Within the study, the article presents the case study that success in experimenting with experiential activities such as sensory therapy for a disabled children with some characteristic of ASD to underlining stronger for the importance of research on sensory therapy with ASD children in Vietnam.
HNUE JOURNAL OF SCIENCE Social Sciences, 2020, Volume 64, Issue 4D, pp 96-104 This paper is available online at http://stdb.hnue.edu.vn RESEARCH ORIENTATIONS FOR SENSORY THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS IN VIETNAM Dinh Nguyen Trang Thu1 and Do Thi Ngoc Ha2 Lecturer at Department of Special Education, Hanoi National University of Education Student at Department of Special Education, Hanoi National University of Education Abstract Autism Spectrum Disorders (ASD) is a neurological disorder that is very complicated and lasts a lifetime, accompanied by other disorders such as sensory processing disorders, sleep disorders, vestibular disorders, etc., which affect children's ability to learn and integrate into the community In the field of education for children with disabilities in the world and currently in Vietnam, there have been studies of intensive therapeutic interventions for children with ASD such as psychomotor therapy, behavioral therapy, sensory integration therapy, etc However, the number of these studies is still limited due to the shortage of specialists and the conditions to perform these therapies in the educational institutions for children with disabilities in general and those with ASD in particular Therefore, in order to meet the requirements of more effective therapeutic interventions for children and families of children with ASD, it is necessary to have indepth research orientations, including those on sensory therapy for children with ASD, based on completed and on-going researches to thereby help professionals, educators and parents of ASD children to identify and select appropriate therapies for developmental characteristics of children with ASD In addition, within the study, the article also presents the case study that success in experimenting with experiential activities such as sensory therapy for a disabled children with some characteristic of ASD to underlining stronger for the importance of research on sensory therapy with ASD children in Vietnam Keywords: Autism spectrum disorder (ASD), sensory proceeding disorders, sensory experience activities, sensory therapy Introduction Feeling is the starting point of all our knowledge about the world and is the basis for development “Apart from the senses, we cannot know any form of matter or any form of movement” (V.I Lenin) Many scientists have also studied the meaning of sensation for the development of human cognition (I.M.Xetrenop) Children with autism spectrum disorder (ASD), due to the specific characteristics of the disorder, always face the problems of sensory processing disorders, which has a lot of influence on the developmental aspects as well as activities of the children For example, a child with ASD having a vestibular problem will have difficulties in organizing information about movement, balance, notions of space and gravity Sensory disorders not only make it difficult for children with ASD to receive stimulation but also result in “search” (for less sensitive group) or “avoid” reactions (for too sensitive group) Self-stimulating behaviors, Received April 11, 2020 Revised April 24, 2020 Accepted May 15, 2020 Contact Dinh Nguyen Trang Thu, e-mail address: trangthund@gmail.com 96 Research orientations for sensory therapy for children with autism spectrum disorders in Vietnam hyperactivity, etc also occur when children have sensory problems and have difficulties in receiving and processing information that also affects their learning and findings of the surrounding world Sensory problems in children with ASD are more noticeable in infancy than teenagers, partly because these problems may reduce as children grow or disappear if children have appropriate treatment [1], [2], [3] In the history of research on ASD, many researchers have been concerned with the abnormalities in processing sensory information of this group of children Many researchers have pointed out the prevalence of sensory information processing disorders of children with ASD, namely: the percentage of children with ASD having sensory abnormalities ranges from 30% to 100% [3]; According to Baranek et al (2006), this number reached 70% of the total number of children studied [3] In 2007, Leekam and his colleagues also conducted another study on this issue and showed that over 90% of children with ASD have abnormal manifestations of sensory information processing From the specific characteristics and effects of sensory processing disorders of children with ASD, in 1970 A Jean Ayres – an activity therapist designed sensory integration therapy to help children with sensory processing problems (including children with ASD) Sensory games are an integral part of sensory therapy for children Sensory games provide a natural (and funny) way for children to discover, test and understand their world, thereby help them develop such skills as: motor, language, social skills and help children self-control their behavior, etc [4], [5] Therefore, it is necessary to have research orientations for sensory therapy through activities, games