Effect of Classroom Modification on Attention and
Engagement of Students With Autism or Dyspraxia
KEY WORDS
 apraxias
 attention
 autistic disorder
 environment
 learning
 sensation
Moya Kinnealey, PhD, OTR/L, FAOTA, is Faculty
Emeritus, Department of Rehabilitation Sciences,
Occupational Therapy Program, Temple University, 648
West Phil Ellena Street, Philadelphia, PA 19119;
moya.kinnealey@temple.edu
Beth Pfeiffer, PhD, OTR/L, BCP, is Assistant
Professor, Department of Rehabilitation Sciences,
Occupational Therapy Program, Temple University,
Philadelphia.
Jennifer Miller, MS, OTR/L, is an Independent
Contractor in Pediatrics, Allentown, PA.
Cecilia Roan, MS, OTR/L, is Occupational Therapist,
Gloucester County School District, Sewell, NJ.
Rachel Shoener, OTR/L, is Head Occupational
Therapist, TALK Inc., Newtown Square, PA.
Matt L. Ellner, MS, OTR/L, is an Occupational
Therapist in private practice, Newtown, PA.
The American Journal of Occupational Therapy
Moya Kinnealey, Beth Pfeiffer, Jennifer Miller, Cecilia Roan,
Rachel Shoener, Matt L. Ellner
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
Students with autism display sensory sensitivities to environmental stimuli that affect their attending and
engagement in classroom learning activities. The purpose of the study was to determine whether attending
of 4 male students, ages 13–20, increased after the installation of sound-absorbing walls and halogen
lighting. The multiple single-subject, mixed-method design, AB(B1C), included a 2-wk baseline and two
intervention phases: 2 wk after sound-absorbing wall installation using the Owens Corning Basement
Finishing System
(Owens Corning, Toledo, OH) and 2 wk after halogen light installation. We calculated
nonattending frequencies from videotaped class sessions and used visual analysis to measure within-phase
and between-phase characteristics. Results included increased frequency and stability of attending and
engagement and improved classroom performance, comfort, and mood. Journaling provided students’
perspective on the modifications and reflected overall increased sensory comfort and themes of improved
classroom environment, positive emotional response (mood), and improved classroom performance.
Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M. L. (2012). Effect of classroom modification on
attention and engagement of students with autism or dyspraxia. American Journal of Occupational Therapy, 66,
511–519. http://dx.doi.org/10.5014/ajot.2012.004010
A utism is a lifelong neurodevelopmental disorder that affects social and
communication skills. It is one of the most prevalent developmental dis-
orders, occurring in 9.0 per 1,000 population, or 1 in every 110 children,
according to the Autism and Developmental Disabilities Monitoring Network
(Rice, 2006). This estimate, which is 10 times higher than before 1990, is in
large part the result of a reclassification that combined three disorders as autism
spectrum disorders (Rice, 2006). The increased prevalence has created a sig-
nificant challenge to public education because many children with autism re-
quire intensive interventions to facilitate their participation and success in the
educational setting.
People diagnosed with autism have common symptoms and characteristics
that affect school participation (Altevogt, Hanson, & Leshner, 2008), including
sensory processing difficulties, stereotyped behaviors, communication and
language difficulties, low muscle tone, and sleep disturbances (Adams, Edelson,
Grandin, & Rimland, 2008; O’Neill & Jones, 1997; Tomchek & Dunn,
2007).
The Individuals With Disabilities Education Improvement Act of 2004
mandates a free appropriate public education in the least restrictive environment
for all students. Access to the general education curriculum and inclusion with
peers without disabilities is the expected method of providing services for
students with disabilities (Jimenez, Graf, & Rose, 2007). Individualized edu-
cation plans document the modifications, accommodations, and related services
required to enable a student to progress through the curriculum. The challenge
511
for schools is to provide services for students with autism
that will allow them to benefit from their educational
placement (Godek, 2008).
Modifications to the educational environment and
adaptations to facilitate learning are essential for many
students to succeed in school as well as in college (Van-
Bergeijk, Klin, & Volkmar, 2008). Universal design, an
approach to making general education more accessible for
children with disabilities, is the concept of simplifying life
for everyone by making environments, products, and
communication systems usable by more people (Jimenez
et al., 2007). Universal design for learners (UDL) applies
principles of universal design to curriculum instruction
and addresses improving engagement through identifi-
cation of distractions and threats and promoting self-
regulation for learners (CAST, 2011).
Attention and engagement are interchangeable terms
that are associated with successful learning and are
common problems for people with autism. Poor atten-
tion is an identified impairment that could be a root
cause (Ornitz, 1988) or could contribute to the core
features of autism (Mundy, Neal, & Glidden, 2001).
