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The American Journal of Occupational Therapy The American Journal of Occupational Therapy

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iors frequent selfstimulating and stereotypic behaviors canalso interfere with participation and engagement in meaningful occupations These behaviors interfere with an individual ID: 363163

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The American Journal of Occupational Therapy iors, frequent self-stimulating and stereotypic behaviors canalso interfere with participation and engagement in mean-ingful occupations. These behaviors interfere with an indi-vidualÕs ability to communicate, learn and interact adap-tively with the environment (Storey, Bates, McGee, &Dycus, 1984) and are incompatible with the establishmentof new skills (Iwasaki & Holm, 1989).gy of these behaviors, several theories have been developedto explain why they may occur. Storey, Bates, McGhee, andDycus (1984), offer two possible explanations for self-stimulating behaviors. The Þrst explanation is that thesebehaviors are inherently reinforcing by providing tactile,proprioceptive, and sensory stimulation to an extent, whichis not achieved through conventional adaptive behavior. Analternate explanation is that self-stimulating behaviors areused to help regulate sensory information for people whootherwise have difÞculty receiving and interpreting thisright, Bittick, and Fleeman (1981) suggest that self-injurious behavior is a form of self-stimulation as well. Theypostulate that persons with multiple handicaps are limitedin their ability to explore and interact with their environ-ment which, when combined with initial central nervoussystem dysfunction, leaves them with some degree of senso-deprivation. This sensory deprivation then leads tobreakdown in the central nervous systemÕs ability to processsensory stimuli and consequently causes Òfurther depriva-tion, perceptual distortion and stimulus hunger,Ó whichmay eventually cause self-stimulation as a way of compen-sation for the lack of natural, environmental stimulation(Bright et al., p. 170).wasaki and Holm (1989) agree that the common fac-tor among many studies into the etiology of stereotypicbehaviors is a dysfunction of the sensory processing system,which manifests itself as a sensory deÞciency or a sensoryerload. The individual with sensory processing dysfunc-tion uses self-stimulation in order to either compensate forestricted sensory input or to avoid over-stimulation. Theavoidance, making it difÞcult to identify its speciÞc func-tion (Iwasaki & Holm).The neurological mechanisms, which precipitatestereotypical behaviors in people with mental retardation,may involve one or more of the sensory systems (Berkson &enport, 1962). Berkson and Mason (1963) believe thatit is likely that tactile, vestibular, and kinesthetic systems aremainly involved. Berkson and Mason found that stereotyp-ic behaviors decreased signiÞcantly when locomotion andmanipulation of environment were increased. This indi-cates that changes in sensory input may reduce the inci-dence of self-stimulating behaviors. Effectively reducingself-injury and self-stimulation raises the potential forincreased participation and independence, as well as thecreation of more productive educational and therapeuticenvironments. The common theme in the literature thatthe cause of these behaviors is sensory in nature provides ausing sensory integration techniques.The use of sensory techniques for the purpose ofdecreasing self-stimulating or self-injurious behaviors inpeople with mental retardation was Þrst explored by Lemkestimulation was effective in decreasing the self-injuriousbehaviors of a 19-year-old woman diagnosed with mentaletardation. Since this study, a number of others haveassessed the effects of sensory stimulation on self-stimulat-eisman (1993) reviewed articles that claimed toesearch the effects of sensory integration intervention oneducing self-stimulating behaviors of adults with develop-mental disabilities (Bright et al., 1981; Dura, Mulick, &mmer, 1988; Favell, McGimsey, & Jones, 1978; Favell,msey, & Schell, 1982; Hirama, 1989; Lemke, 1974;ason & Iwata, 1990; Mulick, Hoyt, Rojahn, &Schroeder, 1978; Wells & Smith, 1983). Reisman reportedsions. According to Reisman this included (1) lack of a con-trol group, (2) activities were provided without initialassessment of the clientsÕ sensory needs, and (3) the use ofvisual and auditory medium may have provided over stim-ulation rather than a balanced sensory diet. Reisman con-cluded that use of a sensory integration approach has beenmisrepresented as a treatment approach in the efÞcacy liter-ature. In a more recent review, Miller (2003) outlines gainsmade in the understanding of behavioral and neurophysio-logic differences in individuals with and without sensoryprocessing dysfunction and efÞcacy work that is currentlyin process to address limitations identiÞed by Reisman(1993) a decade earlier. Miller identiÞes the question Òdoessensory integration therapy work?