Sensory Integration a Review of the Current State of the Evidence

• Journal List
• Front Integr Neurosci
• v.14; 2020
• PMC7726187

Front Integr Neurosci. 2020; xiv: 556660.

Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis

Stephen Camarata

^oneDepartment of Spoken communication and Hearing Sciences, Bill Wilkerson Center, Vanderbilt University School of Medicine, Nashville, TN, United States

Lucy Jane Miller

²STAR Constitute for Sensory Processing, Greenwood Hamlet, Centennial, CO, Us

ⁱⁱⁱSchool of Medicine, University of Colorado, Denver, CO, United states

Mark T. Wallace

¹Department of Oral communication and Hearing Sciences, Bill Wilkerson Center, Vanderbilt University Schoolhouse of Medicine, Nashville, TN, U.s.a.

^fourGraduate School, Vanderbilt University, Nashville, TN, Us

Received 2022 Apr 28; Accepted 2022 Oct 9.

Abstruse

For more fifty years, "Sensory Integration" has been a theoretical framework for diagnosing and treating disabilities in children under the umbrella of "sensory integration dysfunction" (SID). More than recently, the approach has been reframed every bit "the dimensions of sensory processing" or SPD in place of SID, so the review herein describes this commonage framework as sensory integration/sensory processing treatment (SI/SP-T) for ASD. This review is not focused on diagnosis of SI/SPD. Broadly, the SI/SPD intervention arroyo views a plethora of disabilities such as ADHD, ASD, and disruptive behavior equally being exacerbated by difficulties in modulating and integrating sensory input with a primary focus on contributions from tactile, proprioceptive, and vestibular systems which are hypothesized to contribute to core symptoms of the conditions (e.grand., ASD). SI/SP intervention procedures include sensory protocols designed to enhance tactile, proprioceptive, and vestibular experiences. SI/SP-T procedures utilize equipment (e.thousand., lycra swings, balance beams, climbing walls, and trampolines), specific devices (due east.one thousand., weighted vests, sensory brushes) and activities (eastward.g., placing easily in messy substances such as shaving cream, sequenced movements) hypothesized to enhance sensory integration and sensory processing. The approach is reviewed herein to provide a framework for testing SI/SP-T using widely accepted clinical trials and result coding methods used in applied behavior analysis (ABA) and other behavioral interventions. Also, a related but distinct neuroscientific epitome, multisensory integration, is presented as an independent examination of whether SI/SP-T differentially impacts sensory integration and/or multisensory integration. Finally, considering SI/SP-T activities include many incidental behavioral events that are known as developmental facilitators (due east.g., contingent verbal models/recasts during verbal interactions), there is a compelling need to control for confounds to study the unique touch on of sensory-based interventions. Note that SI/SP-T includes very specific and identifiable procedures and materials, so it is reasonable to expect high treatment fidelity when testing the arroyo. A patient case is presented that illustrates this confound with a known facilitator (recast intervention) and a method for decision-making potential confounds in order to conduct unbiased studies of the effects of SI/SP-T approaches that accurately represent SI/SP-T theories of change.

Keywords: sensory integration, sensory processing disorder (SPD) intervention, behavioral intervention, handling effect analysis, naturalistic behavioral intervention

Overview: Sensory Integration/Sensory Processing Handling (SI/SP-T) for ASD Is A Widely-Implemented Intervention Approach simply with An Emerging just Limited Evidence Base

The goal of this article is to provide a review of sensory integration/sensory processing treatment (SI/SP-T) in Autism Spectrum Disorder (ASD), an intervention used widely in schools and clinics, to generate a framework and pedagogy for systematically testing behavioral interventions for children with disabilities. That is, we view SI/SP-T as one of several potential interventions for children with developmental disabilities which can be evaluated using widely accepted testify-based standards and which tin be objectively tested using clinical trial approaches to optimize an intervention for children with disabilities. Considering there is considerable variation in nomenclature, and many researchers and clinicians have shifted from using "sensory integration" to "sensory processing," (come across Miller et al., 2009) nosotros volition be including both of these terms designated as "SI/SP-T" in our review. This combination is utilized because the term "sensory integration" continues to exist included in the literature and in clinical practice along with the term "sensory processing." Large scale intervention studies are needed considering, despite widespread implementation, particularly for children with Autism Spectrum Disorder (ASD), Down syndrome, attending deficit hyperactivity disorder (ADHD), and other developmental disabilities, SI/SP-T has an emerging but limited evidence base of operations in the literature (run into, for example, Pfeiffer et al., 2018), necessitating additional big-calibration studies. Therefore, the review herein will include a description of the origins of SI/SP-T, current evidence, considerations for conducting fair clinical trials, a review of how to control for potential cofounds, a description of how to test for generalized changes in SI/SP using multisensory integration approaches, a example example of how confounds tin impact clinical intervention studies of SI/SP-T, suggestions for future research directions, and clinical implications.

Testify-Based Practise: Levels of Prove

There have long been universal protocols for evaluating treatment efficacy and effectiveness in medicine and in behavioral interventions (Reynolds, 2008). These procedures arose, in part, from the long-standing persistence of treatments in clinical settings that, when tested adequately, proved to be ineffective or even harmful. For instance, chelation, an established biomedical handling for astute exposure to lead and other toxic metals, was hypothesized to exist an effective "detox" for children with ASD (see James et al., 2015). This treatment was based on an unproven presumption that because ASD was acquired, at least in part, past exposure to mercury, chelation would improve autism symptoms (encounter Davis et al., 2013). Moreover, there have been many testimonials and qualitative case studies suggesting that the arroyo was effective. Simply, when tested using clinical trials, chelation non only failed to improve symptoms of ASD, but too acquired adverse reactions, including death, in some cases (Baxter and Krenzelok, 2008). Of course, the overwhelming majority of treatments for autism do not include death as a potential side effect, just at that place are certainly many treatments that despite having express data that arrange to evidence-based practice guidelines (Weiss et al., 2008; Guldberg, 2017), are nevertheless widely implemented.

It must be stated explicitly that a limited evidence base of operations does not mean that a handling is ineffective; when tested, an emerging treatment may subsequently be validated when large scale studies are conducted. Still, upstanding practice guidelines include preferentially delivering treatments that currently take apparent testify over those that do not. At that place is an all-encompassing bear witness base showing moderate to large effect sizes for improving a wide range of ASD symptoms using behavioral intervention procedures that do not directly target SI/SP (east.k., Naturalistic Developmental Behavioral Interventions, NDBI; see Sandbank et al., 2020). That is, SI/SP-T can be conceptualized and tested as a naturalistic behavioral intervention and conditions such as ASD tin can yield fair tests of the arroyo. Because of this, within the framework of widely used treatment efficacy and effectiveness evaluation procedures that include group and single example (single subject) designs, emerging approaches require systematic evaluation and levels of evidence that meet or exceed those of existing interventions (e.one thousand., NDBI) to be included in validated treatment options.

Broadly, evidence-based rubrics classify "evidence" along a weak to strong continuum (see Brighton et al., 2003). The lowest level of evidence includes case presentations and case series studies. These are descriptive and oftentimes include qualitative indices such every bit goal attainment scaling with express or no experimental command of bias. It should be noted, withal, that these studies are indeed evidence and that there have been important discoveries that originated with case reports and case series studies. On the other mitt, a lack of control and potential for bias impacting results, are considered weak evidence (Brighton et al., 2003) and there have been many treatments that showed initial promise in case reports that did non show beneficial when more controlled studies were completed. Instance-command studies are similar to example reports and case serial studies but include a command/comparing patient (or patients). Although nigh are retrospective (a group of similar patients wherein some improved and some did not), this approach can yield fifty-fifty stronger prove when implemented as prospective single subject/unmarried case design control procedures (encounter Kennedy, 2005; Maggin et al., 2019). The next highest level of evidence includes prospective cohort studies, which essentially can be used to determine whether there are differential pre-post- gains in qualitative and/or quantitative benchmarks such equally goal attainment scaling and standardized assessments. These also include limited or no experimental control of bias but are quite useful. The next level, randomized control trial (RCT), is considered the highest level of evidence when randomization and blinding are implemented. Unblinded and/or subjective qualitative RCTs (e.g., Goal Attainment Scaling) are viewed as apparent evidence, but weaker than blinded RCTs. The "ultimate" level of testify includes a meta-assay of aggregated strong RCTs showing consistently meaningful effect sizes beyond studies. Our analysis of SI/SP-T in ASD is predicated on this widely used evidence rubric. Bear in mind that patient and clinician testimonials are not considered evidence.

