1. Weighted Vests Vs. Standard Occupational Therapy on On-Task Behavior in Children with Autism Spectrum Disorders
Brittney Schorr, MOTS

2. Agenda Background Objective Intervention
Methodological Quality of Studies
Results
Discussion
Implications for OT Practitioners
Implications for Future Research

3. Background Autism Spectrum Disorder (ASD) includes:
Autistic disorder
Asperger syndrome
Pervasive Developmental Disorder (PDD)
Neurological developmental disorder
1 in every 150 children diagnosed each year
Unknown cause
Background
photo: medicmagic.net

4. On-Task Behavior photo: whatafy.com Visually attending to materials
Looking at an activity
Manipulating the tools
Transitioning from one activity to another
Sensory Integration (SI) used to improve on-task behavior
photo: whatafy.com

5. Sensory Integration Regulates behavior through sensory systems:
Tactile
Proprioceptive
Vestibular
SI treatments:
weighted vests
pressured vests
weighted blankets
Regulates behavior through sensory systems:
Tactile
Proprioceptive
Vestibular
SI treatments:
weighted vests
pressured vests
weighted blankets

6. Weighted Vests Commonly cloth vests with pockets in the front and back
Weights in the pockets
Weights can be made of any material

7. Occupational Therapy Treatment as Usual
Includes:
Music Therapy
Therapy Ball Chairs
Picture Activity Schedules
Hug Machine

8. Picture Activity Schedule

9. Hug Machine

10. Objective
To examine the extent to which the research literature supports weighted vests as compared to treatment as usual as a more effective approach to improving on-task behavior in children with ASD

11. Search Terms Autism Weighted vest Therapy On-task behavior Attention
Developmental Disorder

12. Types of Studies Controlled Clinical Trials Mixed Study Designs
Experimental Research
Single Subject

13. Participants Children with: 2 to 13 years old
ASD
Attention deficit hyperactive disorders (ADHD)
Developmental delays
2 to 13 years old
45 boys, 11 girls (56 total)

14. Diagnoses & Interventions
Weighted Vest
4 Autism and PDD
Fertel-Daly et al., 2001
Hodgetts et al., 2010
Kane et al., 2005
Leew et al., 2009
1 ADHD
VandenBerg, 2001
1 Developmental Delays
Reichow et al., 2009

15. Diagnoses & Interventions
Therapy as Usual
(all children with autism)
1 Music Therapy
Kim et al., 2008
1 Picture Activity Schedules
Bryan & Gast, 2000
1 Hug Machine Edelson, et al., Therapy Ball Chairs Bagatell et al., 2010

16. Inclusion Criteria Confirmed physician diagnosis
Between 2 and 13 years old
Korean Childhood Autism Rating Scale
Problematic behaviors interfering with ADLs
65 or above on Conners’ Teacher Rating Scale

17. Exclusion Criteria Diagnoses not confirmed by physicians
Over 13 and younger than 2 years old
Current therapy (OT, PT, SLP) in 9 studies
Co-morbid diagnoses

18. Sample Sizes Range: 1 child to 12 children
Average: 6 children per study

19. Weighted Vest Intervention: ABA Withdrawal Design
Initial baseline phases (A)
Classroom fine-motor activity
Intervention phases (B)
2 studies: Vests worn six minute sessions
1 study: Vests worn 2 hrs. per day, 3x/wk for 12 wks
1 study: Vests worn 45 minutes during 14 sessions
Withdrawal phases (A)
Removal of vests

20. Weighted Vest Intervention: ABC Withdrawal Design
Baseline phase (A):
Classroom fine-motor activity
Experimental phase (B):
Vests worn without weight mins./day for 2 wks
Experimental phase (C):
Vests worn with weight mins./day for 2 wks

21. Treatment as Usual: Hug Machine
Two 20 min. sessions/wk. for 6 wks.
Experimental group:
Lie in Hug Machine
Lever provided deep pressure
Control group:
Lie in the Hug Machine
Lever disengaged

22. Treatment as Usual: Therapy Ball Chairs
Baseline phase:
15 minute classroom “Circle Time”
No therapy ball chairs
Intervention phase:
Utilized therapy ball chairs during “Circle Time”

23. Treatment as Usual: Picture Activity Schedules
Baseline phase:
Classroom activity 45 mins./day for 5 days
No picture activity schedule
Intervention phase:
Picture activity books
4 step activity

24. Treatment as Usual: Music Therapy
Baseline phase:
Observed engagement during normal play
30 mins./day for 12 weeks
Intervention phase:
Observed during normal play incorporating music

25. Outcome Measures Data sheets (10 studies) Data collection:
Videotaped recordings
Researcher observations
Conner’s Parent Rating Scale
Parenting Morale Index
Pre-tests and post-tests
Pervasive Developmental Disorder Behavior Inventory-C

26. Data Analysis MANOVA Repeated measures ANOVA 2-standard deviation
Celeration line approach
Predicted an increase or decrease in on-task behavior

27. Methodological Quality of Studies
Natural environments
Classroom
Home
Randomization in 5 studies
Blinding in 5 studies

28. Controlling for Threats to Validity
Same diagnoses
Did not include scores of 3 children who dropped out
Served as own control
Inter-rater reliability
Controlled for maturation by conducting the studies within weeks

29. Limitations Small number of participants
Only male participants in four studies
Only one facility when recruiting participants
Unequal groups in 4 studies:
Group numbers
1 child had previous experiences with weighted vests
Experimental group rated higher on the Tension and Anxiety Scale than control group

