EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 1
Effective Use of Sensory Integration Treatments for
Students with Autism in Inclusive Classroom Settings
Nicole Dobek
Saint Bonaventure University

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 2
Effective Use of Sensory Integration Treatments for Students with Autism in Inclusive Classroom Settings
Each year the number of children with autism is increasing so quickly, that it is now estimated that roughly 1 in 150 children have some form of Pervasive Developmental Disorder
(PDD) or more specifically an Autism Spectrum Disorder (ASD). Recent legislation including
No Child Left Behind (NCLB) 2001 and Individuals with Disabilities Education Improvement
Act (IDEA) 2004 are mandating a push towards inclusive classrooms which have both general education students and special education students (that may previously been taught in a selfcontained classrooms) in the same class and are to be instructed by both general and special education teachers with additional support staff as necessary.
Because of this legistlation, it is common for students with autism to be part of the general or “inclusive” classroom setting.
Yeargin-Allsopp stated that “due to the unique social and communication difficulties that characterize this population, educators agree that students with ASD require specialized services in the schools” (as cited in Hess, Morrier, Heflin & Ivey, 2008). Specialized services can be provided both in and out of the classroom by a variety of school personnel including speech pathologists, social workers, physical therapists and occupational therapists. For children with autism, “sensory integration is a troublesome spot. Students with ASD can have difficulty regulating input into their central nervous system, resulting in sensitivity to touch, sound, taste or smell” (Friedlander, 2009). Typically sensory integration begins while we are in the womb and continues throughout the first few years of life, but for children with autism, there is often an
“inability to modulate, discriminate, coordinate or organize sensation adaptively” as Lane described (as cited in DiMatties & Sammons, 2003). Occupational therapists have recently been using sensory integration treatments as a way to compensate for sensory integration dysfunction.

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 3
Before we consider how sensory integration therapy can be used effectively for students with autism, it is crucial to know more about sensory integration (SI) and sensory integration dysfunction (SID). Lastly we will discuss if and how sensory integration treatments can be incorporated into inclusive classroom settings. The majority of my experience working with students with autism has been in a self-contained autism program for students ages 5-12 in the
Dunkirk City School District. Although the students participate in special such as gym, art, and lunch with their age-appropriate peers, their instructional time is spent in the self-contained room. While in the room, the teachers implement a multisensory approach to teaching and learning. I have observed children with SID and have also been part of witnessing and providing various sensory integration treatments for these students. I see the product of sensory integration dysfunction every day. I want to learn more about sensory integration and how these dysfunctional issues arise for children with autism. I see how sensory integration treatments are used in the self-contained classroom. I want to learn how these treatments can be incorporated into inclusive settings. After all, the majority of students with some form of ASD will be educated primarily in a general education classroom. Aside from the articles I’ve gathered, I utilized the relationships I’ve built with the staff at Dunkirk City School District to interview a general education teacher, a special education teacher and the occupational therapist to give perspective on these topics of interest to me. When researching for articles, I tried to be objective in selecting both articles that supported and disagreed that sensory integration treatments are an effective for treating issues commonly associated with children with autism.
Methods
To gather the perspective of school personnel involved with sensory integration treatments, interviews were organized with a general education teacher, the special education

