Running head: EFFECTS OF SNOEZELEN ON CHILD WITH AUTISM
The Effects of a Snoezelen Environment on
A Seven-Year-Old Male with Severe Autism
Abby M. Rozen
Abstract
This study was
an exploratory study on the effects of a Snoezelen environment on a child with
severe autism. As a repeated-measures
single subject design it compared 10 behaviours across conditions of an
The Effects of a Snoezelen Environment on a
Seven-Year-Old Male With Severe Autism
A
number of studies have examined the effects a multisensory environment has on
clients with profound multiple disabilities.
The multisensory environment, commonly referred to as a Snoezelen
environment, has provided support for this leisure activity to have potential
benefits for this population. Only a
minimal amount of resarch to date has examined the potential effects of
Snoezelen on adults with autism; none have focused specifically on children
with autism (Hogg, Cavet, Lambe & Smeddle, 2001).
This
paper is an exploratory study that sets out to examine potential effects of
Snoezelen in the reduction of maladaptive features of autism, specifically
stereotypical self-stimulating behaviours (SSB). As a secondary factor this study will also
examine Snoezelen’s influence on potential adaptive behaviours.
Autism
affects 2 to 5 out of every 10,000 children, and is generally thought to be
caused by an organic defect in brain development (Field, Lasko, Mundy,
Henteleff, Kabat, Talpins et al., 1997).
Characteristics of autism include failure to develop language or other
forms of social communication, failure to develop normal relationships,
abnormal responses to at least one type of sensory stimulus, stereotypic
movements, limited attention span, excessive off-task behaviour and touch
aversion (Field et al., 1997). Thirty to
100% of these children have some sort of sensory difficulty integrating sensory
information (Dawson & Watling, 2000 as cited in Watling, Deitz & White,
2001), which is a necessary process in order for a child to interact
effectively with the world (Watling et al., 2001). If a child does not develop normally in terms
of perceptive and sensory integration this often leads to maladaptive emotional
and physical responses to stimuli in the environment (Ayres, 1979 as cited in
Watling et al., 2001). Evidence has
supported the idea that children with autism between the ages of 3 to 6 years
differed in sensory processing from same-age controls (Watling et al., 2001).
Self-stimulating
stereotypic behaviour (SSB) is a maladaptive behaviour not unique to those with
autism, yet it is common across this population. These behaviours may be a result of either
sensory overload or sensory restriction (Lovas et al., 1987, as cited in
Shapiro, Parush, Green & Roth, 1997).
SSB may provide stimulation that cannot be acquired otherwise (Carr,
1997 as cited in Shapiro et al. 1997).
Even developmentally typical children would suffer adverse effects in
sensory-deprived environments similar to the disjointed sensory perceptions of
those with autism (Burns, Cox & Plant, 2000). Messbauer (n.d.) theorizes that in addition
to SSB occurring as an attempt to self-regulate through overt behaviour to get
enough sensory input or to eliminate sensory input, it also arises to allow the
brain stem to produce biogenic amines either to excite, inhibit and the
combination thereof, the nervous system.
Reduction of SSB has yet to be accomplished through therapy in mentally
retarded children (Mason & Iwata, 1990 as cited in Shapiro et al.,
1997). However Holmes (1993) and
Reisman, (1993) have suggested that suppression of SSB can lead to dramatic
improvements in the child’s appropriate behaviour (as cited in Shapiro et al.,
1997).
Current
research has pointed towards the reduction of these maladaptive behaviours
through Snoezelen. This leisure activity
is based on the belief that through sensory and motor modalities those with
profound intellectual disabilities interact with their environment (Cunningham
et al., 1991 as cited in Lindsay, Black & Broxholme, 2001). Derived from the two Dutch words “snuffelen”,
to seek out, to explore and to sniff, and ‘doezelen”, to relax, Snoezelen is a
philosophy that believes that people with disabilities have a right to leisure
and relaxation (Thomas, 2002). Snoezelen
originated in
The
main goal of Snoezelen is to provide an enabling, non-directive approach that
fosters a sense of well being (Shapiro et al., 1997). The Snoezelen philosophy asserts that people
with intellectual disabilities interact with their environment by primarily
relying on their senses (Cunningham et al., 1991, as cited in Shapiro et al.,
1997). The Snoezelen room is presumed to
“facilitate increased awareness, environmental exploration, mental and physical
relaxation, enjoyment, social skills, choices, feelings of restoration, and
refreshment in their participants” (Cuvo, May & Post, 2001, pp 184). The Snoezelen environment establishes a
client to reach a state of relaxation that enables other sensory modalities to
be introduced, and once the optimal combination of sensory input is reached it
allows balance to be achieved and the individual can take control (Messauer,
n.d.) Benefits have been found to be
highly individualized (Quon, 1997).
