Gifted-disinkroni

TENTANG ANAK GIFTED YANG MENGALAMI DISINKRONITAS PERKEMBANGAN - suatu kelompok gifted children - dan bukan merupakan kelompok autisme, ASD, Asperger Syndrome ataupun ADHD - namun anak-anak ini sering mengalami salah terdiagnosa menjadi kelompok anak autisme ringan, ASD, Asperger Syndrom ataupun ADHD

Minggu, November 23, 2008

Sensory Integration Therapy (SIT) tidak efektif



Sensory Integration Therapy (SIT) gak ngepek....


Sensory Integration Therapy (SIT)
Sensory integration therapy (SIT) has been proposed as a method to
improve the way the brain processes and organizes external stimuli,
such as touch, movement, body awareness, sight and sound. SIT is
usually performed by occupational or physical therapists, who provide
sensory stimulation in combination with muscle activities,
theoretically in order to improve how the brain processes and
organizes sensory information. SIT usually requires activities that
involve full-body movement using different kinds of equipment, such
as scooter boards, swings, ramps and textured mitts. Therapy is given
in one to three sessions per week over several months or a few years,
with sessions typically lasting 60–90 minutes. SIT was originally
developed as a treatment for learning disabilities and subsequently
has been proposed as treatment for autism, mental retardation, Down
syndrome, and developmental delays.

Definitive patient selection criteria have not been established for
SIT.
Researchers hypothesize that a sensory integration (SI) disorder can
cause academic difficulties that might initially be diagnosed as a
learning disability. Learning-disabled children have normal
intelligence, as measured by intelligence quotient (IQ) testing.
However, their academic skills are considered delayed for their age.
In order to be classified as having SI disorders, therapists indicate
that learning-disabled children must display such symptoms as
problems with motor function or physical coordination. These children
are often described as clumsy, but standardized testing must reveal
difficulties in the processing of vestibular, proprioceptive, or
tactile stimuli. Proponents of SIT believe that SI dysfunctions
contribute to learning disabilities, since up to 70% of children with
learning disabilities have SI disorders (Hayes, 2004).
The following are classifications of the general areas in which a
child is tested to support the diagnosis of SI dysfunction (Hayes,
2004):

• Dysfunction in the vestibular system: This is usually indicated by
a decreased duration of nystagmus (i.e., a repetitive eye motion,
following spinning of the child).

• Apraxia: This is a disorder in the planning and executing of motor
acts, and identification is based on difficulty with imitating the
posture of another person.

• Disorders in space perception: This may cause the child to stand
too close to another person.

• Auditory or language problems

• Tactile defensiveness: This may be defined as physical or emotional
discomfort when touched by an examiner during tests of tactile
perception.

Numerous neuropsychological batteries have been developed to evaluate
levels of dysfunction with relation to these five categories of SI
disorders. These lengthy tests, which comprise multiple subtests, are
administered by individuals who are certified by a private
organization, SI International (Torrance, CA). These tests include
(Hayes, 2004):

• Southern California SI Tests

• Southern California Postrotary Nystagmus Test

• SI and Praxis Tests

Literature Review for Sensory Integration Therapy
Miller et al. (2007) conducted a pilot, randomized controlled trial
of the effectiveness of occupational therapy using a sensory
integration approach (OT-SI) in children with sensory modulation
disorders (SMDs). SMDs are impairments in regulating the degree,
intensity and nature of responses to sensory input, resulting in
considerable problems with daily roles and routines The trial
included 24 children who were randomly assigned to one of three
treatment conditions: OT-SI (n=7), activity protocol (n=10) and no
treatment (n=7). Pretest and post-test measurements of behavior,
sensory and adaptive functioning, and physiology were performed at
baseline and at 10 weeks. As compared to the other groups, the OT-SI
group made significant gains on goal attainment scaling (GAS)
(p<0.001 compared to no treatment and activity protocol) and on the
Attention subtest (p=0.03 compared to no treatment; p=0.07 compared
to activity protocol) and the Cognitive/Social composite of the
Leiter International Performance Scale-Revised (p=0.02 compared to
activity protocol). The OT-SI group showed improvement trends in the
hypothesized direction on the Short Sensory Profile, Child Behavior
Checklist and electrodermal reactivity. Larger randomized controlled
studies are needed to determine whether OT-SI is an effective
intervention, for which patients, and what conditions.
A review of SI outcomes research in relation to faithfulness of
intervention to underlying therapeutic principles or fidelity was
performed (Parham, et al., 2007). The review included 34 studies
which were analyzed for consistency of intervention descriptions with
the following elements: structural (e.g., equipment used, therapist
training) and therapeutic process categories. The reviewers made the
following findings:

• Most studies described structural elements related to therapeutic
equipment and interveners' profession.

• Only one of the 10 process elements, presentation of sensory
opportunities, was addressed in all studies. Most studies described
fewer than half of the process elements.

