Welcome to another article on an autism weighted vest and inattention. After we’ve sifted through all the research one-by-one, we will present to you a full analysis of deep pressure stimulation on various symptoms/ mental ailments and why results vary so drastically, but for now, we invite you to critically think about these studies and develop your own ideas on why the results differ and consider how you would implement deep pressure stimulation in your own life with the new knowledge you gain from each of our articles.
Today’s study differs in that the participants have not been diagnosed with attention-deficit/hyperactivity disorder (ADHD), but rather autism spectrum disorder (ASD) and/or some form of developmental delay. How do these diagnoses differ from ADHD? Previously, clinicians thought of ASD and ADHD as two separate disorders that could never coincide, but with the updated version of the DSM-5, there was an allowance for a dual-diagnosis. Clinicians determined that about 30-80% of children diagnosed with ASD will also meet the criteria for ADHD, and 20-50% of those diagnosed with ADHD will meet the criteria for autism. Due to the high prevalence of comorbidity, there is cause for a deeper look at the two diagnoses and how they are related so that we can better treat children who present with these concerns, but there are still differences that prevent clinicians from grouping these two diagnoses into one.
Inattention associated with ASD could be caused by sensory overload. Sensory conditions are a hallmark indicator of a potential ASD diagnosis and are characterized by one’s inability to manage an excessive amount of sensory stimuli- think about a crowded mall with all the visuals and sound or New York City. ADHD, however, could be contributed to impulsivity, which is also a hallmark indicator of the disorder. If you recall from a previous article, we broke down another component of ADHD, where multiple-step processes overload the brain, and thus it becomes unable to complete the tasks, this is similar to ASD as well. Anecdotal and concrete evidence has shown a link between the two,and for this reason, although today’s study specifies ASD, the results may aid those who have been diagnosed with ADHD as well.
Aside from the ADHD/ ASD debate, another problem lies within the application of deep pressure stimulation. At this point in time, we have not found a study which addresses the proper deep pressure stimulation protocol to be used in the therapeutic setting. We have seen many different variables (i.e. weight percentage, type of deep pressure stimulation, varying times) but have had little to no consistency in the methodology. This study is no different, in that it does not offer clarity in pinpointing an appropriate protocol, but it does bring us that much closer to developing one, by discovering that weighted vests were not effective in alleviating symptoms with this procedure used. Yep, you read that right and spoiler alert.
Study on ASD/Developmental Delay & Weighted Vests
One of the main arguments Reichow, Barton, Sewell, Good, & Wolery (2010) had for conducting yet another study on inattention and weighted blankets, was that previous literature (Case-Smith & Bryan, 1999; Fertel-Daly et al., 2001; Kane et al., 2004/2005; VandenBerg, 2001) did not have an appropriate experimental design. What does this mean? Well, essentially there were flaws in their study that threaten the integrity/ validity of the results they founded. The major flaws were that the previous studies did not have experimental control including obtaining baseline data and return to baseline data, and two of the studies did not define their variables enough for replicability. Thus, here we are.
The inclusion criteria for this study were pretty specific in that the three children they recruited must have had:
- An autism and/or developmental delay diagnosis.
- Familiarity with weighted vests in that they have used them for an extended period of time throughout at least part of the school day.
- An age between 2 and 6 years old.
- A teacher who believed they would benefit from participating in the study.
- Enrollment in a university-affiliated, early childhood center.
It is unclear as to why only three participants were recruited, as this prevents generalizability, and really only serves as a starting point in understanding the effects of weighted vests and this population, through this experimental design. My best guess is that the researchers struggled to find participants that met their criteria. Previous
**Two autism/two developmental delay diagnoses means the sample size had different diagnoses throughout and thus the participants could not be compared against each other, and thus offered as their own unique data set.**
The three participants were in different classrooms within a university-affiliated child center. THe classrooms were each comprised of 12 students (comprised of students with and without disabilities), a teacher, and a teacher assistant. Data were collected through video recording during the first ten minutes of the daily morning activities which included pre-school level tasks (i.e. painting, matching, gluing, cutting ). It was stated within the study that the morning activity occurred at the same time each day, however, the times could have differed between classrooms.
Three conditions were tested:
- Vest with no weight (Foam discs were used that resembled the shape of weights so the observers could not identify what condition the student was being filmed for).
- Vest with a weight equivalent to 5% of child’s body weight (This was the only study who used a protocol to get a precise weight. They weighed each child, calculated 5% of their weight, then rounded up to the nearest ounce).
- No vest.
