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Autism Spectrum Australia (Aspect) 1
“It’s a Sensory Thing…” Classroom Based Sensory
Processing Intervention for Children with Autism
Caroline Mills, Occupational Therapist
Dr Christine Chapparo, Senior Lecturer, The University of Sydney
Autism Spectrum Australia (Aspect) 2
• What do we mean by Sensory Processing?
• Research in Sensory Processing
• Our research with sensory processing in ASD
– Method
– Intervention
– Results
– Discussion
What are we talking about?
Autism Spectrum Australia (Aspect) 3
What is Sensory Processing?
Sensory Processing: (lay terms)
• Taking in information from all the senses and processing these
effectively
• Taking in information from the right senses at the right time
• Using the information effectively in day to day activities
Sensory Integration:
“the neurological process that organises sensations from one’s own
body and from the environment and makes it possible to use the
body effectively within the environment.” (Ayers, 1972)
Sensory Integration VS Sensory Processing
Autism Spectrum Australia (Aspect) 4
Inside
Senses
Outside
Senses
The Seven Senses
movement and balance
(vestibular)
body awareness
(proprioception)
touch (tactile)
sound (auditory)
sight (visual)
smell
taste
Autism Spectrum Australia (Aspect) 5
How common is it really?
• 70.5% of those with ASD showed ‘definite differences’ on
Short Sensory Profile (SSP) (Adamson, O’Hare & Graham, 2006)
• 84% showed definite differences on SSP (Tomcheck & Dunn,
2007), compared with 3.2% of controls
• 95% had definite or probable differences (Tomcheck & Dunn,
2007)
Autism Spectrum Australia (Aspect) 6
Sensory Processing in Autism
• Sensory differences are more prevalent in ASD than typically
developing children or children with other types of
developmental disabilities. (Tomchek & Dunn, 2007; Baranek et al 2007;
Ben-Sasson et al, 2009; Boyd et al, 2010)
• Sensory differences vary between individuals with autism
(Grandin, 2009)
• Greater severity of ASD correlated with greater severity of
sensory difficulties (Adamson et al, 2006; Ben-Sasson et al, 2009)
Autism Spectrum Australia (Aspect) 7
Sensory Sub-Types in Autism
• ‘Hyper’ (over responsive), ‘Hypo’ (under responsive) (Dunn,
2014)
• Behavioural responses (seeking/avoiding) (Dunn, 2014)
• Over focused/pre-occupied/Innattentive (Liss, et al, 2006; Lane, et al
2010)
• Links with specific modalities (taste/smell or movement) (Lane
et al, 2011)
• Links with motor planning and praxis (Roley et al, 2015)
• Enhanced Perception- linked with weak central coherence
account (Baron-Cohen et al, 2009)
Autism Spectrum Australia (Aspect) 8
Impact on Participation
• Sensory difficulties have been associated with emotional
concerns (Baker et al, 2008).
• Hyper-responsive (over-responding) sensory style in Autism
was correlated with repetitive behaviours and a tendency for
sameness (Boyd et al, 2009), decreased participation in activities
(Little, et al, 2015) and anxiety (Green & Ben-Sasson, 2010)
• Auditory filtering and under responsive/seeks sensation
greatest impact on school functioning (Ashburner, Ziviani and Roger,
2008).
Autism Spectrum Australia (Aspect) 9
• Choice to avoid certain situations
because of sensory experiences
• “Integrated” nature of sensory
processing (Kirby, et al 2015)
• Prefer sensations which are controlled
and predictable (Ashburner, et al 2013)
• Meta-cognitive strategies- planning,
focus, self talk
What do people with autism say?
Autism Spectrum Australia (Aspect) 10
• All sensory responses are behavioural
• What is the function of the behaviour?
• Some behaviours have multiple functions
Is it Sensory or is it Behaviour?
Autism Spectrum Australia (Aspect) 11
What about intellectual disability?
• Children with ASD have ID up to
70% of the time, different needs to
those with ASD alone (Matson & Goldin,
2013; Matson & Shoemaker, 2009)
• “Confounding variables”
• Need for an evidence base for
children with Autism and ID with
sensory processing difficulties
Autism Spectrum Australia (Aspect) 12
There is no single instrument which can
comprehensively measure the range of sensory
features in autism (Schaaf & Lane, 2015)
Sensory Interventions are inconsistently defined (Case-Smith et al, 2015)
…insubstantial treatment outcomes, weak
experimental designs, or high risk of bias.
