509838

research-article2013
FOAXXX10.1177/1088357613509838Focus on Autism and Other Developmental DisabilitiesMurdock et al.

Article
Focus on Autism and Other

The Effect of a Platform Swing on the

Developmental Disabilities
2014, Vol. 29(1) 50­–61
© Hammill Institute on Disabilities 2013
Independent Work Behaviors of Children Reprints and permissions:
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With Autism Spectrum Disorders DOI: 10.1177/1088357613509838

focus.sagepub.com

Linda C. Murdock, PhD, CCC-SLP1, John A. Dantzler, PhD2,

Anne N. Walker, MS, OTR/L3, and L. Becca Wood, MS, OTR/L3

Abstract
A randomized pretest–posttest control group design was utilized to measure the effects of a platform swing on independent
work behaviors of 30 children with Autism Spectrum Disorders (ASD). Participants engaged in two 5-min intervals of
independent work. Between the intervals, participants in the treatment group received 5 min of vestibular stimulation using
a platform swing and children in the control group watched a video. No significant differences were evidenced between the
treatment and control groups on engagement, on-task behavior, stereotyped/repetitive behavior, or out-of-seat behavior.
Changes noted for individual participants could not be linked to age, diagnosis, or sensory profile patterns.

Keywords
autism spectrum disorders, integration, sensory, self-stimulatory (STIMS) behavior, intervention, behavior

Autism Spectrum Disorders (ASD) are characterized by integrate sensory information (Baranek, 2002). Sensory
core deficits in communication, social relatedness, and ste- Interventions have been used to target areas such as self-
reotyped behaviors (American Psychiatric Association, stimulatory and self-injurious behaviors (Smith, Press,
1994). Deficits in sensory processing are often linked to Koenig, & Kinnealey, 2005), engagement and undesired
these stereotyped behaviors. Studies have documented the behaviors (Watling & Dietz, 2007), and a reduction in over-
presence of sensory deficits in as many as 95% of children all levels of sensory impairment (Miller, Coll, & Schoen,
with ASD (Tomchek & Dunn, 2007). Arguments have been 2007; Schaaf & Nightlinger, 2007). Despite over 30 years
made that sensory impairments are highly correlated with of research, findings have been variable, leaving little con-
daily living skills (Jasmin et al., 2009) and social impair- sensus and significant controversy as to the efficacy of SI
ment (Hilton et al., 2010) and may impact joint attention, therapy (Parham et al., 2007). Research in SI for children
communication, and social interactivity (Talay-Ongan & with Autism has emerged in two distinct lines. One catego-
Wood, 2000). Sensory deficits, also referred to as sensory rization of SI focuses on the specific and individual inter-
modulation disorders (Miller, Anzalone, Lane, Cermak, & ventions such as brushing, weighted vests, and vestibular
Osten, 2007), are conceptualized into three categories: sen- stimulation designed to reduce symptoms or behaviors
sory overresponsivity, sensory underresponsivity, and sen- associated with sensory dysfunction (see Lang et al., 2012).
sory seeking/craving (Ben-Sasson et al., 2009; Miller, The other suggests these isolated treatments do not ade-
Anzalone, et al., 2007). Recent research has linked sensory quately represent the theoretical construct of Ayres SI
responsiveness to lower levels of participation and compe- (Schaaf & Davies, 2010), which is more child-directed and
tence in school and leisure activities, particularly for indi- utilizes multiple forms of sensory input. As of yet, neither
viduals exhibiting sensory overresponsivity (Reynolds, line of research has garnered sufficient evidentiary support.
Bendixen, Lawrence, & Lane, 2011). Although the sensory
deficits in ASD are well established, much debate exists as 1
University of Montevallo, AL, USA
to the efficacy of interventions targeting these deficits. 2
University of Alabama, Tuscaloosa, USA
Sensory Integration (SI) therapy (Ayres, 1991) is based 3
Mitchell’s Place, Birmingham, AL, USA
on the principle that interference with normal neurological
Corresponding Author:
processing of information impacts purposeful behavior. Linda C. Murdock, Associate Professor, Department of CSD, University
Theoretically, controlled therapeutic sensory input would of Montevallo, Station 6720, Montevallo, AL 35115, USA.
increase the nervous system’s ability to modulate and Email: murdocklc@montevallo.edu

