UK Essay Writing Service - We accept all
subjects. Just send us your instructions. Only £10 per page. www.mywritingassistant.com
Hong Kong Essay Writing Service - We accept all subjects. Just send us your instructions. Only HK$117 per page. www.mywritingassistant.com
Singapore Essay Writing Service - We accept all subjects. Just send us your instruction. Only SG$19.32 per page. www.mywritingassistant.com.
Hong Kong Essay Writing Service - We accept all subjects. Just send us your instructions. Only HK$117 per page. www.mywritingassistant.com
Singapore Essay Writing Service - We accept all subjects. Just send us your instruction. Only SG$19.32 per page. www.mywritingassistant.com.
Effects of
Controlled Multisensory Stimulation in Autism Spectrum
Disorder
Behavioral disorders have been the
concern of psychologists and psychiatrists for decades. Many disorders have
been discovered through intensive research throughout the years. One of which was
the first description and identification of autism by Leo Kanner in 1944
(Harvard Mental Health Letter, 1997). Autism is not a disease but a dysfunction
in the development of the brain, specifically a developmental disability that
typically involves delays and impairment in social skills, language, and
behavior (Adams et al, 2004). Inspired by psychoanalytic theory which was
prevalent during the 1940s, research on autism had grown since Kanner published
a description of early infantile autism in 1943 (Matson et al, 1996). Today,
autism is one of the most researched behavioral disorders with the current prevalence
of 60 per 10,000 people (Prior, 2003). One of the issues associated with the
disorder throughout the years since is treatment. Since the 1960s, researchers
have been trying to develop effective treatments on autism. Yet, even though
many techniques have been discovered to modify target behaviors, there is still
a need for continued research in this area (Pope, 1999). Research should still
verify the effectiveness and safety of the new techniques. Currently, it can be
said that one of interventions that require further investigation is the
multi-sensory stimulation approach to behavioral disorders such as autism. A
multi-sensory therapy such as the ‘snoezelen’ has been around since 1966,
basically as a relaxant environment for the elderly. The approach is now being
used for behavioral disorders but extensive research is still needed to support
its effectiveness (Chung, Lai and Chung, 2004). Thus, the focus of this study
is to investigate the use of snoezelen as a treatment for people with autism.
The aim is to discover the effect of a controlled multi-sensory stimulation
such as snoezelen on the targeted behaviors in the autism spectrum disorder.
Background
Definition of Autism
Commonly, autism is characterized by
qualitative impairments in social interaction and communication (reciprocal
social behavior and language development), and by the presence of restricted
and repetitive behavior (American Psychiatric Association, 1994; World Health
Organisation, 1993). It is a developmental disability that typically involves
delays and impairment in social skills, language, and behavior (Adams et al,
2004). In other terms, people with autism have difficulties in social
relationships, social communication and imagination/rigidity of thought (Adams
et al, 2004). It literally means living in terms of the self. For instance, to an
ordinary observer, an autistic child may seem to be self-centered as the child shows
little reaction to the outside world. Ironically, the autistic child is in a
state with little awareness of what being a self means (Tustin, 1995).
Apart from its common description,
autism is actually a spectrum disorder that encompasses
a variety of forms and types. Autistic Spectrum Disorder (ASD) is the
term that refers to a broad definition of autism including the classical form
of the disorder as well as closely related disabilities that share many of the
core characteristics (ERIC Development Team, 1999). Its diagnoses and
classifications include: Pervasive Developmental Disorder-Not Otherwise
Specified (PDD-NOS), which refers to a collection of features that resemble
autism but may not be as severe or extensive; Rett's syndrome, which affects
girls and is a genetic disorder with hard neurological signs, including
seizures, that become more apparent with age; Asperger syndrome, which refers
to individuals with autistic characteristics but relatively intact language
abilities, and; Childhood Disintegrative Disorder, which refers to children
whose development appears normal for the first few years, but then regresses
with the loss of speech and other skills until the characteristics of autism
are conspicuous.
