Systematic Review of Sound Therapy Based Programmes 2018
Systematic Review of Sound Therapy Based Programmes 2018
Systematic Review of Sound Therapy Based Programmes 2018
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Journal of Occupational Therapy, Schools, & Early
Intervention
To cite this article: Romana F. Villasenor, Sarah L. Smith & Vanessa D. Jewell (2018): A
systematic review of sound-based intervention programs to improve participation in education for
children with sensory processing and integration challenges, Journal of Occupational Therapy,
Schools, & Early Intervention, DOI: 10.1080/19411243.2018.1432444
The sensory-rich nature of the everyday school environment can threaten the learning and
full educational participation of children with challenges in sensory processing and
integration. Children with challenges in sensory processing and integration present with
difficulties in “detecting, regulating, interpreting, and responding to sensory input which
impairs [one’s] daily routines or roles” (Miller, Anzalone, Lane, Cermak, & Osten, 2007,
p.136). Evidence suggests children and adolescents who have challenges in sensory
processing and integration have lower participation in educational activities and decreased
academic performance (Ashburner, Ziviani, & Rodger, 2008; Bar-Shalita, Vatine, &
Parush, 2008; Koenig & Rudney, 2010). A multitude of educational activities such as
completing classroom work, playing during physical education and recess, or eating lunch
in the cafeteria requires discrete processing and integration of sensory information putting
students who have difficulty with this process at risk for decreased participation in
educational activities. Current evidence indicates the prevalence of children without
identified diagnoses experiencing challenges in processing and integrating sensory infor-
mation ranges from 15.8–16.5% (Ben-Sasson, Carter, & Briggs-Gowan, 2009; Fernandez-
Andres, Pasto-Cerezuela, Sanz-Cervera, & Tarraga-Minguez, 2015) and from 40% to 88%
in children with diagnoses (Cheung & Siu, 2009; Fernandez-Andres et al., 2015).
Addressing the unique needs of children with challenges in sensory processing and
integration in the school environment is critical to ensure that all children have access to
their legally mandated educational program.
School-based occupational therapists are distinctly positioned to provide services and
interventions to support children with challenges in sensory processing and integration to
maximize their educational participation. Occupational therapists have not only the
theoretical education and clinical training in sensory processing, but also the professional
purpose of supporting children’s participation in everyday occupations. Participation in
education is one of the primary childhood occupations, and is defined as engagement in
activities needed for learning and participating in the educational environment (American
Occupational Therapy Association [AOTA], 2014). The Individuals with Disabilities
Education Improvement Act (IDEA) mandates that school-based occupational therapists
apply scientifically based skills and knowledge to improve services and outcomes for
children with disabilities (IDEA, 2004, section 662.2). For evidence-based services,
school-based occupational therapists should apply interventions not only supported by
clinical expertise and client preferences, but also by research (Sackett, Rosenberg, Muir
Gray, Haynes, & Richardson, 1996).
Sound-based intervention (SBI) programs are an approach increasingly used by school-
based occupational therapists to support children with challenges in sensory processing
and integration with the intent to improve children’s participation in education (Bazyk,
Cimino, Hayes, Goodman, & Farrell, 2010). SBI programs involve listening to electro-
nically modified music, nature sounds, or a voice using specialized equipment such as
bone conduction headphones and an amplifier. A variety of SBI programs exist including:
The Listening Program (TLP) (Advanced Brain Technologies, 2017), Therapeutic
Listening (Vital Links, 2017), and Integrated Listening Systems (iLs; Integrated Listening
Systems, 2017).
Despite the popularity of SBI programs in supporting children with challenges in
sensory processing and integration, evidence of the intervention in improving a child’s
participation in education is lacking. Previous SBI systematic reviews and a meta-analysis
reported mixed results, and the implications of studied outcomes on school participation
remain unclear. Sinha, Silove, Hayen, and Williams (2011) as well as Sinha, Silove,
Wheeler, and Williams (2006) systematically reviewed randomized controlled trials
(RCTs) of studies using Auditory Integration Training (AIT) and the Tomatis Method
on children and adults with ASD. Both reviews reported no evidence for improvement on
outcomes pertaining to core and associated features of ASD. In contrast, Gilmor (1999)
conducted a meta-analysis of five studies using the Tomatis Method for children with
learning and communication disorders and reported positive effect sizes in linguistic,
psychomotor, personal and social adjustment, cognition, and auditory domains using
standardized measures of aptitude, achievement, and adjustment. Parental reports of
improvement in children’s learning, communication, and general adjustment supported
the positive qualitative findings (Gilmor, 1999). More recently, Wink, McKeown, and
Casey’s (2017) qualitative study reported parents of children with sensory processing
difficulties perceived reduced levels of their child’s anxiety and distress after using
Therapeutic Listening that related to improvements in family life and participation in
social and daily activities. Vargas and Lucker (2016) performed a quantitative summary of
nine studies using The Listening Program (TLP); however, included studies were
JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 3
exploratory pilot studies, not yet published in peer-reviewed journals, with a wide variety
of age ranges and outcomes examined.
