Abstract
Date Presented 4/8/2016
A systematic review showed that massage protocols produce outcomes of improved sleep, behavior regulation, and sensory responsiveness for children with autism spectrum disorder. Other somatosensory-based interventions such as brushing protocol or weighted vests do not yet have adequate research to evaluate their effectiveness with this population.
Primary Author and Speaker: Diane Parham
Additional Author and Speaker: Rachel Goldman
PURPOSE: This study evaluates the rigor of existing research that examines the effectiveness of somatosensory-based interventions (SSBIs) for children with autism spectrum disorders (ASD). Research questions were “Are any SSBIs more effective compared with other treatments, or no treatment, in producing desired outcomes for children with ASD? If so, what outcomes are associated with which particular interventions?”
RATIONALE: Sensory aspects of ASD have gained visibility in recent years, particularly due to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2014), which includes “unusual sensory reactivity” as part of the ASD diagnostic criteria. Occupational therapists (OTs) working with children with ASD commonly use SSBIs such as weighted vests or brushing in order to modulate arousal and improve related functional behavior. It is imperative that occupational therapists working with this population be informed regarding which SSBIs are associated with particular outcomes and which SSBIs do not yet have a strong evidence base. This knowledge will inform their clinical reasoning as they plan interventions and communicate to others regarding occupational therapy intervention options.
DESIGN: A systematic review of quantitative studies examining effects of SSBIs for children with ASD
PARTICIPANTS: Peer-reviewed research articles published in 1961–2015 and meeting inclusion criteria were identified via database searches. To be included, studies must use quantitative methods to evaluate an intervention involving tactile or touch-pressure stimuli with children with ASD. Case studies were included if they reported quantitative data to describe intervention outcomes. The search yielded 30 studies that met inclusion criteria.
METHOD: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures were used to document the search process. Rating systems developed by the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) were used to evaluate level of evidence and rigor of each study included in the analysis.
ANALYSIS: Two independent raters used AACPDM rating systems to evaluate included studies. Single-subject studies were evaluated using AACPDM ratings for single-subject research. All others were evaluated using AACPDM ratings for quantitative group and case study designs.
RESULTS: The only SSBI that was supported by multiple high-level studies of good quality was massage, with outcomes of improvement in sleep, behavior regulation, sensory responsiveness, and parent–child interaction. Weighted-vest interventions were examined in multiple single-subject studies with limited research quality and equivocal findings. Very limited studies examined brushing protocols, with inconclusive results. One small study with a high-level research design supported the use of the Grandin Hug Machine to decrease anxiety.
DISCUSSION: Currently, massage is the only SSBI with emerging evidence to show that it is more effective for children with ASD than an alternative or no treatment. Studies on massage used specific protocols, so OTs wishing to use this SSBI should seek training. OTs should consider massage as an option for children with ASD when desired outcomes include improvements in sleep, behavior regulation, sensory responsiveness, or parent–child interaction. Other SSBIs used by OTs have limited support due to absence of high-quality studies. Future researchers should seek to examine these SSBIs using high-level research designs with high quality.
IMPACT: This study is important for practice because it calls attention to an intervention that OTs seldom use, despite strong evidence of effectiveness for children with ASD. It also signals a critical need for high-quality research that examines the effectiveness of more commonly used SSBIs, such as brushing or weighted vests.
References
American Psychiatric Association. (2014). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
