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A Pilot Study of Integrated Listening Systems for Children With Sensory Processing Problems

Authors:
  • Sensory Processing Disorder Foundation
  • STAR Institute for Sensory Processing Disorder

Abstract and Figures

This pilot study explored the effects of Integrated Listening Systems (iLs) Focus Series on individualized parent goals for children with sensory processing impairments. A nonconcurrent multiple baseline, repeated measure across participants, single-case study design was employed (n = 7). The 40-session intervention was delivered at home and in the clinic. Individualized family goals served as the repeated measure. Exploratory analyses included the evaluation of physiological arousal. Participants showed improvement in home and education-related goals. Changes in physiologic arousal were noted in five of seven participants. Standardized scales demonstrated sensitivity to change. Thus, the iLs program may be beneficial for school- or clinic-based intervention.
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Journal of Occupational Therapy, Schools, & Early Intervention, 8:256–276, 2015
Published with license by Taylor & Francis Group, LLC
ISSN: 1941-1243 print / 1941-1251 online
DOI: 10.1080/19411243.2015.1055418
A Pilot Study of Integrated Listening Systems for
Children With Sensory Processing Problems
SARAH A. SCHOEN, PhD, OTR,1,2LUCY J. MILLER,
PhD, OTR,1,2,3AND JILLIAN SULLIVAN, PhD1
1Sensory Processing Disorder Foundation, Greenwood Village, CO
2Rocky Mountain University of Health Professions, Provo, UT
3University of Colorado Denver, Denver, CO
This pilot study explored the effects of Integrated Listening Systems (iLs) Focus Series
on individualized parent goals for children with sensory processing impairments.
A nonconcurrent multiple baseline, repeated measure across participants, single-case
study design was employed (n=7). The 40-session intervention was delivered at
home and in the clinic. Individualized family goals served as the repeated measure.
Exploratory analyses included the evaluation of physiological arousal. Participants
showed improvement in home and education-related goals. Changes in physiologic
arousal were noted in five of seven participants. Standardized scales demonstrated sen-
sitivity to change. Thus, the iLs program may be beneficial for school- or clinic-based
intervention.
Keywords sound therapy, treatment effectiveness, auditory processing, sensory pro-
cessing disorder, rehabilitation
Introduction
Sensory processing and integration problems exist when sensory signals do not result in
appropriate responses (Miller, Anzalone, Lane, Cermak, & Osten, 2007). A person with
sensory impairments finds it difficult to process and act upon information received through
the senses, which creates challenges in performing everyday tasks and daily routines (Bar-
Shalita, Seltzer, Vatine, Yochman, & Parush, 2009; Bundy, Shia, Qi, & Miller, 2007; Cohn,
Miller, & Tickle-Degnen, 2000; Cosbey, Johnston, & Dunn, 2010). Motor clumsiness,
behavioral problems, anxiety, depression, school failure, and other impacts may result if
the symptoms are not treated effectively (Miller, 2006).
The standard treatment for children with sensory processing challenges is individual
occupational therapy (OT) designed to enhance the child’s ability to participate in daily
activities and routines. The method used for treatment is individually defined and involves
the remediation of underlying sensory impairments that enable participation in daily life
at home and in education-related activities at school. Typically session duration is 30 to
© Sarah A. Schoen, Lucy J. Miller, and Jillian Sullivan.
This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any
medium, provided the original work is properly attributed, cited, and is not altered, transformed, or
built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.
Received 18 December 2014; accepted 22 May 2015.
Address correspondence to Sarah A. Schoen, PhD, OTR, SPD Foundation, 5420 S. Quebec
Street, Suite 135, Greenwood Village, CO 80111. E-mail: schoen@spdfoundation.net
256
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Effect of ILs 257
50 minutes, occurring two to three times per week (Miller, Schoen, James, & Schaaf, 2007;
Pfeiffer, Koenig, Kinnealey, Sheppard, & Henderson, 2011; Schaaf et al., 2013). However,
anecdotal evidence and intervention studies suggest that intensive programs produce more
significant and lasting improvements (Granpeesheh, Tarbox, & Dixon, 2009). Sound-based
intervention is one form of intensive therapy that is sometimes offered to children with
sensory impairments by clinic and school-based occupational therapists to supplement
traditional approaches (Bazyk, Cimino, Hayes, Goodman, & Farrell, 2010;Hall&Case-
Smith, 2007). Also referred to as auditory programs, this form of treatment has widespread
use but with limited empirical validation.
Effects of Auditory Programs
Previous treatment effectiveness research for children with sensory processing challenges
has focused on sensory integration treatment to address the individualized needs of the child
(May-Benson & Koomar, 2010; Miller et al., 2007; Pfeiffer et al., 2011; Schaaf et al., 2013;
Watling, Deitz, Kanny, & McLaughlin, 1999). However, since occupational therapists often
use auditory programs that involve listening to processed musical selections designed to
supplement other sensory-based strategies (Bazyk et al., 2010; Hall & Case-Smith, 2007),
evaluation of their effectiveness is warranted. Auditory programs are growing in popularity
and are used in addition to traditional OT because services can speed progress and can be
implemented at home or school, thus, increasing intensity of service (Bazyk et al., 2010;
Carley, 2013;Hall&Case-Smith,2007; May-Benson, Carley, Szklut, & Schoen, 2013;
May-Benson & Koomar, 2010).
In spite of the evidence supporting the beneficial effects of listening to music (Jing &
Xudong, 2008; Labbé, Schmidt, Babin, & Pharr, 2007; Lai & Good, 2005;Overy,2003;
Sarnthein et al., 1997), controversy still exists regarding the effects of therapeutic audi-
tory programs that use acoustically modified music. A meta-analysis conducted in 1999
(Gilmor) reported positive gains in linguistic skills, psychomotor skills, personal and social
adjustment skills, auditory skills, and cognitive skills following use of a specific type of
auditory program called the Tomatis Method. However, the conclusions from the meta-
analytic study were limited by the characteristics of the original studies. A more recent
study of the Tomatis approach (Corbett, Shickman, & Ferrer, 2008) did not show statis-
tically significant differences between the placebo and Tomatis treatment. Yet this study
has also been criticized for methodological flaws (Gerritsen, 2010). Although not a scien-
tifically rigorous study, Ross-Swain (2007) reported better comprehension, memory, and
ability to follow directions following use of the Tomatis Method in a group of children who
had auditory processing problems.
Mixed results were also demonstrated for use of another auditory program, Auditory
Integration Training (AIT: aka the Berard method). Although several studies suggested lim-
ited benefits (Edelson et al., 1999; Rimland & Edelson, 1994,1995), these studies also had
important methodological weaknesses. Four well-controlled studies of AIT failed to find
any behavioral improvement (Bettison, 1996; Gillberg, Johansson, Steffenburg, & Berlin,
1997; Mudford et al., 2000; Zollweg, Palm, & Vance, 1997), the most recent of which
found no benefit of AIT over a control condition on measures of IQ, of comprehension, or
of social adaptive behavior (Mudford et al., 2000). In a systematic review of six randomized
controlled trials, Sinha, Silove, Wheeler, and Williams (2006) concluded that there was not
enough evidence to support the use of AIT.
Three studies of auditory intervention programs have been published in the occupa-
tional therapy literature. One was a case study (Nwora & Gee, 2009) and the other (Hall
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258 S. A. Schoen et al.
& Case-Smith, 2007) reported improvement only when the intervention was combined
with a sensory diet that was poorly described and not manualized. The third study (Bazyk
et al., 2010), implemented in a preschool setting, found an accelerated rate of develop-
ment on standardized measures; however, the results were confounded because participants
continued to receive routine occupational therapy intervention during the study.
