Sensory integration therapy (SIT) has been one of the treatment mainstays for thousands of children diagnosed with autism spectrum disorders, ADD/ADHD, or other developmental disorders. According to the American Occupational Therapy Association (AOTA), approximately 5 to 15% of children in the general population have sensory processing issues.School-based and private occupational therapists and parents have brushed, swung, and bounced on balls countless children in an effort to improve their ability to process sensory input. Yet, the effectiveness of this therapy, despite accolades it has received from therapists and parents, has been questioned. Now a new study by Lang et al that assesses the benefits of SIT by reviewing 25 existing studies adds additional fuel to the debate. In a nutshell, the study authors state that SIT is neither effective nor research-based and that agencies (such as schools) that are mandated to provide research-based interventions should not be using SIT.
Lang et al culled electronic data bases for different studies that purported to measure the effectiveness of SIT. To be included in the Lang review, the study had to meet certain inclusion criteria; namely, at least one participant had to be diagnosed with an ASD and some form of SIT had to be implemented in an effort to ameliorate the symptoms of the ASD. The SIT was then classified as positive, negative, or mixed depending on its effectiveness. Additionally, the methodological rigor of the study was examined to determine if the study had a true experimental design that among other things could be replicated.
Of the 25 studies included in the review, 3 suggested that SIT was effective, 8 had mixed results, and 14 showed no improvement related to SIT. The study authors went on to state that many of the studies reviewed, including the three with positive results, had serious methodological flaws.
Not surprisingly, the AOTA has come back pretty hard denouncing this review by Lang et al. SIT, according to the AOTA, needs to be tailored very specifically to the child and offered for prolonged periods of time. The SIT used in all 14 of the studies that Lang et al rated ineffective was neither performed appropriately nor in the recommended time frame to be effective, according to the AOTA. Additionally, in a number of those studies that had positive or mixed results, the SIT was used more appropriately, according to the AOTA. With regards to study methodology, the AOTA argues that just because a study's methodology is weak does not mean the SIT was ineffective. More rigorous study may be needed, but researchers need to recognize that the lack of homogeneity in children with ASDs and the need to individuate SIT treatments make it very difficult to design controlled studies.
The American Academy of Pediatrics had jumped into this argument last spring in a policy statement on sensory integration therapies, which adopts a more middle of the road approach. According to the AAP, "Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan." However, the AAP suggests that pediatricians need to discuss with parents the limitations of the research involving the effectiveness of SIT and work with families on how to determine if the SIT is working for their child or not.
Some school districts may perhaps use the Lang study as a justification for removing SIT from their special education programs, since Lang declared it was not research-based, as required by IDEA and NCLB. So, where does this leave children with ASD and other disabilities and their parents? In my experience over the last several years more districts are seeing the benefits of sensory integration, althought the effectiveness of the providers is very broad. Hopefully this study will not move things in the wrong direction. Students need all the tools arrayed in their favor including SIT.
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