Proponents believe that if the environment is non-threatening then the
child may be motivated to explore (Kielhofner, 1985; Ruskin et al., 1984, as
cited in Shapiro et al., 1997). A client
who is profoundly intellectually disabled make take much longer to explore something
to his or her satisfaction, and this timescale needs to be respected (Hulsegge
& Verheul, 1997, as cited in Hong, 1996).
According to King (1993) the Snoezelen environment can cause internal
change in the child thereby reducing SSB, producing more adaptive behaviour and
decreasing stress (as cited in Shapiro et al., 1997). Snoezelen has become internationally accepted
as a method to improve the quality of life for people with special needs
(Lindsay, Pitchaithly, Geelen, Broxholme & Ashby, 1997).
The
emphasis has been placed on the non-directive approach fostered by Snoezelen
(Haggar & Hutchinson, 1991 as cited in Hogg et al., 2001). Snoezelen is not a therapeutic activity but
rather a leisure activity (Martin, Gaffan & Williams, 1998) designed to
provide passive sensory stimulation (Chitsey, Haight & Jones, 2002). The Snoezelen philosophy asserts that leisure
is a basic human right (Egan, 1998). In
itself leisure is now widely accepted as having its own potential for
self-development and self-realization (Hogg et al., 2001). According to Egan (1998) leisure needs to be
defined in terms of participants’ interpretation of an experience, rather than
a specific activity or a period of time free from stress. The benefits are far reaching Egan continues,
and may include self-expression, physical health, companionship and the
development of social relationships, rest and relaxation, novel experiences,
and a chance to meet the expectations of others. Leisure is best defined as an affective
experience rather than a specific category of activities, and generally
includes freedom of choice and intrinsic motivation (Egan, 1998).
Little
research has been done to examine the effectiveness of Snoezelen as a
therapeutic tool (Thompson & Martin, 1994).
The founders resisted conducting formal research as they believed that
it would be forced into a more objective and product-orientated dimension (Burns
et al., 2000, Lindsay et al., 1997;). Ultimately the leisure aspect is more
important in Snoezelen than any behavioural changes (Martin, Gaffan &
Williams, 1998). Anecdotal reports of
improvement in behaviour have been the majority of research published (Lindsay
et al., 1997). On the whole different
types of behaviour have been found to occur in Snoezelen compared to daily
situations (Cook, 1995 as cited in Hong, 1996).
Much of the literature demonstrates a wide range of positive outcomes
(Hogg et al., 2001). However the lack of
methodologically sound empirical research has not prevented special educators
from employing Snoezelen environments with their students (Stephenson, 2002)
and there are currently more than two thousand Snoezelen rooms in Europe and
approximately one hundred in the USA (Chitsey et al., 2002). The general conclusion by consumers is that
Snoezelen allows control of leisure and therefore clients, especially children,
become more motivated, engaged, imaginative, ambitious and spontaneous (Quon,
1997).
The
majority of research has focused on self-injurious behaviour, SSB, relaxation,
enjoyment and facilitation of interpersonal relationships (Hogg et al.,
2001). In 1994 DeBunsen found in her
research at the
Hong’s
1996 research lead to the conclusion that when Snoezelen includes the right
stimulus for the level of the client considerable amounts of learning can occur
beyond expectation. This provides a
great sense of affirmation because the client can do something independently
that is respected by the facilitator.
Furthermore it has been found that clients prefer some stimulus to
others in the Snoezelen environment (Thompson & Martin, 1994). This results in a pleasurable alternative to
harmful self-stimulating behaviours.
Long and Haig (1992) also found that extremely handicapped people
responded well to the Snoezelen environment.
Snoezelen has also been shown to improve average group scores (n=8) on
concentration from baseline to assessments taken at midpoint and in final
sessions (Ashby, Lindsay, Pitcaithly, Broxholme & Greenlen, 1995).
Shapiro et
al., (1997) used children as subjects and found that through an increase in
adaptive behaviours and a decrease in maladaptive behaviours Snoezelen had
positive short-term effect on children with severe mental retardation. Fagny’s 2000 study focused on adults with
profound autism found a decrease in aggression, frustration and SSB in
Snoezelen, with SSB and aggressive behaviours being reduced to one quarter of that
in the classroom control. Symptoms of
anxiety also occurred far less in Snoezelen.
