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Sophie Molholm, Ph.D., professor of pediatrics and associate director of the Rose F. Kennedy Intellectual and Developmental Disabilities Research Center at Einstein.

Using Swings, Slides, and Ladders to Help Children With Autism

By Larry Katzenstein

Einstein researchers are not only seeking new drugs for treating autism spectrum disorders (ASDs). They are also testing the effectiveness of a behavioral intervention called sensory integration therapy (SIT) in a clinical trial funded by the National Institute of Child Health and Human Development.

Up to 90% of children with autism spectrum disorder (ASD) have “sensitivity issues.” They’re either too sensitive or not sensitive enough to the sensory environment—what they see, hear, feel, taste, and smell. So it’s not surprising that parents of children with ASD often request interventions for overcoming sensory issues.

The outcome of the clinical trial, now underway at Einstein and Montefiore, may help parents choose an effective treatment for their children. The trial is directed by Sophie Molholm, Ph.D., professor of pediatrics and in the Dominick P. Purpura Department of Neuroscience, and associate director of the Rose F. Kennedy Intellectual and Developmental Disabilities Research Center.

Children are encouraged to roll around, jump, dance, and climb—all in an effort to normalize how their bodies respond to and integrate sensory stimuli.

When diagnosing ASD, healthcare practitioners take sensitivity issues (e.g., hypersensitivity to touching, fascination with flashing lights, indifference to pain or temperature) into account. Those issues are thought to result from difficulty processing sensory stimuli.

Studies by Dr. Molholm and John Foxe, Ph.D., professor in the departments of pediatrics and neuroscience at Einstein, have shown that children with ASD have difficulty integrating multisensory stimuli and that the extent of this difficulty is related to children’s autism severity.

The theory behind SIT, which was developed in the 1970s, is that sensory integration problems profoundly interfere with children’s functional skills—their ability to communicate, to socialize, to learn, and to participate in routine activities of daily living. By helping such children better process and integrate sensory information, SIT could potentially enhance their lives in critically important ways.

SIT sessions emphasize play-based activities that are tailored to a child’s particular sensitivity issues. A typical SIT site, or “sensory gym,” may include swings, trampolines, sliding boards, ladders, and bean bags. Children are encouraged to roll around, jump, dance, and climb—all in an effort to normalize how their bodies respond to and integrate sensory stimuli. Those sessions are led by Elizabeth Ridgway, OTD, occupational therapy supervisor at the Einstein-Montefiore Children’s Evaluation and Rehabilitation Center.

The ongoing Einstein clinical trial is recruiting a total of 180 children ages 6 to 9.5 years old who have ASD as well as sensory issues. Children are randomized to receive either 30 one-hour sessions of SIT over 10 weeks; 10 weeks without treatment; or 30 one-hour treatment sessions over 10 weeks using applied behavioral analysis (ABA), the most widely used behavioral intervention.

(ABA involves the use of positive reinforcement to bring about desired behaviors. Once the therapist identifies a “goal behavior,” the child receives a reward—praise or a toy, for example—each time he or she uses the behavior.)

To assess the trial’s results, Dr. Molholm and her team will take behavioral and electrophysiological measures of the children at baseline, immediately after treatment, and 12 weeks after treatment has ended. They also will compare how SIT and ABA affected children’s functional skills, ASD severity, and their brain responses.

The trial is expected to be completed by the end of 2021, with results published by 2022.

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