Ó as na•ve and recom-mends that current research focus on Òwhat effects areevident for a speciÞc group of individuals receiving a specif-ically deÞned intervention compared to another interven-tion?Ó (p. 34). Further examination of the efÞcacy andapplication of sensory integration intervention for thetreatment of self-stimulating behaviors in individuals withdevelopmental disabilities is warranted. It is also necessaryto clarify what comprises sensory integration intervention. Sensory Integration Intervention Although originally designed to treat children with learningdisabilities and sensory integrative dysfunction, the sensoryintegration frame of reference has been applied by occupa-tional therapists to other populations (Smith Roley,lanche, & Schaaf, 2001) including children and adultswith autism (Zissermann, 1992) and mental retardation(Arendt, MacLean, & Baumeister, 1988) and adults withprofound handicaps (Reisman, 1993).The difference between using the sensory integrationframe of reference and techniques for intervention versussensory stimulation requires clariÞcation. Sensory integra-tion uses planned, controlled sensory input (somatosenso-, vestibular, proprioception, etc.) in accordance with thechildÕs neurological needs, which usually elicit a sponta-neous adaptive response that integrates the senses. Thepurpose is to create a state of arousal, attention, and sensi-tivity to environmental stimuli that is optimal for learning(Ayres, 1972).ttenbacher (1991) described sensory integration as amultifaceted intervention approach that is difÞcult toeduce to its component parts or to deÞne operationally. Asummary of characteristics of sensory integration treatmentwas developed by Kimball (1988) and elaborated over time(Bundy, 2002; Kimball, 1999; Miller & Kinnealey, 1993)included the following characteristics: active participationthe individual being treated, client directed activity,treatment that is individualized, activities that are purpose-ful and require an adaptive response, an emphasis on senso-stimulation, treatment based on improving underlyingneurological processing, and organization and treatmentprovided by a therapist trained in sensory integration.eisman (1993) elaborated on KimballÕs characteristicswhen using sensory integration for reducing self-stimulato-and self-abusive behaviors in people who were severelyand profoundly disabled. She clariÞed that the characteris-tic of self-direction of treatment by people with severe orprofound handicaps must be broadened to includeesponding to activities offered with communication ofpreference, lack of withdrawal, eye contact, vocalizations ofpleasure, or being relaxed, alert, or smiling (Reisman).The purpose of this study was to compare the effects ofsensory integration intervention and a control interventionon self-stimulating and self-injurious behaviors in childrenand adolescents with severe and profound pervasive devel-opmental disorder and mental retardation. It is assumedthat a reduction of these behaviors will contribute to a calmalert state, which will allow for learning functional skills andsocial participation. We hypothesized that sensory integra-tion intervention will reduce the frequency of engagementin self-stimulating and self-injurious behaviors compared toa control intervention, in children and adolescents withpervasive developmental disorder and mental retardation.The location of the study was a private, nonproÞt, residen-tial facility for children and adults with mental, emotional,physical, and/or developmental disabilities. The facilityhouses approximately 600 clients and provides day pro-gramming and residential accommodations. Subjects wereecruited from individuals at this facility diagnosed withpervasive developmental disorder and/or severe or profoundmental retardation who regularly engaged in self-stimulat-ing, stereotypical, or self-injurious behaviors. The studyconsisted of seven subjects, four boys and three girls, 8Ð19ity and all but one resided there as well. Informed consentwas obtained from the legal guardians of all potential sub-jects prior to participation. In addition, each guardian andsubject was informed that they could withdraw from thestudy at any time without penalty.Intervention Each subject was assessed using The Sensory Integrationentory RevisedÑFor Individuals With Developmentalisabilities (Hanschu & Reisman, 1992), which was com-pleted by the teacher. The Inventory has four sections: tac-tile, vestibular, proprioception, and general reactions. Ineach section behaviors suggestive of sensory needs are listedas well as the self-stimulatory or self-injurious behaviorassociated with that