Fagny concluded that while there was short-term behaviour decreases
maintenance over time would be poor or non-existent without Snoezelen
interventions.
Most of the
literature has ignored the issues of generalization and maintenance, and
short-term benefits of Snoezelen tend to be very short or negative. No evidence of the maintenance of Snoezelen
effects exists. There are two possible
causes for this, first if the multisensory experience is acting on the central
nervous system or the autonomic nervous system then benefits will be limited to the specific situation. Second, learnt skills will be more
generalizeable than physiological states (Hogg et al., 2001).
Shapiro et
al. (1997) suggested that follow-ups with specific populations were needed in
order for generalization to the population.
As there is a general lack of literature focusing on the potential
benefits of Snoezelen for children and no research that focuses specifically on
autistic children this study sets forth to fill the gap. SSB is a common to those with autism and
perhaps the benefits of Snoezelen on both maladaptive behaviour and adaptive
behaviour will generalize to this particular population, with potential
short-term effects. This present study
therefore hypothesizes that:
Method
One 7-year-old male with severe autism was chosen out of convenience for this study. The subject suffers from severe global development disorder and is non-verbal, reliant on others for all dailies, but mobile. His SSB behaviours include vocalization, hand flapping, running, climbing, mouthing hand, mouthing clothing, mouthing objects and face rubbing. This child also suffers from epilepsy and pulmonary valve stenosis. He is on valproic acid (otherwise known as depakene). Consent for participation was given by his mother (Appendix A).
This study was approved by the
Bloorview MacMillan Children’s Centre Research Ethics Review Committee and
employed a repeated measures single subject design where the subject received
the same treatment for 5 consecutive weeks.
Each Saturday at
Apparatus
The
playroom condition took place in a large room that measured approximately 20 x
20 feet. There were various toys in the
room including Lego blocks, train set, books and bead and wire maze toys.
There were also windows facing a waiting room that looked out onto a
swimming pool.
The
Snoezelen room was a brightly colored, dimly lit 12 x 10 foot room. The room had the following apparatus: bean bag chunkie chairs, bubble tube, bubble
wall panel, Catherine wheel, evening breeze, fire optic light spray,
interactive floor carpet, magiglow board, milk way carpet panel, mirror ball,
mirrored line light panel, musical hopscotch, solar effects projector with
“deep” which features underwater images and “shapeland” with bright abstract
shapes, sparkle net fabric, stereo and speakers for music and a vibrating
mattress pad. For a more detailed
description see Appendix B.
All
30-minute sessions were filmed to be rated by 3 trained, semi-blind raters at a
later date. Raters were unaware as to
which sessions in the playroom were pretest and posttest. A random number assigned by a computer
program labeled each session, and these numbers were kept in envelopes and
opened at the time of the filming of that particular session. The same day and time was chosen for 5 weeks
in order to control for any differences that occur across the time of day or
across the week. On the first Saturday
the subject arrived 30 minutes early in order to become habituated to the
facilitator, a trained Snoezelen facilitator and the coordinator of the program
at Bloorview MacMillan.
The
facilitator engaged contact with the subject across both conditions, being
sensitive to the subject’s interests.
During the playroom condition a compulsory 30 minutes was spent in the
environment, however in the Snoezelen room the subject could dictate how long
he preferred to stay in the room as per the Snoezelen philosophy. If the subject attempted during a Snoezelen
session to leave the room (indicated by attempting to open the door) the
facilitator attempted to reengage the subject. If he continued to express a
desire to end the session the facilitator would allow him to do so.
The
sessions were rated across ten variables that fell under maladaptive or
adaptive behaviours. Maladaptive
behaviours included vocalization, flapping, running or climbing, mouthing hand
or object, face rubbing, attempting to leave room and ignoring the facilitator
when she attempted to initiate contact.
Adaptive behaviours included laughter, focusing attention on an activity
for 3 minutes or over and initiating contact.
Snoezelen sessions were further rated across perceived enjoyment of the
session, behaviour and time spent in room (see Appendix C for exact coding
sheet). Statistical tests involved
repeated measures ANOVA and descriptive statistics.