Origins of SI/SP-T: A Brief Overview of Sensory Integration/Sensory Processing Handling Approaches

Ayres (1972, p. 4) described sensory integration dysfunction every bit a problem in the power to "organize sensory information for utilise" and along with motor performance, as a key element of intervention (see too Ayres, 1963; Ayres and Robbins, 2005). In add-on to her clinical work, Ayres published many studies focused on the cess and handling of SI, and she developed assessments for SI (eastward.g., Ayres, 1989, 1996). Ayres' definition encompasses a broad range of behaviors and includes disruptions in social interaction and behavioral regulation (Miller et al., 2007a). While acknowledging that many sensory-based approaches incorporate motor performance in accord with Ayres' framework (Ayres, 1979), we will be focusing the review on sensory parameters. A recent definition of SI derived from a nosology of sensory integration disorder includes "difficulty detecting, modulating, interpreting and/or responding to sensory experiences, which is severe plenty to disrupt participation in daily life activities and routines and learning" (Miller et al., 2007a). Several subtypes are proposed in ane or more sensory systems, including auditory, visual, gustatory (gustatory modality), olfactory (smell), somatosensory (proprioception and touch), vestibular, and interoceptive (the sense involved in the detection of internal regulation, such as heart rate, respiration, hunger, and digestion) domains. In 2009, Miller et al. (2009) suggested a change in nomenclature from "sensory integration" to "sensory processing" disorder while maintaining the foundational sensory elements. Thus, these eight sensations are the central targets of many SI/SP-T sessions. Moreover, SI/SP-T is posited to directly improve attentional, emotional, motoric, communication, and/or social difficulties (see Miller et al., 2014). Difficulty in sensory integration/sensory processing is hypothesized to result in challenges related to initiating or sustaining peer interactions, developing engaged relationships, participating in activities of daily living, and regulating arousal behaviors. Specific developmental domains, such as language development (e.one thousand., Ayres and Mailloux, 1981; Mauer, 1999), are also hypothesized to exist impacted and to thus incidentally benefit from SI/SP-T. The impact of these sensory parameters on quantitative indices of domains such every bit language development is directly testable using well-established experimental approaches.

Inside this theoretical framework, mutual manifestations of sensory integration/sensory processing deficits in children with developmental disabilities, such every bit ASD and ADHD when sensory symptoms are displayed including responses to stimulation more quickly, more intensely, and for a longer duration than do typically developing individuals. It should exist noted that SI/SPD is not exclusive to ASD, ADHD or any other developmental condition and non every child with ASD, ADHD or whatsoever other developmental condition should exist diagnosed with SI/SPD. Examples in everyday life include extreme responses to stimuli such as noise in a classroom, odors in a restaurant, the touch of article of clothing, the clipping of finger and toenails, the movement of playground equipment, and/or the sight of cluttered environments. Behavioral responses are proposed to include a range of "fight, flight or freeze" reactions such as aggression, withdrawal, or preoccupation with the expectation of sensory input. Secondary social effects seen in preschoolers with SI/SPD include severe difficulty forming and maintaining peer relationships and/or extreme efforts to command events in the surroundings past over-reliance on routines. Hypothesized correlates include profound beliefs regulation problems, including temper tantrums, outbursts, hitting, boot, biting, spitting, and other maladaptive behaviors, and profound withdrawal from groups.

Additionally, preschool children with SI/SPD are also reported as being boring to respond to sensation, showing reduced or absent responses, and/or requiring more intense stimuli to respond to the demands of the situation. Examples include not responding to one'south proper noun being called and failing to discover when hurt, thirsty, or hungry (run across the examples in Miller et al., 2014). Some children with SI/SPD are also reported to have an insatiable need for sensation, well beyond that which is typical, ofttimes to the extent that safety is a concern. These children derive swell pleasure from "crashing and falling" and have great difficulty sitting still. Parents and peers may describe such children as being "in my face and in my space," "constantly touching people or objects," and demanding significant time and attention (Miller et al., 2007a; Ben-Sasson et al., 2019). These impulsive and hyperactive behaviors may adversely impact student outcomes. Lastly, preschool children with SI/SPD nowadays with motor delays sometimes categorized every bit "associated symptoms" (Ming et al., 2007) that are purportedly due to an underlying impairment in the ability to translate sensations (Roley et al., 2015). Examples include difficulty initiating, planning, sequencing, and building repertoires of action plans, all of which are essential to motor planning to accomplish multi-step daily routines. This SI/SPD framework is ofttimes applied to symptoms of conditions such every bit ASD when delivering SI/SP-T. Simply it is important to note that the aforementioned features of ASD have likewise been addressed without utilizing sensory activities so that at that place are culling perspectives as to the nature and extent of SI/SP features in ASD interventions (see the review and meta-analysis in Sandbank et al., 2020).

Thus, despite widespread implementation of SI/SP-T based services, at that place is an extensive portion of the assessment and intervention literature for children with disabilities that does not interpret these behaviors through the lens of sensory integration or sensory processing, relying instead upon another operant/applied behavioral analysis and/or physiological foundations (as examples, come across Sappok, 2019; Sandbank et al., 2020). Theoretically motivated, hypothesis-driven studies within the context of fair clinical trials of SI/SP-T are needed to resolve this disparity in the theoretical ontogeny of sequelae of developmental disabilities such as ASD. This volition shed calorie-free on best practices for intervention in atmospheric condition such equally ASD. Moreover, in that location continues to be considerable heterogeneity in the field regarding treatment and the underlying theories driving these interventions (run into for instance, Sandbank et al., 2020). Importantly, the "off-white evaluation" of an intervention must be faithful to the implied or explicit theory of change for that intervention. Considering of this, it is of import to briefly review a representative theory of change for SI/SP-T.

Theory of Alter for Sensory Integration/Sensory Processing Treatment

Hundreds of publications have described SI/SP-T since 1964, though the literature continues to incorporate relatively few large-calibration randomized trials direct testing the intervention (Ayres, 1972; Kimball, 1993; Kinnealey and Miller, 1993; Parham, 1998; Miller et al., 2001, 2007b; Bundy et al., 2002; Pfeiffer et al., 2011, 2018; Schaaf et al., 2014, 2018). Most of the literature on this topic includes inconsistent terminology between studies as well equally limited high-quality evidence, and design limitations (come across Miller et al., 2007c; Schaaf et al., 2018). Additionally, because authors oftentimes utilize terminology, theoretical constructs, and observational frameworks that are inconsistent (meet Schaaf and Davies, 2010), it tin exist difficult to aggregate studies and to specify consistent outcome measures. Thus, although some studies provide credible evidence of treatment effects, SI/SP-T does not nevertheless have a strong testify-base of operations. For example, Schoen et al. (2019) conducted a systematic review of Ayres Sensory Integration (ASI) treatment and found just 2 studies that met a majority of quality indicators and one additional study that met a "plurality" of quality metrics. In contrast, reviews of NBDIs include dozens or even hundreds of studies (e.g., Sandbank et al., 2020). For purposes of this review, we are using the SI/SP-T nosology by Miller et al. (2007a), and we take adjusted the conceptual theory of change from Miller et al. (2001) every bit an example of a testable SI/SP-T framework (come across Table 1). To be sure Ayres Sensory Integration (east.g., the review of ASI in Watling and Hauer, 2015; Schoen et al., 2019) or any other well-defined arroyo within the broad rubric of SI/SP-T could also be tested, nosotros utilise the framework of Miller et al. (2001) herein as an case of how this can be accomplished.