Behavioral Description
Autism
affects people differently. Some children and adults with autism may have
speech, while others may have little or no speech. Less severe cases may be diagnosed with
Pervasive Developmental Disorder (PDD) or with Asperger’s Syndrome where
affected children typically have normal speech, but have many “autistic” social
and behavioral problems (Adams et al, 2004). The co-occurring conditions that
might manifest in the disorder include: mental retardation; seizures; chronic
constipations or diarrhea; sleep problems; pica; low muscle tone; and sensory
sensitivities (Adams et al, 2004). Nonetheless,
despite the abnormal conditions, autistic children
and adults are capable of acting normally e.g. making eye contact (APA, 1994). They
are more than capable of expressing themselves than ordinary people by showing
affection, smiling, laughing and demonstrating other emotions. However,
expressions may come in varying degrees because they have difficulties in
verbal and non-verbal communications, social interactions, and leisure and play
(Pope, 1999). Similar to the responses of behaviorally normal people, children
and adults with autism may respond either negatively or positively to the
environment (APA, 1994). For instance, they can:
exhibit severe mental retardation or be extremely gifted in their
intellectual and academic accomplishments;
prefer isolation and tend to withdraw from social contact, or show high levels
of affection and enjoyment in social situations; and some appear lethargic and
slow to respond, while others are very active and seem to interact constantly
with preferred aspects of their environment (ERIC Development Team, 1999, p.2).
Cause
of Autism
The onset of autism usually occurs
during pregnancy or the first three years of life – basically children are
mostly affected. Until now, a specific cause for autism remains unknown (The
National Institute of Neurological Disorder and Stroke, 1999). However,
continuous research is being conducted to determine the origin of autism. Researchers
have different views regarding the cause of autism. Some believe that genes and
environmental factors i.e. viruses or chemicals contribute to the disorder.
They observed that abnormalities in affiliative behavior of other individuals
are linked to the dysfunction of serotonin, neuropeptides, oxytocin and
vasopressin (Brasic, 2004). Symptoms of autism are also said to be aggravated
by the consumption of phenol-rich foods such as dairy products, corn, sugar,
apples and bananas (Brasic, 2004). On the other hand, other researchers believe
that autism is related with abnormalities in the brain, particularly: the
distinguishing characteristic of the brain size of an autistic, wherein the
cerebellum is larger and the corpus callosum is smaller; the noticeable
reduction in the number of Purkinje cells; and the enlarged amygdala and the
hippocampus in an autistic brain (Taverna, 1998; Pope, 1999). Generally, it is
accepted that it is caused by abnormalities in brain structure or function but little
evidences are presented. Further investigation and more evidences are needed to
determine the cause of autism (Taverna, 1998; Pope, 1999).
Medications
and Interventions
It is accepted that there is no cure
for autism just as there is no clarifications about its origin. However, as
autistic individuals suffer other disorders such as depression and seizures,
drugs can be beneficial to remedy these secondary problems. For instance, some
benefits are derived from taking butyrophenones by controlling the most severe
forms of aggressive and self-destructive behavior. This medication, however
does not resolve psychosis. Aggression, irritability and agitation common among
autistic may be regulated by Ziprasidone. Hyperactivity may be lessened with
methylphenidate therapy (Brasic, 2004). On the other hand, therapies can be
used to modify some autistic behaviors. Therapies being used include: applied behavior
analysis; sensory integration; speech therapy; occupational therapy; physical
therapy; and auditory interventions (Adams et al, 2004). The focus of therapy
efforts should be to develop functional skills that will be of immediate and
ongoing value in the context of daily living (ERIC Development Team, 1999).
This typically includes strategies for enhancing a person's ability to
communicate, to understand language, and to get along socially in complex home,
school, work, and community settings (ERIC Development Team, 1999).
