Sensory integration therapy in

children with autism spectrum

disorder (ASD)

dr. Citra Raditha, Sp.A(K)

 INTRODUCTION
Autism spectrum disorder (ASD) is a complex developmental disorder that
Introduction
can lead to dysfunction in social communication, interaction, and retrictive,
repetitive pattern of behaviour

Studies showed a remarkable increasing prevalence of ASD

Since 2013, ASD was diagnosed according to Diagnostic and Statistical

Manual 5 (DSM-5) included sensory disorder

Wiggins, L. D. et al. Soc. Psychiatry Psychiatr. Epidemiol. 54, 693–701 (2019).

Sanchack, K. E. & Thomas, C. A. Am. Fam. Phys. 94, 972–980 (2016).
Christensen, D. L., Baio, J. & Braun, K. V. MMWR Survaill Summ. 67, 1–28 (2018).
Zwaigenbaum, L., Bauman, M. L. & Fein, D. Pediatrics 136, S41–S59 (2015).
 INTRODUCTION

Sensory integration occupational therapy (SI-OT) based on Ayres theory is a

Introduction common method in ASD therapy

Most studies showed that SI-OT only had low to moderate evidence in older
ASD children

In clinical experience and observation of Prof. Hardiono ( our expert in

autism in Indonesia), SI-OT might be useful as an ASD treatment for younger
children especially those under 5 years

Case-Smith, J., Weaver, L. L. & Fristad, M. A. Autism 19, 133–148 (2015).

Pusponegoro, H. D. Autism: Light in the Dark (University of Indonesia, Jakarta, 2016).
Sensory integration therapy
...Why?
v Anak dengan ASD à sensory processing disorder (SPD)
sebesar 90%

SPD

Ketidakemampuan otak dalam meregister,

mengorganisir, dan mencerna informasi
yang diterima indera

Pesan yang tidak bermakna

Respon motorik, persepsi, emosi, pemikiran

serta perilaku yang tidak tepat

-
Autism360.com
 Patofisiologi SPD

Penurunan respons
sistem saraf simpatik Dampak:
(sensory
underresponsivity) Ketidakmampuan
mempertahankan
keadaan siaga yang
tenang

Peningkatan respons
sistem saraf simpatik
(sensory
overresponsivity)

-
Learning Pyramid
 Sensory integration therapy ( A. Jean Ayres)......What is it?

Clinic- Play
based activities

Children Terapis
Oriented okupasi

Tujuan : Meningkatkan kemampuan sensori agar dapat mendata (register) dan mengatur
(modulasi) input sensori secara efektif, membentuk respon sensori dan yang baik dan
adaptifà
- fokus, interaksi
Ayres AJ. 1972. Western Psycological Services
 Sensory integration therapy ( A. Jean Ayres)......How?
Structural elements

1. Therapist qualification

2. Therapy assessment report

Parham, L. D. et al. Am. J. Occup. Ther. 65, 133–142 (2011).

 Sensory integration therapy ( A. Jean Ayres)......How?
Structural elements
3. Physical environment

Parham, L. D. et al. Am. J. Occup. Ther. 65, 133–142 (2011).

 Sensory integration therapy ( A. Jean Ayres)......How?
Structural elements
4. Communication with parents and teacher

Parham, L. D. et al. Am. J. Occup. Ther. 65, 133–142 (2011).

 Sensory integration therapy ( A. Jean Ayres)......How?
Process elements

1. Ensures physical safety

2. Presents ≥2 sensory opportunities
(tactile, vestibular, proprioceptive)

3. Helps the child to attain and maintain

appropriate levels of alertness

4. Challanges postural, ocular, oral or

bilateral motor control

5. Challenges praxis and organization of

behavior

Parham, L. D. et al. Am. J. Occup. Ther. 65, 133–142 (2011).

 Sensory integration therapy ( A. Jean Ayres)......How?
Process elements

6. Collaborates in activity choice

7. Tailors activity to present just-right

challenge

8. Ensures that activities successful

9. Supports child’s intrinsic motivation

to play

10. Establishes a therapeutic alliance

Parham, L. D. et al. Am. J. Occup. Ther. 65, 133–142 (2011).

https://youtu.be/Haw5m3Zxvy4?si=A7xzXgEFgoTVTaid
 Sensory integration therapy ( A. Jean Ayres)......When?

