Monday, August 04, 2014

Comments re: recent RCT on sensory integration

I received several emails asking me about the dialogue that was recently published in the Journal of Autism and Developmental Disorders regarding the Schaaf, et. al (2013) study.  A kind colleague forwarded the comments to me and I had the chance to review them.

Ashburner, Rodger, Ziviani, and Hinder (2014) made some comments about the original research.  They basically outlined concerns with the parent report measures, lack of blinding, and confounding impact of invested time for the parents.  They also expressed concerns with dosage and non-equivalent treatment conditions between groups. 

The original authors (Schaaf et al, 2014) thanked them for their comments and expressed that a treatment manual would be published later this year that might help others replicate the interventions.  They also expressed that they are following a step-wise method of progression from case study to feasability study to RCT.  They state that future studies will address some of the concerns raised.  The authors defended the non-blinded and non-equivalent design, stating that using blinded evaluators was enough to address concerns and that treatment effects were large.

The concerns raised by Ashburner, Rodger, Ziviani, and Hinder are very similar to what was posted in this blog in December, right after the original study was published.  There really are not any new concerns.  Now they are just formally published concerns.

As I indicated in December, if there are true differences to be measured because of sensory integration treatment we will find them after we design studies that are not so vulnerable to criticism.  I blogged about the design as soon as I read it because the problems seemed rather obvious.  The fact that a group of academics and researchers bothered to write formal comments to the journal would seem to validate the concerns.


Ashburner, J.K., Rodger, S.A., Ziviani, J.M., Hinder, E.A. (2014). Comment on "An intervention for sensory difficulties in children with autism: A randomized trial by Schaaf et al. (2013)." Journal of Autism and Developmental Disorders, 44, 1486-1488.

Schaaf, R. et al (2013). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disabilities, published online at

Schaaf, R. et al (2014).  Response from authors to comments on "An intervention for sensory difficulties in children with autism: A randomized trial."  Journal of Autism and Developmental Disorders, 44, 1489-1491.


Anonymous said...

"a treatment manual would be published later this year that might help others replicate the interventions"
The above quote is interesting because the techniques used in sensory integration therapy are always the same. It doesn't matter what the issues are. The treatment never changes. This is one of the reasons why scholars have recognized it (SI) as a pseudoscience.

Christopher Alterio said...

The charge that the treatment techniques are always the same is interesting to me, because that has not been my observation. I have seen people doing treatment activities that are ritualized and repetitive but I don't think they could be properly labeled 'Ayres SI (TM). That problem with fidelity to a model is longstanding.

I agree, however, that the manual would be interesting, precisely because treatment is supposed to be individualized. I am not certain what to expect in a treatment manual that purports to represent adherence to a concept but yet will maintain that individualized nature.

If you have seen techniques that are always the same, would you mine sharing a little more about what you have seen that brings you to that conclusion?

Anonymous said...

I am not well versed in SI therapy. I am an early childhood educator and the advice I get always seem to be the same for every child. The OT usually instructs me to start with the brushing protocol and then on to rolling the child on a ball or joint compressions etc. It is the same routine for hypersensitive and hypo-sensitive children. Also, I get pretty much the same instructions for all the child's issues. I have never seen it personalize or even any mention of how a technique will help in solving a specified issue. I have attended a few conferences and purchased products to try to understand more.One of these conferences were led by the top experts (or authors) in SI therapy. But I kept hitting a wall. But maybe this is only my experience.

Christopher Alterio said...

Thanks for your clarification. I hope other OTs read it and understand the damage that is done when they use ritualized and repetitive passive sensory techniques and fail to properly explain what they are doing.

Unfortunately, your experience is common, at least based on the email that I get on this topic.