Healing Thresholds - Therapies

Vitamin B6 and Magnesium Therapy for Children with Autism

scottie — Sat, 19 Jul 2008 15:42:07 -0500

What is it?
What's it like?
What is the theory behind it?
Does it work?
Is it harmful?
Cost
Resources
References

What is it?

Vitamin B6 (pyridoxine) is an essential vitamin that is necessary for more than 60 biological processes in a healthy human body. The body converts vitamin B6 into pyroxidal-5-phosphate (PLP), a compound that is used to release energy from carbohydrates and starches, and to break down proteins. PLP is also used in the production of important chemicals in the brain ⁽¹⁾.

Magnesium (Mg) is an essential mineral that is necessary for the health of every cell in the body, including the proper functioning of brain and muscle cells. While, magnesium deficiency is rare, some research suggests that children with autism may have too little magnesium ^{(2 3)}.

Some parents supplement a child's diet with a combination of vitamin B6 and magnesium as an alternative therapy for autism.

What's it like?

Vitamin B6 and magnesium supplements can be purchased online, or from almost any grocery, drug, or health-food store (see Resources).

Vitamin B6 is found in many foods; avocados, liver, nuts, chicken, fish, wheat germ, and bananas are good sources of the vitamin. Vitamin B6 is often included as one of many vitamins in a multivitamin supplement, but check with your child's pediatrician before starting a supplement. Vitamin B6 supplements can be taken every day, but may be difficult to give to children, since some children may find that vitamin B6 tastes bitter in tablet or powder form. Liquid B6 supplements are also available and may be better tasting ⁽⁴⁾. Doses of vitamin B6 in research studies varied from 0.6 mg/kg/day (about 10.8 mg/day for a 40-pound child) ^{(3 )}, to 30 mg/kg body weight/day (about 545 mg/day for a 40-pound child) ^{(5, 6)}.

By comparison, the U.S. recommended daily allowance (RDA) for vitamin B6 is 1.3 mg/day for adults, and 0.5-0.6 mg/day for children ages 1-8 years old (Institute of Medicine: Dietary Reference Intakes Tables).

Magnesium is found in many foods, but is especially plentiful in green vegetables, seeds, nuts, and whole grains. A supplement containing magnesium can be taken every day, but check with your child's pediatrician before starting a supplement. While it is not clear what the proper dose for children with autism should be, research reports used a dose in the range of 6-15 mg/kg/day (or about 108-270 mg total daily for a 40-pound child) ^{(3, 7)}.

For comparison, the U.S. RDA for magnesium is 400 mg/day for adults, and 80-130 mg/day for children ages 1-8 years old (Institute of Medicine: Dietary Reference Intakes Tables).

Some parents supplement magnesium by giving their children Epsom salt (magnesium sulfate) baths. While magnesium can be absorbed through the skin, it is hard to say what dose of magnesium a child is getting from an Epsom salt bath.

If you choose vitamin B6 and magnesium as an alternative therapy, ask your child's pediatrician about the dose appropriate for your child. Vitamin B6 can cause upset stomach when not taken with a meal, so also ask a physician to provide a sample schedule for taking B6 and magnesium (see Is it Harmful?).

What is the theory behind it?

The enzyme that is used to break down vitamin B6 into PLP may not work as well in children with autism ^{(4, 8)}. PLP is needed for the production of dopamine, a brain chemical that is very important for many behaviors ⁽¹⁾. If children with autism are not producing enough PLP from the vitamin B6 they have in their diets, then supplementing with extra B6 may help boost the production of PLP to more normal levels ⁽⁸⁾.

Children with autism can have significantly lower levels of magnesium in hair and blood than non-autistic children ^{(2, 3, 9)}. There is evidence that magnesium supplementation can have a calming effect on some children with attention-deficit hyperactivity disorder (ADHD) ⁽¹⁰⁾.

