As a 20-year experienced Occupational Therapist, private practice director at Occupational Therapy for Children (OTFC), provider of Sensory integration therapy – certified in Sensory Integration Assessment (SIPT) and treatment through the University of Southern California, advocate for families with disabilities (especially children with Autism Spectrum disorder) and mentor/clinical director to 10 amazing occupational therapists I feel compelled to respond to the article “Sensory Therapies For Autism: How much sense do they make?” written by Emily Willingham.
Upon receiving an email from a parent at my practice providing me with the link to the Forbes article, OTFC management and clinical staff have had measured and thoughtful discussions about the article and how to respond. For the record, this is the email I received:
Hi Dino*
I hope you are well.
This article is being shared far and wide, interestingly by providers of ABA. I feel like my kids are the poster children for sensory integration therapy so this annoys me so much.
Thinking it might be time for you to write a response for your blog. ;).
kind regards
Rebecca
My response followed:
Hi Rebecca
Thank you for the email. Yes, we have seen it already, and we are thinking about how to respond in a positive way and not a reactive way through social media. The fact is that some people are impressionable when it comes to information like this but I have always known that honest work, a sound theoretical base and years of proven hard work and real progress for children will always prevail. Those outside (and even some within the profession of OT) have gone to great lengths to question and even condemn SI therapy over the years and this current Psychologist will not be the last. The fact is, there is good evidence based research but there isn’t the same amount as there is in ABA for instance. The research that has been done often states SI therapy but if they actually knew what it was they would see that their research doesn’t actually look at SI therapy in the way it is conducted at OTFC (Ayres SI Therapy). Many OT’s claim to do SI therapy but they do not reach the fidelity measures (gold standard in SI therapy) and therefore it serves to make SI therapy vulnerable to criticism which is understandable. We can talk about this forever but I know what we do at OTFC works and helps many children and their families. Parents like you are our greatest advocates, allies and protectors – we judge what we are doing by scientific data as much as the feedback we get from children and families. It once made me angry and concerned but now I laugh and OTFC keeps pushing forward doing what we have always done. Thank you for your concern and for being a ‘protector.’ The best thing you can do is talk to people about your experiences and hope they take that at face value rather than look at false stats and opinions.
Dino Mennillo (BAppSC – OT)
Clinical Director
We discussed the options available and determined that analysing the referenced articles to see exactly what was used to base the author’s and researcher’s opinions was the most logical approach to take. An amazing final Masters OT student, Erika, took it upon herself to work through a systematic review of the articles and compared them to whether or not they met the fidelity measures for Ayres Sensory Integration. This is also provided for your reference in the table at the end of this response (appendix).
Erika took greater initiative and provided the following correspondence to myself and OTFC staff:
Dear OTFC staff and community members,
On May 27th, 2017, Forbes business magazine released an article titled “Sensory Therapies for Autism: How Much Sense Do They Make?”. This article purported to criticize sensory integration as a treatment modality for autism. A systematic review of 24 journal articles > published in Pediatrics by Wietflauf et al was used to make this argument, concluding that the evidence for Jean Ayres Sensory Integration for autism is non-existent (1). On behalf of Occupational Therapy for Children, we seek to clarify and address any concerns elicited > by the Forbes article.
Looking at the evidence
Firstly, through thorough analysis of these articles, it becomes apparent that the material cited does not reflect Jean Ayres Sensory Integration, but refers to broader sensory based therapies. These include environmental enrichment, qigong massage and auditory > enrichment, to name a few. Moreover, upon further analysis, we have found that only two of the cited articles adhered to Jean Ayres fidelity measures criteria (2). These consist of structural and process elements which are used to measure the degree to which the sensory > integration intervention in a study reflects the therapeutic principles of Jean Ayres Sensory Integration (2). For example, a current requirement of Jean Ayres Sensory Integration fidelity measures is that a minimum of two types of sensory opportunities need to be present > in a sensory integration based intervention. These include, proprioceptive, tactile or vestibular input (2).
As we examined the evidence further, we found further research supporting the Jean Ayres Sensory Integration therapy approach not cited in the Forbes article. These articles include positive outcomes such as parent reported increases in children’s occupational > performance, decreases in sensory reactivity and increases in self-regulation (3).
The research currently published on Jean Ayres Sensory Integration treatment is promising, as it produces significant changes in social skills and self-care, due to improvements in praxis skills, behavioural regulation, and sensory modulation (4). Other beneficial > outcomes of Jean Ayres Sensory Integration include increases in fine motor skills, gross motor skills, as well as auditory, tactile, vestibular and movement perception (4). These findings further align with parent perceived improvements, such as needing less caregiver > assistance during social activities and during self-care.
As the wealth of information pertaining to Jean Ayres Sensory Integration is gathered and synthesized, more rigorous research is needed. No one therapy will work for every child or every family. At OTFC, we emphasize a client-centered, coordinated approach incorporating > multiple disciplines, such as occupational therapy, speech therapy, psychology, neurology, and education. However, the most important voice is and will always be that of the child and their family.
References: 1. Weitlauf AS, Sathe N, McPheeters ML, Warren, ZE. Interventions Targeting Sensory Challenges in Autism Spectrum Disorder: A Systematic Review. Pediatrics. (2017) May;139(6): 1-22
2. Parham LD, Smith Roley S, May-Benson TA, Koomar J, Brett-Green B, Burke JP, Cohn ES, Mailloux Z, Miller LJ, Schaaf RC. Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention. The American Journal of > Occupational Therapy. (2011) March; 65(2):133-14
3. Schaaf RC, Cohn ES, Burke J, Dumont R, Miller A, Mailloux Z. Linking Sensory Factors to Participation: Establishing Intervention Goals with Parents for Children with Autism Spectrum Disorder. The American Journal of Occupational Therapy. (2015) September; 69(5)
4. Schaaf RC, Benevides T, Mailloux Z, Faller P, Hunt J, Van Hooydonk E, Freeman R, Leiby B, Sendecki J, Kelly D. An intervention for Sensory Difficulties in Children with Autism: A Randomized Trial. Journal of Autism and Developmental Disorders. (2014) July; 44(7)> :1493-1506
I feel that the systematic review and responses provide the objective perspective that is needed, rather than to give opinions. I understand that the author, Emily Willingham, is employed to provide ‘her opinion’ and that Forbes clearly states that “opinions expressed by Forbes contributors are their own’, however this does not excuse incorrect citation or one person’s opinion that can have a direct impact on many families and their children with autism worldwide.
Interestingly, Emily references her own son having therapy and the gains that he made. She also discusses the gains possibly being attributed to the ‘Awesomeness of the people and place’ and relates this to the ‘placebo effect.’ A very important part of Sensory Integration therapy is the child-therapist relationship and see it as integral to ‘therapy’ we provide. Many honest parents have questioned the effectiveness of ‘Sensory Integration’ in contributing to the gains their children have made at my practice over the last 15 years and whilst I sincerely thank them for their honesty, my response in question is always the same: “Given the progress your child has made, the money you have spent and what your family life is like today, if you had the time again, would you choose to include Sensory Integration at this practice as part of the coordinated approach to supporting your child’s development?” The answer is always the same.