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Murdock et al. 51
Within the field of ASD, SI therapy continues to be rated as
an unestablished treatment by the National Autism Center
(2009).
A recent review of SI interventions based on the Ayres
approach (May-Benson & Koomar, 2010) found some evi-
dence of improvements in areas such as motor skills, atten-
tion, and behavior regulation. Authors found methodological
problems with all 27 reviewed studies, described as having
a “moderate degree of scientific rigor” (p. 409) overall.
Major limitations included a lack of control for participant
maturation, dosing of intervention, problematic outcome
measures, failure to demonstrate fidelity, and lack of statis-
tical effect sizes. Although intervention effects were vari-
able, outcomes from SI were generally superior to controls
or alternative treatments including academic tutoring or
motor-based interventions. The most recent systematic
review in the area of SI for children with ASD (Lang et al.,
2012) analyzed 25 studies utilizing varying interventions
within the sensory domain including weighted vests, swing-
ing or rocking, brushing, alternative seating, and a sensory
diet. Results showed three studies with positive findings, all
employing multiple sensory interventions. However, the
level of evidence for these three studies was classified as
suggestive rather than conclusive. Eight studies were classi-
fied as having mixed results and 14 as having no benefit.
Five studies were described as having a conclusive level of
evidence; all focused on weighted vests and demonstrated
no evidence of a treatment effect.
Because of inconclusive findings and the controversy
surrounding SI, several recent articles have called for
improvements in methodology and increased fidelity in
efficacy studies (Dawson & Watling, 2000; Miller, Coll, et
al., 2007; Parham et al., 2007) as well as the need to pub-
lish studies with negative findings (Miller, Coll, et al.,
2007). Specifically, continued research in this area should
include randomized control group designs, objective and
reliable outcome measures, documentation of fidelity, and
improved descriptions of the intervention procedures.
New studies following these guidelines are beginning to
emerge. One such investigation utilized a randomized
controlled trial to measure the impact of SI on social
responsiveness, functional motor skills, sensory process-
ing, and social-emotional processing (Pfeiffer, Koenig,
Kinnealey, Sheppard, & Henderson, 2011). Fidelity mea-
sures were provided and duration of intervention was con-
trolled. However, results were still limited, with significant
differences evidenced with goal attainment scaling only,
but not with the measurements from standardized tests and
rating scales.
One complicating variable was the overreliance on par-
ent report and rating scales as measures of treatment effect.
Dawson and Watling (2000) found only four studies of SI
with children with ASD where objective measures were uti-
lized for assessing behavioral changes. Two studies
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employed an AB design: one was a case study and the
remaining group study reported limited effects. Dawson
and Watling reported an inability to draw conclusions
regarding efficacy based on this limited data pool. Two
recent studies utilizing objective behavioral measures and
improved control over the independent variable were iden-
tified. Van Rie and Heflin (2009) utilized an alternating
treatment design to measure the differential effectiveness of
two sensory interventions (swinging and bouncing) and a
control activity on the correct responding of four children
with Autism. Data indicated sensory intervention was effec-
tive for two of the participants. Similarly, Watling and Dietz
(2007) utilized principles of Ayres SI (1991) to target
engagement and undesired behaviors during tabletop activi-
ties. With a multiple baseline design, no objective behav-
ioral changes were demonstrated. These investigations
support the conclusions that results of sensory interventions
can be mixed with individuals responding differently to
sensory input.
Despite the lack of clear efficacy data, sensory interven-
tions continue to be popular and widely utilized autism
treatments (Heflin & Alaimo, 2007). A recent survey indi-
cated that physiological treatments, including SI, were the
second most commonly utilized intervention by parents of
children with ASD (Bowker, D’Angelo, Hicks, & Wells,
2011). Moreover, in a recent survey of Georgia teachers of
children with ASD, 92% reported using SI (Hess, Morrier,
Heflin, & Ivey, 2008). According to respondents, SI was the
only strategy utilized in each grade level from preschool
through high school.
Although the principles of SI have been well described
over the years, the practice is often misrepresented (Schaaf
& Davies, 2010). In practice, individual components are
often utilized in an across-the-board approach with students
with disabilities. For example, students are often sent to a
sensory room where they can engage in activities thought to
provide sensory feedback including trampolines, swings,
and therapy balls. These rooms are often supervised by
paraprofessionals and not tied to individualized sensory
plans. Schools, clinics, and hospitals have established sen-
sory rooms often at great cost. One example, a sensory lab
funded by a $40,000 grant was placed in a Michigan ele-
mentary school to benefit special needs students (“Sensory
Rooms Help Students Learn,” 2011). The principal stated,
“Research is strong that there is a direct connection both in
the short-term attention span and in the long-term brain
development” (“Sensory Rooms Help Students Learn,”
2011, p. 7). Special needs students were described as using
the lab three times per week for 25-min sessions. Staff
described the lab as an instant success, reporting greater
than anticipated gains in on-task behavior and student learn-
ing. Clearly, the expectation exists that students with dis-
abilities can participate in activities in the sensory room at
pre-scheduled times and return to their classrooms
52 Focus on Autism and Other Developmental Disabilities 29(1)
exhibiting immediate, short-term improvements in behavior
and attention. One study on the use of a sensory room was
identified in the current search. Fazlioglu and Baran (2008)
investigated the use of a sensory diet for 30 children with
autism. The students participated in twenty-four, 45-min
sessions in a sensory room. Materials in the room included
items such as brushes, massage instruments, balls, and a
trampoline. Participants in the treatment group exhibited a
statistically significant reduction in sensory problems as
compared to the control group with data based on scores
from a rating scale developed for the study. No behavioral
measures were utilized.
Limited research is also available on the use of the equip-
ment commonly found in sensory rooms. Two studies were
identified on the use of therapy balls to increase engage-
ment and in-seat behavior. Schilling and Schwartz (2004)
utilized a single subject withdrawal design across four par-
ticipants in a classroom setting. All four participants dem-
onstrated improvements in engagement and in-seat behavior
when sitting on a therapy ball rather than a desk chair. In a
follow-up study with similar methodology (Bagatell,
Mirigliani, Patterson, Reyes, & Test, 2010), participants