system. The evaluator indicateswhether or not these behaviors have been observed. A pro-Þle of sensory strengths and needs and associated self-inju-rious and self-stimulating behaviors is elicited through thisprocess that provides a guideline for treatment. The Sensorytegration Inventory RevisedÑFor Individuals Withelopmental Disabilities was designed to assess individu-als with developmental disabilities to decide if they wouldbeneÞt from a sensory integration treatment approach.ince these behaviors are not addressed in standardizedassessments and the behaviors themselves interfere with for-mal test taking skills, this is an effective and appropriatetool for this population and for use in this study. This tool,along with the occupational therapy evaluation, providedinformation on the subjectÕs sensory processing abilities andConsistent with sensory integration theory, interven-tions were designed to incorporate enhanced sensation, uly/August 2005, Volume 59, Number 4 with controlled sensory input to elicit adaptive responses inan environment that offered experiences that met each sub-jectÕs individual needs in order to enhance their processing(Ayres, 1972, Bundy & Murray, 2002, Smith Roley,lanche, & Schaaf, 2001) During the sensory integrationintervention condition, the subject engaged in sensorybased treatment that included a variety of tactile, proprio-ceptive and vestibular input, based on their unique sensoryneeds. This is distinguished from sensory stimulation pro-grams in that treatment was individualized based on assess-ment results, and the type or types of sensation and specif-ic activities used varied depending upon the subjectsÕesponses and desired outcome. Vestibular, tactile, and pro-prioceptive based activities were primarily used, which isconsistent with accepted characteristics of intervention(Bundy, 2002; Case-Smith, 2001; Smith Roley et al.,2001). Responses to intervention were interpreted by thetherapist and the sensory input was altered or continuedbased on the subjectÕs response. Adaptive responses werebehavioral and affective such as calming, indication of con-tentment or pleasure, indications for continuing input suchas reaching, smiles, eye contact, and reduction of purpose-less activity. The purpose was to provide the appropriateamount and type of sensory input to allow the subject to befree to organize a more adaptive response. This is consistentwith AyresÕ central principle of the utilization of a sensoryintegration approach. SpeciÞcally, the therapistsÕ ability tovide planned and controlled sensory input with usual-lyÑbut not invariablyÑeliciting a related adaptiveesponseÓ (Ayres, 1972, p. 114).The control intervention consisted of tabletop activitieselated to each clientÕs speciÞc individualized education pro-gram goals. Tabletop tasks included one or more of the fol-lowing: Sorting tasks such as sorting by color or shape, writ-ing activities, puzzles and/or placing pegs in a peg board.The study took place over a 4-week period. During the2nd and 4th weeks, a sensory integration approach wasemployed during 30-minute treatment sessions, daily, Þvetimes per week. During the 1st and 3rd weeks a 30-minutecontrol session was implemented using the same scheduleand at the same time. Both sensory integration and tabletopinterventions were individual sessions and took place in theoccupational therapy treatment room at the facility.Each subject was videotaped performing their routine schoolactivities for 15 min before the start of each intervention ses-sion. The therapist then took the subject from the classroomto the treatment room. Once in the treatment room, thetherapist provided 30 min of SI intervention or tabletop(control). Following intervention, the client returned to hisor her classroom. He or she was videotaped for 15 minimmediately after returning to the classroom and again for15 min 1 hour after he or she returned to the classroom.The target behaviors were self-stimulating or self-injurious behaviors. They were deÞned as repetitive, fre-bodily harm. Behaviors were speciÞc to each client and hadbeen identiÞed through the assessment using the Sensoryntegration Inventory RevisedÑFor Individuals With Dev-elopmental Disabilities. Behaviors included biting self, hit-ting self, poking self, hand ßapping, ßicking objects, com-pulsively chewing objects or tapping them on teeth, headbanging, and repetitious vocal sounds.The 15-min videotape segments were analyzed to deter-mine the frequency of self-stimulating and self-injuriousbehaviors using a model described by Alberto and Troutman(1999). The researcher recorded whether or not the clientengaged in any sort of self-stimulating or self-injuriousbehaviors during continuous 15-sec intervals. For each 15-sec interval, a plus (+) sign was recorded if self-stimulatingor self-injurious behaviors were observed and a minus (Ð)sign was recorded if there were none. The total number ofplus signs were divided by the total number of 15-sec inter-als for each of the three time periods (before, immediatelyafter, and 1 hour after intervention) to provide a percentageperiod (Alberto & Troutman, 1999). A timing device wasused that beeped every 15 sec to facilitate accuracy of scor-ing. During the videotaping 1 hour after returning to theclassroom, the subjects followed their regular class schedulesand were involved in one or more of the following activities:tabletop tasks, gross motor play, eating lunch, eating snack,unstructured play, watching a video, hearing a story, art,music, gym, swimming, or resting. Classroom activitiesemained on a consistent schedule from week to week.corroborate the results of the analysis and to deter-mine if there was carryover of results into the classroomenvironment, the teacher for each subject rated the fre-the frequency of repetitious vocal sounds at the end of eachday for the 4 weeks of the study. For each subject, theteachers answered the question ÒDid the client engage inself-stimulating or self-injurious behavior?Ó and ÒDid theclient exhibit repetitious vocal sounds?Ó using a Likert scalewith 1 = never, 2 = rarely, 3 = sometimes, 4 = often, andA repeated measures analysis of variance (ANOVA) andBonferroni post hoc test were used to analyze the mean dif-ferences in the percentage of self-stimulating or self-injurious The American Journal of Occupational Therapy behaviors for the sensory integration versus control (table-top activities) intervention weeks and for each daily 15-minvideotape assessment before, immediately after, and 1 hourafter intervention (Figure 1). Mean differences in the per-frequency occurring 1 hour after intervention was assessedusing a repeated measures ANOVA comparing sensoryintegration and control weeks 1Ð4 (Figure 2).imilarly, mean differences in teacher ratings of self-stimulating behavior and repetitious vocal sounds were ana-lyzed using a repeated measure ANOVA on ranks. AnANOVA on ranks method was chosen given the nonpara-metric nature of the survey questions used to assess teacherperception of self-stimulating behavior frequency. Likewise,a nonparametric Spearman rank order correlation was usedto determine the relationship between teacher ratings ofself-stimulating behavior frequency and investigator obser-ations of self-stimulating behavior frequency (Figure 3).assure the interrater reliability of the videotape self-stimulating and self-injurious behavior scoring, three occu-pational therapists not involved with the study were trainedin the observation of behaviors and scoring of the video-taped sessions. The three reviewers rated videotape sessionsindependently and were blinded to the time and conditionof taping. Approximately 10% of the 440 videotaped seg-ments were scored by the three reviewers and comparedwith the original scoring data. Pearson correlation coefÞ-cients between the three reviewers and the original scoringdata were greater than 0.92. SigniÞcance for all analyses waswas hypothesized that sensory integration interventionwill reduce the frequency of engagement in self-stimulatingand self-injurious behaviors compared to a control inter-ention in children and adolescents with severe pervasivedevelopmental delay and mental retardation. Figure 1shows the percentage of self-stimulating behaviors during uly/August 2005, Volume 59, Number 4 60400%SSBSI InterventionControlpre-txpost-0 minpost-60 min 1 hour after (post-60 min) either sensory integration (SI-solidcircles) intervention or tabletop activities (control-open circles). controlSIcontrolSI Figure 2. The percent change (%sensory integration (SI weeks 2 and 4) interventions. indicating a decrease in SSB. Values are means and standard frequency during tabletop activity (control) and sensory integration(SI) intervention weeks. The teacher SSB frequency scores equateto 1 = never, 2 = rarely, 3 = some, 4 = often, and 5 = constant. ÑThe relationship between teacher ratings of SSB frequency andinvestigator observations of SSB frequency 60 min after control orSI intervention. Values are means and standard errors. 