Various types of attention—orienting attention, sustained
attention, shifting attention, social attention, and joint
attention—have been studied in people with autism, as
described by Patten and Watson (2011). Orienting at-
tention is a person’s initial physical orientation to a stim-
ulus, person, or event, and sustained attention is the ability
to maintain the regard of an object or event. Shifting
attention is the process required to disengage attention
from one stimulus and to reorient and engage attention
toward another. In contrast, social attention is a naturally
occurring orientation to social stimuli such as voices and
faces of others, and difficulty in this area is a core feature
of autism. Finally, joint attention is shared attention be-
tween two or more people or between people and an
object or event. Joint attention is particularly pertinent in
the educational context; it involves all other components
of attention and is a social behavior. All of these types of
attention, except for sustained attention, are problematic
for people with autism (Patten & Watson, 2011).
Students who have difficulty modulating the sensory
information in their environment have difficulty attending
to the stimuli relevant for learning (Liss, Saulnier, Fein, &
Kinsbourne, 2006; Pfeiffer, Henry, Miller, & Witherell,
2008). Sensory processing and modulation issues are es-
timated to affect as many as 95% of people with autism
(Baker, Lane, Angley, & Young, 2008). Sensory processing
includes receiving, modulating, integrating, interpreting,
and responding to sensory information, including visual,
auditory, proprioceptive, vestibular, tactile, and olfactory
512
stimuli (Baker et al., 2008; Miller, Coll, & Schoen,
2007). Sensory modulation disorder refers to an inability to
appropriately adapt one’s response to sensory stimuli
from one’s own body or the external environment, which
can affect attention and behavior (Miller, Anzalone, Lane,
Cermak, & Osten, 2007).
Sensory modulation disorders affecting the audi-
tory system may result in hypersensitivity and over-
responsiveness to pitch, volume, specific sounds, or
multiple sounds such as gatherings of people or street
sounds. Researchers have recognized the severity and fre-
quency of auditory hypersensitivity (Minshew & Hobson,
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
2008) and its effect on attention and learning in people
with autism (Ashburner, Ziviani, & Rodger, 2008) in
spite of the lack of identified peripheral auditory differ-
ences (Gravel, Dunn, Lee, & Ellis, 2006). Avoidant
behaviors are often associated with hypersensitivity to
auditory stimuli. Routine classroom noise, especially
when combined with verbal instruction, makes attending
difficult for many students and especially for learners with
autism (Ashburner et al., 2008). In fact, people with
autism may have cognitive abilities similar to those of
nonautistic or gifted people (Barnhill, Hagiwara, Myles,
& Simpson, 2000), but interpersonal and sensory mod-
ulation difficulties, specifically auditory sensitivities, may
negatively affect academic performance (VanBergeijk
et al., 2008). Temple Grandin (2011), a person with
autism and auditory sensitivities, has reported that her
ears amplify sounds and she is unable to modify the
stimulation. She asserted that people with autism should
be “protected from sounds that hurt their ears” (p. 1).
Lighting also has a significant influence on learning.
McCreery and Hill (2005) stated that the use of con-
trolled illumination is a critical aspect of the learning
environment and affects student achievement. The use of
high-quality lighting in school environments has been
linked to students’ improved mood, behavior, and con-
centration (Northeast Energy Efficiency Partnerships,
2002).
Classroom lighting can improve student comfort and
attention. Fluorescent lights, although energy efficient, do
not provide the best quality of light for learning. They
have an unnatural color and a discontinuous spectrum,
and they can be too bright for people who experience light
sensitivity (Lorelei, 2003). Fluorescent lights have been
associated with increased student stress and may nega-
tively affect students’ learning, behavior, and comfort
(Küller & Laike, 1998; Martel, 2003; Northeast Energy
Efficiency Partnerships, 2002). Students in school envi-
ronments that incorporate full-spectrum lighting expe-
rience less stress and anxiety and improved behavior,
September/October 2012, Volume 66, Number 5
attitudes, health, attendance, performance, and academic
achievement (Martel, 2003).
Students with autism are often sensitive to light, and
some lighting may be painful to them, especially bright
and flickering lights. Research has suggested that children
with autism exhibit increased repetitive behavior when
exposed to fluorescent lights (Küller & Laike, 1998).
Grandin (1995) suggested that some people with autism
can see the 60-cycle flicker associated with fluorescent
lighting, resulting in headaches, eyestrain, or the per-
ception of a pulsating room. In contrast, halogen lighting
is soft, producing a golden-white light with continuous
spectral distribution that looks and feels like sunlight
(Lorelei, 2003). Determining the effectiveness of sensory-
based UDL modifications to improve classroom sound
and lighting for students with autism can benefit educa-
tional programs.
