Examining the Use of Deep Touch Pressure to Improve the Educational Performance of Students With Disabilities

Abstract

The current meta-analysis examined the use of deep touch pressure (DTP; e.g., weighted vests) with students with disabilities. DTP is a form of sensory integration therapy that is currently used extensively in schools with students with autism and other disabilities. Each study in the analysis was evaluated using the Council for Exceptional Children's guidelines for evidence-based practices. In addition, noting the debate regarding appropriate single-case effect sizes, the current study calculated omnibus effect sizes utilizing a variety of single-case design effect sizes. Results of the current study suggest that DTP interventions are of generally poor quality and demonstrate effects that do not validate their current use for students with disabilities. Keywords autism, weighted vests, therapeutic brushing, deep touch pressure, sensory integration therapy Both the No Child Left Behind Act (NCLB; 2001) and the Individuals With Disabilities Education Act (IDEA; 2004) mandate that instructional strategies must be research-based. While both pieces of legislation use different terms (research-based vs. peer-reviewed research), the end result is that the field of education has begun to devote considerable attention to identifying evidence-based practices (EBPs) for practitioners to use toward improving student performance (Cook & Tankersley, 2013). The primary method for determining the evidence base for a particular practice entails conducting a systematic review of the literature (Schlosser, Raghavendra, & Sigafoos, 2013). The field of education and special education has a long history of publishing reviews; however, only in the last few decades have guidelines been established for assessing groups of studies to determine whether a practice is evidence based. For example, both the What Works Clearinghouse (2014) and the Council for Exceptional Children (CEC; 2014) have established guidelines for determining the evidence that can be inferred from a single study and the body of studies as a whole. In the case of providing a free appropriate public education (FAPE) to students with disabilities, the identification and use of EBPs is essential (Yell, Katsiyannis, & Losinski, 2015; Yell & Rozalski, 2013). Furthermore, Cook, Tankersley, and Landrum (2013) suggest that students with disabilities require the most effective interventions to succeed; however, practices meeting evidence-based standards are rarely used (Maheady, Smith, & Jabot, 2013). The reasons for the lack of EBP utilization by educators of students with disabilities are varied and

The Immediate Effects of Deep Pressure on Young People with Autism and Severe Intellectual Difficulties: Demonstrating Individual Differences

“…It is widely used by occupational therapists working with children with autism spectrum disorders (ASD) [ 2 ] and is thought to be rewarding, reducing symptoms of stress and anxiety and improving performance in school [ 3 ]. Deep pressure is based on sensory integration theory [ 4 ] as initially developed by Ayres in the 1960s and 1970s [ 5 ]. The use of deep pressure for individuals with autism spectrum disorders has been widely discussed since Temple Grandin described her self-designed machine (hug machine) for giving her the pressure sensations that she craved [ 6 ].…”

“…For instance, Case-Smith et al [ 8 ] identified 2 studies of brushing and joint compression as compared with 7 studies using weighted vests, 2 studies using therapy balls, and 4 studies using multiple methods including deep pressure. Losinski et al [ 4 ] reviewed 14 studies of weighted or snug vests and 2 of Wilbarger brushing. Yunus et al [ 9 ] reviewed 4 studies of weighted vests, three of massage, and one each of brushing, horse riding intervention, and therapy ball chairs.…”

“…Other types of SBI have been less well studied. Losinski et al [ 4 ] concluded that Wilbarger brushing had no effect. A previous systematic review of the Wilbarger brushing studies [ 11 ] found four studies (only one of which is reviewed by Losinski et al [ 4 ]) from which they concluded that “emerging evidence from these studies warrants future robust research on this topic.” Similarly, Yunus et al [ 9 ] concluded that tactile based therapies (such as massage or brushing) offered level 1 evidence of efficacy in managing behaviour problems.…”

“…There is some evidence of short term beneficial effects of squeezing which was not analysed by Case-Smith et al [ 8 ], Losinski et al [ 4 ], or Yunus et al [ 9 ]. A “squeeze machine” controlled by participants themselves (cf.…”

“…In summary, the evidence for deep pressure is equivocal [ 4 , 8 , 9 ], but the reviews cited above fail to cite evidence from case studies. Another evidence suggests that there may be idiosyncratic responses as has been highlighted by McGinnis et al [ 13 ] who demonstrated that only some people will find deep pressure rewarding.…”