A systematic review examining the use of SBI programs for improving participation in
education in children with challenges in sensory processing and integration is needed to
provide updated evidence to inform evidence-based practices for supporting participation
in education. The purpose of this systematic review is to establish the current evidence in
using SBIs to support children with difficulties in sensory processing and integration and
their participation in education, and provide guidance for occupational therapists’ clinical
decision making. This systematic review examines the following research question: What
is the evidence for using sound-based intervention programs to improve participation in
education for children with challenges in sensory processing and integration?
Method
A research team of two occupational therapists with robust experience in school-based
practice, one occupational therapy researcher, and one university health science librarian
completed this systematic review. The research team reviewed 34 full-text articles to
determine evidence level and provide practice guidelines via the Preferred Reporting
Items of Systematic Review and Meta-Analysis Protocol (PRISMA-P; Shamseer et al., 2015).
Search strategy
The first author and an experienced health science librarian developed a comprehensive
list of search terms which are available upon request. The researchers conducted an
extensive database search utilizing the following databases: CINAHL, MEDLINE
Complete, PsychINFO, ERIC, Web of Science, and Cochrane on October 14, 2015, and
secondary search on June 7, 2017. Table 1 includes the ERIC search terms.
(Sackett et al., 1996) were included in the review. This study’s exclusion criteria included:
evidence hierarchy Level V (Sackett et al., 1996), qualitative studies, dissertations, theses,
abstracts, and oral presentations.
Extraction procedures
The initial results from all six database searches yielded 8,540 articles. An additional 21
articles were identified through hand searches and serendipitous findings. After removal of
duplicates, the first author reviewed 7,364 titles and abstracts per the inclusion and
exclusion criteria, leaving 34 articles for full-text review. The first two authors examined
each article to determine if outcomes studied related to occupations, client factors, or
performance skills relevant to participation in education. When disagreement occurred,
the third author reviewed the full-text article and made the final decision on inclusion and
through this process; the research team identified the final 10 articles included in the data
analysis (Figure 1). The outcomes identified in the studies pertaining to participation in
education were: attention, following directions, completing a task, person engagement,
fine motor skills, visual motor skills, communication, social skills, sensory processing, and
sensory modulation.
Data analysis
The PRISMA-P (Shamseer et al., 2015) 17-item checklist for systematic reviews guided the
review process, an Evidence Table Worksheet (Padilla, 2013) assisted with organization of
the data, the Quality Index (Downs & Black, 1998) was used to assess the risk of bias; and
a five-level grading evidence strength system adapted from the United States Preventive
Services Task Force (USPSTF, 2016) provided a rating scale for the strength of evidence.
The evidence table worksheet included participant demographics, levels of evidence,
interventions, outcomes, outcome measures, and results summary (Padilla, 2013). The
Quality Index (Downs & Black, 1998), a 27-item checklist, provided a score profile and
total score based on a study’s risk of bias in reporting, measurement of the intervention
and outcome, participant selection, external validity, and power of the study to enable
comparisons among reviewed studies. To determine whether a power calculation or
sample size calculation was provided in the study, scoring on item 27 was modified to
score either “0” or “1”. The total score is grouped into four quality levels: excellent (24–28
points), good (19–23 points), fair (14–18 points), and poor (13 or less points). The Quality
Index has evidence of high test-retest reliability (r = .88), high criterion validity correlates
(r = 0.90), and adequate inter-rater reliability (r = 0.75; Downs & Black, 1998). All authors
assessed each article and any discrepancies in the rating were resolved by discussion until
agreement occurred about the item in question.