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 4 teacher (from the self-contained Autism room) and the occupational therapist that services students in the Autism program as well as students throughout the Dunkirk City School District.
First, interviewees signed a form to allow their responses to be cited in this paper. Next all responses were recorded on the interview sheet (See Appendices A-D). Because a child’s family is one of the most important tools in exchanging information regarding the child’s reactions to various situations in real life, a parent questionnaire was also created (Geppert Coleman,
Mailloux & Smith Roley, 2004). The questionnaire explained the purpose of the questions and asked if parents would kindly return it to school with their child. Questionnaires were provided in both English and Spanish (See Appendices E & F).
Results
Parents had nearly two weeks to return the at-home questionnaire. Unfortunately, there were no parent responses returned to school. The interviews with the general education teacher, the special education teacher and the occupational therapist proved to be enlightening. The occupational therapist is the one that typically begins the evaluation for sensory integration dysfunction. There are checklists that are completed by parents and teachers to determine the types of issues that the child is struggling with. Occupational therapists such as Stacey Lovern
(Dunkirk City School District) use the information gathered from checklists, tests such as the
Sensory Integration and Praxis Test, and observations to create a “sensory diet”. According to
Lovern, a sensory diet is created to mimimize or eliminate distractive behavior. The goal is to observe a child having a difficult time and trace steps back to the antecedent. What caused this student to act this way? Examples of simple solutions can be the child needed a walking or swinging break before beginning the next activity or the child could use a fidget (manipulative that is small and does not make sound to fufill the tactile need of student). The sensory diet is

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 5 composed of these breaks and tools embedded into the entire school day to help the student focus and remain attentive at specific times. The special education teacher follows the lead of the occupational therapist. Tools such as visual schedules, use of auditory and visual timers for transitions and “the sensory room” alleviate some of the SID in the Autism classroom. In
Dunkirk, there are two classrooms devoted to the Autism program. One room is used for learning, workstations and computers. The other is a “sensory room” where students visit at regular intervals throughout the day to calm and prepare their bodies for workstations for example. Students may also ask for a “break” in which they can go to the sensory room to calm down from a situation that is stressful to them. In the sensory room, there is a ball pit, vibrating mat that moves to the beat of music, a bubble tube that changes colors and vibrates, as well as a variety of smaller toys, balls, etc. to stimulate each sense: tactile, auditory, visual, gustatory, olfactory, vestibular, and proprioceptive (DiMatties & Sammons, 2003) (See Appendix G). At least twice daily in school, students in the Autism program receive The Wilbarger Deep Pressure
& Proprioceptive Technique (DPPT) which consists of brushing, joint compressions and lotion.
The objective of DPPT is “to keep the calming input in the person’s system to help the individual remain in the optimal zone of sensory modulation (that is calm and alert but not overly aroused)” and it should be repeated every 90 minutes to 2 hours as recommended by the responsible OT
(See Appendix H). DPPT can be performed by whoever is working with the child including personal aides and parents while at home. The technique is most effective when used at consistent intervals through the day while the child is awake (Lovern). After spending time with students in the program, it’s very easy to tell when a child’s nervous system is distressed.
Typical behaviors include screaming, rocking, aggression, noncompliance/avoidance, and stimming. Ideally, techniques such as DPPT would be performed before behavior has escalated

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 6 to this point, but the calming effects from brushing, swinging or talking a walk are evident sometime immediately following or shortly thereafter.
Mrs. Lovern gives a variety of tools to general education teachers so that sensory integration issues can be addressed in inclusive classrooms. Sit and stand disks and fidgets are examples of resources students can use to stimulate their senses that are craving input. General education teachers can perform DPPT in the form of giving a hug or the child can learn to apply pressure on their own when needed. The point is to not draw the entire class’s attention but to fit in with the rest of the class. The general education teacher said it is quite simple to do throughout the day. The fidget toys and sit/stand disks are available for any student to use although the ones that truly need them tend to obviously use them more often. A great book that was recommended to use in a classroom is “Arnie and His School Tools-Simple Sensory
Solutions That Build Success” by Jennifer Veenendall. The book is written from the perspective of Arnie, a boy with SID. It explains to children how and why Arnie feels the way that he does about certain situations. The book has proven to be helpful for students in Dunkirk in the past to be understanding of other children’s needs and to “stay cool” even if a child is acting silly.
Discussion
Sensory integration is “essentially the reception of the senses’ neurological data in a realistic way so that it might be reacted to in an appropriate manner” (Vantreese, 2007).
Psychologist and occupational therapist Dr. A. Jean Ayres defined sensory integration using the following princples: sensorimotor development is an important substrate for learning, the interaction of the individual with the environment shapes brain development, the nervous system is capable of change (plasticity), and meaningful sensory-motor activity is a powerful mediator

