Unusual sensory responses are relatively common in children with autism spectrum disorders (ASD) and often one of the earliest indicators of autism in childhood. In fact, sensory issues are now included in the DSM-5 symptom criteria for restricted, repetitive patterns of behavior, interests, or activities (RRB). When present, sensory problems may interfere with performance in many developmental and functional domains across home and school contexts. Best practice guidelines indicate that when needed, educational programs for children with ASD should integrate an appropriately structured physical and sensory milieu in order to accommodate any unique sensory processing challenges.
Sensory integration therapy (SIT) is often used individually or as a component of a broader program of occupational therapy for children with ASD. While sensory activities may be helpful as part of an overall educational program, there is no reliable and convincing empirical evidence that sensory-based treatments have specific effects. A recent study published in the journal Research in Autism Spectrum Disorders systematically analyzed intervention studies involving the use of sensory integration therapy. A total of 25 studies were described in terms of: (a) participant characteristics, (b) assessments used to identify sensory deficits or behavioral functions, (c) dependent variables, (d) intervention procedures, (e) intervention outcomes, and (f) certainty of evidence. Analyses indicated that 3 of the reviewed studies provided evidence that SIT was effective, 8 studies found mixed results, and 14 studies reported no benefits related to SIT. Many of the reviewed studies, including the 3 studies reporting positive results, had serious methodological flaws. The study concluded that the current evidence-base does not support the use of SIT in the education and treatment of children with ASD. According to one of the authors, “Rigorous, methodologically sound studies do not indicate that it helps and, in fact, the majority of studies that were reviewed reported no benefits for children with ASD.” In sum, this review indicates that SIT does not qualify as an evidence-based, or scientifically-based, intervention and that the results support the omission of SIT from several recent peer-reviewed lists of evidenced-based practices for children with ASD. Likewise, the National Autism Center’s National Standards Project identifies SIT as an “Unestablished Treatment,” for which there is little or no evidence in the scientific literature that permits a conclusion about the effectiveness of this intervention with individuals with ASD.
The American Academy of Pediatrics has also issued a policy statement indicating that support is lacking for SIT. The group’s Section on Complementary and Integrative Medicine and Council on Children with Disabilities recommends that because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. They also conclude that although occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan, “parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive.”
Consistent with the Academy’s recommendation, interventions to address sensory related problems, when utilized, should be integrated at various levels into the student’s individualized educational program (IEP). Comprehensive educational programming may also include consultation with knowledgeable professionals (e.g. occupational therapists, speech/language therapists, and physical therapists, adaptive physical educators) to provide guidance about potential interventions for children whose sensory processing or motoric difficulties interfere with educational performance.
All interventions and treatments should be based on sound theoretical constructs, robust methodologies, and empirical studies of effectiveness. Different approaches to intervention have been found to be effective for children with autism, and no comparative research has been conducted that demonstrates one approach is superior to another. The selection of specific interventions should be based on goals developed from a comprehensive assessment of each child’s unique needs and family preferences. A more detailed discussion of assessment domains (e.g. communication, social, sensory, academic) can be found in A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.
Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., … Giesbers, S. (2012). Sensory integration therapy for autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 6, 1004–1018. doi:10.1016/j.rasd.2012.01.006
American Academy of Pediatrics, Section on Complementary and Integrative Medicine and Council on Children with Disabilities, Policy Statement (2012). Sensory Integration Therapies for Children With Developmental and Behavioral Disorders. Pediatrics, 1186-1189. DOI: 10.1542/peds.2012-0876
National Autism Center (2009). National Standards Project-Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Randolph, MA: National Autism Center.
Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.