Sensory Integration...

The Black Oil

Apologies if this is in the wrong place.

Does anyone know much about it, specifically in connection with autism? I've Googled but just wondering if anyone has any first hand knowledge or epxerience of it...

snorlax

yup im a final year Occupational therapy student we learn it as part of paediatric s. very interesting area. ask me any questions.:)

The Black Oil

Ta snorlax.

What's involved in assessing or building a sensory profile, questions or what? When that's complete is it a case of putting a plan together and working on it?

Myksyk

The concept is higly questionable and has been highly questioned. Go here for a summary of some of the issues. Go here for a further discussion. Also interesting is this document and this from Scott Lilienfeld.

Gibs

Here is another review that questions the whole concept. It's actually written by an OT :rolleyes:

snorlax

but if you actually worked as an OT or in the area you might see the benefits yourself. much of the evidence produced as been low quality or involves small sample sizes which aren't rigourously controlled etc, but that just means that more high quality evidence needs to be done aoround the area. what evidence is there that it has no benefit. I have seen it the benefits of it myself on placement but it would be hard to turn that into research as it would just be a few single case studies. it can be really good for reducing tactile defensiveness in kids with autism. this being an example of clients iv worked with and seen improvements with.

Myksyk

snorlax wrote:

but if you actually worked as an OT or in the area you might see the benefits yourself.

Arguments for the benefits of therapies or whether they work or not simply cannot be based on anecdotal evidence as you provide here. This is the "I've seen it work" argument of the Alternative Medicine ranks and has no place in evidence-based health care. There are simply too many factors at work in any intervention to be able to say some one thing in particular is having an effect (general or specific) without controlling for those other factors. These factors (called non-specifics) are recognised as always doing some work and they make it very difficult to tell if anything else is doing any work. This is one reason why our own observations of the impact of interventions is so spectacularly limited. They are also why we need the scientific method. We simply can't prise open complex systems through casual observation and see what factors are doing work and what factors are doing nothing. If we try we can (very) easily make the error of assuming that a factor (e.g. a particular therapy) is doing something when in fact it is doing nothing.

much of the evidence produced as been low quality or involves small sample sizes which aren't rigourously controlled etc, but that just means that more high quality evidence needs to be done aoround the area.

No, more seriously and perhaps more likely is that it might mean that what the research found was flawed or wrong. High quality research might find that the process does little or nothing. In the meantime, should we to use this process for assessment and treatment on the basis of anecdote and poor quality research? No, we should wait until the evidence in its favour is produced. The implication of not doing so is that we take any idea from any quarter which has some anecdotal back-up (is there any idea which doesn't have some?) and then immediately introduce it to our clients and our students and hope that one day some one will show that it has some benefit (and hopefully no actual harmful side effects). If were to go down that route we can kiss goodbye to evidence-based care, the scientist-practitioner model of practice and the whole area of health research.

what evidence is there that it has no benefit.

I'm really surprised at this question. You cannot prove a negative and nor is it the responsibility of anyone to prove something 'doesn't' work. Those who make the claim provide the evidence.

snorlax

Myksyk wrote:

Arguments for the benefits of therapies or whether they work or not simply cannot be based on anecdotal evidence as you provide here. This is the "I've seen it work" argument of the Alternative Medicine ranks and has no place in evidence-based health care. There are simply too many factors at work in any intervention to be able to say some one thing in particular is having an effect (general or specific) without controlling for those other factors. These factors (called non-specifics) are recognised as always doing some work and they make it very difficult to tell if anything else is doing any work. This is one reason why our own observations of the impact of interventions is so spectacularly limited. They are also why we need the scientific method. We simply can't prise open complex systems through casual observation and see what factors are doing work and what factors are doing nothing. If we try we can (very) easily make the error of assuming that a factor (e.g. a particular therapy) is doing something when in fact it is doing nothing.

and that's why most therapist re-test the clients before and after therapies are recieved. most tests are standardised. CLincal observations are just as valid. OF course there are other factors but there would be in nearly any area of medical research