designed appropriately based on the age and characteristics of children with ASD These research orientations thereby contribute to helping professionals, educators, and parents of children with ASD be equipped with more tools and useful intervention methods in the care, education and interventions for children with ASD Content 2.1 Autism spectrum disorder According to the Autism society of America (2005), “Autism is understood to be a developmental disorder that has a serious influence throughout an individual's life Autism often appears in the first three years of a child's life.” According to the United Nations (2008), “Autism is a lifelong developmental disability, usually occurring in the first three years of life Autism caused by a neurological disorder that affects the functioning of the brain Autism can occur in any individual regardless of gender, race, or socio-economic condition Autism is characterized by defects in social interaction, linguistic and non-verbal communication and limited, repetitive behaviors, interests and activities.” According to DSM - IV, Autism spectrum disorder (ASD) is similar to “Pervasive developmental disorder (PDD)” with main types: 1) Autistic Disorder; 2) Asperger Disorder; 3) Childhood Disintegrative Disorder (CDD); 4) Rett Disorder; 5) Pervasive Developmental Disorder - Not Otherwise Specified: PDD - NOS According to DSM - 5, ASD used instead of the name “pervasive developmental disorder”, and it is no longer to categorize the forms of “ASD” but instead use a common name and criteria for diagnosing ASD The ASD is also known as diffuse developmental disorder or considered as a developmental disorder because they involve delays in many areas of different levels of language and communication, social interaction, imagination ability and repetitive and stereotyped behaviors The capacity to perform functions and ASD symptoms varies greatly among children ASD children have a broad range from severe intellectual disability to high 97 Dinh Nguyen Trang Thu and Do Thi Ngoc Ha functioning, thereby it called “spectrum” ASD is a form of developmental disability due to a disorder of the nervous system that affects the brain Children with ASD are characterized by major communication, social, imaginative, and stereotyped behavioral problems, in addition, children with severe ASD often have sensory disorders ASD includes disorders with common characteristics but different in scope, severity, time of onset and progression of disorders over time Criteria for diagnosing ASD according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), which was officially released in May 2013, highlight four basic characteristics of children with ASD as follows: Serious disability in terms of interaction and social communication in many contexts; Developmental disabilities; Limited and stereotyped behavior, interests and activities; These signs jointly limit and impair daily function [6] 2.2 Sensory integration and sensory therapy for children with autism spectrum disorder 2.2.1 Sensory integration Sensory integration is a treatment for children with disorders of such senses as touch, sight, hearing, smell, taste, and balance This technique used to increase or decrease the child's response to different stimuli, with the aim of correcting the abnormal behavior in children with ASD [1, pp 40] [7] Some of the common manifestations of sensory disorders in children with ASD are [8], [9]: - Sight: children often stare at the sky, the lamp, like to squint, look at fingers, computer screens, stare at something (such as story books, sparkling or spinning objects ) for many minutes - Hearing: children often become upset with loud noises or may distracted by sounds unnoticed by others, or many children cover their ears when hearing certain special sounds such as drilling machine, blender - Touch: children often avoid touches from others, refuse, or respond to activities such as brushing hair, water from the shower, dislike messy games (therefore many children have behaviors to arrange objects according to a certain structure) Many children often not respond to pain, heat, or cold, and many children are stimulated by food or clothing (behavior of grabbing people/objects) - Vestibular: children are prone to motion sickness, afraid to climb stairs, like to spin, like to certain movements - Sensation: children often hold objects too loosely or too tightly, like to play rough, pushing games - Smell and taste: children have a strong reaction to smell and taste, often only selectively eat certain foods, or vice versa, children prefer to smell or taste non-food flavors (for example, walls, soil ) Therefore, sensory therapy plays an important role in helping children with ASD respond appropriately to sensory information, integrating and orientating to help children with ASD feel relaxed and interested and free from pressure or stress that leads to unwanted behaviors A sensory treatment room for the development of senses can take many different forms, with the goal of focusing on treatment, education, and relaxation for children with ASD All the layout and specialized equipment of this room can be varied depending on the type, function, and individual needs of the user, which is related to the development of the children 2.2.2 Several studies on sensory therapy interventions for children with autism