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Evaluation of the Effects of Sensory Integration-Based Intervention by a Preschool SpecialEducation TeacherAuthor(s): Penelope Wong Bonggat and Laura J. HallSource: Education and Training in Autism and Developmental Disabilities, Vol. 45, No. 2(June 2010), pp. 294-302Published by: Division on Autism and Developmental DisabilitiesStable URL: http://www.jstor.org/stable/23879813Accessed: 30-09-2016 01:09 UTC

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Education and Training in Autism and Developmental Disabilities, 2010, 45(2), 294-302 © Division on Autism and Developmental Disabilities

Evaluation of the Effects of Sensory Integration-Based

Intervention by a Preschool Special Education Teacher

Penelope Wong Bonggat and Laura J. Hall San Diego State University

Abstract: This study addresses the call for increased research on common public school practices and progress monitoring by public school teachers. An alternating treatment design was implemented by a preschool teacher

to evaluate the effect of sensory-integration based activities compared with an attention control on the on task

behavior of three participants with disabilities. The preschool participants were observed during one-to-one teaching sessions and completing maintenance tasks in an independent workstation during the second half of a school year. The results revealed no differences in the estimated percentages of time on-task when either condition was used for all three participants. More time on task occurred when the participants were working

in one-to-one activities. The design used in this study serves as a model that can be used by teachers and occupational therapists working in a public school.

The process of sensory integration is sup- and environmental stimuli is ongoing (Anza ported by a theoretical construct that de- lone & Williamson, 2000; Baranek, Parham, & scribes the relationship between the neurobi- Bodfish, 2005; Wilbarger & Stackhouse), oc ology of an individual and the environment cupational therapists are actively recommend (Fisher & Murray, 1991). Theorizing about ing practices to address atypical behavior by the interaction between the sensory and mo- individuals identified with disabilities thought tor systems and the environment has been a to be a result of problems with sensory inte focus of the field of occupational therapy gration processing (Mailloux & Smith-Roley). (Mailloux & Smith-Roley, 2004; Wilbarger & Reviewers of research on practices based on Stackhouse, 2005). Current theories build semory integration theory have conciuded upon the work of Dr. Jean Ayres who devel- that there is either little or no evidence to oped a theory of sensory integration and de- suppon such practices when used for children scribed intervention practice for individuals wlth leami disabilities (Hoehn & Baumeis.

fr 1972; Ayres & Tickle, ^ ig94; n Polatajk0) Wilson, & Faris, 1980). Although theory development regard , . . , , , . r , 1993), language and learning disorders

ing the interaction between behavior of the individual, the sensory and motor systems,

(Griffer, 1999), mental retardation (Arendt, MacLean, & Baumeister, 1988), and autism spectrum disorders (Goldstein, 2000; Rogers & Ozonoff, 2005). Although most reviewers

This study would not have been possible without . , ,r . ,, ..... ,, . n ■ ■ i r n identify methodological weaknesses in the de the support of Kim Kossyta, Principal of Rowen ' " Elementary School and the families of the three s'§n as one °f the main reasons for their con preschool students. We are particularly grateful to elusions, there also is a lack of relationship Mary Scott, the classroom Special Education Tech- between any changes in behavior with the pro nician who acted as the primary observer through- posed dysfunctional sensory or motor system out the study. We would also like to acknowledge (Baranek, 2002; Dawson & Watling, 2000). Gretchen Stadnik Grundon who used her many Many of these authors caU for mQre research talents in assistance of this manuscript. Correspon- , , . ,. ,, , on the outcomes of this approach (Dawson & dence concerning this article should be addressed rr to Laura j. Hall, Department of Special Education, Watling; Goffer; Kaplan et al). In spite of this San Diego State University 5500 Campanile Drive lack of evidence, sensory integration-based ac San Diego, California, 92182-1170. Email: ljhall® tivities continue to be recommended by occu mail.sdsu.edu pational therapists and used by educators in

