Sensory Integration Therapy in Autism: Mechanisms and Effectiveness

 描述（由申请人提供）：自闭症谱系障碍（ASD）是最常见的神经发育障碍之一，每68名儿童中就有1名受到影响，经常导致独立生活所需的功能技能受损，并对家庭和社会产生重大影响。高达90%的ASD患者存在处理和整合感觉信息的困难，这些已被证明是影响功能技能的重要因素。对这些感官问题的干预是 最高要求的治疗。我们已经表明，与对照组相比，患有ASD和感觉问题的儿童被随机分配到30次感觉统合治疗（SIT），在功能技能方面取得了显着的进步，表现出与感觉相关的适应不良行为减少，并改善了他们对日常活动的参与。现在，我们有证据支持SIT改善这组有感觉问题的儿童的功能技能，我们试图比较SIT与6-8.5岁ASD和感觉问题儿童功能技能改善的集中行为策略的有效性。重要的是，我们将询问作用机制和预测干预反应的表型特征。经过全面的表型评估后，合格的参与者将被随机分配到30个一小时的SIT，阿坝或无治疗（NT）。将在基线、治疗后和治疗后12周进行结局评估，包括行为和电生理测量，以评估可持续性。该研究的具体目的是：1）将30次SIT与相同剂量的阿坝进行比较，以评估功能技能和适应不良行为的即时和持续变化; 2）评估治疗方案是否对感觉处理和多感觉整合功能具有不同的影响;以及3）确定自闭症严重程度，认知水平或感觉症状的严重程度是否适度干预结果。这项研究解决了多个优先事项的机构间自闭症协调理事会的战略计划的研究，包括需要比较有效性随机对照试验的干预措施，ASD，研究揭示ASD症状的生物机制，以帮助开发定制的，有针对性的干预措施，中介或调解人的干预措施，和治疗的核心缺陷。研究结果将告知父母和提供者有关干预措施，这些干预措施可能最有助于改善基于表型特征和症状的功能技能。利用具有互补专业知识的跨学科研究人员和临床医生团队来解决这一未满足的需求。

 DESCRIPTION (provided by applicant): Autism Spectrum Disorders (ASD) are one of the most commonly occurring neuro- developmental disorders, affecting 1 in 68 children, frequently resulting in impairments in the functional skills necessary for independent living, and presenting a significant impact on families and society. Up to 90% of individuals with ASD present with difficulties processing and integrating sensory information and these have been shown to be a significant factor impacting functional skills. Intervention for these sensory issues is one of the most highly requested treatments. We have showed that children with ASD and sensory issues who were randomized to a 30-session Sensory Integration Treatment (SIT) made significant gains in functional skills, showed reduced sensory-related maladaptive behaviors, and improved their participation in daily activities compared to controls. Now that we have evidence in support of SIT for improvement of functional skills in this group of children with sensory issues, we seek to compare the effectiveness of SIT to focused behavioral strategies on improvement of functional skills for children with ASD and sensory issues ages 6-8.5 years of age. Importantly, we will interrogate the mechanisms of action and the phenotypic characteristics that predict response to intervention. After a comprehensive phenotypic assessment, eligible participants will be randomized to 30 one-hour sessions of SIT, ABA or No Treatment (NT). Outcome assessment, which includes behavioral and electrophysiological measures, will occur at baseline, post treatment and at 12 weeks following treatment to assess sustainability. The specific aims of the study are to: 1) compare 30 session SIT to the same dosage of ABA to evaluate immediate and sustained changes in functional skills and maladaptive behaviors; 2) to assess whether the treatment regimen has differential effects on sensory processing and multisensory integration functions; and 3) to determine whether autism severity, cognitive level or severity of sensory symptoms moderate intervention outcomes. This study addresses multiple priorities of the Interagency Autism Coordinating Council's Strategic Plan for research including the need for comparative effectiveness RCTs of interventions for ASD, studies to uncover the biological mechanisms of ASD symptoms to aid in the development of customized, targeted interventions, identification of mediators or moderators of interventions, and treatment of core deficits. Findings will inform parents and providers about interventions that may best help improve functional skills based on phenotypic characteristics and symptoms. A team of inter-disciplinary researchers and clinicians with complementary expertise is utilized to address this unmet need.