spectrum disorder * Some theoretical studies 98 Research orientations for sensory therapy for children with autism spectrum disorders in Vietnam In the history of research on ASD, many researchers have been concerned with the abnormalities in processing sensory information of this group of children Many researchers have pointed out the prevalence of sensory information processing disorders of children with ASD, namely: the percentage of children with ASD having sensory abnormalities ranges from 30% to 100% [9]; According to Baranek et al (2006), this number reached 70% of the total number of children studied [9] In 2007, Leekam and his colleagues also conducted another study on this issue and showed that over 90% of children with ASD have abnormal manifestations of sensory information processing In the United States, Dr Jean Ayres (1920-1989) - a physiotherapist and psychologist for children with developmental delays of UCLA University, was the first to introduce the phrase “sensory integration dysfunction” in the 1960s She is also famous for her book “Sensory Integration and child” Dr Ayres said that children with developmental delays and autistic children often have disorders of receiving and understanding sensations such as smell, hearing, touch, as well as reactions or movements according to the effects of sensation Currently, in the world, there are many theoretical studies and application of sensory integration in the education and care of children with ASD that have been implemented in some developed countries such as USA, Japan, Israel, etc The authors Fazloiglu, Yesim, Baran, Gulen, Turkish University have conducted research on sensory integration therapy for two groups of children with ASD (7 - 11 years old) in Turkey Center for Intellectual and Physical development of children with disabilities After the research, the results show that the sensory therapy activities have brought positive effects for the two groups of children taking part in the program [1] In addition, many books have been published on methods and activities to integrate feelings for children with ASD such as the “Raising a Sensory Smart Child” by Biel and Linsay published in 2009; the “Sensory Motor Handbook: A Guide for Implementing and Modifying Activities in the Classroom” by Bissell, Julie, Jean Fisher, Carol Owens and Patricia Polcyn (1998) Tracking tables for information processing disorders in children are also given by some authors in their research results such as the “Sensational Kids: Hope and Help for Children with Sensory Processing Disorder”, Miller Lucy J (2006) [3], [9], [10] In many interventions for children at the present time in the world, sensory therapy is a proven treatment for children [2], [5], [9], [11] For many cases of children with ASD, the combination of educational psychological interventions and medical therapies, including intensive therapies such as sensory therapy, is essential for autistic children to develop to the best of their ability and keep growing [1] Especially, young children with ASD and those who not yet have spoken language need to stabilize their senses and learn to use them to explore the world around them as well as learn how to interact with people By that, these children will have a foundation for further development of other areas such as cognition, language, or behavioral mitigation [2] In addition, many researches show that the combination of using sensory therapy with traditional occupational therapy [12], music therapy [5] or auditory integration training has brought positive effects to children with ASD as behavior changes [11], to preschool-age children with ASD [4], etc Currently in Vietnam, in recent years, the care and education of children with special needs in general and children with ASD in particular have been concerned and facilitated for development There are more and more specialized support services such as sensory therapy, music therapy, occupational therapy, speech therapy, etc However, intensive therapeutic activities for children with special needs and especially children with ASD in Vietnam are still lacking There are not enough experts to implement such activities while facilities and economic conditions also not allow the implementation of sensory integration models for children with 99 Dinh Nguyen Trang Thu and Do Thi Ngoc Ha special needs in childcare and education institutions [3], [9] At present in our country, centers for care and education for children with ASD have also paid attention to sensory integration and organized sensory integration activities to support children in learning and minimize their inappropriate behaviors [13], [14] Besides, there are also scientific research topics and scientific articles related to the organization of sensory integration activities for children with ASD such as: “Organizing sensory experience activities for children with ASD” [4] which mentioned the organization of activities to help sensory integration of children with ASD, “Characteristics of sensory disorders in children with sensory integration disorders” [14] also searched for understandings about the relationship between age and the type of sensory disorders in autistic children and the relationship between age and the number of sensory disorders In addition, the Department of Special Education of Hanoi National University