Tabular array one

Hypothesized social and behavioral furnishings of sensory disruptions.

Dimensions	Behaviors observed
Sensory symptoms Results in Open in a dissever window	Difficulty regulating sensory input: over or under responsivity (Tactile, Move, Taste, Scent, Auditory, or Visual stimuli); difficulty interpreting internal sensations (body awareness, interoception), and difficulty discriminating external sensations (from the environs).
Motor symptoms Results in Open in a separate window	Poor coordination, Clumsiness, Clumsiness, Poor posture, Limited planning and sequencing of motor skills; Disability to perform multistep tasks.
Behavioral symptoms Results in Open in a separate window	Assailment, Anger, Dysregulation, Tearfulness, Withdrawal. Feet, Poor attention, Hyperactivity, Poor impulse command.
Social symptoms	Social isolation, Withdrawal, Poor social relationships with peers and adults, Discomfort in social situations.

The model in Effigy 1 suggests that sensory function is foundational to motor ability, social skill, and a broad range of behavior. Thus, when a disruption occurs in sensory abilities (including disruption in modulation, bigotry, and integration of sensory input), testable cascading effects are posited for several "higher-level" domains, such as social skills. These disruptions are believed to translate to problems with participation at home, at school, and in the customs (meet Table 1). A Model of Change using SI/SP-T equally articulated to a higher place relates to proposed changes in motor, social, and behavioral challenges. It is noteworthy that SI/SP-T can be implemented in a manner that is consequent with the model within the context of a blinded RCT with primary and tertiary measures of hypothesized furnishings. Thus, the SI/SP-T theory of change can be measured using a allegiance of handling calibration post-obit evidenced-based standards for all behavioral interventions. The structure and commitment of SI/SP-T are founded on the incorporation of tactile (touch), proprioceptive (pressure, position, and musculus exertion), and vestibular (motility and balance) activities in a naturalistic, play-based intervention session. These sensory events can all be operationally defined and reliably measured using observational coding.

Theory of change for sensory integration/sensory processing (SI/SP) therapy.

For an intervention to exist evaluated fairly, these enhanced sensory integration experiences must be selected specifically to fulfill the needs and behaviors of the individual child and measured systematically. For example, if a child displays an unusual sensory profile marked by tactile over-responsivity, then SI/SP-T activities should provide systematic exposure to different tactile sensations (Miller et al., 2014). Systematic exposure to tactile activities is hypothesized to non only decrease tactile over-responsivity but also to better the behaviors and skills disrupted by tactile over-responsivity, which can all exist measured objectively using event coding and/or rating scales. Again, each of these links changes be tested directly.

Additionally, SI/SP-T is hypothesized to do good children with reduced tactile discrimination. A child who does not interpret (discriminate) tactile sensations delivered to her fingers, hands, and feet, may have trouble participating in activities requiring accurate tactile interpretation (e.one thousand., difficulty buttoning, writing, and manipulating small objects). Again, this functional relationship is testable.

Testing Behavioral Treatments

For this review, behavioral handling is defined broadly as interventions that employ clinician-child or parent-child interaction excluding pharmacological agents (east.g., as in Hampton and Kaiser, 2016). This includes naturalistic play-based interventions and highly structured operant conditioning treatment methods (Sandbank et al., 2020). Although some take argued that only operant "discrete trials" should be identified equally "behavioral" or exclusively falling within the scope of "applied behavioral analysis," behavioral interventions have long been extended to include play-based "naturalistic" treatments (McLean and Snyder-McLean, 1978). As an example, Sid Bijou, one of the founders of the applied behavioral analysis field, adapted Kantor (1977) linguistic theory for study within a behavioral rubric, including conversational elements (see Bijou et al., 1986; Ghezzi, 2010). This framework has been widely practical to study conversational based interventions (see as examples, Koegel et al., 1987; Camarata, 1993; Camarata et al., 1994; Gillum and Camarata, 2004). Table 2 provides a theory of change for a naturalistic behavioral intervention (Pivotal Response Grooming, Koegel et al., 2016) within a behavioral framework. The central signal herein is that SI/SP-T tin can exist examined—and tested—inside a behavioral framework similar to those applied for naturalistic interventions (due east.g., NDBIs).

Table 2

Elements of an example transactional "ABA" handling (pivotal response teaching).

CUE

Kid attention

Proceeds kid'due south attention before providing cue

Articulate and appropriate

Provide related, clear and developmentally appropriate cues

Child choice

Allow child a selection of activity or materials

Accept turns

Have turns by modeling advisable behavior

Maintenance tasks

Intersperse tasks the child has already mastered

Multiple cues

Provide cues that require responding to multiple elements

Child behavior (correct, incorrect, and attempt)

RESPONSE

Contingent

Provide appropriate consequences based on child's behavior

Direct reinforcement

Provide reinforcement straight related to the child'south behavior

Good trying

Reinforce child'southward goal directed attempts

Current Prove Base for SI/SP Treatment

Given the widespread commitment of SI/SP based assessment and treatment, one would look an extensive strong evidence base of operations in the literature. Before delving into the electric current testify on SI/SP-T, it is important to mention that practices are often widely provided to students with disabilities even in the absenteeism of extensive supporting data-driven evidence. As an example, music therapy is a very common approach provided to children with ASD despite its currently limited evidence base (see Lense and Camarata, 2020). Although problematic, an absenteeism of testify, unto itself, cannot exist construed every bit invalidating.

Our review indicated that to date, there accept been small-scale scale studies of several isolated sensory-based procedures, such equally weighted vests or "brushing" programs, which usually suggest the procedures are not constructive (eastward.grand., Lang et al., 2012; Taylor et al., 2012). And in that location are a limited number of studies showing positive furnishings on goal attainment scaling (see the reviews in Schaaf et al., 2018; Schoen et al., 2019). But there are too several systematic reviews indicating inconsistent, weak, and/or inconclusive evidence. For case, Lang et al. (2012) reported, "Overall, three of the reviewed studies suggested that SI/SP-T was effective, 8 studies found mixed results, and fourteen studies reported no benefits related to SI/SP-T" (p. 1004). The majority of the studies reviewed by Lang et al. (2012), however, tested just one sensory-based procedure (east.chiliad., a weighted belong or sensory brushing) but not a comprehensive course of SI/SP-T, in which a multi-component approach is implemented. Thus, a fair test of SI/SP-T necessitates the commitment of multiple elements rather than piecemeal testing of isolated sensory-based procedures and tools (due east.1000., wearing a weighted vest).

A critical review published in Pediatrics provides a comprehensive view that more than accurately represents the treatment (Johnson and Myers, 2007): "The goal of [SI/SP-T] is non to teach specific skills or behaviors only to remediate deficits in neurologic processing and integration of sensory data to allow the kid to interact with the environment more adaptively." This perspective is highlighted in a recent review by Instance-Smith et al. (2015) who ended:

Studies of sensory-based interventions suggest that they may not be effective. Still, these studies did not follow recommended protocols or target specific sensory processing bug. Although pocket-size randomized controlled trials resulted in positive furnishings for [SI/SP-T], boosted rigorous trials using manualized protocols for [SI/SP-T] are needed to evaluate effects for children with [ASD] and sensory processing problems (p. 133).

As these reviews demonstrate, there is currently, at best, an emerging, but limited evidence base on SI/SP-T, with few positive outcomes and some null or negative outcomes.

