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Abstract EFFECTIVENESS OF SENSORY INTEGRATION AND BEHAVIORAL INTERVENTIONS ON NONENGAGEMENT IN PRESCHOOL AGED CHILDREN By Tiffany Ann Kuyper, OTR/L A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Occupational Therapy at Virginia Commonwealth University Virginia Commonwealth University, 2012 Director: Marie Anzalone ScD, OTR, FAOTA This single subject pilot study explored a combination of sensory-based interventions and behavioral interventions in a preschool aged child identified with Sensory Over-Responsivity (SOR). Children often display nonengagement associated with escaping and avoiding tactile and/or vestibular information because they perceive sensory input as negative or aversive. The subject was a 3-year old child who engaged in alternating treatments over the course of six weeks of occupational therapy. The first condition was a sensory-based intervention (SB), a widely used intervention approach for sensory over-responsivity. The alternating condition was a sensory-based intervention combined with behavioral interventions (SBB). The behavioral intervention used tangible reinforcement as the primary technique to facilitate engagement in sensory intensive play that was part of the sensory-based interventions. It was hypothesized that nonengagement behaviors would decrease during the SBB condition and play engagement behaviors would increase during the SBB condition. It was also hypothesized that the subject would demonstrate an improvement in perceived performance and satisfaction of daily living activities. The outcomes of this study included frequencies of nonengagement, play engagement and the family’s perceived performance and satisfaction of a child’s performance of occupations. The frequency of nonengagement behaviors was assessed when the subject was presented with sensory intensive play that was part of sensory-based interventions in each condition. The frequencies of nonengagement and play engagement were coded over each session to determine if there was any change between and within conditions. Also, performance and satisfaction with occupations were compared from the initial evaluation and the last intervention session. Results of this study revealed that the subject’s nonengagement behaviors actually increased throughout the interventions. This finding did not support the first hypothesis that nonengagement behaviors would decrease in the condition using a combination of sensory-based interventions and behavioral interventions. It was also found that the subject’s number of play engagement behaviors decreased within both conditions. This finding did not support the second hypothesis that play engagement behaviors would improve as result of participating in a combination of sensory-based interventions and behavioral interventions over time. However, the qualitative improvements as identified by the subject’s mother when using the Canadian Occupational Performance Measure (COPM; Law, Baptiste, McColl, Polatajko, & Pollock, 2005) improved significantly across both interventions in the home and community settings. As a result of participation in this study, the subject made improvements with regard to all occupational performance areas as initially collaborated upon in the initial evaluation.

The purpose of this review was to determine whether the use of sensory-based alternative seating to increase the appropriate behaviors of individuals with disabilities is an evidence-based practice (EBP). Articles located on this topic were descriptively analyzed, and What Works Clearinghouse (WWC) guidelines were applied to determine each study’s methodological rigor, level of evidence, and whether, taken together, there is enough research to support alternative seating as an EBP. A total of 37 studies of the effects of sensory-based alternative seating on individuals with disabilities were found. These studies included a total of 44 participants, between 3 to 9 years of age. Based on WWC guidelines, six of the 37 studies, or 16%, met standards for rigor, and of those, only one study showed evidence of a positive effect on the target behavior. The results and their implications for teachers/practitioners, and future research are discussed.