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Please visit our new web site www.autism.com
Please visit our new web site www.autism.com
Please visit our new web site www.autism.com
A series of clinical trials were conducted at the Day School (Program: Michael Reese Hospital & Medical Center, Developmental Institute) to evaluate students' use of the equipment and to evaluate related assessment tools. The first question asked was would students actually make use of this equipment and on a consistent basis to warrant its set-up in a school setting. Students with autism experience cycles of stress and changes in behavior as do other individuals with developmental disabilities; it was clinically informative to follow individual students over an extended timeframe. A data base related to this population was established.
STUDY 1. Using minimum standards for encouraged use, records for 16 students with autism (DSM III-R) over a 6 week period were reviewed. Students, 6 to 12 years old, functioning at mild to severe levels of retardation were identified as tactily defensive by an occupational therapist through clinical observation and by scores on the ReACT, Response Assessment of Children to Tactile stimuli, Range 7-26, Mn=14. The Aberrant Behavior Checklist (ABC) was completed before and after the 6 week period. The Goodman Lock Box was also completed in the same time frame. Agreement on scoring ranged from 84-97%. A biweekly Likert rating scale was complete by teachers.
RESULTS: Use of apparatus to criterion(5 minutes +) after the baseline week was categorized as C: meeting criterion, time range 311"-932"; V: variable across weeks, 74"-792"; and N: not meeting criterion, 50"-293" (4 students). Duration of individual pulls or "squeezes" tended to increase in the sustained category, 15 or more seconds, regardless of total time. Students were generally consistent in maintaining their position throughout sessions and across weeks; the variable group showed more change within one session than across sessions. The overall preferences were prone and the recommended quadraped, all fours, position. In 17% of the sessions an additional or shift of position occurred.
Scores on the Goodman Lock Box Test were compared to a group of students also diagnosed as having autism and being tactily defensive (N=7) participating in a different program that also provided one-on-one time in a separate room. Students using the lateral pressure equipment showed a significant increase in total adaptive movements and competence (unlocked boxes) at the p>.05 level (one-tailed). A tendency toward reduced nonadaptive movements and greater variability in such responses was noted. No significant differences were found on the ABC. The school rating scale indicated a significant change in "overall day" ratings (p>.02). Students actually used the equipment longer on their "overall-worst" days (Note: teachers describe behavioral differences over the 6 weeks; the days were considered personally difficult to the student or "Autism was winning" days but students were not behaviorally more aggressive or failing classroom rules.)
STUDY 2. Individual case studies tracking 4 students over a fifteen week period with a one week break at midpoint. Students were observed during 10 minute samples of independent work, recording every 10 seconds for on/off task behavior and stereotypies. No significant changes for this group occurred.
RESULTS: Generally, the number of stereotypies decreased or were less disruptive to on task behavior. That is, two students who previously engaged in hand posturing and gazing at hand/finger movements were able to increase on task behavior but sometimes did engage in the stereotypic movement outside their line of vision at the same time. After the break period, two students initiated a higher rate of use, one maintained his mean use time, one decreased use time over two weeks and then increased time.
OTHER ASSESSMENTS: While observeable behaviors might be attributed to arousal level, tactile defensiveness and related conditions, assessment tools to evaluate change based on use of the equipment is still problematic. Students receive more than one intervention in a therapeutic educational setting; it is difficult to assess individual differences in performance related to cumulative effects and/or the duration of such effects. The following measures were considered across 6 week periods of use. Their report is included for possible design modification and encouragement of further evaluation.
Inhibition tasks. These tasks, with tactile demands, evaluate the ability to stop or monitor one's behavior following use of equipment with great individual differences. The measures only follow use of the equipment for baseline, 3 week, 6 week intervals and may be related to the overall ongoing program.
Arousal level was assessed with a simple sports heart monitor level. A high rate of individual variability was briefly reduced during squeezing time. Self report measures of affect or state using pictures of actual student faces as well as graphic arrays in a forced choice task were not reliable. Students choices reflected position preferences, etc. Activity level wrist recorders were worn during assigned periods; however, students had different tolerances over time to their tactile demands. This information was not consistent with more general behavioral observations made by school staff.
© Copyright, 1997, Margaret P. Creedon
Program: Michael Reese Hospital & Medical Center, Developmental Institute