294 / Education and Training in Autism and Developmental Disabilities-June 2010


public schools (Rogers & Ozonoff). Parents evaluate the use of therapy ball for children have reported (Smith & Antolovich, 2000) with autism spectrum disorders and found and authors have speculated (Kaplan et al.) that children were more engaged when using that interventionists perceive that children im- the therapy ball than when using alternative prove as a result of sensory integration-based forms of seating (chair, bench, carpet square therapy or that positive changes in behavior on floor). These single-subject designs could are attributed to the sensory integration strat- be used by public school personnel to evaluate egies. intervention outcomes if the proper controls Several strategies that are put together in are incorporated,

order to modulate arousal, attention, affect Educators and therapists who work in pub and action for an individual can be referred to lie schools are currently expected to use "evi as a "sensory diet" (Anzalone & Williamson, dence-based" practices (Odom et al., 2004). 2000; Baranek, 2002). Some of the strategies The importance of measuring outcomes and included in a typical "sensory diet" may be using data to guide treatment decisions has enjoyable for both the student and the educa- been emphasized by leaders in the field of tor. Massaging with lotion is an example. Es- occupational therapy (Anzalone & William calona and her colleagues found that children son, 2000; Baranek et al., 2005; Ottenbacher, with autism who received massage from their Tickle-Degnen, & Hasselkus, 2002). Betty Has parents at bedtime exhibited less stereotypic selkus, previous editor of the American Journal behavior and showed more on-task behavior of Occupational Therapy, wrote that best evi during play at school compared with those dence can be determined by quasi-experimen children with autism read a Dr. Seuss story tal designs including single-subject designs (Escalona, Field, Singer-Strunck, Cullen, & (Ottenbacher et al.). The Council for Excep Hartshorn, 2001). The authors state that the tional Children Task Force on Quality Indica underlying mechanism for enhancing atten- tors for Special Education Research also tiveness is not known but they speculate that agrees that the use of single-subject designs massage therapy has been noted to enhance with a set of criteria can be used to determine parasympathetic activity that is correlated with effectiveness of a practice (Odom et al.). In attentiveness. the following study, a single-subject alternat Case-Smith and Bryan (1999) used a single- ing treatment design was used to evaluate the

subject AB design to evaluate the effects of effects of sensory integration-based activities sensory integration based therapy on the en- on the on-task behaviors of three students gagement, play and social behaviors of pre- with developmental disabilities. This study was school children with autism or pervasive de- implemented by a preschool teacher with a velopmental disorders. Although they found credential in early childhood special educa increases in play behavior and engagement tion. for three of the five participants, baseline mea sures were obtained following the winter , , ° • „ Method break, a time the authors describe as typically resulting in regression of skills. Information on the generalization of play behaviors was lacking. Two boys with developmental delay (Jose and Reilly, Nelson, and Bundy (1983) used an Marco) and one boy with autism (Dante) were

alternating treatment design to evaluate a 30- participants in this study. Jose was a four-year minute sensory integration-based intervention old boy of Mexican decent who began early compared with a fine motor activity on the intervention services eight months prior to vocalizations of 18 children with autism. Con- the study. He received an assessment from an trary to predictions they found that the fine occupational therapist that concluded he dis motor activity resulted in more vocalization by played some signs of "tactile defensiveness" participants, however, there was a history of and inconsistently reacted to teacher direc positive reinforcement for vocalizations dur- tions by screaming and crying especially when ing fine motor activities. Schilling and asked to work one-on-one in a structured set Schwartz (2004) used a withdrawal design to ting. Jose was an active boy, who used three to

Evaluation of Sensory Integration / 295

Participants


Preschool Teacher

four word sentences at the time of the study. form fine motor tasks. Dante displayed He showed signs of appropriate play skills parallel play skills during free play, and at the (turn-taking, sharing, and eye contact with time of the study showed limited age-appro verbal reminders), however, the majority of priate play and/or social skills, except for the time he played along side his peers (par- greetings and saying "sorry" when he was told allel play) and did not seem to attend to any he had hurt someone. Dante enjoyed wres activity during play or recess for more than tling and movement activities, five to ten minutes.