No, more seriously and perhaps more likely is that it might mean that what the research found was flawed or wrong. High quality research might find that the process does little or nothing. In the meantime, should we to use this process for assessment and treatment on the basis of anecdote and poor quality research? No, we should wait until the evidence in its favour is produced. The implication of not doing so is that we take any idea from any quarter which has some anecdotal back-up (is there any idea which doesn't have some?) and then immediately introduce it to our clients and our students and hope that one day some one will show that it has some benefit (and hopefully no actual harmful side effects). If were to go down that route we can kiss goodbye to evidence-based care, the scientist-practitioner model of practice and the whole area of health research.

high quality research uses rigourous controls and often RCTs the article above states there is few that have been done already. so therefore more high quality experiments need to be done. i found none on the topic in cochrane (systemic reviews being the highest level of evidence, implying that more needs to be done).
on another point OT is a very practical job and only recently have colleges embraced evidence based practice as a standard which is why evidence around what OTs do and what benefits it has is lacking especially within an irish context. I aggree though that more research needs to done before accepting SI as the be all and end all of intervention/ assessment. it is not somehting that is easily quatifiabile as all clients/ therapists are different .

I'm really surprised at this question. You cannot prove a negative and nor is it the responsibility of anyone to prove something 'doesn't' work. Those who make the claim provide the evidence.

my point is that you shouldn't discount it entirely unless you work in the area and see the results for yourself rather then simply listing articles that may not even be set in Ireland.

snorlax

speaking of which Myksyk you might like this painting/ print i did..:D

Myksyk

snorlax wrote:

and that's why most therapist re-test the clients before and after therapies are recieved.

Test/re-test procedures in clinical work are aimed at assessing change not necessarily assessing what caused that change; although I would agree that there is often an unwarranted assumption that what the professional did was the reason for the change.

Clinical observations are as valid

... as what? They certainly aren't as valid as controlled research if you are talking about assessing the effectiveness of specific therapies.

my point is that you shouldn't discount it entirely unless you work in the area and see the results for yourself

But this again is the bogus 'try it and see' argument. You can do a therapy and see changes but this will tell you nothing about the effectiveness of that therapy unless you are able to demonstrate that your therapy was responsible for the outcome you saw and not the host of other factors (or others) we alluded to above. I can wave crystals over you to cure your jippy tummy and you might happen to get better after I do it ... does that mean that my crystal-waving was responsible? Maybe but not necessarily so. Certainly a 'try it and see' approach will not give us the answer.

rather then simply listing articles that may not even be set in Ireland

Their setting is of no relevance. Unless you're syaing that SI is a questionable practice in some places ... but not in Ireland??

snorlax

Myksyk wrote:

Test/re-test procedures in clinical work are aimed at assessing change not necessarily assessing what caused that change; although I would agree that there is often an unwarranted assumption that what the professional did was the reason for the change.

assuming that you are the prime professional working on a particular area like tactile defensiveness and are following it up with a home program every day and are testing and re-testing that childs tolerance to sensation and you see an improvement that they can actively tolerate more and more every day and over a given time period they're tolerance improves. then the primary cause of change would be the therapy the professional was giving and the follow-up done at home by the parents, and by teachers so therefore the treatment prescribed would be the main factor in change along with follow-up in the child's environment.

... as what? They certainly aren't as valid as controlled research if you are talking about assessing the effectiveness of specific therapies.

assuming that a professional has clinical experience in a given area, and is professionally qualified in that area of expertise professional clinical observations that monitor change are valid. although they may not be standardised observations eg they may be done in the child's home and/ or other environments they are an equally valid and equally important way of assessing treatment effectivess. obviously the down-side is that there are no controls, and it is subjective, but that doesn't make it any less important is assessing how the child will function.
OTs are particularily concerned with how clients function in their environment, and not just how they function on pen and paper tasks and perscribed standardised assessments. with the relevant experience observations in the field of OT (which is a very pratical profession )are equally valid and i think the comparison to an alternative therapist is invalid on your part as most OTs hold undergraduate degress if not masters so it is a tad flippant.

