Running Head: EVIDENCE PAPER

Evidence Paper
Ryan Hua and Carol Mitchell
Touro University Nevada

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Introduction

It is common to see young children with diagnoses such as ADHD, autism, and
intellectual disabilities putting inappropriate items into their mouth. They have a tendency to
chew on objects within their reach such as toys, clothing, cups, crayons, and fingers. During
level one pediatric field work, a two and a half year old boy was unable to participate in many
age appropriate activities due to the fact that he put everything that he touched into his mouth.
His mother showed concern for his safety, as well as his participation in play. Therefore, a
research question was developed to provide the parent with further information regarding an
intervention to help this young boy participate in play without placing inappropriate objects into
his mouth.
Research Question
Does the use of sensory chewy sticks help decrease the amount of mouthing inappropriate
objects?

How does this study relate to your research question?

The study relates to the research question in that the study is looking into the
effectiveness of using a chewy for children with different diagnoses and different uses of the
chewy.
What is the purpose of the study?
The purpose of the study is to provide evidence that the use of a chewy provides a
calming, focusing, and organizing function. Additionally, to provide evidence that a chewy may
provide a sensory alternative to children that put non-edible items into their mouths.
Where research questions asked? If so, what are the research questions?
No research questions were asked in the study.

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What is the study design/ type of qualitative research?

The qualitative research study type is phenomenology. The researcher used a descriptive
study of how individuals experience a phenomenon.
What is the theoretical perspective of the researcher for this study?
For this study there was one sole researcher. The researcher in this study did the literature
review, was the occupational therapist in the case studies presented, and analyzed the results for
the study.
How were the participants recruited and selected?
Over a two year period, 58 children enrolled in the occupational therapy program in the
Cincinnati Public School System were observed in their use of a chewy during therapy sessions.
Of the 58 students, 29 used the chewy inconsistently, and three did not use it at all. Another 19
children were found to use it consistently during every therapy session. Seven children used it
consistently and so intently and vigorously in therapy that these seven children became the focus
of the study. The researcher then chose three of the seven children to be discussed in this study.
How many participants were in the study?
In the research study, three of the seven children are discussed in the case study. The
three children were chosen because they presented to be very different in age, problem areas, and
their parents readily gave consent to be part of the study.
How are the participants described?
The participants are described in great detail. The descriptions include diagnosis,
assessments, testing, symptoms, concerns, use of the chewy, and results. The participants include
a 10-year-old boy with tactile defensiveness, a 5-year-old boy with motor planning deficits and

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an under responsive vestibular system, and an 8-year-old boy diagnosed with autistic like
tendencies.
What is the relationship of the researcher to the participants?
The researcher is the participants school based occupational therapist. The researcher has
worked with some of the participants for the past two years.
What are the sources for data?
There were 58 children enrolled in the occupational therapy program and they were observed
with their use of the chewy during therapy sessions. All of these students were identified as
having a learning disability or behavior disorder. The occupational therapist used a sensory
integrative approach and the children participated in therapy sessions two times a week. Some
were in the program for two years while other children were recently enrolled. A chewy was
offered to use during therapy sessions as well as one to use at home. Of the initial 58 children,
three children were chosen for this review.
How are the findings reported?
The findings were reported using a case study format. Three of the seven children that used
the chewy were discussed in the case studies. The information provided in the case study was
obtained by observations of the therapist, information from school records, classroom teachers,
and interviews with the children and their mothers.
What are the findings?
The findings included that the use of a chewy provides a calming, focusing, and organizing
function. A chewy may provide an appropriate sensory alternative to children seeking oral input.
In some cases, a chewy appears to have dual uses such as relieving stress and frustration,
calming effects, sensory substitute, and to be a moderate exercise.

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How do the findings relate to previous research as described in the literature review?
The researcher attended a workshop by Wilbarger and Royeen called, Sensory affective
disorders: Beyond tactile defensiveness. At the workshop, Wilbarger suggested that the use of a
rubber tubing in the mouth to bite and chew on will help a person organize his or her nervous
system and decrease stress. The author relates her findings to previous research on other oral
stimulation such as the use of a pacifier, nonnutritive sucking, thumb sucking, and gum chewing.
It is also suggested in another study that telling a child to stop sucking on their thumb usually
creates other negative behaviors. Therefore, by using a chewy or some type of oral stimulus to
manage the childs sensory seeking fixations is more successful, than not completely removing
the stimulus.
Does the author state any clinical implications for the findings?
The author states that school-aged children with learning and behavioral problems used a
therapeutic tool called a chewy that appeared to have calming, organizing, and focusing effect
on the child. It also was found to be a sensory alternative for children who put non-edible items
in their mouths.
What are the limitations that the author identifies?
The author states that its not known what kinds of changes would have been made had the
children only used their chewy without receiving therapy. The effects of maturation were not
controlled in this study. Another possible limitation is the sample size. The researcher only
included three participants in the study. Another limitation address in the study is the appearance
of the chewy in the childs mouth. Initially, several teachers and parents commented on the
strangeness of seeing a child chewing on a rubber tube. Taste of the chewy is another possible
drawback as some children in the study did not like the taste. The tube must also be durable

