Systematic review of the effectiveness of the Wilbarger protocol with children

Abstract

Background: Sensory processing disorders have an estimated prevalence of 5%-10% in children without disability and 40%-88% in children with disability. A subtype of sensory processing disorder is sensory overresponsivity, which can result in fear, irritability, aggression, or avoidance behaviors in children. The Wilbarger protocol is the most prescriptive program used to treat sensory overresponsivity in children aged 2-12 years. Strong anecdotal evidence suggests that the Wilbarger protocol successfully reduces challenging behavior in children with sensory overresponsivity. The aim of this systematic review was to identify and appraise the existing evidence for the effectiveness of the Wilbarger protocol with children aged 0-18 years. Methods: A systematic review was conducted of the peer-reviewed literature written in English. The electronic databases searched up to April 2012 included CINAHL, Ovid Medline (R), Embase, Scopus, the Cochrane Library, AMED, and the Web of Science. OT Seeker and Google Scholar were searched for missed literature, along with hand-searching of retained articles. Adult studies were excluded. The Critical Review Form for Quantitative Studies by McMaster University and the levels of hierarchy from the Australian National Health and Medical Research Council were used to appraise the literature. Results: A total of 341 studies were found, and 302 were screened for eligibility after duplicates were removed. Four level IV intervention (case series with pretest/posttest) studies were included for indepth review. All four studies had very small sample sizes, exhibited low methodological quality, differed in outcome measures used, and lacked homogeneity of samples and treatment fidelity. Conclusion: A lack of high quality evidence currently exists to support or refute the use of the Wilbarger protocol with children. While the grade of recommendation, as proposed by the Australian National Health and Medical Research Council, suggests that the Wilbarger protocol should be applied with caution, emerging evidence from these studies warrants future robust research on this topic. Clinicians are advised to use clear outcome measures when using the Wilbarger protocol with clients.

A systematic review of sensory-based treatments for children with disabilities

“…We outline the search strategy shown in Appendix A and adapted it for specific database characteristics. In addition, we hand searched the references of previous reviews (Baranek, 2002;Lang et al, 2012;MayBenson & Koomar, 2010;Schaaf & Blanche, 2011;Weeks, Boshoff, & Stewart, 2012) and included studies.…”

Feasibility of a Research Protocol to Investigate the Effect of the TherapressureTM Program Using Salivary Cortisol

“…Salivary cortisol is produced in a typical diurnal fashion, with a peak just before waking and an evening nadir. This pattern is fixed in children by 4 to 6 years of age (Sumner, Bernard, & Dozier, 2010 (Weeks, Boshoff, & Stewart, 2012). This conclusion was drawn from the low number and poor methodological quality of available studies on this topic, rather than the presence of high quality evidence to refute its effectiveness (Weeks et al, 2012).…”

“…This pattern is fixed in children by 4 to 6 years of age (Sumner, Bernard, & Dozier, 2010 (Weeks, Boshoff, & Stewart, 2012). This conclusion was drawn from the low number and poor methodological quality of available studies on this topic, rather than the presence of high quality evidence to refute its effectiveness (Weeks et al, 2012). In the absence of high quality research, it is acknowledged that subjective anecdotal evidence, from occupational therapists and parents, support the efficacy of this approach for children in reducing their behavioral responses to environmental stimuli (Kimball et al, 2007 …”

The Significance of Somatosensory Stimulation to the Hand: Implications for Occupational Therapy Practice

“…The Wilbarger Approach is based on the premise that "individuals require a certain quality and quantity of sensory experiences to be skillful, adaptive and organized in their daily lives" (Wilbarger & Wilbarger, 2002, p 339). In a systematic review of the Wilbarger approach, Weeks, Boshoff, and Stewart (2012) found that the evidence so far has been drawn from small sample studies and has limited generalizability. Schaaf, Hunt, and Benevides (2012) suggest that the methodologies for evaluating the effectiveness of sensory-based interventions in randomized, controlled trials is improving through a method called Goal Attainment Scaling, which allows varied goals to be quantified on the same scale.…”