But this again is the bogus 'try it and see' argument. You can do a therapy and see changes but this will tell you nothing about the effectiveness of that therapy unless you are able to demonstrate that your therapy was responsible for the outcome you saw and not the host of other factors (or others) we alluded to above. I can wave crystals over you to cure your jippy tummy and you might happen to get better after I do it ... does that mean that my crystal-waving was responsible? Maybe but not necessarily so. Certainly a 'try it and see' approach will not give us the answer.

but certainly the evidence you persented was one-sided and said nothing of your search strategies or how you went about the search assuming you already had a bias before commencing the search then the conclusions would be invalid. as i mentioned there are no systemic reviews and these would be the most relevant evidence as they have rigourous controls would prevent bias in searching occuring.

Their setting is of no relevance. Unless you're syaing that SI is a questionable practice in some places ... but not in Ireland??

where do i say that?
my point is that those articles were set abroad so may not be relevant in Ireland so perphaps giving them some much weight would be invalid given the cultural differences espeically between the us and ireland.

my other point was that more research needs to be done in an irish context based on services that can be offered here rather then relying soley on what is done in a different health care system.

Gibs

I think you are missing the point a little bit snorlax. There is no criticism in what Myksyk says of the overall effectiveness of OT interventions. It's clear that OT's do excellent work that produces excellent results. The issue is one of identifying the active ingredient(s) that cause change in clients and determining how effective each ingredient is.

At present, despite a few reasonable attempts by various researchers in various places to establish the validity and reliability of SIT specifically, there is no good, reproducible evidence to say (a) SIT in particular causes improvement and (b) the improvement is significant and (c) changes caused by SIT are persistent. You may intervene on a clinical level with individual clients and produce great results, but unless you subject your treatment to evaluation by using rigorous, scientifically valid, methodologically sound experimental confirmation, Myksyk is absolutely correct when he says that you can't attribute any clinical effectiveness specifically to the SIT. It may or may not be effective, you simply can't say for sure until you test it in a proper way, and anecdotal, clinical evidence is not a proper, valid or reliable way to do so.

There is a move afoot in clinical research away from relying solely on double blind placebo-controlled RCTs and the idea of evidence-based-practice, towards the concept of practice-based evidence and quasi-experimental designs. However, you need to have good, well-designed studies that determine efficacy before you can begin to evaluate effectiveness in a real-world situation. Otherwise you are opening the floodgates to the acceptance of any kind of intervention as long as the patient/client improves. Outcome-based research is useful but not if it fails to have discriminatory power between active and placebo ingredients.

Myksyk

snorlax wrote:

my point is that those articles were set abroad so may not be relevant in Ireland so perphaps giving them some much weight would be invalid given the cultural differences espeically between the us and ireland.

To save my fingers, see Gibs' response. With regard to the pieces I linked to -they are not research papers, they are opinion pieces which are commenting on the available research; therefore their setting is entirely irrelevant.
If there was good quality research to back SIT up then they would have referenced it and presumably so would you. There isn't.

snorlax

[quote=

Myksyk]To save my fingers, see Gibs' response. With regard to the pieces I linked to -they are not research papers, they are opinion pieces which are commenting on the available research; therefore their setting is entirely irrelevant.

most research on SI has been done in america not ireland so i think it is relevant if that is the only research they are commenting on

If there was good quality research to back SIT up then they would have referenced it and presumably so would you. There isn't.

[/QUOTE]

yes. i agree so my main point is that mosre needs to be done before jumping to conclusion based on comments that may have a bias in the first place. Qualitative research may have a role to play in SI considering a lot of cases will be different.

Myksyk

most research on SI has been done in america not ireland so i think it is relevant if that is the only research they are commenting on

So there's very poor research in America (which is relevant unless you have a good reason for suspecting that cultural differences play a part in the effectiveness of SIT) and no research at all in Ireland?

yes. i agree so my main point is that mosre needs to be done before jumping to conclusion based on comments that may have a bias in the first place.