Moreover, the current state of the testify for SI/SP-T is accurately characterized in a review by the American Academy of Pediatrics (2012): "… the amount of research regarding the effectiveness of [SI/SP-T] is limited and inconclusive" (p. 1186). More recently, Weitlauf et al. (2017) reported in a follow-up review:

Some interventions may yield modest short-term (<6 months) improvements in sensory and ASD symptom severity-related outcomes; the evidence base is small, and the durability of the effects is unclear. Although some therapies may hold promise, substantial needs exist for continuing improvements in methodologic rigor (p. 347).

Moreover, recent meta-analyses and systematic reviews have consistently highlighted: (a) the paucity of intervention studies in SI/SP-T; and (b) a crucial demand for credible intervention studies of SI/SP-T (encounter Sandbank et al., 2020). As an example, Pfeiffer et al. (2018) conducted a systematic review of SI/SP-T that yielded 5 articles meeting inclusion criteria and concluded "Because the number of studies that measured sensory processing or SI challenges were limited, researchers are encouraged to include these measures in time to come research to understand the bear upon of a broader range of cerebral and occupation-based interventions" (Pfeiffer et al., 2018, p. 1). Similarly, Pingale et al. (2020) reported "occupational therapists (OTs) apply sensory diets to manage sensory processing disorder in children. The electric current evidence is limited. As well, the findings of the studies on the furnishings of sensory diets are mixed" (Pingale et al., 2020, p. 1). Schaaf et al. (2018) reviewed v studies and reported that "The evidence is strong that ASI [Ayres Sensory Integration] demonstrates positive outcomes for improving individually generated goals of operation and participation equally measured using Goal Attainment Scaling for children with autism," but also reported that "Child outcomes in play, sensory-motor, and linguistic communication skills and reduced caregiver aid with social skills had emerging but bereft bear witness" (Schaaf et al., 2018, p. 1). In sum, large scale clinical trials are needed considering there is evidence that SI/SP-T can improve "near point" proximal measures using qualitative Goal Attainment Scaling, only definitive outcomes for broader objective measures are less clear.

Despite a consensus in the literature on the need for additional evidence, SI/SP-T is currently widely implemented in schools by occupational therapists, speech-language pathologists, and other related services personnel (see McIntyre and Zemantic, 2017). For case, Devlin et al. (2011) recently reported that SI/SP-T using Ayres Sensory Integration Approach was i of the nearly prevalent intervention models in schools, which substantiates previous inquiry findings (Spitzer et al., 1996; Instance-Smith and Miller, 1999; Watling et al., 1999; Roley et al., 2001). A survey of occupational therapists revealed that 82% of respondents reported that they "always" use sensory-based treatment when working with children with ASD (Watling et al., 1999). Fifty-six percentage of parents of children who received practical beliefs analysis (ABA) treatment noted that their children with ASD had been exposed to sensory treatment as well (Smith and Antolovich, 2000, p. 1304; see also McIntyre and Zemantic, 2017). At that place is no doubt that sensory integration procedures have gained widespread popularity despite the ongoing need for a stronger evidence base. Given that SI/SP-T is "testable" inside an evidence-based framework, further research is warranted to make up one's mind the efficacy of the arroyo (see Baker et al., 2008). The post-obit sections depict approaches that could potentially strengthen the evidence base of operations for SI/SP-T if the results of clinical-translational studies reveal unique furnishings for SI/SP-T.

(Multi)Sensory Perception as A Window into SI/Sp-T: Multisensory Integration as A Distal Measure out of The Affect of Sensory-Based Handling

Multisensory integration is divers as the study of how the brain integrates and interprets input from multiple unisensory systems (Alais et al., 2010). The overlap in nomenclature with sensory integration/sensory processing may be confusing to clinicians and researchers. Multisensory integration differs from sensory integration/sensory processing in that it does non include intervention recommendations or downstream sequelae of disability while specifically focusing on tightly designed neural and cognitive studies of how specific primary sensory streams are integrated in existent-time (east.g., auditory and visual). Studies of multisensory integration oftentimes elicit unisensory responses from two or more than primary senses (e.g., audience and vision) and then compare the separate responses to effects observed when the inputs are combined (see Stevenson et al., 2014). If the core tenant of SI/SP-T is authentic, namely that SI/SP-T enhances sensory integration, multisensory integration provides a potent test of generalized effects of treatment explicitly designed to better sensory integration. The literature on ASD provides an example of how ane can expect distal multisensory impacts if SI/SP-T is delivered and the theory of change is accurate. Every bit noted above, Sensory Integration Theory and do was originated by Ayres (1972). Multisensory Integration, a branch of contemporary neuroscience devoted to understanding how the brain synthesizes information from the unlike sensory systems, establish hitting behavioral and perceptual benefits derived from multisensory inputs (see Stein, 2012) and may provide a neurological test of SI/SP-T.

Although the terms "sensory integration" and "multisensory integration" have divergent theoretical and empirical origins, the hypothesized theory of change for the SI/SP-T approach is directly predicated on disruptions in the ability to integrate sensory and multisensory data. Consequently, multisensory integration assessment is hypothesized to exist a useful distal, quantitative arroyo for testing this aspect of the SI/SP-T approach. Recent studies are developing highly effective methods for characterizing multisensory integration in developing children (Neil et al., 2006; Stephen et al., 2007; Hillock et al., 2011; Hillock-Dunn and Wallace, 2012), and some studies are focused on children with ASD. While there is a strong conceptual link betwixt sensory integration and multisensory integration, there has not equally yet been a systematic report of whether sensory-based treatment procedures take an incidental effect on multisensory integration. Indeed, sensory-based treatments are specifically designed to increase inputs from multiple sensory sources, which would facilitate learning and improve beliefs as a effect of improved multisensory integration as a upshot of the sensory-based treatment. Although therapists and teachers across many disciplines often incidentally comprise data from multiple sensory modalities during treatment in the absence of targeted sensory integration procedures, sensory-based treatments specifically focus on delivering elements across dissimilar sensory systems. This approach of providing input from multiple sensory modalities is believed to benefit students by facilitating multisensory integration.

Ayres (1972) proposed that multisensory systems play a critical part in establishing a foundation upon which "college-level" evolution can occur. Indeed, sensory and multisensory representations are viewed as forming the "edifice blocks" upon which higher cerebral abilities and learning can occur. Yet, whatever social/behavioral intervention, including sensory-based treatment, must ultimately be founded upon a series of empirically tested and validated procedures (Devlin et al., 2011). The strength of these multisensory integration assessments as distal consequence measures lies in the fact that SI/SP-T, if valid, should accept a differential pregnant bear upon on MSI every bit compared to nonsensory comparison intervention weather condition which do NOT include straight sensory-based treatment. Thus, a comparing of multisensory abilities between SI/SP-T and fair nonsensory behavioral handling groups may exist used to assess the specificity of treatments aimed at improving multisensory function. As an case, the aforementioned NDBI recast communication therapy approach yields strong effects on linguistic communication, but, hypothetically should NOT improve MSI whereas SI/SP-T is hypothesized to ameliorate language and MSI.

Tests that specifically alphabetize multisensory part are condign increasingly important tools to provide an empirical evaluation of the integrity of sensory processing in individuals with disabilities (see Kwakye et al., 2011). Much of the piece of work to appointment has focused on testing the power to detect and discriminate sensory stimuli—both inside and across unlike sensory modalities—in children and adults with disabilities compared to those considered "typically developing." This work has revealed substantial differences in the mode in which individuals with disabilities, specifically ASD and dyslexia, integrate auditory and visual information. Therefore, there is a strong rationale for including multisensory assessments in futurity evaluations of the differential impact of SI/SP-T on individuals with ASD or who are typically developing equally a direct link in the theory of change for sensory-based handling approaches.

Case From ASD and Multisensory Auditory-Visual Integration

Stevenson et al. (2014) reported that the "window" within which the brain integrates and "binds" visual and auditory information—chosen auditory-visual temporal binding (approximately 100 ms in typically developing school-historic period children)—is highly variable and often considerably more latent (up to 500 ms or even more) in matched participants with ASD. That is, the auditory and visual sensory streams are not "integrated" within the aforementioned fourth dimension frame in people with ASD. This phenomenon is depicted in Effigy 2, wherein the temporal binding curve for ASD and matched command participants are overlaid on one another. This is also illustrated in Figure 3, which presents a histogram depicting the relative distribution of the temporal binding window in each group.