Purpose and Research Questions
The purpose of our study was to determine whether
students with autism demonstrate increased attention
during learning activities in a classroom after the in-
stallation of sound-absorbing walls and halogen lighting
and to explore how the modifications affect attending and
learning from the students’ perspective. The research
questions were as follows:
1. Will students diagnosed with autism or dyspraxia
demonstrate increased attention for learning activities
after the installation of sound-absorbing wall material?
(The material used was the Owens Corning Basement
Finishing System
; Owens Corning, Toledo, OH.)
2. Will students with autism or dyspraxia demonstrate
increased attention for learning activities after the in-
stallation of halogen lighting?
3. From the students’ perspective, do sound and lighting
modifications affect their ability to attend to classroom
activities?
Method
Research Design
We used a mixed-method, multiple single-subject AB
(B1C) design that provided systematic repeated mea-
surements of behavioral responses over time, including
baseline and intervention phases (Portney & Watkins,
2000). For this study, A was a 2-wk baseline (BL), B was
2 wk after the installation of sound-absorbing walls (wall
phase, or WP), and C was installation of halogen lighting
(lighting phase, or LP) in a sound-absorbing ceiling. The
B1C segment included the installation of halogen lights
The American Journal of Occupational Therapy
and ceiling panels in addition to the sound-absorbing walls.
We chose this design because it allowed us to quantify and
compare behaviors across phases with participants func-
tioning as their own controls. In addition, we interviewed
each student 3 times in each phase with predetermined,
open-ended questions about the student’s perceptions of
the environmental modifications. Parents were requested
not to change medications or diet during the study.
Setting
The study took place in a licensed, nonprofit, private ac-
ademic school for prekindergarten through 12th-grade
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
students with severe communication disorders, including
students diagnosed with autism. Total school enrollment
was 16–20 students. One classroom was modified for this
study, and the 4 study participants were the students as-
signed to this classroom. The 11-mo academic curriculum
uses a structured, multisensory, phonics-based curriculum
for teaching speech, reading, language, writing, and liter-
acy. Occupational therapy is integrated within the curric-
ulum supplemented by individualized sessions.
Participants
The study was approved by Temple University’s in-
stitutional review board. A letter was sent from the school
director to parents of students in the classroom targeted for
modification. The letter described the classroom mod-
ifications, the study, and allowance for exclusion of student
data on parental request. Parents contacted the school
director in writing to permit their child to participate in
the study. Participants were 4 male students ages 13–20
assigned to the classroom targeted for modification to
improve the sensory environment. Participants needed to
demonstrate classroom-ready behaviors as defined by the
school and be free of special health concerns, cognitive
impairment, or a psychiatric condition.
Instruments
A decibel (dB) is a unit of sound or loudness measure-
ment. The weakest heard sound is 0 dB, a whisper is
approximately 3 dB, and normal conversation is 60–70
dB. Death of hearing tissue occurs at 180 dB (Chasin,
2007).
We used a decibel meter to measure ambient class-
room sound before and after the sound-absorbing walls
and ceiling were installed. The meter recorded sound
ranging from 50 dB to 126 dB. Sound <50 dB was dis-
played as low without a specific dB value.
The frequency of attending and nonattending be-
haviors was measured through analysis of 10-min video-
taped segments on 4 days during four academic periods
513
during each phase (A, B, and B1C) for a total of sixteen
10-min video segments of each child per phase. Video-
taping is used regularly in the school and was a familiar
routine for the students.
Before the study, the occupational therapist familiar
with the students developed behavioral descriptors of
nonattending behaviors specific to each student that were
then corroborated by the teachers. For example, non-
attending behaviors for Participant 4 included rubbing his
eyes and face, covering his ears, vocalizing ³3 s without
visually attending, getting out of his chair, and requiring
three or more teacher prompts for a response.
Journaling was used to record the subjective experi-
ence and opinions of the students responding to a set of
questions about the environmental changes in BL, WP,
and LP. Interviews took place in a familiar quiet room
adjacent to the classroom and were conducted by the
occupational therapist (author Rachel Shoener). Three
students used spoken language to respond, and 1 typed the
responses.
The Sensory Profile (Dunn, 1999), a standardized
caregiver questionnaire, is completed by the parents an-
nually and provides ongoing information about how
a student processes information that in turn helps guide
programming. The 125 items are categorized into three
main groups: sensory processing, modulation, and be-
havioral and emotional responses. Content validity on
item selection was 80%, Cronbach’s a ranged from .47
to .91, and the test was found to discriminate among
groups without disability and diagnostic groups with
autism and attention deficit hyperactivity disorder.