0.40.6A.B. the 15-min periods before (pretreatment), immediatelysensory integration (SI) intervention or tabletop activities(control). The solid circles represent mean and standarderror data from weeks 2 and 4 when the subjects receivedsensory integration intervention and the open circles repre-sent data from weeks 1 and 3 when the subjects receivedtabletop activities as a control. The percentage of self-stim-ulating behavior was reduced 1 hour after sensory integra-tion intervention when compared to the pretreatment andpost 0 min percentages (behavior 1 hour after sensory integration intervention, wecompared the change in self-stimulating behavior frequen-cy occurring 1 hour after intervention across the 4 weeks.igure 2A shows the individual results for the change inthese behaviors 1 hour after integration activities for weeks1 through 4. Figure 2B shows the mean data for the percentchange in self-stimulating behaviors with values greaterthan zero indicating an increase in behavior frequency andalues less than zero indicating a decrease in behavior fre-quency. Self-stimulating behaviors decrease by an average of11 ±5% one hour after sensory integration intervention(weeks 2 and 4) when compared to a 2 ±4 % increase 1hour after tabletop intervention (weeks 1 and 3) (addition, the frequency of self-stimulating behaviorsdeclined from weeks 1 to 4 (injurious behavior frequency and repetitious vocal soundfrequency for the control and sensory integration condi-tions are shown in Figure 3A. Teachers reported fewer self-stimulating and repetitious vocal sound behaviors duringthe sensory integration weeks compared to the control)iven the similarity in the self-stimulat-ing and repetitious vocal sound results, the data were com-bined in Figure 3A. The primary objective for collectingthe teachersÕ ratings of self-stimulating behavior was todetermine whether the teachersÕ perceptions of self-stimulating behavior frequency related to the investigatorobservations of self-stimulating behavior frequency. Apearman rank order correlation was used to determinethe relationship between teacher ratings and the investiga-tor observations of self-stimulatory behaviors. Figure 3Bshows a moderate but signiÞcant correlation (0.001) between the frequency of behaviors scored by theinvestigators 1 hour following the sensory integration orcontrol intervention, and the teacher ratings of self-stim-ulating and repetitious vocal sound frequency combined.These results further support the reliability of the methodused by the investigators to determine self-stimulatorybehavior frequency.Clinical research has shown that self-injurious and self-stimulating behaviors have a tendency to interfere with a per-sonÕs ability to function independently and therefore mustoften be addressed before any signiÞcant increase in functionis accomplished through intervention (Harris & Wolchick,1979). This study found the frequency of self-stimulatingand self-injurious behaviors remained relatively the samebefore and after both the sensory integration and controlinterventions. However, 1 hour after sensory integrationintervention the frequency of self-stimulating behaviors= 0.01, Figure 1). Figure 2 illustrates that duringeeks 2 and 4, when participants received sensory integra-tion intervention, self-stimulating behaviors decreased by anaverage of 11% (= 0.02). In contrast, during weeks 1 and3, when participants were engaged in tabletop activities,self-stimulating behaviors increased by an average of 2% onehour following intervention. Figure 2 also shows a decline inself-stimulating behaviors over the 4-week period in spite ofthe intervening control week (The results of this study support the Þndings of severalother researchers (Bonadonna, 1981; Bright et al., 1981;lowing sensory integration intervention however, after alatency period, they report a reduction in self-stimulatingand self-injurious behaviors. In addition, some researchers(Bonadonna; Case-Smith & Bryan, 1999) found an overalldownward trend of behaviors over time. Case-Smith andyan reported positive results when intervention occurreder a 10-week period. The results of this study conducteder four weeks with only 2 weeks of sensory integrationintervention support these Þndings. The Þndings of thesestudies suggest that future research examine the long-termeffects of more extensive intervention.The independent rating of behavior by the classroomteachers working with the subjects corroborated the obser-ations of the therapist (Figure 3). This suggests that reduc-tion of self-stimulatory and self-injurious behavior is carrieder into the classroom. The purpose of occupational ther-apy as a related service in schools is to enable students tobeneÞt from their educational placement. The results pro-vide evidence that sensory integration intervention waseffective overall in reducing self-stimulating and self-injurious behaviors in the classroom, which interfere withfunction and participation. Activities that were rich inestibular, tactile, and proprioceptive input that speciÞcallyaddressed the individualÕs sensory processing needs weremost beneÞcial in reducing the maladaptive behaviors whencompared to the control conditions. By incorporating inter-ention that used sensory integration, better organization of The American Journal of Occupational Therapy adaptive responses to input appeared to enhance the sub-jectÕs general behavior organization.Limitations of this study include the small sample size,use of a single clinical site and lack of psychometrics for theensory