Date Presented 04/01/2022
Many children with autism experience attention deficits that limit their participation in daily occupations. Sensory interventions are commonly used to improve self-regulation and attention in children with autism. This systematic review summarizes current sensory interventions used by OT practitioners and determines the quality of evidence for these interventions. This analysis allows practitioners to use best evidence when choosing intervention strategies for their clients.
Primary Author and Speaker: Nicole Roberge
Contributing Authors: Jewel Elias Crasta
PURPOSE: Attention and self-regulation skills are critical for participation in meaningful occupations including school, play, and self-care. Children with autism have demonstrated deficits in attention and self-regulation that impact their ability to participate in daily occupations, indicating a need for interventions to address both these skills. Sensory interventions are commonly used for self-regulation in this population, but due to the variety of interventions, goals, and methods used by occupational therapists, evidence is mixed. A systematic review was conducted to determine the effectiveness of sensory interventions on attention and self-regulation and which sensory interventions have the best evidence for use with this population.
DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to complete this systematic review on the effectiveness of sensory interventions on attention and self-regulation for children with autism.
METHOD: Following the PRISMA guidelines, four databases were searched for relevant articles using keywords related to the research question. After screening and review, the articles that met inclusion and exclusion criteria were critically appraised, given a level of evidence score, and assessed for elements of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to determine the overall quality of evidence and the strength of the recommendation for use of each sensory intervention. Based on the GRADE score, each intervention was given a Traffic Light Score from the Evidence Alert Traffic Light System.
RESULTS: Thirty articles investigating the use of six different sensory interventions were included in this review. The sensory interventions included: Sensory Integration Therapy, massage, adaptive seating, environmental modification, weighted vests, and sensory diets/strategies. These interventions had varying degrees of quality of the evidence supporting their use. All of the interventions were given a Weak+ score for Strength of Recommendation and a Yellow Traffic Light Score due to the lack of harmful effects and inclusion of positive results in some studies. Sensory Integration Therapy and massage interventions had the highest quality of evidence, both receiving a moderate score. Factors that added to their effectiveness include high-intensity dosage, fidelity to a specific protocol, and addressing the individual client factors rather than the environment. The remaining four studies received either a low or very low score.
CONCLUSION: Occupational therapists currently use a variety of sensory interventions to address attention and self-regulation; however, not all sensory interventions are equally effective. While all six interventions had some evidence supporting their efficacy, two interventions were found to have a higher level of evidence. Sensory Integration Therapy and massage were both found to have a Moderate score for level of evidence supporting their use in addressing attention and self-regulation for children with autism. When providing sensory interventions to this population, occupational therapists need to match their interventions to appropriate goals and carefully track outcomes to determine the effectiveness of each intervention.
IMPACT STATEMENT: This review concludes that sensory interventions appear to be effective when addressing attention and self-regulation for children with autism, but more evidence is needed to determine which interventions are the most effective and should be recommended.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A Meta-Analysis of Sensory Modulation Symptoms in Individuals with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 39(1), 1–11. https://doi.org/10.1007/s10803-008-0593-3
Case-Smith, Jane, Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 19(2), 133–148. https://doi.org/10.1177/1362361313517762
Crasta, J. E., Salzinger, E., Lin, M.-H., Gavin, W. J., & Davies, P. L. (2020). Sensory Processing and Attention Profiles Among Children With Sensory Processing Disorders and Autism Spectrum Disorders. Frontiers in Integrative Neuroscience, 14. https://doi.org/10.3389/fnint.2020.00022
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of Occupational Therapy Using Ayres Sensory Integration®: A Systematic Review. American Journal of Occupational Therapy, 72, 7201190010. https://doi.org/10.5014/ajot.2018.028431