Unlimited Learning, PLLC - Neurodevelopmental treatment center
Using Sensory-Wise Communication to promote development
Developing Ability, Changing Lives
Unlimited Learning, PLLC - Neurodevelopmental treatment center Using Sensory-Wise Communication to promote development Developing Ability, Changing Lives
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The effects of Sensory-Wise
Communication on improving participation: Teaching communication, socialization,
sensory regulation and interpersonal skills to decrease adverse behavior in
children with Autism and other neurodevelopmental disorders. Shelli Dry & Robin O’Neil Introduction
In the
field of Autism and neurodevelopmental disabilities there is a focus on
increasing participation and independence in all aspects of functional skills
and its impact on increasing positive behaviors. Improving an individual’s
ability to gain independence in life skills will serve to increase positive
behaviors by teaching replacement behaviors through communication,
socialization, self-management, leisure participation and development of
interpersonal skills. Research
has shown that one way to teach skills to individuals with developmental
disabilities is through the use of operant learning. Westling and Fox (1995)
explain operant learning as a paradigm in which behavior occurs as a function of
the external environment and a history of reinforcement. Skills that are social
in nature are generally learned through observation and imitation, while other
skills are learned through verbal direction and through physical guidance (Westling
and Fox). To provide superior information when teaching concepts multi-sensory
representation with multiple repetitions of the concept should be provided.
Providing the repetition with moderate differences will enhance the
pre-existing knowledge and strengthen neurological connections (Burkhardt). Another
aspect of learning is through movement and tactile-kinesthetic awareness.
Blythe (2004) discusses movement’s involvement in all aspects of
sensory perception. For instance,
she explains balance as a response to slow movement, hearing as a reception of
vibration and vision as movement of photons of light traveling at vast speed
(Blythe). Through movement an individual develops proprioceptive awareness or
knowledge of their body relationships, inner self, a sense of direction, and
gravitational security. Vestibular processing develops as responses to movement
of the head in various planes and it is the basis for effective sensory
processing, speech and language development, and sensory-motor coordination.
An efficient vestibular system provides adequate muscle tone, postural
control and motor planning, which are all essential elements of nonverbal
communication. Enhanced respiratory support necessary for verbalizations rely on
postural control, motor planning and muscle tone and can be improved through
vestibular input. The tactile and
kinesthetic systems are necessary for identification of pressure, touch, pain,
temperature, and mobility of body parts. Tactile-kinesthetic awareness assists
in speech development of articulation, prosody, word formation and tongue
control.
Learning
is a stepping stone process in which skills build upon one another and when one
sequence is interrupted or skipped, the individual lacks the ability to
generalize by relating new information to previously acquired information.
Combining the multiple aspects of learning methods and viewing learning as a
holistic undertaking helps the person incorporate strategies to facilitate skill
development. For example, to
effectively learn communication requires effective motor planning, refined motor
control, sensory integration, cognitive support and socio-emotional development.
The brain has to develop the idea for speech, carry the motor plan out for
forming the words; recognize the feedback received from the formation of words
and use fine motor movements during the feedforward process in order to
accurately form the letters and sounds. The tactile system is necessary to
discriminate tongue and lip placements, the auditory system is needed to hear
the sounds of the words, the vestibular system to keep the head upright and to
align the body for speech and the proprioceptive system is necessary to grade
jaw movements and to provide knowledge of how the tongue, lips, facial muscles
and jaw are working together to formulate verbalizations. In the case of
pre-verbal communicators, each of those systems is more important for making
gestures, selecting pictures and using assistive technology. The visual system
also has a large impact on communicative ability for pre-verbal communicators.
Effective communication impacts us socially during group settings, individually
in our self-concept and emotionally in making and keeping friends and
relationships. A study by Donahue and Cole (1994) found a significant
relationship between language disorders and behavioral/emotional disorders. In
this study at least 50% of the children with emotional/behavioral disorders also
exhibit significant problems with oral language and communication skills. In a
related study 38 students with mild to moderate behavior disorders were assessed
with the Test of Language Development-intermediate (TOLD-I) and 71 % of those
children performed two or more standard deviations below the mean and 97% were
one standard deviation or more below the mean (Donahue & Cole). It was
determined from these studies that children with language impairments who also
showed social and emotional problems made the smallest language gains. The relationship between the social use of language and
socially appropriate behaviors identifies the need for a converging theoretical
framework. Analyses have shown a direct relationship between early risk factors,
such as pre-term birth, child abuse and neglect, and emotional/behavioral
disorders. In these cases, an association between early intervention and an
integrated focus on language has been identified as essential to healthy
emotional development. A relationship between sensory impairments and emotional/
behavioral disorders also exists. Carvill (2001) reports a higher prevalence of
sensory impairments in people with intellectual disability and higher prevalence
of psychological and psychiatric disorders in people with sensory impairments.
