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Structured Abstract
Objectives:
To evaluate the effectiveness and safety of interventions targeting sensory challenges in children with autism spectrum disorder (ASD).
Data sources:
We searched MEDLINE®, Embase®, the Cumulative Index of Nursing and Allied Health Literature®, and PsycINFO® from January 2010 to September 2016.
Review methods:
We included studies comparing interventions incorporating sensory-focused modalities with alternative treatments or no treatment. Studies had to include at least 10 children with ASD ages 2–12 years. Two investigators independently screened studies and rated risk of bias. We extracted and summarized data qualitatively because of the significant heterogeneity. We also assessed strength of the evidence (SOE).
Results:
We identified 24 unique comparative studies (17 newly published studies and 7 studies addressed in our 2011 review of therapies for children with ASD). Studies included 20 randomized controlled trials (RCTs), 1 nonrandomized trial, and 3 retrospective cohort studies (3 low, 10 moderate, and 11 high risk of bias [ROB]). Populations, intervention approaches, and outcomes assessed varied across studies. Relative to usual care or other interventions, sensory integration–based approaches improved measures related to sensory and motor skills in the short term (3 RCTs with high, moderate, and low ROB and 1 high ROB retrospective cohort study). Environmental enrichment improved nonverbal cognitive skills in treated children compared with standard care in two small RCTs (low and moderate ROB). Four small RCTs (2 moderate and 2 high ROB) of auditory integration–based approaches reported mixed results. Studies of music therapy (4 RCTs—1 low, 2 moderate, and 1 high ROB—and 1 high ROB nonrandomized trial) used different protocols and addressed different outcomes, precluding synthesis. Massage improved ASD symptom severity and sensory challenges versus a waitlist control condition (7 studies, 5 with likely overlapping participants, 3 moderate and 4 high ROB). Additional RCTs (moderate and high ROB) of interventions with sensory-related components (tactile stimulation exercises, weighted blankets) reported few significant differences between treatment groups.
Conclusions:
Some interventions targeting sensory challenges may produce modest short-term (<6 months) improvements, primarily in sensory-related outcomes and outcomes related to ASD symptom severity; however, the evidence base for any category of intervention is small, and durability of effects beyond the immediate intervention period is unclear. Sensory integration–based approaches improved outcomes related to sensory challenges (low SOE) and motor skills (low SOE), and massage improved sensory responses (low SOE) and ASD symptoms (low SOE). Environmental enrichment improved nonverbal cognitive skills (low SOE). Auditory integration–based approaches did not improve language outcomes (low SOE). Some positive effects were associated with other approaches studied (music therapy, weighted blankets), but findings in these small studies were not consistent (insufficient SOE). Data on longer term results are lacking, as are data on characteristics that modify outcomes, effectiveness of interventions across environments or contexts, and components of interventions that may drive effects. In sum, while some therapies may hold promise and warrant further study, substantial needs exist for continuing improvements in methodologic rigor in the field.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Introduction
- Methods
- Results
- Results of Literature Searches for Key Questions
- Key Question 1. Benefits and Harms of Interventions Targeting Sensory Challenges
- Key Question 2. Modifiers of Treatment Outcomes
- Key Question 3. Time to Effect of Interventions
- Key Question 4. Evidence That Effects Measured at the End of Treatment Predict Long-Term Functional Outcomes
- Key Question 5. Effectiveness Across Environments or Contexts
- Key Question 6. Drivers of Treatment Outcomes
- Discussion
- References
- Acronyms and Abbreviations
- Appendix A. Detailed Methods
- Appendix B. Search Strategies
- Appendix C. Screening and Quality Assessment Forms
- Appendix D. Excluded Studies
- Appendix E. Risk of Bias Ratings
- Appendix F. Applicability of Findings
- Appendix G. Detailed Table of Findings
Suggested citation:
Weitlauf AS, Sathe NA, McPheeters ML, Warren Z. Interventions Targeting Sensory Challenges in Children With Autism Spectrum Disorder—An Update. Comparative Effectiveness Review No. 186. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2015-00003-I.) AHRQ Publication No. 17-EHC004-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm. doi: https://doi.org/10.23970/AHRQEPCCER186.-->
This report is based on research conducted by the Vanderbilt Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00003-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.
This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.
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