of Education also cooperates with GVI organization of the United States to organize annual training sessions on issues related to children with ASD, including training sessions on organizing sensory integration activities for children with ASD in the center or at home for teachers, students and parents of children with autism Thus, the study of sensory disorders and sensory integration for children with ASD has mentioned by many domestic and foreign studies However, the research and application of specific measures or activities or games for children with developmental disabilities with different characteristics of sensory disorders are few In fact, teachers and parents of these children still face many difficulties in organizing games of sensory integration for children to help them reduce inappropriate behaviors and take part in activities and learning better * Several case-studies There are many methods, treatments, interventions, and education for children with ASD that have been developed and applied In the study of a group of authors [1], incomplete statistics show that there are currently more than 100 autism intervention and treatment methods introduced in the US and about 30 of which are currently used in Vietnam At present, there are three main groups of therapeutic interventions for children with ASD, include: (1) Biologically based treatments; (2) Psychodynamic treatments and (3) Educational interventions Educational interventions consist of Behavioral interventions, Developmental interventions, Therapy based interventions, Combined interventions and Family based interventions Also, the research on the situation of 29 professional managers in the care and education facilities for children with ASD in Hanoi city [1, pp 63-72] indicates that no professional take on the role of sensory therapy for children with ASD The fact also shows that many centers are just beginning to experiment with sensory experiences and integrate this activity in advocacy activities, at individual intervention hours for children with ASD However, in the programs selected to design an individual intervention program for children with ASD, although it still accounts for a small percentage (about 2.4%), the Sensory Therapy program has been selected by many professionals In addition, there are also several studies suggesting sensory experience activities suitable for children with ASD in integrated kindergarten [15], [16] and during individual interventions [17], [18] 2.3 Case studies using sensory therapy 2.3.1 Description of the case study * General information about the child: T.T.H is a boy born on June 19, 2010 He is the first child and has a 4-year-old younger brother His mother had a fever (about week) in the first months during pregnancy At the final week of the pregnancy check-up, the doctor announced that the baby had a small head The boy was born normally, at 39th week He was suffocated at 100 Research orientations for sensory therapy for children with autism spectrum disorders in Vietnam birth but cried right away and did not have to stay in the hospital In terms of medical history, he has problems with slow movement The family sent him to check up at the National Hospital of Pediatrics at months and he was diagnosed with spastic cerebral palsy All his physical development milestones are slower than his actual age Currently, he still cannot sit down or control the head, neck and is not good at holding things He still does not have the language The family used to send him to some facilities but due to poor performance, the medical impact caused injuries to his hip In terms of eating ability, he can eat vegetables, rice and chopped food He often has sputum in his chest/throat Currently, the family is giving him brain tonic At home, he is taken care of regularly by his mother and grandparents The family also tried to spend time playing with him but not often The family's desire is to help him develop the ability to hold, feel, perceive, gradually be able to speak and to sit He has not gone to school yet and just stays home and gets medical intervention * Characteristics of the child's ability: the child is tested by the Kyoto Scale of Psychological Development (Japan) on March 2, 2008, at the age of years and months Because he has a physical problem (cerebral palsy), he could hardly perform operations with the test tool By observing his behavior, his reaction and his ability to interact with the examiner as well as between him and his mother, we predict that his ability is only equivalent to the development of the child of year old to 1.5 years old Thus, compared with the actual age, he has a very severe developmental delays in comparison with children of his age (about years behind his actual age) All three areas of development (movement, awareness - thinking and language - social interaction) are slow In particular, the field of interaction (by facial expressions, gestures, eyes) is the best, which is also his strong point 2.3.2 An individual plan using sensory therapy Based on the ability of H, an individual intervention plan for him is set with long-term goals for year (from August 2018 to September 2019) as follows: (1) Strengthen the ability to control muscle force, especially the arm muscles because his leg muscles contract, and reduce spasticity of his whole body (2) Enhance the