…insufficient evidence exists to support their use (Barton et al, 2015)
…but what can we do to help these children?
Autism Spectrum Australia (Aspect) 13
So
what
did we
do?
Autism Spectrum Australia (Aspect) 14
Background to the Research
Why is he doing that?
How can I help him to meet his sensory needs so he can learn?
Sensory based
behaviour happens
for a reason
Sensory activities
or opportunities
The need for
suitable
replacement
behaviours
Autism Spectrum Australia (Aspect) 15
Background
• Children with ASD, ID, autism specific special
school in Sydney
• Pilot Study
Research Question: What is the impact of an In-
Class Sensory Activity Schedule (SAS) on
task mastery and cognitive strategy application
children with autism?
Autism Spectrum Australia (Aspect) 16
Name Age Diagnosis
M 7 y 10 mo Autistic Disorder, moderate intellectual
disability, severe language delay
B 5 y 7 mo Autism spectrum disorder, intellectual disability
L 6 y 3 mo Autistic disorder, moderate intellectual disability
C 6 y 8 mo Autistic disorder, moderate intellectual disability
A 6 y 9 mo Autistic Disorder, moderate intellectual disability
Meet the Participants n=5, mean age= 6.6yrs
Autism Spectrum Australia (Aspect) 17
• Single System AB design: non-concurrent, repeated measures
• Teacher designed desk work tasks were rated including cutting,
sticking, put in tasks, puzzles and matching.
• Sampling of class task performance was videotaped by school
staff
Method
Autism Spectrum Australia (Aspect) 18
Informal Assessment:
• Teacher report and classroom observation
• ‘Off task’ behaviour- sensory seeking- climbing on
furniture/staff or sensory avoiding function- hiding from the
group, frustrated, fixed in routine- quite upset with
changes, difficulties transitioning
Formal Assessment:
Short Sensory Profile (McIntosh, Miller & Shyu, 1999) findings
summary: All total scores showed definite difference
Assessment for Inclusion
Autism Spectrum Australia (Aspect) 19
Intervention: Sensory Activity Schedule
(SAS)
• Terminology should be clarified (QLD DET, 2011)
• Difficulties with sensory aspects of task
performance
• Based on the ‘sensory diet’ (Wilbarger & Wilbarger, 1991)
• Brushing (Deep Pressure Proprioceptive
Technique) was not used (Wilbarger & Wilbarger, 1991)
Autism Spectrum Australia (Aspect) 20
• Administered by teacher’s aide and teacher.
• Morning session- after morning circle, before desk work.
• Used classroom based equipment
• 10-15 mins
Sensory Activity Schedule (SAS)
Autism Spectrum Australia (Aspect) 21
Sensory ActivitiesExample of Sensory Activities
Movement activities while wearing tight lycra
Jumping on a mini-tramp and crashing into cushions
Squashing games with a bean bag
Rolled over a therapy ball, bouncing on therapy ball
Tactile activities
Jumping on a mini tramp
Autism Spectrum Australia (Aspect) 22
Sensory Activity Schedule (SAS) Key Components
Evidence of Need- assessment of sensory differences (formal
and informal)
Use of Sensory Activities- deep touch, proprioception,
vestibular, selected as they appeared to benefit the student
Task Specific- Activities were used before specific tasks to
improve performance in those tasks.
Teacher Directed- Consultation- sensory activities and
classroom tasks
Contextual Fit- Considers the child’s school environment
Autism Spectrum Australia (Aspect) 23
PERCEIVE RECALL
PLANPERFORM
Outcome Measure:
PRPP System of Task
Analysis
- Criterion referenced
- Four processing
areas (Quadrants)
- Cognitive disorder-
mismatch between
task, person’s
capacity,
environment
Perceive, Recall, Plan, Perform (PRPP) System of Task Analysis (Chapparo & Ranka, 2011)
Autism Spectrum Australia (Aspect) 24
Data Collection Procedures
• Task performance was videotaped by school staff
• 125 videos were rated using PRPP Stage One and Two
Analysis (55 Baseline and 70 Intervention)
• Videos were randomly ordered and scored by researchers
• PRPP Stage One and Two Analysis was completed
Autism Spectrum Australia (Aspect) 25
• Procedural task analysis
for teacher designated
desk work tasks in the
classroom.
