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Author(s): Roseann C. Schaaf [sup.1] , Zoe Mailloux [sup.1] , Elizabeth Ridgway [sup.2] , Alaina S. Berruti [sup.3] , Rachel L. Dumont [sup.1] , Emily A. Jones [sup.4] , Benjamin [...], Sensory features are part of the diagnostic criteria for autism and include sensory hypo/hyper reactivity and unusual sensory interest; however, additional sensory differences, namely differences in sensory integration, have not been routinely explored. This study characterized sensory integration differences in a cohort of children (n = 93) with a confirmed diagnosis of autism (5-9 years) using a standardized, norm-referenced battery. Mean z scores, autism diagnostic scores, and IQ are reported. Participants showed substantial deficits in tactile perception, praxis, balance, visual perception, and visual-motor skills. Relationship with autism diagnostic test scores were weak or absent. Findings suggest additional sensory difficulties that are not typically assessed or considered when characterizing sensory features in autism. These data have implications for a greater understanding of the sensory features in the autism phenotype and the development of personalized treatments.

Challenges with processing and integrating sensory information affect children's ability to successfully engage in their occupations at school and fully participate in the educational process. Occupational therapy using Ayres Sensory Integration® (ASI) is an evidence-based intervention for autistic children that has emerging evidence for children with idiopathic sensory integration differences. This article is a call to action for the occupational therapy profession to increase the use of ASI principles in school settings because it historically has been limited in its application. In this column, we respond to two main questions. First, is ASI necessary, essential, and inherently appropriate in school settings? Second, does ASI align with education laws and mandates? We present evidence showing that interventions to address sensory integration and processing function fall within the domain of school-based occupational therapy practitioners and provide examples for ways to use the principles of ASI across all the tiers of a multitiered system of supports. We also make recommendations for next steps that focus on best practices for implementing ASI in the academic setting and address concerns related to the feasibility of ASI in school-based practice within existing systemic and logistical constraints. As a result, occupational therapy practitioners will be empowered to advocate for use of ASI and its principles in the educational setting to proactively provide the support their students deserve. This article is a call to action for the occupational therapy profession to increase the use of Ayres Sensory Integration® in school settings. [ABSTRACT FROM AUTHOR]

Sensory difficulties are a commonly occurring feature of autism spectrum disorders and are now included as one manifestation of the "restricted, repetitive patterns of behavior, interests, or activities" diagnostic criteria of the DSM5 necessitating guidelines for comprehensive assessment of these features. To facilitate the development of such guidelines, this paper provides an overview of the literature on sensory features in autism spectrum disorder. We summarize the literature pertaining to: terminology, current assessment practices, sensory development, and the relationship of sensory features to core symptoms of autism. The paper concludes with recommendations for clinical assessment of sensory features in Autism.

Autonomic nervous system (ANS) activity during sensory stimulation was measured in 59 children with autism spectrum disorder (ASD) ages 6-9 in comparison to 30 typically developing controls. Multivariate comparisons revealed significant differences between groups in the respiratory sinus arrhythmia (parasympathetic measure) vector of means across sensory stimuli (p = 0.02) and in change from domain to domain (p = 0.01). Sympathetic activity, measured by pre-ejection period, did not differ significantly between groups, although it was higher in ASD participants. Findings suggest that participants with ASD demonstrated a different pattern of parasympathetic activity during sensory stimulation. Findings are discussed in relation to the biological mechanisms of sensory processing in autism, insight into the autism phenotype, and the utility of ANS activity as an outcomes marker.

This study evaluated a manualized intervention for sensory difficulties for children with autism, ages 4-8 years, using a randomized trial design. Diagnosis of autism was confirmed using gold standard measures. Results show that the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) than the Usual Care control group (n = 15). The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol, and provides support for the use of this intervention for children with autism. Findings are discussed in terms of their implications for practice and future research.

Objective: To examine the feasibility, safety, and acceptability of a manualized protocol of occupational therapy using sensory integration principles for children with autism. Methods: Ten children diagnosed with autism spectrum disorder ages 4-8 years received intensive occupational therapy intervention using sensory integration principles following a manualized protocol. Measures of feasibility, acceptability and safety were collected from parents and interveners, and fidelity was measured using a valid and reliable fidelity instrument. Results: The intervention is safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocol with adequate fidelity. These data provide support for implementation of a randomized control trial of this intervention and identify specific procedural enhancements to improve study implementation. (Contains 1 table and 1 figure.)