Concurrent validity was completed with the School
Function Assessment (Coster, Deeney, Haltiwanger, &
Haley, 1998). In this study, we did not use the student’s
Sensory Profile as either an inclusion criterion or a mea-
sure of change. Alternatively, we used it to provide insight
into and context for behavioral changes. For example,
insight into the students’ sensory makeup through his
Sensory Profile helped explain why visual or auditory
changes in the environment contributed to improved
attention. Additionally, the students’ subjective responses,
in light of his Sensory Profile, provided a more holistic
understanding of the student–environment interaction.
Procedure
The study took place over 6 wk and included three phases:
a 2-wk BL before the environmental changes, 2 wk after
the installation of sound-absorbing walls (WP), and 2 wk
after installation of halogen lighting (LP). Classroom
physical layout, white walls, curriculum, routines, and
activities were unchanged and uninterrupted during the
514
course of the study. Installations were completed over
non–school days (weekends). The materials and instal-
lation were donated to the school.
The intervention was the installation of the Owens
Corning Basement Finishing System and included wall-
covering material, installed in Phase 2, made of light-
weight fiberglass panels, PVC lineal, and foam PVC trim
moldings. Ceiling covering and halogen lights were in-
stalled in LP. The noise reduction coefficient of the
sound-absorbing walls was 0.75 (Owens Corning, 2007).
Data Collection
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
To measure the reduction of sound levels in the class-
room, decibel readings were taken in five locations in the
classroom once per week during each phase of the study
(1) in the empty classroom, (2) during class time when
students were working quietly, and (3) during group
sessions. Heat and air vents were open during each phase.
To measure attending, 10-min classroom segments
were videotaped 2 days/wk during four academic periods
in BL, WP, and LP, resulting in a total of sixteen 10-min
video segments of each student for each phase. Videotaped
sessions were analyzed to determine the rate of attending
or nonattending behaviors.
To ascertain the student perspective, we interviewed
students 3 times each in BL, WP, and LP, using pre-
determined questions about students’ perception of the
environmental modifications. Their responses were tran-
scribed as they answered questions, and 1 student typed
his answers independently.
A Sensory Profile was completed by parents 6 wk
before the study. We used it to provide insight into and
a clinical explanation of behavioral response or changes.
Consistently using the same form was valued by the
school.
Two observers not familiar with the students and
blinded to the phases independently viewed videotapes
and scored the presence or absence of attending behaviors.
Videos were scored at 15-s intervals within each 10-min
segment for a total of 40 intervals. Decision rules were
established for scoring behaviors specific to each student
and consistent with the established targeted behaviors. If
one or more nonattending behaviors were observed within
a 15-s interval, a negative was scored for that interval.
Interrater reliability (96%) was established using the in-
terval-by-interval approach.
Data Analysis
Frequencies of nonattending behaviors were determined
for each student in BL, WP, and LP. To determine the
frequency of attending, we calculated the number of
September/October 2012, Volume 66, Number 5
negatives divided by the number of intervals times 100.
The frequency and percentage of nonattending behaviors
in each phase were compared for each student. The sum of
negatives for each interval was plotted on a graph for each
phase for each student for visual analysis.
The student interview transcripts were analyzed
through theme identification across BL, WP, and LP for
each student and then across students. Two independent
reviewers established interrater reliability for the themes.
This phenomenological methodology allowed us to ex-
plore the participants’ perspective and subjective experi-
ence with the modifications.
Results
The participants were 4 male students with language
impairment ages 13–20 assigned to the classroom tar-
geted for environmental modification. Three students
were diagnosed with autism (Participants 1, 3, and 4 [P1,
P3, and P4]), and 1 was diagnosed with dyspraxia (Par-
ticipant 2 [P2]). Three participants were verbal, and 1
(P4) was nonverbal and communicated through typing.
Participants were White, middle-class students who re-
sided in the suburbs of a major metropolitan area.
Classroom Sound
To illustrate the reduction of classroom sound created by
the wall installation, decibel readings are given in Table 1.
Sound averages and ranges were lower, and the percent-
age of low readings increased after the installation of the
sound-absorbing walls.
Attending and Nonattending Behaviors
Results demonstrated a reduction in the frequency of
nonattending behaviors across the two intervention
phases as well as increased stability of attending. Each
student exhibited a decline in nonattending behaviors
in the WP. Three of the 4 students (P1, P2, and P4)
demonstrated a continued decline in nonattending
behaviors in LP. P3, diagnosed with autism, showed an
Table 1. Classroom Loudness: Averages for Individual Work and
Group Work in Baseline, Wall Phase, and Light Phase
Individual Work Group Work
dB % Low Range, dB dB % Low Range, dB
Baseline 50.1 45 Low–52 60.2 0 50–68
Wall phase >49 100 Low 51.1 25 Low–56
Light phase >49 100 Low 51.6 60 Low–64
Note. Meter measured 50–130 dB; <50 registered as low. For calculations,
low 5 49. dB 5 decibels.
