There are many treatment options when looking for services for a child with developmental and behavioral disorders. As a parent, treatment options can seem overwhelming and pricey, and selecting the best service provider can be a challenge. Treatments include, but are not limited to: Speech-Language Pathology, Physical Therapy, Occupational Therapy, Psychology, Psychiatry, Special Education, and Applied Behavior Analysis. Parents often seek services to increase skill acquisition, decrease skill deficits, decrease problem behaviors, or to address a combination of goals. When parents look for different treatment options, it is always important to ensure the intervention is evidence-based. Evidence-based interventions are ones which have been researched and scientifically-proven to be effective. Although there are many treatment options available, as a parent it is critical to be cautious. It can be disheartening to select a treatment plan that is ineffective, but it much more problematic when the intervention selected may actually increase problem behaviors, limit skill acquisition, or cause aversive effects.
Children with developmental and behavioral disorders often simultaneously have sensory processing disorders. In 2012, the American Academy of Pediatrics wrote a policy statement on the use of Sensory-Integration Therapy (SIT) for sensory processing disorders. However, the definition of sensory processing disorder has been proposed but has not been universally accepted (Pediatrics, 2012). Sensory integration was first described by an occupational therapist named A. Jean Ayres, Ph.D. in the 1970s. He believed that sensory integration issues happen when sensory neurons do not signal or function effectively. Ayres thought the malfunction of the neurons could lead to deficits in development, emotional regulation, and learning.
Some researchers believe that children with developmental and behavioral disorders may be hyper- or hyposensitive to sensory input (Cook, 1990), which means they are over- or under stimulated in one of the three areas related to sensory input (vestibular, proprioceptive, and tactile). SIT is based on the idea that children with developmental and behavioral disorders (Autism Spectrum Disorder, etc.) may experience problems with their vestibular, proprioceptive, and tactile systems. Interventions for children using SIT are based on a “sensory diet” specific to the individual’s child’s areas of deficit or overstimulation (Alhage-Kientz, 1996).
“Sensory diet” activities include but are not limited to: rocking, jumping on a trampoline, swinging, rolling and riding on scooter boards, “deep pressure” or “joint compression”, body brushing, weighted vests, oral motor exercises, and body massage. SIT treatment focuses on increasing arousal in sensory areas which are under-stimulated and decreasing arousal in sensory areas which are hyper-stimulated. Although some studies (Wilbarger & Wilbarger, 1991; Bright & Fleeman, 1981; Ayers, 1979; and Magrum et al., 1981) show that SIT enhances the ability to focus, reduces the rate of problem behavior such as self-injury, and improves the nervous systems’ functioning, there is no scientific basis for these assertions (Arendt, MacLean, Baumeister, 1998).
Two studies were conducted which compared SIT to a Behavioral Intervention (Devlin, Leader, & Healy, 2009; Mason & Iwata, 1990). Both studies showed that the Behavioral Intervention was more effective at reducing challenging behavior. Behavioral Interventions are based on Applied Behavior Analysis (ABA) which focuses on determining the function of the challenging behavior. Functions of behavior are: access to attention or tangibles, escape or avoidance, and sensory-stimulation. Once the function of the challenging behavior is systematically determined (Functional Assessment or Functional Analysis), an intervention is designed which will decrease the challenging behavior by addressing the function it serves for the child. Additionally, replacement behaviors are taught which are functional and appropriate for the child.
In 2011, Devlin et al. conducted a study to compare SIT and a Behavioral Intervention to see which was more effective at reducing challenging behavior in four boys with Autism Spectrum Disorder. An Occupational Therapist was involved in the development of the treatment using SIT. The Behavioral Intervention was based on the results of a functional assessment of the challenging behavior. An alternating treatment design was implemented to compare the effects of each intervention on the reduction of challenging behaviors. The boys in the study ranged from 6- to 11-years-old and challenging behaviors for the four combined included: aggression (hitting, kicking), self-injury (head hitting, stamping feet, forcefully squeezing hands together, hair pulling, scratching self, finger-biting), and crying.
Results of the study showed that the Behavioral Intervention was more effective at reducing challenging behavior for all four boys. In addition, the SIT intervention showed very little change in challenging behavior when compared to baseline rates. One participant’s average rate of challenging behavior actually increased during the SIT intervention. This increase may have occurred because contingent on challenging behavior, the participant received access to sensory input which may have also unintentionally included providing attention (Devlin, Healy, Leader, & Hughes, 2011).
The research studies mentioned above showed that Behavioral Interventions were more effective at reducing challenging behavior than SIT. However, future studies should examine the effects of a Behavioral Intervention which systematically incorporated the use of Sensory-Integration techniques as positive reinforcement for appropriate behaviors. Children with developmental and behavioral disorders may be hyper- or hyposensitive to sensory input and might benefit from systematic sensory input. By examining the effects of Sensory-Integration Therapy applied using behavioral interventions which address the function the challenging behavior serves for the child, the challenging behavior may be decreased more effectively.
Parents of children with developmental and behavioral disorders should be cautious when considering SIT as an intervention for challenging behavior until future studies are conducted which show it is effective and research-based. Behavioral Intervention are research-based and effective at increasing skill acquisition, decreasing skill deficits, decreasing problem behaviors, or a combination of these. If you have any questions regarding the importance of the function-based interventions using Behavioral Interventions, contact a Board Certified Behavior Analyst (BCBA) at Behavioral Consulting of Tampa Bay. For additional information on things to look for evaluating a potential treatment for Autism, read Kelley Prince’s blog here.