that the few minutes necessary to conduct a craniosacral system evaluation in the delivery room, nursery, or shortly after birth is a worthwhile investment in the child's future health and well-being.

The Tomatis Method with Severely Autistic Boys: Individual Case Studies of Behavioral Changes

Article

Mar 2001
S AFR J PSYCHOL

JM Neysmith-Roy

Six severely autistic males ranging in age from 4 years to 11 years received the Tomatis Method to assist in alleviating the severity of behaviours contributing to the diagnosis of autism. Ten minute video samples were taken of each boy, under two conditions of play, every time he completed one section of the treatment programme. As measured by the Children's Autism Rating Scale (CARS) all of the boys were severely autistic at the beginning of treatment. Three (50%) of the boys demonstrated positive behavioural changes by the end of the treatment. One boy was no longer considered to be autistic, two boys showed mild symptoms of autism and three boys remained within the severely autistic range. Of particular interest were the changes that occurred in pre-linguistic areas for five of the six boys. These included Adaptation to Change, Listening Response, Non Verbal Communication, Emotional Response and Activity Level. These behaviours are considered prerequisites for successful verbal communication. The children who demonstrated behavioural change were 6 years of age or younger at the beginning of treatment. The author suggests that the Tomatis Method may be helpful in making prelinguistic behaviours manageable and thus help prepare the child to learn basic skills necessary for the development of language and learning.

The Effects of Exercise Intensity on the Stereotypic Behaviors of Individuals with Autism

Article

Jul 1993
ADAPT PHYS ACT Q

The effects of exercise intensity on the stereotypic behaviors of three subjects with autism were examined. Two exercise programs of different intensities were implemented. The mild exercise program involved 15 min of walking, and the vigorous program involved 15 min of jogging. The frequency of stereotypic behavior was measured prior to exercise, immediately following exercise, and 90 min following exercise. The results indicated that significant reductions in stereotypic behaviors occurred as a function of the vigorous exercise condition only. The mean reduction of stereotypic behaviors between prejogging and postjogging was 17.5%. However, the duration of these reductions was temporary. Increases to preexercise levels were noted in stereotypic behaviors 90 min after exercise. The stereotypic behaviors of subjects were categorized into three components: motor, vocal/oral, and other. The motor component was most common. The mild exercise condition had little effect on the motor component; the vigorous condition resulted in a mean reduction of 17%.

Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses

Article

Jan 1997

Clinical Evaluation of the Effectiveness of Sensory Integrative and Perceptual Motor Therapy in Improving Sensory Integrative Function in Children with Learning Disabilities

Article

May 1993

After 72 1-hour therapy sessions for 3 hours per week, significantly more subjects, aged 58 to 107 months, receiving sensory integration therapy (n=35) and perceptual motor training (n=35) than those receiving no treatment (n=33) showed improvement in their sensory integrative functioning. The same effect was found for a subgroup of children exhibiting vestibular dysfunction only. Improvement could include an increase of all test scores defining a child's particular dysfunction into the normal range with associated clinical observations indicating no problem, or a reduction in the severity of a child's dysfunction, the number of their dysfunctional systems, or both severity and dysfunctional systems. The groups did not differ in the incidence of any one of these individual types of improvement, but only in their overall improvement represented by the total of all types. Discussion focused on the type and degree of improvement therapists can expect from treatment and problems associated with evaluating outcome.

The Effects of Auditory Integration Training on Autism

Article

May 1994

The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.

The Efficacy of Auditory Integration Training: A Double Blind Study

Article

Nov 1997

The present study evaluates the efficacy of auditory integration training (AIT) in a population with multiple handicaps using a double blind experimental design. Thirty residents of a habilitation institute who had multiple handicaps received AIT over a 10-day period. Changes in hearing sensitivity and loudness tolerance, as measured audiometrically, and behavior, as measured by the Aberrant Behavior Checklist (ABC), were evaluated at discrete intervals from 1 week to 9 months post-AIT. Post-AIT data were then compared to pre-AIT data to determine if changes occurred in either hearing or behavior that could be attributed to the experimental stimulus (AIT). We found no significant difference in hearing threshold or loudness tolerance following AIT. Slight improvement in behavior was seen in both the treatment group and the control group, suggesting that factors other than AIT were responsible for behavioral improvement.

Efficacy of Sensory and Motor Interventions for Children with Autism

Abstract

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