The American Journal of Occupational Therapy
initial increase in nonattending behavior in LP fol-
lowed by a reduction in nonattending behaviors.
P1 was diagnosed with autism. His Sensory Profile
indicated that he had difficulty with sensory modulation
related to endurance and tone and effecting emotional
responses and behavioral outcomes. He had difficulty
paying attention, was easily distracted by movement in the
room, and preferred sedentary activities. The targeted
nonattending behaviors, identified by the occupational
therapist and teacher, included head down on desk, eyes
closed, looking away from teacher or task, meltdowns, and
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
needing three or more teacher prompts.
Figure 1 depicts the frequency of P1’s nonattending
behaviors (BL, 18.3%; WP, 18.1%; LP, 1.9%). During
BL and WP, he was frequently observed with his head
down on his desk and looking away from the teacher or
task. After the installation of halogen lighting, P1 ex-
hibited no occurrences with his head down on the desk or
eyes closed. Journaling responses were not related to the
question asked and did not capture his subjective re-
sponses to the modifications.
P2 was diagnosed with dyspraxia. His Sensory Profile
revealed typical performance in all areas of sensory
processing; however, specific item responses indicated
distraction in a noisy environment, difficulty paying at-
tention, and a tendency to look away from tasks to regard
all activity in the room. Targeted behaviors included
fidgeting in his chair without visually attending, hands in
desk, shoes on and off, looking around the room, and
requiring teacher prompts ³3 times.
Although P2’s Sensory Profile indicated minimal
difficulty with sensory processing, he exhibited improve-
ments in attention after wall and light modifications.
Figure 1 depicts the frequency of his nonattending be-
haviors (BL, 11.7%; WP, 5.6%; LP, 3.8%). The range of
nonattending behavior also declined over the two in-
tervention phases. During BL, 50% of the videotaped
segments had five or more nonattending behaviors com-
pared with 16% of the sessions in WP and LP combined.
P2’s journaling responses in WP were
The noise level has really not [been] as loud as it’s been . . .
when I am in my classroom it’s nice and quiet . . . my
handwriting is much better than it was when we did not
have the walls, much more focused in my work than
when we did not have the walls.
In LP, he reported,
Yes I did [notice a difference]. Much more calmer than
when the big lights shine. . . . I could see my teacher
better than before cause the lights are much more
dimmer than before, they shined right in my eye. . . . I’m
515

Figure 1. Number of nonattending behaviors of four participants.
really happy, very happy that I can finally come to
a quiet room, finally I can concentrate. . . . I feel like it
really has made a difference in the way I learn and the
way I work.
P3 was diagnosed with autism. Scores on his Sensory
Profile indicated typical processing in all areas except for
auditory processing. He expressed occasional discomfort
with or avoided bright lights but primarily had difficulty
with auditory distractibility and sensitivity. He was
reported to exhibit frequent difficulty completing tasks
with the radio on and often held his hands over his ears in
response to sound. The targeted nonattending behaviors
included vocalizing or talking to self, requiring three or
more teacher prompts, response time >3 s, and having
516
a glazed look in his eyes. These behaviors are consistent
with difficulty processing auditory stimulation.
Figure 1 depicts the frequency of nonattending be-
haviors for P3 (BL, 12.8%; WP, 3.3%; LP, 7.3%). The
stability of behaviors increased from 37% of the videotaped
sessions having 5–20 nonattending behaviors in BL to
100% having <5 nonattending behaviors in WP. In the first
day of LP, 25% of the sessions showed 5–10 nonattending
behaviors with a decrease to <5 for the remainder of LP.
P3’s journaling reflected an awareness of the environmental
changes, but most comments were not classroom related.
P4 was diagnosed with autism. Scores on his Sensory
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
Profile indicated a high level of difficulty with sensory pro-
cessing, including definite differences in auditory processing,
vestibular processing, touch processing, and modulation of
movement affecting activity level. Targeted nonattending
behaviors included rubbing eyes or face, covering ears, fidg-
eting, turning sideways or getting out of the chair, head down
on the desk, smelling or pulling on his shirt; vocalizing for
>3 s, and requiring teacher prompts ³3 times.
Figure 1 depicts the frequency of nonattending behav-
iors for P4 (BL, 17.2%; WP, 13.5%; LP, 12.2%). During
BL, 40% of the sessions had ³10 nonattending behaviors
compared with 12% of the sessions in the WP and LP
combined. P4, who was nonverbal and communicated
through independent typing, expressed an appreciation of
the environmental modifications through his journaling.
In WP, when asked whether he noticed a difference
after the sound-absorbing walls were installed, P4
responded,
Better able to hear the teachers. Sounds identified easier.