Marco was a four-year eleven-month old boy of Mexican decent who began early interven tion services at an early age. He transitioned The classroom teacher, and first author of this into this preschool classroom at the age of research, held a B.A. in psychology and her three years. Some of the behaviors Marco ex- teaching credential in Early Childhood Spe hibited in the classroom were: resistance to cial Education. She was enrolled in an ad

being touched by the staff, crying and scream- vanced degree program and this study fill ing if anyone left the classroom, hitting his filled one of the requirements for the degree, head when angry, frustrated, and/or sad, and She had worked as a classroom aide for a year closing his eyes or covering his eyes with his and as a home program tutor for ten years, arm to avoid task demands. Marco's occupa- She was trained to use discrete trial teaching tional therapy assessment also concluded methods, structured TEACCH activities (Mesi signs of "tactile defensiveness". Unlike Jose, bov & Howley, 2003) including independent Marco had Individualized Educational Plan work stations, Pivotal Response Training, a (IEP) goals and objectives written to address child lead approach based on the principles of this issue. Marco also displayed oral motor applied behavior analysis (Koegel, Koegel, & difficulties, such as low tone around his Carter, 1999), and sensory integration-based mouth and drooling, and it was at the sugges- activities. The sensory activities were demon tion of the occupational therapist that oral strated by an occupational therapist who swipes and oral massage be performed on worked for the district. The teacher had ar Marco as part of his "sensory diet". ranged a class-wide data collection system

In addition, Marco had difficulties in the prior to commencement of the study, areas of fine motor, self-help, and strength/ coordination. Marco was nonverbal and dem

onstrated his liking of Jose by walking hand in-hand with him, sitting next to him during Two observers were trained for this study. The table activities, and helping him with class- primary observer was the Special Education room chores such as pulling the wagon and Technician (SET or aide) currently working cleaning up toys. Marco also approached two in the classroom and the secondary observer or three of the typical peers in his after school was the second author and the university ad program and would follow their verbal and visor for the teacher's degree program, physical directions to play and/or sit with them. Marco spent the majority of his time engaged in parallel play and did not demon strate age appropriate play skills. This Special Education Early Childhood class

Dante was a four-year old boy of African- room is located on the campus of an urban American decent who transitioned from a less elementary school in San Diego. Located in a structured class one-and-a-half months prior low-income neighborhood, the majority of the to the beginning of this study because of his school's population is traditionally underrep lack of progress and his display of challenging resented and the majority of students are on behaviors (hitting and pushing others). free and reduced lunch programs. Students Dante's occupational therapy assessment with Individualized Educational Plans who identified his greatest areas of need to in- typically have a diagnosis of autism, mental crease his ability to: attend to tasks and peo- retardation, and/or have sensory deficits pie, complete transitions smoothly, and per- and/or behavior problems are placed in spe


Observers


cialized preschool classrooms in this district. via joint compressions, a therapy ball, Because of the unique needs of the students, weighted vests, weighted pillows, and a blan the student to staff member ratio is approxi- ket. The following materials were used during mately one or two students to one adult. attention control activities: puzzles, puppets, School sessions for the preschool classrooms interactive (music/lights) toys, bubbles, are three hours and forty-five minutes long books, blocks, and play dough. with the morning session taking place from The dependent measures for this study 9:00 am to 12:45 pm and the afternoon ses- were: attention to task and disruptive behav sion taking place from 11:50 to 3:35 pm. jors. Attention to task was selected because it

As the children arrive at school they are was a reported benefit of sensory integration greeted at the bus and walked to the class- based activities according to the occupational room where each student checks their sched- therapist and the classroom teacher. For the ule and proceeds to put their backpack away, purposes of this study, attention to task was go to the bathroom and participate in their defined as the ability to demonstrate eye con individualized sensory diets (usually consist- tact with the teacher and appropriate partici ing of some or all of the following activities: pation in an activity Disruptive behaviors were brushing, joint compressions, oral swipes, and defined as. screaming (S) or any vocalization exercises, therapy ball activities, the ham- aboye conversational noise level that demon mock, and scooter board). Once each student strated the participant.s rejection of a corn is finished, the students begin their work ro- mand and/or ,ask and kad tQ thdr inabm tations. These activities include but are not , . , , r . , r

to attend to, and/or perform a task lor more limited to: discrete trial teaching of pre-aca- , , . . r

° r than two seconds; crying (C) or crying tor demic skills, structured teaching independent , , , . . , , .

° r more than two seconds that lead to the par work staüons for maintenance tasks, fine mo

ticipants' inability to attend to, and/or per form a task; turning away (T) or any physical movement which was demonstrated by the participant turning their body and/or head away from the task or averting their eye gaze

tor rotations (writing, cutting, puzzles, beads), structured play, circle time, art, and specialist services.

