Sensory-based intervention in improving sensory processing, social, and play skills among children on the autism spectrum: a systematic review
DOI:
https://doi.org/10.47197/retos.v67.110525Keywords:
sensory-based intervention, occupational therapy, sensory processing, autism spectrum disorder, social, playAbstract
Introduction: Sensory-based intervention (SBI) is commonly implemented by occupational therapists for children on the autism spectrum. Despite its widespread use, evidence regarding its effectiveness remains mixed and inconclusive.
Objective: This review aimed to evaluate the clinical evidence and effectiveness of SBI in improving sensory processing, social interaction, and play skills in children with autism spectrum disorder (ASD).
Methodology: A systematic search was conducted across five databases: EBSCOhost, Web of Science, OT Seeker, PubMed, and Scopus. From 1345 identified articles, six met the inclusion criteria and were reviewed. The review followed PRISMA guidelines, with methodological quality assessed using the PEDro scale and risk of bias evaluated through the RoB 2 tool.
Results: The included studies reported SBI activities targeting tactile, vestibular, proprioceptive, visual, auditory, and olfactory systems. Interventions were delivered two to seven times weekly, with durations ranging from 15 to 60 minutes per session. Outcomes were measured across eleven domains, including sensory processing, social skills, play, sleep, cognition, autism symptomology, behaviour, adaptive functioning, language, goal attainment, and quality of life.
Discussion: While some studies showed improvements in specific areas, the findings were inconsistent. Variations in intervention frequency, duration, assessment tools, and participant characteristics contributed to the lack of consensus in the literature.
Conclusions: This review revealed limited and conflicting evidence on the effectiveness of SBI for children with ASD. Further rigorous research is needed to clarify its clinical value in addressing sensory processing challenges.
References
Abshirini, M., Khafaie, M.A., Bahrani, M.R., Rayshahri, A.P., & Khafaie, B. (2016) TEACCH and SIT ap-proach program in children with autism spectrum disorders. Online J Health Allied Sci 15(3), 1–5.
Aguiar, R. S., Lopes, G. C., de Castro, J. B. P., Prince, V. A., Mazini, F.M. L., Nogueira da Gama, D. R., Nunes, R.A., dos Santos, J.L.P., & Vale, R. G. S. (2021). Effects of high-intense resistance training on sali-vary cortisol in trained individuals: A systematic review. Retos, 41, 265–271. https://doi.org/10.47197/retos.v0i41.82770
Allen, S., & Casey, J. (2017). Developmental coordination disorders and sensory processing and integra-tion: Incidence, associations, and co-morbidities. British Journal of Occupational Therapy, 80(9), 549–557. https://doi.org/10.1177/0308022617709183
American Psychiatric Association. (2013). In Diagnostic and statistical manual of mental disorders (5th ed.). Journal American Psychology Association. https://doi.org/10.1176/appi.books.9780890425596.
Armstrong, J. E., Bregman, J. D., & Farmer, J. E. (2012). Autism spectrum disorders: Guide to evidence-based interventions. Missouri Autism Guidelines Initiative. Retrieved May 14, 2023, from http://www.autismguidelines.dmh.mo.gov
Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorders. American Journal of Occupational Therapy, 64, 895–903.
Baranek, G. T., David, F. J., Poe, M. D., Stone, W. L., & Watson, L. R. (2006). Sensory Experiences Ques-tionnaire: Discriminating sensory features in young children with autism, developmental de-lays, and typical development. Journal of Child Psychology and Psychiatry, 47, 591–601. https://doi.org/10.1111/j.1469-7610.2005.01546.x
Barton, E. E., Reichow, B., Schnitz, A., Smith, I. C., & Sherlock, D. (2015). A systematic review of sensory-based treatments for children with disabilities. Research in Developmental Disabilities, 37, 64–80. https://doi.org/10.1016/j.ridd.2014.11.006
Basuki, K. (2019). Supplementary material to explanation document. Journal of Online International Research, 7(3), 1689–1699. https://doi.org/1010.1136/bmj.n160.Correspondence
Bauminger-Zviely, N., Eytan, D., Hoshmand, S., & Rajwan Ben–Shlomo, O. (2020). Preschool Peer Social Intervention (PPSI) to enhance social play, interaction, and conversation: Study outcomes. Journal of Autism and Developmental Disorders, 50, 844–863.
