Thursday, February 15, 2007

When is DTT Unreasonable? When SI Techniques Eliminate a Behavior!

Sensory Integration (SI) techniques have very few studies, and I cannot argue with the conclusion, “There exist so few studies that conclusions cannot be drawn.” However, some comments from extreme ABA proponents that exaggerate the claims of SI therapists push my buttons,
Those who promise that autism can be cured or ameliorated substantially with a pill, a vitamin, a diet, some sensory stimulation, some exercises for the ears or eyes or brain, or some play time with their parents or typical children find a large and eager market for their services and products.
I have yet to read SI material promising to cure autism and what I usually find are conservative descriptions like these, “Our goal is to improve quality of life for persons with sensory processing disorders” or “Our vision is to . . . improve the quality of life for children, adolescents, and adults with Sensory Processing Disorder.”

Designing experiments for a complicated treatment protocol like SI is not easy. No two children receive the exact same treatment because the role of the therapist is to develop a profile of the sensory needs and challenges of each individual child. A child with gravitational insecurity would be terrified when placed on a swing, but a craver of vestibular stimulation might turn into a chatterbox after a good swing! Sensory stimulation for the sake of sensory stimulation is not the point of sensory integration. Therapists target specific sensory stimulation to children who show a specific sensory profile.

A properly designed experiment would compare apples to apples: rather than study randomly selected autistic children, researchers need to study randomly selected autistic children who crave vestibular stimulation for a swing study. A researcher would not give reading glasses to all children to test how effective glasses are. Only children who needed glasses should be studied with glasses that match their unique vision profile. This analogy applies to sensory integration.

What also bothers me is the complete lack of concern about very real sensory differences that make life difficult for autistic people. Almost every single autobiography written by an adult with autism discusses sensory sensitivities, and some experienced problems integrating sensory input. Tactile defensiveness led Temple Grandin to develop her own squeeze machine that calmed her and helped her overcome her oversensitivity to touch.

Parents can implement sensory integration techniques in conjunction with other therapies and at a reasonable cost. I attended a three-day workshop on sensory integration, and Nancy Kashman graciously consulted with me when I had questions. Several inexpensive books can help a parent on a shoestring budget go far: The Sensory Connection, The Out-of-Sync Child, and The Out-of-Sync Child Has Fun. That combined with online resources and consultation with therapists open to the parent administering a carefully designed sensory diet at home can reduce costs. Parents can make their own squeeze machine, platform swing, weighted vests, etc. and find alternatives at discount stores.

Autistic children can fall into the habit of tantrums because their sensory systems are easily overloaded. Charlotte Mason recommended strategies for strong-willed children one hundred years ago similar to our approach: (1) stay alert to the warning systems of meltdown and take steps to prevent it, (2) teach Pamela to be self-aware and allow her to self-manage this issue, and (3) find ways to calm her down if she blew her stack. Like the researcher in this study, we began to look for the sensory integration techniques that maintained calmness to allow Pamela to keep learning and doing activities she enjoyed. We also sought techniques (antecedents) that helped her recover from tantrums quickly (behavior) to prevent her from being put in time out and further isolated from social activities (consequences).

When Pamela first entered a homeschooling co-op that lasted six hours one day a week, she had meltdowns several times a day. I volunteered to set up the K-2 class and had the flexibility to make it autism friendly. We taught two subjects every half hour that varied between challenging and easy classes. I wrote a schedule on the chalkboard to help her transition. I functioned as her aide to keep her on task. When I saw signs of frustration and ignored them or tried to redirect her, she would meltdown.

I never saw consistent antecedents, but tight muscles and looks of frustration alerted me to take precautions against pending meltdown. I decided to relax her with SI techniques. I walked with her in the hallway while she still had self-control. Then I spun her and gave her several deep pressure hugs. It usually only required five minutes for her muscles to relax before she could head back to class without tantrums. Consistently, calming techniques (antecedent) produced calmness (behavior) and allowed her to stay mainstreamed with typical peers (consequences). Over the months, she needed fewer and fewer sessions in the hallway. By the end of three years, she could last an entire day without incident. I could leave her unattended for sign language and art classes (two one-hour periods) to go teach other classes!