During data analysis, the studies were grouped by sound-based intervention program
and outcomes relevant to participation in education. A qualitative data synthesis was
performed using the strength of the evidence five-level grading system adapted from the
USPSTF (2016). A designation of strong evidence was based on consistent results from
well-conducted studies and usually at least two RCTs. A designation of moderate evidence
was made based on results from one RCT, or two or more studies with lower levels of
evidence. The designation of limited evidence was made based on results from a few
JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 5
Identification
Records identified through Additional records identified
database searching through other sources
(n = 8,540) (n = 21)
for eligibility
(n = 34) (n = 24)
Studies included in
qualitative synthesis
Included
(n = 10)
Studies included in
quantitative synthesis
(meta-analysis)
(n = 0 )
Figure 1. Preferred reporting items for systematic reviews and meta-analyses flow diagram of pub-
lished literature search.
Note. Prisma Flow Diagram is from “Preferred reporting items for systematic reviews and meta-analyses:
The PRISMA statement”, by D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, & The PRISMA Group, 2009,
Annals of Internal Medicine, 151(4), p. 264–269. doi: 10.7326/0003–4819-151–4-200908180–00135
studies, flaws in the available studies, or some inconsistency in the findings across
individual studies. A designation of mixed evidence was based on inconsistent results
from the study findings across studies within a category. Insufficient evidence was
designated when the number and quality of studies were too limited to make any clear
classification.
6 R. F. VILLASENOR ET AL.
Results
Ten studies measured outcomes of relevance to participation in education as result of a
sound-based intervention for children with challenges processing and integrating sensory
information. No single study within our search explicitly measured participation-level
educational outcomes such as the child’s level of participation in school-related activities
such as in classroom settings, on playgrounds, or during lunch mealtimes and other self-
care activities. The identified articles encompassed four SBI programs: AIT (AIT Institute,
2017), iLs (Integrated Listening Systems, 2017), TLP (Advanced Brain Technologies,
2017), and Therapeutic Listening (Vital Links, 2017). A total of 185 children utilized a
SBI program: 138 utilized AIT, 25 utilized Therapeutic Listening, 15 utilized TLP, and 7
children utilized iLs. The children ranged from 3 to 19 years of age: AIT listeners were
ages 3–17, Therapeutic Listening listeners were ages 3–11, TLP listeners were ages 5–19,
and iLs listeners were ages 4–18.
All children in the studies experienced reported challenges in processing and interpret-
ing sensory information, with most children reported to have general sensory processing
difficulties (n = 102), sensory modulation difficulties (n = 54), and combinations of
sensory processing and sensory modulation difficulties (n = 53; Table 2). One study
reported participants’ scores on the sensory/cognitive awareness section of the Autism
Treatment Evaluation Checklist (ATEC; Vadivel & Missal, 2014). Seven studies reported
specific types of sensory modulation difficulties (Al-Ayadhi, Al-Drees, & Al-Arfaj, 2013;
Brockett, Lawton-Shirley, & Kimball, 2014; Francis, 2011; Gee, Thompson, Pierce, Toupin,
& Holst, 2015; Gee, Thompson, & St. John, 2014; Nwora & Gee, 2009; Schoen, Miller, &
Sullivan, 2015) with the most common type experienced by participants involving sensory
overresponsivity (SOR) or auditory sensitivity (Al-Ayadhi et al., 2013; Brockett et al., 2014;
Francis, 2011; Gee et al., 2015, 2014; Schoen et al., 2015). Other categories of participants’
sensory modulation challenges described in the studies included tactile sensitivity, oral
SOR, sensory underresponsivity (SUR), and sensory seeking (SS; Table 2). Participants
across the 10 studies also had varying diagnoses such as autism spectrum disorder (ASD),
attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and
developmental delays.
The 10 studies scored an average Quality Index score of 18 (fair), with a range from 13
to 21 points (poor to good quality). Three studies received a good quality rating (Bazyk
et al., 2010; Francis, 2011; Hall & Case-Smith, 2007), six studies obtained a fair rating (Al-
Ayadhi et al., 2013; Brockett et al., 2014; Gee et al., 2015, 2014; Nwora & Gee, 2009;
Schoen et al., 2015), and one study received a poor rating (Vadivel & Missal, 2014). The
studies consisted of one Level II pretest/posttest quasi-experimental design with a control
group (Vadivel & Missal, 2014), two Level III one group pretest/posttest design (Al-
Ayadhi et al., 2013; Bazyk et al., 2010), and seven Level IV single case studies (Brockett
et al., 2014; Francis, 2011; Gee et al., 2015, 2014; Hall & Case-Smith, 2007; Nwora & Gee,
2009; Schoen et al., 2015).