She indicates a vital need for recognition and use of appropriate teaching
techniques with children who have intellectual disability, autism and sensory
impairment to maximize potential and minimize behavior problems. DeGangi and
Greenspan (1989) found tactile defensiveness, vestibular dysfunction and poor
ocular motor control in children with developmental delays and regulatory
disorder. A strong relationship exists between sensory defensiveness and sensory
dormancy in children with disabilities, suggesting a relationship between these
two ways of responding. In children with autism and developmental delays there
are different ways of responding to visual, auditory, touch and body position
stimuli (Dunn). The purpose of this study was to enhance evidence based
practice methods by designing an intensive treatment program that utilizes
multi-modal teaching strategies embedded in occupational and speech based
therapies. The hypothesis of the study states incorporating tactile, visual,
gustatory, olfactory and auditory sensation, throughout the day, in social
based, whole language activities will facilitate learning replacement skills to
decrease adverse behaviors. Research
has proven that the use of a multi-modal approach allows children to learn
through their strengths while providing associated information to weaker areas
and that multi-sensory representation of concepts provides richer information
about the concepts. Along that concept, the use of repetition with moderate
differences enhances pre-existing cognitive schema and strengthens neurological
connections.
Levy
and Hyman (2002) state: “the cornerstone of treatment is a comprehensive,
intensive program of educational, developmental and behavioral strategies” and
that the best first line of treatment is “an intensive, coordinated program
including education, occupational therapy, speech therapy and behavior
management”. From this perspective a treatment program was developed known as
the Sensory-Wise Communication method. The Sensory-Wise Communication method is
an integrated approach using all teaching strategies and incorporating total
communication procedures using multi-modal teaching strategies in social based,
whole language activities. The multi-modal strategies incorporate providing
information through all sensory systems. An important aspect of using the
sensory systems is in making sure the system remains regulated throughout the
day to ensure a ready state of arousal for learning to occur.
All aspects of learning are included in the teaching of communication and
socialization and all sensory systems are utilized to enhance learning and
generalization. The methods are based on concepts that are taught over a
week’s time using multiple repetitions with moderate differences. This method
will create an ideal learning environment to decrease risks associated with
language disorders, sensory impairments, psychiatric disorders, and behavior
impairments in children with neurodevelopmental disorders. Sensory-wise
communication incorporates movement, assistive technology, augmentative
communication devices, social skill training, relationship development,
communication procedures, sensory integration and behavior therapy in one
integrated program. The program can begin during infancy and it focuses on the
use of a developmental approach to teach foundation skills to enhance a
child’s natural learning ability. By
combining multi-modal sensory-based approach generalization and ingrained
learning is developed through active involvement, instead of providing the child
with multiple drills and trials to develop robotic responses. Through the use of
Sensory-Wise communication replacement skills are developed to improve
generalization and positive behaviors are developed through reinforcement
procedures. This method will help the child learn the strategies necessary to
make requests, to engage in self-management, to communicate socially and to
share emotional development. Combining occupational and speech/language
therapies to treat deficits simultaneously will target all deficit areas and by
teaching appropriate replacement behaviors participants in the program will
improve their ability to participate in the community. Methods Participants Participants in the
study were twenty-four boys and girls with co-morbid diagnoses of mental retardation, developmental delays and psychiatric disorders.