Keeps my sounds from travelling to distract me and
everyone. Necessary in all rooms for autistics to listen
easier without pain or fear.
In LP, P4 mentioned that the buzzing of the lights
was gone and resulted in
less noise better freedom to think . . . great sound-
absorbing walls and lights in class I love it. . . . Now less
sound bothers me I can hear in class I’m not bom-
barded . . . free to think . . . less bothered and more
focused. . . . Yes thanks to all I love to hear now very
kind of you can enjoy voices without fear of pain in
my head.
Cross-Student Themes
No cross-student themes were identified at BL. The WP
and LP produced three cross-student themes: perception
of environment improvement, positive emotional re-
sponse to the changes, and self-assessment of improved
classroom performance.
September/October 2012, Volume 66, Number 5
 Classroom environmental improvements were de-
scribed in both WP and LP. Journaling for WP indicated
that 2 of 4 students provided positive comments about the
sound in the room: “I noticed a lot more people a lot
more quieter. Without the wall covering it was loud,
plain old loud” (P2) and “better ability to hear teachers,
sounds identified easier” (P4).
After halogen lighting installation, 3 of 4 students
mentioned positive improvements, 1 of whom also men-
tioned light sounds (i.e., the absence of the buzzing of the
fluorescent lights): “Much more calmer than when the big
lights are on” (P2); “Yes, I really like the lights” (P3); and
“New lights made calmer days” (P4).
A theme of positive emotional response to the envi-
ronment after the installations was noted among 3 of 4
students: “I’m really happy, very happy that I have finally
come in a nice quiet room” (P2); “Yes, I really like the
lights” (P3); and “I love to hear now” (P4).
After both the installation of the walls and the change
in lighting, 3 of 4 students identified a theme of self-
assessment of improved performance: “Handwriting im-
proved . . . much more focused on my work” (WP) and
“I can see and I can listen better and I can do a lot of stuff
now . . . finally I can concentrate” (LP; P2); “It is a lot
more easier to see and I can work a lot more quicker than
I used to” (P3); and “Free to think” . . . “less noise better
freedom to think” . . . “I feel like nice minded my just
very self is now able to meet my learning. . . . Lots of
calm new I now am might be an ordinary guy” (P4).
The thread running through these three themes
appears to be the concept of sensory comfort, which ap-
pears to be an important enabling factor for a classroom
environment from the students’ perspective.
Discussion
This mixed-method, multiple single-subject study dem-
onstrated a reduction in classroom sound as measured by
a decibel meter in the classroom after the installation of
the Owens Corning Basement Finishing System. Decibel
readings indicated a decrease in sound levels in the empty
classroom: BL, five of five areas >52 dB; WP, four of five
areas low; and LP, five of five areas low. Fluorescent lights
emit a low-level buzz that may explain the further re-
duction in sound after the light installation. Reductions
in sound levels were reflected during individual and
group classroom activities. Nonattending behaviors de-
creased in frequency and range for all 4 participants in
WP, with a further decrease in LP. Participant journaling
themes reflected that students perceived positive change
in the classroom environment, generating a positive
The American Journal of Occupational Therapy
emotional response and improvement in classroom per-
formance, including handwriting, hearing, and thinking.
A subsequent analysis of videotaped segments iden-
tified that 3 of 4 participants spontaneously and repeatedly
initiated social interaction in Weeks 2 and 3 of LP,
suggesting that a comfortable sensory environment freed
them to interact socially, as supported by the contention in
the literature (Greenspan, 2006; Greenspan & Weider,
1997; Ruble & Robson, 2007) that sensory hyper-
sensitivities impede social interaction.
Study results provide evidence that the use of sound-
absorbing walls and halogen lighting can benefit students
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
with sensory hypersensitivity and improve their attention
and engagement in the classroom. Results support the liter-
ature providing evidence that sensory-based adaptations can
improve attention (Fertel-Daly, Bedell, & Hinojosa, 2001;
Schilling & Schwartz, 2004). Classroom modifications using
commercially available products and UDL principles could
increase the accessibility of the general education curriculum
for all students. The occupational therapists’ role in the
school setting should include recommending UDL to reduce
visual and auditory stimuli that impede learning.
Limitations of this explorative mixed-method study in-
clude the small sample size and single location. Case study and
qualitative methodology, although appropriate for exploration,
are weak designs for empirical research. The AB(B1C) design,
although practical for this study, does not include a return
to baseline condition as would an ABAB design, thereby
strengthening the reliability of the results and providing in-
creased confidence in the effectiveness of the interventions.
Further research that uses experimental research
designs, varies the sequence of intervention, uses a larger
sample, and randomizes participants or classrooms is rec-
ommended. A decibel meter that provides sound meas-
urements at a lower decibel is also recommended.