Arousal Mechanisms
Many of the reported outcomes of auditory programs are hypothesized to be related to
changes in arousal linked to activitation of the autonomic nervous system (Sollier, 2005).
For the purposes of this paper, arousal is defined as “increased neuronal excitability that
mobiizes the internal resources needed to maintain alertness” (p. 93). Classic theories of
arousal assert that an appropriate level of arousal is necessary to support attention and
enhance learning (Fischer, Langner, Birbaumer, & Brocke, 2008; Hebb, 1955). Thus, if
changes in arousal occur following participation in an auditory program it may be rele-
vant to understanding the underlying mechnaism of change. Drawing on this supposition,
several speculations have been made as to the observed changes in arousal being due
to (a) the calming effect of listening to music (Alvarsson, Wiens, & Nilsson), (b) the
style of music being listened to (Roque et al., 2013), or (c) the person experiencing
pleasure during music listening (Salimpoor, Benovoy, Longo, Cooperstock, & Zatorre,
2009).
Arousal is frequently studied by measuring electrodermal activity (EDA), a physio-
logic measure used in the laboratory (Dawson, Schell, & Filion, 2000) in children with
and without sensory processing challenges (Schoen, Miller, Brett-Green, & Nielsen, 2009).
Only one previous study has explored changes in arousal following a sensory based inter-
vention. That pilot study of the effectiveness of occupational therapy with children who
had sensory processing challenges showed a decrease in electrodermal activity following
intervention two times a week for 10 weeks (Miller, Coll, & Schoen, 2007). What is not
known is whether arousal changes with auditory interventions.
Aims of the Study
Thus, the primary aim of this pilot study was to explore the effects of a newly devel-
oped auditory program, known as Integrated Listening Systems (iLs). Specifically, the
Focus Series sensory motor program (heretofore referred to as the iLs program) combines
listening to acoustically processed, low frequency music via air conduction and bone con-
duction with participation balance, movement, and visual-motor activities. Our research
questions were exploratory in nature due to the lack of research using this program—
specifically, (1) What individualized family goals are impacted following participation in
the iLs program? (2) Does the iLs program produce changes in arousal? (3) Are stan-
dardized measures of behavior, emotion, and functional abilities sensitive to change, and
(4) What are parents’ qualitative experiences relative to the feasibility and utility of the iLs
program?
Materials and Methods
Ethics Statement
The study received institutional review board approval from Rocky Mountain University
of Health Professions and followed all standards set by the board. All participants’ parents
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Effect of ILs 259
provided written consent, and participants above age 7 provided written assent. Following
study participation, all families were allowed to keep the iLs system.
Research Design
This study employed a single-subject, nonconcurrent, multiple-baseline, repeated-measure-
across-subjects, AB design in which A represented the baseline phase and B represented the
intervention phase with a postintervention no-treatment phase. This design is a useful first
step in treatment-effectiveness research seeking to establish a relationship between an indi-
vidualized intervention and change in targeted outcomes (Bloom, Fischer, & Orme, 2006;
Kennedy, 2005; Kielhofner, 2006). The subject serves as his or her own control, with perfor-
mance of a subject prior to intervention compared to his or her performance during and after
intervention. The nonconcurrent design offers greater flexibility in clinical settings because
baseline data from the participants does not have to be collected concurrently (i.e., at the
same time) (Harvey, May, & Kennedy, 2004; Kennedy, 2005). When repeated with multi-
ple subjects, this design provides a cost-effective and systematic method for replication of
results (Kennedy, 2005).
The repeated measure for this study was individualized behavioral goals. Each par-
ticipant’s data was collected for approximately 16 weeks. Baseline (A) was the control
period. During this phase, the goals were scored by the parent each week, for each par-
ticipant, over a 3- to 5-week period. The intervention phase (B), consisted of 40 one-hour
sessions of the iLs program delivered 5 days a week over an 8-week period, four times at
home and once at the clinic. Each week the goals were scored again by the parent. The
postintervention phase consisted of 2 to 5 weeks of data collection on individualized goals
to evaluate whether gains could be maintained when the intervention was stopped.
Instruments: Assessment Measures
Scale Assessment and Inventory. The Sensory Processing (SP) scale is a comprehensive
assessment of Sensory Modulation Disorder. It has two parts: (1) the Inventory, which is an
informant-based measure completed by parents/caregivers and (2) the Assessment, which
is an examiner-administered performance measure (Schoen, Miller, & Sullivan, 2014).
The SP Scale consists of three subscales: Sensory Over-Responsivity, Sensory Under-
Responsivity and Sensory Seeking/Craving. Each subscale provides information about
behavioral responses to sensory experiences across seven sensory domains (touch, vision,
sound, movement (proprioception, vestibular), taste, and smell). Children and adults from
ages 3 to 49 have been tested, with internal reliability >.90 and discriminant validity effect
sizes >1.0 (Schoen, Miller, & Green, 2008; Schoen et al., 2014). Used in combination with
parent interview and clinical observation, this scale allows the clinician to characterize an
individual’s sensory processing impairments.
Tests for Auditory Processing Disorders in Children—SCAN-3:C. The SCAN-3:C (Keith,
2009) is a standardized assessment of auditory processing skills for children between
the ages 5.0 to 12.11. The three diagnostic tests, Filtered Words, Competing Words and
Competing Sentences were used to characterize the sample and to screen for auditory pro-
cessing challenges. These tests had high internal reliability and test—retest reliability and
therefore were used for this study to screen for auditory processing challenges. Validity
data support the use of the SCAN-3:C largely for screening purposes (Keith, 2009).
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260 S. A. Schoen et al.
Outcome Measures
Individualized Goals: Visual Analog Scale. Individualized family goals were constructed
for each participant following the parent interview. Each goal was converted into a Visual
Analog scale (VAS) by the lead investigator and was stated in a positive direction along a
5-inch horizontal line ranging from 1, indicating that the behavior occurs none of the time,
to 5, indicating that the behavior occurs all of the time. For example, Ability to Follow
Directions was a goal for six out of seven participants. The VAS was the repeated measure
recorded weekly for the entire 16 weeks. VAS has been found to be a reliable and valid
measure of a variety of subjective phenomena (Wewers & Lowe, 1990) and is one of the
most commonly used paradigms in the study of pain (Jensen, Chen, & Brugger, 2003). The
VAS was scored by measuring the distance in inches (to the closest 32nd of an inch) from
the beginning end of the scale to the parent’s mark on the line.
Arousal Measures: Sensory Challenge Protocol. The Sensory Challenge Protocol (Miller
et al., 1999) is a well-studied standard psychophysiologic laboratory paradigm that has
been in use since 1995 (Hagerman et al., 2002; McIntosh, Miller, Shyu, & Hagerman,
1999; Miller, Reisman, McIntosh, & Simon, 2001).
Electrodermal activity is obtained using the palmar electrodes supplied with PSYLAB
(Contact Precision Instruments, Cambridge, MA). The PSYLAB software program col-
lects EDA measures of arousal at rest during baseline and recovery when the child sits
quietly and no stimuli are presented. Skin conductance level is recorded in microSeimans
(µS). During the stimulation phase of the experiment, EDA amplitudes reflective of sen-
sory reactivity are recorded for responses that are >.02 µS and occur between 0.8 and
4.0 seconds after each stimulus.
EDA data is collected continuously in three phases: (1) a 3-minute baseline phase
with no stimuli presented; (2) eight trials of sensory stimuli (presented for 3 seconds at
a pseudorandom interstimulus interval of 10 or 15 seconds) across six sensory domains—
auditory (tone and siren), visual (strobe light), olfactory (wintergreen), tactile (feather), and
vestibular (chair tip); and (3) a 3-minute recovery period with no stimuli.