Bella, M., & Evaggelinou, C. (2018). Theatrical play and social skills development: Teachers’ perspec-tives on educating autistic students. Cypriot Journal of Educational Sciences, 13, 408–421.
Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2009). Sensory over-responsivity in elementary school: Prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37(5), 705–716. https://doi.org/10.1007/s10802-009-9303-8
Boucher, H., Carder, D., & Schoen, S. A. (2022). A pilot study investigating the methodology for studying the effectiveness of intervention for toddlers with vestibular over-responsivity. Journal of Oc-cupational Therapy, Schools, & Early Intervention.
Boyd, B. A., McBee, M., Holtzclaw, T., et al. (2009). Relationships among repetitive behaviors, sensory features, and executive functions in high-functioning autism. Research in Autism Spectrum Dis-orders, 3(4), 959–966. https://doi.org/10.1016/j.rasd.2009.05.003
Camarata, S., Miller, L. J., & Wallace, M. T. (2020). Evaluating sensory integration/sensory processing treatment: Issues and analysis. Frontiers in Integrative Neuroscience, 14(31). https://doi.org/10.3389/fnint.2020.00031
Carnahan, R. and Kee, V. (2012). A systematic review of validated methods for identifying transfu-sion‐related abo incompatibility reactions using administrative and claims data. Pharmacoep-idemiology and Drug Safety, 21(S1), 230-235. https://doi.org/10.1002/pds.2325
Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing inter-ventions for children with autism spectrum disorders. Autism, 19(2), 133–148. https://doi.org/10.1177/1362361313517762
Christensen, D. L., Maenner, M. J., Bilder, D., et al. (2019). Prevalence and characteristics of autism spec-trum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR Surveillance Summaries, 68(1), 1–19. https://doi.org/10.15585/mmwr.ss6811a1
Christopher, S. (2019). Hypersensitivity in children with autism: An analysis. IJRAR-International Jour-nal of Research and Analytical Reviews, 6, 616–622. Available from: http://ijrar.com/
Cosbey, J., Johnston, S. S., & Dunn, M. L. (2012). Playground behaviors of children with and without sen-sory processing disorders. OTJR: Occupation, Participation and Health, 32(1), 39–47. https://doi.org/10.3928/15394492-20110930-02
Escalona, A., Field, T., Singer-Strunck, R., Cullen, C., & Hartshorn, K. (2001). Improvements in the behav-ior of children with autism following massage therapy. Journal of Autism and Developmental Disorders, 31, 513–516.
Fazlioğlu, Y., & Baran, G. A. (2008). Sensory integration therapy program on sensory problems for chil-dren with autism. Perceptual and Motor Skills, 106, 415–422.
Foss-Feig, J. H., Heacock, J. L., & Cascio, C. J. (2012). Tactile responsiveness patterns and their associa-tion with core features in autism spectrum disorders. Research in Autism Spectrum Disorders, 6(1), 337–344. https://doi.org/10.1016/j.rasd.2011.06.007
Green, M., Kirby, J. N., & Nielsen, M. (2018). The cost of helping: An exploration of compassionate re-sponding in children. British Journal of Developmental Psychology, 36, 673–678. https://doi.org/10.1111/bjdp.12252
Hayes, G. R., Hirano, S., Marcu, G., Monibi, M., Nguyen, D. H., & Yeganyan, M. (2010). Interactive visual supports for children with autism. Personal and Ubiquitous Computing, 14, 663–680.
Hellendoorn, A. (2014). Understanding social engagement in autism: Being different in perceiving and sharing affordances. Frontiers in Psychology, 5(268). https://doi.org/10.3389/fpsyg.2014.00268
Higgins, J. P., Sterne, J. A., Savović, J., Page, M. J., Hróbjartsson, A., Boutron, I., et al. (2016). A revised tool for assessing risk of bias in randomized trials. Cochrane Database of Systematic Reviews, 29–31.
