Systematic Review on Sound-Based Interventions to Improve School-Related Abilities

PURPOSE: Current sound-based intervention (SBI) programs have grown in practice in clinic, home, and school settings. Occupational therapists use SBIs to support sensory integration treatment to improve school-related tasks. Given the growing application of SBIs and increasing number of studies, a systematic review was conducted to determine the effectiveness of SBIs for children with sensory processing dysfunction (SPD) in improving school-related abilities.

METHOD: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines, an exhaustive database search was conducted using CINAHL, MEDLINE Complete, PsycINFO, ERIC, Web of Science, and Cochrane, which yielded 5,321 articles. An additional 21 articles were identified through hand searches. Inclusion criteria were as follows: peer-reviewed articles published 2005–2015; English language; evidence Levels I–IV; use of an SBI; outcome measures for school-related abilities of attention, following directions, task engagement and completion, fine motor skills, visual motor skills, communication, social skills, sensory processing, and sensory modulation; and participants ages 2–19 yr with identified SPD. Exclusion criteria included Level V evidence and qualitative studies, dissertations, theses, abstracts, and other oral presentations. The research team organized the data into an evidence table and assessed for risk of bias using the Quality Index. The team individually assessed each article, and discrepancies were resolved by discussion and mutual agreement on the item question. A qualitative data synthesis was then performed using the strength of the evidence grading system.

RESULTS: Ten full-text articles remained after application of the inclusion and exclusion criteria. Due to low levels of evidence and inconsistencies in the findings on outcomes in sensory processing and auditory sensory overresponsivity, SBI programs demonstrate limited evidence to address school-related abilities. Studies on SBIs published in peer-reviewed journals have increased, and the evidence appears to be building, which is a departure from previous anecdotal stories. Nine of ten outcomes in school-related abilities had positive results based on a few standardized outcome measures such as the Beery–Buktenica Developmental Test of Visual–Motor Integration, Peabody Developmental Motor Scales, Evaluation Tool of Children’s Handwriting, Adaptive Behavior Assessment System, and Social Skills Rating System. The average Quality Index score across studies was fair, ranging from poor to good quality.

DISCUSSION: Given the growing and popular application of SBI programs among children with SPD, this review found limited evidence for its application to improve outcomes in school-related abilities pertaining to following directions, task engagement and completion, fine motor skills, visual motor skills, communication, social skills, sensory processing, and sensory modulation. Occupational therapists using an SBI should be diligent in providing education to clients about the risks and benefits of SBIs, following appropriate guidelines for the application of the SBI, and performing data collection including clinical assessment and outcome measures.

CONCLUSION: Future research on SBI should focus on improving the research methodological design by using a control group, randomization of treatment, larger sample sizes, and control for cointerventions. This review suggests SBIs may have a positive effect on school-related abilities and support performance in the classroom. As primary providers, occupational therapists need to implement more rigorous research that examines the effectiveness of SBIs.