Improvements in occupation-based outcomes reported across the studies with p < 0.01
included the following: completes spelling work in a timely manner, completes homework
in a timely manner, completes writing assignments without emotional incident, and
completes morning routines without incident. Improvements in performance skills and
client factors with the potential to support a child’s participation in education as result of
the SBI program with p < 0.05 included fine motor skills, visual motor skills, commu-
nication and social skills, following directions (p < 0.001), and sensory modulation
(p < 0.01). Auditory SOR, auditory filtering, and visual/auditory sensitivity were combined
under sensory modulation.
Brockett et al., (2014) Level IV AIT 2×/day, 30 min. each, Sensory Modulation (SSP) All individual factors of the SSP 18 Fair
Retrospective Chart Review for 10 days Other services (Client Factors) showed significant changes at 1, 3, 6
n = 54, 83% Male, 17% Female; not reported mos. post AIT w/p value < 0.01 in:
Inclusion Criteria: Tactile Sensitivity Taste/Smell
● SPD: Sensory Modulation Sensitivity Movement Sensitivity
(visual/auditory sensitivity, Auditory filtering
auditory filtering, under- Low energy/weak Visual/auditory
responsivity, movement sen- sensitivity Under-responsivity w/p
sitivity, tactile sensitivity) value < 0.03
● Age: 3–10 yrs.
No control group
Vadivel and Missal (2014) Level II AIT 2×/day, 30 min. each Speech/language/ Significant changes in pre/post test 13 Poor
Pretest/Posttest Quasi- for 10 days (SBI only) communication, scores of the intervention group in
Experimental Design Sociability, Sensory/ ATEC components in speech/
n = 12, 66%Male, 34%Female Cognition (ATEC) language/communication, sociability,
Inclusion Criteria: (Performance Skills) sensory/cognition, w/p = 0.005
● SPD: Sensory Modulation Significant changes also noted in pre/
(auditory sensitivity) post test scores of the control group
● Age group 3.5 – 6 yrs. in ATEC components in speech/
Control Group: language/communication, sociability,
OT, SI, & Spec. Ed. sensory/cognition w/p = < 0.10, <
0.005, < 0.05 respectively
Bazyk et al. (2010) Level III TL 1–2×/day, 20–30 min. Fine Motor,(PDMS-2) Significant changes noted from 21 Good
Pre-Experimental Pretest/Posttest; each, 5 days/wk. for6– Visual-motor skills,(VMI) pretest to posttest scores with p value
n = 15, 66%Male, 34%Female 20 weeks; + Typical Social skills(SSRS)Sensory < 0.05in fine motor (PDMS-2
Inclusion Criteria: therapy services processing(SP)(Client composite score)visual motor (VMI
● SPD: Sensory Processing/ Factors &Performance composite std. score)social skills (SSRS
Sensory Modulation Skills) – Social skills std. score)No significant
● Age: 3–6 yrs. changes noted in the Sensory Profile
No control group subtests
Hall and Case-Smith Level IV TL2×/day, 20–30 min. Visual-motor skills(VMI,Significant changes from pretest to 21 Good
(2007) Multiple Single Subject Series each for8 weeks+Sensory ETCH)Sensory Processing posttest scores noted in visual &
n = 10 (12), 90%Male, 10%Female Diet;Some w/OT (SP)(Client Factors motor scales of VMI, and lowercase,
Inclusion Criteria: &Performance Skills) number, and total legibility scores of
● SPD: Sensory Processing the ETCH,w/p value < 0.05Significant
● Age: 5–11 yrs. improvements noted in 9 of the 14
No control group subtests of the Sensory Profile, w/p
value <_ 0.05 in:Auditory
processingTouch
processingMultisensory
processingOral sensory
processingBody position &
movementEmotional
responsesModulation of visual input
affecting emotional
responsesEmotional/social
responsesBehavioral outcomes
Francis (2011) Level IV TLP1×/day,15 min. Person engagement(Video Increased person and/or activity 19 Good
Multiple Single Case Studies each,5 days/wk. recording/analysis; engagement in 6/10 students (video
n = 10 (12), 42%Male, 58%Female for16 weeksOther Profound Education analysis)8/12 students had higher
Inclusion Criteria: servicesnot reported Curriculum Profile; level of achievement compared to the
● SPD: Sensory Modulation Questionnaire) previous year (s) as reported in
(difficulties tolerating or con- (Performance Skills) Profound Education Curriculum profile
centrating on sounds)
● Age: 9–19 yrs.