Aside from the necessity of magnesium for the overall physical health as well as the proper functioning of the brain, there is no specific theory about how magnesium deficiency could contribute to autism. The two supplements are often given together, as some researchers have reported that the side effects of vitamin B6 treatment are eliminated by magnesium ⁽¹¹⁾. However, studies in which vitamin B6 was used alone did not report any adverse side effects ^{(7, 12)}.

Does it work?

There is some controversy surrounding the evidence for the effectiveness of vitamin B6 and magnesium in autism ⁽¹¹⁾. Two small but well-controlled studies showed no effects, positive or negative, of combined vitamin B6 and magnesium therapy ^{(13 , 14)}. One larger, but less well-controlled study showed positive and significant behavioral effects of combined vitamin B6 and magnesium, but not vitamin B6 or magnesium alone ⁽¹³⁾.

Three additional studies showed that vitamin B6 and magnesium had significant positive effects on behavior in children with autism. There were, however, major problems with the designs of these studies ^{(3, 15, 16)}. In particular, the researchers in these studies knew that the children were receiving supplements. Therefore, their ratings of the children's behavior could be biased. However, one of these studies did include another small, double-blind, portion suggesting that vitamin B6 and Mg treatment can improve behavior in some children with autism ⁽¹⁵⁾.

The difference in outcomes of the various studies could be because vitamin B6 and magnesium results in positive behavioral effects for about half of those who try the therapy ⁽¹⁷⁾. Another explanation is that vitamin B6 and magnesium supplementation is not effective. The better-designed studies suggest that this may be the case, although these studies were so small, it is difficult to draw conclusions from them ^{(11, 17)}.

Is it harmful?

Vitamin B6 can cause nerve problems at high doses (in adults, over 2g/day; ⁽¹⁸⁾). However, studies of children with autism taking vitamin B6 and magnesium have reported no significant side effects ^{(4, 13)}. Furthermore, in children with epilepsy who had been taking high doses of vitamin B6 or PLP (900 mg for a 40 pound child) for six months, no significant side effects were reported ⁽¹²⁾.

Magnesium can be toxic at doses greater than 600 mg a day. However, studies using magnesium supplements at moderate doses (around 200 mg a day) have not reported significant side effects ^{(7, 10)}.

Check with your child's pediatrician before starting treatment.

Cost

A bottle of 100 multivitamin tablets containing B6 can cost anywhere from $10-40, and a bottle of 100 tablets of magnesium supplements at 250 mg per tablet can cost anywhere from $5-20. Prices depend on the store and the brand of the supplement.

Magnesium and vitamin B6 can come in several forms; ask your child's pediatrician which forms are best for your child.

Resources

Vitamin B6 and magnesium can be purchased online or in a drugstore. They can be included in a multivitamin supplement or they can be purchased individually. Supplements can also be found online, sometimes at a discount.

References

Vitamin C Therapy for Children with Autism

scottie — Sun, 13 Jul 2008 16:02:05 -0500

What is it?
What's it like?
What is the theory behind it?
Does it work?
Is it harmful?
Cost
Resources
References

What is it?

Vitamin C (ascorbic acid) is an essential water-soluble vitamin that is found naturally in many foods. Vitamin C is important for many normally occurring biological processes including the production of neurotransmitters. Vitamin C also acts as an anti-oxidant, protecting the body against damage from free radicals. ⁽¹⁾.

What's it like?

Vitamin C is found naturally in many foods, particularly citrus fruits such as oranges, tangerines, and grapefruits. Vitamin C can be purchased over-the-counter online, or at grocery, drug, or health-food stores. It can be taken every day. Unfortunately, it is not clear what the proper dose for children with autism should be. The only published research report on treatment of children with autism used a dose of 8 grams/70 kg/day (or about 2 grams daily for a 40-pound child) divided into two or three doses ⁽²⁾. If you choose vitamin C as an alternative therapy, ask your child's pediatrician what dose is appropriate for your child.

