Posted by occupational therapist Alison Wheeland, a doctoral student at the University of Southern California serving her doctoral residency with Autism Speaks. Her work with Autism Speaks involves developing information about occupational therapy services across the lifespan for those with autism.
This month, researchers with Philadelphia’s Farber Institute of Neuroscience published a ground-breaking study in the Journal of Autism and Developmental Disorders. This study is among the first scientifically rigorous clinical trials to assess the effectiveness of occupational therapy using sensory integration (OT-SI) for improving the ability of children with autism to participate meaningfully in daily life. [Read our news story on this study’s findings here.]
The new study is important because it used a randomized, controlled trial to assess OT-SI intervention while assuring that it was delivered in a way that met all the characteristics of sensory integration intervention. It showed that children who received OT-SI in addition to their other autism treatments achieved greater improvements in their ability to function in daily life than did children who received the same standard autism treatments without OT-SI.
As the autism community knows well, many individuals with autism have difficulty processing and integrating sensory information. These sensitivities can create great barriers to participating in daily life for those with autism and their families. As a result, interventions that address sensory difficulties are among the most requested by parents of children with autism.
Unfortunately, OT-SI – which can change brain function – is sometimes confused with other sensory-based strategies that help calm individuals but don’t have long term effects. Examples of the latter include weighted blankets and compression vests.
OT-SI has also remained poorly understood, in part, I think, because it looks like mere play. To the uninformed onlooker, it can be hard to see the serious neuroscience beneath the play. I’d like to use a classic scenario to illustrate.
When you look through the window of a sensory integration clinic, you might see something like this: A little boy is sitting in a ball pit, with a therapist kneeling next to the pit. As she points down, the little boy reaches sideways into the pit and pulls out a Beanie Baby. The woman holds up another Beanie Baby, and the boy makes his Beanie Baby give her Beanie Baby a kiss. The woman smiles and rubs the boy firmly on his back. Nearby, a second woman sits, watching.
If you didn’t know this was a therapy clinic, you might assume you were looking into the window of, say, a daycare during play time. Perhaps nothing in this scene would make you think “therapy.”
But with a little more background, you would understand that this 4-year-old has autism. He’s working with an occupational therapist using the principles of OT-SI. His mother is observing the session, so she can make use of the techniques at home.
The boy was referred to occupational therapy because of severe challenges bathing, dressing, eating and participating in social interactions with his family. His mom’s biggest hope is that her son will someday let her kiss him.
He was also having trouble in school, with repeated tantrums and distracting self-stimulatory behaviors such as hand waving.
The occupational therapist’s evaluation determined that extreme sensitivity to sensory input was the root cause of the boy’s challenges. He had sensitivities not only to touch, bright lights, loud noises and movement, but also to quiet background noises that most people easily tune out. This little boy even reacted to the feel of his sock seams. He constantly felt under stress from all this incoming sensory information. As a result, it took very little to push him into panic.
With this information, you can now see the above scene in a different light. The OT is using play (one of the most important occupations of childhood) to help change how the boy’s brain reacts to touch, sound, sight and movement. Over the past few months, she has introduced him to new textures and challenged his sensory systems with a variety of carefully selected games.
She follows his interests and lets him pick the games, but always tweaks the activity to make sure he’s making progress towards his goals. She makes sure the game is the “just right challenge” for his skills. It’s not so easy that he’s bored, but not so hard that he can’t succeed. She watches him carefully for signs that he’s feeling overwhelmed – and has a strategy ready for calming him down.
If you look closely, you’ll see that he’s doing well in the ball-pit activity, but the sensory input is challenging. Those balls felt strange to him at first. But he’s getting used to how they feel and the rattling sound they make when he moves. Today, he’s even sitting in the pit with the balls up to his chest. He also has to lean his head sideways when he reaches down. This gently challenges his vestibular system (the sense of balance and movement aided by a small organ in the inner ear). It’s engaged every time he moves forward, backwards, up, down, side to side, or in a circle.
To find the Beanie Baby, he even plunged his bare arms down into the ball pit. This made a loud sound, and the balls felt funny on his arms. But he was able to tolerate it while focusing his attention on the therapist’s directions.
She points as a visual cue to help him understand her spoken directions. She is also using calming, deep-pressure touch when she rubs him firmly on the back. She might rub his arms, too, if she senses that it’s bothering him to push them between the balls. These techniques help her teach the boy that slow, deep-pressure is an important strategy for self-soothing when he starts to feel overwhelmed.
The OT is using this sensory integration approach to change the way that the boy’s brain interprets sensory information. It’s becoming easier for his parents to dress him because his clothes don’t bother him as much. Washing his hair is easier because he can tip his head back without panicking. He’s been playing with new foods, too, acquainting himself with their textures as a first step toward taking a bite.
His growing ability to tune out distracting sights, sounds and touch sensations will help him focus and learn in school. In fact, his OT has been working with his teacher to incorporate socially acceptable self-soothing strategies that can replace the self-stimulatory behaviors that had been getting him teased in class.
And, yes, he’s getting used to the idea of kisses – though just between Beanie Babies for now. I’d say things are looking hopeful for real kisses with his mom in the not too distant future.
Editor’s note: For more on the effectiveness of OT-SI “play therapy,” see today’s research news here.