In general stereotypic behaviour is defined as the repetition of meaningless gestures or movements (Marshall & Firestone, 1999). For the purpose of this research this subject’s stereotypic self-stimulating behaviour (SSB) is defined as flapping his hands, running, climbing, mouthing hand or object and face rubbing.
The filmed sessions were later rated by 3 raters, the primary research (rater 1), a rater that was unfamiliar with the subject (rater 2) and a rater who worked on the subject’s applied behaviour analysis team (rater 3). Rater 1 rated all 15 sessions, Rater 2 rated 53% and Rater 3 rated the remaining 47%. Neither of the raters were aware of the hypotheses of the experiment, nor did they know which session they were coding unless it was in the Snoezelen condition.
Behaviour |
Pre-test |
Test |
Post-test |
Vocalization |
.97 |
.95 |
.98 |
Laughter |
.94 |
1 |
.88 |
Flapping |
.75 |
.61 |
.99 |
Face Rubbing |
.87 |
1 |
1 |
Mouthing |
.91 |
1 |
.97 |
Focus on activity for 3+ min |
.97 |
1 |
1 |
Running & Climbing |
.99 |
1 |
.96 |
Attempt to leave |
1 |
.98 |
.99 |
Initiates contact |
.96 |
.98 |
.91 |
Ignores Facilitator |
1 |
1 |
.99 |
Note: Inter-rater reliabilities are
between rater 1 and the combined ratings from two other raters for each
condition.
An alpha level of .10 was used for all statistical tests as this was an exploratory study. An adjustment was made to control for family-wise error.
Two
maladaptive behaviours had a statistically significant p value. Flapping had a positive change with the
Greenhouse-Geisser p-value at .009 (df=1.1556, F =11.922). Upon closer examination there was a
significant difference between flapping pretest and flapping posttest
(Greenhouse-Geisser p=.002, df=1, f =47.610).
The means for flapping were 5.60 for pretest, 0.30 for test, and 3.60
for posttest.
Running and
climbing was the other maladaptive behaviour with a statistically significant
difference between Snoezelen and the playroom.
The Greenhouse-Geisser p-value was .010, (df=1.408, f=13.152). Running and climbing pretest versus test
showed a Greenhouse-Geisser p-value of .009 (df=1.00, f=22.533). Test versus posttest for running and climbing
was significant at Greenhouse-Geisser p-value at .005 (df=1.00, f=30.303). The means for this variable were as follows:
pretest 8.10, test 0.80 and posttest 5.80.
The
following means were found between conditions for maladaptive behaviours. See
table 2 for a description of the means.
Maladaptive Behaviour |
Pretest |
Test |
Posttest |
Vocalization |
11.50 |
8.80 |
12.50 |
Face
rubbing |
1.70 |
0.80 |
1.80 |
Mouthing |
3.20 |
2.20 |
5.80 |
Attempt
to leave |
2.40 |
3.50 |
2.30 |
Ignore
facilitator |
5.50 |
1.20 |
4.40 |
None of the p-values for the adaptive behaviours were at significant values. See table 3 for a description of the means.
Table 3
Means for
Adaptive Behaviours between Conditions
Adaptive Behaviour |
Pretest |
Test |
Posttest |
Focus on activity for 3 or more
minutes |
3.90 |
1.20 |
2.40 |
Initiate contact |
4.80 |
6.40 |
6.50 |
Laughter |
1.30 |
19.00 |
1.20 |
Perceived enjoyment of the subject’s experience differed from day to day and can be seen in Figure 1.
Time spent
in Snoezelen Room
The time that the subject chose to spend in the Snoezelen room also differed between days, see Figure 2 for exact amounts of time.
Discussion
The purpose of this study was to examine three hypotheses: That there would be a statistically significant reduction of SSB in the Snoezelen room. The second hypothesis stated that there would be a statistically significant increase in adaptive behaviours while in the Snoezelen room. The final hypothesis theorized that there would be moderate short-term effects in the 30-minute posttest following Snoezelen. To recap, the results on assessment of Snoezelen effects on maladaptive behaviour suggest that Snoezelen had a positive effect in reducing two of the subject’s SSB. No statistically significant effects were found for increasing adaptive behaviours. No evidence supported any short-term effects of Snoezelen. However it was a serious limitation of this study for n=1, as statistical investigation is near impossible. There were noticeable differences between means for most variables, and had there been more subjects there may have been statistically significant relationships between the conditions. As this is the case each variable will be examined on this assumption.