exhibited mixed results for in-seat behavior and no positive
changes in engagement. One additional study was identi-
fied on the use of brushing to reduce stereotypical behaviors
in one child with autism; however, no effect was evidenced
with the intervention (Davis, Durand, & Chan, 2011). A
larger body of work has been completed on the use of
weighted vests as an intervention to decrease inattentive-
ness, hyperactivity, clumsiness, and presence of stereotypic
behaviors. A recent review identified seven studies, four of
which reported non-significant intervention results, leading
to the reviewer conclusion that weighted vests are “ineffec-
tive” (Stephenson & Carter, 2009, p. 105). Three studies
published after this review yielded similar negative and
mixed findings for weighted vests (Hodgetts, Magill-Evans,
& Misiaszek, 2011a, 2011b; Reichow, Barton, Good, &
Wolery, 2009).
A smaller, less defined body of evidence exists on the
use of platform swings. One study was identified with the
exclusive use of a platform swing (Ray, King, & Grandin,
1988). This study included one participant and lacked an
experimental design. Authors reported an increase in vocal-
izations during vestibular stimulation; however, vocaliza-
tions after treatment were lower than during pretest
measurement. Reilly, Nelson, and Bundy (1983) utilized
swinging and bouncing to target variety and length of utter-
ances. Negative findings were reported as the control activ-
ity resulted in greater changes in the target behaviors. Only
the previously mentioned Van Rie and Heflin study (2009)
documented positive treatment effects with slow, linear
swinging. Positive effects in academic responding were
noted for two of the three participants following 5-min of
intervention.
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With increasing public demand for sensory interventions
(Green et al., 2006; Schaaf & Davies, 2010) and schools
and hospitals continuing to build sensory rooms, research
into the use of sensory stimulation equipment (e.g., trampo-
lines, platform swings, and weighted vests) to deliver
immediate changes in attention and on-task behaviors is
needed. The purpose of the current study was to investigate
the immediate behavioral impact of one sensory treatment,
vestibular stimulation delivered via platform swing, on
engagement, on-task behavior, out-of-seat behavior, and
stereotyped/repetitive behavior during independent work
tasks for young children with ASD.
Method
Setting and Participants
The study took place at a private, comprehensive treatment
center for individuals with ASD. The center housed four
inclusive preschool classrooms as well as a behavioral ther-
apy program and outpatient services in occupational ther-
apy, speech-language pathology, psychology, and
psychiatry. All data were collected in the private treatment
rooms of the on-staff occupational therapists.
Individuals meeting study parameters were identified
from the client database at the center. Individuals were
required to have a diagnosis of autism or pervasive develop-
ment disorder not otherwise specified (PDD-NOS), and a
score within the range of Probable or Definite Difference in
at least one area of sensory processing and modulation on
the sensory profile (Dunn, 1999). Approval for the study
was granted by the University Human and Animal Subjects
Review Board and the executive director of the treatment
facility. Parents and children provided informed consent. At
the conclusion of the study, parents were provided with
results and offered the opportunity to complete a social
validity survey.
The sample consisted of 30 randomly assigned children
with ASD. A majority of the sample comprised males (n =
26, 86.7%) with 4 female participants (13.3%). Twenty-two
(73.3%) of the children in the sample were diagnosed with
autism with 8 (26.7%) diagnosed with PDD-NOS.
Diagnostic records indicated 20 participants were diag-
nosed by clinical psychologists utilizing the Autism
Diagnostic Observation Schedule (Lord, Rutter, DiLavore,
& Risi, 2001), 1 with the Autism Diagnostic Interview–
Revised (ADI-R; Le Couteur, Lord, & Rutter, 2003), and 9
were diagnosed by clinical psychologists utilizing the
Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (American Psychiatric Association, 1994).
The median age was 52 months with a range of 30 to 77
months. Participants were blindly assigned to a treatment or
control group, by a statistician who was not involved with
the implementation of the study, using a random numbers
Murdock et al. 53
Table 1.  Sample Demographics.
Gender
Group M (%) F (%)
Treatment 12 (80.0) 3 (20.0)
Control 14 (93.3) 1 (6.7)
  χ2(1) = 1.15, p = .283
Note. PDD = pervasive development disorder.
table. There was no statistically significant difference
between the treatment and control group in terms of gender,
χ2(1) = 1.15, p = .283; diagnosis, χ2(1) = 0.00, p = 1.0; or
age, t(28) = 0.101, p = .920 (Table 1).
Procedure
A randomized pretest–posttest control group design was
utilized. Both groups participated in one data collection ses-
sion with a licensed occupational therapist. During this ses-
sion, participants were given two 5-min opportunities to
engage in independent tabletop activities which served as
the data collection periods. In between these intervals, the
children in the control group received a 5-min non-sensory
break during which they watched a movie. The children in
the treatment group received a sensory break.
Based on the methodological problems faced in previous
studies due to an inability to adequately define the indepen-
dent variable (Baranek, 2002), the current study utilized
one sensory technique. The vestibular stimulation provided
here included swinging in a slow, linear motion on a plat-
form swing. The vestibular system is thought to be the uni-
fying system of the senses. Gentle, linear swinging provides
a calming effect on the vestibular system, helping to acti-
vate the entire nervous system to work more effectively and
consistently (Kranowitz, 1998). A literature search revealed
limited information regarding recommended duration of
treatment intervals. However, the clearest precedent was
established with Van Rie and Heflin (2009), who docu-
mented positive treatments effects after 5 min of slow, lin-
ear swinging. Prior to beginning the study, the second and
third authors, both occupational therapists, piloted a range
of durations utilizing children not participating in this study.
Five minutes was concluded to be an amount of time suffi-
cient to calm a child but not so lengthy to induce boredom
or negative behaviors. When longer times were utilized,
some children attempted to climb off the swing or asked to
stop swinging.
At the beginning of each data collection interval, the
therapist explained to the participants that they would be
sitting at the table for 5 min and that they could choose puz-
zles, stringing beads, or coloring. In addition, if they wanted
to play with something else before the timer sounded, they
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Diagnosis Age (months)
Aut (%) PDD (%) M (SE) SD
12 (80.0) 3 (20.0) 49.9 (3.5) 13.5
11 (73.3) 4 (26.7) 53.1 (2.4) 9.2
χ2(1) = 1.86, p = .666 t(28) = 0.76, p = .454
could choose one of the other activities. In order to allow
the therapists to manage behavior yet still control for
prompting, directions for the independent work were briefly
