Theoretical And Evidence-Based Research On Sensory Integration Therapy For The Treatment Of Behavioral Problems In Children With Autism Spectrum Disorders

Objective: To investigate the rationale and evidence-based support of the therapeutic use of sensory integration therapy(SIT)for behavioral problems in children with autism spectrum disorders(ASD).Methods: 1.Theoretical research: The article did literature searching to look up and sort out materials related to SIT,Sensory Integration Theory and behavioral problems of children with ASD from books and scientific documents.Information was collected to explain the rational and applicability of SIT in the rehabilitation of behavioral problems in children with ASD.2.Systematic review and Meta-analysis: Both Chinese and English searching strategies was formulated according to certain searching rules.The literature retrieval procedures were performed in four Chinese databases(including China Knowledge Network database,China Biomedical Database,Wan-Fang database and VIP Chinese journal database)and four English databases(including Pub Med,Embase,Cochrane Library and Web of Science),to find out clinical research literature on the effectiveness of SIT in the rehabilitation of behavioral problems in children with ASD.The entire retrieval process was conducted for the period from database inception until December,2020.The literature screening procedures were carried out according to the pre-established inclusion and exclusion criteria.The research information and data from the included literature was extracted by researchers,and the quantitative synthesis of the extracted data was carried out by the Rev Man 5.4 software.Results: 1.Theoretical research: The result showed that SIT is the application of Sensory Integration Theory,which proposed by Dr.Ayres,in the field of rehabilitation.Sensory Integration Theory believes that the occurrence of behavioral problems in children with ASD is related to the sensory integration dysfunctions of autistic children.This view is consistent with the “sensory arousal level” theory,which was used to explain the causes of behavioral problem in children with ASD.Both the above-mentioned theories believe that behavioral problems of autistic children are external manifestations of seeking or avoiding specific sensory stimuli.The SIT based on Sensory Integration Theory advocates that through personalized customized and meaningful therapeutic activities,children with ASD are provided with appropriate and diverse sensory stimulation.These benign interactions with the external environment can improve autistic children’s abilities to process and integrate sensory information,so as to effectively alleviate their abnormal behaviors,and creating ideal conditions for the growth and development of children and subsequent treatment activities.2.Systematic review and Meta-analysis: A total of 1132 articles were retrieved,15 randomized controlled trials were finally included in the qualitative analysis,and 11 studies that met the requirements were quantitatively analyzed.The results of quantitative analysis showed that: Firstly,SIT had an ideal effect on alleviating behavioral problems of children with ASD.Compared with the control group without intervention,the behavior-related sub-item scores of the ATEC scale(WMD=-6.40,95%CI-9.99 to-2.80,P<0.01)and behavior-related sub-items scores of other scales(SMD=-1.81,95%CI-2.91 to-0.71,P<0.01)of children in the intervention group were significantly improved with statistically significant.The limitation of this result was that the included data all come from the perspective of the parents of the ASD children,rather than teachers or therapists.Secondly,SIT had a positive effect on the improvement of the sensory integration ability of children with ASD(SMD=-1.67,95%CI-2.23 to-1.11,P<0.01),but the sample size of the included study is relatively small,resulting in limited evidence strength.Thirdly,SIT can improve the scores of the ATEC scale for children with ASD(WMD=-15.09,95%CI-21.39 to-8.80,P<0.01).Besides,the included study data all from Chinese clinical research,suggesting that in the clinical rehabilitation practice of ASD in China,SIT has achieved ideal results in improving the overall health condition of children with ASD.Fourthly,SIT can improve the achievement of personalized treatment goals related to behavioral problems for children with ASD(SMD=-1.67,95%CI-2.23 to-1.11,P<0.01),due to the small sample size of the included study,the strength of the evidence is limited.Conclusion: The theoretical research results suggest that the application of SIT in the rehabilitation of behavioral problems in children with ASD has sufficient theoretical basis and ideal clinical applicability.Thus,SIT is worthy of further promotion and application in the clinical rehabilitation of autistic children.The results of systematic reviews and Meta-analysis suggest that SIT can improve the behavioral problems and some related short-term functional indicators(such as goal achievement)of children with ASD,but the strength of the evidence is limited.In addition,there is no sufficient evidence-based support for the effectiveness of SIT for long-term indicators related to autistic children’s behavioral problems,such as occupational performance.And the current evidence is not sufficient to prove that SIT is better than alternative treatments,for example,Theory of Mind Therapy,attention control training,etc.