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Background/Aim: Sensory-based interventions, including sensory integration therapy (SIT), are one o f the
m ost highly requested and provided services fo r children w ith autism spectrum disorders (ASDs). A lthough
SIT is predom inantly provided b y occupational therapists, other service providers, including speechlanguage pathologists, are expected to understand and, on occasion, are requested to integrate SIT Into
their treatment. The purpose o f this study was to determine whether: (a) SIT im proved the communication
skills o f children w ith autism, specifically spontaneity, complexity o f utterance, and engagement; (b) effects
continued follow ing the provision o f SIT; and (c) effects were consistent across young children w ith autism
w ith different learning profiles.
Methods: A single-subject applied behaviour analysis design was im plem ented to assess the effectiveness
o f SIT on verbal spontaneity, gram m atical complexity (measured through mean length o f utterance) and
engagem ent in fo u r young children w ith ASD, measuring each area before, during and a fte r SIT. The effects
o f sensory integration intervention were measured by comparing each participant's expressive language and
engagem ent in a no-treatm ent phase (A phase) to those same skills in the treatm ent phase (B phase).
Conclusions: Results fro m this sm all stu d y indicate th a t the SIT c o n d itio n (occupational therapy)
y ie ld e d b e tte r co m m u n ica tio n a n d engag e m e n t than the co n d itio n im m e d ia te ly p rio r (preo ccu p a tio n a l therapy); therefore, specific com ponents o f SIT n eed to be examined, p a rticu la rly issues
o f m o tiv a tio n a n d m o m e n tu m .
Key words: Autism Sensory integration therapy Sensory-based interventions Speech-language pathology
Janet Preis is a
speech-language
pathologist at Loyola
University MD\
Meaghan McKenna
is a speech-language
pathologist at Loyola
University MD
Correspondence to:
Janet Preis
e-mail:
jpreisl@ loyola. edu
476
Submitted 17 February 2014, sent back for revisions 7 July 201 4;accepted for publication following double-blind peer
review 22 September 2014
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477
C a s e s tu d y
A IM
M ETH O D S
Participants
Design
< Protocol
ABA: applied behaviour analysis; OT: occupational therapy; SS: summer school;
ST: Speech-language therapy
^Pseudonyms
479
Case study
T-score (M eanSD=50+10)
Percentile
Visual reception
25
Fine m o to r
23
Receptive language
39
14
Expressive language
27
Gross m o to r
N.A.
N.A.
Percentile
66
Expressive language
65
Total language
62
Percentile
100
50
103
58
Socialization do m ain
83
13
111
77
99
47
Percentile
69
Expressive language
74
Total language
69
Percentile
Full scale IQ
114
82
hhhhhi
N on-verbal IQ
115
Percentile
Picture vocabulary
25
10
50
mm
Oral vocabulary
11
63
37
Percentile
C o m m u n ic a tio n do m ain
104
61
93
32
75
84
14
86
18
Percentile
65
89
Percentile
67
Percentile
50
Expressive language
Total Language
480
50
f ; 50
b h b
1
Adam
Eating (2/7)
in te g ra tio n skills
Colin
S w in ging (4/7)
Josh