Hilton, C. L., Harper, J. D., Kueker, R. H., et al. (2010). Sensory responsiveness as a predictor of social severity in children with high-functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(8), 937–945. https://doi.org/10.1007/s10803-010-0944-8
Kashefimehr, B., Kayihan, H., & Huri, M. (2018). The effect of sensory integration therapy on occupa-tional performance in children with autism. OTJR: Occupation, Participation, and Health, 38, 75–83.
Koegel, R., Openden, D., & Koegel, L. (2004). A systematic desensitization paradigm to treat hypersensi-tivity to auditory stimuli in children with autism in family contexts. Research and Practice for Persons with Severe Disabilities, 29(2), 122–134. https://doi.org/10.2511/rpsd.29.2.122
Koegel, L. K., Koegel, R. L., Ashbaugh, K., & Bradshaw, J. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International Jour-nal of Speech-Language Pathology, 16, 50–56.
Kuliński, W. & Nowicka, A. (2020). Effects of sensory integration therapy on selected fitness skillss in autistic children. Wiad Lek 73(8), 1620-1625. https://doi.org/10.36740/Wlek202008106
Lahera, G., Ruiz-Murugarren, S., Fernández-Liria, A., Saiz-Ruiz, J., Buck, B., Penn, D., & others. (2016). Relationship between olfactory function and social cognition in euthymic bipolar patients. CNS Spectrums, 21, 53–59. https://doi.org/10.1007/s10928-529-13000-382
Lane, A. E. (2020). Effective management of functional difficulties associated with sensory symptoms in children and adolescents. Journal of Child Psychology and Psychiatry, 61(9), 943–958. https://doi.org/10.1111/jcpp.13216
Lane, A. E., Young, R. L., Baker, A. E. Z. & Angley, M.T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders, 40(1), 112–122. https://doi.org/10.1007/s10803-009-0840-2
Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., Furnier, S. M., Hallas, L., Hall-Lande, J., Hudson, A., Hughes, M. M., Patrick, M., Pierce, K., Poynter, J. N., Salinas, A., Shenou-da, J., Vehorn, A., Warren, Z., Constantino, J. N., ... & Cogswell, M. E. (2021). Prevalence and char-acteristics of autism spectrum disorder among children aged 8 years—Autism and Develop-mental Disabilities Monitoring Network, 11 sites, United States, 2018. MMWR Surveillance Summaries, 70(11), 1–19. https://doi.org/10.15585/mmwr.ss7011a1
McCormick, C., Hepburn, S., Young, G. S., & Rogers, S. J. (2016). Sensory symptoms in children with au-tism spectrum disorder, other developmental disorders, and typical development: A longitudi-nal study. Autism, 20(5), 572–579. https://doi.org/10.1177/1362361315599755
Mikkelsen, M., Wodka, E. L., Mostofsky, S. H., & Puts, N. A. J. (2018). Autism spectrum disorder in the scope of tactile processing. Developmental Cognitive Neuroscience, 29, 140–150. http://dx.doi.org/10.1016/j.dcn.2016.12.005
Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61(2), 135–142. https://doi.org/10.5014/ajot.61.2.135
Miller, L. J., Schoen, S. A., Camarata, S. M., et al. (2017). Play in natural environments: A pilot study quan-tifying the behavior of children on playground equipment. Journal of Occupational Therapy in Schools & Early Intervention, 10(3), 213–231. https://doi.org/10.1080/19411243.2017.1325818
Morrison, R. S., Sainato, D. M., Benchaaban, D., & Endo, S. (2002). Increasing play skills of children with autism using activity schedules and correspondence training. Journal of Early Intervention, 25, 58–72.
Moseley, A. M., Herbert, R. D., Sherrington, C., & Maher, C. G. (2002). Evidence for physiotherapy prac-tice: A survey of the Physiotherapy Evidence Database (PEDro). Australian Journal of Physio-therapy, 48(1), 43–49.