Efektifitas terapi SI masih terbatas dan inkonklusif,

penelitan terutama melibatkan subyek anak ASD
usia > 5 tahun

-
 Sensory integration therapy ( A. Jean Ayres)......When?

Studi Luaran Metode Hasil

Pfeiffer dkk Pengaruh terhadap Goal Uji klinis tersamar Sebagian
(2011) Attainment Score (GAS), N = 37 bermakna
perilaku adaptif (Vineland-II) usia 6–12 tahun
SI (n = 20);
fine motor (n = 17)

Schaaf dkk Pengaruh terhadap GAS, Uji klinis tersamar; Sebagian

(2014) perilaku adaptif (Vineland-II), N = 32 bermakna
Keterampilan fungsional, Usia 56–83 bulan
pendampingan (PEDI) SI (n = 17)
usual care (n = 15)

-
 Studi Obyektif Desain penelitian Hasil

Kashefimehr dkk Pengaruh terhadap nilai Uji klinis tersamar Bermakna

(2017) SCOPE ( short child N = 31
Occupational profile) usia 3-8 tahun
SI (n= 16)
Kontrol (n = 15)

Sensory integration therapy ( A. Jean Ayres)......When?

Iwanaga dkk Pengaruh terhadap Uji klinis tanpa random Sebagian

(2013) kognitif, verbal, dan N = 20, bermakna
sensori-motor pada anak SI (n= 8)
high-functioning GSA usia 56.8 ± 9.0bulan
terapi kelompok (n = 12)
usia 56.3 ± 6.8 bulan
-
 Sensory integration therapy ( A. Jean Ayres)......When?

Systematic review: Terapi SI metode Ayres dapat

dipertimbangkan pada anak ASD à melibatkan
subyek anak ASD usia > 4 tahun

Schoen SA,dkk. Autism Res. 2019;12:6-19

-
 Sensory integration therapy ( A. Jean Ayres)......When?
Efektifitas terapi SI pada anak ASD usia <5 tahun?

Elvira J, Pusponegoro HD, Handryastuti S

 Sensory integration therapy ( A. Jean Ayres)......When?
Efektifitas terapi SI pada anak ASD usia <5 tahun?

-
 Evaluasi Kemajuan Terapi SI
( Setelah 3 bulan)

Penilaian
Penilaian Dokter Penilaian Terapis
Orangtua
Evaluasi Kemajuan Terapi SI
Partisipasi sosial

Penglihatan
 Pendengaran

Sentuhan

Pengecap dan penciuman

 Body awareness

Keseimbangan dan Gerak

Perencanaan dan Gagasan

 Usia 1 tahun

Early Start Denver

Model

DIR/ Floor Time

Terapi berikutnya Sekolah Transisi
Sensory Integration Usia 1,5 – 3 tahun
bersifat
sekuensialà lebih
baik
Fisioterapi/ Terapi Terapi Perilaku
* Lovaas
Wicara
* Hanya bila perlu
*VB MAPP Usia > 3 tahun
*PRT etc

Okupasi Vokasi
Usia > 3-4 tahun

Pusponegoro HD. Autism Spectrum Disorder situasi dan penatalaksanaan. 2021

 Dokter

Orangtua Psikolog

Anak
Guru Terapis

Pekerja
Sosial
Pusponegoro HD. Autism Spectrum Disorder situasi dan penatalaksanaan. 2021
 Target tatalaksana

4. Bekerja , Mandiri
3. Edukasi akademik lebih tinggi
2. Sekolah dasar
1. Bicara, Bahasa, Komunikasi

Bennet AE, dkk. Curr Psychiatry Rep. 2018;103-122

 Conclusions
● Terapi sensori integrasi berdasarkan teori Ayres selama 60 menit, 2x
seminggu pada anak ASD usia 0-5 tahun

• Peningkatan bermakna komunikasi

Perilaku (ekspresif, reseptif), sosialisasi (coping skill),
positif kemampuan aktivitas harian ( personal,
komunitas)

• Penurunan bermakna perilaku hiperaktifitas ,

Perilaku penarikan sosial iritabilitas, gerakan
negatif stereotipik dan bicara tidak tepat
Thank you