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 7 of plasticity (Schaaf & Miller, 2005). With this in mind, sensory integration theory explains why individuals respond in a certain way to various sensory input and how it affects their behavior.
Sensory Integration Dysfunction “involves difficulty in processing or organizing the flow of sensory information that gives us information about our bodies and the world around us”
(Geppert Coleman, Mailloux, & Smith Roley, 2004). SID hinders children from using their senses to learn about the world around them and can cause anxiety, confusion, attention deficit, and difficulty doings things in a skilled fashion that come naturally to many others. (See
Appendices I & J) They may be unable to maintain the optimal state of calm and alertness throughout the school day. Due to the often inappropriate behaviors exhibited by these children, they are often misunderstood as “bad” kids. Chan says that “teachers need to be able to identify these children in order to prevent their mislabeling as troublemakers and to end the possibility of initiating a vicious cycle of problem behavior.” Interestingly, every child in the world probably has some SID but for most children it does not create a problem. If the severity is great enough to affect daily activities at home and school, then it becomes a concern that should be dealt with
(Vantreese, 2007)
Sensory integration issues are common in children with attention deficit disorder, fragile
X syndrome and other autistic spectrum disorders. Various research studies report unusual sensory responses in up to 88% of children with autism. Stereotypical autistic behavior includes extreme aversion to or excessive seeking of sensory stimuli, avoidance of noisy situations, unusual preoccupation with smells or visual stimuli, or fearfulness of typical activities that involve touch, sounds and movement (Schaaf & Miller, 2005). No two children have exactly the same reaction to given stimuli and both hyper-and hypo-responses are often evident in the same child (Baranek, 2002). Sensory integration treatments are prescribed by occupational therapists

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 8 for nearly half of all children with ASD. SI therapy tends to look a lot like play. The purpose of this is for the child to have fun and be enthusiastic about participating in challenges that involve weakness in sensory integration. Vantreese reminds us that “no one can organize a child’s brain for them. They have to do it by themselves, which is only possible if they are enjoying the activities and having fun.” Children’s lives revolve around playing. Of course they don’t want to do difficult or boring tasks. Boring tasks at school for example are often when the problematic behaviors that the therapy is trying to alleviate usually appear. By disguising treatments as fun activities, occupational therapists are able to “improve the ability to process and integrate sensory information and to provide a basis for improved independence and participation in daily life activities, play, and school tasks (Schaaf & Miller, 2005).
Classically SI treatments were typically given in clinical settings in a one-to-one intervention. This therapy required the use of specialized equipment which makes limits its feasibility for use within a school settings. Also, the traditional “pull-out” model conflicts with inclusionary principles stated in recent federal legislation. A modernized version of an SI-based program is known as the “Sensory Diet”. A child is provided with this program to be used at home and/or in school. The schedule is filled with “frequent and systematically applied somatosensory stimulation” which is then followed by “a prescribed set of activities
[specifically] designed to meet the child’s sensory needs. The Sensory Diet requires less specialized equipment and can often be provided in an inclusive setting (Baranek, 2002).
DiMatties and Sammons believe this type of therapy “can help maintain an age appropriate level of attention for optimal function to reduce sensory defensiveness.”
Sensory Integration therapy sounds like a great treatment option for children with autism.
The problem is that there is little evidence to support its effectiveness. Only approximately 80