These psychiatric disorders consisted of, but were not
limited to, the following: bipolar disorder, autism, obsessive-compulsive disorder, Asperger's syndrome, and Tourette
syndrome. All participants were hospitalized in an MR/DD unit at an acute care
psychiatric facility. Hospitalization was necessary due to
opposing or unfavorable conduct (adverse behaviors) that
primarily consisted of the following: extreme self-injury, aggression, property destruction and sexually acting out. For the purpose of
this study, adverse behaviors were clearly defined based on the four target
behaviors that were monitored throughout the study. Aggression is any intensity
of kicking, hitting, biting, pinching, scratching, pushing, spitting on people, throwing items at people or head butting. Essentially,
aggression is any behavior that results in the injury of someone
else besides the person engaging in aggressive behaviors. Property destruction
is defined as any intensity of throwing items (not at people), destroying peers'
projects or games, breaking objects, kicking objects, drawing on furniture or
drawing on walls. Self-injury is any
intensity of self hitting, self biting, self pinching, head banging, smashing body parts forcefully into walls or furniture, biting inner
cheek, eye-gouging, pulling out finger or toe nails, rubbing
body parts into sharp objects to open skin, pulling out permanent teeth and opening wounds. Sexual acting out is defined as
any form of touching others sexually, inappropriate sexual
based comments about body parts or desire to engage in intercourse, engaging in
sexual contact with another person, or open self-stimulatory acts in public places. In addition to these four major
target behaviors, participants were also monitored for
noncompliance (refusing to follow directions after two prompts), theft,
elopement, and pica. All participants were required to have
noticeable and debilitating deficits in the areas of cognition,
language, socialization, and sensory integration. (Standardized testing instruments were used to determine degrees of deficits for each subject
and will be further discussed in the Procedures section
of this article.) After subject
eligibility was determined, subjects were randomly divided
into two groups - a control group and an experimental group. Group profiles were
created for each group. Group Profiles All subjects in both the control group
and the experimental group received psychiatric and
nursing care in addition to medication management throughout the study. Control Group Eleven subjects, consisting of both males and females, made up the
control group. Participants ranged in age from eight to fifteen years of age,
with the mean age being eleven years, one month. Median age for the control
group was ten years, five months. The average length of treatment for this group
was 45.25 days. There were three study mortalities in the
control group due to early or unexpected discharge from the hospital.
A communication profile was
created based on the results of the Receptive One Word Picture Vocabulary Test (ROWPVT) and the Expressive One Word Picture
Vocabulary Test (EOWPVT). These results
revealed that forty-nine percent of the control group was
able to understand language and verbally express wants and needs effectively using words and sentences. Thirteen percent of the control
group had limited verbal skills and required assistance
for language comprehension and verbal expression. Thirty-eight percent of the
control group was completely nonverbal and either used PECS or signs to communicate or had no established method of communication.
(Table 1) All participants in the
control group scored well below age-appropriate levels on both the ROWPVT and the EOWPVT.
A sensory profile was created based on the
results of standardized testing (Table 2). Tactile processing
was within normal limits for 45% of the children and the remaining 55% processed
tactile information differently than other people. For taste and smell
sensitivity 63% of the children processed within normal limits and 37% processed
taste and smell information differently than their peers. There were 63% of the
children with no movement sensitivity problems and 37% with a difference in the
way they process movement input. The sensation seekers were equal for the number of typical
processing and definite difference and the most significant area of diminished
processing ability was for the auditory filtering section of the assessment.
Only 18% of the individuals were able to filter irrelevant auditory input
in the same manner as other individuals, 82% of the individuals showed a
difference in the way they processed auditory information.
The information from the low energy/ low muscle tone section indicates
36% of the individuals functioned within normal limits and the remaining 64% had
a difference in the way they processed the information.
Visual and auditory sensitivity was the control group’s strength with
72% of the individuals functioning within normal limits and only 28% indicating
a difference.