Vocalization decreased during Snoezelen, and remained essentially at the same level during the playroom conditions. This subject often screams when upset or extremely excited, and therefore the decreased level of vocalization provides tentative support for relaxation of the subject in the Snoezelen room. There was a significant reduction during Snoezelen for the subject’s flapping behaviour. Flapping also occurred less, on average, in the posttest condition. This too provides evidence not only for the subject’s possible relaxed state, but also for short-term effects of the Snoezelen environment. Previous research implies that a reduction in SSB is an indication of fulfilling sensory needs from the environment and this appears to have occurred with this subject. The subject’s face rubbing only increased slightly during Snoezelen, but still implies that perhaps sensory needs were being met from the environment. Interestingly enough while mouthing decreased during Snoezelen it increased to a higher rate during posttest than in pretest. Further research needs to be done to examine the implications of this. This subject’s maladaptive behaviours did appear to be sensory driven as suggested in other research (Shapiro et al., 1997).
Running and climbing also decreased during Snoezelen significantly. However, a confounding variable not considered were the difference in size of the Snoezelen room compared to the playroom. While it is possible that this reduction was a result of a relaxed mood it is also possible that this reduction occurred due to the fact that running and climbing behaviours were not really possible in the Snoezelen room. Attempts to leave also increased during Snoezelen, but also may have been due to the type of door. The Snoezelen room door was a sliding door, and during the research the subject did leave the room only to stand outside and roll the door open and closed. Such things often preoccupy those with autism and the researcher did experience a similar behaviour from another client with autism outside of this study. Ignoring the facilitator also decreased by a noticeable amount, and actually remained somewhat lower in the posttest than in the pretest. This does provide speculative support for the fostering of a positive relationship between client and facilitator as indicated by previous research.
This subject’s posture did not allow the rater’s to rate the frequency of smiling, however laughter was a large indicator of the subject’s enjoyment of a condition, and his laughter increased greatly during Snoezelen, an indication that this was indeed a leisure activity for the subject. Interestingly the subject not only initiated contact more frequently during Snoezelen, but this carried over and the subject maintained the same elevated rate of contact during the posttest. This supports the idea that Snoezelen encourages positive relations between the client and facilitator, similar to the findings of Hutchinson and Haggar in 1991 (as cited in Shapiro et al., 1997). Focus on activity decreased from pretest during Snoezelen and was only slightly raised during posttest. This does not support Lindsay et al.’s 1997 study that found increases in concentration as a result of Snoezelen. However experimental subjects were made to do a specific task and here the subject was allowed to choose what activities he would engage in.
A confounding variable did drastically change the results of the experiment. Referring back to Figure 2 the reader can see a large difference in time spent in Snoezelen between days 1, 2, 5 and days 3 and 4. Much to the researcher and facilitator’s surprise, this difference appeared to have been caused by the art in the Solar Effects Projector. Days 1, 2 and 5 the projector held “Shapeland” which consisted of abstract colourful shapes. Days 3 and 4 exhibited “Deep”, an underwater scene, and during these sessions the subject was more difficult to engage and opted to leave less than half way into the session both times. There were actual certain parts of “shapeland” that had the subject laugh hysterically each time the projector rotated. Due to his choice to leave early on days 3 and 4 a reduction or increase in behaviours were difficult to establish on these days. One interesting difference between these days was the subject’s enjoyment which can be gauged not only by his time spent in the room and the perceived enjoyment scores, but also by the amount of laughter emitted by the subject. See figure 3 for details.
Figure 3: Subject’s Laughter
Between Snoezelen Sessions
This
supports Lindsay et al.’s conclusion that a client’s enjoyment of a Snoezelen
environment is variable according to client preferences (2001). Long & Haig (1992) suggested that
designed change will give rise to an observable change in client behaviour, and
this too is supported here.
When
rating a Snoezelen experience purely by frequency of behaviour some of the
subject’s experience is lost. One of the
raters asserted that she could tell which playroom sessions were pretest and
which were posttest as during pretest he was more concentrated at the task at
hand, during the posttest he was more explorative of his environment. This too needs to be further researched, and
may have been a limitation of rater-bias.
The rater who noticed this difference was someone who was well
acquainted with the subject.
