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Research Update:
Environmental Enrichment as a Therapy for Autism: A Clinical Trial Replication and Extension

Abstract

Based on work done in animal models showing that autism-like symptoms are ameliorated following exposure to an enriched sensorimotor environment, we attempted to develop a comparable therapy for children with autism. In an initial randomized controlled trial, children with autism who received sensorimotor enrichment at home for six months had significant improvements in both their cognitive ability and the severity of their autism symptoms (Woo & Leon, 2013). We now report the outcomes of a similar randomized controlled trial in which children with autism, aged 3-6 years old, were randomly assigned to groups that received either daily sensorimotor enrichment, administered by their parents, along with standard care, or they received standard care alone. After six months, enriched children showed statistically significant gains in their IQ scores, a decline in their atypical sensory responses, and an improvement in their receptive language performance, compared to controls. Furthermore, after six months of enrichment therapy, 21% of the children who initially had been given an autism classification, using the Autism Diagnostic Observation Schedule, improved to the point that, although they remained on the autism spectrum, they no longer met the criteria for classic autism. None of the standard care controls reached an equivalent level of improvement. Finally, the outcome measures for children who received only a subset of sensory stimuli were similar to those receiving the full complement of enrichment exercises. Sensorimotor enrichment therapy therefore appears to be a cost-effective means of treating a range of symptoms for children with autism.

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Active participation in everyday life

After a day of great rugby this is a good reminder about the importance of active participation in meaningful activity – initially maybe in therapy in a clinic setting – but the essence of Ayres’ SI is how sensory integration therapy ultimately supports participation in everyday life including as a team member, sports person, friend or scholar.

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Post Rotary Nystagmus Adults

The SIPT Assessment and it’s precursor the SCSIT (Southern California Test of Sensory Integration) include the test of Post Rotary Nystagmus. 

Norms for adults in the research include:

Shuer, J., Clark, F. A., & Azen, S. P. (1980). Vestibular function in mildly mentally retarded adults. American Journal of Occupational Therapy, 34(10), 664-670. ← Abstract

The purpose of this study was to compare the duration of nystagmus in mildly mentally retarded and normal adults as measured by the Southern California Postrotary Nystagmus Test. The results revealed that the retarded males demonstrated attenuated duration of nystagmus. These findings support the need for further investigation of possible sensory integrative deficits in this population so that proper treatment can be provided.

A comparison of duration of nystagmus as measured by the Southern California Postrotary Nystagmus Test and electronystagmography.

Keating NR. Am J Occup Ther. 1979. Show full citation

Abstract

The Southern California Postrotary Nystagmus Test (SCPNT) and electronystagmography are methods used to evaluate one aspect of vestibular function. The SCPNT is based on the examiner’s observation of eye movements and is used in combination with other information as part of a diagnostic battery for children with learning disorders. Electronystagmography is the permanent recording of eye movements through the use of surface electrodes. In this study. The SCPNT and an electronystagmograph were used to record postrotary nystagmus in 20 normal females aged 25 to 30. A significant correlation was found between the two tests for both duration and excursion. In addition, scores of both tests were compared for four normal and for four learning-disabled girls aged 7 to 8. The only significant correlation found was in terms of duration in the normal girls. Results were discussed in terms of factors affecting observation of eye movement, and differences between the nystagmus response of adults and children.

https://www.ncbi.nlm.nih.gov/m/pubmed/312002/

The Southern California Postrotary Nystagmus Test and electronystagmography under different conditions of visual input.

Randomized controlled trialNelson DL, et al. Am J Occup Ther. 1984.Show full citation

Abstract

This study assessed the Southern California Postrotary Nystagmus Test (SCPNT)-stimulated nystagmus under three conditions of indoor illumination (bright, dim, and dark), and it studied the concurrent validity of SCPNT and electronystagmographic (ENG) measures of nystagmus duration and excursion. Eighteen adult subjects received three sets of rotations to the left under different lighting conditions in a counterbalanced order. The duration and excursion of the SCPNT were monitored under the bright and dim conditions, and ENG-recorded duration, excursion, frequency, slow-phase velocity, and average intersaccadic interval were measured under all three lighting conditions. No significant differences were found between nystagmus duration or excursion under the bright and dim conditions, but highly significant differences were found between the dark condition and the other two conditions. The correlation between ENG-recorded duration and SCPNT visually monitored duration across bright and dim conditions was .73, and the correlation for excursion was .24. These results suggest that occupational therapy researchers and clinicians need not question the validity of ENG recordings under different indoor lighting conditions, and suggest that the concurrent validity of ENG recordings and SCPNT measures requires more study.