No control group
JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION
(Continued )
9
10
Table 3. (Continued).
Level of evidence/study design/ Outcomes related to Downs & Black Quality
Author/Year participants/inclusion criteria SBI & other services participation in education Results Index
Gee et al.,(2014) Level IV TLP2×/day, 15 min./each, Auditory SOR(SensOR Based on the SensOR Scales, 16 Fair
ABA Single Subject Case- 5 days/wk. for 10 weeks Scales; SPM)(Client Factors) participant showed increased positive
controlled +OT, ST, Spec. Ed., ABA behaviors (tolerating & accepting
n = 1, 100% Female auditory stimulus), and decreased
Inclusion Criteria: negative behaviors (covering ears,
R. F. VILLASENOR ET AL.
Schoen et al. (2015) Level IV iLs 1×/day, 60 min., Individual parent goals: Based on the VAS, significant 18 Fair
Single subject non-concurrent 5 days/wk. for 8 weeks (VAS) Follows verbal difference was noted from baseline
multiple baseline AB design (SBI only) directions, Follows multi- goal performance to intervention
n = 7, 57% Male, 43%Female step verbal directions, phase across all participants, with p
Inclusion Criteria: Follows directions in a value at <0.001; In the BASC-2,
timely manner, Completes attention, social, and communication
● SPD: Sensory Modulation morning routine w/out subtests were not significant; In the
(tactile/auditory incident, Completes ABAS-II, statistically significant
overresponsivity, sensory spelling work in a timely changes were noted in
craving, sensory manner, Completes communication subtest with p
underresponsivity) writing assignments w/out value = 0.02; subtests in social was
● Age 4–18 emotional incident, Gets not significant
No control group dressed in morning
without incident, Has
legible handwriting
(Performance Skills &
Occupation-based)
Note. AIT = Auditory Integration Training; TLP = The Listening Program; iLs = Integrated Listening Systems; TL = Therapeutic Listening; ATEC = Autism Treatment Evaluation Checklist; ABAS–
II = Adaptive Behavior Assessment System; BASC-2 = Behavior Assessment System for Children; DAP = Draw a Person Test; VAS = Visual Analog Scale; VMI = Visual Motor Integration;
SensOR Scales = Sensory Over-Responsivity Scale; SPM = Sensory Processing Measure; SP = Sensory Profile; SSP = Short Sensory Profile; ABC = Aberrant Behavior Checklist; SRS = Social
Responsiveness Scale, SSRS = Social Skills Rating System.
JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION
11
12 R. F. VILLASENOR ET AL.
Short Sensory Profile (Brockett et al., 2014). The potential for confounding variables
existed as occupational therapy services or other interventions were not explicitly stated
in two of the three studies (Al-Ayadhi et al., 2013; Brockett et al., 2014).
Al-Ayadhi et al. (2013) conducted a Level III pretest/posttest design study using AIT
with a sample of 72 children with moderate-to-severe ASD. Findings suggested improve-
ments in sociability as result of AIT as measured by the Autism Treatment Evaluation
Checklist (ATEC). The authors also reported improvements in social awareness, social
cognition, and social communication skills based on the Social Responsiveness Scale (SRS)
at three and six months follow-up. Both results were statistically significant with p < 0.05.
Vadivel and Missal (2014) examined the effectiveness of AIT using a Level II pretest/
posttest quasi-experimental design with a control group of six children with ASD. The
control group consisted of OT, sensory integration therapy, and special education.
Improvements in all components of the ATEC, consisting of speech/language/commu-
nication, sociability, sensory and cognitive awareness, health/physical/behavior, were
reported in both groups with p < 0.05 except the speech/language/communication com-
ponent of the control group which was not significant (p < 0.10). The study did not use a
true Berard AIT device but a modified AIT device from Addonuss Electronic Research
Technologies in India which utilized ordinary integrated circuit and Indian-based elec-
trical and electronics components.
