Journal of Autism and Developmental Disorders

, Volume 41, Issue 10, pp 1303–1320 | Cite as

Comparison of Behavioral Intervention and Sensory-Integration Therapy in the Treatment of Challenging Behavior

  • Sarah Devlin
  • Olive HealyEmail author
  • Geraldine Leader
  • Brian M. Hughes
Original Paper


The objective of the current study was to compare the effects of sensory-integration therapy (SIT) and a behavioral intervention on rates of challenging behavior (including self-injurious behavior) in four children diagnosed with Autism Spectrum Disorder. For each of the participants a functional assessment was conducted to identify the variables maintaining challenging behavior. Results of these assessments were used to design function-based behavioral interventions for each participant. Recommendations for the sensory-integration treatment were designed by an Occupational Therapist, trained in the use of sensory-integration theory and techniques. The sensory-integration techniques were not dependent on the results of the functional assessments. The study was conducted within an alternating treatments design, with initial baseline and final best treatment phase. For each participant, results demonstrated that the behavioral intervention was more effective than the sensory integration therapy in the treatment of challenging behavior. In the best treatment phase, the behavioral intervention alone was implemented and further reduction was observed in the rate of challenging behavior. Analysis of saliva samples revealed relatively low levels of cortisol and very little stress-responsivity across the SIT condition and the behavioral intervention condition, which may be related to the participants’ capacity to perceive stress in terms of its social significance.


Autism Challenging behavior Behavioral intervention Sensory-integration therapy Cortisol Stress-responsivity 



The authors would like to sincerely thank the staff and management of Stepping Stones ABA School, Co. Meath, Ireland and Sinéad Conneely for her help in certain aspects of the investigation.