Shift in temporal binding window in multisensory integration in autism spectrum disorder (ASD). *Significant difference (p < 0.05).

Theory of change for tactile sensory stimulation.

We hypothesize that auditory-visual temporal binding should differentially decrease for ASD under SI/SP-T considering the theory of alter for sensory-based treatment specifically posits that sensory integration will be improved following the delivery of these treatments. We as well hypothesize that auditory-visual temporal binding will not be affected in children with ASD who are treated using practical behavioral intervention (east.g., Pivotal Response Training™; Koegel et al., 2016). A plausible theory of alter including multisensory integration and employ of tactile stimulation as an ancestor treatment ingredient is depicted in Effigy iii.

Decision-making for Developmental Confounds

Fair and unbiased evaluation of SI/SP-T requires delivery of SI/SP-T procedures in an appropriate social and chatty developmental context (see Bialer and Miller, 2011; Miller et al., 2014), not decontextualized applications of sensory equipment, activities, and/or personal appliances such as weighted or pressure level vests. While acknowledging the validity of this perspective, there be challenges to testing the unique contributions of SI/SP-T procedures in a context that includes known active ingredients that are causally linked to developmental growth. For example, the aforementioned NDBI recast treatment involves language transactions that are ubiquitous in clinician-child interactions. That is, SI/SP-T conducted in naturalistic play contexts with supportive clinicians contains many known efficacious NDBI recast education events in addition to sensory events. As stated directly, social and communication elements themselves without enhanced tactile, proprioceptive, or vestibular enhancements are well established (and powerful) active ingredients in a plethora of naturalistic behavioral interventions (encounter Koegel et al., 1987; Cleave et al., 2015; Sandbank et al., 2020) that do not include SI/SP activities. Thus, it volition be of import to test whether unique handling effects are arising from SI/SP activities and/or whether at that place are synergistic "value-added" contributions for SI/SP activities when implemented inside the context of naturalistic social and communication intervention such as NDBIs.

As a specific instance, it is well-established in the handling literature that transactional advice exchanges facilitate language and social skills development (come across National Academies of Sciences, Engineering and Medicine, 2016). The theory of change for recast treatment is based upon a naturalistic ABA arroyo to transactional developmental modeling (see Camarata and Yoder, 2002). Key elements for the theory of change in this naturalistic ABA approach include reinforcing attempts using social attention and natural reinforcers and pairing teaching models within meaningful advice interactions.

Recast treatment and other transactional approaches (east.g., pivotal response handling, Koegel and Koegel, 2019) incorporate transactional elements such as reinforcing and pairing in handling sessions (see Figure iv). Stahmer et al. (2010) describe pivotal response training or pivotal response handling as a grade of naturalistic behavioral intervention based on the principles of ABA, an approach soundly supported past the scientific literature (National Research Quango, 2001). Thus, transactional intervention fits within the broad rubric of bear witness-based naturalistic ABA interventions that include the design, utilise, and evaluation of environmental modifications and interventions to produce socially significant improvement in human beliefs. ABA uses ancestor stimuli (events that happen before a behavior occurs, such as a teacher asking a child what color a crayon is) and consequences (events that happen afterwards a beliefs occurs, such as giving the child the crayon afterward he or she names the colour), to produce changes in behavior. Table two (from Stahmer et al., 2010) describes the key elements in the intervention.

Instance of language transaction.

Considering of this, at that place is a potential confound within SI/SP-T that must exist considered when conducting treatment trials; namely, fair implementation of SI/SP-T includes numerous communication transactions that are known drivers of development in typical children and in various populations of children with disabilities, and then the unique impact of SI/SP procedures should exist tested. The question is whether treatment gains associated with SI/SP-T are differentially associated with the sensory ingredients or, more broadly, to the transactional ingredients.

Therefore, information technology is important to discriminate the furnishings of sensory ingredients from those of transactional ingredients. A potential solution could be to deliver SI/SP-T while omitting transactions, merely experts in SI/SP-T concur that this type of socially unusual intervention—wherein the clinician does not collaborate with a child in a normal fashion—may unfairly bias the results against SI/SP-T. Some other solution is to behave an RCT wherein ane arm includes delivery of transactional treatment with sensory events, as compared to transactional intervention without sensory ingredients. This alternative approach is both practical and feasible and can exist conducted with high fidelity of implementation and to exam for synergistic "value-added" effects from SI/SP-T.

As a example, for instance, which nosotros admit is a weak grade of evidence, but none the less a useful analogy of this bespeak, consider the following patient. A male, age 6; 3, with ASD displayed salient facial rubbing. Within the SI/SP-T theoretical framework, an OT diagnosed "sensory seeking" type sensory processing disorder and prescribed handling using contingent sensory brushing wherein brushing on the forearm was delivered in response to facial rubbing events. Note that facial rubbing and delivery of sensory brushing are both highly salient events that were coded from video records with 100% concordance betwixt independent coders. In addition to the sensory brushing, the clinician incidentally delivered communication transactions while sensory brushing (i.e., she interacted verbally with the child while brushing him). A counterfactual condition, wherein transactions were delivered in the absence of brushing, was developed and subjected to video coding for the fidelity of treatment. Naturally, coders concurred that there were no sensory events in this condition with 100% accurateness, and the concordance for communication transaction commitment was 92% (which is within the usual range of fidelity for transactional treatment, see Davis et al., 2022 as an example).

Two different treatments–sensory brushing plus incidental advice transaction and communication transaction WITHOUT brushing–were delivered to this case using an alternate treatment blueprint within the rubric of a single-instance design (come across Kennedy, 2005). Sensory brushing plus transaction was delivered first, followed by a return to baseline (no treatment) phase, then a transactional only stage, then another return to baseline (no treatment) phase, and finally, another sensory brushing phase. The results are depicted in Figure 5. The blueish dots and lines represent the session counts for the "sensory seeking" facial rub events and the red squares draw the number of sensory brushing events in the session. Both atmospheric condition included an average of two advice transactions per minute. Every bit seen in the figure, the high baseline count for facial rubbing before initiating treatment decreased during sensory brushing treatment conditions. Subsequently each handling condition was completed, facial rub counts quickly increased during the return to baseline phases.

Case example illustrating confounds in sensory and transactional handling elements.

Information technology is possibly useful to examine the first baseline and treatment phases, which included sensory brushing. Equally can be seen, no brushing was delivered during baseline, during which time the participant exhibited a very loftier level of facial rubbing, ranging from 33 to 52 events per one-h session. In the beginning treatment phase, the beliefs decreased dramatically, falling to fewer than 20 face rubs in every session and to naught in 6 of the 22 sessions. A clinician keeping these data could certainly conclude that the sensory brushing was highly effective! The return to baseline phase provides further confirmation of treatment efficacy considering the facial rub count immediately increased higher up the levels observed in treatment. However, it is important to bear in mind that sensory brushing was not the only "ingredient" delivered during this stage; incidentally, an average of ii transactional events per minute during the session was provided besides when the clinician verbally interacted with the child while brushing him.

Note that in the second treatment phase, the same clinician delivered NO sensory brushing (encounter the red squares in phase 2) while continuing to deliver communication transactions at the same rate. As tin can be seen by the blue circles and line, the number of face rub events mirrored the frequency of behaviors observed in phase i; these events decreased precipitously to below twenty per session, and on two occasions, betwixt zero and 10 events were recorded (the numbers were a niggling confusing without nouns) at that place were two at zero and six that were less than x (only college than nada). Again, a return to baseline yielded an increase to nearly baseline frequency of behaviors, and reinstatement of the sensory brushing treatment replicated the results from stage 1, except for a spike in face rub events during sessions 7–9. 1 could argue that these results suggest that communication transactions were driving the decrease in facial rub events rather than the sensory brushing. This instance graphically illustrates the demand to control for confounds when testing SI/SP-T.

