Evaluation of the Effects of Sensory Integration-Based Intervention by a Preschool Special Education Teacher

This study addresses the call for increased research on common public school practices and progress monitoring by public school teachers. An alternating treatment design was implemented by a preschool teacher to evaluate the effect of sensory-integration based activities compared with an attention control on the on task behavior of three participants with disabilities. The preschool participants were observed during one-to-one teaching sessions and completing maintenance tasks in an independent workstation during the second half of a school year. The results revealed no differences in the estimated percentages of time on-task when either condition was used for all three participants. More time on task occurred when the participants were working in one-to-one activities. The design used in this study serves as a model that can be used by teachers and occupational therapists working in a public school. The process of sensory integration is supported by a theoretical construct that describes the relationship between the neurobiology of an individual and the environment (Fisher & Murray, 1991). Theorizing about the interaction between the sensory and motor systems and the environment has been a focus of the field of occupational therapy (Mailloux & Smith-Roley, 2004; Wilbarger & Stackhouse, 2005). Current theories build upon the work of Dr. Jean Ayres who developed a theory of sensory integration and described intervention practice for individuals with disabilities (Ayres, 1972; Ayres & Tickle, 1980). Although theory development regarding the interaction between behavior of the individual, the sensory and motor systems, and environmental stimuli is ongoing (Anzalone & Williamson, 2000; Baranek, Parham, & Bodfish, 2005; Wilbarger & Stackhouse), occupational therapists are actively recommending practices to address atypical behavior by individuals identified with disabilities thought to be a result of problems with sensory integration processing (Mailloux & Smith-Roley). Reviewers of research on practices based on sensory integration theory have concluded that there is either little or no evidence to support such practices when used for children with learning disabilities (Hoehn & Baumeister, 1994; Kaplan, Polatajko, Wilson, & Faris, 1993), language and learning disorders (Griffer, 1999), mental retardation (Arendt, MacLean, & Baumeister, 1988), and autism spectrum disorders (Goldstein, 2000; Rogers & Ozonoff, 2005). Although most reviewers identify methodological weaknesses in the design as one of the main reasons for their conclusions, there also is a lack of relationship between any changes in behavior with the proposed dysfunctional sensory or motor system (Baranek, 2002; Dawson & Watling, 2000). Many of these authors call for more research on the outcomes of this approach (Dawson & Watling; Griffer; Kaplan et al). In spite of this lack of evidence, sensory integration-based activities continue to be recommended by occupational therapists and used by educators in This study would not have been possible without the support of Kim Kossyta, Principal of Rowen Elementary School and the families of the three preschool students. We are particularly grateful to Mary Scott, the classroom Special Education Technician who acted as the primary observer throughout the study. We would also like to acknowledge Gretchen Stadnik Grundon who used her many talents in assistance of this manuscript. Correspondence concerning this article should be addressed to Laura J. Hall, Department of Special Education, San Diego State University 5500 Campanile Drive San Diego, California, 92182-1170. Email: ljhall@ mail.sdsu.edu Education and Training in Autism and Developmental Disabilities, 2010, 45(2), 294–302 © Division on Autism and Developmental Disabilities 294 / Education and Training in Autism and Developmental Disabilities-June 2010 public schools (Rogers & Ozonoff). Parents have reported (Smith & Antolovich, 2000) and authors have speculated (Kaplan et al.) that interventionists perceive that children improve as a result of sensory integration-based therapy or that positive changes in behavior are attributed to the sensory integration strategies. Several strategies that are put together in order to modulate arousal, attention, affect and action for an individual can be referred to as a “sensory diet” (Anzalone & Williamson, 2000; Baranek, 2002). Some of the strategies included in a typical “sensory diet” may be enjoyable for both the student and the educator. Massaging with lotion is an example. Escalona and her colleagues found that children with autism who received massage from their parents at bedtime exhibited less stereotypic behavior and showed more on-task behavior during play at school compared with those children with autism read a Dr. Seuss story (Escalona, Field, Singer-Strunck, Cullen, & Hartshorn, 2001). The authors state that the underlying mechanism for enhancing attentiveness is not known but they speculate that massage therapy has been noted to enhance parasympathetic activity that is correlated with attentiveness. Case-Smith and Bryan (1999) used a singlesubject AB design to evaluate the effects of sensory integration based therapy on the engagement, play and social behaviors of preschool children with autism or pervasive developmental disorders. Although they found increases in play behavior and engagement for three of the five participants, baseline measures were obtained following the winter break, a time the authors describe as typically resulting in regression of skills. Information on the generalization of play behaviors was lacking. Reilly, Nelson, and Bundy (1983) used an alternating treatment design to evaluate a 30minute sensory integration-based intervention compared with a fine motor activity on the vocalizations of 18 children with autism. Contrary to predictions they found that the fine motor activity resulted in more vocalization by participants, however, there was a history of positive reinforcement for vocalizations during fine motor activities. Schilling and Schwartz (2004) used a withdrawal design to evaluate the use of therapy ball for children with autism spectrum disorders and found that children were more engaged when using the therapy ball than when using alternative forms of seating (chair, bench, carpet square on floor). These single-subject designs could be used by public school personnel to evaluate intervention outcomes if the proper controls are incorporated. Educators and therapists who work in public schools are currently expected to use “evidence-based” practices (Odom et al., 2004). The importance of measuring outcomes and using data to guide treatment decisions has been emphasized by leaders in the field of occupational therapy (Anzalone & Williamson, 2000; Baranek et al., 2005; Ottenbacher, Tickle-Degnen, & Hasselkus, 2002). Betty Hasselkus, previous editor of the American Journal of Occupational Therapy, wrote that best evidence can be determined by quasi-experimental designs including single-subject designs (Ottenbacher et al.). The Council for Exceptional Children Task Force on Quality Indicators for Special Education Research also agrees that the use of single-subject designs with a set of criteria can be used to determine effectiveness of a practice (Odom et al.). In the following study, a single-subject alternating treatment design was used to evaluate the effects of sensory integration-based activities on the on-task behaviors of three students with developmental disabilities. This study was implemented by a preschool teacher with a credential in early childhood special education.