  1. Alhage-Kientz, M. (1996). Sensory-based need in children with autism: Motivation for behavior and suggestions for intervention. AOTA Developmental Disabilities Special Interest Section Newsletter, 19(3), 1–3.Google Scholar
  2. Arendt, R. E., MacLean, W. E., & Baumeister, A. A. (1998). Critique of sensory integration therapy and its application in mental retardation. American Journal of Mental Retardation, 92, 401–411.Google Scholar
  3. Ayres, A. J. (1972a). Sensory integration and the child. Los Angeles: Western.Google Scholar
  4. Ayres, A. J. (1972b). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.Google Scholar
  5. Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.Google Scholar
  6. Bachman, J. A. (1972). Self-injurious behavior: A behavioral analysis. Journal of Abnormal Psychology, 80, 211–224.PubMedCrossRefGoogle Scholar
  7. Bailey, J. S., & Bostow, D. E. (1979). Research methods in applied behavior analysis. Tallahassee, FL: Copy Grafix.Google Scholar
  8. Borrero, C. S., & Vollmer, T. R. (2006). Experimental analysis and treatment of multiply controlled problem behavior: A systematic replication and extension. Journal of Applied Behavior Analysis, 39, 375–379.PubMedCrossRefGoogle Scholar
  9. Bright, T., Bittick, K., & Fleeman, B. (1981). Reduction of self-injurious behavior using sensory-integrative techniques. American Journal of Occupational Therapy, 35, 167–172.PubMedGoogle Scholar
  10. Brosnan, M., Turner-Cobb, J., Munro-Naan, Z., & Jessop, D. (2009). Absence of a normal cortisol awakening response (CAR) in adolescent males with Asperger Syndrome (AS). Psychoneuroendocrinology, 34, 1095–1100.PubMedCrossRefGoogle Scholar
  11. Case-Smith, J., & Miller, H. (1999). Occupational therapy with children with pervasive developmental disorders. American Journal of Occupational Therapy, 53, 506–513.PubMedGoogle Scholar
  12. Chu, S., & Green, D. (1996). Application of sensory processing theory in the treatment of individuals with learning disabilities. Course Handbook, London.Google Scholar
  13. Clark, F. A., & Shuer, J. (1978). A clarification of sensory integrative therapy and its application to programming with retarded people. Mental Retardation, 16, 227–232.PubMedGoogle Scholar
  14. Cook, D. A. (1990). A sensory approach to the treatment and management of children with autism. Focus on Autistic Behavior, 5, 1–19.Google Scholar
  15. Corbett, B. A., Mendoza, S., Abdullah, M., Wegelin, J. A., & Levine, S. (2006). Cortisol circadian rhythms and response to stress in children with autism. Psychoneuroendocrinology, 31, 59–68.PubMedCrossRefGoogle Scholar
  16. Corbett, B. A., Mendoza, S., Wegelin, J. A., Carmean, V., & Levine, S. (2008). Variable cortisol circardian rhythms in children with autism and anticipatory stress. Journal of Psychiatry and Neuroscience, 33, 227–234.PubMedGoogle Scholar
  17. Daems, J. (Ed.). (1994). Reviews of research in sensory integration. Torrance, CA: Sensory Integration International.Google Scholar
  18. Densem, J. F., Nuthall, G. A., Bushnell, J., & Horn, J. (1989). Effectiveness of a sensory integrative therapy program for children with perceptual-motor deficits. Journal of Learning Disabilities, 22, 221–229.PubMedCrossRefGoogle Scholar
  19. Devlin, S., Leader, G., & Healy, O. (2009). Comparison of behavioral intervention and sensory-integration therapy in the treatment of self-injurious behavior. Research in Autism Spectrum Disorders, 3(1), 223–231.CrossRefGoogle Scholar
  20. Dura, J. R., Mulick, J. A., & Hammer, D. (1988). Rapid clinical evaluation of sensory integrative therapy for self-injurious behavior. Mental Retardation, 26, 83–87.PubMedGoogle Scholar
  21. Fisher, A. G., & Murray, E. A. (1991). Introduction to sensory integration theory. In A. G. Fisher, E. A. Murray, & A. C. Bundy (Eds.), Sensory integration, Theory and practice. Philadelphia: F.A. Davis.Google Scholar
  22. Garde, A. H., & Hansen, A. M. (2005). Long-term stability of salivary cortisol. Scandinavian Journal of Clinical Laboratory Investigation, 65, 433–436.CrossRefGoogle Scholar
  23. Gunnar, M. R., Talge, N. M., & Herrera, A. (2009). Stressor paradigms in developmental studies: What does and does not work to produce mean increases in salivary cortisol. Psychoneuroendocrinology, 34, 953–967.PubMedCrossRefGoogle Scholar
  24. Gunnar, M., & Vazquez, D. (2006). Stress neurobiology and developmental psychopathology. In D. Cicchetti & D. Cohen (Eds.), Developmental Psychopathology, 2nd ed.: Developmental Neuroscience (Vol. 2, pp. 533–577). New York: Wiley.Google Scholar
  25. Hanrahan, K., McCarthy, A. M., Kleiber, C., Lutgendorf, S., & Tsalikian, E. (2006). Strategies for salivary coritsol collection and analysis in research with children. Applied Nursing Research, 19, 95–101.PubMedCrossRefGoogle Scholar
