Date Presented 4/20/2018
This study explored relationships between child and therapist behaviors during sensory integration therapy. Data reveal strong correlations between behaviors children improved in and specific therapist activities, which can guide sensory integration therapy for young clients with autism to improve child outcomes.
Primary Author and Speaker: Cristin Holland
Additional Authors and Speakers: Ozan Yay, Giorgio Gallini, Erna Blanche, Barbara Thompson
BACKGROUND AND PURPOSE: Sensory integration therapy (SIT) is widely used by occupational therapists for clients with autism spectrum disorder (ASD). Recent research provides compelling support for SIT as an effective intervention for improving both sensory-related and functional difficulties in children with ASD (Schaaf et al., 2014). However, research on therapists’ activities in relation to clients’ behaviors has been limited to small increments of time during the intervention session (Dunkerly et al., 1997). Therefore, the goal of this study was to further investigate relationships between child outcomes and therapist behaviors.
METHOD: In this retrospective study, occupational therapists and their clients aged 18–60 mo with ASD were video recorded over the course of intervention. Intervention was provided by occupational therapists in two local occupational therapy clinics in the Los Angeles area in which sensory integration is the primary mode of intervention. Twenty-six videos of nine clients and seven therapists were analyzed using continuous sampling behavior coding with Observer XT (Noldus Information Technologies, Wageningen, The Netherlands). Videos ranged from 23 to 60 min, with a mean time of 40 min.
Individualized and comprehensive coding schemas for the child and the therapist were created in collaboration with experts in SIT. For the child, a coding schema of 190 behaviors relevant to sensory processing, ASD core symptomatology, and general impression scores was created. For the therapist, a schema of 140 behaviors related to facilitated activities and social interactions with the child was created. Therapist and session activities were rated on general impression scores relevant to therapeutic modes and type of play. Research personnel blind to intervention status of the videos were trained and coded the videos. Mean interrater reliability for child and therapist behaviors was k = .66.
To account for differences in video length, behavior counts were converted to frequency per minute. Pearson correlations were used to explore relationships between child improved outcomes in decreased tactile exploration, improved eye contact and shared affect, social reciprocity, and engagement with therapist behaviors during intervention.
RESULTS: We found strong positive correlations between child eye contact and shared affect, social reciprocity, and engagement with therapist feedback and therapist behaviors that promoted challenge, problem solving, and planning (rs = .474–.765, ps = .000–.030). These findings suggest that the just-right challenge is critical to child engagement during SIT. Additionally, eye contact and shared affect were associated with joking and fun (r = .784, p = .000), and engagement (r = .629, p = .001) and social reciprocity (r = .708, p = .000) were related to collaboration between client and therapist during the session, indicating the importance of the therapist–child alliance. Tactile exploration was associated with both linear (r = .584, p = .002) and rotary (r = .597, p = .002) vestibular input and postural control activities (r = .562, p = .003).
CONCLUSION: This study is the first to quantify entire SIT sessions in a detailed manner for both the child and the therapist. Results describe therapist actions and child behavior responses that can help guide therapists’ activities and therapeutic use of self during intervention to enhance both behavioral and sensory processing outcomes because it appears that specific therapist actions may influence child behavior. Revealing reciprocal interactions between therapist and child that improve child performance will significantly impact future SIT, ultimately leading to improved child outcomes as a result of intervention.
References
Dunkerly, E., Tickle-Degnen, L., & Coster, W. J. (1997). Therapist–child interaction in the middle minutes of sensory integration treatment. American Journal of Occupational Therapy, 51, 799–805. https://doi.org/10.5014/ajot.51.10.799
Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., . . . Kelly, D. (2014). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44, 1493–1506. https://doi.org/10.1007/s10803-013-1983-8
