Date Presented 04/05/19
This study addresses the need of families by reporting on treatment effectiveness research for sensory processing and integration challenges. Information is provided on the use of a multiple baseline design along with an objective method to code outcomes in the area of play level, positive affect, joint attention, and novel use of equipment. Preliminary support is provided for a novel treatment that includes principles of sensory integration, relationship-based therapy, and parental participation.
Primary Author and Speaker: Sarah Schoen
Additional Authors and Speakers: Lucy Miller
Contributing Authors: Andrea Valdez
PURPOSE: This study addresses caregiver needs by.demonstrating the value and feasibility of a single-case research design to study of treatment effectiveness for children with sensory processing/integration challenges. The purpose was twofold: to quantify changes in children receiving therapy as well as apply an objective, participation measure of social interaction and play in the natural environment of the playground.
BACKGROUND: Children with sensory processing/integration challenges present with deficits in a number of physical, social and emotional areas that negatively affect participation in daily life activities (Bar-Shalita, Vatine, & Parush, 2008).. Limitations are reported in children’s ability to take advantage of learning opportunities in the natural environment, including on a playground, which results in further social isolation and lack of development of age appropriate play skills (Cosbey et al., 2012). This study adds to the literature by testing the effectiveness of an intensive, short term intervention that combines principles of sensory integration, relationship-based therapy and parental participation.
DESIGN: A non-concurrent, multiple baseline repeated measures design was used to study the effects of intervention for children with sensory processing/integration challenges. Four boys, aged 5 years 0 months to 7 years 9 months, participated in this study. The mean length of intervention was 22 sessions delivered 3-5 times per week. All participants had impairments in sensory processing/integration that affected participation in daily life activities.
METHOD: A behavioral coding scheme (Miller et al., 2017) was used to measure change in four areas: play level, positive affect, joint attention and novel use of equipment. The theory of change focused on the use of multisensory experiences in combination with parent participation to affect outcomes. All data were collected in the natural environment of a sensory friendly playground. Ten minute behavioral samples of play interactions between parent and child were collected and videotaped for later coding. Data analysis consisted of visual inspection of graphs for baseline and intervention phases on each of the dependent variable for all four participants. The following analyses were conducted for baseline and intervention phases (Richards, 2018): 1) mean level and range of scores, 2) slope of change using ordinary least squares regression and 3) Wilcoxon signed rank test to estimate the difference in mean level between phases.
RESULTS: Graphs for participants 1 and 2 showed weak to moderate effects. Graphs for participants 3 and 4 showed moderate to strong effects. Play level consistently changed across all participants. Multisensory experiences and parent participation were associated with these changes in two of the four participants. Wilcoxon signed ranks test showed the means of play level, multisensory experiences and parent participation tended toward significance (p = .068 for all).
CONCLUSION: Results suggest that a single-case research design is a feasible methodology to study the effectiveness of occupational therapy interventions. The behavioral coding system was sensitive to change in all participants. Play abilities changed in all four children. Preliminary support was provided for the theory of change with respect to the use of multisensory experiences in combination with parent participation.
IMPACT STATEMENT: Single-case research is a valuable methodology for studying treatment effectiveness. A targeted treatment approach that emphasizes parents as play partners within a multisensory environment shows promise in remediating deficits in children’s play abilities.
References
Bar-Shalita, T., Vatine, J. J., & Parush, S. (2008). Sensory modulation disorder: A risk factor for participation in daily life activities. Developmental Medicine & Child Neurology, 50(12), 932-937. doi:10.1111/j.1469-8749.2008.03095
Cosbey, J., Johnston, S. S., Dunn, M. L., & Bauman, M. (2012). Playground behaviors of children with and without sensory processing disorders. Occupational Therapy Journal of Research, 32(2), 39-47. doi:10.1016/j.ridd.2011.01.033
Miller, L. J., Schoen, S. A., Camarata, S. M., McConkey, J., Kanics, I. M., Valdez, A. D., & Hampton, S. R. (2017). Play in natural environments: A pilot study quantifying the behavior of children on playground equipment. Journal of Occupational Therapy, Schools, & Early Intervention, 10(3), 213-231.
Richards, S. B. (2018). Single Subject Research: Applications in Educational Settings (Vol. 3). Independance, KY: Cengage Learning.