Multi-sensory
Stimulation
People with autism are affected with
many personality and behavior problems. Their disability often prevents them
from expressing and fulfilling many needs in an appropriate way. One example is
their failure to fulfill the human need of stimulation (Chan et al, 2002). Fortunately,
through multi-sensory stimulation, their need for stimulation or leisure can be
fulfilled. This is based on the belief that people with developmental
disability can benefit from sensory input (Hutchinson, 1994). One type and perhaps the
most popular approach in multi-sensory stimulation is the use of multi-sensory
environment – “a quiet room with a selection of sensory equipment arranged to
stimulate the primary senses, without need for intellectual or structured
responses and relying on immediate pleasurable sensation” (Leng et al, 2003). It
was first for children with learning disabilities, and then applied to adults
with profound and multiple learning disabilities and with dementia (Ashbey et
al, 1995; Leng et al, 2003). Popularly known as the ‘snoelezen’ – based on two Dutch words meaning "to sniff" and
"to doze” - the therapy stimulates the primary senses of touch, hearing,
sight, smell, and taste by creating a relaxing ambience through the combination
of soft music, aromatherapy, textured objects, colored lighting effects, and
favorite foods (Chitsey, Haight and Jones, 2002; De et al, 2004). Basically,
the ‘snoezelen’ can act as a sanctuary because it places the resident in
a failure-free environment with no rules and gives him/her control over
interactions within the environment (De et al, 2004).
Children with autism may seek sensory stimulation from the environment
in order to calm, or self-regulate, their nervous systems (Grandin, 1995). Overall,
attributes included in a multi-sensory environment or a snoezelen that might
benefit children with autism are: opportunity for affective/emotional
development; stimulation for all senses; relaxation; facilitation of therapy;
enhancement of communication; minimization of challenging behavior; development
of self-determination; and Opportunity for social interaction with non-disabled
children/families (Pagliano, 1999).
Statement of the Problem
The use of snoezelen flourished
since its introduction in Netherlands
in the 1980s. Although multi-sensory stimulation was first introduced in America in the
60s, the introduction of snoezelen gave children with disabilities a chance to
fulfill their need for stimulation and relaxation. The therapy can be a
potentially useful intervention for children with autism as stimulation may
calm them and may prevent them from resorting
to self-injury, anger, or repetitive behavior
as a substitute. Findings from previous studies show the many benefits that
‘snoezelen’ can give, basically includes all the attributes mentioned earlier
(Pagliano, 1999). However, the effects of ‘snoezelen’ on autism are still less
explored, at least in terms of the Autistic Spectrum Disorder’s level. For
instance, the effects of the therapy on the negative behavior of children with
severe autism still lack comparison with the effects of the therapy on the
negative behavior of children with Asperger syndrome or other types of ASD. Most
findings were based on a generalized hypothesis that ‘snoezelen’ positively
affects the behavior of children or adults with autism or any developmental
disabilities. Obviously, there is a need to compare the stimulating effects of
snoezelen on each types of ASD. By doing so would open new opportunities to
discover new facts about the effects of MSE on autistic behavior.
The
following research questions will help specify the problem:
1. What are the effects of snoezelen on the
behavior of children diagnosed with PDD-NOS?
2. What are the effects of snoezelen on
the behavior of children diagnosed with Rett’s syndrome?
3. What are the effects of snoezelen on
the behavior of children diagnosed with Asperger’s syndrome?
4. What are the effects of snoezelen on
the behavior of children diagnosed with CDD?
5. What are the effects of snoezelen on
the behavior of children who developed severe autism?
6. Does the stimulating effect of
snoezelen differ in terms of how severe or how low the autistic disorder of the
children?
Aims
and Objectives
The aim of the study is to be able
to determine the differences of the snoezelen’s effect on different ADSs to be
able to provide recommendations on how the attributes of MSEs can be taken full
advantage. The focus is on autistic behavior and not on the disease itself.