restated up to two more times during the first interval, for
example, “I want you to put the beads on the string.” The
therapist recorded these prompts and utilized the same
number of prompts during the post-test interval for each
participant. If a participant left the table, the therapists were
instructed to assist them in returning.
Tabletop activities were representative of items com-
monly utilized in early childhood classrooms. Participants
had a selection of three activities utilizing skills in separate
areas targeting visual motor integration, visual perceptual,
and bilateral coordination skills: coloring, puzzles, and
beading and lacing, respectively. The same three activities
were available during both data collection intervals. The
child was free to choose the same or different items for both
intervals. Prior to beginning the study, the participants were
exposed to the concept of independent work in the presence
of a video camera in order to familiarize the participants
with the study procedure.
Measurement
Data were video recorded with a free-standing camera on a
tripod for later review by coders. Partial interval time sam-
pling was utilized to code child behaviors in 10-s intervals.
Four behaviors were coded in every interval. Based on
behavioral definitions, observers marked the intervals as
on-task/off-task, engaged/disengaged, and/or exhibiting
stereotyped/repetitive behaviors/no stereotyped/repetitive
behaviors. In addition, the code for out of seat was marked
if the child stood up for more than 1 s or left the table at any
point in the interval. On-task was defined as listening to and
following directions or interacting with the materials in the
manner intended for the completion of the work task.
Engaged was coded if the participant was giving his or her
attention to a task by actively participating in the given
activity or a purposeful activity of his or her making. This
included listening and talking appropriately and purpose-
fully with the therapist. It was possible for a participant to
be actively engaged in a productive activity that did not lead
to completion of the intended work task. For example, if the
54 Focus on Autism and Other Developmental Disabilities 29(1)
child stopped stringing beads to tell a story to the adult, the
child was coded as engaged but not on-task. Stereotyped/
repetitive behaviors included obvious and marked engage-
ment in behaviors classically associated with ASD. These
behaviors included rocking, bouncing, spinning, flapping
hands or arms, rubbing things, mouthing items, squeezing
or smelling items, ruminating, licking items, banging
objects, repetitive nonfunctional vocalizations, covering
eyes or ears, filtering light, rapidly blinking eyes, grinding
teeth, chewing on items, and biting self (Mays, Beal-
Alvarez, & Jolivette, 2011; Powers, Thibadeau, & Rose,
1992; Smith et al., 2005; Young, Simpson, Smith Myles, &
Kamps, 1997). This category was marked if the behavior
lasted for at least 2 s.
Coders could also mark out of view if the participant
could not be seen on camera for 5 or more seconds of the
interval. The categories were not mutually exclusive with
the exception of out of view. At the end of each 10-s inter-
val, the coder marked the behavior on the record form cre-
ated for this study pausing the video if necessary. In order to
ensure each participant would have thirty, 10-s intervals, the
data timer was set for 5 min and 20 s allowing two extra
intervals that would be available for coding if a participant
were to go out of view, causing an interval to be excluded.
All participants had 30 data intervals available for coding.
Reliability and Fidelity
Prior to initiating the study, coders passed a written test on
the behavioral definitions with 100% accuracy and inde-
pendently coded sample videos until interrater reliability of
greater than 90% was achieved for each of the four target
behaviors. During the study, the primary coder was blind to
the group assignment of the participants and was provided
video footage of the data intervals excluding the vestibular
stimulation or control interval. Interrater reliability was
conducted on 25% of the data by dividing the total number
of agreements by the number of agreements plus disagree-
ments and multiplying by 100. Overall interrater reliability
was calculated at 95%: on-task (92%), engaged (94%), ste-
reotyped/repetitive behaviors (97%), and out of seat (97%).
Fidelity checks were performed on 20% of the sessions to
evaluate whether the established procedures for vestibular
stimulation were followed and that only the allowed behav-
ioral prompts were provided during data collection.
Observers were provided a nine-item study procedure pro-
tocol and asked to note any deviations from these proce-
dures. No deviations from the protocol were identified.
Results
Individual growth curve (IGC) modeling was conducted to
model individual change over time for children in the con-
trol and experimental groups. Multilevel modeling for
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change (Singer & Willett, 2003) allows for the assessment
of interindividual and intraindividual changes in growth
parameters with the ability to add predictors in higher level
models to assess group differences and differences in trajec-
tory due to intervention. In the present study, the examina-
tion of changes in behavior before and after intervention
between control and experimental groups is of primary
interest. Multilevel modeling allows for the inspection of
differences between and within individuals in initial status
and over time.
The following research questions for each of the four
behaviors were explored: (1) Is there evidence of behav-
ioral differences between control and experimental groups
over time and (2) Is there evidence of differences in behav-
ioral trajectories after intervention for the experimental
group? To examine these questions, parameters to a series
of four models were estimated with the linear mixed model-
ing procedure in SPSS version 20. Maximum likelihood
estimation with an unstructured error-covariance structure
was used to estimate parameter values in all models. The
first model (Model A) estimates parameters for an uncondi-
tional means model in which only the fixed effect of the
initial behavior is modeled for all participants. This baseline
model examines individual variation in behaviors without
including time as a parameter (Shek & Ma, 2011). The only
parameter estimated is for the intercept (Y00) and takes the
form:
Yij = Y00 + ε ij .
The second model (Model B) is considered to be an
unconditional growth model in which individual variation
in growth trajectories are examined. Parameters for the
intercept (Y00) and trajectory (Y10) are estimated for indi-
viduals in the population. Model B takes the form
Yij = Y00 + Y10 ( time ) + ε ij .
The third model (Model C) is a composite model with
the initial status parameter (Y00), initial group (control or
experimental) parameter (Y01), trajectory parameter (Y10),
and group trajectory parameter (Y11). This model assesses
differences in outcome change over time by group. The
composite model takes the form
Yij = π 0i + π 1i ( time ) + ε ij ,
where π 0i = Y00 + Y01 ( group ) and π 1i =Y10 + Y11 ( group ) .
The final model estimated and assessed (Model D) is
designed to examine rate over time by group and if that tra-
jectory by group changes after the point of intervention.
Murdock et al. 55