Two Special Education Technicians (SET's) support these classrooms. Typically these _ , , . , , **, . ,, , ,. . , , from the task leading to a lack of attending to,

SET s are not trained by the distnct or by the ° , ... . , . . and/or perform a task for more than two

special education department in the various r „ , . i , . . , . . . seconds; running away (R) or any physical techniques and strategies used in these class- ° ' ' ' -

TT, ™T ... , , attempt made by the participant to escape, rooms. The SEI in this classroom, however, ' 1 1 '

was informally trained by the classroom avoid' and/or re¡ect the lask b>' removing teacher in discrete trial teaching, sensory in- their bod>' from the ¡^mediate work environ tegration-based occupational therapy, over- ment; eyes closed (E) or an action made bY seeing the structured teaching independent the participant to escape, avoid, and/or reject work stations, and was consistent with the tbe b>' closing Lheir e>'es for a duration of classroom teacher in how to teach fine motor more than two seconds; and other (O) or any

skills such as prewriting and cutting. The SET other behavior not previously mentioned was also trained by the teacher on how to take which demonstrated an attempt to escape, data throughout all teaching strategies and avoid, and/or reject the task for a duration of activities. more than two seconds (playing with materi

als, staring without movement). Recording sheets were created to score the

occurrence of dependent variables. Depen For the sensory diets that all participants re- dent measures were scored using whole inter ceived, a surgical brush was used as well as a val time sampling (5 minutes of each 15 specialized brush designed for oral swipes for minute activity) with 10 seconds observation Marco who was given oral swipes after joint and 5 seconds recording. If off task and dis compressions. Vestibular equipment was also ruptive behavior occurred, any part of the used and included: a hammock, swing, and interval, the type of behavior was recorded by scooter board. Proprioceptive input was given circling the letter coded for that behavior.


Materials and Measures


Design and Analysis and swung in the hammock (stretched out, stomach down). If Marco received the sensory

An alternating-treatments design (Barlow & integration intervention, his sensory diet Hersen, 1984; Cooper, Heron, & Heward, would also include oral swipes after joint com 200?) was used to evaluate the effects of sen- preSsions and wheelbarrow walking for a dis sory integration-based occupational therapy tance of ten feet and an attention control on activity engage- when participants received the attention ment and disruptive behaviors. The two treat- control they were exposed tQ a vanety of in_ ments or conditions of sensory integration ac- teractive activities with a staff member (not ti vi ties and attention control activities were rdated R) the sensor^. integration activities in implemented for one to two weeks in a coun- their "sensoly diets") for the same amount of terbalanced order within each single subject time that they would have spent receiving (Cooper et al.). their "sensory diets". An example 10-minute

period might include the participant choosing

Procedure an 'n,eractive story to read then, completing a series of puzzles or turn-taking games with

Training of the observers took place prior to bubbles or a ball. beginning the observations. The observers Dante and Marco also received additional scored videotapes of the participants in vari- sensory integrative-based occupational ther ous activities (the same activities that they apy for half-an-hour three and four times a would be observed in during the treatment month respectively with a trained occupa phase) until the criterion of an inter-observer tional therapist who worked specially on occu agreement rating with the classroom teacher pational therapy goals (from the student's of a minimum of 80% over three consecutive IEP). Sessions were typically held every Friday observations was obtained for each observer. at 9:00 am and 9:30 am, however, for the

During intervention, participants were ran- purposes of this study, occupational therapy domly assigned to a sensory integration or services were rescheduled to occur after data attention control schedule that alternated ev- had been collected during two targeted activ ely one or two weeks. Sensory diets or atten- ities following intervention. Occupational tion control activities were implemented upon therapy sessions were designed to develop fine the participants' arrival at school and lasted motor skills, attending, and transitions for for about ten minutes. The observers were not Dante, and fine motor skills, toileting, feed in the classroom at the time of intervention to ing, and dressing for Marco, ensure that they were blind to the interven- Observations were made during the two ed tion or condition the participants had re- ucational activities (independent workstations ceived. The SET took the non-participating and one-on-one activity) that were scheduled students to the restroom and the second ob- directly following the intervention sessions, server did not arrive on the school grounds Independent workstations were modeled until after the intervention had been pro- from the structured teaching approach from vided. the TEACCH program (Mesibov & Howley, The sensory integration intervention con- 2003) where students independently worked