Each day during the school week the children were randomly assigned to one of the three variables so that they had 2days of weighted vest use, 2 days of the vest with no weight use, and 1 day of no vest use. Researchers manipulated the randomization slightly in that they prevented the occurrence of a condition occurring three days in a row.
tommy’s condition schedule/ condition breakdown
bert’s condition schedule/ condition breakdown
Sam’s condition schedule/ condition breakdown
Tommy was the first to be videotaped, and it was determined after him that adding a few sessions of the no-vest condition as a baseline would be appropriate to strengthen the experimental design. Sam and Bert were initially recorded without vests until their data stabilized.
**The lack of baseline in previous studies was a strong rationale for conducting this study, so I wonder why they decided only after Tommy’s initial data were collected to include a baseline.**
After the participants were recorded for various amounts of sessions, coders watched the recordings and categorized every 10-second clip into groups based on one of the following criteria:
- Engagement in Activity: Child was directly working on activity or was clearly attending to the teacher.
- Nonengagement in Activity: This included wait time before the activity began, or situations where the child was not paying attention to the task or engaging in inappropriate behaviors.
- Stereotypical Behavior: Repetitive movement that each particular child had a history of.
- Tommy’s Stereotypical Behavior: Arm Flapping/ Squinting eyes when looking at light.
- Bert’s Stereotypical Behavior: Flicking fingers in front of eye line/ Squinting eyes.
- Sam’s Stereotypical Behaviors: Squinting eyes/ Arm Flapping.
- Problem Behavior: Actions which prevented other children from engaging in the activity (i.e. tantrums or hitting).
- Could not see child’s face.
The researchers noted that they sought to implement a double-blind placebo trial within this study, which means that both the children and observers would not know what condition was being used for each session. They reported that although they were not able to ensure the participant’s did not know, they took extra measures to ensure the observers would not know. Their rationale for the double-blind was to prevent bias, which is common in alternative treatment methods being tested for autism.
- There was no significant relationship between weighted vest use and the participant’s engagement levels. Engagement levels actually decreased as the experiment went on.
- Problem behaviors increased when the weighted vests were used, more so for Tommy.
- Stereotypical Behaviors were at their lowest when the weighted vests were worn.
As a final way to truly determine if weighted vests had any benefit, the researchers turned to graduate students and the teachers. The teacher’s observations revealed no true benfits associated with the weighted vest. The graduate students were shown various videos with various conditions and were asked the rate the engagement level and stereotypical behavior level. Their answers vared, but in general they thought that for Bert there was low engagement associated with the weighted vest use, and Tommy’s stereotypical behaviors decreased.
The cause for the author’s to take initiative for this study was due to the lack of validity that they saw from other studies, but I would argue that this study has just as many flaws. There are only three participants and their data was collected over a different amount of sessions with varying patterns of conditions. Tommy only had three sessions with the weighted blanket out of the thirteen sessions. It does not appear as though the conditions were split up equally for all three of the participants. Also, the conditions were only filmed for 10 minutes, so it is possible that this brevity could have prevented a full picture of benefits from emerging.
Though the author’s made extreme efforts to control for certain confounds such as coder bias (by including foam discs so coders could not differentiate between unweighted and weighted vests as they were reviewing the videos) and controlled the amount of weight, they changed their procedure after the first participant. Tommy did not have a baseline, but rather the conditions were randomized from the start. It becomes difficult to compare data when a study begins with no adjustment period. Tommy did not have time to adjust to the fact that he was being filmed and would be wearing a different vest (probably than what he is used to).
Although their hypothesis was rejected, I do find it impressive that stereotypical behavior decreased with the brief weighted vest use, as this is a common symptom associated with autism and other sensory disorders. Even though the study’s results appear bleak and unpromising, it does offer a glimmer of hope that weighted vests could provide relief from stereotypical behaviors.
To determine the truth, and find out more, stick with us as we continue our journey through the literature. As I mentioned at the start of this article, eventually we will write a large article dissecting all of these weighted vest articles to come to our own conclusion on the effectiveness.
Case-Smith, J., & Bryan, T. (1999). The effects of occupational therapy with sensory integration emphasis on preschool age children with autism. American Journal of Occupational Therapy, 53, 489-497.
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. American Journal of Occupational Therapy, 55, 629-640
Kane, A., Luiselli, J., Dearborn, S., & Young, N. (2004/2005). Wearing a weighted vest as intervention for children with autism/pervasive developmental disorder: Behavioral assessment of stereotypy and attention to task. Scientific Review of Mental Health Practice, 3(2), 19-24.
Reichow, B., Barton, E., Sewell, J., Good, L., & Wolery, M. (2010). Effects of weighted vests on the engagement of children with developmental delays and autism. Focus on Autism and Other Developmental Disabilities, 25(1), 3-11.
VandenBerg, N. (2001). The use of a weighted vest to increase on-task behavior in children with attention difficulties. Journal of Occupational Therapy, 55, 621-628.