Integration Inventory RevisedÑFor Individualsith Developmental Disabilities. Continued research isindicated in this area to further examine the effectiveness ofsensory integration intervention on reducing self-stimulatingand self-injurious behaviors and increasing positive partici-pation in educational and work settings of people withsevere and profound mental retardation. Future studies areneeded in the following areas: (1) employing a larger sam-ple size in order to increase the probability of signiÞcantesults, (2) examining the results of sensory integrationintervention over a longer period and its inßuence on pro-moting positive behaviors as well as reducing self-stimulatingand self-injurious behaviors, and (3) researching the effec-tiveness of nontraditional models of intervention such ashaving an appropriate sensory diet implemented withindaily routines by caretakers to counteract the tendency forself-stimulatory and self-injurious behaviors thereby facili-tating continuous attending, functional development andparticipation in society.The authors would that to thank the staff, students, andccupational Therapy Department at Woods Services fortheir support and guidance. In addition, the authors wouldthat to recognize the contributions of Karen Kile, MS,TR/L, and Ellen Gilfor, MS, OTR/L, to the reliabilityand validity of the research project.Alberto, P. A., & Troutman, A. C. (1999). pper Saddle River, NJ: Prentice-Hall.Arendt, R. E., MacLean, W. E., & Baumeister, A. A. (1988).ritique of sensory integration therapy and its application inmental retardation.merican Journal on Mental Retardation,Ayres, A. J. (1972). ensory Integration and Learning Disorders.Los Angeles: Western Psychological Services Publishers andson, G., & Davenport, R. K., Jr. (1962). Stereotyped move-ments of mental defectives I. Initial survey. American Journalof Mental DeÞciency, 66,son, G., & Mason, W. (1963). Stereotyped movements ofmental defectives III. Situation effects. American Journal ofental DeÞciency, 75Bonadonna, P. (1981). Effects of a vestibular stimulation programon stereotypic rocking behavior. American Journal ofccupational Therapy, 35,right, T., Bittick, K., & Fleeman, B. (1981). Reduction of self-injurious behavior using sensory integrative techniquesmerican Journal of Occupational Therapy, 35,undy, A. C. (2002). The process of planning and implementingintervention. In A. C. Bundy, S. J. Lane, & E. A. Murray(Ed.), ensory integration theory and practice(pp. 211Ð225).hiladelphia: F. A. Davis.undy. A. C., & Murray, E. A. (2002). Sensory integration: A.ean AyresÕ theory revisited. In A. C. Bundy, S. J. Lane, & E.A. Murray (Eds.), ensory integration theory and practice(pp.3Ð34). Philadelphia: F. A. Davis.Case-Smith, J. (2001). ccupational therapy for childrenhiladelphia: Mosby.Case-Smith, J., & Bryan, T. (1999). The effects of occupationaltherapy with sensory integration emphasis on preschool-agechildren with autism. American Journal of OccupationalTherapy, 53ura, J. R., Mulick, J. A., & Hammer, D. (1988). Rapid clinicalevaluation of sensory integrative therapy for self-injurious. Mental Retardation, 26ell, J. E., McGimsey, J. F., & Jones, M. L. (1978). The use ofphysical restraint in the treatment of self-injury and as a pos-itive reinforcement. Journal of Applied Behavior Analysis, 11ell, J. E., McGimsey, J. F., & Schell, R. M. (1982). Treatmentof self-injury by providing alternate sensory activitiesnalysis and Intervention in Developmental Disabilities, 2,nschu, B., & Reisman, J. E. (1992). ensory Integrationentory RevisedÑFor Individuals With Developmentalugo, MN: PDP Press.arris, S. L., & Wolchik, S. A. (1979). Suppression of self-stimulation: Three alternative strategies. Journal of Appliedehavior Analysis, 12, elf-injurious behavior: A somatosensory treat-ment approach. ethesda, MD: Chess Publications.wasaki, K., & Holm, M. B. (1989). Sensory treatment for theeduction of stereotypic behaviors in persons with severeccupational Therapy Journal ofesearch, 9The issue is integration not sensory.merican Journal of Mental Retardation, 92,Kimball, J. G. (1999). Sensory integration frame of reference:ostulates regarding change and application to practice. In P.Kramer & J. Hinojosa (Eds.), ames of reference for pediatricoccupational therapy(pp. 169Ð204). Philadelphia: Lippincottilliams & Wilkins.Lemke, H. (1974). Self-abusive behavior in the mentally retard-. American Journal of Occupational Therapy, 28,ason, S. A., & Iwata, B. A. (1990). Artifactual effects of senso-y-integrative therapy on self-injurious behavior. Journal ofpplied Behavior Analysis, 23,errill Advanced Studies Center. (2002). elf-injurious behavior.etrieved September 9, 2002, from http://merrill.ku.edu/ntheKnow/sciencearticles/selÞnjuriousbehavior.htmliller, L. J. (2003). mpirical evidence related to therapies for sen-sory processing