Functional behavior analysis
was used to determine likely causes for adverse behaviors in the control group (Table 3). Many of the behaviors were
determined to have multiple functions. Results indicated that eighty-seven
percent of the control group subjects used adverse
behaviors in order to receive attention from adults or peers. Sixty-two percent of these subjects used adverse behaviors to
escape a task or activity in which they did not want to
participate. Fifty percent of this group used adverse behaviors in order to receive tangibles such as food, activities or
objects. Twelve percent of the group engaged in
adverse behaviors simply because they are internally rewarding. Experimental GroupThe experimental group consisted of 13
participants who were a mixture of males and females. Subjects
ranged in age from five to 13 years of age, with the mean age being nine years, six months. Median age for this group was ten years of
age. The average length of treatment for this group was
40.38 days. There were zero study mortalities in the
experimental group. Using results from the ROWPVT and the EOWPVT, a communication profile was created for the experimental group (Table 4). Sixty-six percent of
subjects in the experimental group (compared to only
thirty-eight percent of the control group) were nonverbal and relied on either
PECS or signs to communicate or had no established method of communication. Seventeen percent of this group had limited
verbal skills and required assistance with language comprehension and verbal
expression. Another seventeen percent of the experimental group had adequate
verbal skills for efficient communication of wants and needs. This profile
revealed a significant difference in the communicative abilities of each group
of this study. A sensory profile of the experimental group
also revealed significant differences in the sensory-processing abilities of the
control and experimental groups (Table 5). In the experimental group only 15% of
the individuals processed tactile information within normal limits and 85% of
the group processed tactile information differently than the typical population.
For taste and smell sensitivity 38% of the population processed information
within normal limits and 62% processed the information with a definite
difference from the typical population. 69% of the individuals had no movement sensitivity and 31% of
the group had a difference in the way they processed movement. The
sensation-seeking category indicates 15% of the experimental group had sensation
seeking that was typical of other individuals and 85% of the experimental group
had difference in sensation seeking behavior.
There was a 100% difference in auditory filtering ability with this group
and 23% of the individuals performed within normal limits for low energy/low
tone and 77% of the individuals performed with a difference from the typical
population. Visual and auditory
sensitivity was also a problem for the majority of this group with 38%
functioning within normal limits and 62% indicating a difference in the way they
process visual and auditory input. Overall sensory processing problems were
significantly higher in the experimental group compared to the control group. Functional behavior analysis revealed multiply
controlled behaviors with seventy-seven percent of subjects in the experimental group engaged in adverse behaviors to gain attention from
adults or peers. Sixty-nine percent of the experimental group used adverse
behaviors to escape an unwanted task or activity.
Forty-eight percent of subjects in this group used adverse behaviors as method of obtaining tangible items such as food, objects or
activities. Twenty-four percent engaged in adverse
behaviors for internal reward or stimulation. (Table 6) MaterialsSix standardized testing instruments were used to acquire baseline data for each participant in the areas of sensory, motor, cognition and language. The
Sensory Profile was administered to each participant for the purpose of
gathering information on sensory processing abilities. This testing
instrument provides information on whether a person processes sensory
information the same as the typical population, requires more input than others
before being able to process the information or requires less input than others
before being able to process sensory information. It provides a standard
method for measuring a child’s responses to sensory events in their daily
life. The profile yields quadrant scores
and individual scores corresponding to each sensory system. These scores
identify whether or not a child’s scores are significantly different from
their peers and whether they are under-responding to input or over-responding to
input. From the results determination can be made according to whether or not
the profile affects the child’s functional performance. The Sensorimotor Performance Analysis (SPA)
was administered as a means of measuring reflex integrity,
equilibrium, reactions, vestibular/tactile/visual processing, motor planning,
bilateral integration, stability, mobility, neurological status and development
levels. The SPA is normed on children with intellectual disability and provides criterion-referenced information on sensorimotor performance. The
Developmental Activities Screening Inventory (DASI-II) was used to evaluate developmental
skills for each participant and to provide a developmental age based on the
number of activities completed. The DASI-II
is designed to provide early detection of developmental disabilities in a child
from birth to five years old. Developmental skills assessed by DASI-II cover 15
skills categories ranging from sensory intactness, means-end relationships, and
causality to memory, seriation, and reasoning. The DASI-II was designed to be
used with children with language impairments and does not penalize a child with
known language deficits. The Receptive One Word Picture Vocabulary Test
(ROWPVT) was administered to obtain a measurement of
participants' abilities to identify basic linguistic concepts in pictures. The ROWPVT provides standard scores, percentile rankings and
age equivalents. The Expressive One Word Picture Vocabulary
Test (EOWPVT) was administered to obtain a measurement of
participants' abilities to label basic linguistic concepts in pictures. The EOWPVT provides standard scores, percentile rankings and
age equivalents. Finally, the Adaptive Behavior Scale - 2 -
School Age (ABS - 2) was used to evaluate independent functioning, community
mobility, physical development, language development,
numbers/time, pre-vocational and vocational activities, self-direction,
responsibility, socialization, social behavior conformity, trustworthiness,
stereotyped and hyperactive behavior, self-abusive behavior,
social engagement and disturbing interpersonal behavior. The
ABS-2 provides age equivalents and standard scores for children with intellectual disability Procedures Before initial testing began, all patients on the chosen hospital unit
were evaluated to determine if they met the following
eligibility criteria: registered as receiving inpatient hospital treatment (no participants in the hospital partial program were
considered eligible), assigned as a patient on the chosen hospital unit
(patients sleeping on the chosen unit because other hospital units had no
available beds were not considered eligible), and expected to be receiving
inpatient care for a minimum of thirty days as verified by their psychiatrist.
