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Brittney Schorr, MOTS

Weighted Vests Vs. Standard Occupational Therapy on On-Task Behavior in Children with Autism Spectrum Disorders. Brittney Schorr, MOTS. Agenda. Background Objective Intervention Methodological Quality of Studies Results Discussion Implications for OT Practitioners

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Brittney Schorr, MOTS

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  1. Weighted Vests Vs. Standard Occupational Therapy onOn-Task Behavior in Children with Autism Spectrum Disorders Brittney Schorr, MOTS

  2. Agenda • Background • Objective • Intervention • Methodological Quality of Studies • Results • Discussion • Implications for OT Practitioners • Implications for Future Research

  3. Background photo: medicmagic.net

  4. On-Task Behavior photo: whatafy.com

  5. Sensory Integration • Regulates behavior through sensory systems: • Tactile • Proprioceptive • Vestibular • SI treatments: • weighted vests • pressured vests • weighted blankets

  6. Weighted Vests • Commonly cloth vests with pockets in the front and back • Weights in the pockets • Weights can be made of any material

  7. Occupational Therapy Treatment as Usual • Includes: • Music Therapy • Therapy Ball Chairs • Picture Activity Schedules • Hug Machine

  8. Picture Activity Schedule

  9. Hug Machine

  10. Objective • To examine the extent to which the research literature supports weighted vests as compared to treatment as usual as a more effective approach to improving on-task behavior in children with ASD

  11. Search Terms • Autism • Weighted vest • Therapy • On-task behavior • Attention • Developmental Disorder

  12. Types of Studies • Controlled Clinical Trials • Mixed Study Designs • Experimental Research • Single Subject

  13. Participants • Children with: • ASD • Attention deficit hyperactive disorders (ADHD) • Developmental delays • 2 to 13 years old • 45 boys, 11 girls (56 total)

  14. Weighted Vest Diagnoses & Interventions 4 Autism and PDD Fertel-Daly et al., 2001 Hodgetts et al., 2010 Kane et al., 2005 Leew et al., 2009 1 ADHD VandenBerg, 2001 1 Developmental Delays Reichow et al., 2009

  15. Diagnoses & Interventions Therapy as Usual (all children with autism) 1 Music Therapy Kim et al., 2008 1 Picture Activity Schedules Bryan & Gast, 2000 1 Hug Machine Edelson, et al., 1998 1 Therapy Ball Chairs Bagatell et al., 2010

  16. Inclusion Criteria • Confirmed physician diagnosis • Between 2 and 13 years old • Korean Childhood Autism Rating Scale • Problematic behaviors interfering with ADLs • 65 or above on Conners’ Teacher Rating Scale

  17. Exclusion Criteria • Diagnoses not confirmed by physicians • Over 13 and younger than 2 years old • Current therapy (OT, PT, SLP) in 9 studies • Co-morbid diagnoses

  18. Sample Sizes • Range: 1 child to 12 children • Average: 6 children per study

  19. Weighted Vest Intervention: ABA Withdrawal Design • Initial baseline phases (A) • Classroom fine-motor activity • Intervention phases (B) • Classroom fine-motor activity • 2 studies: Vests worn six 20-30 minute sessions • 1 study: Vests worn 2 hrs. per day, 3x/wk for 12 wks • 1 study: Vests worn 45 minutes during 14 sessions • Withdrawal phases (A) • Classroom fine-motor activity • Removal of vests

  20. Weighted Vest Intervention:ABC Withdrawal Design • Baseline phase (A): • Classroom fine-motor activity • Experimental phase (B): • Vests worn without weight 20-30 mins./day for 2 wks • Experimental phase (C): • Vests worn with weight 20-30 mins./day for 2 wks

  21. Treatment as Usual: Hug Machine • Two 20 min. sessions/wk. for 6 wks. • Experimental group: • Lie in Hug Machine • Lever provided deep pressure • Control group: • Lie in the Hug Machine • Lever disengaged

  22. Treatment as Usual: Therapy Ball Chairs • Baseline phase: • 15 minute classroom “Circle Time” • No therapy ball chairs • Intervention phase: • Utilized therapy ball chairs during “Circle Time”

  23. Treatment as Usual:Picture Activity Schedules • Baseline phase: • Classroom activity 45 mins./day for 5 days • No picture activity schedule • Intervention phase: • Picture activity books • 4 step activity

  24. Treatment as Usual: Music Therapy • Baseline phase: • Observed engagement during normal play • 30 mins./day for 12 weeks • Intervention phase: • Observed during normal play incorporating music • 30 mins./day for 12 weeks

  25. Outcome Measures • Data sheets (10 studies) • Data collection: • Videotaped recordings • Researcher observations • Conner’s Parent Rating Scale • Parenting Morale Index • Pre-tests and post-tests • Pervasive Developmental Disorder Behavior Inventory-C

  26. Data Analysis • MANOVA • Repeated measures ANOVA • 2-standard deviation • Celeration line approach • Predicted an increase or decrease in on-task behavior

  27. Methodological Quality of Studies • Natural environments • Classroom • Home • Randomization in 5 studies • Blinding in 5 studies

  28. Controlling for Threats to Validity • Same diagnoses • Did not include scores of 3 children who dropped out • Served as own control • Inter-rater reliability • Controlled for maturation by conducting the studies within weeks

  29. Limitations • Small number of participants • Only male participants in four studies • Only one facility when recruiting participants • Unequal groups in 4 studies: • Group numbers • 1 child had previous experiences with weighted vests • Experimental group rated higher on the Tension and Anxiety Scale than control group