Standardized Measures: Adaptive Behavior Assessment System-II. The Adaptive Behavior
Assessment System (ABAS; Harrison & Oakland, 2003)is a norm-referenced report mea-
sure designed to assess adaptive behavior in individuals from birth to age 89 years. The
scale includes 10 adaptive skill areas from which four composite scores are derived:
(1) conceptual composite (e.g., communication, functional academics, and self-direction);
(2) social composite (e.g., leisure and social skills); (3) practical composite (e.g., self-care,
home living, community use, and health and safety); and (4) general adaptive composite
(e.g., the sum of all adaptive skill areas). The parent/primary caregiver form was used in
this study and the composite scores and subtest scores were computed to monitor progress
over time. Internal reliability is reported to be high for the composite scores, the adap-
tive domains, and all skill areas (Harrison & Oakland, 2003). Similarly strong evidence of
content and concurrent validity is reported (Harrison & Oakland, 2003).
Standardized Measures: Behavior Assessment System for Children-2. The Behavior
Assessment System for Children-2 (BASC-2) Reynolds & Kamphaus, 2004)isa
multidimensional/multimethod system for assessing children’s social, emotional, behav-
ioral, and adaptive functioning. The parent rating form was used in this study. It consists
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Effect of ILs 261
of a clinical profile, which has nine scales that are used to compute the three compos-
ite scores: externalizing, internalizing, and behavior symptom index. The adaptive profile
comprises five scales that make up the adaptive skills composite. Composite scores and
subscale scores were used in this study to measure progress. It is reported that composite
scores have stronger internal reliability than the individual scales and have strong construct,
convergent, and divergent validity (Reynolds & Kamphaus, 2004).
Participants
Seven children and their families participated in this study. The study was conducted at a
private clinic in Greenwood Village, CO. Participants were recruited through posted invi-
tation letters from the center. Interested parents signed a form consenting to be contacted.
Children were selected if they met inclusion criteria and families were willing to postpone
participation in other interventions (e.g., occupational therapy, speech therapy) for the dura-
tion of the study. All parents reported that their child had challenges in daily activities at
home and school but had not received previous treatment for sensory issues.
Inclusion criteria were: (1) significant sensory processing impairments reported to be
interfering with performance at home or school based on parent report on the Sensory
Processing Scale Inventory, parent interview, and confirmation by an occupational thera-
pist trained in using the Sensory Processing Scale Assessment and Inventory; (2) between
ages 4 and 18; (3) an intelligence level of “within normal limits” as determined by school
aptitude tests; (4) parent report of auditory over-responsivity and/or auditory processing
problems and normal hearing; and (5) parent/child willingness to commit to the time and
scheduling requirements of the study protocol.
Exclusion criteria were the presence of comorbid disorders such as a seizure disor-
der, bipolar disorder, deafness, physical disabilities (e.g., cerebral palsy), or neurological
impairments; participation in other therapies during the time of the study; and an inability
to tolerate wearing headphones for the designated 60 minutes required by the study design.
Four males and three females ranging in age from 5 to 12 years participated in the
study. All were Caucasian; socioeconomic status was defined by the education level of the
mother—all had at least a high school degree). Interpretation of findings by the evaluat-
ing occupational therapist confirmed the presence of tactile and auditory over-responsivity
as reported by on the SP Scale Inventory and observed on the SP Scale Assessment for
all participants. Three participants also had symptoms of sensory craving behavior and
one participant had symptoms of sensory under-responsivity based on the above measures.
Four out of seven participants had atypical scores on two subtests of the SCAN-3:C (e.g.
scores <1 standard deviation below the mean) suggestive of auditory processing chal-
lenges. The other three participants scored within the typical range for auditory processing.
No other comorbid diagnoses were reported.
Procedures
Three stages constituted the study: (1) administration of the pretest measures, (2) baseline
and intervention, and (3) return to baseline, post-testing, and follow-up.
Stage 1. Administration of the pretest measures. Participants first completed the Sensory
Processing (SP) Scale Assessment and Inventory in order to fully characterize their
sensory processing challenges. The SCAN-3:C was also administered to screen for audi-
tory processing difficulties. A parent interview–goal-setting session was conducted in
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262 S. A. Schoen et al.
order to establish the individualized goals for the visual analog scale (VAS) that served
as the repeated measure. Pretest measures also included all standardized parent report
questionnaires and administration of the Sensory Challenge Protocol Laboratory.
Stage 2. Baseline and intervention. The second stage began with a 3- to 5-week baseline
phase (A) during which individualized VAS goals were determined (where the iLs program
was not used). Goals whose baselines were unstable could not be extended due to restric-
tions in participant schedules and, therefore, were not included in the study. Next came the
intervention phase (B), which consisted of 40 sessions of the iLs program. The program
was administered four times a week at home by the parent and once a week at the clinic by
the same research assistant (RA; intervention defined later).
Stage 3. Return to baseline. The final phase of the study (A) was a 2- to 4-week–
return-to-baseline period of no intervention, post-testing of all standardized parent report
questionnaires, and re-administration of the Sensory Challenge Protocol Laboratory. At this
time, parent reactions to participation in the study were solicited, including feasibility and
utility of the iLs program as well as subjective changes noted in their child not elicited by
the individualized goals or report questionnaires.
Description of the Intervention
The intervention consisted of 40 sessions using the iLs Focus Series sensory motor pro-
gram. The iLs program is a protocol that uses specific classical music selections that
are heard each day. The program is loaded onto an Apple iPod and delivered through a
miniamplifier with adjustable air- and bone-conduction volume to Sennheiser headphones
custom fitted with bone-conduction capability. Specifically, the sensory motor program
emphasizes frequencies at 750 Hz and lower. The iLs music is processed such that different
frequencies in each selection are enhanced or dampened. An additional process shifts subtle
volume changes from the right-ear channel to the left-ear channel. Both of these alterations
to the musical selections are designed into the iLs program in a graded fashion, beginning
gently and gradually increasing as the program progresses.
Intervention included listening to the preprogrammed music 5 days a week for 60 min-
utes. Each program had a specific listening schedule accompanied by visual motor activities
performed during the first 15 to 20 minutes of each session that were selected from the
Playbook manual and user guide. The sets of activities included balance and core, ball
and bean bag, and eye-hand coordination games. The rest of each session was spent doing
child-selected motor activities; creative and/or relaxing activities such as drawing, painting,
puzzles, building with blocks, and playing cards; or just sitting in a comfortable chair.
Intervention sessions were completed by the RA once a week in the clinic and by
the parent 4 days a week at home. Training to the RA and parents in the use of the iLs
listening components as well as in the selection and administration of Playbook visual-
motor activities was provided by the lead investigator. A program tracker was completed for
each participant’s clinic sessions and home sessions to ensure compliance with and fidelity
to the program. Intervention fidelity was also ensured through weekly meetings of the RA
and the lead investigator and of the RA and participants’ parents to discuss intervention
administration, manual adherence, and plans for subsequent sessions.
Parents did not pay for the intervention nor were they required to purchase the iLs unit
in order to participate in the study.
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Effect of ILs 263
Data Collection
Preintervention data were collected during the participant’s first visit. Included were the
Sensory Challenge Protocol and the caregiver report questionnaires. The visual analog scale
(VAS) goals were developed by the lead investigator following the first parent meeting.
Baseline data were collected on the VAS goals via parent report once a week over a 3- to
5-week period prior to initiating the intervention. Each week during the participant’s visit
to the clinic in the intervention phase, parents returned to the RA the score for each week’s
VAS goals (parent’s mark along the 5-inch line). Postintervention data were collected on
the VAS goals using the same procedure as during the baseline phase. Participants returned
2 to 4 weeks following intervention to participate in the Sensory Challenge Protocol and
for parents to complete the caregiver report measures and provide subjective feedback on
the feasibility and utility of the iLs program.