Once participant eligibility was determined, participants were randomly assigned to the control and experimental groups. Due to the nature of an acute care psychiatric
facility, special provisions had to be made to allow for new patients entering the hospital program while the
study was ongoing and for those being discharged from the
hospital and hence the study. Data was included in the study results providing
the following criteria were met: 1.
All subjects in both the control group
and the experimental group were initially evaluated using standardized testing
instruments to assess baseline motor, sensory-processing, cognitive and language
skills. 2.
At the end of the study, or as subjects
were discharged from the hospital unit, all participants were reassessed using
the same testing instruments used during the initial assessments (excluding the
Sensory Profile) to determine loss or gain in the areas of motor,
sensory-processing, cognitive and language skills. 3.
When subjects were admitted to the
specialty units during the study period, they were alternately assigned between
the experimental and control groups in the order in which they became hospital
patients. 4.
Participants were required to complete a
minimum of twenty days of treatment in addition to initial and final assessments
in order for their data to be included in the
study results. 5.
Data for subjects discharged without
final assessments or before receiving the minimum
amount of treatment was not included in the study results. The study design was based on combining the principles of occupational
and speech-language therapies in order to increase cognitive,
motor, sensory processing and language skills. Multi-modal treatment strategies
were created and used throughout a twelve-week period with children in the
experimental group. These children participated in a structured weekly schedule
that incorporated sensory input during a daily large group (8-10 children)
breakfast activity, daily large group lunch activity, thirty minutes daily of
oral motor exercises, and twice weekly small group (4-5 children) afternoon
activity. During these groups, both the
occupational and speech-language therapist were present and participated in all group activities. Each therapist was responsible for
assisting half of the participants in each group with the activities. None of
the participants in the experimental group received individual occupational or
speech language therapy. Groups were designed around the weekly concept
that was being taught. They also
worked on teaching specific skills. For example, breakfast and lunch group
focused on washing hands before sitting at the table, use of social greetings,
use of napkin, use of utensils when eating, eating only from your own plate of
food, remaining seated throughout the meal, use of social greetings, use of
napkin, use of utensils when eating, putting tray away when finished, cleaning
off the table with a wet rag and using PECS, signs or words to verbalize wants
and needs throughout the meal. Representational pictures for items necessary at
meals, items necessary to occupy free time, requests for wants and needs and
social greetings were placed on choice boards, worn on communication aprons,
placed on voice output devices and place on a transportable pad for sharing with
group members. Fidgets, sit and move cushions, vibratory and visual input were
available as necessary to assist the individuals with remaining seated during
the group. Oral motor groups focused on specific facial exercises,
experimentation with tastes and textures and use of oral motor skills such as
tongue lateralization, rotary chewing, sucking, blowing and licking items.
Individuals were provided with sequencing pictures in order to complete any
crafts or cooking items during groups. Data trackers were
used to accurately collect data on each participant’s
level of independence throughout each session. Participants in the experimental group were
divided into Group A and Group B for the afternoon group
sessions. These sessions focused on the use of signs, PECS or verbal language
during whole-language behaviors based in sensorimotor activities.