What is the theory behind it?

Some children with autism may have a vitamin C deficiency. One study demonstrated normal vitamin C levels among children with autism ⁽³⁾, while another reported low levels ⁽⁴⁾. Some investigators believe, however, that supplementation with vitamin C can be helpful even for children with normal levels of vitamin C ⁽³⁾.

Vitamin C has been shown to have a calming effect on behavior in humans ⁽⁵⁾. In animals, stereotyped behavior, one of the characteristics of autism ⁽³⁾, was reduced by treatment with vitamin C ⁽⁶⁾. Scientists hypothesize that vitamin C has these effects because it affects the brain's response to an important neurotransmitter called dopamine ⁽⁶⁾.

Another explanation for the effectiveness of vitamin C is its anti-oxidant properties ⁽¹⁾. Some researchers have theorized that children with autism may have more trouble managing free radicals than other children do ^{(7, 8)}. Free radicals are naturally-occurring chemicals that play important roles in normal functions in the body, but also can cause damage in the brain, immune system, and other tissues or organs in the body. The body has systems to protect tissues from free radical damage, and anti-oxidants are important for this protection. Because it is an anti-oxidant, vitamin C can protect the body against the damaging effects of free radicals.

Does it work?

So far, only one controlled study has shown that vitamin C can help treat behavioral problems associated with autism ⁽²⁾. This double-blind experiment showed that high doses of vitamin C in children with autism had significant positive effects on behavior, compared against their own behavior scores when they were taking a placebo. However, this study was very small (only 18 children), and has not been replicated ⁽⁹⁾.

Another research report showed that high doses of vitamin C may help sleep and gastrointestinal problems in children with autism ⁽⁴⁾. In this study, vitamin C was taken along with other vitamins, so it's not clear which vitamin was responsible for the positive outcomes.

Is it harmful?

For most people, vitamin C is thought to be harmless. However, tolerance for vitamin C can vary. Therefore, you should watch your child carefully for signs of an upset stomach or diarrhea ⁽¹⁾. Check with your child's pediatrician before starting treatment.

Cost

The cost of vitamin C treatment depends on the dosage selected. A bottle of 100 tablets at 1000 mg (1 g) can cost anywhere from $5-20, depending on the quality of the ingredients and the store. The study showing positive effects on behavior used vitamin C donated from a pharmaceutical supply company (Hoffman-LaRoche). Vitamin C supplements may contain sodium, calcium, magnesium, potassium, or zinc ascorbates (salts) of ascorbic acid ⁽⁴⁾; ask your child's pediatrician which form is best for your child. Vitamin C supplements can also be found online, sometimes at a discount.

Resources

Vitamin C can be purchased at most grocery stores and drug stores. There are also many places to purchase Vitamin C online.

References

Social Story Therapy for Children with Autism

scottie — Fri, 04 Jul 2008 13:32:09 -0500

What is it?
What's it like?
What is the theory behind it?
Does it work?
Is it harmful?
Cost
Resources
References

What is it?

Social stories are used to teach social skills to children with autism ⁽¹⁾. A social story is a simple description of an everyday social situation, written from a child's perspective. Social stories can be used in different situations. For example, social stories can help a child prepare for upcoming changes in routine, or learn appropriate social interactions for situations that they encounter ⁽²⁾. The idea is that the child rehearses the story ahead of time, with an adult. When the situation actually happens, the child can then use the story to help guide his or her behavior ⁽¹⁾.

Each social story uses several different types of sentences:

Descriptive sentences (De) give who, what, where, and why details about the situation so the child can recognize when that situation actually occurs.
Directive sentences (Di) tell the child the appropriate social responses in that situation.
Perspective sentences (P) describe one of the child's possible feelings or responses.
Affirmative sentences (A) give the child a sense of what others may be thinking or feeling in that situation. What does this mean?
Cooperative sentences (Co) describe how other people will help out in a given situation.
Control sentences (Cn) are created by the child, to help remember strategies that work for him or her. ^{(1, 3)}.