The objective of the study is to
observe the behavior of children with different types of ASD in a snoezelen and
to compare the effects’ similarities and differences. Another objective is to
interview resident nurses of snoezelen centers about their personal
observations on the effects of the therapy on the behavior of children
diagnosed with ADS. Furthermore, the objective is to prove that the effects of
snoezelen on behavior differ in the level of ADS.
Significance of the Study
The significance of the study lies on
the fact that investigations on the effects of snoezelen are still limited and
still requires further exploration. The path that this study will take is
unique compared with previous studies in a sense that it will investigate the
effects of snoezelen depending on the severity of the autistic disorder. If
ever such differences will be proven, results can contribute in opening up new
areas of investigation in subject and further research will be conducted to
strengthen and findings or prove the findings wrong. In other words, it will
stimulate knowledge in the field of occupational therapy. It will also help
establish new standards in snoezelen usage, particularly on how different
levels of autistic conditions can be accommodated.
Purpose
of the Study
The purpose of the study is to
contribute to the growing but limited body of research studies on the effects
of snoezelen on autism or ASD. This is to help occupational therapists in
discovering the full potential of snoezelen or MSE so that they can take
advantage of its benefits easily. Another purpose of the study is to help the
family of those with ASD to think about several factors first before deciding
to use snoezelen.
Hypotheses of the Study
The research will utilize observation, but will conduct a few
rounds of quantitative research on occupational therapists in several
snoezelens - thus, there is a need to state hypotheses. The following
hypotheses will be tested in the study:
H1: Snoezelen, in the
view of the occupational therapist, has different effects on behavior depending
on the severity of the ASD.
H2: The snoezelen helps
children with ASD relax and help them sustain anger, self-injury, repetitive
behavior and communication skills.
Important Terms
Asperger’s
Syndrome - refers to individuals with autistic
characteristics but relatively intact language abilities.
Autism
– defined by the American Psychiatric Association
(2000) as a deficit that has three criterions namely: reciprocal social
behavior; language development; and stereotypic/repetitive behavior.
Autistic
Spectrum Disorder – refers to the broad definitions and
classifications of autism, which are: Pervasive Developmental Disorder-Not
Otherwise Specified (PDD-NOS); Rett’s Syndrome; Asperger’s Syndrome; and
Childhood Disintegrative Disorder.
Behavior
- The actions or reactions of a person or animal in
response to external or internal stimuli.
Childhood
Disintegrative Disorder - resembles autism but only after a
relatively prolonged period (usually 2 to 4 years) of clearly normal
development.
Multi-sensory
Environment – a quiet room with a selection of
sensory equipment arranged to stimulate the primary senses, without need for
intellectual or structured responses and relying on immediate pleasurable
sensation.
Multi-sensory
Stimulation – a therapy that stimulates the five
senses simultaneously.
Pervasive
Developmental Disorder-Not Otherwise Specified (PDD-NOS) - refers
to a collection of features that resemble autism but may not be as severe or
extensive.
Qualitative
Research – a
naturalistic research whose findings do not arrived at by statistical or other
quantitative procedures.
Quantitative Research – a research conducted through the use of statistical treatment to test
hypotheses and show relationships between variables.
Rett’s Syndrome - affects
girls and is a genetic disorder with hard neurological signs that become more
apparent with age; most develop repetitive hand movements, irregular breathing
patterns, seizures and extreme motor control problems.
Snoezelen
– A type of multi-sensory stimulation that is based on two Dutch words meaning "to sniff" and
"to doze”. Its purpose is to stimulate the primary senses of touch,
hearing, sight, smell, and taste.
Literature Review
Snoezelen
is being used by many people with different developmental and behavior
disabilities. Some of the literatures that will be reviewed in this section do
not involve people with autism per se, but those who have other developmental
difficulties related or similar with autistic behavior.