They are considering and commenting on the available research which by consensus is almost non-existent and where there is some it is of poor quality. Where is the bias? There is either evidence of effectiveness and validity or there isn't.

In the absence of acceptable evidence to support an intervention (and in the presence of dubious theoretical claims) the default position is healthy scepticism. The 'jumping to conclusions' is being done by those who in the absence of supportive evidence of any kind feel it is a good idea to promote these ideas and practices to students and clients. Surely the current position demands responsible professionals to be much more cautious than this.

snorlax

[quote=Myksyk

]So there's very poor research in America (which is relevant unless you have a good reason for suspecting that cultural differences play a part in the effectiveness of SIT) and no research at all in Ireland?

you said yourself they are multipile factors that need to be take into consideration. the health system and educational system would be different in the US especially given that you need to be insured to get anything in healthcare, so therapy sessions would be altered to facilitate this (they may be more intense, or the child may not get all he/she needs). yup im saying more needs to be done in ireland because we have a different health care system, also services for autism are pretty poor in ireland in different areas which would otherwise effect treatment if take years just to diagnose the patient. waiting lists are really bad.

They are considering and commenting on the available research which by consensus is almost non-existent and where there is some it is of poor quality. Where is the bias? There is either evidence of effectiveness and validity or there isn't.

the bias is if someone has a pre-concieved idea before commencing research and therefor they're search is one-sided.

In the absence of acceptable evidence to support an intervention (and in the presence of dubious theoretical claims) the default position is healthy scepticism. The 'jumping to conclusions' is being done by those who in the absence of supportive evidence of any kind feel it is a good idea to promote these ideas and practices to students and clients. Surely the current position demands responsible professionals to be much more cautious than this.

[/QUOTE]

i aggree a certain amount of sceptism is neccessary but then when you see some direct results of somehting you have been working on and see that it has helped someone it can be good for practice, if something isn't practiced/ tried out how would anyone know how to treat clients?

Myksyk

you said yourself they are multipile factors that need to be take into consideration. the health system and educational system would be different in the US especially given that you need to be insured to get anything in healthcare, so therapy sessions would be altered to facilitate this (they may be more intense, or the child may not get all he/she needs). yup im saying more needs to be done in ireland because we have a different health care system, also services for autism are pretty poor in ireland in different areas which would otherwise effect treatment if take years just to diagnose the patient. waiting lists are really bad.

Ok so we should just about ignore all research and reviews of research from the States on therapeutic interventions? I'm sure you couldn't be arguing this yet you seem to be??? In addition, we should take the reviews which highlight the lack of quality research in the States with a pinch of salt and we should recognise that there's no research of any quality in Ireland. Bizzarely, on the basis of this your conclusion is that we should have no problem teaching and practicing SIT?

the bias is if someone has a pre-concieved idea before commencing research and therefor they're search is one-sided.

You're claiming the reviews are one-sided and biased. What research did they leave out? If I had known you had access to references to good quality research re SIT I wouldn't have argued the point so heartily. Please link to the research here. Otherwise your claim of bias and one-sidedness is spurious and unhelpful.

snorlax

Myksyk wrote:

Ok so we should just about ignore all research and reviews of research from the States on therapeutic interventions? I'm sure you couldn't be arguing this yet you seem to be??? In addition, we should take the reviews which highlight the lack of quality research in the States with a pinch of salt and we should recognise that there's no research of any quality in Ireland. Bizzarely, on the basis of this your conclusion is that we should have no problem teaching and practicing SIT?

em where did i use the word ignore? i said we need to take them all with a pinch of salt until further investigations have be carried out in a context similiar to our own rather them simply posting up opinon pieces from there. Even articles from the uk would be better as they are closer related to ireland in context. again your putting words in my mouth. my conclusion is that we need to practice but with a pinch of salt, and that the only way reasearch in ireland will be done is if people are actively practicing it and reviewing their progress not if we jsut ignore it altogether.

You're claiming the reviews are one-sided and biased. What research did they leave out? If I had known you had access to references to good quality research re SIT I wouldn't have argued the point so heartily. Please link to the research here. Otherwise your claim of bias and one-sidedness is spurious and unhelpful.