For example, a social story using all six sentence types is:

When we go to the shoe store,

There will be many shoes to choose from. (De)

I might not know which shoes I like. (P)

That is okay with everyone. (A)

I can hold onto my string while I decide. (Cn)

When I decide about the shoes, I will tell the grown-up. (Di)

The grown-up will go get the shoes for me. (Co)

It has been suggested that social stories should use each of these types of sentences only in specific ratios or amounts. For example, some researchers suggest that directive sentences should not be used as much as descriptive sentences ⁽¹⁾. However, social stories can still be effective without following these rules ⁽³⁾. Social stories are usually written by teachers, speech therapists, and parents, and are individualized for the child with autism ⁽⁴⁾.

What's it like?

Social stories are written in the first person, in the present tense, and from the child's point of view. The parent, teacher, therapist, or counselor should write the story to match the child's vocabulary and comprehension level. The story is written and put into booklet format. Once it is ready, an adult should read the story with the child at least twice, even if the child is capable of reading it. The adult then checks to make sure the child understands the important elements, either using a checklist or role-playing the situation ("Let's pretend we're at the shoe store. What happens next?") After that, the child reviews the story each day. For children who cannot read, audio tapes, videotapes, or picture books of the story can be made for the child to review each day. Finally, the effectiveness of each story should be monitored, with the story being faded out when the behavior has been learned. ⁽¹⁾.

Social stories can be enlightening and enjoyable. One child responded "Now I'll know what to do!" after the first reading of a social story about lunchtime behavior at school. Later, after using the story for about six weeks, that child remarked, "I don't even read the story. Now I just remember it." ⁽⁵⁾.

What is the theory behind it?

Difficulty with reciprocal social interaction is one of the main characteristics of autism. This impairment might result from unusual activity or functioning of certain areas of the brain that are used for social skills ⁽⁶⁾.

Social stories were developed to help improve social interactions in children with autism by giving simple and clear descriptions of social cues and appropriate behaviors ⁽¹⁾. However, it is not clear why social stories work for children with autism, when picking up social cues from the everyday environment does not. Some researchers believe that individuals with autism have trouble understanding what others believe, know, or don't know. This difficulty is sometimes called the theory of mind deficit in autism. ⁽⁷⁾.

There are several ways that social stories may help improve a child's theory of mind. One is that, by giving examples of specific social cues and behaviors, social stories may improve social problem-solving in general ⁽¹⁾. Social stories may also help organize social ides and cues that were previously disorganized ⁽⁵⁾. Moreover, by using print, audio, video, or pictures to replace in-person teaching, social stories may take away some of the anxiety of social relationships ⁽⁸⁾. In this way, autistic children can concentrate on what is being said rather than their relationship with the person who is saying it.

Does it work?

Recent research studies show that social stories can help reduce problem behaviors, increase social awareness, and/or teach new skills. In some cases, the new behaviors were maintained and generalized to other situations, even after the story was faded out. Social stories are most useful for children who have basic language skills ⁽²⁾.

To date, research studies on social stories have only had very small numbers of children (one to five children per study). One review article found that social stories were shown to be significantly effective on average, but not in every case ⁽³⁾. Another recent review article found that the limited studies available showed generally positive results, and concluded that the approach is promising ⁽⁴⁾.

Although social stories in picture-book form are available for children with hearing impairments, there is no research to date on whether social stories have the same effectiveness if communicated with sign language.

More research is needed to understand what factors make social stories effective in some cases and not in others ^{(4, 9, 10)}.

Is it harmful?

There are no known negative effects of social stories. However, among physicians, there is a belief that social stories may train children with autism to learn only one response to a given situation. As a result, some physicians recommend RDI, Relationship Development Intervention, which seeks to teach children how to have appropriate responses in any situation ⁽¹¹⁾.