https://www.ncbi.nlm.nih.gov/m/pubmed/6476072/

http://www.tandfonline.com/doi/abs/10.1300/J004v03n04_03?journalCode=womh20

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Research Update: A Systematic Review of Interventions to Improve the Occupation of Play in Children With Autism

A great paper to see published! Thank you to Heather Kuhaneck,  Susan Spitzer and Stefanie Bodison. This systematic review provides a thorough exploration of studies, and most importantly contemporary studies, which support the role of occupational therapy for children with Autism.

“…occupational therapists should feel most confident including imitation of the child and modeling for the child, as they currently have the strongest evidence. Other strategies have emerging support such as the modification of materials, environment, and interaction style.”

The paper includes a review of literature related to play and Autism and the reasons play is essential to developing skills needed for participation in everyday life. The paper highlights the importance of modeling by adults and imitation by children. 

“The strongest interventions in this review used imitation of the child and modeling for the child and combined adult-structured and child-directed approaches.”

Abstract: Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger’s, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.

Ref: https://journals.sagepub.com/doi/10.1177/1539449219880531

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Research for Practice: Sensory Integration and Dyslexia.


Ayres’ published her research findings, making a case for emerging patterns of sensory integration dysfunction including;   

  • developmental dyspraxia – this pattern linking motor planning difficulties with deficits in tactile perception
  • difficulties with integration of both sides of the body; poor right-left discrimination, difficulties crossing the midline, and  reduced bilateral motor coordination – impacting on posture and postural control, thought to related difficulties processing vestibular input 
  • visual perception, form and space perception deficits impacting on visual-motor functions
  • difficulties with visual figure-ground discrimination
  • deficits in auditory and language functions.
  • tactile defensiveness and related sensory reactivity difficulties impacting negatively on attention 

A key feature of Ayres’ Sensory Integration is the adaptive response;  “an adaptive response is a purposeful, goal-directed response to a sensory experience … play consists of a series of adaptive responses that make the sensory integration happen. In turn, as sensory integration develops, better organization and more complex skills are possible” Ayres 2005.

In 2013, Viana et al reported that children with dyslexia show poor performance and variability while relating visual and somatosensory information. Children with dyslexia showed less coherent and more variable body sway;  suggesting difficulties in multisensory integration from sensory cues coming from multiple sources.

 

man in brown jacket holding a book

Studies with adults and children found that there is reduced neurophysiological adaptation in adults and children with dyslexia. In 2016, Perrachione et al published research suggesting that people with dyslexia are likely to have differences in sensory integration and processing, noting significantly reduced adaptation to speech from a consistent voice and less adaptation to the repetition of words, objects, and faces. They provide evidence to support the hypothesis that reading skills in dyslexia are related to the degree of neural adaptation.

In 2017 Wandel and Le confirmed the importance of the effective processing of multiple sensory inputs, including successful sensory integration for competent reading. 

“Successful reading involves the ability to efficiently integrate visual signals with the sounds of speech and the language system; thus, diagnosing the reading circuitry requires testing the cortical and white matter regions that carry reading information from the visual, auditory, and language systems. Reading impairment can result from problems within neural circuits that are used for multiple purposes, not uniquely reading (Rayner et al., 2012, Seidenberg, 2017). Hence, we advocate assessing the circuitry broadly, not just portions that are highly specialized for reading.”

In clinical practice, some children with sensory integration difficulties benefit more from the use of coloured overlays. Research from Kriss and Evans (2005) suggests that 

“Children with dyslexia seem to benefit more from coloured overlays than non‐dyslexic children. MIS and dyslexia are separate entities and are detected and treated in different ways. If a child has both problems then they are likely to be markedly disadvantaged and they should receive prompt treatments appropriate to the two conditions. It is recommended that education professionals as well as eye‐care professionals are alert to the symptoms of MIS and that children are screened for this condition, as well as for other visual anomalies.”

Read the full article: The relationship between dyslexia and Meares‐Irlen Syndrome

Read more here:

Dyslexia link to eye spots confusing brain say scientists.

Dyslexia and Sensory Processing, is there a link?