Mundy, P. (2003). Annotation: The neural basis of social impairments in autism: The role of the dorsal medial‐frontal cortex and anterior cingulate system. Journal of Child Psychology and Psychia-try, 44, 793–809. https://doi.org/10.1111/1469-7610.00165
Padmanabha, H., Singhi, P., Sahu, J. K., & Malhi, P. (2019). Home-based sensory interventions in children with autism spectrum disorder: A randomized controlled trial. Indian Journal of Pediatrics, 86, 18–25.
Page, M. J., McKenzie, J. E., M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Aki, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S.,...Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLOS Medicine, 18(3), 1-36. https://doi.org/10.1371/journal.pmed.1003583
Parham, L. D., Clark, G. F., Watling, R., & Schaaf, R. (2019). Occupational therapy interventions for chil-dren and youth with challenges in sensory integration and sensory processing: A clinic-based practice case example. American Journal of Occupational Therapy, 73(3). https://doi.org/10.5014/ajot.2019.030460
Patejak, S., Forrest, J., Harting, E., Sisk, M., & Schussler, E. (2021). A systematic review of center of mass as a measure of dynamic postural control following concussion. International Journal of Sports Physical Therapy, 16(5). https://doi.org/10.26603/001c.27983
Peña, M., Ng, Y., Ripat, J., & Anagnostou, E. (2021). Brief report: Parent perspectives on sensory-based interventions for children with autism spectrum disorder. Journal of Autism and Developmen-tal Disorders, 51, 2109–2114. https://doi.org/10.1007/s10803-020-04644-8
Pfeiffer, B. A. (2011). Effectiveness of sensory integration interventions in children with autism spec-trum disorders: A pilot study. American Journal of Occupational Therapy, 26.
Pfeiffer, B., Kinnealey, M., Reed, C., & Herzberg, G. (2005). Sensory modulation and affective disorders in children and adolescents with Asperger’s disorder. American Journal of Occupational Thera-py, 59(3), 335–345. https://doi.org/10.5014/ajot.59.3.335
Piravej, K., Tangtrongchitr, P., Chandarasiri, P., Paothong, L., & Sukprasong, S. (2009). Effects of Thai traditional massage on autistic children’s behavior. Journal of Alternative and Complementary Medicine, 15, 1355–1361.
Reis, H. I. S., Pereira, A. P. S., & Almeida, L. S. (2018). Intervention effects on communication skills and sensory regulation in children with ASD. Journal of Occupational Therapy, Schools, & Early In-tervention, 11(1), 45–59. https://doi.org/10.1080/19411243.2018.1455552
Reséndiz-Benhumea, G., Sangati, E., Sangati, F., & Keshmiri, S. (2021). Social brains? A minimal model of the role of social interaction in neural complexity. Frontiers in Neurorobotics, 15. https://doi.org/10.3389/fnbot.2021.634085
Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M., Kuhaneck, H. M., & Pfeiffer, B. (2017). Using a multifaceted approach to working with children who have differences in sensory processing and integration. American Journal of Occupational Therapy, 71(5), 1–10. https://doi.org/10.5014/ajot.2017.019281
Robles-Campos, A., Gallegos-Abello, C., Ulloa-Campos, N., Cabrera-Castillo, M., Zapata-Lamana, R., Tapia-Figueroa, A., Reyes-Molina, D., Chavez-Askins, M., Ortiz, C., & Cigarroa, I. (2023). Characteristics and effects of school-based physical activity programs for schoolchildren with autism spec-trum disorder: A scoping review. Retos, 49, 203–213. https://doi.org/10.47197/retos.v49.95002
Rogers, S. J., & Ozonoff, S. (2005). What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry, 46(12), 1255–1268. https://doi.org/10.1111/j.1469-7610.2005.01431.x
Roșca, A. M., Rusu, L., Marin, M. I., Ene Voiculescu, V., & Ene Voiculescu, C. (2022). Physical activity de-sign for balance rehabilitation in children with autism spectrum disorder. Children, 9(1). https://doi.org/10.3390/children9010009
Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., Freeman, R., Leiby, B., Sendecki, J. & Kelly, D. (2013). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 43(7), 1446–1459. https://doi.org/10.1007/s10803-012-1700-4
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., et al. (2015). Preferred report-ing items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349, 1–25. http://dx.doi.org/doi:10.1136/bmj.g7647
Silva, L. M. T., Schalock, M., Ayres, R., Bunse, C., & Budden, S. (2009). Qigong massage treatment for sen-sory and self-regulation problems in young children with autism: A randomized controlled trial. American Journal of Occupational Therapy, 63, 423–432.