  26. Hawkins, R. P., & Dotson, V. A. (1975). Reliability scores that delude: An “Alice in Wonderland” trip through the misleading characteristics of interobserver agreement scores in interval recording. In E. Ramp & G. Semb (Eds.), Behavior analysis: Areas of research and application. Englewood Cliffs, New Jersey: Prentice-Hall.Google Scholar
  27. Horner, R. H., Day, H. M., Sprague, J. R., O’ Brien, M., & Heathfield, L. T. (1991). Interspersed requests: A nonaversive procedure for reducing aggression and self-injury during instruction. Journal of Applied Behavior Analysis, 24, 265–278.PubMedCrossRefGoogle Scholar
  28. Horvath, K., Papadimitriou, J. C., Rabsztyn, A., Drachenberg, C., & Tildon, J. T. (1999). Gastrointestinal abnormalities in children with autistic disorder. Journal of Pediatrics, 135, 559–563.PubMedCrossRefGoogle Scholar
  29. Hrdlicka, M., Dudlova, I., Beranova, I., Lisy, J., Belsan, T., Neuwirth, J., et al. (2005). Subtypes of autism by cluster analysis based on structural MRI data. European Child and Adolescent Psychiatry, 14, 138–144.PubMedCrossRefGoogle Scholar
  30. Iwasaki, K., & Holm, M. (1989). Sensory treatment for the reduction of stereotypic behaviors in persons with severe multiple disabilities. Occupational Therapy Journal of Research, 9, 170–183.Google Scholar
  31. Iwata, B. A., & DeLeon, I. G. (1995). The functional analysis screening tool (FAST). Unpublished manuscript, University of Florida.Google Scholar
  32. Iwata, B. A., & DeLeon, I. G. (1996). The functional analysis screening tool (FAST). Gainesville: The Florida Center on Self-Injury, University of Florida.Google Scholar
  33. Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self-injury. Journal of Applied Behavior Analysis, 27, 197–209.PubMedCrossRefGoogle Scholar
  34. Iwata, B. A., Pace, G. M., Kalsher, M. J., Cowdery, G. E., & Cataldo, M. F. (1990). Experimental analysis and extinction of self-injurious escape behavior. Journal of Applied Behavior Analysis, 23, 11–27.PubMedCrossRefGoogle Scholar
  35. Jansen, L. M., Gispen-de Wied, C. C., van der Gaag, R. J., ten Hove, F., Willemsen-Swinkels, S. W., Harteveld, E., et al. (2000). Unresponsiveness to psychosocial stress in subgroup of autistic-like children, multiple complex developmental disorder. Psychoneuroendocrinology, 25, 753–764.PubMedCrossRefGoogle Scholar
  36. Jansen, L. M. C., Gispen-de Wied, C. C., van der Gaag, R. J., & van Engeland, H. (2003). Differentiation between autism and multiple complex developmental disorder in response to psychosocial stress. Neuropsychopharmacology, 28, 582–590.PubMedCrossRefGoogle Scholar
  37. Kirschbaum, C., & Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19, 313–333.PubMedCrossRefGoogle Scholar
  38. Kirschbaum, C., & Hellhammer, D. H. (2000). Salivary cortisol. In G. Fink (Ed.), Encyclopedia of stress (pp. 379–383). San Diego: Academic Press.Google Scholar
  39. Lalli, J. S., Vollmer, T. R., Progar, P. R., Wright, C., Borrero, J., Daniel, D., et al. (1999). Competition between positive and negative reinforcement in the treatment of escape behavior. Journal of Applied Behavior Analysis, 32, 285–296.PubMedCrossRefGoogle Scholar
  40. Lam, K. S. L., Aman, M. G., & Arnold, L. W. (2006). Neurochemcial correlates of autistic disorder: A review of the literature. Research in Developmental Disabilities, 27, 254–289.PubMedCrossRefGoogle Scholar
  41. Lemke, H. (1974). Self-abusive behavior in the mentally retarded. American Journal of Occupational Therapy, 28, 94–97.PubMedGoogle Scholar
  42. Leong, H. M., & Carter, M. (2008). Research on the efficacy of sensory integration therapy: Past, present and future. Australasian Journal of Special Education, 32, 83–99.CrossRefGoogle Scholar
  43. Lucarelli, S., Frediani, T., Singoni, A. M., Ferruzzi, F., Giardi, O., Quinteieri, F., et al. (1995). Food allergy and infantile autism. Panminerva Medica, 37, 137–141.PubMedGoogle Scholar
  44. Magrun, W. M., Ottenbacher, K., McCue, S., & Keefe, R. (1981). Effects of vestibular stimulation on spontaneous use of verbal language in developmentally delayed children. American Journal of Occupational Therapy, 35, 101–104.PubMedGoogle Scholar
  45. Marcus, B. A., & Vollmer, T. R. (1996). Combining noncontingent reinforcement and differential reinforcement schedules as treatment for aberrant behavior. Journal of Applied Behavior Analysis, 29, 43–51.PubMedCrossRefGoogle Scholar
  46. Marinović-Ćurin, J., Marinović-Terzić, I., Bujas-Petković, Z., Zekan, L., Škrabić, V., Đogaš, Z., et al. (2008). Slower cortisol response during ACTH stimulation test in autistic children. European Child and Adolescent Psychiatry, 17, 39–43.PubMedCrossRefGoogle Scholar
  47. Marinović-Ćurin, J., Terzić, J., Bujas-Petković, Z., Zekan, L. J., Marinović-Terzić, I., & Marisović-Susnjara, I. (2003). Lower cortisol and higher ACTH levels in individuals with autism. Journal of Autism and Developmental Disorders, 33, 443–448.CrossRefGoogle Scholar
  48. Mason, S. A., & Iwata, B. A. (1990). Artifactual effects of sensory-integrative therapy on self-injurious behavior. Journal of Applied Behavior Analysis, 23, 361–370.PubMedCrossRefGoogle Scholar