ability to use non-verbal factors in expressing his needs: eye direction, facial expressions, gestures (use of the hand muscles up and down and positions around) (3) Enhance the ability of listening comprehension, choosing according to individual needs, based on eye control along with communication cards or objects (4) Enhance interaction, improve emotional expression through participation in interactive games and activities with children Short-term goals are made in detail through monthly individualized education plans, for example: Table Short-term goals of IEP for H child No Short-term goal Identify some objects, things and toys in learning Activities Respond to his/her name (turning head toward the teacher when the teacher calls his/her name) Touch familiar close distance objects of Tools Personal items, school supplies (hand puppets, nuts ) Sensory experience activities Result Q C I Sight: look, observe Touch: hold, grasp, string, make colored dots 101 Dinh Nguyen Trang Thu and Do Thi Ngoc Ha activities Gesture corresponding objects (raise hands ) to Show appropriate expressions with his/her favorite things Express feelings by the situation Some responses show the child's needs Hand puppet, soap ball, nuts Sight: look, observe Choose the object he/she likes between the two Turn head left and right when the teach calls Motor Sitting on the teacher’s lap, swaying to the music Raise hands higher - move fingers gently Know how to wait for his/her turn, interact 1-1 Make some verbal requests with the teacher Make eye contact with the teacher when doing activities with the teacher Sight: look, observe Pillows, specialized chairs for treatment and experience Specific activities and games during class Hearing: hear, feel and differentiate Touch: hold, grasp, string, touch Sight: look, observe Hearing: hear, feel and differentiate Note: Q: Qualified (children complete activities without support) C: Capable (children are capable of completing activities with the support of teachers) I: Incapable (children are incapable of completing the activity even with the support of teachers) 2.3.3 Results of intervention using sensory therapy Some results obtained through the observation of H - Summary of monthly observations on H of the teacher who directly provides interventions: - Regarding movement: H has tried his best to move neck muscles more gently and flexibly He moves and holds his neck for a longer time, two arms are also raised higher under his self-control, his fingers are in constant contact with the sand, which makes him more sensitive and have faster touch reflexes on the palm of the hand; he performs the squatting position within minutes with some help from the teacher; he knows how to coordinate better with the teacher in activities related to foot movement - Regarding cognition-language: he shows ability to understand his own possessions better He starts to have a little memory of his shirt, pants, etc Besides, he knows how to express the recognition of familiar pets (when the teacher asks him by showing him pictures, he responds by quickly directing his eyes toward the pictures) He shows his interest and tries hard in every activity with the teacher - Sensory experience activity: he responds to sensory experience activities, which is most reflected in the fact that he holds things longer He loves to lie on the ball for the teacher to rock back and forth He can also lie on his stomach and slowly lift his neck to look forward He fairly likes to grab pinecones or gloves filled with sand and water inside, he tries very hard to hold the clumps of clay for a long time - Regarding emotion expressions: he expresses his feelings more clearly He directs his 102 Research orientations for sensory therapy for children with autism spectrum disorders in Vietnam eyes more clearly when looking at the object (when asked with pictures), looks at the eyes of the opposite person in interactive activities, laughs in exciting games (for example, the game of Chanting while sawing wood, pulling springs, blowing bubbles), knowing to show uncomfortable emotions in activities that he does not like (for example, he expresses that he dislikes being forced to sit by making some sounds immediately) Some results are collected through interviews with H's family – his grandfather: Through the time he was intervened, we noticed that he had significant changes He actively expresses more emotions, or shows that he likes or dislikes very clearly, either by making some small sounds or gesturing (raising hands, nodding away) He also knows how to use eye contacts to express his needs more clearly, for example, looking into the eyes of the opposite person when communicating with him/her, looking at the direction of things when others raise and ask him He expresses his feelings better, for instance being happy to play with or talk to someone, being able to “call” someone, responding when he wants someone around, listening and understanding better (when the teacher talks and explains what he/she intends to with him, for example picking him up, etc., his muscles not contract and he knows how to relax them) Conclusions Through theoretical studies and the initial situation on the use of sensory therapy in the process of care, interventions and education of children with ASD, based on the actual conditions of existing facilities