Skonieczna-Żydecka, K., Gorzkowska, I., Pierzak-Sominka, J., & Adler, G. (2017). The prevalence of au-tism spectrum disorders in West Pomeranian and Pomeranian regions of Poland. Journal of Applied Research in Intellectual Disabilities, 30(3), 283–289. https://doi.org/10.1111/jar.12238
Sterman, J., Gustafson, E., Eisenmenger, L., Hamm, L., & Edwards, J. (2022). Autistic adult perspectives on occupational therapy for autistic children and youth. OTJR: Occupation, Participation and Health. https://doi.org/10.1177/15394492221103850
Sterne, J., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., et al. (2021). RoB 2: A revised tool for assessing risk of bias in randomized trials. Retrieved from https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool/current-version-of-rob-2
Stuart, N., Whitehouse, A., Palermo, R., Bothe, E., & Badcock, N. (2023). Eye gaze in autism spectrum disorder: A review of neural evidence for the eye avoidance hypothesis. Journal of Autism and Developmental Disorders, 53, 1884–1905. https://doi.org/10.1007/s10803-022-05443-z
Suarez, M. A. (2012). Sensory processing in children with autism spectrum disorders and impact on functioning. Pediatric Clinics of North America, 59(1), 203–214. https://doi.org/10.1016/j.pcl.2011.10.013
van Laarhoven, T., Stekelenburg, J. J., Eussen, M. L. J. M., & Vroomen, J. (2020). Atypical visual-auditory predictive coding in autism spectrum disorder: Electrophysiological evidence from stimulus omissions. Autism, 24, 1849–1859.
Wan Yunus, F., Liu, K. P. Y., Bissett, M., & Penkala, S. (2015). Sensory-based intervention for children with behavioral problems: A systematic review. Journal of Autism and Developmental Disor-ders, 45, 3565–3579. https://doi.org/10.1007/s10803-015-2503-9
Watling, R., & Hauer, S. (2015). Effectiveness of Ayres sensory integration® and sensory-based inter-ventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69(5).
Watling, R., Koenig, K., Schaaf, R., & Davies, P. (2011). Occupational therapy practice guidelines for chil-dren and adolescents with challenges in sensory processing and integration. AOTA Press.
Weitlauf, A. S., Sathe, N., & McPheeters, M. L. (2017). Interventions targeting sensory challenges in au-tism spectrum disorder: A systematic review. Pediatrics, 139(1). https://doi.org/10.1542/peds.2017-0347
Willems, M., Waninge, A., & Hilgenkamp, T. I. M. (2018). Effects of lifestyle change interventions for people with intellectual disabilities: Systematic review and meta-analysis of randomized con-trolled trials. Journal of Applied Research in Intellectual Disabilities, 31, 929–961.
Woo, C. C., & Leon, M. (2013). Environmental enrichment as an effective treatment for autism: A ran-domized controlled trial. Behavioral Neuroscience, 127, 487–497.
Yaakop, N., Koh, D., & Mohammad Yasin, R. (2023). Tendencias Globales del Conocimiento Docente de Educación Física: Un Análisis Bibliométrico (Global Trends of the Teacher Knowledge of Physi-cal Education: A Bibliometric Analysis). Retos, 49, 174–188. https://doi.org/10.47197/retos.v49.97291
Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A, Durkin, M.S., Saxena, S., Yusuf, A., Shih, A. & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research, 15(5), 778–790. https://doi.org/10.1002/aur.2696
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