*3.4.3. Review of the evidence*

The evidence to support the efficacy of using weighted blankets is scarce. Creasey and Finlay were unable to find any relevant primary or secondary evidence exploring the effectiveness of weighted blankets' impact on sleep in children with ASD [51]. Despite this lack of evidence, there is parental/caregiver anecdotal support of use, and as such, many advocate for the use of weighted blankets. One study published after Creasey and Finlay's review studied 73 children, aged 5–16 years, all of whom had an autism spectrum disorder diagnosis and reported sleep disturbances [52]. Using a crossover design, study participants were given a weighed blanket to sleep with for 2 weeks, followed by a period during which they slept with a nonweighted blanket that was provided by the researchers. The core findings were that weighted blankets were no more effective than a typical blanket in helping children with ASD improve their total sleep time or other qualitative and quantitative sleep measures. Parents of the children in the study, however, reported an improvement in next-day behaviors, a finding that the authors hypothesized might have been due to improved bedtime behaviors, improved parent/child interactions, or inflated reports by parents wishing to please the study team.

reported that using weighted vests among young children was on the ineffective side, partially due to small sample sizes and poor methodology within the literature [58]. In another meta-synthesis by Losinski and associates, the research studies included were found to be of low quality, with the effects of deep pressure via weighted vests for individuals with disabilities (including ASD) were small among the variables of attention, disruptive behavior,

Occupational Therapy's Role in the Treatment of Children with Autism Spectrum Disorders

http://dx.doi.org/10.5772/intechopen.78696

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Small scale studies offer mixed results of the use of weighted vests. McGinnis and associates, reported that young children with ASD actual enjoy using weighted vests, and the application of these vests may serve as positive reinforcement, rather than bringing about changes in sensory processing [60]. Another study using an AB single subject design, found that weighted vests did not decrease problem behaviors (distraction, emotional reaction, withdrawal, escape/avoid, etc.) nor facilitate joint attention with primary caregivers among four toddlers

The evidence in support of using weighted vests to address challenging behaviors rooted in sensory processing is almost absent, with additional research exploring the intervention with more typical behaviors among individuals with ASD. As such, AOTA does not include the use of weighted vests as a therapeutic technique in its publications. This is exemplified in two recent seminal works that therapists rely upon to guide practice: *Autism: A Comprehensive Occupational Therapy Approach* [61] and *Occupational Therapy Practice Guidelines for Individuals with Autism Spectrum Disorder* [62]. Due to the lack of evidence, weighted vests should be used with caution. Any use of weighted vests should be aligned with strong diagnostics related to

Task-oriented treatment approaches assist children with ASD to develop the skills necessary to complete a particular task. Children with ASD often have difficulty completing tasks due to a variety of difficulties in communication, socialization, motor skills, and sensory processing. Task-oriented approaches consider the task to be completed and ways in which to accomplish the goal. Task-oriented approaches are utilized by both occupational and physical therapists

**3.7. Treatment and Education of Autistic and Related Communication-Handicapped** 

The Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) program is intended to assist children in completing daily tasks by providing instructions that are clear and understandable in an environment that is highly structured and supportive [63]. TEACCH is considered a structured teaching program that recognizes the characteristics commonly associated with autism spectrum disorder, specifically communication problems, preference for visual information, sensory-related difficulties, attention variability, intense interests/impulses, and time management issues [64]. By offering a highly structured teaching environment focused on each child's individual ASD characteristics and

self-injury, and stereotypy [59].

with ASD and sensory processing difficulties [55].

sensory processing behaviors, deficits, and outcomes.

**3.6. Task-oriented treatment approaches**

to teach functional skills.

*3.7.1. Purpose of the technique*

**Children (TEACCH)**

Gee and associates conducted a study to explore the efficacy of weighted blankets with children with an ASD and sleep disturbances using a single case, multiple baseline design [44]. This study focused on two children with an ASD and sensory over-responsivity. The authors found that there were minimal changes reported via caregivers after 14 nights of use, yet they indicated improvement in the areas of time to fall asleep, number of wakings in the night, duration of sleep and behavior in the morning. Gee and associates, utilizing a similar demographic, sample size, and measures, reported that children with ASD and sensory overresponsivity demonstrated a correlation between their morning mood and the number of hours slept the previous night [53]. Furthermore, it was reported that morning mood of the participants improved during the intervention phase of the ABA design.

Overall, the evidence supporting the use of weighted blankets continues to be weak, as such, this technique is considered experimental and should be used with caution.