Table 2.  Model Parameters for Four Models Predicting Engaged Behavior Change Over Time.

Parameter Type Parameter Model A Model B Model C Model D

Fixed effects
 Intercept γ00 4.35*** (0.271) 4.69*** (0.303) 4.86*** (0.426) 5.03*** (0.449)
Initial status, π0i
 Group γ01 −0.34 (0.602) −0.48 (0.636)
 Order γ02 0.27 (0.794)
  Group × Order γ03 −0.693 (1.122)
Rate of change, π1i
 Intercept γ10 −0.08 (0.043) −0.02 (0.060) −0.11 (.093)
 Group γ11 −0.10 (0.084) −0.03 (0.132)
 Order γ21 −0.01 (0.085)
  Group × Order γ31 0.06 (0.121)
Variance components
Level 1
 Within-person σ2e 2.03*** (0.181) 1.69*** (0.159) 1.69*** (0.159) 1.67*** (0.158)
Level 2
  In initial status σ20 1.85** (0.550) 1.98** (0.688) 1.96** (0.681) 1.96** (0.681)
  In rate of change σ12 −0.08 (0.077) −0.09 (0.076) −0.09 (0.076)
 Covariance σ01 0.03* (0.014) 0.03* (0.013) 0.03* (0.014)
Pseudo R2 statistics and goodness of fit
2
Ry,y ′ .109 .242 .249
2
Rε .167 .167 .177
R02 .010 .010
R12 −.013 −.013
  −2 log likelihood 1,057.9 1,036.4*** 1,033.2 1,031.0

Note. Model A = unconditional means model; Model B = unconditional growth model; Model C = Level 2 predictor group; and Model D = Level 2
predictor order and group to assess change after intervention.
*p < .05. **p < .01. ***p < .001.

Model D examines the possibility of a change in slope after
intervention by modeling a discontinuous change starting at
the fifth wave. The composite model is the same as Model
D above, with the addition of parameters for pre- or post-
intervention order by individual (Y02), order by group inter-
action by individual (Y03), rate of change by order (Y21), and
rate of change interaction by group and order (Y21):
Yij = π 0i + π 1i ( time ) + ε ij ,
where
π 0i = Y00 + Y01 ( group ) + Y02 ( order ) + Y03 ( group × order )
and π 1i = Y10 + Y11 ( group ) + Y21 ( order ) + Y31 ( group × order ) .
Treatment of the Data
Data were collected at 60 intervals of 10 s per interval.
After the 30th interval, intervention occurred for the
experimental group. At each interval, an observer indi-
cated if the behavior of interest was present or absent.
Data were then collapsed into 10 intervals consisting of a
total behaviors observed during a minute of observation.
Intervals one through five were pre-intervention baseline
observations and intervals 6 through 10 were post inter-
vention observations.
Analysis
Tables 2 through 5 detail the parameters for the four models
by behavior. The intercept only model (Model A) for each
of the four behaviors indicated that the parameter estimate
for the intercept in engaged (Y00 = 4.35, p < .001), in-seat
(Y00 = 5.05, p < .001), on-task (Y00 = 3.76, p < .001), and
stereotyped/repetitive (Y00 = 0.66, p < .01) behaviors were
all statistically significant. These results simply suggest that
the initial behavior rates observed at the first wave were
variable across participants. Model B parameters indicate a
significant rate of change for participants in in-seat behav-
iors (Y10 = −0.15, p < .01) and on-task behaviors (Y10 =
−0.14, p < .01). The negative parameters suggest a slight
decrease in number of incidences of the behavior over time
from the initial wave. A pseudo-R2 statistic examining the
change in within-person residual variance from the uncon-
ditional means model (Model A) to the unconditional

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56 Focus on Autism and Other Developmental Disabilities 29(1)

Table 3.  Model Parameters for Four Models Predicting In-Seat Behavior Change Over Time.

Parameter Type Parameter Model A Model B Model C Model D

Fixed effects
 Intercept γ00 5.05*** (0.175) 5.74*** (0.143) 5.78*** (0.202) 5.77*** (0.242)
Initial status, π0i
 Group γ01 −0.07 (0.285) −0.10 (0.342)
 Order γ02 0.26 (0.737)
  Group × Order γ03 −0.38 (1.043)
Rate of Change, π1i
 Intercept γ10 −0.15** (0.053) −0.16* (0.074) −0.16 (0.100)
 Group γ11 −0.01 (0.105) −0.03 (0.141)
 Order γ21 −0.03 (0.079)
  Group × Order γ31 0.04 (0.112)
Variance components
Level 1
 Within-person σ2e 2.21*** (0.197) 1.44*** (0.137) 1.44*** (0.137) 1.44*** (0.136)
Level 2
  In initial status σ20 0.63** (0.229) 0.07 (0.160) 0.07 (0.159) 0.07 (0.159)
  In rate of change σ12 −0.06 (0.049) −0.06 (0.049) −0.06 (0.049)
 Covariance σ01 0.06** (0.021) 0.06** (0.021) 0.06** (0.021)
Pseudo R2 statistics and goodness of fit
2
Ry,y ′ .263 .263 .263
2
Rε .348 .348 .348
R02 .000 .000
R12 .000 .000
  −2 log likelihood 1,054.7 960.3*** 960.3 960.0