impairments. Retrieved January 15, 2004, fromhttp://www.nasponline.org/publications/cq315sensory. uly/August 2005, Volume 59, Number 4 iller, L. J., & Kinnealey, L. J. (1993). Researching the effective-ness of sensory integrationensory Integration Special Interestection Quarterly, 11lick, J. A., Hoyt, P., Rojahn, J., & Schroeder, S. R. (1978).eduction of a Ònervous habitÓ in a profoundly retardedouth by increasing toy play. ournal of Behavior Therapy andxperimental Psychiatry, 9, ational Institutes of Health. (1989). eatment of destructivebehaviors in persons with developmental disabilities: Consensusconference statement. Retrieved July 15, 2003, from http://www.consensus.nih.gov/cons/075/075_intro.htm/ttenbacher, K. (1991). Research in sensory integration:pirical perceptions and progress. In A. G. Fisher, E. A.rray, & A. C. Bundy (Eds.), ensory integration: Theoryand practice.hiladelphia: F. A. Davis.eisman, J. (1993). Using a sensory integrative approach to treatself-injurious behavior in an adult with profound mentaletardation. American Journal of Occupational Therapy, 47,ith Roley, S., Blanche, E. I., & Schaaf, R. C. (2001). ensoryintegration with diverse populations. n Antonio, TX:Therapy Skill Builders.torey, K., Bates, P., McGhee, N., & Dycus, S. (1984). Reducingthe self-stimulatory behavior of a profoundly retarded femalethrough sensory awareness training. American Journal ofccupational Therapy, 38,ells, M. E., & Smith, D. W. (1983). Reduction of self-injuriousbehavior of mentally retarded persons using sensory integra-tive techniques. American Journal of Mental DeÞciency, 87issermann, L. (1992). The effects of deep pressure on self-. American Journal of Occupational Therapy, 46 The American Journal of Occupational Therapy uly/August 2005, Volume 59, Number 4 Effects of Sensory Integration Intervention on Kristie P. Koenig, Moya Kinnealey This study compared the effects of occupational therapy, using a sensory integration (SI) approach and a con-trol intervention of tabletop activities, on the frequency of self-stimulating behaviors in seven children 8Ð19years of age with pervasive developmental delay and mental retardation. Daily 15-min videotape segments ofthe subjects were recorded before, immediately after, and 1 hour after either SI or control interventions per-signiÞcantly reduced by 11% one hour after SI intervention in comparison with the tabletop activity interven-= 0.02). There was no change immediately following SI or tabletop interventions. Daily ratings of self-stimulating behavior frequency by classroom teachers using a 5-point scale correlated signiÞcantly with the)y inte-Smith, S. A., Press, B., Koenig, K. P., & Kinnealey, M. (2005). Effects of sensory integration intervention on self-stimulatingAmerican Journal of Occupational Therapy, 59, Among the many challenges for therapists treating individuals with mental retar-dation or developmental disabilities is the tendency for people in this populationto engage in self-stimulating, self-injurious, or stereotypic behaviors. Self-injuriousbehavior is one of two major categories of destructive behavior as identiÞed by theational Institutes of Health (1989); the other is aggression toward others andproperty. In the United States it is estimated that 160,000 individuals with devel-opmental disabilities demonstrate destructive behavior at a cost that exceeds $3 bil-lion. Self-injurious behavior is more prevalent in persons with severe to profoundetardation. Severe self-injurious behavior is found in 20,000 to 25,000 individu-als. All forms of destructive behavior have serious social, personal, educational, andeconomic impact (National Institutes of Health, 1989) and limit an individualÕsability to participate in normal life routines. The majority of individuals display-ing self-injurious behavior also have stereotypical behavior. Between 5% and 17%of people with mental retardation self-inßict tissue damage on a regular basis(Merrill Advanced Studies Center, 2002).elf-stimulating or stereotypic behavior is Òrepetitive bodily movement whichserves no apparent purpose in the external environmentÓ (Harris & Wolchick, 1979,185). These behaviors frequently interfere with the ability to function indepen-dently and therefore must often be addressed before any signiÞcant improvement infunction can be accomplished through intervention (Harris & Wolchick). Sinclair A. Smith, ScD, is Director, NeuromuscularFunction Laboratory, Department of Occupational Therapy,emple University, 3307 North Broad Street, Philadelphia,Pennsylvania 19140; sinclair.smith@temple.eduoods Services, Langhorne, Pennsylvania.Kristie P. Koenig, PhD, OTR/L, is Assistant Professor,emple University, Department of Occupational Therapy,Moya Kinnealey, PhD, OTR/L, is Associate Professor andChair, Temple University, Department of OccupationalTherapy, Philadelphia, Pennsylvania.