The purpose of this qualitative study was to explore the lived experience of how sensory-related behaviors of children with autism affected family routines. In-depth semi-structured interviews were conducted with four primary caregivers regarding the meaning and impact of their child's sensory-related behaviors on family routines that occurred inside and outside the home. Findings indicated that sensory behaviors are one factor that limited family participation in work, family and leisure activities; and that parents employed specific strategies to manage individual and family routines in light of the child's sensory-related behaviors. This information has important implications for professionals who work with families of children with autism to decrease caregiver stress and to increase life satisfaction for the child and family. (Contains 1 table and 1 figure.)

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families. (Contains 1 table and 1 figure.)

Importance: Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. Objective: To evaluate evidence of construct validity and internal reliability of data gathered with four newly developed praxis tests. Design: Comparative descriptive design. Setting: Homes, schools, and therapy practices across the United States. Participants: A control group consisting of 163 children without any concerns or diagnoses and a case group of 145 children with sensory integration difficulties, ages 3 to 12 yr. Outcomes and Measures: Rasch analyses to evaluate construct validity, and Student's t tests to evaluate group differences. Results: Total test scores and most item scores conformed to Rasch model expectations. Group differences were significant; the control group scored higher. Internal reliability was strong. Conclusions and Relevance: Findings support the validity and internal reliability of the four praxis tests. What This Article Adds: This study adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® tests. This brief report adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® Praxis tests. Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. [ABSTRACT FROM AUTHOR]

Importance: Assessment of tactile perception is foundational for addressing aspects of occupational performance. Objective: To evaluate the construct validity and internal reliability of four new tactile perception tests. Design: Causal comparative groups design. Settings: Homes, schools, and therapy practices across the United States. Participants: Children ages 3 to 12 yr: typically developing (n = 174) and those with sensory integration concerns (n = 153). Outcomes and Measures: Rasch analyses to evaluate construct validity; analysis of covariance to evaluate group differences. Results: The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests (η2p =.040–.105, p <.001). Person reliability indices and strata indicated moderate to strong internal reliability (Rasch person reliability indices =.69–.87; strata = 2.33–3.82). Conclusions and Relevance: The Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr. Findings suggest that these tests are likely to be clinically useful and appropriate for children in this age range and may provide critical information regarding underlying sensory functions necessary for optimal occupational performance. What This Article Adds: This article provides data supporting the reliability and validity of the EASI Tactile Perception Tests in a U.S. sample. These assessments can be used by therapists trained in their administration to assess tactile functions that may affect participation in activities, tasks, and occupations. The Evaluation in Ayres Sensory Integration (EASI) Tactile Perception Tests are reliable and valid measures and can be used by therapists trained in their administration to assess tactile functions in children that may affect participation in activities, tasks, and occupations. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy using Ayres Sensory Integration® (ASI) is an evidence-based intervention that includes parent education and participation to support outcomes. However, guidelines for this parent component have not been published. Objective: To obtain input from stakeholders on a revised guidebook for parent education during ASI intervention. Design: Cross-sectional survey design. Setting: Online surveys. Participants: Experts in ASI, occupational therapy practitioners who use this approach, and parents of children with autism who received occupational therapy using this intervention. Outcomes and Measures: Surveys designed and vetted to obtain input on content and usability. Results: Experts rated the guidebook as consistent with ASI principles, practitioners rated it as clinically useful, and parents rated it as useful and clear. Conclusions and Relevance: The parent guidebook for ASI is ready for further testing and use. What This Article Adds: This report adds knowledge translation and best practice strategies in parent education to the parent guidebook for ASI and provides evidence that it is acceptable by experts, parents, and clinicians. This report adds knowledge translation and best practice strategies in parent education to the parent guidebook for using Ayres Sensory Integration® (ASI) and provides evidence that the guidebook is acceptable by experts, parents, and clinicians. [ABSTRACT FROM AUTHOR]