Note. Model A = Unconditional means model, Model B = unconditional growth model, Model C = level 2 predictor group, and Model D = level 2
predictor order and group to assess change after intervention.
*p < .05. **p < .01. ***p < .001.

growth model (Model B) was calculated to observe the
effect of the addition of time in Model B using the follow-
ing formula from Singer and Willett (2003):
 unconditional 
2  unconditional 
σ s2   −σs   introduction of vestibular stimulation for the experimental
Pseudo Rs2 =  means model   growth model 
σ s2 ( unconditional means model )
For in-seat behavior, 34.8% of variation in the outcome
variable can be explained by time with 24.9% of variation
in on-task behavior being explained by time. There was no
significant rate of change effect in Model B for engaged
(Y10 = −0.08, p > .05) or self-stimulation behaviors. (Y10 =
−0.02, p > .05). The non-significant Model B time parame-
ters can be interpreted as a flat trajectory for all individuals
over each of the 10 waves for these two outcome variables.
The effect of group (control [0] or experimental [1]) over
time for each of the four behaviors was examined through
Model C. Model C estimates parameters related to differ-
ences between groups over time, and Model D further esti-
mates differences between groups over time and at the point
of intervention. None of the Model C and Model D analysis
for the four behaviors under study indicated that the time by
group, time by order, or time by order by group interaction
parameters were statistically significant (Tables 2–4). These
results suggest that group (control or experimental) had no
effect, nor did order (pre [0] or post intervention [1]). The
group did not have a positive or negative effect on behav-
iors after intervention in this study.
Because much of the evidence for the use of SI in this
population reports mixed results (e.g., Lang et al., 2012)
where some participants derive benefit and others do not, it
is prudent to examine outcomes of individual participants.
In examining individual performance, participants who
seemed to demonstrate the greatest positive change (a 20%
improvement in at least one behavior) from pre-test to post-
test were identified from the data. The intent was to analyze
the factors that may have allowed these participants to ben-
efit from the intervention. Although five participants met
this criterion, only three of these had been members of the
treatment group, the other two seemingly demonstrating as
much derived benefit from the non-sensory break.
Further analysis revealed 13 participants who evidenced
at least a 10% improvement in one or more of the target

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Murdock et al. 57

Table 4.  Model Parameters for Four Models Predicting On-Task Behavior Change Over Time.

Parameter Type Parameter Model A Model B Model C Model D

Fixed effects
 Intercept γ00 3.76*** (0.298) 4.41*** (0.299) 4.64*** (0.418) 4.63*** (0.446)
Initial status, π0i
 Group γ01 −0.44 (0.592) −0.30 (0.631)
 Order γ02 −0.10 (0.854)
  Group × Order γ03 −0.54 (1.208)
Rate of Change, π1i
 Intercept γ10 −0.14** (0.051) −0.08 (0.071) −0.08 (.104)
 Group γ11 −0.13 (0.100) −0.18 (0.147)
 Order γ21 −0.01 (0.092)
  Group × Order γ31 0.08 (0.130)
Variance components
Level 1
 Within-person σ2e 2.61*** (0.232) 1.96*** (0.185) 1.96*** (0.185) 1.94*** (0.182)
Level 2
  In initial status σ20 2.22** (0.664) 1.82** (0.671) 1.77** (0.658) 1.78** (0.658)
  In rate of change σ12 −0.06 (0.088) −0.08 (0.859) −0.08 (0.859)
 Covariance σ01 0.05** (0.020) 0.05** (0.019) 0.05** (0.019)
Pseudo R2 statistics and goodness of fit
2
Ry,y ′ .189 .311 .307
2
Rε .249 .249 .256
R02 .028 .022
R12 −.333 −.333
  −2 log likelihood 1,126.2 1,081.1*** 1,077.5 1,075.0

Note. Model A = unconditional means model; Model B = unconditional growth model; Model C = Level 2 predictor group; and Model D = Level 2
predictor order and group to assess change after intervention.
*p < .05. **p < .01. ***p < .001.

behaviors. Only 5 of these were included in the treatment
group. In order to identify any potential factors that may
have accounted for the improvements noted within this
group of 5 participants, age, diagnosis, and sensory charac-
teristics were examined. These 5 participants had an aver-
age age of 55 months, only slightly greater than the overall
participant average of 52 months and the treatment group
average of 52 months. Overall, 77% of the participants in
the study were diagnosed with autism, as was 80% of this
group of 5. Moreover, it might be expected that participants
benefiting from vestibular stimulation would evidence defi-
nite differences in vestibular processing. However, three of
the five scored within the range of typical performance, and
the other two participants scored within the range of prob-
able difference in this area.
Because sensory patterns have not been validated as a
procedure for matching an individual to a particular type of
sensory treatment, participants were not chosen based on
their overall sensory patterns. However, in post hoc analy-
sis, the sensory profiles (Dunn, 1999) of the participants
were utilized to classify the sensory patterns of the partici-
pants as sensory overresponsivity, sensory underresponsiv-
ity, and sensory seeking/craving (Ben-Sasson et al., 2009;
Miller, Anzalone, et al., 2007) in order to enhance the inter-
pretation of the findings. A participant was categorized as
sensory overresponsive if he or she scored a probable or
definite difference in the sensory sensitivity section of the
sensory profile. A participant was categorized as sensory
underresponsive if he or she scored a probable or definite
difference in the poor registration section, and categorized
as sensory seeking if he or she scored a probable or definite
difference in the sensory seeking section. Overall, 3 partici-
pants were classified as underresponsive, 4 as overrespon-
sive, 9 as seeking, and 11 demonstrated primary needs in
seeking with a secondary pattern of underresponsiveness.
Three participants did not demonstrate clear patterns for
classification into this taxonomy. When the treatment group
was examined by itself, 66% of participants classified as
seekers and 14% of those with the seeking/underresponsive
pattern demonstrated improvement. Both of the participants
without classifications improved. However, similar patterns
were identified in the control group. The patterns of the five
participants in the treatment group who demonstrated at
least 10% improvement were reviewed in an effort to
explain individual differences in performance. Two partici-
pants were characterized as sensory seeking, one was