30. Limitations Poorly defined procedures:
Did not state the frequency, duration, or intensity of OT
Undisclosed treatment environment
No means of controlling environmental distractions
Disruptive classmates
Loud noises
No randomization in group assignments in 5 studies

31. Limitations No experimenter blinding in 5 studies
No psychometric properties of tests were disclosed in 5 studies
Hawthorne effect
Children knew they were being observed

32. Results: Treatment as Usual
Hug Machine:
Experimental group lower tension levels on the Tension Scale than control group
t(10)= 3.124, p<.05
Lower on Anxiety Scale than the control group
t(10)=1.959, p<10
Therapy Ball Chairs:
Positive effects during “Circle Time”
Decreased number of minutes spent out of chair
No p values given

33. Results: Treatment as Usual
Picture Activity Schedule:
Children remained on-task and on-schedule when using the books
No p values given
Music therapy:
Increased eye contact (p<0.0001).
Medium effect on on-task behavior (d=.63)

34. Results: Weighted Vests
ADHD:
Significant change (p<.05) from baseline to intervention
Increase in on-task behavior (18% - 25%)
Developmental Delays:
No improvement in on-task behavior
Greater incidences of problematic behavior
No p values

35. Results: Weighted Vests
PDD:
1st study
Decrease in number of distractions
Increase in focused attention
No p values
2nd study (PDD & autism)
No increase in on-task behavior

36. Results: Weighted Vests
Autism:
1st study
No overall improvement in on-task behavior
Slight increase in on-task behavior in one child, but not maintained
No p values
2nd study
No increase in on-task behavior

37. Discussion
Evidence suggests that weighted vests are not a more effective intervention than OT as usual for increasing on-task behavior in children with Developmental Delays and ASD (autism, PDD)

38. Discussion
Weighted vests appeared to temporarily improve on-task behavior in one child with PDD
Long term effects not evaluated
Child received OT throughout the study
Unable to determine whether the results were contributed to the vests or from OT

39. Discussion
Weighted vests appeared to have significant effects on children with ADHD
Only included 4 children
Convenience sampling recruitment method
Long term effects not evaluated

40. Discussion
OT as usual is noted to be a more effective method for promoting on-task behavior in children with ASD
Therapy ball chairs
Positive effects on in-seat and on-task behavior
Music therapy
Effective intervention

41. Discussion Hug Machine Picture activity schedules
Deep pressure can contribute to an increase in on-task behavior
Extensive measures to control for threats
Picture activity schedules
Children’s performance increased by 100%

42. Conclusion
Efficacy of weighted vests depends on the child and his or her diagnosis
OT as usual appears to be a more reliable option for improving on-task behavior in children with ASD

43. Implications for OT Practice
Weighted vests may provide short-term calming effects on children with ADHD, but long-term effects have not been evaluated
OTs should not generalize the results to adults and diagnoses outside of the study
OTs who use weighted vests must proceed with caution until further evidence can be established

44. Implications for Future Research
Replicating in other contexts
Long term effects
Longer intervention period
Examining other protocols
Larger sample sizes
Boys and girls
Increasing amounts of weight in vests

45. References
Bagatell, N., Mirigliani, G., Patterson, C., Reyes, Y., & Test, L. (2010). Effectiveness of therapy ball chairs on classroom participation in children with autism spectrum disorders. American Journal of Occupational Therapy, 64, 895–903.
Bryan, L., & Gast, D. (2000). Teaching on-task and on-schedule behaviors to high-functioning children with autism via picture activity schedules. Journal of Autism and Developmental Disorders, 30(6),
Edelson, S., Edelson, M., Kerr, D., & Grandin, T. (1999). Behavioral and physiological effects of deep pressure on children with autism: a pilot study evaluating the efficacy of grandin's hug machine. The American Journal of Occupational Therapy, 53(2),
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. The American Journal of Occupational Therapy, 55(6), Retrieved from
Hodgetts, S., Magill-Evans, J., & Misiaszek, J. (2010). Weighted vests, stereotyped behaviors and arousal in children with autism. Journal of Autism and Developmental Disorders, 41,
Kane, A., Luiselli, J., Dearborn, S., & Young, N. (2004). Wearing a weighted vest as intervention for children with autism/pervasive developmental disorder. The Scientific Review of Mental Health Practice, 3(2),
Kim, J., Wigram, T., & Gold, C. (2008). The effects of improvisational music therapy on joint attention behaviors in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders, 38,
Krebs, M, McDaniel, M, & Neely, R. (2011). The effects of peer training on the social interactions of children with autism spectrum disorders. Education, 131(2),
Leew, S., Stein, N., & Gibbard, B. (2010). Weighted vests' effect on social attention for toddlers with autism spectrum disorders. Canadian Journal of Occupational Therapy, 77(2),
Moss, J, & Howlin, P. (2009). Autism spectrum disorders in genetic syndromes: implications for diagnosis, intervention and understanding the wider autism spectrum disorder population. Journal of Intellectual Disability Research, 53(10),
Reichow, B., Barton, E., Good, L., & Wolery, M. (2009). Brief report: effects of pressure vest usage on engagement and problem behaviors of a young child with developmental delays. Journal of Autism and Developmental Disorder, 39,
Sansosti, F. (2010). Teaching social skills to children with autism spectrum disorders using tiers of support: a guide for school-based professionals. Psychology in the Schools, 47(3),
VandenBerg, N. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. The American Journal of Occupational Therapy, 55(6), Retrieved from
Watling, R. L., & Dietz, J. (2007). Immediate effect of Ayres’s sensory integration–based occupational therapy intervention on children with autism spectrum disorders. American Journal of Occupational Therapy, 61, 574–583.

46. Thank You!