Cost

Social stories may be included as a component of speech therapy. The cost of speech therapy is covered by the government through the Individuals with Disabilities Education Act (IDEA). This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21. Private speech therapy can be expensive (approximately $100/hour or more). Parents, teachers, counselors, and caretakers can also learn how to use social stories (2).

Books, audiotapes, and videotapes of several commonly used social stories for children with autism are available at a fairly low cost (see Resources).

Resources

The Gray Center works to improve social understanding in autistic children, and provides details about the social stories approach.

Natural Learning Concepts offers communication tools, including illustrated social stories, audio, and videotapes for children with autism.

Several books that might be helpful in understanding the social stories approach are:

The New Social Story Book by Carol Gray (2000. Future Horizons) includes basic illustrated social stories as well as a kit detailing how you can write your own social stories.

Comic Strip Conversations by Carol Gray (1994. Future Horizons) includes more social stories.

References

Applied Behavior Analysis Therapy for Autism

scottie — Sat, 28 Jun 2008 19:47:20 -0500

What is it?
What's it like?
What is the theory behind it?
Does it work?
Is it harmful?
Cost
Resources
References

What is it?

The Applied Behavior Analysis (ABA) approach teaches social, motor, and verbal behaviors as well as reasoning skills ⁽¹⁾. ABA treatment is especially useful in teaching behaviors to children with autism who may otherwise not "pick up" these behaviors on their own as other children would. The ABA approach can be used by a parent, counselor, or certified behavior analyst.

ABA uses careful behavioral observation and positive reinforcement or prompting to teach each step of a behavior ⁽²⁾. A child's behavior is reinforced with a reward when he or she performs each of the steps correctly. Undesirable behaviors, or those that interfere with learning and social skills, are watched closely. The goal is to determine what happens to trigger a behavior, and what happens after that behavior to reinforce it. The idea is to remove these triggers and reinforcers from the child's environment. New reinforcers are then used to teach the child a different behavior in response to the same trigger ⁽³⁾.

ABA treatment can include any of several established teaching tools: discrete trial training, incidental teaching, pivotal response training, fluency building, and verbal behavior (VB).

In discrete trial training, an ABA practitioner gives a clear instruction about a desired behavior (e.g., "Pick up the paper."); if the child responds correctly, the behavior is reinforced (e.g., "Great job! Have a sticker."). If the child doesn't respond correctly, the practitioner gives a gentle prompt (e.g., places child's hand over the paper). The hope is that the child will eventually learn to generalize the correct response ⁽⁴⁾.

Incidental teaching uses the same ideas as discrete trial training, except the goal is to teach behaviors and concepts throughout a child's day-to-day experience, rather than focusing on a specific behavior ⁽¹⁾.

Pivotal response training uses ABA techniques to target crucial skills that are important (or pivotal) for many other skills. Thus, if the child improves on one of these pivotal skills, improvements are seen in a wide variety of behaviors that were not specifically trained. The idea is that this approach can help the child generalize behaviors from a therapy setting to everyday settings ^{(4, 5)}.

In fluency building, the practitioner helps the child build up a complex behavior by teaching each element of that behavior until it is automatic or "fluent," using the ABA approach of behavioral observation, reinforcement, and prompting. Then, the more complex behavior can be built from each of these fluent elements ⁽⁶⁾.

Finally, an ABA-related approach for teaching language and communication is called "verbal behavior" or VB for short ⁽⁷⁾. In VB, the practitioner analyzes the child's language skills, then teaches and reinforces more useful and complex language skills.

What's it like?