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58 Focus on Autism and Other Developmental Disabilities 29(1)

Table 5.  Model Parameters for Four Models Predicting Stereotyped/Repetitive Behavior Change Over Time.

Parameter Type Parameter Model A Model B Model C Model D

Fixed effects
 Intercept γ00 0.66** (0.223) 0.56* (0.215) 0.11 (0.280) 0.01 (0.297)
Initial status, π0i
 Group γ01 0.90* (0.396) 0.85* (0.421)
 Order γ02 −0.32 (0.554)
  Group × Order γ03 1.11 (0.784)
Rate of Change, π1i
 Intercept γ10 0.02 (0.032) 0.03 (0.045) 0.07 (.067)
 Group γ11 −0.01 (0.063) −0.001 (0.095)
 Order γ21 0.03 (0.060)
  Group × Order γ31 −0.14 (0.084)
Variance components
Level 1
 Within-person σ2e 1.01*** (0.090) 0.85*** (0.080) 0.85*** (0.080) 0.81*** (0.077)
Level 2
  In initial status σ20 1.29** (0.372) 1.01** (0.348) 0.81** (0.294) 0.82** (0.294)
  In rate of change σ12 −0.01 (0.038) −0.01 (0.035) −0.01 (0.035)
 Covariance σ01 0.02* (0.008) 0.02* (0.008) 0.02* (0.008)
Pseudo R2 statistics and goodness of fit
2
Ry,y ′ .043 .290 .308
2
Rε .158 .158 .198
R02 .198 .188
R12 .000 .000
  −2 log likelihood 871.5 849.9*** 844.9 836.6*

Note. Model A = unconditional means model; Model B = unconditional growth model; Model C = Level 2 predictor group; and Model D = Level 2
predictor order and group to assess change after intervention.
*p < .05. **p < .01. ***p < .001.

characterized as primarily seeking with underresponsivity,
and the remaining two did not exhibit a clear pattern for
classification. Vestibular stimulation provided in a slow lin-
ear movement would be expected to have the most impact
for individuals characterized as overresponsive, which was
not evidenced here. Two participants in the treatment group
and two in the control group were characterized as overre-
sponsive. The participants in the control group were both
included among the 13 participants making the most indi-
vidual improvement, whereas the 2 overresponsive partici-
pants in the treatment group did not evidence improvement.
Although it would be difficult to draw conclusions based
upon these 2 participants, the data seem to indicate that ves-
tibular stimulation was not impactful on the overresponsive
children.
Social Validity
Social validity was measured with an informal survey cre-
ated by the authors. The survey contained five yes/no ques-
tions designed to explore the parents’ knowledge and
attitudes regarding SI and platform swings. The survey was
returned by 24 of the 30 families (80%). Sixteen percent of
responding families reported attending a conference on SI.
Twenty-one percent reported receiving information on plat-
form swings at conferences and 50% reported receiving
information on using platform swings as a treatment strat-
egy from another source other than a conference. Thirty-
three percent of responding families have considered
purchasing a platform swing for their homes. While only
4% reported incorporating a platform swing into their
child’s daily routine, an additional 13% report using other
types of swings to administer vestibular stimulation.
Discussion
Analyses revealed no significant differences in trajectories
between the treatment and the control groups before or
after intervention on any of the four behaviors: on-task,
engaged, stereotyped/repetitive, or out of seat. Results
suggest the platform swing was not an effective interven-
tion for these participants. A significant time effect with a
negative parameter for on-task and out of seat indicated
that all the participants were less on-task and more likely
to be out of their seats in the second and subsequent inter-
vals. Losing focus over time is not surprising; however,