Zinn
(2000) conducted an in-depth interview about snoezelen use of people with
Alzheimer’s disease in O'Brien Memorial Health Care Center. She was welcomed by the
secretary as she observed that the place has a "homelike" atmosphere.
She was shown to the snoezelen room by a staff member and explained to her that
for the residents with Alzheimer’s, snoezelen has proven useful for helping
reduce the agitation, confusion and combativeness that sometimes come with the
disease. Zinn (2000) described the room as a reminiscent of the sixties, with
translucent plastic "ropes" containing strings of flashing lights
placed on a large table. It also contains “softly illuminated aquarium takes up
a large share of one wall, and lava lamps and other decorative
lights--containing swirling bubbles and bouncing plastic fish and other
eye-catching objects and patterns--sit on smaller tables”. Furthermore, Zinn
(2000) also observed a rotating glass ball on the ceiling and a window covered
with a black felt curtain with glow-in-the dark stars and planets attached.
There is also a scent of aromatherapy and the sound of soft nature and relaxing
music (Zinn, 2000). Zinn (2000) found that residents are brought in the room by
staff members, where they will receive one-on-one attention. They are brought
in only one at a time, and therapy includes soft talking with the staff member
and touch therapy such as massaging skin with lotion. Regarding the perception
of the residents about the room, Zinn’s (2000) guide member stated: “each
resident perceives the room differently, and it can be a new adventure each
time”. Most of the residents love the fish tank and the lightings of the room.
According to the staff, the room is effective for stimulation, but residents
should always have staffs to supervise them to make sure they are safe. It is
also the staff’s job to “fluff the residents' pillows, comb their hair, massage
them with lotion, play tapes and read to them”. Agitated residents are brought
in the snoezelen and it would make them calm for only within half an hour. It
also helps the residents’ activity level-up, develop a long-term memory, and
gives them a place nice and quiet to sit down with their family members. For
the staff, it helps them reduce unwanted behavior of residents and helps them
“…greatly reduce the use of chemical restraints”. Those were the information
that Zinn (2000) collected during her visit.
Kinkead (2003) of the New York
Times, in her investigation about snoezelen, receives opinion from the
administrator of the place that ''There have to be key studies to show that it
is effective”. In terms of benefits on mentally disabled children, Kinkead’s
(2003) interviewee answered that it can be based on personal feelings and
interpretation: “If benefit means smiling, engaging and relaxing, then I
believe it is beneficial'', says the interviewee.
On the other hand, Chung et al (2004) conducted a study review to
examine the clinical efficacy of snoezelen for older people with dementia. They
searched the databases PsyLIT and Medline with the keywords “randomized
control/single control/double control”. The list of trials was compared with
those identified from a search of the Specialized Register of the Cochrane
Dementia and Cognitive Improvement Group. However, only two trials were valid –
Baker (1997) and Kragt’s (1997) study. Furthermore, only Baker’s results were
analyzed because Kragt did not examine the carryover and long-term effects of
snoezelen. The study found that there were improvements in apathy, mood, speech
skills, and psychomotor ability of the respondents. But the problem is that the
study was limited for two reasons: very limited data were available for
analysis, thus limiting data inference and generalization; and different
methodology and control conditions were adopted in the two trials.
Cox, Burns, and Savage (2004) also
believes that there are limited studies that show the effectiveness of MSEs
such as snoezelen. They conducted a study of their own to examine how effective
two types of multi-sensory environments were in improving the well-being of
older individuals with dementia. They focused on a Snoezelen room and a landscaped
garden and used two methods – quantitative and qualitative. In their
quantitative investigation, they used the Affect Rating Scale (ARS) as the
instrument and the Friedman tests chi-square statistics for analyses. They also
used the Kruskal-Wallis test to measure the differences of effects by stage. One
insightful finding is that more sadness was recorded as the affect in the
living room environment compared with the garden or Snoezelen room. They also
found that Stage 1 was more likely to display pleasure, and that in Stage 3 was
more likely to display contentment for the residents. The study also found that
participants display higher contentment and pleasure during the session
compared to before the session. On the other hand, in the qualitative research,
Cox and company conducted interviews to six caregivers and six visitors. The
respondents observed that people become calmer in both environments. Agitated
residents become calm and their communication abilities improve. Furthermore,
they also become happier. Visitors stated that both places are better than
pills – a room for privacy, meditation and fascination.