• Intervention descriptions in 35% of the studies were inconsistent
with one process element, therapist-child collaboration.

The authors note that the validity of SI outcomes studies is affected
by weak fidelity in regard to the therapeutic process.
Watling and Dietz (2007) reported on a study of the effect of Ayres's
sensory integration-based occupational therapy on the behavior and
task engagement of four children with autism spectrum disorders
(ASD). The single-subject study used an ABAB design to compare the
immediate effect of SI and a play scenario on the undesired behavior
and task engagement. The participants each received a different
number of study sessions due to absences and different enrollment
dates. The sessions ranged from 31 to 34. The results indicated that
no clear patterns of change in undesired behavior or task management
emerged through objective measurements. The subject data suggested
that each child exhibited positive changes during and after
intervention.
Smith et al. (2005) conducted a study for the purpose of comparing
the effects of occupational therapy, using a sensory integration
approach along with a control intervention of tabletop activities, on
the frequency of self-stimulating behaviors. The study involved seven
children, ranging in age from 8–19, diagnosed with pervasive
developmental delay and mental retardation. The study took place over
a four-week time period. During the second and fourth weeks, a
sensory integration treatment was provided for daily 30-minute
sessions, five times a week. During the first and third weeks, a 30-
minute controls session was provided, following the same schedule.
The study found that the frequency of self-stimulating and self-
injurious behaviors declined during the weeks when SIT was provided.
Limitations with the study included the small sample size, use of a
single clinical site, and the short-term follow-up. It was noted that
continued research is needed to examine the long-term effects of more
extensive intervention.
Dawson and Watling (2000) conducted a systematic review of the
research regarding the effectiveness of interventions for sensory and
motor abnormalities in autism. The interventions included SIT and
auditory integration training (AIT). Four studies on the
effectiveness of sensory integration therapy in autism that utilized
objective measures of behavior to assess outcome were found. All but
one had sample size of fewer than six subjects. None of the studies
had a comparison group. One study that had a larger sample size and
better design found no change in vocal behavior following brief
participation in sensory activities. Five studies were found
regarding the effectiveness of auditory integration training, three
of which included a control condition. Two of the studies that
included a control condition found improvement in both AIT and
control conditions. The third study that included control conditions
did find improvement in the AIT condition as compared to the control
condition; however, it was noted that there were methodological
difficulties with this study. The review concluded that although
sensory and motor impairments are commonly found in autism, the
interventions developed to address them have not been well validated.
In the case of SIT, it was noted, "there exist so few studies that
conclusions cannot be drawn" (Dawson and Watling, 2000). In the case
of AIT, it is noted that "there is no, or at best equivocal support
for this intervention approach based on the available controlled
studies" (Dawson and Watling, 2000).There is little known regarding
which ages or subgroups of individuals are most likely to benefit
from therapies addressing sensory and motor difficulties, and further
research is recommended.
A meta-analysis was conducted for the purpose of determining whether
existing studies of treatment using sensory integration approaches
support the efficacy of this method (Vargas, et al., 1999). Sixteen
studies were used to compare SIT with no treatment, and 16 studies
were used to compare SIT with alternative treatments. The review
noted that there was a significant difference between the average
size of effect of the earlier studies compared to the more recent
studies. The authors concluded that in the SIT and no treatment
studies, the recent studies did not demonstrate an overall positive
effect and that the sensory integration methods were found to be as
effective as various alternative treatment methods.
The peer-reviewed literature fails to demonstrate that SIT, compared
with other treatments or with no treatment, provides clinically
relevant, long-term improvements in outcomes in children with
learning disabilities, Down syndrome, developmental disorders or SI
disorders. Studies of SIT in children with cerebral palsy or autism
are also lacking, and therefore the evidence is insufficient to
evaluate SIT for these indications as well.

Professional Societies/Organizations for Sensory Integration Therapy
An assessment conducted by the National Academy of Sciences (NAS)
concluded that there is insufficient evidence as to the effectiveness
of SIT for autism. The NAS report states that there is a paucity of
research
concerning SIT in autism and that these interventions have not yet
been supported by empirical studies (NAS, 2001).
The American Academy of Pediatrics (AAP) Committee on Children with
Disabilities has stated that the scientific legitimacy of SIT has not
been established for children with motor disabilities (Michaud, et
al., 2004).
The Association for Science in Autism Treatment (ASAT) has noted in a
viewpoint appearing on their website that the overwhelming scientific
evidence indicates that SIT is ineffective and that practitioners of
this therapy need to provide reliable evidence of its effectiveness
instead of opinions and anecdotal reports (Fox, 2004).

http://www.cigna.com/customer_care/healthcare_professional/coverage_po
sitions/medical/mm_0283_coveragepositioncriteria_sensory_auditory_inte
gration_therapy.pdf.

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