Data Analysis
Owing to the small sample size and the variables’ non-normal distribution (Kolmogorov-
Smirnov test, p<.1), nonparametric tests were utilized for all statistical analyses described
in the next sections (i.e., individualized goals and standardized measures).
Individualized Goals. VAS goals were converted into numeric scores by measuring the
distance in inches (to the closest 32nd of an inch) from the beginning end of the scale
to the parent’s mark along the line. Each goal for each participant, from baseline to
postintervention, was plotted on a graph.
Several methods of data analysis were used. Data for individualized VAS goals were
examined to determine whether a stable or declining pattern was established during base-
line. As is recommended in multiple baseline research, only goals that have a baseline
period meeting the following criteria should be included in the intervention phase of a study
(Engel & Schutt, 2014): (1) performance that has a relatively stable pattern (no improve-
ment) with little variability; (2) a slope less than .1; or (3) a linear downward trend based
on a linear regression analysis. Each participant had at least one goal that met these criteria.
Initial investigation of VAS goals was based on visual analysis of the data. VAS goal
data were plotted across phases of the study and analyzed in terms of three dimensions
recommended by Kennedy (2005). The first dimension examined was level, referring to
the mean of the data within a condition. The second dimension examined was trend (or
slope), which refers to the best-fit straight line for the data within each condition. The
descriptors low, medium, and high are assigned to describe the size of the slope. The
third dimension examined was variability of the data, which reflects the degree to which
the data points deviate from the best-fit straight line. Variability is a qualitative descriptor
like trend, which is classified as high, medium, or low (Kennedy, 2005). Patterns of goal
achievement were similar within each participant; therefore, the data depicted in Figure 1
is the mean goal performance for each participant across phases of the study. To evaluate
these changes in parent-prioritized goals, the Wilcoxin matched-pairs–signed-rank test was
used to determine whether differences in level and slope of VAS goal scores changes were
statistically significant.
Arousal Measures. To evaluate physiologic changes, difference scores were computed
comparing pre- and postadministration of the Sensory Challenge Protocol. Variables
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264 S. A. Schoen et al.
Figure 1. Individual mean goal performance across time.
included the average difference in amplitude by sensory domain and the average difference
in EDA during baseline and recovery.
Standardized Measures. To further evaluate parent perceptions of changes over time, the
Wilcoxin matched-pairs–signed-rank test was used to evaluate differences on both the
BASC and the ABAS, pre- versus postintervention. Analyses were considered exploratory
and designed to inform future studies; therefore, no correction for multiple comparisons
was made.
Qualitative Experiences. Subjective feedback from parents on the feasibility and utility of
the iLs program was aggregated and summarized by the first author.
Results
Individualized Goals
Participant goals demonstrated some commonality: six of seven participants had a goal
involving “following directions” and five of seven participants had a goal involving “com-
pleting a task” (e.g., homework, morning routine, cleaning room) in a timely manner and
without incident. Other parent goals related to emotion regulation, frustration tolerance,
and social participation with siblings or peers (see Table 1 for a complete list of goals).
Eight goals were discarded prior to the initiation of intervention because they did
not meet criteria for a stable or declining baseline pattern. One participant had a single
remaining goal; all other participants had between three and six goals. A total of 28 goals
were evaluated. With respect to 23 of the 28 goals, participants demonstrated a positive
change in level from baseline to intervention, which was sustained or increased after inter-
vention. The five goals that showed minimal change were for participant 7 (e.g., <.3
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Table 1
Mean Level and Slope by Study Phase
Goals by participant
Baseline
mean
Intervention
mean
Postintervention
mean
Baseline
slope
Intervention
slope
Postintervention
slope
Participant 1
Follows verbal directions 0.96 2.20 3.26 0.01 0.30 0.52
Sleeps without waking to external noise 0.99 2.48 4.19 0.03 0.33 0.17
Not distracted by outside noise 1.01 2.86 4.13 0.06 0.35 0.04
Participant 2
Follows multistep verbal directions 1.60 3.12 4.35 0.02 0.19 0.08
Participant 3
Completes morning routine without incident 1.42 3.18 4.37 0.00 0.14 0.05
Has adequate nutritional intake throughout the day 1.08 2.93 4.42 0.11 0.31 0.05
Completes spelling work in a timely manner 0.38 3.78 4.41 0.30 0.16 0.05
Completes writing assignments without emotional
incident
0.80 3.82 4.47 0.09 0.18 0.03
Participant 4
Completes homework in a timely manner 0.55 1.65 1.98 0.02 0.35 0.29
Understands what mother is saying 1.39 1.71 2.16 0.19 0.26 0.50
Experiences less frustration 2.05 1.65 2.72 0.08 0.28 0.12
Emotionally is not too hard on self 0.62 1.58 2.41 0.04 0.19 0.66
(Continued)
265
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Table 1
(Continued)
Goals by participant
Baseline
mean
Intervention
mean
Postintervention
mean
Baseline
slope
Intervention
slope
Postintervention
slope
Participant 5
Gets dressed in morning without incident 0.62 1.64 3.07 0.05 0.31 0.02
Does not misinterpret others’ behavior 0.37 1.17 2.78 0.06 0.17 0.13
Follows directions within a timely manner 0.63 1.09 1.99 0.01 0.16 0.38
Understands sarcastic statements 0.72 1.26 2.22 0.07 0.22 0.31
Fully comprehends what he reads out loud 0.33 1.47 1.83 0.09 0.24 0.31
Does not get frustrated when reading 0.42 1.57 2.30 0.07 0.32 0.13
Participant 6
Follows multistep directions 0.34 1.63 2.48 0.06 0.34 0.33
Cleans up his room 0.41 1.62 2.34 0.02 0.36 0.95
Has legible handwriting 0.30 1.88 3.01 0.06 0.35 1.07
Puts things where they belong 0.56 1.95 2.31 0.01 0.36 1.08
Participant 7
Allows touch from family members 0.37 0.78 0.93 0.02 0.07 0.08
Displays flexibility in play 0.84 0.88 1.07 0 0.05 0.01
Keeps bedroom organized 0.43 0.53 0.99 0.01 0.02 0.16
Gets through morning routine in a timely manner 0.53 0.70 1.24 0.03 0.00 0.11
Willingly participates in physical activities 0.79 1.06 1.26 0.01 0.06 0.26
Gets through school work in a timely manner 0.91 0.93 1.37 0.02 0.01 0.28
266
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Effect of ILs 267
change in level from baseline to intervention). Participant 4 had one goal that decreased
slightly (e.g., “experiences less frustration”) (levels are depicted in Table 1). The data
continued its upward trend from baseline to intervention for all participant goals but the
magnitude of the slope varied. During the intervention phase, 11 of the 28 goals had
medium-positive-magnitude slopes (e.g., >.3), suggesting a gradual increase; while 13 of
the 28 goals had a low-magnitude slope (e.g., <.19), suggesting a more slowly increasing
trend. Participant 6 had declining/negative slopes in the postintervention phase although the
overall level of goal achievement was higher compared to baseline. Slopes for participant
7 remained relatively flat from baseline to intervention, with little change in level. In the
postintervention phase for this participant, levels increased for all six goals and slopes grad-
ually increased for three of the six goals (e.g., a low-magnitude slope). High variability was
noted for participant 3 during the intervention phase of the study. A fluctuating pattern of
improvement was evident across her goals, with an initial large improvement in three out
of four goals that had low-magnitude slopes. For this participant, gains were sustained into
the postintervention phase for all of these goals.
