Sensory integration therapy versus usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised controlled trial

Abstract

Background: Autism spectrum disorder (ASD) is a common lifelong condition affecting 1 in 100 people. ASD affects how a person relates to others and the world around them. Difficulty responding to sensory information (noise, touch, movement, taste, sight) is common, and might include feeling overwhelmed or distressed by loud or constant low-level noise (e.g. in the classroom). Affected children may also show little or no response to these sensory cues. These 'sensory processing difficulties' are associated with behaviour and socialisation problems, and affect education, relationships, and participation in daily life. Sensory integration therapy (SIT) is a face-to-face therapy or treatment provided by trained occupational therapists who use play-based sensory-motor activities and the just-right challenge to influence the way the child responds to sensation, reducing distress, and improving motor skills, adaptive responses, concentration, and interaction with others. With limited research into SIT, this protocol describes in detail how the intervention will be defined and evaluated.

Methods: This is a two-arm pragmatic individually 1:1 randomised controlled trial with an internal pilot of SIT versus usual care for primary school aged children (aged 4 to 11 years) with ASD and sensory processing difficulties; 216 children will be recruited from multiple sources. Therapy will be delivered in clinics meeting full fidelity criteria for manualised SIT over 26 weeks (face-to-face sessions: two per week for 10 weeks, two per month for 2 months; telephone call: one per month for 2 months). Follow-up assessments will be completed at 6 and 12 months post-randomisation. Prior to recruitment, therapists will be invited to participate in focus groups/interviews to explore what is delivered as usual care in trial regions; carers will be invited to complete an online survey to map out their experience of services. Following recruitment, carers will be given diaries to record their contact with services. Following intervention, carer and therapist interviews will be completed.

Discussion: Results of this trial will provide high-quality evidence on the clinical and cost effectiveness of SIT aimed at improving behavioural, functional, social, educational, and well-being outcomes for children and well-being outcomes for carers and families.

Trial registration: ISRCTN14716440 . Registered on 8 November 2016.

Keywords: Autism spectrum disorder; Ayres; Occupational therapy; School; Sensory integration therapy; Sensory processing.

Fig. 1

SPIRIT figure. Schedule of enrolment, interventions, and assessments. ABC Aberrant Behaviour Checklist, ABC-I Aberrant Behaviour Checklist irritability scale, ADOS Autism Diagnostic Observation Schedule, APSI Autism Parenting Stress Index, CARQOL carer quality of life, CSRI Client Service Receipt Inventory, EQ5D EuroQol 5D, SIT sensory integration therapy, SPM Sensory Processing Measure, VABS Vineland Adaptive Behaviour Scale

Fig. 2

Summary flow chart. ABC Aberrant Behaviour Checklist, ADOS Autism Diagnostic Observation Schedule, APSI Autism Parenting Stress Index, ASD autism spectrum disorder, CarerQOL carer quality of life, COPM Canadian Occupational Performance Measure, CSRI Client Service Receipt Inventory, EQ5D EuroQol 5D, SIT sensory integration therapy, SIPT Sensory Integration and Praxis Test, SP sensory processing, SPM Sensory Processing Measure, UC usual care, VABS Vineland Adaptive Behaviour Scale