RESEARCH QUESTION: Can we measure changes in autism-relevant behaviors during sensory integration (SI) therapy using innovative behavioral observation techniques?

BACKGROUND: According to the Centers for Disease Control and Prevention, 1 in 68 children are diagnosed with an autism spectrum disorder (ASD). Of note, it has been estimated that ≥90% of children with ASD also have sensory abnormalities, and sensory deficits have shown to be correlated with restricted repetitive behaviors, a core feature of ASD. The use of therapies focused on improving sensory processing is of high relevance. One such intervention, SI therapy, has a significant body of research demonstrating successful use in children with ASD, and it continues to be one of the therapies most frequently sought out by parents. We were interested in directly measuring changes in sensory processing and core behaviors relevant to ASD to further support the use of SI for children with ASD.

DESIGN: Retrospective analysis of previously recorded SI intervention sessions for children with ASD

PARTICIPANTS: Ten children ages 18–60 mo with a diagnosis of ASD.

METHOD: Videos collected by local occupational therapy clinics for educational or clinical purposes were obtained by the research team. Videos were then coded using Observer XT (Noldus Information Technology, Wageningen, The Netherlands), a software package for analysis of observational data.

ANALYSIS: A coding scheme was created and included 167 behaviors belonging to nine distinct categories: social, behavior, play, tactile, vestibular, heavy work–resistance, fine motor–tabletop activity, moves in space, and for an activity–task. Research personnel blind to the hypothesis coded frequency and duration of behaviors elicited by the child during intervention sessions. Percentage of change in rate of these behaviors from the first and last intervention session was calculated, and paired two-tailed t tests were used to determine statistical significance (p < .05).

RESULTS: Analyses revealed changes in several ASD-relevant behaviors. Specific sensory, motor, and social–communication behaviors increased and decreased following SI intervention (p < .05).

DISCUSSION: Observer XT was found to be a reliable and user-friendly software package for the detailed analysis of behaviors elicited during intervention. The coding scheme created for the analysis captured an array of behaviors elicited during intervention. The coding protocol we created was sensitive enough to detect changes in behaviors across SI intervention sessions. Moreover, we determined that video capturing during SI intervention sessions requires minimal effort, is of low risk to children and therapists, and can easily be incorporated into routine intervention sessions as a means to document changes in behaviors across sessions.

This study provides additional support for the use of SI in children with ASD and serves as a guide for potential outcome measures in future studies of SI interventions.

IMPACT STATEMENT: Behavioral coding with Observer XT is sensitive enough to measure change in behaviors across SI intervention sessions. Further research using this innovative method is needed to examine how SI intervention specifically affects sensory and core ASD behaviors.

To our knowledge, this study is the first detailed analysis of behaviors elicited during an SI session. This study helps identify most effective SI treatment strategies for future use in children with ASD.