To evaluate whether there was a significant difference between baseline goal perfor-
mance and goal performance during intervention, the Wilcoxin matched-pairs–signed-rank
test (as data was nonparametric) was used. A significant difference was found between level
at baseline (M=.76; SD =.43) and level during intervention (M=1.82; SD =.91) across
all participants (z=−4.46; p<.001). A significant difference was also obtained between
slopes at baseline (M=.02; SD =.08) and slopes during intervention (M=.21; SD =
.13) across all participants (z=−4.49; p<.001). After intervention, participants continued
to improve with respect to 19 of the 28 goals (see Table 1).
Arousal Mechanisms
One participant had incomplete data due to equipment failure during the postintervention
administration of the Sensory Challenge Protocol; therefore, there is missing posttest
data for wintergreen, feather, chair tip, and recovery. Table 2 depicts the mean difference
between pretest and post-test scores for amplitude of EDA by domain and EDA at baseline
and recovery. Three of seven participants had a reduction in EDA to 2 to 4 of the sensory
challenges, both of which involved the two sound stimuli. Both increases and decreases in
EDA for baseline and recovery were noted. Four of the seven participants had a reduction
in EDA from pretest to post-test at either baseline or recovery, and two had an increase in
EDA from pretest to post-test for both baseline and recovery.
Table 2
Mean and Changes in Arousal from Pre- to Postintervention
Participant Baseline Recovery Tone Strobe Siren Winter-green Feather
Chair
tip
112.67 1.44 1.05 1.05
26.33 9.13 0.20 0.31 0.05 0.30 0.21 0.01
31.04 0.93 1.29 0.58 1.04 1.19 0.33 0.92
40.38 0.40 1.85 0.42 1.31 0.54 0.06 0.68
5 8.68 11.47 0.09 0.04 0.08 0.02 0.01 0.31
60.38 1.67 0.31 0.04 0.14 0.00 0.00 0.29
7 1.98 2.25 0.13 0.12 0.20 0.55 0.43 0.29
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268 S. A. Schoen et al.
Standardized Scales
Analyses were conducted to determine which standardized measures might be useful for
future study of the effectiveness of the iLs program. Subtests and composite scores of
the Adaptive Behavior Assessment System (ABAS) and Behavior Assessment System
for Children (BASC) were explored. All of the dimensions of the BASC changed in
the predicted direction with the Wilcoxin matched-pairs–signed-rank test showing signif-
icant changes in all the composite scores of the BASC (e.g., Externalizing, Internalizing,
Behavioral Symptoms Index, and Adaptive Skills) and in seven of the total 13 subtests,
including the following: Hyperactivity, Aggression, Anxiety, Depression, Atypicality,
Adaptability, and Activities of Daily Living. All the composite scores and subtests of the
ABAS changed in the predicted direction; however, statistically significant changes were
found in only two of the seven subtests: Communication and Self-care. (See Table 3 and
Table 4).
Table 3
Changes in BASC Subtest and Composite Standard Scores
Intervention
Pre (n=7)
M(SD)
Post (n=7)
M(SD)
Wilcoxin
matched pairs p
Effect
size
Clinical subtests and composites (M=50; SD =10)
Externalizing composite 62.14 (15.31) 52.86 (11.44) 2.20 0.03 0.69
Hyperactivity 61.43 (16.72) 52.14 (13.21) 2.20 0.03 0.62
Aggression 62.71 (15.68) 52.29 (9.57) 2.37 0.02 0.80
Conduct problems 58.00 (13.28) 54.67 (10.93) 1.37 0.17 0.27
Internalizing composite 56.43 (11.39) 46.29 (7.89) 2.20 0.03 1.03
Anxiety 60.57 (16.37) 52.71 (10.34) 1.99 0.04 0.57
Depression 59.29 (12.47) 46.14 (7.47) 2.20 0.03 1.28
Somatization 46.14 (8.49) 42.57 (7.70) 0.32 0.75 0.44
Behavioral symptoms
index
60.43 (13.88) 49.71 (8.08) 2.20 0.03 0.94
Atypicality 55.14 (11.14) 45.57 (3.99) 2.03 0.04 1.14
Withdrawal 52.86 (12.56) 47.86 (11.85) 1.57 0.12 0.41
Attention 56.29 (13.57) 54.71 (11.25) 0.51 0.61 0.13
Adaptive subtests and composite (M=50; SD =10)
Adaptive skills 45.29 (13.66) 49.71 (12.72) 2.02 0.04 0.33
Adaptability 41.29 (15.21) 49.14 (13.84) 2.26 0.02 0.54
Social 48.71 (16.43) 50.71 (14.45) 1.10 0.27 0.13
Leadership 51.33 (10.86) 53.00 (7.64) 0.73 0.47 0.18
ADL 44.71 (14.12) 47.57 (12.61) 2.06 0.04 0.21
Communication 42.00 (16.17) 45.71 (13.61) 1.68 0.09 0.25
Note. Higher scores are worse for all clinical subtests and composites. Higher scores are better for
all adaptive subtests and composites.
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Effect of ILs 269
Table 4
Changes in ABAS Subtest and Composite Standard Scores
Intervention
Pre (n=7)
M(SD)
Post (n=7)
M(SD)
Wilcoxin
matched pairs p
Effect
size
Subtests (M=10, SD =3)
Communication 7.71 (3.40) 9.71 (3.55) 2.41 0.02 0.58
Functional academics 7.29 (2.98) 8.43 (4.61) 0.74 0.46 0.30
Self-direction 6.43 (3.91) 7.57 (4.50) 1.29 0.20 0.27
Leisure 9.29 (1.70) 10.86 (3.49) 1.69 0.09 0.57
Social 7.14 (3.49) 8.29 (4.23) 0.96 0.34 0.30
Community use 9.14 (3.81) 9.86 (5.15) 0.11 0.92 0.16
Home living 6.00 (3.51) 7.29 (4.68) 1.05 0.29 0.31
Health and safety 8.14 (1.68) 9.86 (2.80) 1.44 0.15 0.75
Self-care 5.71 (2.29) 8.57 (3.55) 2.04 0.04 0.96
Composites (M=100, SD =15)
General adaptive 84.71 (11.27) 93.43 (23.94) 1.36 0.18 0.18
Conceptual 85.86 (13.50) 93.71 (22.13) 1.78 0.08 0.43
Social 91.00 (11.97) 99.14 (19.16) 1.36 0.18 0.51
Practical 85.57 (7.19) 94.71 (21.43) 0.94 0.35 0.58
Qualitative Experiences
Gains reported by individual parents were as follows:
“His reading scores came up 4 levels”;
“Her face seems more animated”;
“She is able to joke with others”;
“He sleeps better”;
“He picks up on sarcasm more quickly”;
“He is happier at school”;
“The legibility of her handwriting improved”; and
“His behavior in school is better.”
Discussion
Individualized Goals
This pilot study provides preliminary evidence that the iLs program is effective in ame-
liorating conditions for some of the children with sensory over-responsivity and auditory
processing impairments. Notable changes were reported in parent-developed individualized
child goals such as following directions, completing daily tasks (e.g., homework, morning
routine, putting away belongings) in a timely manner, and reducing emotional outbursts—
problems that affect functioning at home and school. These gains continued to be noted
with respect to most of the goals (19 out of 28) into the postintervention phase.
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270 S. A. Schoen et al.
Previous research reflects controversy as to the effectiveness of auditory programs.