Ultimately
this study did suffer from severe limitations that did not allow it to
contribute much statistically significant support for the benefits of
Snoezelen. However, upon closer
examination this study did show effects of the Snoezelen environment on the
subject’s behaviours. A major accidental
finding that has not been researched in previous literature was the effect of
artwork in the projector on the subject’s experience of the Snoezelen
environment. Further research needs to
address differences between not only art stimulus but also a variety of sensory
objects in the Snoezelen room. While
subjects have preferred certain stimulus in the room in other research, this is
the first study to find that a single stimulus may dictate an entire Snoezelen
experience. Further research needs to
occur not only to establish whether this is common amongst those with autism,
but also in other populations. Overall
this study concludes that Snoezelen did affect the subject’s maladaptive and
adaptive behaviours, as well as encouraged a positive relationship between the
facilitator and the subject. As a result
the parent of this subject has requested Snoezelen sessions to become an
ongoing part of his treatment and leisure experience.
References
Ashby, M.,
Lindsay, W. R., Pitcaithly, D., Broxholme, S. & Geelen, N. (1995). Snoezelen:
Its Effects on Concentration and Responsiveness in People With Profound
Multiple Handicaps. British Journal of Occupational Therapy, 58(7), 303-307.
Burns,
Chitsey, A., Haight, B. & Jones, M. M. (2002). Snoezelen.
A Multisensory Environmental
Intervention. Journal
of Gerontological Nursing, 28(3):41-9.
Cuvo, A.
J., May, M. E. & Post, T. M. (2001).
Effects of living room, Snoezelen room, and outdoor activities on
stereotypic behaviour and engagement by adults with profound mental
retardation. Research in Developmental Disabilities, 22, 183-204.
DeBunsen,
A. (1994). A study in the implication of
the Snoezelen resources at
Egan, K. L.
(1998). An Exploration of a Snoezelen Multisensory Leisure Program for Individuals
with Multiple Disabilities.
Unpublished undergraduate student project,
Fagny, M.
(2000). L’impact de la Technique du “Snoezelen” sur les Comportements Indiquant
L’apaisement Chez des Adults Autistes. Revue Francophone de la Deficience
Intelectuelle, 11(2), 105-115.
Field, T.,
Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S., Dowling, M.,
(1997). Brief Report: Autistic Children’s Attentiveness and
Responsibility Improve After Touch Therapy.
Journal of Autism and
Developmental Disorders, 27(3),
333-338.
Hogg, J.,
Cavet, J., Lambe, L. & Smeddle, M. (2001).
The use of ‘Snoezelen’ as multisensory stimulation with people with
intellectual disabilities: a review of
the research. Research in Developmental Disabilities, 22, 353-372.
Hong, C. S.
(1996). What is Snoezelen? British
Journal of Therapy & Rehabilitation, May, (no page number provided).
Lindsay, W.
R., Black, E. & Broxholme, S. (2001).
Effects of Four Therapy Procedures on Communication in People with
Profound Intellectual Disabilities. Journal of Applied Research in Intellectual
Disabilities, 14, 110-119.
Lindsay, W.
R., Pitchaithly, D., Geelen, N., Broxholme, S. & Ashby, M. (1997). A comparison of the effects of four therapy
procedures on concentration and responsiveness in people with profound learning
disabilities. Journal of Intellectual Disability Research, 41(3), 201-207.
Long, A. P.
& Haig, L. (1992). How do Clients
Benefit from Snoezelen? An Exploratory
Study. British Journal of Occupational Therapy, 55(3), 103-106.
Martin, N.
T., Gaffan, E. A. & Williams, T. (1998).
Behavioural effects of long-term multi-sensory stimulation. British
Journal of Clinical Psychology, 37, 69-82.
Messbauer,
L. (n.d.). Snoezelen & Sensory
Disorders. (no information provided).
Quon, A.
(1997). The Magic of Snoezelen
Rooms. Ability Network, 5(2), (no page number provided).
Shapiro,
M., Parush, S., Green, M. & Roth D. (1997).
The Efficacy of the “Snoezelen” in the Management of Children with
Mental Retardation who Exhibit Maladaptive Behaviours. The
British Journal of Developmental Disabilities, 43(2), 140-155.
Stephenson,
J. (2002). Characterization of
Multisensory Environments: Why do Teachers Use Them? [Abstract]. Journal
of Applied Research in Intellectual Disabilities, 15(1), 73.
Thomas, L.
(2002). Guidelines: Bloorview MacMillan
Snoezelen Room Orientation (MacMillan site) [Orientation Pamphlet].
Thompson,
S. B. N. & Martin, S. (1994). Making
Sense of Multisensory Rooms for People with Learning Disabilities. British
Journal of Occupational Therapy, 57(9), 341-344.