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 9 studies have been conducted that measure some aspect of the effectiveness of sensory integration interventions. The lack of research and evidence to support this therapy causes tension by the scientific community. While the therapeutic community will continue to push for services, the sensory integrative approach will not be widely accepted until empirical consensus is reached
(Dawson & Watling, 2000). One reason for the lag in research is that occupational therapy is a relatively new science. It is also very difficult to draw conclusions from research because the sample populations in the studies have been small and the results vary from one individual to another. Schaaf and Miller agree that “given the current level of research, diverse findings are not surprising. This inconsistency is predictable, given the variation in sample characteristics, intervention methods and duration, and outcomes measured.” Evidence from the current research does give us some promising information however. One study indicated that selfstimulating and self-injurious behaviors were reduced by 11% within just one hour of receiving
SI intervention (Smith, Press, Koenig & Kinnealey, 2005). A pilot study out of Brown
University found that children receiving sensory integration therapy saw significantly more progress in the areas of processing/regulation, social-emotional functioning and functional motor skills than those in the control group. Other studies concluded that the approach is equally effective as other approaches used to treat sensory integration dysfunction. Baranek reminds us that “we must keep in mind that a lack of empirical data does not infer that the treatment is ineffective, but rather that efficacy has not been objectively demonstrated. When parents were asked to rate and compare their experience with different treatments for autism, there were mixed responses. Nearly half of parents said that sensory integration treatments were easy to administer while approximately 16% felt it was difficult at least in the beginning. The remaining parents chose not to answer this question. One parent said “It had improved his learning, more

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 10 communicative, more social, better balance, able to ride a bike…If I saw improvement in one sense, I saw improvement in other. Of all the different things we tried, this would be the most important for children with sensory issues.” Other parents in this study stated that SI treatments
“did not meet my expectations” and “overall, it was negative; self-stimulatory behaviors increased” (Green, 2007). Differing opinions on the effectiveness of sensory integration therapy should be expected. Not all of children will exhibit the same improvements and parents have different expectations of treatment options. As Baranek put it, “given the variability in developmental profiles of children with autism, it should be expected that not all children benefit equally from sensory or motor interventions. There is not a “one-size-fits-all” treatment for a diagnosis of autism.” Children tend to show greater improvements when they are receiving treatment consistently throughout the day; at school and at home. Licensed occupational therapist Lesley Crider “sets the state for greater gains by coaching parents in how to provide activities and stimulation daily, teaching them methods for both calming and alerting children, whatever is necessary (as quoted in Vantreese, 2007). Occupational therapists also collaborate with others who are involved with the child to “help them understand the child’s behavior from a sensory perspective, adapt the environment to the needs of the child, crate needed sensory and motor experiences throughout their day in their natural environments, and assure that therapy is helping the child become more functional in their daily life activities (Schaaf & Miller, 2005)”.
With the help of occupational therapists, it is absolutely possible for sensory integration treatments to be incorporated into inclusive classroom settings. Once the OT has set up a sensory diet or similar program, it can be helpful to share the book “Arnie and His School Tools-
Simple Sensory Solutions That Build Success” by Jennifer Veenendall. It will prepare students for behaviors that they may see and will show them how to act appropriately when a situation

EFFECTIVE USE OF SENSORY INTEGRATION TREATMENTS 11 arises. General education teachers can structure their classrooms to mimimize distractions (See
Appendices K & L). The height of desks and chairs can actually affect a child’s attention.
Teachers should use consistent schedules and provide transition time between activities. Pictures schedules may be used for younger children while older children may benefit from checklists.
Fidget toys should be available for tactile stimulation. All students may benefit from these adaptations and they should be available to everyone. The students that truly need these additional supports will definitely utilize them. To minimize anxiety, an area in the classroom should be set up to which the child can “escape” for several minutes. Any activity that “provides for change of setting or allows children to move around will help the child who craves stimulation (Chan, 1995) (See Appendix M).” Other adaptations that would likely be feasible in many educational programs include “changing performance expectations, teaching compensatory strategies, and/or maximizing the child’s strengths to bypass sensory and motor difficulties
(Baranek, 2002).” Each of these adaptations will facilitate fuller participation in inclusive classrooms.
Although sensory integration therapy is yet to be widely accepted, current research does indicate some improvements in learning, attention, behavior and social interaction. There is enough confidence in these treatments by occupational therapists to continue using sensory integration programs for children with autism. As more and more children with ASD and other developmental disabilities are present in inclusive classrooms, SI therapy has been modernized so that it can be integrated into the child’s routine. Children with autism will likely benefit from a multisensory approach in the classroom and sensory integration therapy embedded in their daily routine. All of this can be done in an inclusive setting with the collaboration of caring teachers, occupational therapists and parents.