However, study has been limited to the Tomatis Method (Corbett et al., 2008; Gilmor,
1999; Ross-Swain, 2007); to Berard’s Auditory Integration Training (Edelson et al., 1999;
Gillberg et al., 1997; Rimland & Edelson, 1994,1995); and to Therapeutic Listening
(Bazyk et al., 2010; Hall & Case-Smith, 2007). This is only the second study to evaluate the
use of the iLs program for children with sensory processing impairments. The iLs program
is unique because it combines an individualized auditory program with visual and move-
ment activities. The other study of the iLs program reported improvements in behavioral,
emotional, and sensory regulation; social skills; and functional listening and communica-
tion in children ages 7 to 10 years with autism spectrum (unpublished data). Similar to that
study, our study supports the effectiveness of the iLs program based on parent perceptions
of improvement. Because parents’ opinions as to the value of an intervention often deter-
mine what interventions they try and continue to use (Bowker, D’Angelo, Hicks, & Wells,
2011; Green et al., 2006), tapping their perceptions is critical to evaluating the effectiveness
of an intervention. The effectiveness of the iLs program based on parent perceptions of
the attainment of individualized goals established at the start of the study is an important
outcome demonstrated by this study.
Research evaluating the optimal frequency and duration of the therapeutic interven-
tions used by rehabilitation professions is also greatly needed (AOTA, 2011). Many studies
suggest that children with sensory processing challenges should receive therapy two to
three times a week over a period of at least 10 weeks (Miller et al., 2007; Pfeiffer et al.,
2011; Schaaf, Benevides, Kelly, & Mailloux-Maggio, 2012; Schaaf et al., 2013). However,
this study utilized the iLs program five times a week (for an hour) over an 8-week period.
Parents had to attend the clinic only once a week (or 8 times) because they were able to
administer the program at home on the other days. Thus, the iLs program may be a use-
ful method of supplementing school or clinic-based intervention for some children with
sensory processing challenges.
Arousal Mechanisms
To the best of our knowledge, this is the first study to report physiological changes using
an auditory program that delivers processed music. Four participants showed a decrease
in arousal level and two showed an increase in arousal following intervention. Unlike a
previous study that found a reduction in anxiety levels following music listening but no
change in physiological outcomes (Wang, Kulkarni, Dolev, & Kain, 2002), for the four
participants in this study whose arousal decreased, the behavioral changes reported by their
parents were also suggestive of reduced arousal. For example, parent reports included “He
generally appears calmer”; “She seems more relaxed”; and “Meltdowns are less often and
less lengthy.” In addition, these participants also showed a reduction in parent-reported
hyperactivity, aggression, anxiety, and depression as measured on the BASC. However,
two participants showed an increase in physiological arousal. An alternative explanation
comes from the music-listening literature which suggests that the experience of listening to
familiar music may have become pleasurable and emotionally rewarding, thus, increasing
rather than decreasing their arousal (Van Den Bosch, Salimpoor, & Zatorre, 2013).
This study also demonstrated changes in arousal in response to sensory challenges.
Three participants showed a reduction in EDA to two or more sensory domains, reflect-
ing decreased arousal with regard to that sensory domain. The two sensory domains that
consistently elicited change among these participants were the tone and siren. Given that
these participants at the start of the study were reported to be over-responsive to auditory
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Effect of ILs 271
stimuli, this finding is notable. One participant reported better sleep due to a reduction in
auditory over-responsivity, and two reported having less difficulty filtering out background
noise during daily interactions at home and school. Miller and colleagues (Miller, Coll,
& Schoen, 2007) reported similar improvement in electrodermal activity (e.g., reduction
in amplitudes to sensory challenges) in a small sample (n=4) following a sensory-based
intervention. Taken all together, the physiological findings from this study provide only
preliminary information, which can be used for hypothesis generation in future studies.
Standardized Measures
Two standardized scales were evaluated to determine sensitivity in detecting improve-
ments following intervention with the iLs program. The BASC showed potential for use
in future studies. All four composite scores were sensitive to change, as were seven of the
subtests. This finding suggests that the dimensions tapped by the BASC (e.g., behavioral
and emotional characteristics of the individual) may be target areas, most affected by the
iLs program However, only the Self-care and Communication subtests of the ABAS showed
significant pre–post change during the study. This finding may be owing to chance because
we did not correct for multiple comparisons, but it is noteworthy that the values for the
Communication subtest of the ABAS changed in the predicted direction especially since
four out of seven participants screened positive for auditory processing challenges prior to
participation in the study. Further study is indicated but identifying specific measures that
are sensitive to the outcomes of this intervention will decrease the likelihood of obtaining
spurious findings in future studies.
Qualitative Experiences
In general, parents in this study were pleased with their child’s results. Parent reactions that
were solicited at the end of the study indicated that use of the iLs program was beneficial
and easy to use, suggesting feasibility and utility of the program. Some suggested that three
times per week might be a more realistic expectation in the future. They indicated enjoying
the convenience of administering the iLs program at home and going to the clinic only once
a week. Specific gains reported by individual parents predominantly related to performance
in school.
Implications for School-based Practice
The iLs program is a feasible home program for parents of children with sensory processing
impairments and has potential for use in school-based practice. The iLs program appears to
address some of the problems of children with sensory processing challenges. This study
found changes in the performance of many daily routines essential to participation at home,
at school, and in the community. Improvements were noted in functional communication
and in education-related abilities such as handwriting, reading comprehension, and school-
work. Although teachers were not interviewed at the completion of this study, many of
the parents reported having pursued this intervention as a means of improving their child’s
success in school.
This study contributes to evidence-based practices (Thomas & Law, 2013) that are
available and required of therapists practicing in the school system (Clark & Chandler,
2013). Since the parent and a research assistant administered the intervention in this study,
it suggests a cost effective and time efficient application to school based practice; the iLs
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272 S. A. Schoen et al.
program could be administered by a paraprofessional and not require the full time attention
of an occupational therapist. A Visual Analog Scale can be used to measure progress and is
a potential tool for supporting evidence-based practice. Links between the auditory program
and changes in arousal suggest a potential impact on optimizing and enhancing attention
skills necessary for learning.
Limitations
This was a single-subject research design with only seven participants, therefore, results are
not generalizable to the larger population of children with sensory over-responsivity and
auditory processing challenges. One strength of the study is that we looked at functional,
behavioral, and emotional goals related to parents’ primary concerns for their child and
gains were reflected in daily life experiences at home and school. However, since we did
not have blind raters of individualized goals, there was potential bias in parental report of
change.
Parents implemented the intervention and they were offered a free iLs unit at the
completion of the study. Since the intervention was protocolized and music selections
were unalterable, we believe this bias was minimized. Fidelity to the intervention was
insured through weekly meetings and we assume that parents would not have wanted
to keep the iLs unit if their child had not experienced some positive benefit from the
program.
This study was designed to examine short-terms effects of the iLs program. Thus we
did not follow participants beyond 3 to 4 weeks after completion of the program to deter-
mine whether their gains had been maintained. Additionally, fluctuating patterns at the end
of treatment could not be interpreted owing to the paucity of data points. Future study
designs should incorporate a planned reassessment in 3-, 6-, and 12-month intervals to
establish how long progress is sustained.
Finally, future research needs to determine whether the type of physiological changes
reported in this study are clinically significant and to further explore the relationship
between such physiological measures and behavioral change. This study provided only pre-
liminary evidence that arousal and reactivity change as a result of iLs intervention. These
measures have the potential to provide greater insight into the arousal mechanisms that
underlie this intervention.
Directions for Future Research
Additional research is indicated to substantiate the benefits of the iLs program Although
not administered in a school setting, results of this study reflect gains in academic
and nonacademic abilities. Implementation of the iLs program at school may provide
an even more convenient alternative to parents. This hypothesis requires further study.
An assessment of school function is needed along with the inclusion of standardized mea-
sures directly related to educational success. Functional changes should be confirmed by
teacher-report measures and teacher observation of a child’s abilities in the classroom.
Conclusion
This pilot study provides preliminary and partial support for the effectiveness of the iLs pro-
gram delivered five times a week for children with sensory over-responsivity and auditory
processing problems. The attainment of individualized functional goals was an important
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Effect of ILs 273
outcome of this study. Additionally, physiological changes in arousal and reactivity to sen-
sory challenges were noted following intervention, which can be used for future hypothesis
generation. Behavioral and emotional dimensions tapped by the BASC show potential for
use in future studies. Overall parents had a positive reaction to participation in the pro-
gram and expressed satisfaction with their child’s progress. Further study of this auditory
program is warranted.