Barbara McCormack, a mother to a
child with Aicardi Syndrome, wrote an article to express her testimonies about
the wonders that snoezelen din for her and her daughter (McCormack, 2003).
Barbara testified that the day they discovered snoezelen was the first day her
daughter “squeal with delight” and “put on the widest smiles”. Now that her
daughter is already a teenager, Barbara stated that the snoezelen helped her
daughter developed communications skills, improvements in eye/hand coordination
and sense of humor (McCormack, 2003). Their relationship improved because of
the snoezelen. Basically, what McCormack experienced were similar to what studies
show – that “children seem happier while visiting the room, vocalize more, and
tend to stay on task in the Snoezelen environment as opposed to their regular
environment” (Nicodemus, 1999).
Kwok, To and Sung (2003)
investigated the effects of snoezelen on people
with learning disabilities. They explained that the concept of snoezelen is to
provide: sensory stimulation; make sense of the world; relaxation; and
enjoyment. Ninety-six patients with learning
disabilities were included in the study. In summary, the most prominent effects
of snoezelen that they discovered are: leisure (62.5%), relaxation (55.2%),
improved rapport (51.0%), and reduction of self-injurious behavior (58.1%).
They also concluded that snoezelen creates an atmosphere of warmth, trust, and
relaxation, and provides scope for exploration, discovery, and learning.
However, the findings on the positive effects of limiting aggression towards
others were limited, showing the possibility that snoezelen’s effects differ in
terms of the severity of the disorder.
Similarly, Stadele and Malaney
(2001) studied the effects of MSEs, but they focused on its effects on the
negative behavior and functional performance of people with autism. Their study
is only one of the few studies conducted about snoezelen’s effects that
specifically focus on autism negative behavior and functional performance. They
had two subjects that were chosen non-randomly
by the occupational therapist at the facility. Both subjects have common
diagnosis of autism and exhibited non-verbal communication. The design was a
single subject ABA
design with an A phase (baseline condition), a B phase (intervention
condition), and an A phase (follow-up condition) (Stadele and Malaney, 2001). Interestingly,
they found that both subject 1 and 2 had no significant decrease in number of
target behaviors between baseline and intervention, nor between intervention
and post-intervention. They concluded that there is no clear pattern of
decreased target behaviors during periods of sensory room intervention. Their
findings suggested that sensory room intervention needs to be individualized in
order to be effective in decreasing target behaviors among autistic children
and young adults. However, their findings were limited because only two subjects
were observed and that there are no variations on the severity of the subjects’
autistic behavior. Furthermore, the sensory room used was only an improvised
one and not an actual snoezelen.
Methodology
Design
A cross-sectional randomized
controlled trial study will be conducted to identify the effects of snoezelen
on the negative behavior of children with different severity of autistic
behavior. The cross-sectional approach is
a study of a particular phenomenon (or phenomena) at a particular time (Saunders
et al, 2003). Accordingly,
cross-sectional studies often employ the survey strategy, and they may be
seeking to describe the incidence of a phenomenon or to compare factors in
different organizations, but they may, as well, employ qualitative methods, as
many case studies are based on interviews conducted over a short period of time
(Easterby-Smith et al, 2002; Robson,
2002; Saunders et al, 2003). On the
other hand, a randomized controlled trial will also be used as one of the
process because the concern of the study is not only on the changes of the
behavior, but also on the efficacy of the treatment on the disease. RTC can
address issues regarding the strengths and weaknesses of snoezelen on the
different severities of autistic behavior. Basically, quantitative and
qualitative research will be conducted.
