**3. Auditory integration therapy**

and rhythm patterns hand games, building obstacle courses, activities that require whole body movements and timing such as kicking a rolled ball, hitting a ball with a bat, imitation of animal

Sensory integration therapy is a clinical based intervention that uses play activities and sensory integration principles to increase adaptive responses of children [12]. In a systematic review research by Benson and Koomar, 27 studies on the impact of sensory integration approach on children were reviewed. It's reported that sensory integration approaches are effective in terms of sensory-motor skills, motor planning, socialization, attention and behavioural regulation, skills related with reading, active participation in plays and personal goal attainment, however, the findings are limited due to small sample size, different practice dosages, therapy

Schaaf *et al* implemented sensory integration protocol for 10 weeks on a case with autism and consequently an increase was reported in sensory processing and home, school and family activities measured with Goal Attainment Scale [40]. Another study by Schaaf *et al* reviewed the safety, validity and applicability of sensory integration and occupational therapy in children with autism. 10 children with autism at 4-8 years of age were under therapy for 3 days a week for 6 weeks and an assessment was made with Ayres Sensory Integration Fidelity Measure. Sensory integration approaches in children with autism were reported to be a safe and applicable intervention [41]. Sensory integration therapy of 10 weeks for pre-schooler children with autism resulted with a decrease in non-engagement behaviours and an im‐

Pfeiffer *et al* reviewed the impact of fine motor activity with sensory integration therapy in 37 children between the ages of 6 and 12 with autism spectrum disorders in randomized con‐ trolled studies. Consequent to practice of 18 sessions, each for 45 minutes for six weeks, a significant improvement was reported in the sensory integration group. In sensory integration group, positive changes in sensory processing, motor skills and social functions and decrease in stereotypical and self-stimulating behaviours were reported [43]. A study by Smith *et al* reports that self-stimulating and self-injurious behaviours remain stable in children with pervasive developmental disorders as a result of sensory integration therapy [44]. Sensory integration and sensory based treatments resulted in increase in engagement in plays and social interaction, proper adaptive response, decrease in stereotypical and self-stimulating behaviours, decrease in sensitivity against touching and movement in hyper responsive children and decrease in sensory vulnerability. Sensory integration therapy improves skills of

Some studies report that sensory integration therapy does not have a positive impact due to small sample size, short therapy duration, no fidelity measure, study design and due to the

postures etc. can be used to improve motor planning [23, 38].

duration and result measurements not being appropriate [39].

engagement in social interaction and modulating behaviours [45, 46].

provement in purposeful behaviours [42].

fact that assessments are not blinded [47-51].

**2.3. Researches about sensory integration therapy**

170 Autism Spectrum Disorder - Recent Advances

Auditory processing problems are one of the sensory processing disorders commonly reported in children with autism. These disorders are classified either as auditory hypersensitivity or auditory underresponsivity [3, 52, 53] and Rimland and Edelson reported that nearly 40% of 17.000 children with autism have sound sensitivity [54].

Auditory Integration Therapy is a technique developed by Dr Guy Berard, an otorhinolar‐ yngologist in order to reduce abnormal sound sensitivity in autism spectrum disorders. In this method, electronically modulated music is listened by headphones for half an hour twice a day for 10 days. Audio metrical assessment is made before the therapy. Auditory integration training devices filters peak frequencies against which the individual has hypersensitivity. It aims to regulate behaviour by reducing hypersensitivity. The filtered music is modulated by a brief dampening of high and low frequencies for periods ranging from 250 milliseconds to 2 seconds [54-56].

445 individuals with autism who received auditory integration therapy were reported to have a decrease in problem behaviours and increased hearing acuity and the observed changes remained stable for nine months [57].

Changes in brain functions were measured before and after auditory integration therapy with positron emission tomography and an increase in occipital lobe activity and a decrease in hyper metabolism in frontal lobe were reported [58]. Auditory therapy according to Tomatis method is reported to create an increase in daily life skills, motor skills, socialization and communica‐ tion skills in 6 cases. Furthermore, decrease in hyperactivity, atypical behaviours and increase in attention was reported in cases [59]. Brockett *et al* assessed impacts of auditory integration training on behavioural changes related with sensory modulation in children with autism. Following a 10-days training for two times a day, a decrease was reported in sensory behaviour problems of children [60]. In 72 cases with autism spectrum disorders, auditory integration therapy was reported to have a therapeutic impact on social awareness, social cognition and social communication as well as speech and communication [61]. Some studies report that there is not difference between auditory integration therapy and control group and that evidence based studies are required [62-64].