Another way to prevent tantrums was to respect her sensory needs. I did not take her on field trips that featured loud noise, such as the tour of a fire engine. On a tour of a grocery store, Pamela flatly refused to go in the back of the store where they stored packaged food. Her language was so limited, she could not tell me why, but she was ready to tantrum if I forced her through the door. This was highly unusual behavior. I asked one of the mothers to take David with them, and Pamela and I waited at the meat counter. When they returned, some friends cleared up the mystery. One of the rooms had these monstrous, very loud box-crushing machines that boys loved and mothers hated! They all wished they could have stayed behind with Pamela. This convinced them to believe my stories of Pamela's bionic hearing.

Occasionally, tantrums were unavoidable! Ten minutes before church, we were at the front of the sanctuary, getting ready for choir. The director flipped on the new mike system, and Pamela went berserk. She ran the Indy 500 around the altar, covering her ears and humming loudly. I asked the director to shut down the sound system and grabbed Pamela. In a split second, I decided not to haul her off by brute force because I wanted to teach her to calm herself and graciously leave a troubling situation. So, with bewildered eyes watching me, I plopped her on the steps and rocked her and firmly hugged her. In a few minutes, she stood up and quietly walked out with me. Over the years, I saw a clear pattern between vestibular stimulation and deep pressure as the antecedents to produce calm behavior, even after a tantrum, which had the consequence of learning how to recover after a meltdown.

The good news is that therapists, parents, and teachers can blend ABA and SI! Temple Grandin has reported that many parents find DTT more effective when combining with swinging on a platform swing or deep pressure tactics. A child can easily respond during ABA sessions while wearing a weighted vested, stuffed shirt, or stuffed pants. A child can practice letter recognition by pulling wooden puzzle pieces out of a plastic tub of dry beans and rice and naming each letter. Encourage the child to draw letters (or numbers) in shaving cream, fingerpaint, sand, or pudding and name them. A child can don a swimsuit and practice naming magnetic letters (or numbers) in the tub while surrounded by the deep pressure of water. He can wrap himself in a weighted blanket and name objects or flashcards displayed by the therapist. She can sit on a cheap big ball or jump on a mini-trampoline and count the number of bounces.

A therapist can track the data and see if the child performs differently with or without SI techniques. In fact, if extreme ABA proponents really believe that SI is hogwash, they have nothing to fear by incorporating sensory strategies into their sessions. If they are right, they have proved their point. If they are wrong, then the child can progress even faster. That sounds like a win-win to me!


Anonymous said...

Thank you for posting. Just what I needed. GFCF does work. And sensory issues are something we can NOT ignore. Thank you for your blog and website. Sincerely, Diane

walking said...

I have faith that parents can figure these things out and learn by trial and error, an experiment of sample size one, what works for an individual child and what does not work for that child. Each child is different, and no one approach works for all children.

Willa said...

Thanks for this very detailed post. I'm going to link to it on my blog.

walking said...

Thanks, Willa! I hope you will find it of use with your son.

I was worried this post might be too long, but I thought this information all fit together too well to split up.

I am almost finished with another post on Auditory Integration Training, and that one will have some great sensory stuff too!

Prince Andrew and the Queen Mum said...

Great post..i found it by accident while searching for SI stuff my son ...6 yo... we homeschool as well. do a combo of CM stuff, and RDI. gonna add you to my links:)

Prince Andrew and the Queen Mum said...

I have a question upon reading this again. Did you purchase your swing from 'take a swing?' We are looking to buy one and they have a different rotational device than places like southpaw. (They are within miles of us as well but do not have a retail store. DARN!)


walking said...


We did without an indoor swing and headed to the nearest park. We found that one good swing a day was enough for Pamela! If she looked like she was going to melt in a public place, I would take her to a quiet place and spin her.