and human resources in Vietnam, the article proposes a number of research orientations for sensory therapy for children with ASD as follows: Although this is a relatively new research method in Vietnam and there are not many professionally trained specialists yet, it is necessary to continue developing the theoretical research and practice of sensory therapy at various levels: specific therapies, sensory therapy activities, sensory experience activities, which are carried out in individual intervention sessions or integrated in other interventions for children with ASD, such as psychomotor activity, playing activity, cognitive and language development activity, etc The current solution is to popularize and to use the designing and application of experiential activities, in the form of games appropriate to the ages and characteristics of children with ASD, based on easily accessible and available materials In the long term, it is essential to have formal training by the sensory therapists, investment in adequate facilities, qualified and properly operated treatment rooms in order to gradually ensure professionalism and the improvement of the effectiveness of sensory therapies for children with ASD It is also required to have comprehensive studies on the application of theory to practice in Vietnam to have counter assessments and experiences when applying sensory therapy in Vietnam REFERENCES [1] Dian Keans (2008) Art Therapy with a Child Experiencing Sensory Integration Difficulty: Journal of the American Art Therapy Association, 21 (2), 95 - 101 [2] Dunn, Winnie (2008) Living Sensationally: understanding your senses Jessica Kingsley Publishers, Philadelphia, PA, USA [3] Hoang Thi Nho, Hoang Nhat Linh (2015) Organizing sensory integration activities for children with autism spectrum disorder Science journal - Hanoi National University of Education, Vol 8, pp 103-107 [4] Patricia Howlin, Simon Baron-Cohen, Julie A Hadwin () Teaching Children with Autism to Mind-Read: A Practical Guide for Teachers and Parents (translated and shared by 103 Dinh Nguyen Trang Thu and Do Thi Ngoc Ha Hanoi Autism Children Club) [5] Rusell Lang, Mark O’Reily, Olive Healy Mandy Rispoli, Helena Lydon, William Streusand, Tonya Davis, Soyeon Kang, Jeff Sigafoos, Giulio Lancioni, Robert Diden, Sanne Giesbers (2012) Sensory integration therapy for autism spectrum disorder: A systematic review Research in Autism Spectrum Disorders, Vol 6, Issue 3, pp 1004-1018 https://doi.org/10.1016/j.rasd.2012.01.006 [6] American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders - DSM [7] Vietnam Academy of Educational Sciences (2013) Proceedings of the Workshop on the Care of Autism Children Education in Vietnam, the situation and prospects, Hanoi [8] Arkwright, Jan (1998) An Introduction to Sensory Integration Pro-ed, Inc Autism, Texas, www.proedinc.com [9] Micheal C, Abraham (2002) Sensory Integration Practical strategies and sensory Motor – Activities for use in the Classroom [10] Geraldine Dawson, Renee Watling (2000) Interventions to facilitate Auditory, Visual, and Motor Integration in Autism: A review of the Evidence Journal of Autism and Developmental Disorders, Vol 30, pp 415-421 [11] Nguyen Ha My, Tran Thi Bich Ngoc, Nguyen Minh Phuong and Pham Thi Hai Yen (2018) Occupational therapy and sensory integration for children with autism spectrum disorders Science journal – Hanoi National University of Education, pp 468-474 [12] Miller Lucy J (2006) Sensational Kids: hope and help for children with sensory processing disorder Penguin Group (USA) Inc New York, New York 10014, USA [13] Beth A Pfeiffer; Kristie Koenig; Moya Kinnealey; Megan Sheppard; Lorrie Henderson (2011) Effectiveness of Sensory Integration Interventions in Children with Autism Spectrum Disorders: A Pilot Study American Journal of Occupational Therapy, Vol 65, pp 76-85 https://doi.org/10.5014/ajot.2011.09205 [14] Dinh Nguyen Trang Thu (2018) The model of therapeutic education activities to support children with developmental disorder in community integration - Introduction of the operation model at the Kazuo Center for Integrated Education Development Research Proceedings of the International Conference on “Promoting therapeutic services in social work in Vietnam”, Social Labor Publishing House, ISBN 978-604-65-3790-8, pp 123-129 [15] Jane Case-Smith; Teresa Bryan (1999) The Effects of Occupational Therapy with Sensory Integration Emphasis on Preschool-Age Children with Autism American Journal of Occupational Therapy, Vol 53, pp 489-497 https://doi.org/10.5014/ajot.53.5.489 [16] www pinterest.com Ideas for sensory smart classroom set-ups [17] www.famlii.com What is sensory play [18] www.stacysss.com Stacy’s Sensory Solutions provide products to enhance sensory integration 104 ... designed sensory integration therapy to help children with sensory processing problems (including children with ASD) Sensory games are an integral part of sensory therapy for children Sensory. . .Research orientations for sensory therapy for children with autism spectrum disorders in Vietnam hyperactivity, etc also occur when children have sensory problems and have difficulties in. .. the children 2.2.2 Several studies on sensory therapy interventions for children with autism spectrum disorder * Some theoretical studies 98 Research orientations for sensory therapy for children