sisted of the participant being brushed via the on a series of mastered tasks until they had Wilbarger deep pressure and proprioceptive completed all the tasks arranged for that ses technique (DPPT) - brushing each arm, back, sion. Activities in a one-to one format with the and each leg using long, firm strokes for a classroom staff included pre-academic tasks count of ten per body part, given joint com- taught with a discrete trial format, fine motor pressions - applying firm pressure to the activities such as cutting and drawing and im shoulders, elbow, wrists, fingers, hips, knees, itation of simple play sequences. Participants and ankles for a count of ten per joint, use of rotated through these activities for two 15 a therapy ball (rolled on front of entire body minute sessions following the initial sensory or for a count of ten - except on face and on top attention activity. Each participant was re stomach down, pushing and pulling legs for a corded one child at a time for five-minute count of ten) (Wilbarger & Wilbarger, 1991), samples with the order of observation ran



Results

domly conducted. All observations were made curred only once for Dante (session 9) with within the 30-minute period following the in- the second highest session scored during the tervention activity. During intervention, 43 ob- attention control condition (session 23). servations were recorded for Jose, 40 for Marco scored both the highest and lowest per Marco, and 46 for Dante. centages under the sensory condition during

the independent work activity. Marco had , . . . greater variability of on task performance Inter-Observer Agreement ° , ' .r ,

when the sensory condition was implemented. Two observers scored 63% of all observations Jose and Marco were on-task between 80% including both conditions (sensory and atten- and 100% of the one-to-one sessions regard tion) throughout the study. Interobserver less of condition except for two observations agreement scores were calculated using the following the sensory intervention for Marco formula: the number of agreements divided and one during each condition for Jose when by the number of agreements plus the num- lower percentages were scored (see Figure 1). ber of disagreements divided by 100 (Sulzer- Dante's data was more variable during one-to Azaroff & Mayer, 1991). The overall mean one activities in both conditions. inter-rater agreement was 91% with a range There was more variety in the type of off from 69% to 100%. The lowest agreement task behaviors scored during in the indepen score occurred during a day with a fire drill dent work stations compared with the one-to (day 6). The mean inter-rater agreement score one activities for all participants. "Turning for Jose was 93% (range = 69% to 100%), for away" was scored for each of the boys with Marco 92% (range = 70% to 100%), and for estimated ranges of between 5 and 65% for Dante 89% (range = 75% to 100%). Marco, 10 and 55% for Dante and 5 and 40%

for Jose. Jose was scored as "crying" during two sessions (with 10% & 45%). "Running" from the station was observed for Dante for 5 to

The percentage of on-task behaviors during 10% during nine sessions and by Marco for two separate activities (independent vs. one- 5% of two sessions. "Other" types of off task on-one) and across two conditions (sensory vs. behaviors were recorded in thirteen (Jose) to attention) for each of the three participants twenty (Marco) of the observations and be appear in Figure 1. The diamond represents tween 5 and 65% (Jose & Marco) of the ses the percentage of attention to task following sion when the participants were in the inde the sensory integration-based condition and pendent work stations. the square represents the percentage of on The highest category of off task behaviors task behavior when the attention control was scored during one-on-one sessions were for used. "turning away" for all participants with esti The data indicated that there were no dif- mated percentages scored for Jose and Marco

ferences in the trend as a result of treatment as between 5 and 25% and for Dante as be

intervention or by condition across all three tween 5 and 50% of a session. Dante was also participants (see Figure 1). The only differ- scored as "crying" for 5% of one session, enees observed were for the type of activity, "Other behaviors", were recorded in low per with the participants maintaining a higher centages during one-to-one sessions for all level of on task behavior when working in a participants and following both conditions one-on-one activity than when in an indepen- with the exception of Jose who scored be dent activity (see Figure 1 - lower graph). This tween 0% and 15% in this category during five difference could be a result of the skilled staff sessions,

that were familiar with the participants and

thus, were able to prevent off task behaviors Discussion during the one-to-one sessions.