Brockett et al. (2014) performed a Level IV retrospective chart review on 54 children
with a variety of diagnoses including autism, auditory processing disorder, and attention-
deficit disorder. In all the areas pertaining to sensory modulation, positive results of the
AIT intervention were reported based on the Short Sensory Profile with p < 0.01.
Researchers reported large effect sizes, sustained at three and six months follow-up in
auditory filtering (0.88), and visual/auditory sensitivity (0.86) based on Cohen’s (1988)
classified effect sizes.
motor skills. A variety of assessment tools were utilized including the Visual Analog
Scale (VAS), Adaptive Behavior Assessment System-II (ABAS-II), and the Behavior
Assessment System for Children-2 (BASC-2; Table 2). Significant differences were
noted from baseline performance to the intervention phase for all participants with
p < 0.001 based on the VAS. Additionally, the ABAS-II and the BASC-2 was utilized as
exploratory outcome measures in the study. Based on Cohen’s (1988) classification, a
moderate effect size (0.58) with p < 0.02 was reported in the communication subtest of
the ABAS-II. The BASC-2 clinical subtest on attention did not produce significant
results. The presence of therapy services including occupational therapy was an
exclusion criterion for this study which decreased potential cointervention bias.
Based on the Quality Index score, the Schoen et al. (2015) study scored an 18 (fair
quality). Limitations of the study were limited sample size recruited through conve-
nience sample, potential intervention bias as treatment occurred at both home and
office settings, and self-reported bias in the parent completed outcome measures
(Table 3).
Therapeutic listening
Therapeutic Listening was developed by occupational therapist, Sheila Frick, to improve
an individual’s attention, timing, and sequencing of motor skills, irritability and mood,
perception and navigation of space, regulation of energy levels, and motor planning skills
(Vital Links, 2017). Therapeutic Listening uses electronically modified music to comple-
ment a sensory-based or sensory integration treatment approach (Vital Links, 2017).
Therapeutic Listening consists of listening to modulated music and SAMONAS CDs
30 min twice daily for 3–6 months depending on the listener’s needs.
Therapeutic Listening was utilized in two studies in this systematic review (Bazyk
et al., 2010; Hall & Case-Smith, 2007). The Quality Index scores were both 21 (good
quality; Table 2). Limitations of the studies included the use of convenience sampling, a
heterogeneous sample with participants who had a variety of medical diagnoses, lack of
a control group, and mixed frequencies of occupational therapy services or no occupa-
tional therapy services. In both studies, Therapeutic Listening was provided in con-
junction with traditional school-based occupational therapy services for most study
participants.
Bazyk et al. (2010) examined the effects of Therapeutic Listening with 15 preschoolers
with developmental disabilities using a Level III preexperimental pretest/posttest study
design. Hall and Case-Smith (2007) examined the effects of Therapeutic Listening using a
multiple single-subject series design with 10 children with visual motor delays and SPD.
Both Therapeutic Listening studies used standardized measures to evaluate performance
skills that potentially contribute to a child’s participation in education such as fine motor,
visual motor, and social skills.
After implementation of Therapeutic Listening, children’s social skills improved sig-
nificantly as measured by the Social Skills Rating System, grasp and visual motor skills
improved as measured by the Peabody Developmental Motor Scale-2nd edition (Folio &
Fewell, 2000), and handwriting skills improved as measured by the total legibility subscale
from the Evaluation Tool of Children’s Handwriting (Amundson, 1995), all with p < 0.05.
The Developmental Test of Visual Motor Integration (VMI; Beery, Buktenica, & Beery,
14 R. F. VILLASENOR ET AL.
2004) composite score increased significantly in one Therapeutic Listening study (Bazyk
et al., 2010), but in Hall and Case-Smith (2007), only the VMI visual perception subscale
reached significance at p < 0.05. Improvements in children’s sensory processing as result
of the program were mixed in both studies. Hall and Case-Smith (2007) found children
improved in sensory processing on 8/14 subtests (p < 0.05) as measured by the Sensory
Profile (Dunn, 1999); however, Bazyk et al.’s (2010) study reported no significant changes
in any Sensory Profile subtests.
measured using the Sensory Over-Responsivity Scales (SensOR Scales) and the Sensory
Processing Measure (SPM). p values were not available in the studies.