Each week, a specific unit topic was chosen and all activities, including oral motor group, focused on this
specific topic. For example, during "weather" week
a different season was chosen for each of the four days in which therapy was
provided. During oral motor groups, activities centered around weather-related themes and consisted of things such as making a snowman
from large marshmallows, pretzel sticks and raisins, then
eating the snowman without using the hands in order to practice lip closure,
chewing, tongue lateralization and elevation, and stabilization of the jaw. An
afternoon group activity during weather week would include activities such as
making "oceans in a bottle" using baby oil, water, glitter and empty
soft drink bottles or making a snowman using tube socks, rubber bands, colored
socks and sharpie markers. Sensory
motor activities were incorporated into groups as well. For example, for a winter-based activity, the kids would go "snow
sledding" on scooter boards. Multi-modal treatment strategies embedded in
the sensory-wise communication method included the use of communication aprons
with removable pictures, use of voice output devices, implementation of sensory
diets, three dimensional games and activities, pet therapy and games to develop
component skills in prevocational language and play. Data trackers were used to accurately collect data for each
participant throughout each afternoon therapy
session as well. Children in the control group received occupational or speech-language therapy was provided on an individual or group treatment setting, once a week. For children in the
control group, individual therapy sessions lasted between
45-60 minutes. These children were allowed to participate in similar activities as the experimental group, but the activities did not
involve multi-modal treatment or sensory input on a scheduled basis. Study Results
The results of the study were obtained from direct
observation, from data tracker cards, from standardized assessments comparing
baseline abilities in specific areas of social, cognitive, motor and language
skills to mean of progression/regression in those same areas and from anecdotal
reports.
The data tracker cards identify level of assistance required for specific
skills being taught and each card contains interval tracking of target
behaviors. On the tracker cards the individual’s level of independence with
each skill is circled. The rules for the levels of independence follow the
Medicare guidelines. The group
trackers also included an area to mark the response to sensations included in
each group according to sensory seeking, avoidance, typical response or severe
seeking and severe avoidance.
Sensory-Wise Communication methods were used twice per day at meals,
during oral motor groups and twice per week during group treatment sessions.
During meals, the members had specific pro-social behaviors,
communication and component skills for eating that they were being taught. At
mealtime the tracker cards were composed of 9 sub-skills that were identified as
necessary skills after years of observation during mealtimes in the psychiatric
setting. These sub-skills included washing their hands, using social greetings,
use of utensils, eating off of their own tray (not taking peers food), using
their napkin, remaining seated, putting their tray away, cleaning the table and
communicating with staff and peers using any of the communication strategies
being implemented. Each sub-skill had a section to circle the level of
independence achieved and two columns to identify any target behaviors noted. To
avoid data collector bias, the therapists alternated the participants they would
collect data on each day. Individual progress was graphed according to grouped
skills for presentation at treatment team meetings after the study was completed
(Graph 1).
On the developmental activities screening inventory (DASI-II) the results
were summarized in tables with an individual comparison of baseline scores to
final scores for both the control and the experimental groups. Each
individual’s rate of change in developmental age was compared, and then the
mean rate of change in developmental ages was obtained for each group.
Table 7 indicates the comparison between the control group and the
experimental group with an overall rate of improvement at 125.75% for the
experimental group versus the control group.
On the individual group analysis for the Sensorimotor performance
analysis (SPA), the cumulative scores were used to identify the rate of change.
The control group had an overall mean percentage of change of 50.89 points and
the experimental group obtained a mean percentage of change of 407.2 points. The
group-to-group comparison indicates that the experimental group had a 700.16%
higher rate of improvement in skills gained when compared to the control
group’s rate of improvement.
Using the results from the overall improvement on the receptive one word
picture vocabulary test, the control group achieved a 37.6% rate of change and
the experimental group achieved a 273.5% improved rate of change.
When comparing the experimental group’s rate of
improvement to the control group’s rate of improvement the experimental group
had a 626.99% better rate of improvement than the control group.
To compare the ABS: S2 results the cumulative scores on the ADL portion
of the test, the behavior function portion of the test and the factor analysis
scores on the personal and community sufficiency and social responsibility and
the social and personal adjustment scores were all outlined separately, then the
group-to-group comparisons were calculated. The overall rate of improvement for
the experimental group compared to the control group for the ADL domain was
1782.04%; for the behavior function domain the improvement was 9724.93%; the
factor analysis for the personal & community self sufficiency indicated a
2171.76% improvement and for the personal and social adjustment there was a
1225.94% rate of improvement.
Anecdotal reports from teachers, staff and physicians addressed the
increased verbalizations that pre-verbal children had developed, the behavior
control that was being exhibited in the lunchroom and how this had carried over
into the classrooms and onto the units, and the ability the children were
exhibiting to stay calm and focused with less fidgeting or tantrum behaviors.
