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Autism Occupational Therapy

Updated on July 1, 2017

Abstract

This hypothetical study is designed to evaluate the effect occupational therapy has on improving skill generalization and sensory integration in people with autism from a developmental psychology perspective, ages 6-12, using an experimental research design. Study participants will have a confirmed diagnosis of autism from a licensed psychologist based on the results of the Autism Diagnostic Interview-Revised (Lord et al. 1994), possess a non-verbal cognitive level greater than 65 (Schaaf Benevides et al. 2012), and have a difficultly with skill generalization and sensory integration. The research study will require 380 research participants in order for the study to have a 5% margin of error and a 95% confidence level as the population of autistic individuals in the United States is about 32,276 according to Elsabbagh et al. (2012). Results are expected to show that the children in the experimental group (n=190) who received three weekly one hour-long occupational therapy sessions for one year will have an improved level of skill generalization and sensory integration in comparison to the control group (n=190). Research findings are discussed in terms of their implications towards improving quality of life for autistic individuals and possible branches of future research.

Literature Review

My study will focus on the effect occupational therapy has on improving skill generalization and sensory integration in people with autism from a developmental psychology perspective. The study will use an experimental research method with an experimental and control group composed of autistic children; the experimental group will receive occupation therapy while control group will not have any changes in treatment for the duration of the study.

“The Occupational Transition Process”

Baric’s et al., (2016) study examines the occupational transition process of those with autism and ADHD; the study found that there are three effective transitioning paths that work well for those with autism and ADHD. The results were based on participants who were recruited from municipality services; the recruitment location could mean that these participants were more willing to make use of the support offered. The qualitative research study used semi-structured interviews as a method of gaining information about what each participant experienced during his or her transition. The qualitative research design was appropriate as the aim of the study was observation and interview and the semi-structured interview process allowed for flexibility. The study aligned with the expectations of the principle of integrity when it provided descriptions on the selection of the participants.

“An Intervention for Sensory Difficulties in Children with Autism”

Schaaf et al., (2013) evaluated whether the intervention of occupational therapy was effective in lessening sensory dysfunction in children with autism; the results indicated that the participants who received an extra three hours of sensory integration therapy per week scored higher when attaining their goals. The fact that the study was designed to gather preliminary efficacy information could indicate that the study was too short to obtain a full finding. The case study used a randomized trial design, which was appropriate as the study focused on a small group who all shared the similarity of autism. The study aligned with the principles of beneficence and non-maleficence when the psychologist use of the Sensory Integration Fidelity Measure and the goal attainment scale.

“Efficacy of the Get Ready to Learn Yoga Program Among Children With Autism”

Koenig, Buckley-Reen, and Garg’s (2012) examined the effectiveness of the Get Ready to Learn yoga program on children with autism; they found a decrease in maladaptive behaviors in the autistic children who took part in the program. The study used a convenience sample of an intact group from a school and did not make use of random sampling; this indicates that there may have been an inherent selection bias, which may have influenced the results of the study. The experimental research study used an experimental pretest-posttest control group design, which was appropriate as it allowed the researchers to compare the control and experimental groups. The study aligned with the expectations of the principle of integrity when it altered all the identifying information of the participants.

Therapeutic Horseback Riding Outcomes

Holm’s et al., (2014) scrutinized the effect of different doses of therapeutic horseback riding on parent-nominated target behaviors of autistic children; the results indicated a reduction of the targeted behaviors. The used a small sample of three autistic boys, which could lead to results that would not apply to a larger sample or population. The case study used a single subject multiple baseline design, with parent data recording. The study design was not appropriate because it involved untrained biased evaluators; in this way, it also failed to meet the principle of integrity from the APA Ethical Principles of Psychologists.

“Evaluating Intervention Using Time Aids In Children With Disabilities”

Janeslätt, Kottorp, and Granlund (2014) evaluated the effect time aids as an intervention strategy on special needs children with time management difficulties; they found that the intervention increased the participants’ ability to handle time management. The fact that the study made used children with a variety of disabilities could cause miscommunication between the researchers and the participants, which could skew the results of the study. This experimental research study used a randomized block design, which was appropriate as the researchers analyzed the experimental and control groups to ensure both had an equal number of people with the same disabilities and ages. The fair treatment and grouping of the participants was an example of the APA Ethical Principles of Psychologists known as justice.