Through ABA training, parents and other caretakers can learn to see the natural triggers and reinforcers in the child's environment. For example, by keeping a chart of the times and events both before and after Sammy's tantrums, a parent might discover that Sammy always throws a tantrum right after the lights go on at night without warning. Looking deeper at the behavior, Sammy's mother might also notice that her most natural response is to cuddle Sammy in order to get him to calm down. In effect, even though she is doing something completely natural, the cuddling is reinforcing Sammy's tantrum. According to the ABA approach, both the trigger (lights going on at night without a warning) and the reinforcer (cuddling) must be stopped. Then a more appropriate set of behaviors (like leaving the room or dimming the lights) can be taught to Sammy, each one being reinforced or prompted as needed. Eventually, the hope is that this kind of approach will lead to a time when the lights can go on without warning and Sammy still does not throw a tantrum.

What is the theory behind it?

Many experts believe that children with autism are less likely than other children to learn from the everyday environment ⁽⁸⁾. The ABA approach attempts to fill this gap by providing teaching tools that focus on simplified instructional steps and consistent reinforcement. At best, the ABA approach can help children with autism lead more independent and socially active lives ⁽⁸⁾. Research suggests that this positive outcome is more common for children who have received early intervention. This may be due to critical brain development that occurs during the preschool years and can be affected by training ^{(3, 9)}.

Does it work?

ABA is considered by many researchers and clinicians to be the most effective evidence-based therapeutic approach demonstrated thus far for children with autism ⁽¹⁰⁾. The U.S. Surgeon General states that thirty years of research on the ABA approach have shown very positive outcomes when ABA is used as an early-intervention tool for autism ⁽¹¹⁾. This research includes several landmark studies showing that about 50% of children with autism who were treated with the ABA approach before the age of four had significant increases in IQ, verbal ability, and/or social functioning. Even those who did not show these dramatic improvements had significantly better improvement than matched children in the control groups. In addition, some children who received ABA therapy were eventually able to attend classes with their peers ^{(8, 12, 13)}. A similar study in older children showed improvements in behavior but not IQ ⁽¹⁴⁾.

Parents are often trained in ABA therapy, and several single-subject studies have shown that parental training helps children with autism who receive ABA therapy. Larger controlled studies looking at this issue are underway ⁽¹⁵⁾. Studies of parental satisfaction with ABA indicate that parents believe the approach is effective ⁽¹⁶⁾. Parents also report that they experience less stress as a result of applying ABA ⁽¹⁷⁾.

There are, however, some controversies surrounding the ABA approach ⁽¹⁰⁾. Early ABA practice (in the 1980's and early 1990's) included the use of aversive techniques such as yelling at or restraining a child. Most ABA practitioners no longer consider aversive techniques to be acceptable, and the current ABA approach is equally effective without these techniques ⁽¹⁸⁾.

Experts also disagree as to whether the ABA approach should be used alone or along with other treatment methods. While there are varied opinions ⁽¹⁰⁾, most practitioners agree upon the importance of early intervention, intensive treatment for as much time as possible each day (in the range of 25 to 40 hours per week), well-trained practitioners, and consistent application of the ABA approach within and outside of school ⁽³⁾.

A crucial element of the ABA approach that is especially important for children with autism is finding appropriate reinforcement for each child. Because praise may not be rewarding for these children, careful analysis of each child's behavior can help reveal more effective reinforcement tools ⁽¹⁹⁾. Examples of successful reinforcers may include access to a favorite toy or chair.

Is it harmful?

There are no known negative effects of the ABA approach. This is especially the case if gentle prompting is used rather than aversive techniques.

Cost

In order to effectively implement ABA, both parents and any other major caretakers must be trained in ABA ⁽¹⁵⁾. Workshops covering the basics of ABA treatment can last from 2-7 days, and cost between $175-1,000 per person. Online ABA courses are especially useful for parents who do not live in a large city.

Children can also be enrolled in schools and clinics that specialize in ABA treatment. These can be found in most major cities and university towns. The cost of such schools can be quite high; tuition ranges from $16,000-25,000 per year. However, some schools offer scholarships to parents in need.