Sampling
Twenty
(20) children with different autistic behavior severity will be trialed. The
children will be recommended to attend sessions of snoezelen for a period of
four weeks. Children will be observed and then nursing staffs of the snoezelen
branch will be interviewed. Respondents will be randomly chosen from the list
of clinics or mental centers. On the other hand, staffs will be self-selected
given that they participated in the snoezelen experiences of the respondents.
The criteria for the children are that they should be diagnosed previously for
autistic behavior or autism and that there should be variation in the severity
of their condition. The severity of their condition will be measured through
the Childhood Autism Rating Scale (CARS).
Instrumentation
Instruments to be used are
semi-structured open questionnaires for the nursing staff and the CARS for the
children with autistic behavior. An open type questionnaire will be used for
the respondents so that: their answers are guided; they can complete answers
for duration of time they can be comfortable of; their answers will be simple
to analyze; and factual information can be obtained. On the other hand, the
CARS will be useful in determining the level of severity of the children’s
autistic behavior. It is the most widely used standardized instrument
specifically designed to aid in the diagnosis of autism for use with children.
Its 15 items include: relationships with people; imitation; affect; use of
body; relation to non-human objects; adaptation to environmental change; visual
responsiveness; auditory responsiveness; near receptor responsiveness; anxiety
reaction; verbal communication; nonverbal communication; activity level; intellectual
functioning, and the clinician's general impression. All can be used to measure
the severity of the respondents’ autistic behavior (Clinical Practice
Guideline, 1999).
Aside
from the semi-structured questionnaires that will be presented for the nursing
staff, a series of personal interviews will also be conducted. During these
interviews, an audio-tape recorder will be used to record the conservation. Furthermore,
if possible, a video recorder will also be used to monitor the behavior of the
children while inside the snoezelen. This will be helpful to further evaluate
and analyze their experience inside an MSE.
Data
Analysis
The severity of the children’s
autistic behavior will be acquired through CARS and will be analyzed through
percentage and mean analysis. On the other hand, the effects of snoezelen on
their negative behavior will be analyzed through observation and then
transcribed to quantity. The effects on each severity will be compared and
analyzed through the use of chi-square. For the nursing staff respondents,
their responses will be analyzed also through percentage and mean analysis.
Their more in-depth observation on the situation will be written down and will
be analyzed and compared with the statistics collected from the semi-structured
interview.
Ethical
Considerations
Confidentiality of the respondents’
personal profiles and preferences will be ensured. This will be stated to
everyone concerned especially the guardians of the children with autistic
behavior. Furthermore, safety during the activities will be ensured at all
times.
Limitations
Children with autistic behavior and
snoezelen nursing staffs will be the only respondents in the study. The trial
will only take two times every four weeks.
References:
Adams,
J.B., Edelson, S.M., Grandin, T. and Rimland, B. (2004). Advice
for Parents of Young Autistic Children. Autism Research Institute, San
Diego, CA, U.S.
American Psychiatric Association
(1994). Diagnostic and statistical Manual of mental
disorder (4th Edition). Washington DC. American Psychiatric Association.
Ashby M, Lindsay WR, Pitcaithly D,
Brotholme S, and Geelen N. (1995).
Snoezelen: its effect on concentration
and responsiveness in people with profound multiple handicaps. British
Journal of Occupational Therapy,
Vol.58, No.1; pp.303–307.
Brasic, J.R. (2004). Pervasive
developmental Disorder: Autism (online).
Available at: www.emedicine.com
[Accessed: 06/27/05].
Chan, S., Thompson, D. and Chau, J.
(2002). Effects
of multisensory therapy on behaviour of adult clients with developmental
disabilities. Hong Kong
Centre for Evidence Based Nursing, Joanna Briggs Institute.
Chitsey,
A.M., Haight, B.K. and Jones, M.M. (2002). Snoezelen:
A mutisensory environmental intervention. Journal of Gerontological Nursing,
Vol.28, No. 3; pp. 41-50.