“Equine-Assisted Occupational Therapy: Increasing Engagement”

Llambias, Magill-Evans, Smith, and Warren (2016) investigated the effect of horses in occupational therapy on improving engagement in autistic children; the results found an increased level of engagement in the participants. The use of horses alongside occupational therapy techniques the use of multiple strategies could skew the cause of the results. The multiple-baseline study design was appropriate as it allowed the researchers to get a baseline read on the participants in order to compare to their level of engagement after intervention. The study demonstrated the principle of respect for dignity when all participants were checked to be comfortable and not scared with interacting with the horses before being made participants.

My Research

Based on my evaluations of the articles I would prefer to use an experimental study in order to ensure an unbiased approach. This study design would allow for a comparison between the experimental and control groups. In order to guarantee that my research aligns with the expectations of the APA Ethical Principles of Psychologists I would seek approval from an institutional review board (IRB) and the assent of each child participant after making sure they understood their participation in the study and the way it could affect them.

Hypothesis

My hypothesis states: occupational therapy improves skill generalization and sensory integration in people with autism. I based my hypothesis on the results of the literature that I reviewed. My literature review presented me with the areas that occupational therapy can assist an autistic individual with and the results of that therapy on the individual. Schaaf’s et al., (2013) study found that the children who received an extra three hours of sensory integration therapy per week scored higher on sensory integration. This study presented the sensory integration section of my hypothesis and it demonstrated that occupational therapy improved sensory integration, which is an important life skill that an autistic individual would require in order to participate in society. The results from Janeslätt’s et al., (2014) study proved that skill generalization could be taught when the study used time aids in order to foster participants’ time management ability. I utilized these results in my hypothesis when I added skill generalization as an area that could be improved through occupational therapy.

Methods

An experimental research design is the most appropriate research design as my hypothesis requires causal based research. The experimental research design will provide an experimental group and a control group. This will allow for the measuring of the results from occupational therapy in skill generalization and sensory integration.

Participants

The research participants selected for the study all need to be: between the ages of 6 and 12, have a confirmed diagnosis of autism from a licensed psychologist based on the results of the Autism Diagnostic Interview-Revised (Lord et al. 1994), possess a non-verbal cognitive level greater than 65 (Schaaf Benevides et al. 2012), and have a difficultly with skill generalization and sensory integration. The parents or guardians of the research participant must be willing to be interviewed once a month for a year and refrain from starting any new treatments for one year, and be willing to not alter the participants’ current treatment for the period of one year.

Sampling Frame

The research study will require 380 research participants in order for the study to have a 5% margin of error and a 95% confidence level as the population of autistic individuals in the United States is about 32,276 according to Elsabbagh et al. (2012). The research subjects will be recruited from school districts. School districts that have a special needs program will be contacted and sent informational brochures on the research study; these brochures shall be sent home with autistic children who are between the ages of 6 and 12. Every respondent will be confirmed to be autistic based on the Autism Diagnostic Interview-Revised (Lord et al. 1994). Once the autism is confirmed the potential participants will be evaluated to determine if they have a non-verbal cognitive level greater than 65 (Schaaf Benevides et al. 2012) and have a difficultly with skill generalization and sensory integration.

Once the child is confirmed as a good candidate, the assent of each participant and the substitute consent of their parent or legal guardian will be established provided each child and parent agree to take part in the study for a period of one year and to refrain from any treatment changes during the study. This process would continue until a sample of 380 research participants was successfully recruited.

Instrument

An experimental research design will be used in order to create an experimental and control group composed of an equal mix of age groups and genders. The experimental group will receive three weekly one hour-long sessions with an occupational therapist; these sessions will be recorded, observed, and evaluated to ensure fidelity. The control group will continue to receive only their usual level of care with no new treatment additions or alterations during the time of the study. The occupational therapy sessions will continue for one year for those in the experimental group, while those in the control group will not alter their treatment in any way for one year.

At the conclusion of each month every participant, in both the experimental and control group, will evaluated by blinded independent evaluators. The participants will be evaluated on their skill generalization, sensory integration, communication, social engagement, and task engagement. These evaluations will allow each participant’s progress to be recorded, observed, and compared in order to chart their progress. In addition, the parents or guardians will be interviewed at the conclusion of each month by blinded independent researchers on their child’s reactions to the therapy, behavior variations, and the parent’s own observations on any changes or lack of changes in their child.