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enough to withstand any tearing or breakage. Small pieces could be choked on or swallowed.
The tube of the chewy was created to be big enough so that the child could not swallow it. If the
chewy is any smaller than 12 inches long and a quarter inch in diameter, it could provide a
choking hazard. Monitoring the child during the use of the chewy is crucial. Lastly, sanitation of
the chewy must be considered.
Does the author discuss implications for future research?
Growth and development can bring about changes in behavior and in social and emotional
development. Because of this, the author states that a quantitative research study could determine
to what extent the factor of maturity would have on the use of such therapeutic tool as a chewy.
The author mentions in the article that further empirical documentation of the effectiveness of a
chewy is needed. Both quantitative and qualitative studies would help to further document the
positive effects and aid in understanding of this therapeutic tool.
What are potential sources of bias on the part of the researcher? Did the researcher
describe methods for avoiding bias?
The author does not state potential biases or methods to avoid biases throughout the study.
However, the author was the researcher and occupational therapist that led the study, which in
turn may produce a bias.
Is there a rationale for the participant selection? Are the participants credible
(believable)?
As an occupational therapist the researcher observed the use of the chewy with multiple
children in her practice. The overwhelming acceptance and repeated use of the chewy prompted
her to complete this study. She had a sample size readily available to her in her own practice;
therefore she chose to use the seven children that consistently used the chewy as her sample size.

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How does the researcher use methods to establish trustworthiness of the data? Do these
methods seem adequate?
The use of a chewy was observed for two years in an occupational therapy program which
lead the researcher to do this review. The researcher also had a conference with some of the
parents to review the purpose, use, and precautions when using the chewy. These methods
would be adequate if the researcher had a conference with all the parents participating in the
study instead of just some of them. Also, the researcher only used three participants for this
review which is not adequate to obtain sufficient evidence.
Are the themes presented consistent with the data presented? Do the conclusions make
sense to you or do you think the researcher was reading into the findings (or trying to find
what he/she wanted to find)?
The themes presented in this study were consistent with the data given. The themes
determined showed that the use of a chewy does promote calming, organizing, and focusing
effects. It also showed that a chewy provides a sensory alternative for children who put nonedible items in their mouths. The results are conclusive with the researchers hypothesis;
however, due to the extremely small sample size there is speculation that the researcher only
included participants that agreed with the hypothesis.
Was the researcher flexible in the data collection process? Did he/she allow the data to
guide the process?
The researcher observed the use of the chewy for two years. Due to the overwhelming
positive response to the chewy, the researcher determined the need of further research. This
facilitated the researcher to observe and collect data from her own clients on the use and

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diagnoses appropriate for the use of chewies. However, the researcher only reported the findings
for three of the 58 clients observed which demonstrated some control on the reported results.
How would you use this article as a therapist?
A therapist could use this article as a starting point for their personal research on the
topic. The information presented in this study will provide the therapist with guidance on the
types of children and types of behaviors that the chewies have been successful with. A therapist
would note the sample size and that a chewy may not provide the same results for their clients as
it did in the study. A therapist must provide an explanation, a rationale, and the expected
outcomes when recommending a chewy to a parent and child. Therefore, this article alone would
not fulfil the requirements needed and a therapist would need to seek other studies done on the
topic to feel comfortable recommending the chewy to a family.
How does this article support/not support participation in occupation and the field of
occupational therapy?
This article was written by an occupational therapist working in the Cincinnati public
school system. The researcher used her own students as participants for the study. She expressed
her personal experience using the chewy and how she found it to be a therapeutic tool in the
classroom. The study and researcher support participation in occupation by providing children
with a sensory substitute, the chewy, during activities where they would normally place
nonedible items in their mouths. For example, if a school aged child that chews on his pencil,
shirt, desk, or glue stick while in the classroom is given a chewy, he will chew on the chewy to
meet his sensory seeking sensation rather than the non-edible items. This will provide the student
with confidence, attention, and relief of his sensory needs. The researcher also talks about
experience working with children that are hyperactive, easily distracted, low frustration

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tolerance, and the affects the chewy has on their behavior in the classroom. This articles main
focus is to find a way to provide children with a functional and safe way to manage their oral
sensation seeking behaviors in the classroom and during play which are the main occupations of
children.

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References

Scheerer, C.R. (1992). Perspectives on an oral motor activity: The use of rubber tubing as a
chewy. The American Journal of Occupational Therapy, 46(4), 344-352.