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名儿童中就有一名受到影响，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%的自闭症患者在处理和整合感觉信息方面存在困难，这已被证明是影响功能技能的一个重要因素。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，随机接受30个疗程的感觉整合治疗(SIT)的患有自闭症和感觉问题的儿童在功能技能方面取得了显著进步，表现出与感觉相关的适应不良行为的减少，并提高了他们对日常活动的参与度。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和专注于改善6-8.5岁ASD和感觉问题儿童功能技能的行为策略的有效性。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，符合条件的参与者将被随机分成30个一小时的SIT、ABA或无治疗(NT)疗程。结果评估，包括行为和电生理措施，将在基线、治疗后和治疗后12周进行，以评估可持续性。这项研究的具体目的是：1)将30次SIT与相同剂量的ABA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加工和多感觉整合功能有不同的影响；3)确定自闭症的严重程度、认知水平或感觉症状的严重程度是否适中干预结果。这项研究涉及机构间自闭症协调理事会研究战略计划的多个优先事项，包括自闭症干预措施的相对有效性RCT的必要性，揭示自闭症症状的生物学机制以帮助制定定制的、有针对性的干预措施的研究，确定干预措施的调解人或调解人，以及治疗核心缺陷。研究结果将根据表型特征和症状向父母和提供者通报最有助于提高功能技能的干预措施。具有互补专业知识的跨学科研究人员和临床医生团队被用来解决这一未得到满足的需求。

 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.