Background/Aims: Sleep and rest disturbances in children with an autism spectrum disorder and sensory over-responsivity are challenging issues to address. These are important self-care challenges that are commonly faced by many individuals with an autism spectrum disorder, with a high percentage of individuals with an an autism spectrum disorder reporting sleep disturbances. Many health-related professions, including occupational therapy, use weighted blankets to assist children with an autism spectrum disorder to calm, fall asleep and remain asleep. The purpose of this study was to explore the efficacy of weighted blankets with children with an autism spectrum disorder and sleep disturbances using a single case, multiple baseline design. Methods: This pilot study included two children with an autism spectrum disorder and sensory over-responsivity. Results: Using a single subject design found that there were minimal changes reported via caregivers, indicating that weighted blankets assisted in improving the overall quality of sleep for their child with an autism spectrum disorder, specifically time to fall asleep, number of wakings in the night, duration of sleep and behaviour in the morning. Using visual analysis, changes were noted in the variability of data points but not with abrupt changes in the slope of trend lines. Conclusions: This study provides a valuable springboard justifying the necessity for additional research studies related to improving the quality of sleep in children with an autism spectrum disorder and sensory over-responsivity using more robust single subject design methodology and objective measurement resources.

Key Points Question Can data from patient-collected audio recordings of their visits help clinicians improve their attention to patient life context when planning care, improve patient outcomes, and reduce health care costs? Findings In this quality improvement study, feedback was delivered to 666 clinicians based on analysis of 4496 audio-recorded visits. Attention to patient contextual factors increased from 67% to 72%, and contextualized care planning was associated with a greater likelihood of improved outcomes, resulting in an estimated cost savings of $25.2 million from avoided hospitalizations. Meaning These findings suggest that continuous feedback to clinicians about their attention to patient life context, based on audio recordings of their care, may substantially improve their performance, with measurable benefits for their patients and substantial cost savings.

Sound-based interventions (SBIs) are being used by paediatric occupational therapists to help children with autism spectrum disorders and co-morbid sensory processing disorders. A limited yet growing body of evidence is emerging related to the efficacy of SBIs in reducing sensory processing deficits among paediatric clients with co-morbid conditions. The current study employed an ABA single-subject case-controlled design, implementing The Listening Program® with a 7-year-old child diagnosed with autism spectrum disorder who demonstrated auditory sensory over-responsivity (SOR). The intervention consisted of 10 weeks of psycho-acoustically modified classical music that was delivered using specialized headphones and amplifier and a standard CD player. Repeated measures were conducted during the A(1), B and A(2) phases of the study using the Sensory Processing Measure, a subjective caregiver questionnaire, and the Sensory Over-Responsivity Scales, an examiner-based assessment measure to track changes of the participant's auditory SOR-related behaviours. The results indicated that the participant exhibited a decrease in the number of negative (avoidant, verbal and physical negative) and self-stimulatory behaviours. The decreases in negative and self-stimulatory behaviour may have been due to the therapeutic effect of the repeated exposure to the Sensory Over-Responsivity Scales or The Listening Program SBI.

The aim of this study was to determine the efficacy of The Listening Program (TLP) in treating a child with pervasive developmental disorder-not otherwise specified (PDD-NOS). Using a single-subject case study design, one child with PDD-NOS was administered a 20-week TLP intervention focused on improving sensory processing and language function. Data collection included pre- and post-evaluations using video footage, and Sensory Profile and Listening Checklist questionnaires. Results of the study indicated improved behaviour and sensory tolerance in the post-intervention video footage, including active participation in singing and movements to song. Sensory Profile and Listening Checklist questionnaires indicated significant improvements in sensory processing, receptive/expressive listening and language, motor skills, and behavioural/social adjustment at the post-intervention assessment. Although small in scope, this study highlights the need for continued research by occupational therapists into sound-based interventions. Particularly, occupational therapists need to perform larger-scale studies utilizing TLP to verify the efficacy of this alternative treatment method.

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Sound-based interventions (SBIs) involve listening to psychoacoustically modified music as a means for promoting new neural pathways in individuals with neurological dysfunction. Multiple forms of SBIs exist and are being used by healthcare professionals despite the lack of evidence to support their efficacy. The purpose of this study was to describe how occupational therapists (OTs) are using SBIs as an intervention in paediatric practice. An online survey was conducted using SurveyMonkey® and was completed by OTs describing their use of SBIs with paediatric clients. Paediatric OTs are using SBIs in a variety of practice settings, with children with a variety of medical and developmental conditions, and primarily use a subjective assessment process for determining effectiveness. Most referrals for SBIs come from other OTs and parents, and reimbursement primarily is achieved through private-pay mechanisms. This study had a small sample size (n = 74) and an estimated response rate of 14.7%, so generalization to occupational therapy practice in the United States is not possible. Further research is needed to identify the internal and external influences on the selection of SBIs as an OT intervention in paediatric practice.

The purpose of the study was to explore the efficacy of weighted blanket applications and sleep quality in children with autism spectrum disorder and behavioral manifestations of sensory processing deficits. Two 4-year-old participants diagnosed with autism spectrum disorder who also experienced sleep disturbances took part in a single-subject design study. Objective sleep measures and caregiver surveys were tracked for a baseline period of eight days, followed by a 14-day weighted blanket intervention and a seven-day withdrawal phase. Caregiver reports and objective data were evaluated using visual analysis and the percentage of non-overlapping data methods. The results suggest minimal changes in sleep patterns as a result of the weighted blanket intervention. The findings based on using a weighted blanket intervention were enhanced morning mood after night use and a significantly decreased time to fall asleep for participants, though they were not strong enough to recommend for clinical use. Future directions include single-subject and cohort-designed studies exploring the efficacy of weighted blankets with increasing sleep quality among children with autism.

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