Does a Sensory Integration Approach Help Regulate Maladaptive

Behaviors in Children with Sensory Processing Disorder?

Orah Kabaei, OTS & Sara Silverberg, OTS
Touro University Nevada, School of Occupational Therapy
Level of
Evidence
I

Background
What is Sensory Processing Disorder (SPD)?
The inability to properly organize sensory signals into
appropriate responses.
Dr. Ayres (1979) described it as a neurological traffic jam
inhibiting the interpretation of necessary sensory information
to function optimally.

Role of Occupational Therapy (OT)

OTs implement family-centered sensory integration (SI)
approaches when addressing the sensory needs of children
(Stackhouse, 2014).
The primary focus of SI treatment is on engagement in
individualized, sensory-rich experiences aimed at addressing
each childs specific sensory needs (Ayres, 1979).
The goal is to foster appropriate responses to sensation in an
active, meaningful, and fun way to encourage engagement in
functional behaviors.
Rationale
While the utilization of SI is prevalent in treating children with
SPD, the evidence suggests that utilization of this treatment
method is controversial and inconclusive.

Methods
Databases Searched:
Google Scholar, Cinhal, ERIC, Medline, Psychinfo, ProQuest,
OTSearch. Hand searching was also conducted.
Initial search results yielded 22,690 articles.
Inclusion Criteria:
Peer reviewed
Studies published within the last 16 years, seminal articles
English and full-text
Levels I IV
Exclusion Criteria:
Participants over 19 years of age

III
IV
V

Systematic reviews, meta-analysis, randomized

controlled trials (RTC)
Two groups, nonrandomized studies (e.g. cohort,
case-control)
One group, nonrandomized (e.g. before and after,
pretest and posttest)
Descriptive studies that included analysis of
outcomes (single subject designs and case series)
Case reports and expert opinion, which include
narrative literature reviews and consensus
statements
TOTAL:

Number of Articles
Selected
3

Implications for OT Practice

The clinical and community-based practice of OT:
Preliminary research indicates that sensory integration
techniques are effective in reducing maladaptive behaviors.
Sensory integration approaches have been found to be effective
in multiple contexts including the home, school and various
clinical settings.

0
3
4
0

10
Retrieved from: http://cdn2.perfectpatients.com/childsites/uploads/824/files/boy-behind-glass-300x169.jpg

Implications
SPD leads to disruptive and aggressive behaviors, poor
attention, and lower scores in cognitive measures (Roberts,
King-Thomas & Boccia, 2007).
SPD impacts age expected social, cognitive, and sensory
functioning (Roberts et al., 2007).
SPD places a barrier in developing positive skills in academics
and socialization (Parham & Mailloux, 2010).
One in six children are impacted by sensory dysfunctions
severe enough to impact their ability to engage in everyday
activities (Sensory Processing Foundation, n.d.)

II

Study Design/Methodology of Selected Articles

Summary of Results and Conclusion

Summary of Results
The findings suggest that OT-SI is effective in treating sensory modulation deficits. Significant gains
were noted in selected measures utilized (Case-Smith & Bryan, 1999; Linderman & Stewart, 1999;
Miller, Coll & Schoen, 2007; Roberts et al., 2007; Smith, Press, Koening & Kinnealley, 2005).
The SI group demonstrated more significant improvements than the control group in their GAS scores
and demonstrated significantly fewer autistic mannerism. The GAS has been identified as an
effective outcome measure when treating children with SPD. (Pfeiffer, Koenig, Kinnealey, Sheppard, &
Henderson, 2011; Schaaf et al., 2013; Schaaf & Nightlinger, 2007).
Infants presenting with high attachment and poor self-regulation benefited from parental education
and the implementation of a home-based sensory diet to manage their Regulatory Sensory Processing
Disorder (Jorge, de Witt, & Frazen, 2013).
Findings concluded that activities rich in vestibular, tactile, and proprioceptive input, specifically
addressing an individuals sensory processing needs, were more beneficial in reducing maladaptive
behaviors when compared to a control group (Pfeiffer, et al., 2011; Smith et al., 2005)
One study demonstrated the effectiveness of a behavioral intervention over a sensory based
intervention in treating challenging behaviors (Devlin, Healy, Leader & Hughes, 2011).
Conclusion
Research has demonstrated SI to be effective in reducing maladaptive behaviors for children with
SPD. However, small sample size and limitations of study design indicates further research is
necessary to allow for generalizability.

Program development:
The implications taken from these studies indicate that direct and
consultative SI treatment can elicit enhanced outcomes for
developmental milestones and age-appropriate behaviors to
promote participation in desired occupations. However, one
study indicated that behavioral interventions based on functional
analysis or assessment of the problem behavior were more
successful in reducing and eliminating the target behavior. The
Goal Attainment Scale (GAS) has been consistently used as a
valid and reliable outcome measure to devise and evaluate
client-centered goals.
Societal needs:
Children displaying SPD are less independent and require more
full time care than their typically developing peers. Studies
suggest that SI protocol is effective in addressing these areas of
concern. However, limitations such as small sample size, lack of
Level I studies and potential biases indicate that further research
needs to be conducted to generalize results to a societal level.

Healthcare delivery and policy:

Further evidence is required before healthcare delivery and/or
policy can be shaped by the use of SI due to the small sample
size within existing research and the lack of generalizability.
Education and training of OT students:
OTs are provided with a generalist education on the principles of
SI and are well equipped in their clinical reasoning to implement
SI interventions that will in turn promote proper development. It
is recommended, however, that further certification and training
be obtained to apply appropriate individualized treatments.
Refinement, revision, and advancement of factual
knowledge or theory:
While the results of these studies show that SI interventions can
be an effective treatment strategy for reducing maladaptive
behaviors for children with SPD, future research in this area is
justified due to small sample size, study design and lack of
generalizability. The completion of more evidence-based and
rigorous research studies are needed to replicate the results of
this study within this review.

References (A Partial List)

Case - Smith, J., & Bryan, T. (1999). The effects of occupational therapy with
sensory integration emphasis on preschool-age children with autism.
American
Journal of Occupational Therapy, 53, 489497. doi: 10.5014/ajot.53.5.489.
Devlin, S., Healy, O., Leader, G., & Hughes, B. M. (2011). Comparison of
behavioral intervention and sensory-integration therapy in the treatment of
challenging behavior.Journal of Autism and Developmental Disorders,41(10),
1303-1320.

Contact Information
Orah Kabaei: ot16.orah.kabaei@tun.touro.edu
Sara Silverberg: ot16.sara.silverberg@tun.touro.edu