It is possible to set up ABA treatment at home using therapists in training or college students who have taken a workshop in the ABA approach. This can also be expensive ($5,000-20,000/year), and requires a great deal of time organizing and structuring the program.

A qualified, full-time (30 hours/week or more) ABA therapist devoted to your child costs approximately $30,000-$50,000 per year. Because of the success of ABA and the evidence indicating that training should be intensive (25-40 hours/week), there is very high demand for ABA-trained therapists, and it may be difficult to find one who is available (see Resources).

Resources

Although autism is a condition covered under the Individuals with Disabilities Education Act (IDEA), whether IDEA covers intensive ABA treatment is still being considered by the courts. See www.wrightslaw.com/info/autism.index.htm for a discussion of court cases and their outcomes.

The Behavior Analyst Certification Board was established to provide consistent credentialing for behavior analysts; search in their "Certificant Registry " to find a local behavior analyst.

The Association for Behavior Analysis International was developed to enhance and support the growth and vitality of behavior analysis. The Web site provides links and resources for ABA practitioners.

Several books that might be helpful in understanding the ABA approach are:

Psychosocial Treatment for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice (2nd Edition). by E. D. Hibbs & P. S. Jensen (Eds.). 2005. American Psychological Association.

Raising a Child with Autism: A Guide to Applied Behavior Analysis for Parents, by S. Richman. 2000. Jessica Kingsley Publishers.

Teaching Language to Children with Autism or Other Developmental Disabilities, by M. Sundberg and J. Partington. 1998. Behavior Analysts, Inc.

Understanding Applied Behavior Analysis: An Introduction to ABA for Parents, Teachers, and Other Professionals, by A.J. Kearney. 2007. Jessica Kingsley Publishers.

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References

Sensory Integration Therapy for Children with Autism

scottie — Sun, 22 Jun 2008 10:45:45 -0500

What is it?
What is it like?
What is the theory behind it?
Does it work?
Is it harmful?
Cost
Resources
References

What is it?

Most of us unconsciously learn to combine our senses (sight, sound, smell, touch, taste, balance, body in space) in order to make sense of our environment. Children with autism have trouble learning to do this. Sensory integration therapy is a type of occupational therapy (OT) that places a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to encourage movement within the room. Sensory integration therapy is driven by four key principles ⁽¹⁾:

the child must be able to successfully meet the challenges that are presented through playful activities (Just Right Challenge);
the child adapts her behavior with new and useful strategies in response to the challenges presented (Adaptive Response);
the child will want to participate because the activities are fun (Active Engagement); and
the child's preferences are used to initiate therapeutic experiences within the session (Child Directed).

Sensory integration therapy is based on the assumption that the child is either overstimulated or understimulated by the environment ⁽²⁾. Therefore, the aim of sensory integration therapy is to improve the ability of the brain to process sensory information so that the child will function better in his daily activities ⁽²⁾.

Recently another sensory-related therapy has been reported called Sensory Stories ⁽³⁾. Sensory Stories are similar to social stories (see Social Stories Therapy Fact Sheet ) in that they use individualized stories about sensory situations that an individual child may encounter, and then provides instructions on appropriate behaviors for the child to use in response ⁽³⁾.

What's it like?

A sensory integration room is designed to make the child want to run into it and play ⁽¹⁾. During sensory integration therapy, the child interacts one-on-one with the occupational therapist and performs an activity that combines sensory input with motion ^{(1, 2, 4)}. Examples of such activities include:

swinging in a hammock (movement through space);
dancing to music (sound);
playing in boxes filled with beans (touch);
crawling through tunnels (touch and movement through space);
hitting swinging balls (eye-hand coordination);
spinning on a chair (balance and vision); and
balancing on a beam (balance).

The child is guided through all of these activities in a way that is stimulating and challenging ⁽¹⁾. The focus of sensory integration therapy is helping children with autism combine appropriate movements with input they get from the different senses.