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References
Baranek, G. T. (2002). Efficacy of Sensory and Motor Interventions for Children with Autism.
Journal of Autism and Developmental Disorders , 32(5), 397-420.
Chan, C. (1995, February). Dealing with Sensory Integrative Dysfunction in the Classroom: A
Guide for Early Elementary Teachers. Paper presented at the American Univeristy
College of Arts and Sciences Student Research Conference, Washington, DC.
Cohen, A. (2009, January 31). Treating Sensory Impairment Dysfunction: Interview with Dr.
Sydney Spiesel.. National Public Radio.
Dawson, G. & Watling, R. (2000). Interventions to Facilitate Auditory, Visual, and Motor
Integration in Autism: A Review of the Evidence.
Disorders , 30(5), 415-420.
Journal of Autism and Developmental
DiMatties, M.E. & Sammons, J.H. (2003). Understanding Sensory Integration. ERIC Digest .
ERIC Clearinghouse on Disabilities and Gifted Education. Arlington, VA.
Friedlander, D. (2009) Sam Comes to School: Including Students with Autism in Your
Classroom. The Clearing House , 82(3), 141-144.
Geppert Coleman, G., Mailloux, Z. & Smith Roley, S. (2004). Sensory Integration: Answers for
Parents. Pediatric Therapy Network.
Green, V.A. Parental Experience with Treatments for Autism. (2007). Journal of Developmental and Physical Disabilities , 19, 91-101.
Hess, K.L., Morrier, M.J., Heflin, L.J. & Ivey, M.L. (2007). Autism Treatment Survey: Services
Received by Children with Autism Spectrum Disorders in Public School Classrooms.
Journal for Autism and Developmental Disorders , 38, 961-971.

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Kranowitz, C.S., Szklut, S. et al. Answers to Questions Teachers Ask About Sensory Integration:
Forms, Checklistss, and Practical Tools. Sensory Resources.
Pilot Study Supports Sensory Integration for Autism. (2008, August). The Brown University
Child and Adolescent Behavior Letter.
Schaaf, R.C. & Miller, L.J. (2005). Occupational Therapy Using a Sensory Integrative Approach for Children with Developmental Disabilities. Mental Retardation and Developmental
Disabilities Research Reviews , 11, 143-148.
Smith, S.A., Press, B., Koenig, K.P. & Kinnealey, M. (2005). Effects of Sensory Integration
Intervention on Self-stimulating and Self-injurious Behaviors. The American Journal of
Occupational Therapy , 59(4), 418-425.
Vantreese, S. (2007, August 22). Making Sensory Sense: Therapy Turns to Play to Allow Kids to
Train Their Own Brains to Sort Through Bodies’ Messages. The Paducah Sun . Kentucky.

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Appendices
A.
Interview Permission Form
B.
Interview with Occupational Therapist
C.
Interview with Special Education Teacher
D.
Interview with General Education Teacher
E.
Parent Letter (English)
F.
Parent Letter (Spanish)
G.
Senses and Ideas for the Classroom
H.
The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT)
I.
Comparison of Sensory Integration and Sensory Integration Dysfunction
J.
Using Sensory Activities with All Student in the Classroom
K.
Organizing Sensory Input and Activities for the Classroom
L.
Classroom Accommodation Checklist
M.
Heavy Word Activities List for Teachers
N.
Literature Review