Watling, R.
L., Deitz, J. & White, O. (2001).
Comparison of Sensory Profile Score of Young Children With and Without
Autism Spectrum Disorders. The American Journal of Occupational
Therapy, 55(4), 416-423.
Appendix A
CONSENT FORM
TITLE OF STUDY: The
Effects of a Snoezelen Environment on a Seven-Year-Old Male with Severe Autism
INVESTIGATOR: Abby M. Rozen (Student)
Purpose of the study
Snoezelen
is a multi-sensory leisure environment that was developed in the late 1970’s by
therapists Jan Hulsegge and Ad Verheul at the Dehartenburg Institute in
Description of the study
This is a
single-subject, repeated measures 5-week study.
During 5 consecutive Saturday’s I will be picking up your son from your
home at
In the Snoezelen room we
will be using has a variety of different equipment, including a light
projector, a Catherine’s Wheel, vibrating massage mat, bubble tube, bean bag
chairs, musical-light hopscotch, bubble wall, disco-ball, and other sensory
light activities. The floors in this
small room are padded, and the light and music levels can be controlled. Overall a Snoezelen room is a relaxing
environment with different activities that do not need intellectualizing to be
enjoyed.
As Snoezelen is not a
therapy or medical intervention, but simply a leisure activity, no alternatives
have been offered.
Potential harms
As Snoezelen is not
considered a medical intervention or a therapy, there are no potential
risks. If your son exhibits any
discomfort or expresses a desire to leave that I may recognize, he will not be
forced to stay. You are aware of the
flashing lights in the room, and have provided me with the information that
this will in no way affect your son negatively, such as a seizure.
Potential benefits
The good thing about
this study is that it will be a chance for your child to relax and enjoy
himself in this multi-sensory leisure environment. If there is a reduction in your son’s
self-stimulating behavior, it means that he is relaxed and finding stimulation
through other sources. Ideally, we will
find a lowered amount of self-stimulating behavior, as the Snoezelen room may
fulfill a stimulation substitution role.
Confidentiality
Confidentially will be
respected and no information that discloses the identity of the subject will be
released or published without consent unless required by law. The results of the tests described above will
be used for research purposes only in the context of this study. We would need your permission and signed
consent to send these test scores to another professional involved in your
son’s care.
Participation
Participation in this
study is voluntary. You have the right
to decide not to allow your son to be a part of this study. You also have the right to withdraw your son
from this study at any time. If your son expresses any desire to be removed
from the Snoezelen room at the time of the study, we will do so immediately and
continue the research as planned the following week. If you do not want to participate or if you
choose to withdraw at a later date, this will not affect the quality and care
of your child during
For questions and further information
Please do not hesitate
to contact myself, Abby Rozen, the primary investigator at (905) 731-5533,
Lorraine Thomas at 1800-855-0511 to get Bell Operator. When prompted give (416)
422-7049. You can contact both of us with
any questions or concerns you may have in regards to this study, Monday to
Friday,
Please complete the consent portion
of this form below.
I have taken part in research at this Centre in the past. _______ ______
Yes No
I am currently participating in another research study at this
Centre. ______ ______
Yes No
The name of this study is ______________________________________
The researcher, named below, has explained the study to me. I know the quality of care with Abby Rozen,
or any future care at Bloorview MacMillan Children’s Centre will not be affect
if I chose not to be in the study. I
know I may ask questions now, and in the future, about the study or the
research procedures. When the study
concludes, I will be given a copy of all findings.
I hereby consent to my son’s participation in this study.
____________________ ________________________ __________________
Print Name Signature Date
_________________________
Investigator’s Signatures
EQUIPMENT
|
DESCRIPTION
|
Bean bag chunkie (red
and blue)
|
Who can
resist a brightly coloured beanbag chair filled with poly beads? Sit on it and you’re enveloped in a
billowing cloud. Punch it, and you can
hear the beads rustle. Hug it close
and it provides intense proprioceptive support.