Acknowledgments
We wish to thank the children and families who participated in this study and Mariah
Davidson, the research assistant and coordinator of this project. We would also like to
thank Shannon Hampton for her efforts on this paper.
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... All participants in this section were children aged 3-12. Three studies investigated the influence of therapeutic listening intervention on children with SPD ( Esteves et al., 2009;Hall & Case-Smith, 2007;Schoen, Miller, & Sullivan, 2015). All the studies reported significant improvement in progress made by the children after the completion of the therapeutic listening program. ...
... Another important finding that may have meaningful clinical implications is the reduction in behavioral problems and improvement in self-regulation. For children who need self-regulation, some studies reported a positive influence of music, especially listening programs ( Esteves et al., 2009;Schoen et al., 2015), where there was a significant improvement in sensory profile. Therapeutic listening combined with a sensory diet appeared to be effective in improving behavioral problems (Hall & Case-Smith, 2007). ...
... Whether focusing on musical training ( Kuchenbuch et al., 2014;Landry & Champoux, 2017), active music making (Perry, 2015), or passive listening (Esteves et al., 2009;Hall & Case-Smith, 2007;Kantono et al., 2016;Schoen et al., 2015), the studies reviewed here also suggest that both playing or listening to music had a significant influence on the sensory system. Both children and adults manifesting arousal through sensation-seeking showed specific musical preferences ( Glasgow et al., 1985;Heydari et al., 2013;Litle & Zuckerman, 1986;McNamara & Ballard, 1999;Nater et al., 2005) which may also affect musical career choice (Vuust et al., 2010). ...
Article
Sensory processing disorder (SPD) is a disruption in the organization of sensory input that affects appropriate responses to the demands of the environment. The consequences of SPD in children may include a developmental lag as well as behavioral and emotional problems. Music therapy is particularly suitable for children with a sensory processing disorder because music and the sensory system are both linked to the nervous system. This suggests there is a need to better understand the relationship between the sensory system and the characteristics of music. An integrative review method was chosen here, given the small number of published articles on music and SPD. This integrative review covers 17 articles published between 1985 and 2017. A search was carried out in five major databases, eight music therapy journals, and grey literature. To assess the quality of a study, the Cochrane Collaboration tool for assessing risk of bias was used when possible. The results point to two types of associations: between music and the sensory system, and between sensation-seeking and features of music. Studies have also shown that therapeutic listening programs improved the sensory profiles of children with SPD. These findings lead to the practical conclusion that music is a suitable therapy for children with SPD. The benefits include improvement in the plasticity of the sensory system, motivation, self-confidence, communication and social skills.
... One study reported participants' scores on the sensory/cognitive awareness section of the Autism Treatment Evaluation Checklist (ATEC; Vadivel & Missal, 2014). Seven studies reported specific types of sensory modulation difficulties (Al-Ayadhi, Al-Drees, & Al-Arfaj, 2013;Brockett, Lawton-Shirley, & Kimball, 2014;Francis, 2011;Gee, Thompson, Pierce, Toupin, & Holst, 2015;Gee, Thompson, & St. John, 2014;Nwora & Gee, 2009;Schoen, Miller, & Note. SM = sensory modulation. ...
... Sullivan, 2015) with the most common type experienced by participants involving sensory overresponsivity (SOR) or auditory sensitivity (Al-Ayadhi et al., 2013;Brockett et al., 2014;Francis, 2011;Gee et al., 2015Gee et al., , 2014Schoen et al., 2015). Other categories of participants' sensory modulation challenges described in the studies included tactile sensitivity, oral SOR, sensory underresponsivity (SUR), and sensory seeking (SS; Table 2). ...
... The 10 studies scored an average Quality Index score of 18 (fair), with a range from 13 to 21 points (poor to good quality). Three studies received a good quality rating (Bazyk et al., 2010;Francis, 2011;Hall & Case-Smith, 2007), six studies obtained a fair rating (Al-Ayadhi et al., 2013;Brockett et al., 2014;Gee et al., 2015Gee et al., , 2014Nwora & Gee, 2009;Schoen et al., 2015), and one study received a poor rating (Vadivel & Missal, 2014). The studies consisted of one Level II pretest/posttest quasi-experimental design with a control group (Vadivel & Missal, 2014), two Level III one group pretest/posttest design (Al-Ayadhi et al., 2013;Bazyk et al., 2010), and seven Level IV single case studies (Brockett et al., 2014;Francis, 2011;Gee et al., 2015Gee et al., , 2014Hall & Case-Smith, 2007;Nwora & Gee, 2009;Schoen et al., 2015). ...
Article
Full-text available
This systematic review evaluates current evidence for using sound-based interventions (SBIs) to improve educational participation for children with challenges in sensory processing and integration. Databases searched included CINAHL, MEDLINE Complete, PsychINFO, ERIC, Web of Science, and Cochrane. No studies explicitly measured participation-level outcomes in education. Ten studies provided limited evidence supporting the use of SBIs based on preliminary positive effects on occupations, client factors, and performance skills related to participation in education. Stronger experimental designs are needed measuring educational participation. Therapists should use caution using SBIs for this population and outcome until further research clearly substantiates or refutes this intervention.
... There is limited research on auditory intervention and controversy as to its effectiveness (Schoen, Miller, & Sullivan, 2015). Auditory interventions currently used in practice are based on the original work of Tomatis (Tomatis Method) and Berard (Auditory Integration Training). ...
... Four studies on auditory intervention have been published in OT literature, two of which (Hall & Case-Smith, 2007;Schoen et al., 2015) concern children with sensory processing difficulties. One of these studies (Nwora & Gee, 2009) is a single-subject case study in which improvements were reported in the participant's skills (including eye contact, peer interaction, and receptive language) and sensory processing following the "listening program." ...
... Results were confounded by the participant receiving other interventions at the time of the auditory intervention. The second study (Schoen et al., 2015) is a pilot study investigating the effects of "integrated listening systems" in which changes in physiological arousal were found in five of seven participants. Participants showed improvement in home-and education-related goals. ...
Article
This phenomenological study explored parents’ perspectives of Therapeutic Listening (TL) implemented as a home program to treat their children with sensory processing difficulties. Ten parents participated in semistructured interviews. Interviews were transcribed verbatim and analyzed thematically. Parents were concerned about their child’s anxiety and distress, which they commonly perceived to be reduced with TL. Parents perceived that TL brought a sense of calm to their child, which they linked to improvements in their family life and child’s participation in social and daily activities. Parent engagement (problem solving) enabled successful implementation of the program. Findings are discussed in relation to existing literature.
... This event and its supporting data were shared with the therapist, who was surprised at the results that the iLs Voice Pro program helped increase the child's arousal as marked by the increase in EDA. This data helped suggest a follow-up evidence based study (Schoen et al., 2015). For another child, the therapist scheduled the iLs Voice Pro program at the beginning of therapy rather than at the end of a treatment session to achieve increased arousal. ...
Article
Full-text available
Purpose: One goal of occupational therapists working with children who have sensory processing challenges is the regulation of arousal. Regulation strategies have not been evaluated using an empirical measure of physiological arousal. Objective: To establish the feasibility of using an objective physiologic measure of sympathetic arousal in therapeutic settings and explore the relation between therapeutic activities and sympathetic arousal. To evaluate changes in electrodermal activity (EDA) during occupational therapy sessions. Methods: Twenty-two children identified with sensory modulation dysfunction (SMD) wore a wireless EDA sensor during 50 min occupational therapy sessions (n = 77 sessions). Results: All children were able to wear the sensor on the lower calf without being distracted by the device. The five insights below are based on a comparison of EDA recordings in relation to therapists' reflections describing how sympathetic arousal might correspond to therapeutic activities. Conclusion: Objective physiological assessment of a child's sympathetic arousal during therapy is possible using a wireless EDA measurement system. Changes in EDA may correspond directly with therapeutic activities. The article provides a foundation for designing future therapeutic studies that include continuous measures of EDA.
