A systematic review of ayres sensory integration intervention for children with autism

Abstract

Sensory integration is one of the most highly utilized interventions in autism, however, a lack of consensus exists regarding its evidence base. An increasing number of studies are investigating the effectiveness of this approach. This study used the Council for Exceptional Children (CEC) Standards for Evidence‐based Practices in Special Education to evaluate the effectiveness research from 2006 to 2017 on Ayres Sensory Integration (ASI) intervention for children with autism. A systematic review was conducted in three stages. Stage 1 involved an extensive database search for relevant studies using search terms related to sensory integration and autism, interventions suggesting a sensory integration approach, and high‐quality study designs. Searches yielded 19 studies that were evaluated in Stage 2. Six of these met inclusion criteria of being peer‐reviewed, written in English, description of intervention this is consistent with ASI intervention, and comparison group design or single subject method employed. Prior to analysis using CEC standards, three articles were excluded because intervention details were not consistent with the core principles of ASI, or because of major methodological flaws. In Stage 3, the remaining three studies were rated using the CEC quality indicators and standards for an evidence‐based practice. Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items. One additional study met more than 50% of the criteria. Based on CEC criteria, ASI can be considered an evidence‐based practice for children with autism ages 4–12 years old. Autism Research 2019, 12: 6–19. © 2018 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. Lay Summary Ayres Sensory Integration intervention is one of the most frequently requested and highly utilized interventions in autism. This intervention has specific requirements for therapist qualifications and the process of therapy. This systematic review of studies providing Ayres Sensory Integration therapy to children with autism indicates that it is an evidence‐based practice according to the criteria of the Council for Exceptional Children.

Ayres Sensory Integration Meets Criteria for an Evidence‐Based Practice: A Response to Stevenson [2019]

“…We are grateful for the opportunity to address Stevenson's [] response to our paper entitled “A systematic review of Ayres Sensory Integration Intervention for children with autism” [Schoen et al, ]. These authors challenge our conclusion that Ayres Sensory Integration (ASI) meets criteria for an evidence‐based intervention based on the Council for Exceptional Children's Standards for Classifying the Evidence Base of Practices in Special Education [Council for Exceptional Children (CEC), ].…”

“…Study reports one or more appropriate effect size statistics for all outcomes relevant to review being conducted, even if the outcome is not statistically significant or provides data from which appropriate ESs can be calculated” [CEC, , p. 228]. As indicated in the Schoen et al [] review, the study by Pfeiffer and colleagues used analyses that were appropriate for the data, and effect sizes were calculated on all measures. Thus, it fully meets this quality indicator and therefore should be considered a methodologically sound study.…”

Letter to the editor RE: Novak and Honan (2019)

“…First, SI is defined incorrectly here as including sensory diets, brushing and weighted vests. Recent systematic reviews have highlighted the importance of correctly defining SI using a specific fidelity measure (Schaaf, Dumont, Arbesman, & May-Benson, 2018;Schoen et al, 2019). A correct definition is an important first step in evaluating the evidence of interventions.…”

“…Novak and Honan have included a number of studies in their systematic review, which claim to evaluate SI, but do not meet the fidelity criteria and are therefore not SI.Our second concern is that Novak and Honan (2019) appear to have conflated the research evidence for children from different disabilities, for example, autism and cerebral palsy, in relation to sensory interventions and this is problematic. Recent systematic reviews demonstrate effectiveness of SI for children with autism in relation to functional and participation outcomes, provided specific fidelity criteria were met (Schaaf et al, 2018;Schoen et al, 2019). Novak and Honan appear to have conflated SI and Bobath citing an editorial (Mayston, 2016) which is relevant to Bobath for children with cerebral palsy, not SI for children with autism, without reference to updated SI fidelity literature.…”

Reply to: Letter to the Editor RE: Novak and Honan (2019)

“…We agree that assessing fidelity is essential. The systematic review by Schoen et al, (2019) about sensory integration (SI) for autism spectrum disorder (ASD), was unfortunately published after our search, and thus not included. Schoen's review includes two of three primary source trials within Schaaf's earlier 2018 review, which we appraised (Schaaf, Dumont, Arbesman, & May-Benson, 2018).…”