Eating (3/3)
Sensory in p u t (0/3)
S w inging (2/3)
Victor
a 2x2 inch picture, w ith m inim al verbal cues, a fte r 10 m inutes o f structured
Eating (1/6)
Fine m o to r: b u tto n in g
Sensory in p u t (0/6)
com p le tin g d ra w in g and c o lou ring tasks; inde pen den tly stabilising paper by
S w inging (5/6)
RESULTS
481
C a s e s tu d y
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Table 4. Mean score, standard deviation and mean rank across conditions
Pre-OT
OT
Post-OT
Mean (SD)
Mean rank
Mean (SD)
Mean rank
M (SD)
Mean rank
Spontaneity**
92.42 (8.28)
1.21
99.71 (0.48)
2.43
99.28(1.49)
2.36
MLUf
2.60 (0.40)
1.29
3.23 (0.42)
2.71
3.02 (0.38)
2.00
Engagement1
95.85 (2.03)
1.00
99.28(1.25)
2.64
99.00(1.00)
2.36
Spontaneity
75.2 (19.05)
1.50
83.25 (8.6)
2.00
85.5 (10.34)
2.50
MLU*
1.81 (0.29)
1.50
2.40 (0.09)
3.00
1.90 (0.18)
1.50
Engagement
96.75(2.36)
1.50
99.75 (0.5)
2.50
95.5(7.0)
2.00
Spontaneity
99.3 (9.86)
1.67
99.0(1.73)
1.83
100 (0.00)
2.50
MLU
3.04 (0.70)
1.33
3.53 (0.31)
3.00
3.18(0.30)
1.67
Engagement
93.3 (9.86)
1.83
94.66 (3.78)
2.00
96.0 (3.60)
2.17
Adam
Colin
Josh
Victor
Spontaneity
65.3 (26.38)
1.67
78.83 (8.42)
2.08
79.83 (7.93)
2.25
MLU
1.69 (0.23)
2.00
1.86 (0.39)
2.33
1.64 (0.32)
1.67
Engagement
87.16(1.60)
1.00
98.33 (2.42)
2.33
99.00 (2.44)
2.67
OT
Post-OT
Pre-OT to OT
OT to post-OT
Pre-OT to post-OT
Z-score (d)
Adam
Spontaneity
95 (75-100)
100 (99-100)
100 (96-100)
-2.20* (1.24)
-0.38 (0.39)
-2.19* (1.15)
MLU
2.44 (2.25-3.38)
3.33 (2.54-3.72)
3.02 (2.32-3.49)
-1.69* (1.54)
-1.86* (1.07)
-1.35 (1.07)
Engagement
96 (93-99)
99 (97-100)
99 (98-100)
-2.38* (2.03)
-0.37 (0.25)
-2.37* (1.97)
Spontaneity
N.A.
N.A.
N.A.
N.A. (0.54)
N.A. (0/24)
N.A. (0.67)
MLU
1.83 (1.44-2.14)
2.40 (2.29-2.51)
1.88(1.71-2.15)
-1.86* (2.75)
-2.02* (3.51)
-0.36 (0.34)
Engagement
N.A.
N.A.
N.A.
N.A. (1.76)
N.A. (0.86)
N.A. (0.24)
Colin
Josh
Spontaneity
N.A.
N.A.
N.A.
N.A. (0.04)
N.A. (0.82)
N.A. (0.10)
MLU
N.A.
N.A.
N.A.
N.A. (0.90)
N.A. (1.15)
N.A. (0.26)
Engagement
N.A.
N.A.
N.A.
N.A. (0.18)
N.A. (0.36)
N.A. (0.36)
Spontaneity
N.A.
N.A.
N.A.
N.A. (0.69)
N.A. (0.12)
N.A. (0.74)
MLU
N.A.
N.A.
N.A.
N.A. (0.53)
N.A. (0.62)
N.A. (0.18)
Engagement
86.50(86.0-90.0)
99.5(94.0-100.0)
100.0(94.0-100.0)
-2.21* (5.44)
-1.34(0.27)
-2.21* (5.73)
Victor
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DISCUSSION
483
C a s e s tu d y
f
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S
Limitations
CONCLUSIONS
485
C a s e s tu d y
KEY POINTS
The core elements of sensory integration therapy (SIT) hold valuable
lessons for the speech-language pathologist in its multifaceted approach to
engagement and m otivation
In the present small study, all o f the participants performed best in the
occupational therapy (OT) or post-OT conditions fo r spontaneity, complexity
o f utterance, and engagement; and the w orst in the pre-OT condition, a
possible rationale fo r its inclusion in communication therapy
Continued research is needed on which elements o f SIT are most responsible
fo r improvements in communication: motivation, physicality or scaffolding
486
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