A Retrospective Pretest/Posttest Study of Occupational Therapy Intervention for Children With Sensory Challenges

SIGNIFICANCE/INNOVATION: In this study, we address an important need for evidence-based practice by providing preliminary information about an effective treatment for children with sensory challenges and evidence about functional and behavioral measures sensitive to change for inclusion in future prospective studies. We describe a novel treatment approach that (1) combines intensive, short-term occupational therapy using principles from sensory integration and DIRFloortime^TM and (2) shifts current clinical practice to embrace extensive parent education and coaching as an integral part of intervention. We attempt to answer the following research question: Does an intensive, short-term model of intervention in which direct treatment is combined with extensive parent participation affect the adaptive behavior and emotional functioning of children with sensory challenges?

RATIONALE: Sensory processing problems are a significant impairment for many school-aged children, which may result in more enduring social and emotional problems. Occupational therapists have used direct intervention with a sensory integration approach to treat children with these problems, but few studies have examined the effectiveness of sensory-based approaches in which short-term treatment is combined with parent coaching and education.

METHOD: In this study, we used a retrospective pretest and posttest design. Children with sensory challenges participated in an intensive, short-term program of occupational therapy intervention. The setting was a private pediatric clinic. Intervention was conducted 3 to 5 times per week for a total of 30 sessions and included parent participation in clinic sessions and six parent-only education sessions. Direct treatment utilized strategies from the sensory integration frame of reference, DIRFloortime, integrated listening systems, and cognitive-behavioral approaches. Parent education focused on home strategies guided by clinical reasoning using the model of ASECRET.

Ninety-eight children aged 2 to 13 yr met criteria for impairment on the basis of standardized testing and clinical observation. Children with known psychiatric, neurological, mental, or physical disorders were excluded. Outcomes were measured by parent report using the Adaptive Behavior Assessment System—Second Edition (ABAS–II) and the Behavior Assessment System for Children—Second Edition (BASC–2) before and after treatment. Analyses included the use of nonparametric paired-samples tests to assess change in adaptive behavior and emotional functioning.

RESULTS: Significant improvements were reported for all composite scores of the ABAS–II and the BASC–2. Effects sizes were largest for the practical composite of the ABAS–II (r = .56), reflecting activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for all clinical composites of the BASC–2, particularly for the Hyperactivity (r = .43) and Depression (r = .41) subtests.

CONCLUSION: This study provides preliminary evidence for the effectiveness of a sensory-based, intensive, short-term intervention program for children with sensory challenges in which direct treatment is paired with parent coaching and parent education. Standardized measures were sensitive to change and hold promise for use in more scientifically rigorous studies. Limitations include lack of a control group and nonrandomization.

References

Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2009). Sensory over-responsivity in elementary school: Prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37, 705–716. http://dx.doi.org/10.1007/s10802-008-9295-8

Bialer, D., & Miller, L. J. (2011). No longer a secret: Unique common sense strategies for children with sensory or motor challenges. Arlington, TX: Sensory World.