[/QUOTE]

nope im not. im claiming that perphaps you looked for articles that best suited your own opinons and hence that would bias the search results as knowwhere did you post your search engines/ methods etc and to be perfectly the only reason im debating this right now as that your reponses in my opinion were disrepectful and patronizing in some parts when you compared a trained health professionals opinons to that of an alternative therapists. it's not the first time you've had such a cavalier attitidue which i believe could people off posting here.

i have access to all archives from college, most people here will be unable to access them though as they are on a subscription only basis.

Myksyk

snorlax wrote:

the only way reasearch in ireland will be done is if people are actively practicing it and reviewing their progress not if we jsut ignore it altogether.

I'm sorry. I didn;t realise you were carrying out or are involved in clinic-based research on SIT. However, I would like to know where the results will be published? ... Unless of course you are not doing research and are just practising a therapy which has no evidence of efficacy to back it up.

im claiming that perphaps you looked for articles that best suited your own opinons and hence that would bias the search results as knowwhere did you post your search engines/ methods

Em ... I googled SIT. But this is beside the point. If you have information or research in support of SIT PLEASE post it here. I'm not trying to be obtuse but you seem to fail to realise that it is the duty of those making claims on behalf of a therapy to provide the evidence to support that claim. The fact of the matter is that you have produced no research to support your claims, only anecdote. I am simply pointing out to you that that is not considered a reliable or acceptable form of evidence.

etc and to be perfectly the only reason im debating this right now as that your reponses in my opinion were disrepectful and patronizing in some parts when you compared a trained health professionals opinons to that of an alternative therapists.

I said the 'try it and see' approach to assessing something 'works' is typical of Alternative Medicine which it unquestionably is. If you support the same approach then I'm afraid Snorlax that the comparison, although critical, is entirely legitimate.

it's not the first time you've had such a cavalier attitidue which i believe could people off posting here.

I'm sure I've had my moments on Boards, like most. Although I don't know to what you're referring here. The discussion here so far in my opinion has been wholly appropriate. The only other poster (a well-respected one here I think) has agreed with my position. Healthy and rigorous debate is a hallmark of scientific disciplines. You've taken offence where none was intended and have now descended to personal attacks. Pity.

JuliusCaesar

http://chronicle.com/free/v49/i25/25b00701.htm

An interesting paper on the Scientist-Practitioner gap, by a social psychologist, covering thing like the confirmation bias.

We work in a difficult field, rife with people who headed off with their qualifications from college and seemingly promptly forgot all they had learned about science (if they ever took it on board). We constantly end up debating whether psychology is a science, because of all the charletans, some of whom seem to have impressive qulifications. Some of whom actually have a sound academic background, and some whose qualifications don't bear too much scrutiny. >Sigh!<

Myksyk

Very interesting and pertinent.

snorlax

Myksyk wrote:

Em ... I googled SIT. But this is beside the point. If you have information or research in support of SIT PLEASE post it here. I'm not trying to be obtuse but you seem to fail to realise that it is the duty of those making claims on behalf of a therapy to provide the evidence to support that claim. The fact of the matter is that you have produced no research to support your claims, only anecdote. I am simply pointing out to you that that is not considered a reliable or acceptable form of evidence

well google is hardly a fool proof reliable source of research articles unless they're peer reviewd :rolleyes: my claims are first hand experience, ancetol or nto id wager by saying i have more first hand experince then you do.....

I said the 'try it and see' approach to assessing something 'works' is typical of Alternative Medicine which it unquestionably is. If you support the same approach then I'm afraid Snorlax that the comparison, although critical, is entirely legitimate.

and how will we get any evidence im ireland to support it's use if knowone is using it to comment or do studies on it.

I'm sure I've had my moments on Boards, like most. Although I don't know to what you're referring here. The discussion here so far in my opinion has been wholly appropriate. The only other poster (a well-respected one here I think) has agreed with my position. Healthy and rigorous debate is a hallmark of scientific disciplines. You've taken offence where none was intended and have now descended to personal attacks. Pity.