Summary, Conclusions, and Future Directions

SI/SP-T is a widely-used arroyo for treating individuals with diverse conditions and symptomology. A currently limited but emerging show base necessitates fair, unbiased clinical studies comparing SI/SP-T procedures to those of other established treatment approaches. This review included a presentation of ane such validated NDBI treatment: Recast Handling, which is based on a broader transactional intervention framework. Also, multisensory integration, broadly, and auditory-visual integration specifically, were discussed as promising approaches to differentially test the SI/SP-T theory of change. The article also includes a case presentation wherein confounding factors could potentially account for treatment effects that may be inaccurately attributable to an SI/SP procedure, sensory brushing, which more than plausibly could be attributed to conversation transactions.

SI/SP-T is testable within the context of rigorous handling studies, and key ingredients can exist measured. Importantly, these trials should be conducted fairly and without bias to empirically evaluate the efficacy of SI/SP-T. Moreover, there has been an ongoing need for fair clinical trials of SI/SI-T. The review herein indicates that such trials can exist conducted using the highest quality standards of implementation and employing objective quantitative proximal and distal measures in add-on to more qualitative indices such as goal attainment scaling. Finally, these studies must exist conducted using procedures that are not simply faithful to the authentic implementation of SI/SP-T only also control for confounding factors. These studies should be conducted with all populations posited to do good from SI/SP-T such as ASD, ADHD, Language Disorders, and Down's syndrome. Calls for off-white studies have been actualization in the literature for more than two decades; these must exist conducted soon.

Author Contributions

SC and MTW have collaborated on the multi-sensory processing inquiry described in this article. LM and SC have collaborated on behavioral event coding for evaluation of sensory based treatments described herein and on developing a measurable theory of change for testing sensory based intervention approaches. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the enquiry was conducted in the absence of any commercial or financial relationships that could exist construed as a potential conflict of interest.

Footnotes

Funding. This research was supported in part by a grant from the Wallace Research Foundation and past 1R34DC010927-01 from the National Institute on Deafness and Other Communication Disorders (SC and MTW, MPI). The Scottish Rite Foundation of Nashville too provided support.

