Managing controversial therapies in special education - sensory integration therapy
This thesis by publication consists of five related papers that examine the evidence for the efficacy of Sensory Integration therapy (SIT) and why it is commonly used. SIT is a controversial intervention that is frequently used for children with special needs. SIT involves providing controlled sensory stimulation to participants in order to purportedly improve the neurological processing of sensory stimuli.
The first part of this thesis consists of two reviews that examine the current state of the evidence on the efficacy of SIT. The first paper provides a meta-analysis of group design studies with individuals with, or at-risk of, a developmental or learning disability, disorder, or delay. The meta-analysis extends previous studies in several important ways including the examination of process elements related to treatment integrity of SIT, the conduct of interrater reliability on selection and coding of studies, systematic evaluation of study quality and redress of several methodological issues present in prior analyses. It is concluded that the evidence for the efficacy of SIT is very weak and studies are methodologically problematic. Specific recommendations for conduct of future research are offered.
The second paper provides a review of single case research design studies. This is the only existing review of SIT that exclusively examines single case studies. A specific focus is on the quality of the research using criteria that are relevant to single case designs as well as consideration of process elements. Overall, the studies were of extremely poor methodological quality with many key conventions in the conduct of single case research being routinely disregarded. Better quality studies generally yielded negative results.
The use of controversial therapies in developing countries, where resources are scarce, is poorly documented. The second part of this thesis provides an exploration of the use of SIT in Malaysia, specifically in early intervention settings. Foci included the way SIT was used as well as the rationale for its application. The third paper provides a report of an initial qualitative study that was conducted by interviewing teachers and administrators of early intervention centers in Malaysia where SIT was used. Occupational therapists played a major role in advocating the use of SIT. A wide range of effects were attributed to SIT and respondents considered that SIT was particularly appropriate for managing challenging behaviors that were related to sensory stimuli.
Building on the findings of the initial qualitative study, questionnaires for teachers and administrators were designed and distributed to early intervention centers around Malaysia and Singapore. Malaysia was chosen as an example of a developing country, where resources may be limited, whereas Singapore is a neighboring advanced economy that provided a point of comparison. Two papers are presented reporting the results of the questionnaires for teachers and administrators respectively. The survey of administrators focused on why they chose to use SIT, their sources of information and training in its use, and the ways in which it was employed. The survey for early intervention teachers asked how they learned about SIT, the forms of SIT they used, and the benefits they expected. These studies provided insight into the motivation of professionals in special education for using controversial therapies such as SIT. Recommendations are offered for strategies to address the issue of adoption of evidence-based practice in developing countries.