|
Bubble Tube |
Streams of bubbles rise inside an illuminated column
of water. The bubbles slowly change
colour as they float to the top proving a great visual effect. The plastic tube gently vibrates and hums
for added stimulation |
Bubble Wall Panel |
This panel features random columns of bubbles that
float to the top, changing colours as they go. It is great for visual stimulation and can
be used directly with an interactive switch to control the light (for visual effects) or the bubbles (for
hearing effects) |
Evening Breeze |
A large white fan which must be turned on manually
by hitting the large surface mounted switch. This gentle sensation is often
pleasurable for those who find the wind outdoors too strong and
overwhelming. |
Fibre Optic Light Spray |
Light travel through the cables of this spray to
give a glimmering effect. The cables are smooth to the touch and can be
draped over a user’s body or explored with his/her hands. The spray is also great for individuals
with limited vision. Gathering the
ends of the cables together provides an extremely bright visual stimulus for
tracking. |
Interactive floor carpet
|
Placing
physical pressure on this interactive fibre optic carpet creates a stunning
light effect of shimmering colours. Remove your weight from it, and it goes
off. Step back on it, and it comes
back on! It reinforces cause and
effect through any from of movement: walking, crawling, pushing, jumping and
provides visual and tactile stimulation.
|
Magiglow Board
|
This board is
used with a lighted writing device to create glowing pictures that gradually
fade away. This activity is great for
eye-hand coordination and creativity.
If an individual cannot operate the writing device independently, you
can used hand-over-hand guidance to assist then. You can also try placing the
user’s hand on the board so you can trace around it
|
Milky way carpet wall panel
|
Fibre optics woven into the pile of the black carpet provide both visual and tactile stimulation as they create a shimmering effect of continually changing colours. A switch can also be plugged in so that the colours can be turned on and off, reinforcing cause and effect. |
Mirror ball
|
Light from the projector creates colored
reflections on the floor and walls for added visual arousal. |
Mirrored Line Light Panel
|
Thin strands that glow in fluorescent colours as it is exposed to ultraviolet black light. This creates a unique tactile experience that is visually stimulating. To increase the effect of the black light, turn off the overhead projector. |
Musical Hopscotch |
The brightly
coloured squares on a mat correspond to the panel on the wall. The wall panel can be activated by
stepping, crawling, rolling, or pressing the squares on the mat. On the simple program, stepping on a square
will cause the corresponding square on the wall panel to light up while a
musical tone sounds.
There are
eight different programs available which are labeled and can b set using the
dial on the sidewall panel. The volume
of the musical tones can also be adjusted using the second dial on the wall
panel. The musical hopscotch is great
for providing tactile, auditory, and visual feedback
|
Solar Effects Projector
|
This projector rotates special effect wheel which
creates patterns and pictures that move slowly around the room. The images
are great for visual stimulation and tracking. Simply changing the Effect wheel can change
the atmosphere from vibrant to tranquil, or just plain funky! Pictures and patterns include: “Deep” which
features underwater images, and “Shapeland”, a swirl of brightly coloured
abstract shapes. |
Sparkle net fabric
|
Soft, white
nylon tricot material is embedded with sparkles that catch the smallest
amount of light passing over the fabric.
Use the fabric to create a puffy cloud like effect on the ceiling or
to create a cozier room setting.
Great for enhancing ‘make-believe’ and story telling!
|
Stereo and speakers (music)
|
The inclusion of stimulating yet comforting music can greatly enhance the Snoezelen experience for clients. Selections range from serene ocean sounds, classical compositions by the masters or lullabies e.g. “Ascension”: Lush harmonies blend with gentle
melodies for a deep calming effect “Heavenly Realms”: divine sounds and peaceful offerings |
Vibrating mattress pad
|
This is a
soft comfortable pad, which is great for relaxation and for users who enjoy
vibration. The intensity and position of the vibration can be adjusted using
the remote control. Pillows can be
used to help with positioning and comfort
|
Appendix C
CODING SHEET
Coder: Session#: Date:
Vocalization / Screaming: |
Total:____
|
Laughter: |
Total:____
|
Flapping: |
Total:____ |
Running / Climbing: |
Total:____ |
Mouthing Object or hand: |
Total:____ |
Remaining focused on activity
for 3 minutes or over: |
Total:____ |
Face Rubbing: |
Total:____ |
Attempts to leave room: |
Total:____ |
Ignoring facilitator when
attempts of contact: |
Total:____ |
Initiates Contact: |
Total:____ |
SNOOEZELEN SPECIFIC:
1)
Rate the
subject’s perceived enjoyment of the session:
1 2 3 4 5
Not at Somewhat Neutral Somewhat Enjoyed
All Disliked Enjoyed
2)
Behavior
during treatment: 1 2 3
1=Irritable and not cooperative,
2= partial cooperation, 3=relaxed and cooperative
3)
How long was
the period of time spent in the room?:______________min