Chung, J.C.C., Lai, C.K.Y. and French,
H.P. (2002). Snoezelen for dementia (online). Available at:
http://www.medscape.com/viewarticle/486451 [Accessed: 06/27/05].
Clinical Practice Guideline (1999). Autism/Pervasive
Development Disorders. Assessment and Interventions for Young Children Age 0-3
years. New York State Department of Health Early
Intervention Program.
Cox, H., Burns, I.
and Savage, S. (2004).
Multi-sensory environments for leisure:
promoting well-being of nursing home residents with dementia. Journal of Gerontological Nursing, Vol.30, No. 2; pp.37-45.
De, M., Hoffstetter, P., Casey, L. and
Jones, D. (2004). Snoezelen
activity: the Good Shepherd Nursing Home Experience. Journal of Nursing Care Quality,
Vol.19, No.4; pp.343-346.
Easterby-Smith,
M., Thorpe, R. and Lowe, A. (2002). Management Research: An Introduction, 2nd Ed.
London: Sage.
ERIC Development Team (1999). ED436068 1999-10-00 Autism and Autism
Spectrum Disorder (ASD). ERIC Digest #E583. ERIC Clearinghouse on Disabilities and
Gifted Education Reston VA.
Hutchison,
R. (1994). Sensory environments. Chesterfield: Whittington Hall
Hospital.
Grandin, T. (1995). Thinking
in pictures: and other reports from my life with autism. New York : Doubleday.
KIinkead, G. (2003). A
room comes alive with colors and sound. New York Times, December 23; pg.F.7.
Kwok, H.W.M., To, Y.F. and Sung, H.F.
(2003). The application of a multisensory Snoezelen room for
people with learning disabilities—Hong Kong
experience. Hong
Kong Medical Journal; Vol.9, No.1; pp.122-6
Leng, T.R., Woodward, M.J., Strokes,
M.J., Swan, A.V., Wareing, L.A.
and Baker, R. (2003).
Effects of multisensory stimulation in
people with Huntington’s disease: a randomized controlled pilot study. Clinical
Rehabilitation, Vol.1 7, No.1; pp.30–41
Mcormack,
B. (2003). A
mother’s story. The Exceptional
Parent, Vol.33, No.10; pg. 38
National Institute of Neurological
Disorders and Strokes (1999).
In K.L. Pope. Autism: an overview and
investigation into the Lovaas Intervention Technique. Master Research Paper, Chicago University.
Nicodemus,
T. (1999). Snoezelen:
a magical place at camp. The Camping Magazine,
Vol.72, No. 5;
pp.18-19.
Pagliano, P.J. (1999). Multisensory environments. London: David Fulton Publishers.
Pope,
K.L. (1999). Autism: an overview and investigation into
the Lovaas Intervention Technique. Master
Research Paper, Chicago
University.
Robson,
C. (2002). Real World Research, 2nd Ed.
Oxford: Blackwell.
Saunders,
M., Lewis, P. and Thornhill, A. (2003). Research Methods for
Business Students, 3rd
Ed. London: Prentice Hall Financial Times.
Stadele, K.D. and Malaney, L.A. (2001). The effects of a multisensory environment on negative behavior and
functional performance on individuals with autism. University of Wisconsin-La
Crosse Journal of Undergraduate Research, Vol.4, No.1; pp.211-218.
Taverna,
K. (1998). The
analysis of autism facilitates Neuroanatomical Investigations. First Web Reports.
Tustin,
F. (1995). Autism and childhood psychosis. London:
Karnac Books
World Health Organisation (1993). The
ICD-10 classification of mental and behavioural disorders: Clinical
descriptions and diagnostic guidelines. Geneva: World Health Organisation.
Zinn,
L. (2000). A
family affair. Nursing Homes,
Vol.49, No.10; pp. 36-43.
