Date Presented 03/22/24
Findings from a National Institutes of Health–funded comparative effectiveness trial comparing Ayres Sensory Integration (ASI) and applied behavioral analysis (ABA) for children with autism are presented, and their implications for OT practice are discussed.
Primary Author and Speaker: Roseann C. Schaaf
Additional Authors and Speakers: Zoe Mailloux, Elizabeth Ridgway
Contributing Authors: Sophie C. Molholm, Emily Joneshuwer, Joanne Hunt, Rachel L. Dumont, Benjamin C. Leiby, Misung C. Li, Catherine C. Sancimino
PURPOSE: Occupational Therapy using Ayres Sensory Integration® (OT-ASI) is a frequently requested and utilized evidence-based intervention for autism (Steinbrenner, et al, 2000). Studies show it improves daily living skills and socialization using standardized outcome measures. However, this intervention has not been compared to other autism interventions such as behavioral intervention. This session presents the findings of a highly controlled randomized trial comparing these interventions.
DESIGN: A randomized comparative effectiveness trial. Ninety children from an inner-city population of families with a confirmed diagnosis of autism and presence of sensory features were randomized to either OT-ASI, behavioral intervention or no treatment group. Stratification variables included IQ, sensory severity, and severity of autism.
METHOD: Standardized outcome measures of daily living skills and repetitive behaviors were conducted at pre and post intervention. Interventionists were trained to competence and fidelity was measured. The primary statistical approach modeled each outcome using mixed effects linear regression with fixed effects of time, interaction and stratification variables.
RESULTS: Analyses showed that both treatment groups improved in daily living skills (measured by the Pediatric Evaluation of Disability Inventory – Computer Assisted Scoring; PEDI-CAT2; Haley, et al, 2020) and in individual goals using Goal Attainment Scaling. The ASI group improved more in daily living skills while the ABA group improved more on repetitive behaviors.
CONCLUSIONS: Differences in group outcomes will be discussed in light of implications for tailoring treatment to individual needs for ‘precision’ therapy. Translation of these findings to clinical practice are discussed including the use of the manualized protocol in practice, replication of the assessment protocol and intervention planning, and areas for collaboration with behavioral specialist.
References
Steinbrenner JR, Hume K, Odom SL, et al. Evidence-Based Practices for Children, Youth, and Young Adults with Autism. National Clearinghouse on Autism Evidence and Practice Review Team; 2020. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team.
Haley, S. M., Coster, W. J., Dumas, H. M., Fragala-Pinkham, M. A., Moed, R. (2020).The Pediatric Evaluation of Disability Inventory Computer Adaptive Test. New York: Pearson.
Schaaf, R. C., and Mailloux, Z. (2015). A clinician’s guide for implementing Ayres Sensory Integration: Promoting participation for children with autism. Bethesda: The American Occupational Therapy Association.
Madden G. J., (2011). APA handbook of behavior analysis. Washington, DC: APA Books.