Discussion
Children with challenges in sensory processing and integration are at risk of experiencing
difficulties participating in education due to occupational performance limitations related
to challenges processing and interpreting sensory information in the context of a sensory-
rich school environment. Many interventions exist for school-based occupational therapy
practitioners to select in supporting children’s participation in education. School-based
therapists must use thoughtful procedural reasoning in determining interventions that will
best meet individual children’s educational objectives.
Sound-based interventions continue to be utilized in occupational therapy practice for
children with challenges processing and integrating sensory information. This systematic
review sought to examine the current evidence related to sound-based interventions for
supporting children’s participation in education for this population. No study explicitly
measured participation-level outcomes in education. The findings of this review suggest
limited preliminary published evidence to support the use of SBI’s to improve perfor-
mance skills and client factors relevant to participation in education for children with
challenges in sensory processing. Evidence is limited due to methodological limitations
within the studies, and some inconsistency in findings across individual studies (USPSTF,
2016). Published studies are increasing, including those with higher level experimental
designs than identified in previous SBI systematic reviews by Sinha et al. (2006) and Sinha
et al. (2011).
The 10 included studies examined four different SBI programs: Auditory Integration
Training, Integrated Listening Systems, Therapeutic Listening, and The Listening
Program. The Auditory Integration Training studies suggested overall improvements in
children’s sociability, social responsiveness, and sensory modulation specifically auditory
filtering and visual/auditory sensitivity. The Integrated Listening Systems study reported
improvement in children’s communication skills. The Therapeutic Listening studies
reported improvements in children’s social skills. Finally, the Listening Program studies
reported improvements in sensory modulation as well as engagement with others and
improved IEP objective achievement.
ASD with decreased social skills spent approximately 30% of their recess time engaged in
solitary play as compared to their typically developing peers who spent about 9% of their
recess time in solitary play. Social skills also predicted consistent sports participation for
both children with and without disabilities (Marquis & Baker, 2015) and in turn, children
participating in after school sports and clubs demonstrated higher social skills (Howie,
Lukacs, Pastor, Reuben, & Mendola, 2010). Given the consistent link between social skills
and educational engagement across children with a variety of needs, future research of SBI
programs explicitly measuring educational participation outcomes concurrent with social
skill outcome measurement is warranted to determine SBIs potential contributions to
educational participation through social skill development.
Limitations
The included studies in this systematic review have inherent limitations which should be
considered when evaluating the evidence for application to occupational therapy practice.
First, many studies utilized descriptive or discriminative measures (e.g. Sensory Profile) in
a manner for which the tool was not designed as pre/post-outcome measure and thus
findings must be interpreted cautiously. Additionally, in many studies given the lack of a
control group, randomization of treatment, and small sample sizes, findings cannot be
directly attributed to the generalizable population. Additionally, only two of the 10 studies
controlled for co-interventions with at least half of the studies including participants who
received therapy services in addition to the SBI. Lastly, although researchers consulted
with an experienced health science librarian to develop a thorough list of search terms for
all databases, 21 articles were found through hand searches.
JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 17
Conclusion
No single study in this systematic review explicitly measured participation-level outcomes in
education as a result of a SBI for children with challenges processing and interpreting sensory
information. However, 10 studies examined outcomes of relevance to the educational
participation of children. The 10 studies indicate there is currently limited evidence in
using SBIs supporting outcomes related to participation in education based on Level II to
Level IV studies. Individual studies reviewed did report preliminary positive effects of SBI’s
on children’s communication, social, fine motor, visual motor skills, sensory modulation,
following directions, and completing a task suggesting the potential for SBIs to support
education-related occupations for children with sensory processing and integration chal-
lenges. The effects of SBIs on improving children’s sensory processing were mixed with three
of five studies reporting positive effects, and two of five reporting no significant
18 R. F. VILLASENOR ET AL.
Declaration of interest
We have no conflict of interest to declare.
Notes on contributors
Romana F. Villasenor, Occupational Therapy Dept., Creighton University, 356 County Center Rd.
White Plains, N.Y. 10603, [email protected]
Sarah L. Smith is now at Occupational Therapy Dept., University of New Hampshire, 119 Hewitt
Hall, Durham, N.H. 03824, [email protected]
Vanessa D. Jewell, Occupational Therapy Dept., Creighton University, 2500 California Plaza,
Omaha, NE 68178, [email protected]
ORCID
Sarah L. Smith http://orcid.org/0000-0002-8793-0934
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