Implications for Occupational
Therapy Practice
The results of this study have the following implications
for occupational therapy practice:
• Occupational therapists’ role in school systems should
include strategies incorporating universal designs for
learning that address the sensory environment and
contribute to student self-regulation.
• Installation of sound-absorbing walls can improve the
classroom attention and engagement of students with
auditory sensitivities.
• Use of nonfluorescent lighting can improve at-
tention and engagement of students with visual
hypersensitivity.
517
• Sensory comfort in a classroom improves attention as
well as engagement, mood, and performance of stu-
dents from the perspective of the students. s
Acknowledgments
We are grateful for the support of the administration,
staff, students, and families of TALK Inc. and consultant
Jeannetta Burpee. The donation of the modification
materials by Owens Corning and the installation headed
by Jack Dillman were pivotal to this project and deeply
appreciated.
References
Adams, J. B., Edelson, S. M., Grandin, T., & Rimland, B.
(2008). Advice for parents of young autistic children (rev.).
San Diego: Autism Research Institute.
Altevogt, B. M., Hanson, S. L., & Leshner, A. I. (2008).
Autism and the environment: Challenges and opportuni-
ties for research. Pediatrics, 121, 1225–1229. http://dx.
doi.org/10.1542/peds.2007-3000
Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory pro-
cessing and classroom emotional, behavioral, and educa-
tional outcomes in children with autism spectrum disorder.
American Journal of Occupational Therapy, 62, 564–573.
http://dx.doi.org/10.5014/ajot.62.5.564
Baker, A., Lane, A., Angley, M. T., & Young, R. L. (2008). The
relationship between sensory processing patterns and behav-
ioral responsiveness in autistic disorder: A pilot study. Jour-
nal of Autism and Developmental Disorders, 38, 867–875.
http://dx.doi.org/10.1007/s10803-007-0459-0
Barnhill, G., Hagiwara, T., Myles, B. S., & Simpson, R. L.
(2000). Asperger syndrome: A study of the cognitive pro-
files of 37 children and adolescents. Focus on Autism and
Other Developmental Disabilities, 15, 146–153. http://dx.
doi.org/10.1177/108835760001500303
CAST. (2011). Universal design for learning guidelines, version
2.0. Wakefield, MA: Author.
Chasin, M. (2007). Statistics for the decibel (loudness) compari-
son chart. San Antonio, TX: Galen Carol Audio.
Coster, W., Deeney, T., Haltiwanger, J., & Haley, S. (1998).
School Function Assessment. San Antonio, TX: Psychologi-
cal Corp.
Dunn, W. (1999). The Sensory Profile: User’s manual. San Antonio
TX: Psychological Corp.
Fertel-Daly, D., Bedell, G., & Hinojosa, J. (2001). Effects of
a weighted vest on attention to task and self-stimulatory
behaviors in preschoolers with pervasive developmental
disorders. American Journal of Occupational Therapy, 55,
629–640. http://dx.doi.org/10.5014/ajot.55.6.629
Godek, J. (2008). Inclusion for students on the autism spec-
trum. School Administrator, 65, 32–37.
Grandin, T. (1995). Thinking in pictures: And other reports from
my life with autism. New York: Vintage Books.
Grandin, T. (2011). My experiences with visual thinking sensory
problems and communication difficulties. San Diego: Autism
518
Research Institute. Retrieved from http://legacy.autism.com/
families/therapy/visual.htm
Gravel, J. S., Dunn, M., Lee, W. W., & Ellis, M. A. (2006).
Peripheral audition of children on the autistic spectrum. Ear
and Hearing, 27, 299–312. http://dx.doi.org/ 10.1097/01.
aud.0000215979.65645.22
Greenspan, S. I. (2006). Working with the child who shows atten-
tion problems: Understanding the reasons why children have
difficulty paying attention. Early Childhood Today, 21, 21–23.
Greenspan, S., & Weider, S. (1997). An integral developmen-
tal approach to interventions for young children with se-
vere difficulties in relating and communicating. Zero to
Three, 17, 5–8.
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
Individuals With Disabilities Education Improvement Act of
2004, Pub. L. 108–446, 20 U.S.C. 1400 et seq.
Jimenez, T., Graf, V., & Rose, F. (2007). Gaining access to
general education: The promise of universal design for
learning. Issues in Special Education, 16, 41–52.
Küller, R., & Laike, T. (1998). The impact of flicker from
fluorescent lighting on well-being, performance and phys-
iological arousal. Ergonomics, 41, 433–447. http://dx.doi.
org/10.1080/001401398186928
Liss, M., Saulnier, C., Fein, D., & Kinsbourne, M. (2006).