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Murdock et al. 59
had the intervention been effective, the performance of the
treatment group after intervention should have deterio-
rated to a lesser extent than the control group over time.
This was not evidenced by the analysis.
Overall, any potential benefit derived from the interven-
tion could not be readily attributed to age, diagnosis, or
scores on the sensory profile. Although some previous stud-
ies have demonstrated mixed findings with some partici-
pants deriving clear benefit, this was not evidenced in the
current study. Although much work has been accomplished
in establishing profiles of sensory deficits, as of yet, we do
not know how to predict which children will benefit from a
given sensory treatment (Baranek, 2002). Sensory profile
scores should not be utilized as the exclusive factor in rec-
ommending a particular sensory intervention. These find-
ings underscore the consensus in the literature that sensory
treatment decisions must be evaluated on a case-by-case
basis and cannot be recommended without data to indicate
a clear and individualized benefit (Baranek, 2002).
For individuals with ASD, studies demonstrating posi-
tive effects have often evidenced problematic methodology
(Lang et al., 2012) or documented effects through parent
report instruments rather than through objective behavioral
measures (Baranek, 2002). An effort is underway in recent
research to utilize improved methodologies. However, even
with heightened controls and objective behavioral mea-
sures, effects are mixed (Pfeiffer et al., 2011; Van Rie &
Heflin, 2009; Watling & Dietz, 2007). Studies of more iso-
lated sensory-based techniques such as weighted vests and
therapy balls have utilized objective behavioral measure-
ment, but demonstrated negative or mixed results and relied
on small sample sizes (e.g. Bagatell et al., 2010; Stephenson
& Carter, 2009). The current study sought to build on this
line of research by using objective behavioral measures, a
more stringent design, and a larger sample size. Given that
in the current study no significant differences were evi-
denced between the treatment and control groups, the use of
a platform swing cannot be recommended at this time. In
addition, no pattern was identified to assist in predicting
which children were likely to benefit on an individual basis,
more research is clearly needed in the use of platform
swings as well as other equipment and procedures thought
to provide sensory feedback to individuals with ASD.
Clinical Implications
Although current research does not support the practice,
sensory breaks and platform swings continue to be com-
monly used treatments for off-task and stereotyped behav-
iors demonstrated in school and therapy settings.
Disagreement about the benefits of sensory intervention
exists within the literature; however, even proponents agree
that SI is not a one-size-fits-all treatment (Bowker et al.,
2011). Blanket assignment of a child to time spent in the
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sensory room cannot be hypothesized to result in immediate
and meaningful changes in student behaviors. Deficits in
sensory processing are manifested through behaviors.
Individuals are thought to exhibit behaviors in their quest to
find balance in their neurological processing systems.
However, these behaviors could also be the result of other
deficits or disorders and not a manifestation of a sensory
deficit (Kranowitz, 1998). For example, a child might have
difficulty sitting still in a chair, continuously standing up
and sitting down, bouncing his feet, or fidgeting with
objects. These behaviors could be due to overstimulation or
an inability to block out the sensory stimuli in the environ-
ment but could also be the result of hyperactivity, difficulty
attending to one task, boredom, or noncompliance with the
task. Findings in this study underscore the need for thera-
pists to utilize clinical judgment in conjunction with stan-
dardized and functional behavioral assessments to identify
children with sensory deficits (Mays et al., 2011). Any SI
treatment should be provided cautiously, in short-term
increments with individual improvements documented
before continuing intervention with a given client (Baranek,
2002). Social validity findings in this study support existing
data that parents are aware of SI therapies (Green et al.,
2006) and specifically the use of platform swings as compo-
nent of SI. This study demonstrates that the commonly used
platform swing as a calming strategy is not appropriate for
every child with sensory processing deficits and cannot be
assumed to provide an immediate change in behavior.
Limitations and Future Research
This study sought to investigate the effect of using a plat-
form swing during a pre-scheduled sensory break on the
immediate behavior of children with ASD. In order to con-
trol for changes in frustration levels or inattention related to
the amount of time children were engaged in independent
work before intervention was provided, all participants
received intervention after 5 min of independent work.
Although this seems a brief amount of time, the participants
in this study were not accustomed to longer periods of inde-
pendent work and began exhibiting inattentive and off-task
behavior fairly rapidly. Results may have been different had
the break been provided in response to aberrant behavior or
extreme inattention rather than at a pre-scheduled time. In
addition, one of the major criticisms of the SI literature has
been the inability to adequately define the independent vari-
able. Therefore, the independent variable of this study was
narrowly focused on the platform swing. Although a child
may utilize several pieces of equipment during a typical
visit to a sensory room, use of multiple forms of sensory
equipment in this study would have introduced a problem-
atic level of variability making it more difficult to demon-
strate cause and effect relationships. It was also necessary to
establish a consistent duration of treatment. After an
60 Focus on Autism and Other Developmental Disabilities 29(1)
extensive literature search through both scientific- and
practitioner-focused journals, no clear precedent could be
found for duration of vestibular stimulation. A limitation of
the current study is that the duration of treatment was based
on the clinical judgment of the third and fourth authors and
the findings of one study (Van Rie & Heflin, 2009). It is
possible that the dosage was insufficient to achieve a treat-
ment effect.
The study is further limited in that data were not col-
lected inside the classroom environment. Because the plat-
form swing was not located in the classroom, this would
have necessitated the participants transitioning across the
center to use the equipment, and then transitioning back to
the classroom, thus introducing an additional extraneous
variable possibly impacting behavior. Therefore, the deci-
sion was made to conduct both the work sessions and the
sensory break in the clinical setting. Future studies are
needed to investigate additional forms of sensory feedback
and the differential effects thereof. Future research is also
needed to determine the efficacy of sensory breaks of vary-
ing duration, cumulative impact, and the potential benefit of
matching sensory needs to sensory stimulus. In this study,
some participants (43%) seemed to derive an immediate
benefit from the 5-min break with or without the presence
of an intervention. Future research should examine the
comparative effects of sensory breaks to non-sensory breaks
utilizing within subject comparisons. As demonstrated in
the current study, an individual’s profile of sensory deficits
does not necessarily correlate with an SI-treatment approach
that will benefit a given child. Additional research would be
needed to understand the connection between sensory test
scores/profiles and interventions.
Acknowledgment
Authors would like to thank the children, parents, and staff of
Mitchell’s Place for participating in this research.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
research was partially supported with a research and special proj-
ects grant from the University of Montevallo.
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