Protection of Participants

In order to protect the participants involved, all identifying information will be altered before being stored on a secure server at the testing facility in accordance with the APA ethical principles of fidelity and responsibility. The data will only be available to those involved in the study until it is peer reviewed and published in order to respect the rights and dignity of the participants. The participants are not expected to suffer any adverse effects from the experiment, but all participants will be carefully monitored to ensure their health and safety in accordance with the principles of beneficence and nonmaleficence.

Discussion

The articles I evaluated support my research proposal in that they demonstrate the fact that autistic children can learn skill generalization and sensory integration. Several research studies (Holm et al., 2014; Janeslätt, Kottorp, and Granlund, 2014 Llambias, Magill-Evans, Smith, and Warren, 2016; Schaaf et al, 2013; Koenig, Buckley-Reen, and Garg, 2012) demonstrated that autistic children can successfully learn skill generalization and sensory integration through occupational therapy. These results are important because they show that autistic children can learn the skills they need to better themselves and to improve their lives as shown in Baric’s et al., (2016) study, which proved that those with autism can apply skill generalization and sensory integration to their everyday lives. The results of these studies were conveyed through peer-reviewed journals. I would convey my research findings through publication in peer reviewed academic journals like the Journal of Autism and Developmental Disorders. This would allow my research studies to be shared with a wide audience and to influence other psychologists and inspire further research.

Further research could be conducted on numerous topics involving autism and occupation therapy such as: long term effects of occupational therapy, effect of occupational therapy on adults, the skills that occupational therapy can successfully teach, most successful occupational therapy techniques, and the effect of occupational therapy on other developmental disorders. The amount of further research that could be done is limitless as not much is currently known or studied about autism and occupational therapies effect on it.

References

American Psychological Association (2017). Ethical Principles of Psychologists and Code of Conduct. Retrieved From http://www.apa.org/ethics/code/

Baric, V.B., Hemmingsson, H., Hellberg, K. et al. J Autism Dev Disord (2016). The Occupational Transition Process to Upper Secondary School, Further Education and/or Work in Sweden: As Described by Young Adults with Asperger Syndrome and Attention Deficit Hyperactivity Disorder. Journal of Autism and Developmental Disorders. Doi:10.1007/s10803-016-2986-z

Elsabbagh, M., Divan, G., Koh, Y., Kim, Y. S., Kauchali, S., Marcín, C., . . . Fombonne, E. (2012). Global Prevalence of Autism and Other Pervasive Developmental Disorders. Autism Research, 5(3), 160-179. doi:10.1002/aur.239

Holm, M. m., Baird, J., Kim, Y., Rajora, K., D'Silva, D., Podolinsky, L., & ... Minshew, N. (2014). Therapeutic Horseback Riding Outcomes of Parent-Identified Goals for Children with Autism Spectrum Disorder: An ABA′ Multiple Case Design Examining Dosing and Generalization to the Home and Community. Journal Of Autism & Developmental Disorders, 44(4), 937-947.

Janeslätt, G., Kottorp, A., & Granlund, M. (2014). Evaluating intervention using time aids in children with disabilities. Scandinavian Journal Of Occupational Therapy, 21(3), 181-190. doi:10.3109/11038128.2013.870225

Llambias, C., Magill-Evans, J., Smith, V., & Warren, S. (2016). Equine-Assisted Occupational Therapy: Increasing Engagement for Children with Autism Spectrum Disorder. American Journal Of Occupational Therapy, 70(6), 1. doi:10.5014/ajot.2016.020701

Lord, C., Rutter, M., & Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.

Koenig, K., Buckley-Reen, A., & Garg, S. (2012). Efficacy of the Get Ready to Learn Yoga Program Among Children With Autism Spectrum Disorders: A Pretest-Posttest Control Group Design. American Journal Of Occupational Therapy, 66(5), 538. doi:10.5014/ajot.2012.004390

Schaaf, R. C., Benevides, T., Kelly, D., & Mailloux, Z. (2012). Occupational therapy and sensory integration for children with autism: A feasibility, safety, acceptability and fidelity study. Autism: The International Journal of Research and Practice,. doi:10.1177/1362361311435157

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., Hooydonk, E. V., . . . Kelly, D. (2013). An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial. Journal of Autism and Developmental Disorders, 44(7), 1493-1506. doi:10.1007/s10803-013-1983-8

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