Sensory and attention abnormalities in autistic spectrum
disorders. Autism, 10, 155–172. http://dx.doi.org/10.1177/
1362361306062021
Lorelei, I. (2003). Incandescent light: The healthier alternative?
Nexus Magazine, 10(3), 1–22. Retrieved December 5,
2008, from www.creative-minds.info/Lorelei/Light.htm
Martel, L. (2003). Light: An element in the ergonomics of learning
in full spectrum lighting. Retrieved December 5, 2008, from
www.full-spectrum-lighting.com/durotest/Light%20Element
%20Ergonomics%20Learning.htm
McCreery, J., & Hill, T. (2005). Illuminating the classroom
environment. School Planning and Management, 44(2),
1–3.
Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., &
Osten, E. T. (2007). Concept evolution in sensory inte-
gration: A proposed nosology for diagnosis. American Jour-
nal of Occupational Therapy, 61, 135–140. http://dx.doi.
org/10.5014/ajot.61.2.135
Miller, L. J., Coll, J. R., & Schoen, S. A. (2007). A randomized
controlled pilot study of the effectiveness of occupational
therapy for children with sensory modulation disorder.
American Journal of Occupational Therapy, 61, 228–238.
http://dx.doi.org/10.5014/ajot.61.2.228
Minshew, N. J., & Hobson, J. A. (2008). Sensory sensitiv-
ities and performance on sensory perceptual tasks in
high-functioning individuals with autism. Journal of Au-
tism and Developmental Disorders, 38, 1485–1498. http://
dx.doi.org/10.1007/s10803-007-0528-4
Mundy, P., Neal, A. R., & Glidden, L. M. (2001). Neural
plasticity, joint attention, and a transactional social orient-
ing model of autism. International Review of Research in
Mental Retardation, 23, 139–168. http://dx.doi.org/10.
1016/S0074-7750(00)80009-9
Northeast Energy Efficiency Partnerships. (2002). Classroom
lighting know-how. Retrieved December 10, 2008, from
www.designlights.org/downloads_guide.pdf
September/October 2012, Volume 66, Number 5
O’Neill, M., & Jones, R. S. (1997). Sensory–perceptual abnor-
malities in autism: A case for more research. Journal of
Autism and Developmental Disorders, 27, 283–293. http://
dx.doi.org/10.1023/A:1025850431170
Ornitz, E. M. (1988). Autism: A disorder of directed attention.
Brain Dysfunction, 1, 309–322.
Owens Corning. (2007). Owens Corning basement finishing
system (Interior wall panel submittal sheet). Toledo, OH:
Owens Corning Remodeling Systems.
Patten, E., & Watson, L. R. (2011). Interventions targeting
attention in young children with autism. American Journal
of Speech–Language Pathology, 20, 60–69. http://dx.doi.
org/10.1044/1058-0360(2010/09-0081)
Pfeiffer, B., Henry, A., Miller, S., & Witherell, S. (2008).
Effectiveness of Disc ‘O’ Sit cushions on attention to task
in second-grade students with attention difficulties. Amer-
ican Journal of Occupational Therapy, 62, 274–281. http://
dx.doi.org/10.5014/ajot.62.3.274
Portney, L. G., & Watkins, M. P. (2000). Foundations of clinical
research applications to practice. Upper Saddle River, NJ:
Prentice-Hall.
The American Journal of Occupational Therapy
Rice, C. (2006). Prevalence of autism spectrum disorder—
Autism and Developmental Disabilities Monitoring Net-
work, United States, 2006. MMWR, 58(SS10), 1–20.
Ruble, L. A., & Robson, D. M. (2007). Individual and envi-
ronmental determinants of engagement in autism. Journal
of Autism and Developmental Disorders, 37, 1457–1468.
http://dx.doi.org/10.1007/s10803-006-0222-y
Schilling, D. L., & Schwartz, I. S. (2004). Alternative seating
for young children with autism spectrum disorder: Effects
on classroom behavior. Journal of Autism and Developmen-
tal Disorders, 34, 423–432. http://dx.doi.org/10.1023/B:
JADD.0000037418.48587.f4
Tomchek, S. D., & Dunn, W. (2007). Sensory processing in
Downloaded from http://research.aota.org/ajot/article-pdf/66/5/511/63806/511.pdf by Integracion Sensorial Acis, Adriana Ramirez on 30 September 2022
children with and without autism: A comparative study
using the Short Sensory Profile. American Journal of
Occupational Therapy, 61, 190–200. http://dx.doi.org/10.
5014/ajot.61.2.190
VanBergeijk, E., Klin, A., & Volkmar, F. (2008). Supporting
more able students on the autism spectrum: College and
beyond. Journal of Autism and Developmental Disorders,
38, 1359–1370. http://dx.doi.org/10.1007/s10803-007-
0524-8
519