• Steps containing errors
were recorded
• Percentage of error free
performance was
calculated
PRPP Stage One
Put in Task
Errors
Sit down
Take plastic bottle
Take bottle cap
Place in bottle
Take bottle cap
Place in bottle
Put bottle in finish tray
ERROR FREE- 5/7 71.4%
X
X
Data Analysis- PRPP Stage One
Autism Spectrum Australia (Aspect) 26
Results- PRPP Stage One
Performance Mastery
50
55
60
65
70
75
80
85
90
95
100
1 2 3 4 5 6 7 8 9 10 11
Pe
rce
nta
ge
Sco
re
Task Performances
Phase A- Baseline Phase B- SAS Intervention
p=0.038, p<0.05Two band standard deviation method (Ottenbacher, 1986)
M
Autism Spectrum Australia (Aspect) 27
50
55
60
65
70
75
80
85
90
95
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Pe
rce
nta
ge
Sco
re
Task Performances
Phase A Baseline Phase B SAS Intervention
p=0.01, p<0.05
Performance MasteryB
Autism Spectrum Australia (Aspect) 28
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
1 2 3 4 5 6 7 8 9 10 11 12
Pe
rce
nta
ge
Sco
re
Task Performance
Phase A Baseline Phase B SAS Intervention
p=0.502, p>0.05
Performance MasteryL
Autism Spectrum Australia (Aspect) 29
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Pe
rce
nta
ge
Sco
res
Task Performances
Phase A Phase B
p<0.001
C Performance MasteryC
Autism Spectrum Australia (Aspect) 30
Performance Mastery
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Pe
rce
nta
ge
Sco
res
Task Performances
Phase A Phase B
p=0.01, p<0.05
A
Autism Spectrum Australia (Aspect) 31
Results Summary PRPP Stage One
*Mann Whitney U statistic
** Significance at the 0.05 level, *** Significance at the 0.01 level
Child Stage One Task Mastery Result Statistics*
Baseline (A) Intervention (B)
M 69.5% 82.64% p=0.038**
B 86.67% 95.88% p=0.01***
L 81.32% 84.39% p=0.502
C 85.2% 98.18% p<0.001***
A 73.23% 85.24% p= 0.01***
Autism Spectrum Australia (Aspect) 32
• 4 out of 5 showed improved task mastery following a
classroom based SAS as measured by Stage One
PRPP
• Why was intervention effective for 4 out of 5 children?
• A targeted opportunity to meet a child’s sensory needs
contributed to better self regulation prior to completion of
work tasks in the classroom.
• L’s results were not significant- baseline not stable, trend
lines showed improvements
• L needed a longer baseline
Discussion- PRPP Stage One
Autism Spectrum Australia (Aspect) 33
PERCEIVE RECALL
PLANPERFORM
Outcome Measure:
PRPP System of Task
Analysis
- Criterion referenced
- Four processing
areas (Quadrants)
- Cognitive disorder-
mismatch between
task, person’s
capacity,
environment
Perceive, Recall, Plan, Perform (PRPP) System of Task Analysis (Chapparo & Ranka, 2011)
Perceive- Attending- Sensing- Discriminating
Perceive- Attending- Sensing- Discriminating
Recall - Recall Facts- Recall Schemes- Recall
Procedures
Plan- Mapping- Programming- Evaluating
Perform- Initiating- Continuing- Controlling
Perform- Initiating- Continuing- Controlling
Autism Spectrum Australia (Aspect) 34
• Cognitive strategies are scored
based on observation of task
performance.
� 3- no errors and no assistance.
� 2- some prompting.
� 1- deficit or excessive prompting.
• Total sub-quadrant raw scores are converted to percentage scores.
PRPP Stage Two
PERCEIVE RECALL
PLANPERFORM
• Cognitive Task Analysis- How cognitive strategies were used
• The four quadrants are further divided into 12 Sub-Quadrants.
