Thursday, March 26, 2015

Sensory Integration Therapy and Decreasing Stereotypy

One of the disorders sensory integration (SI) therapy is said to help with is the decrease of behavioral excesses in children with autism. In a new single-subject experimental design to evaluate the efficacy of various SI techniques on reduction of stereotypic behaviors, a net swing, “deep pressure,” and a sensory diet consisting of “deep compression” via a therapy ball, “deep pressure” via heavy work activities, “meatball squeeze,” and joint compression were examined with three preschoolers with autism. 

Single-subject studies are truly experimental; the other truly experimental type of research is randomized control trials. Single-subject studies involve a small number of participants but many data on the dependent variable are collected over time. What you give up in the number of participants, you gain in the number of observations per participant. Furthermore, the controls on the independent variable (i.e., the treatment) are very tight. Finally, you can see the exact results of the difference between conditions—between baseline and treatment, for example.

The study is by Sniezyk and Zane and was published in March in Focus on Autism and Other DevelopmentalDisabilities, Volume 30, Number 1. The occupational therapists conducting the treatments had the freedom to determine what specific behaviors to target and what exact treatments to use. The study used rigorous inter-observer agreement procedures, to ensure the reliability of the data, and they measured the fidelity of the procedures to ensure the children really were receiving the SIT described by their therapists. Quoting the abstract, “The results showed that there was no causal relationship between the sensory procedures and improvements in the targeted dependent variables. Thus, SIT remains an unproven treatment for autism.”

The purpose of this post isn't simply to bash SIT, which is too easy, but rather to encourage the evidence-based treatments for reducing stereotypies. The National Professional Development Center on ASD has an excellent review of evidence-based practices.

Monday, March 16, 2015

End of the RBI

Where do most people have difficulty following the protocol of the Routines-Based Interview? The end. The biggest mistake is interviewers confusing the starred items, which were concerns or things the family would like to see happen in the next 6 months, with outcomes. Confused interviewers read the starred items and ask parents which ones they want to put down as outcomes. No! A good interview ends up with many more stars than outcomes. Furthermore, stars are often repeated. For example, if the child doesn't communicate during breakfast, the interviewer or note taker marks a star next to his or her note about this. If the same issue comes up at lunch, another star. So stars or so-called concerns aren't outcomes.

After reading the concerns, which we train people to do in boom-boom-boom fashion, meaning quickly and without elaboration, we set the notes aside, take out a blank piece of paper or the blank form from the Protocol, and ask the parents what they want us all to work on. The parents' answers are the outcomes. We make sure we get the routines where they'd said they wanted to see that skill, but we don't, at that point, get much more. We're trying to finish up the interview, and this outcome selection takes about 20 minutes.

To help remember how the interview ends, here are three very short, very lame silent cartoons.

Beginning of the End

End of End Part 1

End of End Part 2