References

• Alais D., Newell F., Mamassian P. (2010). Multisensory processing in review: from physiology to behaviour. Seeing Perceiving 23, 3–38. 10.1163/187847510X488603 [PubMed] [CrossRef] [Google Scholar]
• American Academy of Pediatrics (2012). Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Available online at: https://pediatrics.aappublications.org/content/129/half dozen/1186. Accessed Oct 10, 2020.
• Ayres A. J. (1963). The development of perceptual-motor abilities: a theoretical basis for handling of dysfunction. Am. J. Occup. Ther. 17, 221–225. [PubMed] [Google Scholar]
• Ayres A. J. (1972). Sensory Integration and Learning Disorders. Los Angeles, CA: Western Psychological Services. [Google Scholar]
• Ayres A. J. (1989). Sensory Integration and Praxis Tests. Los Angeles, CA: Western Psychological Services. [Google Scholar]
• Ayres A. J. (1996). Sensory Integration and Praxis Tests (SIPT). Los Angeles, CA: Western Psychological Services (WPS). [Google Scholar]
• Ayres A. J. (1979). Sensory Integration and the Child: Understanding Subconscious Sensory Challenges. Los Angeles, CA: Western Psychological Services. [Google Scholar]
• Ayres A. J., Mailloux Z. (1981). Influence of sensory integration procedures on language development. Am. J. Occup. Ther. 35, 383–390. 10.5014/ajot.35.6.383 [PubMed] [CrossRef] [Google Scholar]
• Ayres A. J., Robbins J. (2005). Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Los Angeles, CA: Western Psychological Services. [Google Scholar]
• Baker A. E., Lane A., Angley M. T., Young R. L. (2008). The relationship between sensory processing patterns and behavioral responsiveness in autistic disorder: a pilot study. J. Autism Dev. Disord. 38, 867–875. 10.1007/s10803-007-0459-0 [PubMed] [CrossRef] [Google Scholar]
• Baxter A. J., Krenzelok Due east. P. (2008). Pediatric fatality secondary to EDTA chelation. Clin. Toxicol. 46, 1083–1084. 10.1080/15563650701261488 [PubMed] [CrossRef] [Google Scholar]
• Ben-Sasson A., Gal E., Fluss R., Katz-Zetler N., Cermak S. A. (2019). Update of a meta-analysis of sensory symptoms in ASD: a new decade of enquiry. J. Autism Dev. Disord. 49, 4974–4996. 10.1007/s10803-019-04180-0 [PubMed] [CrossRef] [Google Scholar]
• Bialer D., Miller Fifty. J. (2011). No Longer A Hush-hush: Unique Mutual Sense Strategies for Children With Sensory or Motor Challenges. Arlington, TX: Time to come Horizons. [Google Scholar]
• Bijou S. W., Umbreit J., Ghezzi P. M., Chao C. C. (1986). Psychological linguistics: a natural science approach to the study of linguistic communication interactions. Anal. Verb. Behav. four, 23–29. 10.1007/BF03392812 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Brighton B., Bhandari M., Tornetta P., Felson D. T. (2003). Bureaucracy of evidence: from instance reports to randomized controlled trials. Clin. Orthop. Relat Res. 413, 19–24. ten.1097/01.blo.0000079323.41006.12 [PubMed] [CrossRef] [Google Scholar]
• Bundy A. C., Lane Due south. J., Murray Eastward. A. (2002). Sensory Integration: Theory and Practise. Philadelphia, PA: FA Davis. [Google Scholar]
• Camarata S. (1993). The application of naturalistic chat grooming to spoken communication production in children with spoken language disabilities. J. Appl. Behav. Anal. 26, 173–182. ten.1901/jaba.1993.26-173 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Camarata South. Thousand., Nelson Yard. E., Camarata M. Due north. (1994). Comparison of conversational-recasting and imitative procedures for training grammatical structures in children with specific language impairment. J. Speech Lang. Hear. Res. 37, 1414–1423. 10.1044/jshr.3706.1414 [PubMed] [CrossRef] [Google Scholar]
• Camarata S., Yoder P. (2002). Linguistic communication transactions during development and intervention: theoretical implications for developmental neuroscience. Int. J. Dev Neurosci. 20, 459–465. 10.1016/s0736-5748(02)00044-8 [PubMed] [CrossRef] [Google Scholar]
• Example-Smith J., Miller H. (1999). Occupational therapy with children with pervasive developmental disorders. Am. J. Occup. Ther. 53, 506–513. 10.5014/ajot.53.5.506 [PubMed] [CrossRef] [Google Scholar]
• Case-Smith J., Weaver L. L., Fristad M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism nineteen, 133–148. 10.1177/1362361313517762 [PubMed] [CrossRef] [Google Scholar]
• Cleave P. L., Becker Due south. D., Curran One thousand. K., Van Horne A. J. O., Fey One thousand. E. (2015). The efficacy of recasts in language intervention: a systematic review and meta-analysis. Am. J. Spoken language Lang. Pathol. 24, 237–255. x.1044/2015_AJSLP-14-0105 [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
• Davis T. Due north., Lancaster H. South., Camarata S. (2016). Expressive and receptive vocabulary learning in children with diverse disability typologies. Int. J. Dev. Disabil. 62, 77–88. ten.1179/2047387715y.0000000010 [CrossRef] [Google Scholar]
• Davis T. Northward., O'Reilly M., Kang S., Lang R., Rispoli M., Sigafoos J., et al. (2013). Chelation handling for autism spectrum disorders: a systematic review. Res. Autism Spectr. Disord. 7, 49–55. 10.1016/j.rasd.2012.06.005 [CrossRef] [Google Scholar]
• Devlin S., Healy O., Leader Chiliad., Hughes B. G. (2011). Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior. J. Autism Dev. Disord. 41, 1303–1320. 10.1007/s10803-010-1149-x [PubMed] [CrossRef] [Google Scholar]
• Ghezzi P. M. (2010). In memoriam: Sidney West. Bijou. J. Appl. Behav. Anal.sis 43:175. 10.1901/jaba.2010.43-160 [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]
• Gillum H., Camarata S. (2004). Importance of treatment efficacy inquiry on language comprehension in MR/DD enquiry. Ment. Retard. Dev. Disabil Res. Rev. x, 201–207. 10.1002/mrdd.20034 [PubMed] [CrossRef] [Google Scholar]
• Guldberg K. (2017). Evidence-based practice in autism educational inquiry: tin we span the research and practice gap? Oxford Rev. Educ. 43, 149–161. 10.1080/03054985.2016.1248818 [CrossRef] [Google Scholar]
• Hampton Fifty. H., Kaiser A. P. (2016). Intervention furnishings on spoken-language outcomes for children with autism: a systematic review and meta-analysis. J. Intellect. Disabil. Res. 60, 444–463. 10.1111/jir.12283 [PubMed] [CrossRef] [Google Scholar]
• Hillock A. R., Powers A. R., Wallace M. T. (2011). Binding of sights and sounds: age-related changes in multisensory temporal processing. Neuropsychologia 49, 461–467. 10.1016/j.neuropsychologia.2010.xi.041 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Hillock-Dunn A., Wallace M. T. (2012). Developmental changes in the multisensory temporal bounden window persist into adolescence. Dev. Sci. 15, 688–696. x.17116/stomat20209905146 [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]
• James S., Stevenson S. W., Silove N., Williams Yard. (2015). Chelation for autism spectrum disorder (ASD). Cochrane Database Syst. Rev. v:CD010766. 10.1002/14651858.CD010766.pub2 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Johnson C., Myers Southward. (2007). American academy of pediatrics quango on children with disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics 120, 1183–1215. 10.1542/peds.2007-2361 [PubMed] [CrossRef] [Google Scholar]
• Kantor J. R. (1977). Psychological Linguistics. Chicago, IL: Principia. [Google Scholar]
• Kennedy C. H. (2005). Unmarried-Example Designs for Educational Enquiry. Upper Saddle River, NJ: Prentice Hall. [Google Scholar]
• Kimball J. Grand. (1993). "Sensory integrative frame of reference," in Frames of Reference for Pediatric Occupational Therapy, eds Kramer P., Hinajosa J. (Philadelphia, PA: Lippincott; ), 87–167. [Google Scholar]
• Kinnealey One thousand., Miller L. J. (1993). "Sensory integration. Learning disabilities," in Willard and Spackman's Occupational Therapy, 8th Edn., eds Hopkins H. L., Smith H. D. (Philadelphia, PA: Lippincott Co.), 474–489. [Google Scholar]
• Koegel R., Koegel L. (2019). Pivotal Response Handling for Autism Spectrum Disorders (second edition). Baltimore, MD: Brookes Publishing. [Google Scholar]
• Koegel L. G., Ashbaugh K., Koegel R. 50. (2016). "Pivotal response treatment," in Early Intervention for Young Children With Autism Spectrum Disorder, eds Lang R., Hancock T., Singh N. (Cham: Springer; ), 85–112. [Google Scholar]
• Koegel R. L., O'Dell G. C., Koegel Fifty. K. (1987). A tongue teaching epitome for nonverbal autistic children. J. Autism Dev. Disord. 17, 187–200. 10.1007/BF01495055 [PubMed] [CrossRef] [Google Scholar]
• Kwakye 50. D., Foss-Feig J. H., Cascio C. J., Stone W. L., Wallace M. T. (2011). Altered auditory and multisensory temporal processing in autism spectrum disorders. Front end. Integr. Neurosci. iv:129. 10.3389/fnint.2010.00129 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Lense 1000. D., Camarata South. (2020). Press-Play: Musical engagement every bit a motivating platform for social interaction and social play in young children with ASD. Music Sci. iii. 10.1177/2059204320933080 [PMC gratuitous article] [PubMed] [CrossRef] [Google Scholar]
• Lang R., O'Reilly Yard., Healy O., Rispoli M., Lydon H., Streusand W., et al. (2012). Sensory integration therapy for autism spectrum disorders: a systematic review. Res. Autism Spectr. Disord. vi, 1004–1018. x.1016/j.rasd.2012.01.006 [CrossRef] [Google Scholar]
• Maggin D. Chiliad., Cook B. 1000., Cook Fifty. (2019). Making sense of single-example design effect sizes. Learn. Disabil. Res. Pract. 34, 124–132. 10.1111/ldrp.12204 [CrossRef] [Google Scholar]
• Mauer D. Chiliad. (1999). Issues and applications of sensory integration theory and treatment with children with linguistic communication disorders. Lang. Speech Hear. Serv. Sch. xxx, 383–392. 10.1044/0161-1461.3004.383 [PubMed] [CrossRef] [Google Scholar]