Dante and Marco's highest percentage of This study investigated the effects of therapist on task behavior during the independent recommended sensory integration-based ac work activity occurred under the sensory con- tivities on the on-task behavior in preschool dition, however, this high percentage oc- children with disabilities. Results indicated



100 Marco - Independent

50 ^

0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

100 ■

50

Marco - One-to-one

0 r T T T T * T 1 T I T T T T T T T ; r—

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

A Sensory

Figure 1. The estimated percentage of time on task for the three participants during independent and one-to-one activities following the two conditions of sensory integration based activities (triangle) and attention control activities (square).

that sensory integration activities had no bet- behaviors than attention control activities. All ter effect on the participants' ability to remain three participants chosen for this study had on task and reduce the number of disruptive been prescribed "sensory diets" by an occupa



tion therapist for sensory defensiveness, and progress monitoring by their occupational difficulty with attention, yet there was no ob- therapy staff. vious benefit to starting their day with a "sen- Limitations to this study include the limited sory diet" compared with an attention control time frame in which data was collected. This activity. Similar to results from the alternating study was conducted at the later half of the treatments design used by Reilly and col- school year when participants were accustom leagues (1983), the sensory integration-based to the staff, routine, and classroom environ condition did not have a greater effect on ment and the data may have looked different targeted outcomes. if the study was conducted at the beginning of

What seemed to make the most significant the school year. Follow-up data for Jose once difference in the participants' on task behav- sensory-based occupational therapy sessions iors was the individualized attention they re- were discontinued would have yielded inter ceived in a one-on-one educational activity esting information on the maintenance of his versus an independent activity setting. The on-task behavior. high percentage of on task behavior for all This study serves as a model for collecting participants during the one-to-one activities outcome data on interventions used in a pub demonstrated the effectiveness of using sound lie school classroom. Teachers are urged to teaching strategies along with motivating ma- develop a data collection system and to docu terials to maintain on task behavior. ment student progress. Clearly, it is also im

This study was organized and implemented portant for occupational therapists to become by a preschool teacher working in a public accountable for the strategies they recom school with the assistance of her classroom mend and to provide research indicating that aide. Collecting the data on the student's be- those strategies are evidence-based. Classroom havior provided important information. The teachers are expected to know the purpose for preschool teacher became aware that she had implementing any strategy and be able to incorrectly attributed some positive changes identify the intended outcome. Teachers us in student behavior to the sensory integration- ing ongoing progress monitoring systems can based activities, an occurrence speculated by make data-based decisions regarding modifi Raplan and colleagues (1993) to be common. cations or discontinuation of interventions in

Review of the data by the occupational ther- a timely manner in order to provide maxi apist and the Individualized Education Plan mum benefit for their students with disabili (IEP) team resulted in the decision to remove ties. the "sensory diet" forjóse and to place him in a less restrictive environment for the following academic year. If data on the efficacy of the References "sensory diet" had been collected on a consis

. r • r T u +u «-• • Anzalone, M. E., 8c Williamson, G. G. (2000). Sen tent basis for Tose, perhaps the sensory activi- . , ' . , , , , • i sory processing and motor performance in autism

ties would have been discontinued sooner. /r , T A TA7 , 0 D spectrum disorders. In A. M. Wetherby & B. M.

Interobserver agreement was obtained, in Prizam (£ds } Auti$m spectmm A tmnsac_ part, by a professor who does not work in the tional developmental perspective (pp. 143-166). Bal public school. Arranging for scoring with the timore: Brookes. assigned occupational therapist would serve Ayres, A. J. (1972). Sensory integration and learning multiple purposes including assessing the out- disabilities. Los Angeles, CA: Western Psychologi comes of proposed intervention strategies and cal Services. avoiding requiring teachers to spend valuable Ayres, A. J., & Tickle, L. S., (1980). Hyper-responsi time implementing ineffective or no longer bilitXto touch and vestibular stimuli as a predictor needed interventions. Baranek (2002) recom- °f Pos'utive espouse to sensory integration proce , . , dures by autistic children. 1 he American loumal ot

mends that professionals provide sensory or Occupational Therapy, 34, 375-381. motor treatments in shorter-term duraüons Arendt R £ MacLean> w E _ & Baumeister, A. A. such as between 6 and 12 weeks, and that (1988). Critique of sensory integration therapy progress is well documented in a systematic an(j ¡(S application in mental retardation. Ameri manner. Public school personnel could facili- can Journal on Mental Retardation, 92, 401-411. täte this process by requiring ongoing Baranek, G. T. (2002). Efficacy of sensory and mo


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Received: 23 October 2008

Initial Acceptance: 9 January 2009 Final Acceptance: 22 July 2009



division on autism and developmental disabilities ... · division on autism and developmental...

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