Sensory interventions for children with autism.

Abstract

Difficulty processing, integrating and responding to sensory stimuli (hereafter referred to as sensory difficulties) have been described as a feature of autism spectrum disorders (ASD) since the disorder was first identified [1]. Current estimates show that between 45 and 90% of children with ASD demonstrate these sensory difficulties and that they range from over and under reactivity to poor perception and discrimination of sensation [2–4]. Sensory difficulties are now included in the DSM 5 under the restricted, repetitive patterns of behavior, interest or activities criteria [5]. Families report that these sensory difficulties create social isolation, restrict participation in daily activities, and impact social engagement for them and their child [6–8]. Consequently, interventions to address sensory difficulties are among the most often requested and highly rated interventions by parents of children with ASD [9–11]. Survey findings report that over 60% of children with ASD receive some type of sensory intervention. Although sensory interventions are common for ASD, a wide range of protocols are implemented with conflicting evidence of efficacy. In this editorial, we explain the types of sensory interventions practiced and evidence of their efficacy. As found in the literature and in practice, sensory interventions utilize a variety of sensory modalities (e.g., vestibular, somatosensory, auditory and multisensory); target behaviors that may or may not be associated with sensory difficulties; involve a continuum of passive to active child participation; and are applied in different contexts. Many authors have inaccurately used the term sensory integration therapy (SIT) to describe sensory-based interventions (SBIs) and these variations in intervention protocols, combined with inconsistent use of terminology and conflicting findings, has resulted in considerable confusion for parents, practitioners and researchers [12,13]. SIT is an occupational therapy intervention that uses individually tailored, sensoryrich activities in a child-directed, playful and interactive manner to facilitate adaptive responses and functional behaviors [14–18]. When using SIT, occupational therapists individually tailor intervention goals and activities to the child’s needs based on a thorough assessment of the sensory-motor factors that may be impacting participation in desired activities and skill development. The specific principles of SIT target improving the child’s adaptive responses as a foundation for higher level skills [19,20]. By contrast, SBIs are adult-directed sensory strategies designed to address sensory over or under reactivity and facilitate behavioral regulation. SBIs are prescriptive rather than interactive in nature [21,22]. Examples of SBI include wearing a weighted vest, brushing, sitting on a therapy ball or applying multisensory stimulation using a highly structured protocol [23–26]. SBIs have often been implemented without assessment of the child’s sensory needs, providing child choice or adapting the activity according to the child’s responses [24,23,27]. A recent review of SIT and SBI for children with ASD found that SITs have emerging positive evidence while SBIs have mixed part of Sensory interventions for children with autism