Effects of Alternative Seating on Attention and In-Seat Behavior for Children With Autism

PURPOSE AND BACKGROUND: The purpose of this study was to determine the effects of alternative seating on attention and in-seat behavior of preschoolers with autism. “For young children with ASD, the occupation of student can be especially complex and challenging” (Umeda & Deitz, 2011, p. 152). This difficulty may be attributable to the dynamic sensory components of a classroom, some promoting and others prohibiting optimal attention (Umeda & Deitz, 2011).

One strategy is alternative seating, such as a therapy ball or t-stool. Wu et al. (2012) found that the provision of therapy balls narrowed attentional gaps between children with and without attention deficit hyperactivity disorder (ADHD). Fedewa and Erwin (2011) found that therapy balls improved attention for those with ADHD and undiagnosed hyperactivity. Schilling and Schwartz (2004) found therapy balls effective in improving in-seat behavior and engagement for preschoolers with autism spectrum disorder (ASD). However, Umeda and Deitz (2011) did not find therapy cushions effective in improving in-seat and on-task behavior of kindergarteners with ASD. Although overwhelming support for use of alternative seating for children with ADHD exists, the literature is mixed regarding its effects for those with ASD.

METHOD: A single-subject ABAB design was used. During baseline phases (A), participants used the floor; during intervention phases (B), they used alternative seating (t-stool or cube chair). The study took place over 4 wk, with each phase lasting 1 wk. A convenience sample was used. Three boys and one girl participated; they had a diagnosis of autism and were between ages 4 yr, 2 mo, and 4 yr, 6 mo. Data were collected via videotape of morning circle 2×/wk. In-seat behavior and attention were documented. The operational definition of attention was a state of awareness of the available sensory information from the environment. Target behaviors included the following: child contributes via verbalizations or answering or asking of questions, child participates on request, child is quiet and responsive to teacher directives, teacher uses no more than two cues to elicit engagement that matches the ongoing instruction, and child concentrates on some feature of the process to the relative exclusion of others.

Researchers independently viewed videotapes and timed the duration of in-seat behavior and attention. The team met to review data once collection was complete. For discrepancies larger than 3 s, researchers re-viewed the video together to determine the correct duration. For discrepancies within 3 s (e.g., 4:56 and 4:58), the team chose the average as the data point (e.g., 4:57). The average duration of attention in each phase was calculated. The duration of attention and in-seat behavior was plotted for visual analysis using the two standard deviation band method.

RESULTS: Half of participants demonstrated an increase in average attention in at least one AB phase comparison, and 75% demonstrated an increase in average in-seat time in at least one AB phase comparison. However, none of these observed changes was statistically significant using the two standard deviation band method. Limitations include a short study duration, small sample size, and convenience sampling. In addition, the sensory components of the classroom and class activities may be another contributing factor to attention or in-seat behavior.

CONCLUSION: Alternative seating provides an opportunity for self-modulation and classroom participation while promoting attention and in-seat behavior. It is a noninvasive, cost-effective strategy that promotes education in the least restrictive environment. Implications include consultation to discuss alternative seating to facilitate engagement. Because the body of research on alternative seating and ASD is limited, research must continue to examine its effects.

References

Fedewa, A. L., & Erwin, H. E. (2011). Stability balls and students with attention and hyperactivity concerns: Implications for on-task and in-seat behavior. American Journal of Occupational Therapy, 65, 393–399. https://doi.org/10.5014/ajot.2011.000554

Schilling, D. L., & Schwartz, I. S. (2004). Alternative seating for young children with autism spectrum disorder: Effects on classroom behavior. Journal of Autism and Developmental Disorders, 34, 423–432. https://doi.org/10.1023/B:JADD.0000037418.48587.f4

Umeda, C., & Deitz, J. (2011). Effects of therapy cushions on classroom behaviors of children with autism spectrum disorder. American Journal of Occupational Therapy, 65, 152–159. https://doi.org/10.5014/ajot.2011.000760

Wu, W.-L., Wang, C.-C., Chen, C.-H., Lai, C.-L., Yang, P.-C., & Guo, L.-Y. (2012). Influence of therapy ball seats on attentional ability in children with attention deficit/hyperactivity disorder. Journal of Physical Therapy Science, 24, 1177–1182. https://doi.org/10.1589/jpts.24.1177