The staff reported that mealtimes had significantly improved for all children
and they felt they were able to do their own job better with the implementations
of the groups.
The null hypothesis stated that the percent of improvement on the
comparison between initial and final standardized assessments of the
experimental population will be less than or equal to the percent of improvement
on the comparison between the initial and final standardized assessments on the
control group after 4-12 weeks of using the Sensory-wise communication methods.
The alternative hypothesis states the percent of improvement on the comparison
between initial and final standardized assessments of the experimental
population will be greater than the percent of improvement on the comparison
between the initial and final standardized assessments on the control group
after 4-12 weeks of using the Sensory-wise communication methods. The two-sample
t-test assuming unequal variances was used at a 99% level of significance to
obtain a p value of .004. Since the p-value is less than sigma of .01 we can
reject the null hypothesis and accept the research hypothesis indicating that
the Sensory-wise communication methods have a significant impact on improving
participation to decrease adverse behavior in children with Autism and other
neurodevelopmental disabilities. Discussion LimitationsThe present study was experimental in nature
and highly controlled with regard to a number of variables.
In order to account for data collection bias, standardized testing procedures were utilized for initial and final assessments, which were
used to determine a baseline in each area for all participants as well as
measure any gains or losses in skills at the end of the
study. Furthermore, initial testing results were kept separate from final testing results to prevent therapists from having access to prior levels
of functioning. Information collected for developmental histories for each
participant in the experimental and control groups was obtained from multiple
disciplines and sources in order to establish accurate
patient histories for all participants. These sources included parent interviews, client interviews when possible, teacher input, chart reviews
and unit behavior trackers kept by floor staff. To
ensure each participant received equal amounts of time with the occupational and speech-language therapist, a schedule was designed so
that each therapist’s half of the group alternated on
a daily basis. All group therapy sessions were held at the same time
each day and in consistent locations. Breakfast group was from 8:15 a.m. to 9:00
a.m. each morning Monday through Friday. Lunch group was from 11:30 a.m. to 12:00 p.m. Monday – Friday. Oral motor group was from
12:00 p.m. -12:30 p.m. Monday through Friday and afternoon group was held from
2:30 p.m. to 3:30 p.m. Monday through Thursday.
Both Group A and Group B participated in two afternoon group sessions each week.
Data trackers were used during all group sessions and in individual sessions
with the control group to accurately collect behavior data. Furthermore, a
consistent group format was used for implementation of all activities with both groups. One limitation of this study was the small
group sizes. In order to generalize this across individuals the study needs to
be repeated to determine if results can be replicated. Another limitation may be
the mixture of psychiatric and medical diagnoses, which may impact the ability
to compare the findings with those of other studies that do not include
co-morbid diagnoses. However it is believed that individuals without the
co-morbid diagnoses could benefit from the same program at a much more rapid
pace. Conclusions The information obtained from this study
serves to increase the knowledge base of treatment options and techniques
available for utilization in children with developmental disabilities.
Problem behaviors, poor socialization, and deficits in sensory processing can
contribute to long-term institutionalization if not treated. Limitations in
social and pragmatic skills adversely affect ability to
participate effectively in the community. Our participants were
able to become more successful and make dramatic developmental improvements over a short time span. By focusing treatment on teaching
developmental, social, communicative, sensory-processing and
motor skills, we were able to decrease aversive behaviors so
that the child will be more functional and acceptable in the community. Our
results are incongruent with the findings of Schery (1985) whose longitudinal study concluded that children with language impairment and psychiatric
illness showed the least amount of gains in language skills.
However, the results we obtained confirm the research of Stagnitti, Raison, and
Ryan (1999) who found sensory diets to be effective in increasing tactile
tolerance, affect and activity level while decreasing temper tantrums at home
and in the school or community. This research is further supported by Ray, et
al. (1988) who found vestibular stimulation increased vocalizations. In
conclusion, our treatment proved to be very effective and we feel it can be
utilized successfully with multiple populations. Acknowledgements We would like to thank the families of all our
participants for their support and willingness to allow
their children to participate in this study. We also thank all the physicians,
social workers and unit staff. Finally, we would like to specifically thank Ithel Brown and Aon Fykes for their
extraordinary efforts in gathering the materials, maintaining our therapy rooms and helping obtain last minute items.
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