... Through filtered and modulated frequencies, AIT aims to suppress the peaks of frequency by random dampening of high and low frequencies in order to normalize the sounds and retrain the brain of someone who is hypersensitive (Sinha et al., 2006). Although different types of AIT, including the Listening Program, Berard Method and Tomatis Method are used, there is limited scientific research to support their ability to decrease auditory hypersensitivity (Dawson et al., 2007;Miller and Schoen, 2015;Sokhadze et al., 2016). ...
Article
Full-text available
Objective: The purpose of this study was to evaluate the proof of concept of an intervention to decrease sympathetic activation as measured by skin conductivity (electrodermal activity, EDA) in children with an autism spectrum disorder (ASD) and auditory hypersensitivity (hyperacusis). In addition, researchers examined if the intervention provided protection against the negative effects of decibel level of environmental noises on electrodermal measures between interventions. The feasibility of implementation and outcome measures within natural environments were evaluated. Method: A single-subject multi-treatment design was used with six children, aged 8–16 years, with a form of Autism (i.e., Autism, PDD-NOS). Participants used in-ear (IE) and over-ear (OE) headphones for two randomly sequenced treatment phases. Each child completed four phases: (1) a week of baseline data collection; (2) a week of an intervention; (3) a week of no intervention; and (4) a week of the other intervention. Empatica E4 wristbands collected EDA data. Data was collected on 16–20 occasions per participant, with five measurements per phase. Results: Separated tests for paired study phases suggested that regardless of intervention type, noise attenuating headphones led to a significance difference in both skin conductance levels (SCL) and frequency of non-specific conductance responses (NS-SCRs) between the baseline measurement and subsequent phases. Overall, SCL and NS-SCR frequency significantly decreased between baseline and the first intervention phase. A protective effect of the intervention was tested by collapsing intervention results into three phases. Slope correlation suggested constant SCL and NS-SCR frequency after initial use of the headphones regardless of the increase in environmental noises. A subsequent analysis of the quality of EDA data identified that later phases of data collection were associated with better data quality. Conclusion: Many children with ASD have hypersensitivities to sound resulting in high levels of sympathetic nervous system reactivity, which is associated with problematic behaviors and distress. The findings of this study suggest that the use of noise attenuating headphones for individuals with ASD and hyperacusis may reduce sympathetic activation. Additionally, results suggest that the use of wearable sensors to collect physiological data in natural environments is feasible with established protocols and training procedures.
... So this study, examines the relationship between behavioral patterns and sensory processing patterns. Considering problems that occur in the occupational performance, the primary treatment for children with sensory processing difficulty is occupational therapy (OT) to help them engage in daily activities and routine (Schoen, Miller, & Sullivan, 2015). The finding of this study could help occupational therapist to develop proper and comprehensive intervention for these children. ...
Article
This study investigates the relationship between sensory processing patterns and behavioral patterns in children. The population consisted of all children in Tehran city. Participation included 229 school and 155 preschool children. We collected data using the Sensory Profile School Companion and Conners Teacher Rating Scale. Results showed that ‘conduct’, ‘inattentive/passive’, and ‘hyperactivity’ behavior patterns from the CTRS were significantly correlated with registration, seeking, sensitivity and avoiding from the SPSC in preschool and elementary school children (p < 0.001). Because of scoring, this means that behavior patterns were more prevalent when children had more frequent sensory processing patterns as well. This relationship should be considered when children are referred to occupational therapy for sensory processing problems or behavioral challenges.
... In our search, additional studies were located that examined other specific sensory techniques commonly used by occupational therapy practitioners, such as the Wilbarger brushing protocol (Benson, Beeman, Smitsky, & Provident, 2011), therapy ball chairs (Fedewa & Erwin, 2011), sensory diets (Hall & Case-Smith, 2007), and auditory stimulation programs including Therapeutic Listening (Hall & Case-Smith, 2007) and Integrated Listening Systems (Schoen, Miller, & Sullivan, 2015). These studies were not included in our review because their research designs fell at lower levels of evidence (Level IV or V), indicating significant threats to internal validity that limit the conclusions that can be drawn from them. ...
Article
Full-text available
This systematic review examined the effectiveness of specific sensory techniques and sensory environmental modifications to improve participation of children with sensory integration (SI) difficulties. Abstracts of 11,436 articles published between January 2007 and May 2015 were examined. Studies were included if designs reflected high levels of evidence, participants demonstrated SI difficulties, and outcome measures addressed function or participation. Eight studies met inclusion criteria. Seven studies evaluated effects of specific sensory techniques for children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder: Qigong massage, weighted vests, slow swinging, and incorporation of multisensory activities into preschool routines. One study of sensory environmental modifications examined adaptations to a dental clinic for children with ASD. Strong evidence supported Qigong massage, moderate evidence supported sensory modifications to the dental care environment, and limited evidence supported weighted vests. The evidence is insufficient to draw conclusions regarding slow linear swinging and incorporation of multisensory activities into preschool settings.
Article
Full-text available
OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups and for clinical work in guiding treatment planning. We thus evaluated the new Sensory Processing Scale (SPS) Assessment. METHOD. Research included item development, behavioral scoring system development, test administration, and item analyses to evaluate reliability and validity across sensory domains. RESULTS. Items with adequate reliability (internal reliability >.4) and discriminant validity (p < .01) were retained. Feedback from the expert panel also contributed to decisions about retaining items in the scale. CONCLUSION. The SPS Assessment appears to be a reliable and valid measure of sensory modulation (scale reliability >.90; discrimination between group effect sizes >1.00). This scale has the potential to aid in differential diagnosis of sensory modulation issues.
Book
This book summarizes information on adaptive behavior and skills as well as general issues in adaptive behavior assessment with the goal of promoting sound assessment practice during uses, interpretations, and applications of the Adaptive Behavior Assessment System-II. Adaptive behavior and skills refer to personal qualities associated with the ability to meet one's personal needs such as communication, self-care, socialization, etc. and those of others. Data from measures of adaptive behavior have been used most commonly in assessment and intervention services for persons with mental retardation. However, the display of adaptive behaviors and skills is relevant to all persons. The Adaptive Behavior Assessment System-II (ABAS-II) provides a comprehensive, norm-referenced assessment of the adaptive behavior and skills of individuals from birth through age 89. The comprehensive natures of the ABAS-II, ease in administration and scoring, and wide age range have resulted in its widespread use for a large number of assessment purposes. The book provides practical information and thus serves as a valuable resource for those who use the ABAS-II.
Article
The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
Article
The present study evaluates the efficacy of auditory integration training (AIT) in a population with multiple handicaps using a double blind experimental design. Thirty residents of a habilitation institute who had multiple handicaps received AIT over a 10-day period. Changes in hearing sensitivity and loudness tolerance, as measured audiometrically, and behavior, as measured by the Aberrant Behavior Checklist (ABC), were evaluated at discrete intervals from 1 week to 9 months post-AIT. Post-AIT data were then compared to pre-AIT data to determine if changes occurred in either hearing or behavior that could be attributed to the experimental stimulus (AIT). We found no significant difference in hearing threshold or loudness tolerance following AIT. Slight improvement in behavior was seen in both the treatment group and the control group, suggesting that factors other than AIT were responsible for behavioral improvement.