  30. Limitations • Poorly defined procedures: • Did not state the frequency, duration, or intensity of OT • Undisclosed treatment environment • No means of controlling environmental distractions • Disruptive classmates • Loud noises • No randomization in group assignments in 5 studies

  31. Limitations • No experimenter blinding in 5 studies • No psychometric properties of tests were disclosed in 5 studies • Hawthorne effect • Children knew they were being observed

  32. Results: Treatment as Usual • Hug Machine: • Experimental group lower tension levels on the Tension Scale than control group • t(10)= 3.124, p<.05 • Lower on Anxiety Scale than the control group • t(10)=1.959, p<10 • Therapy Ball Chairs: • Positive effects during “Circle Time” • Decreased number of minutes spent out of chair • No p values given

  33. Results: Treatment as Usual • Picture Activity Schedule: • Children remained on-task and on-schedule when using the books • No p values given • Music therapy: • Increased eye contact (p<0.0001). • Medium effect on on-task behavior (d=.63)

  34. Results: Weighted Vests • ADHD: • Significant change (p<.05) from baseline to intervention • Increase in on-task behavior (18% - 25%) • Developmental Delays: • No improvement in on-task behavior • Greater incidences of problematic behavior • No p values

  35. Results: Weighted Vests • PDD: • 1st study • Decrease in number of distractions • Increase in focused attention • No p values • 2nd study (PDD & autism) • No increase in on-task behavior • No p values

  36. Results: Weighted Vests • Autism: • 1st study • No overall improvement in on-task behavior • Slight increase in on-task behavior in one child, but not maintained • No p values • 2nd study • No increase in on-task behavior • No p values

  37. Discussion • Evidence suggests that weighted vests are not a more effective intervention than OT as usual for increasing on-task behavior in children with Developmental Delays and ASD (autism, PDD)

  38. Discussion • Weighted vests appeared to temporarily improve on-task behavior in one child with PDD • Long term effects not evaluated • Child received OT throughout the study • Unable to determine whether the results were contributed to the vests or from OT

  39. Discussion • Weighted vests appeared to have significant effects on children with ADHD • Only included 4 children • Convenience sampling recruitment method • Long term effects not evaluated

  40. Discussion • OT as usual is noted to be a more effective method for promoting on-task behavior in children with ASD • Therapy ball chairs • Positive effects on in-seat and on-task behavior • Music therapy • Effective intervention

  41. Discussion • Hug Machine • Deep pressure can contribute to an increase in on-task behavior • Extensive measures to control for threats • Picture activity schedules • Children’s performance increased by 100%

  42. Conclusion • Efficacy of weighted vests depends on the child and his or her diagnosis • OT as usual appears to be a more reliable option for improving on-task behavior in children with ASD

  43. Implications for OT Practice • Weighted vests may provide short-term calming effects on children with ADHD, but long-term effects have not been evaluated • OTs should not generalize the results to adults and diagnoses outside of the study • OTs who use weighted vests must proceed with caution until further evidence can be established

  44. Implications for Future Research • Replicating in other contexts • Long term effects • Longer intervention period • Examining other protocols • Larger sample sizes • Boys and girls • Increasing amounts of weight in vests

  45. References • Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorders. American Journal of Occupational Therapy, 64, 895–903. • Bryan, L., & Gast, D. (2000). Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of Autism and Developmental Disorders, 30(6), 553-567. • Edelson, S., Edelson, M., Kerr, D., & Grandin, T. (1999). Behavioral and physiological effects of deep pressure on children with autism: a pilot study evaluating the efficacy of grandin's hug machine. The American Journal of Occupational Therapy, 53(2), 145-152. • Fertel-Daly, D., Bedell, G., & Hinojosa, J. (2001). Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders. The American Journal of Occupational Therapy, 55(6), 629-640. Retrieved from http://www1.aota.org/ajot/index.asp • Hodgetts, S., Magill-Evans, J., & Misiaszek, J. (2010). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal of Autism and Developmental Disorders, 41, 805-814. • Kane, A., Luiselli, J., Dearborn, S., & Young, N. (2004). Wearing a weighted vest as intervention for children with autism/pervasive developmental disorder. The Scientific Review of Mental Health Practice, 3(2), 19-24. • Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders, 38, 1758-1766. • Krebs, M, McDaniel, M, & Neely, R. (2011). The effects of peer training on the social interactions of children with autism spectrum disorders. Education, 131(2), 393-403. • Leew, S., Stein, N., & Gibbard, B. (2010). Weighted vests' effect on social attention for toddlers with autism spectrum disorders. Canadian Journal of Occupational Therapy, 77(2), 113-124. • Moss, J, & Howlin, P. (2009). Autism spectrum disorders in genetic syndromes: implications for diagnosis, intervention and understanding the wider autism spectrum disorder population. Journal of Intellectual Disability Research, 53(10), 852-873. • Reichow, B., Barton, E., Good, L., & Wolery, M. (2009). Brief report: effects of pressure vest usage on engagement and problem behaviors of a young child with developmental delays. Journal of Autism and Developmental Disorder, 39, 1218-1221. • Sansosti, F. (2010). Teaching social skills to children with autism spectrum disorders using tiers of support: a guide for school-based professionals. Psychology in the Schools, 47(3), 257-278. • VandenBerg, N. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. The American Journal of Occupational Therapy, 55(6), 621-628. Retrieved from http://www1.aota.org/ajot/index.asp • Watling, R. L., & Dietz, J. (2007). Immediate effect of Ayres’s sensory integration–based occupational therapy intervention on children with autism spectrum disorders. American Journal of Occupational Therapy, 61, 574–583.

  46. Thank You!

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