[/QUOTE]

to be honest your very first post would be enough to put anyone off posting here, it was a load of gibberish to be honest and it sounded quite arrogant (much like a previous post where you said thank god i was only a student)..and to be honest wasn't half as well written as Gibs post which i have taken into consideration because his post wasn't entirely one-sided. if you felt the need to reply to my posts i must had some good points, it's the fact that you dont' listen then and assume a high and mighty attitude that i have a problem with:)..i'm sorry if your offended but someone had to say it and it was not meant as a personal attack rather i was making a point about the style of your posts:)

The Black Oil

Jaysus, what have I started?! Interesting to read though.

Myksyk

snorlax wrote:

well google is hardly a fool proof reliable source of research articles unless they're peer reviewd :rolleyes:

The articles I linked to were not research articles. If you cannot even tell that you are in far more serious trouble than I believe right now. They are review articles. I take them seriously because I know the people involved. Scott Lilenfeld for example is Founder and Editor of the Scientific Review of Mental Health Practice. I take his word seriously. I'm not saying it's the last word but if people like him have qualms then we should take them seriously. You don't, I do.

my claims are first hand experience, ancetol or nto id wager by saying i have more first hand experince then you do.....

You probably have more first hand experience than me when it comes to SIT. The again, I try not to engage in assessments or therapies which have no evidence to support them. And you still have clearly failed to grasp the fundamental point of this debate which I've made from the start and which was echoed in Gibs' post.

and how will we get any evidence im ireland to support it's use if knowone is using it to comment or do studies on it.

Research studies on SIT would need to be set up carefully. It is not a case of practising it and assuming that one day you'll be part of a research programme into it. I wouldn't have a problem with a clinic-based research programme being run to investigate the efficacy of SIT. That would be a good idea. That, however, is not what you're doing so let's not pretend it is.


[/QUOTE]

to be honest your very first post would be enough to put anyone off posting here,

My first post was a link to four articles. ????

it was a load of gibberish to be honest and it sounded quite arrogant (much like a previous post where you said thank god i was only a student)..and to be honest wasn't half as well written as Gibs post which i have taken into consideration because his post wasn't entirely one-sided.

I have a feeling you're referring to my second post. I don't mind getting constructive feedback Snorlax but it wasn't gibberish by any reasonable standards. If you didn't understand it (as Gibs clearly did) then admit it.

if you felt the need to reply to my posts i must had some good points,

Em ... I thought I was disagreeing with most of your points actually.

it's the fact that you dont' listen then and assume a high and mighty attitude that i have a problem with:)..i'm sorry if your offended but someone had to say it and it was not meant as a personal attack rather i was making a point about the style of your posts:)

You see Snorlax, the fact is that I DO listen. I address your points very carefully but your replies and arguments are ill-conceived and poorly articulated. Your problem is that I don't agree with you and your reply is not to engage in well-thought out argument (the cut and thrust of scientific debate) but to become personal. My style of posting in this thread is strong but it is not arrogant. You are not arrogant just because you hold a position.

Btw, saying something is not a personal attack doesn't mean it isn't one. You are personally attacking me while I am trying to be clear and impersonal. I'm not particularly bothered by it but it makes having a debate impossible.

You are one of the mods on this board and all you're doing is setting a marker down that articulate, rigorous debate in the psychology forum is to be discouraged and that if you can't actually frame a consistent, reasoned argument, well then it's ok to become personal.

I'd really like others' opinions on this.

snorlax

Myksk it's not so much the content of your posts i have a problem with it's your attitude. you will be banned if you post like that again. the fact is people besides yourself have opinons that are worthy to take into account and you simply don't listen to them but because you assume your knowledge will make some google search more worthy yet me a student can tell you you need far more then a google search to produce a worthy argument. i don't care what your background is/ academic or not you can give some will respect all posters here. people like you put people off posting here wiht their arrogance. thread locked for the time being. you just did it again the post above, and it such a load of codswollop i don't think i adds anything of value so it is deleted.