  49. Matson, J. L., & Vollmer, T. (1995). Questions about behavioral function (QABF). Baton Rouge, LA: Disability Consultants, LLC.Google Scholar
  50. McCarthy, A. M., Hanrahan, K., Kleiber, C., Zimmerman, M. B., Lutgendorf, S., & Tsalikian, E. (2009). Normative salivary cortisol values and responsivity in children. Applied Nursing Research, 22, 54–62.PubMedCrossRefGoogle Scholar
  51. Miller, L. J. (2003). Empirical evidence related to therapies for sensory processing impairments. Communiqué, 31, 34–37.Google Scholar
  52. Mudford, O. C., Cross, B. A., Breen, S., Cullen, C., Reeves, D., Gould, J., et al. (2000). Auditory integration training for children with autism: No behavioral benefits detected. American Journal of Mental Retardation, 105, 118–129.PubMedCrossRefGoogle Scholar
  53. National Board for Certification in Occupational Therapy. (2004). A practice analysis study for entry-level occupational therapist registered and certified occupational therapy assistant practice. Occupational Therapy Journal of Research, 24(1), 1–31.Google Scholar
  54. Nir, I., Meir, D., Zilber, N., Knobler, H., Hadjez, J., & Lerner, Y. (1995). Brief report: Circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism. Journal of Autism and Developmental Disorders, 25, 641–654.PubMedCrossRefGoogle Scholar
  55. Ottenbacher, K., & Short, M. A. (1985). Sensory integrative dysfunction in children: A review of theory and treatment. In M. Wolraich & D. K. Routh (Eds.), Advances in developmental and behavioral pediatrics (Vol. 6, pp. 287–329). Greenwich, CT: JAI.Google Scholar
  56. Richdale, A. L., & Prior, M. R. (1992). Urinary cortisol circadian rhythm in a group of high-functioning children with autism. Journal of Autism and Developmental Disorders, 22, 433–447.PubMedCrossRefGoogle Scholar
  57. Roley, S. S., Blanche, E. I., & Schaaf, R. C. (Eds.). (2001). Understanding sensory integration dysfunction. New York: Perigree.Google Scholar
  58. Sandman, C. A., Barron, J. L., Chiez-DeMet, A., & DeMet, E. M. (1991). Brief report: Plasma beta-endorphin and cortisol levels in autistic patients. Journal of Autism and Developmental Disorders, 21, 83–87.PubMedCrossRefGoogle Scholar
  59. Smith, T., & Antolovich, M. (2000). Parental perceptions of supplemental interventions received by young children with autism in intensive behavior analytic treatment. Behavioral Interventions, 15(2), 83–97.CrossRefGoogle Scholar
  60. Spitzer, S., Roley, S. S., Clark, F., & Parham, D. (1996). Sensory integration: Current trends in the United States. Scandinavian Journal of Occupational Therapy, 3, 123–138.CrossRefGoogle Scholar
  61. Stock Kranowitz, C. (1998). The out of synch child: Recognizing and coping with the nature of sensory integration with diverse populations. San Antonio, TX: Therapy Skill Builders.Google Scholar
  62. Tordjman, S., Anderson, G. M., McBride, P. A., Hertzing, M. E., Snow, M. E., Hall, L. M., et al. (1997). Plasma beta-endorphin, adrenocorticotropin hormone, and cortisol in autism. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 38, 705–715.PubMedCrossRefGoogle Scholar
  63. Vargas, S., & Camilli, G. (1998). A meta-analysis of research on sensory integration treatment. American Journal of Occupational Therapy, 53, 189–198.Google Scholar
  64. Vedhara, K., Hyde, J., Gilchrist, I. D., Tytherleigh, M., & Plummer, S. (2000). Acute stress, memory, attention and cortisol. Psychoneuroendocrinology, 25, 535–549.PubMedCrossRefGoogle Scholar
  65. Vollmer, T. R., Iwata, B. A., Zarcone, J. R., Smith, R. G., & Mazaleski, J. L. (1993). The role of attention in the treatment of attention-maintained self-injurious behavior: Noncontingent reinforcement and differential reinforcement of other behavior. Journal of Applied Behavior Analysis, 26, 9–21.PubMedCrossRefGoogle Scholar
  66. Watling, R., Deitz, J., Kanny, E. M., & McLaughlin, J. F. (1999). Current practice of occupational therapy for children with autism. American Journal of Occupational Therapy, 53, 489–497.Google Scholar
  67. Wells, M., & Smith, D. W. (1983). Reduction of self-injurious behavior of mentally retarded persons using sensory integrative techniques. American Journal of Mental Deficiency, 87, 664–666.PubMedGoogle Scholar
  68. Wilbarger, P. (1995). The sensory diet: Activity programs based on sensory processing theory. Sensory Integration: Special Interest Section Newsletter, 18(2), 1–4.Google Scholar
  69. Wilbarger, P., & Wilbarger, J. (1991). Sensory defensiveness in children aged 2–12: An intervention guide for parents and caregivers. Denver, CO: Avanti Educational Programs.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Sarah Devlin
    • 1
  • Olive Healy
    • 1
    Email author
  • Geraldine Leader
    • 1
  • Brian M. Hughes
    • 1
  1. 1.School of PsychologyNational University of IrelandGalwayIreland

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