Autism Spectrum Australia (Aspect) 35
Results- PRPP Stage Two
Sub-quadrant Analysis- PRPP
Significant Improvements in Recalling Facts (p=0.028) :
“knowing what you need to know to do what you need to do”
Recall - Recall Facts- Recall Schemes- Recall
Procedures
A displayed more labelling during task performance. Recognition of tasks-spelling words
Autism Spectrum Australia (Aspect) 36
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
PR
PP
Recall
Qu
ad
ran
t P
erc
en
tag
e S
co
re
Task Performances
PRPP Recall Quadrant Scores
Phase A-
baseline
Phase B-
intervention
B
CL A
Autism Spectrum Australia (Aspect) 37
Significant improvements in Plan:
“coping with novel, complex and difficult situations,
knowing the goal and keeping it in mind”
Plan- Mapping (p= 0.012), Programming (p= 0.017),
Evaluating (p= 0.012)
Results- PRPP Stage Two
Sub-quadrant Analysis
Plan- Mapping- Programming- Evaluating
Both M and B self correcting-
matching task (evaluating),
A- questioning when asked to spell
out words.
Autism Spectrum Australia (Aspect) 38
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
PR
PP
Pla
n Q
uad
ran
t P
erc
en
tag
e S
co
re
Task Performances
PRPP Plan Quadrant Scores
Phase A-
baseline
Phase B-
intervention
M
B
L A
Autism Spectrum Australia (Aspect) 39
ResultsPRPP Stage Two Quadrant Analysis
PRPP Quadrant Statistical Analysis
Perceive Z=-1.68, p= 0.093
Recall** Z=-2.521, p= 0.012**
Plan** Z= -2.521, p= 0.012**
Perform Z= -1.82, p= 0.069
TOTAL Z= -2.521, p= 0.012**
** Statistically significant differences between baseline and interventionWilcoxon signed ranks test
Autism Spectrum Australia (Aspect) 40
PRPP Stage Two: Improvements in Plan and Recall,
but not Perceive
• Significant improvements in Plan (all sub-quadrants) and
Recall (recalling facts).
• No Significant improvements in Perceive
• Perceive traditionally associated with sensory processing
(Attending, sensing, discriminating)
• Discriminating is a strength for children with ASD
Autism Spectrum Australia (Aspect) 41
PRPP Stage Two Discussion
• Improved cognitive strategy application as
measured by Stage Two PRPP
• Statistically significant improvement in planning
and recall, not perceive or perform.
• We hypothesise:
– Children didn’t get better at perceiving information,
– they got better at using the information for task
performance
Autism Spectrum Australia (Aspect) 42
• Benefits observed in specific sensory intervention
• Key components that make up SAS intervention
• Qualitative feedback from teachers confirmed statistical
results
• PRPP is a suitable tool to use to measure task mastery
and cognitive strategy use in context
• Small pilot study, many limitations
• Real life research
Overall Discussion
Autism Spectrum Australia (Aspect) 43
Where to Next?
• Randomised Control Trial (RCT)- in progress
• Seven autism specific schools
• Approximately 40 students and 30 teachers
• Sensory Activity Schedule intervention for least one
school term (9 weeks)
• Quantitative and qualitative measures of occupational
performance in the classroom
• Guidelines for practice
Autism Spectrum Australia (Aspect) 44
Acknowledgements
Julie Fardell, Allyce Cunningham, Lydia Hicks, Jamie Togle, Lara Cheney,
Rebecca Fitzroy, Nala Simmons, Yasmina Adamson, Ashwini Reddy,
Rowena Perritt, Tamara Freeburn, Nicole Maskell, Janet Milhouse, Karen
Horne, Pam Lea, Jen Crawford, Lauren Rolfe, Liz Murray, Sally Hewett,
Kelly Karlson, Philippa Sherrington, Kristy O’Sullivan, Bruce Rowles,
Belinda Harris, Gio Gulli, Catherine Thompson, Michelle Lee, Dr Debra
Costley, Dr Trevor Clark, Dr Susan Bruck, Mark Schlosser
Dr Joanne Hinitt, Dr Rob Heard
Participating students and families, teachers, teacher’s aides
Aspect Elizabeth Hoyles Fellowship
Autism Spectrum Australia (Aspect) 45
Adamson, A., O’Hare, A. & Graham, C. (2006) 'Impairments in Sensory Modulation in Children with Autistic Spectrum Disorder.’ British Journal of Occupational Therapy, 69(8): 357-364
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Autism Spectrum Australia (Aspect) 49
Start where you are.
Use what you have.
Do what you can.
Arthur Ashe
Questions…
Contact: Caroline Mills, cmills@autismspectrum.org.au
www.autismspectrum.org.au
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