A parent can integrate sensory integration into the home by providing many different opportunities for a child to move in different ways and feel different things. For example, a swing set can be a form of sensory integration therapy, as can a ball pit or a lambskin rug.

What is the theory behind it?

On a daily basis, most people experience events that simultaneously stimulate more than one sense ⁽⁵⁾. We use our multiple senses to take in this varied information, and combine them to give us a clear understanding of the world around us. We learn during childhood how to do this ⁽⁶⁾. Thus, through childhood experiences we gain the ability to use all of our senses together to plan a response to anything we notice in our environment ⁽⁵⁾. Children with autism are less capable of this kind of synthesis and therefore they may have trouble responding appropriately to differently stimuli.

Children with autism may also have a difficult time listening when they are preoccupied with looking with at something. This is an example of their difficulty in receiving information via more than one sense simultaneously ^{(5, 7)}. Physicians who treat children with autism believe that these difficulties are the result of differences between the brains of children with autism and other children ^{(5, 7, 8)}.

The underlying concepts of sensory integration therapy are based on research in the areas of neuroscience, developmental psychology, occupational therapy, and education ^{(1-3, 9)}. Research suggests that sensory information received from the environment is critical; interactions between the child and the environment shape the brain and influence learning. Furthermore, research suggests that the brain can change in response to environmental input, and rich sensory experiences can stimulate change in the brain.

Does it work?

The effectiveness of sensory integration therapy is controversial and there are very few well-designed studies upon which to base a clear assessment of whether or not it works^{(1, 2, 10)}. Approximately half of the reports in the scientific literature show some type of effectiveness with sensory integration therapy, and half show no benefits at all ⁽¹⁾. Some researchers suggest that sensory integration therapy would be more useful for younger children than for older children ⁽⁴⁾. Some experts suggest that sensory integration therapy be discontinued if effects are not apparent during a specified time frame or if the child has a negative reaction ⁽⁴⁾.

Successful sensory integration therapy has been able to decrease sensitivities to touch and other stimuli (1, 11). The result is that the children are better able to play, learn, and interact with people and surroundings ^{(1, 11)}.

Is it harmful?

While sensory integration therapy is not harmful, some forms of sensory therapy may be uncomfortable for the child. Children with autism can be especially sensitive to certain types of sensory stimulation; the therapist should respond appropriately to each child. Children should be closely monitored for any negative reactions or self-soothing behavior which might indicate the child is feeling uncomfortable ⁽⁴⁾.

True sensory integration therapy, however, should be child-directed, playful, and pleasant for the child ^{(1, 12)}.

Cost

Sensory integration therapy is frequently included as a component of occupational therapy ⁽²⁾. The cost of occupational therapy may be covered by the government through the Individuals with Disabilities Education Act (IDEA). Private occupational therapy can be expensive (approximately $100/hour or more).

Sensory integration equipment is relatively low-tech, but can be moderately expensive ⁽⁴⁾. These include anything from large bins of rice that a child can climb into, to an indoor swing set.

Sensory Stories that can be adapted for individual children are available online at www.sensorystories.com. A collection of 30 Sensory Stories, which can be adapted for the individual child, is available for about $150 through this site.

Resources

Autism is a condition covered under the Individuals with Disabilities Education Act (IDEA). Services covered by IDEA include early identification and assessment by an occupational therapist. This law protects the rights of patients with autism and provides guidelines to assist in their education. It covers children from birth to age 21. Pediatricians can provide contact information for your state's early intervention program (for children 0 to 3 years old). School districts will coordinate special services for children 3-21 years old.

An excellent overview of sensory integration can be found in: The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder, Revised Edition by Carol Stock Kranowitz and Lucy Jane Miller. 2006. Perigree Trade.

Sensory integration equipment can be purchased online through many sites. These include: Abilitations, The Adaptive Child, Pacific Pediatric Supply, and The Child Inside.