• McIntyre 50. Fifty., Zemantic P. K. (2017). Examining services for young children with autism spectrum disorder: parent satisfaction and predictors of service utilization. Early Child. Educ. J. 45, 727–734. 10.1007/s10643-016-0821-y [PMC complimentary commodity] [PubMed] [CrossRef] [Google Scholar]
• McLean J. Due east., Snyder-McLean L. G. (1978). A Transactional Approach to Early on Language Learning. Columbus, OH: Charles Eastward. Merrill Publishing Visitor. [Google Scholar]
• Miller L. J., Anzalone One thousand., Lane S., Cermak S., Osten E. (2007a). Concept evolution sensory integration: a proposed nosology for diagnosis. Am. J. Occup. Ther. 61, 135–140. ten.5014/ajot.61.ii.135 [PubMed] [CrossRef] [Google Scholar]
• Miller L. J., Coll J. R., Schoen S. A. (2007b). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. Am. J. Occup. Ther. 61, 228–238. 10.5014/ajot.61.2.228 [PubMed] [CrossRef] [Google Scholar]
• Miller Fifty. J., Schoen Southward. A., James K., Schaaf R. C. (2007c). Lessons learned: a pilot written report on occupational therapy effectiveness for children with sensory modulation disorder. Am. J. Occup. Ther. 61, 161–169. 10.5014/ajot.61.two.161 [PubMed] [CrossRef] [Google Scholar]
• Miller L. J., Fuller D. A., Roetenberg J. (2014). Sensational Kids: Hope and Assist for Children With Sensory Processing Disorder (SPD). New York, NY: Penguin. [Google Scholar]
• Miller L. J., Nielsen D. Grand., Schoen S. A., Brett-Green B. A. (2009). Perspectives on sensory processing disorder: a call for translational research. Front. Integr. Neurosci. 3:22. x.3389/neuro.07.022.2009 [PMC costless commodity] [PubMed] [CrossRef] [Google Scholar]
• Miller L. J., Reisman J. E., McIntosh D. N., Simon J. (2001). "An ecological model of sensory modulation: operation of children with delicate X syndrome, autistic disorder, attention-deficit/hyperactivity disorder and sensory modulation dysfunction," in Understanding the Nature of Sensory Integration With Various Populations, eds Roley S. South., Blanche Eastward. I., Schaaf R. C. (San Antonio, TX: Therapy Skill Builders; ), 57–88. [Google Scholar]
• Ming X., Brimacombe Chiliad., Wagner G. C. (2007). Prevalence of motor damage in autism spectrum disorders. Brain Dev. 29, 565–570. 10.1016/j.braindev.2007.03.002 [PubMed] [CrossRef] [Google Scholar]
• National Academies of Sciences, Applied science and Medicine (2016). Speech and Language Disorders in Children: Implications for the Social Security Assistants's Supplemental Security Income Plan. Washington, DC: National Academies Press; 10.17226/21872 [CrossRef] [Google Scholar]
• National Research Council (2001). "Educating children with autism," in Committee on Educational Interventions for Children With Autism, eds Lord C., McGee J. (Washington, DC: National Academy Press; ), 193–210. 10.17226/10017 [CrossRef] [Google Scholar]
• Neil P. A., Chee-Ruiter C., Scheier C., Lewkowicz D. J., Shimojo South. (2006). Development of multisensory spatial integration and perception in humans. Dev. Sci. 9, 454–464. x.1111/j.1467-7687.2006.00512.x [PubMed] [CrossRef] [Google Scholar]
• Parham Fifty. D. (1998). The human relationship of sensory integrative development to achievement in elementary students: 4-year longitudinal patterns. Occup. Ther. J. Res. xviii, 105–127. ten.1177/153944929801800304 [CrossRef] [Google Scholar]
• Pfeiffer B., Clark Yard. F., Arbesman Yard. (2018). Effectiveness of cerebral and occupation-based interventions for children with challenges in sensory processing and integration: a systematic review. Am. J. Occup. Ther. 72, 7201190020.p1–7201190020.p9.10.5014/ajot.2018.028233 [PubMed] [CrossRef] [Google Scholar]
• Pfeiffer B. A., Koenig K., Kinnealey Chiliad., Sheppard M., Henderson Fifty. (2011). Effectiveness of sensory integration interventions in children with autism spectrum disorders: a airplane pilot study. Am. J. Occup. Ther. 65, 76–85. 10.5014/ajot.2011.09205 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Pingale V., Fletcher T., Candler C., Pickens N., Dunlap K. (2020). Sensory diets: practice they work? Am. J. Occup. Ther. 74, 7411520419.p1–7411520419.p1. 10.5014/ajot.2020.74s1-po6800 [CrossRef] [Google Scholar]
• Reynolds S. (2008). Testify-Based Practice: A Disquisitional Appraisal. Hoboken, NJ: John Wiley & Sons. [Google Scholar]
• Roley S. Southward., Blanche E. I., Schaaf R. C. (2001). Understanding the Nature of Sensory Integration With Diverse Populations. Hoboken, NJ: Pro-Ed. [Google Scholar]
• Roley S. Southward., Mailloux Z., Parham L. D., Schaaf R. C., Lane C. J., Cermak Southward. (2015). Sensory integration and praxis patterns in children with autism. Am. J. Occup. Ther. 69, 6901220010.p1–6901220010.p8. 10.5014/ajot.2015.012476 [PubMed] [CrossRef] [Google Scholar]
• Sandbank G., Bottema-Beutel One thousand., Crowley S., Cassidy Thou., Dunham K., Feldman J. I., et al. . (2020). Project AIM: autism intervention meta-assay for studies of immature children. Psychol. Balderdash. 146, 1–29. 10.1037/bul0000215 [PMC costless article] [PubMed] [CrossRef] [Google Scholar]
• Sappok T. (2019). "Links between autism spectrum disorders, intellectual disability, emotional development and challenging behaviour," in A Clinician'south Guide to Mental Health Atmospheric condition in Adults With Autism Spectrum Disorders: Cess and Interventions, eds Chaplin E., Kingdom of spain D., McCarthy J. (Philadelphia, PA: Jessica Kingsley Publishers; ), 68–80. [Google Scholar]
• Schaaf R. C., Benevides T., Mailloux Z., Faller P., Hunt J., Van Hooydonk E., et al. . (2014). An intervention for sensory difficulties in children with autism: a randomized trial. J. Autism Dev. Disord. 44, 1493–1506. 10.1007/s10803-013-1983-8 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
• Schaaf R. C., Davies P. L. (2010). Development of the sensory integration frame of reference. Am. J. Occup. Ther. 64, 363–367. 10.5014/ajot.2010.090000 [PubMed] [CrossRef] [Google Scholar]
• Schaaf R. C., Dumont R. L., Arbesman K., May-Benson T. A. (2018). Efficacy of occupational therapy using Ayres Sensory Integration^®: a systematic review. Am. J. Occup. Ther. 72, 7201190010p1–7201190010p10.. ten.5014/ajot.2018.028431 [PubMed] [CrossRef] [Google Scholar]
• Schoen Southward. A., Lane S. J., Mailloux Z., May-Benson T., Parham 50. D., Smith Roley Due south., et al. . (2019). A systematic review of ayres sensory integration intervention for children with autism. Autism Res. 12, half-dozen–nineteen. 10.1002/aur.2046 [PMC gratis article] [PubMed] [CrossRef] [Google Scholar]
• Smith T., Antolovich Grand. (2000). Parental perceptions of supplemental interventions received by young children with autism in intensive beliefs analytic treatment. Behav. Intervent. 15, 83–97. 10.1002/(SICI)1099-078X(200004/06)15:2<83::Assistance-BIN47>iii.0.CO;2-West [CrossRef] [Google Scholar]
• Spitzer S., Roley S. S., Clark F., Parham D. (1996). Sensory integration: current trends in the The states. Scand. J. Occup. Ther. 3, 123–138. [Google Scholar]
• Stahmer A. C., Suhrheinrich J., Reed S., Bolduc C., Schreibman Fifty. (2010). Pivotal response instruction in the classroom setting. Preventing School Failure: Alternative Education for Children and Youth 54, 265–274. 10.1080/10459881003800743 [CrossRef] [Google Scholar]
• Stein B. E. (2012). The New Handbook of Multisensory Processing. Cambridge MA: MIT Press. [Google Scholar]
• Stephen J. Grand., Romero L., Zhang T., Okada Y. (2007). Auditory and somatosensory integration in infants. International Congress Serial 1300, 107–110. 10.1016/j.ics.2007.01.041 [CrossRef] [Google Scholar]
• Stevenson R. A., Siemann J. K., Schneider B. C., Eberly H. East., Woynaroski T. Chiliad., Camarata S. M., et al. . (2014). Multisensory temporal integration in autism spectrum disorders. J. Neurosci. 34, 691–697. 10.1523/JNEUROSCI.3615-13.2014 [PMC costless commodity] [PubMed] [CrossRef] [Google Scholar]
• Taylor J. Fifty., Pigeon D., Veenstra-VanderWeele J., Sathe N. A., McPheeters One thousand. L., Jerome R. Northward., et al. (2012). Interventions for Adolescents and Young Adults With Autism Spectrum Disorders. Rockville, MD: Agency for Healthcare Research and Quality (United states of america). [Google Scholar]
• Watling R., Deitz J., Kanny E. M., McLaughlin J. F. (1999). Current do of occupational therapy for children with autism. Am. J. Occup. Ther. 53, 498–505. x.5014/ajot.53.five.498 [PubMed] [CrossRef] [Google Scholar]
• Watling R., Hauer S. (2015). Effectiveness of ayres sensory integration^® and sensory-based interventions for people with autism spectrum disorder: a systematic review. Am. J. Occup. Ther. 69, 6905180030.p1–6905180030.p12.10.5014/ajot.2015.018051 [PubMed] [CrossRef] [Google Scholar]
• Weiss K. J., Fiske K., Ferraioli Due south. (2008). "Evidence-based practice for autism spectrum disorders," in Clinical Assessment and Intervention for Autism Spectrum Disorders, ed. Matson J. (Cambridge, MA: Bookish Press; ), 33–63. 10.1016/B978-012373606-ii.50004-viii [CrossRef] [Google Scholar]
• Weitlauf A. S., Sathe N., McPheeters M. L., Warren Z. Due east. (2017). Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics 139:e20170347. 10.1542/peds.2017-0347 [PubMed] [CrossRef] [Google Scholar]

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Articles from Frontiers in Integrative Neuroscience are provided here courtesy of Frontiers Media SA

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726187/

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