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The Effectiveness of an Auditory Integration-Based Developmental Support Programme on the Sensory Development and Self-Regulation Skills of Autistic Children in Turkey

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Title: The Effectiveness of an Auditory Integration-Based Developmental Support Programme on the Sensory Development and Self-Regulation Skills of Autistic Children in Turkey
Language: English
Authors: Saliha Cetin-Sultanoglu (ORCID 0000-0003-1374-2399), Neriman Aral
Source: British Journal of Special Education. 2025 52(1):100-110.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Autism Spectrum Disorders, Auditory Training, Sensory Integration, Sensory Training, Sensory Aids, Self Management, Preschool Children, Program Development, Program Evaluation, Program Effectiveness, Program Implementation, Behavior Development, Child Development
Geographic Terms: Turkey
DOI: 10.1111/1467-8578.12576
ISSN: 0952-3383
1467-8578
Abstract: This study examines the impact of an auditory integration-based developmental support programme on the sensory development and self-regulation skills of children with autism aged three to five years in Turkey. This mixed-methodology research combined quantitative and qualitative methods, and data were collected using a general information form, the individual needs determination form, the adapted autism behaviour checklist (ABC), the Gilliam autism rating scale-2-Turkish version (GARS-2-T), the sense and self-regulation checklist (SSC) and semi-structured interviews. An AB model was used to determine the effectiveness of the auditory integration programme in supporting the sensory and self-regulation skills of children with autism. The quantitative data were graphically analysed, while the qualitative data underwent content analysis. The findings establish that the children's final evaluation results were lower than their initial assessments, signifying that the intervention had a positive impact. The qualitative data obtained from interviews with the participating children's mothers concurred with the quantitative results, and the mothers expressed favourable views regarding the programme.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1461756
Database: ERIC
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  Value: <anid>AN0184014411;bmp01mar.25;2025Mar27.06:33;v2.2.500</anid> <title id="AN0184014411-1">The effectiveness of an auditory integration‐based developmental support programme on the sensory development and self‐regulation skills of autistic children in Turkey </title> <p>This study examines the impact of an auditory integration‐based developmental support programme on the sensory development and self‐regulation skills of children with autism aged three to five years in Turkey. This mixed‐methodology research combined quantitative and qualitative methods, and data were collected using a general information form, the individual needs determination form, the adapted autism behaviour checklist (ABC), the Gilliam autism rating scale‐2‐Turkish version (GARS‐2‐T), the sense and self‐regulation checklist (SSC) and semi‐structured interviews. An AB model was used to determine the effectiveness of the auditory integration programme in supporting the sensory and self‐regulation skills of children with autism. The quantitative data were graphically analysed, while the qualitative data underwent content analysis. The findings establish that the children's final evaluation results were lower than their initial assessments, signifying that the intervention had a positive impact. The qualitative data obtained from interviews with the participating children's mothers concurred with the quantitative results, and the mothers expressed favourable views regarding the programme.</p> <p>Keywords: auditory integration; autism; development; self‐regulation; sensory</p> <hd id="AN0184014411-2">Key Points</hd> <p></p> <ulist> <item> Autistic children can experience unusual sensory experiences and self‐regulation difficulties compared to their typically developing peers, and these experiences might lead to behavioural and adaptation problems.</item> <p></p> <item> Self‐regulation is the individual's ability to control their emotions, shape their behaviours and concentrate according to social rules.</item> <p></p> <item> These results contribute to the academic field by illustrating the efficacy of auditory integration methods in improving the sensory and self‐regulation skills of autistic children within the Turkish context.</item> </ulist> <hd id="AN0184014411-3">INTRODUCTION</hd> <p>We investigated the impact of an auditory integration‐based developmental support programme on the sensory development and self‐regulation skills of autistic children in Turkey. Autism is defined as a developmental–communicative disability, which manifests in an inability to make eye contact from infancy, inadequacy in joint attention behaviour and difficulty in interpersonal communication. Repetitive behaviours and discourses are frequently exhibited along with the absence of or difficulty in symbolic play behaviour (Genovese & Butler, [<reflink idref="bib18" id="ref1">18</reflink>]; Hughes et al., [<reflink idref="bib22" id="ref2">22</reflink>]; Kamp‐Becker, [<reflink idref="bib23" id="ref3">23</reflink>]). Symptoms of autism usually appear before the age of three. They take the form of problems in verbal and non‐verbal communication, interaction, play and social relationships as well as stereotypic movements (DSM‐V, [<reflink idref="bib15" id="ref4">15</reflink>]; Kissine et al., [<reflink idref="bib25" id="ref5">25</reflink>]).</p> <p>Various symptoms accompany autism. The most common are sensory problems. Children with autism have unusual sensory experiences compared to their typically developing peers, and these experiences lead to behavioural and adaptation problems (De Domenico et al., [<reflink idref="bib12" id="ref6">12</reflink>]; Derakhshanrad et al., [<reflink idref="bib13" id="ref7">13</reflink>]). Autistic children can have difficulties related to hearing. Some children with auditory problems hear sounds but interpret them incorrectly. For some children with auditory integration disorder, the daily sounds they hear are disturbing, while others may be attracted to higher‐frequency sounds (Lau et al., [<reflink idref="bib31" id="ref8">31</reflink>]; Robertson & Baron‐Cohen, [<reflink idref="bib42" id="ref9">42</reflink>]). Problems with auditory integration can negatively affect a child's other senses.</p> <p>Children with autism, who have limited interaction and communication skills due to auditory problems, struggle to express themselves effectively, self‐regulate and cope with the problems they experience (Geveke et al., [<reflink idref="bib19" id="ref10">19</reflink>]; Poulsen et al., [<reflink idref="bib38" id="ref11">38</reflink>]). These difficulties can cause an individual's self‐regulation skills to be inappropriate for their age and developmental level (Hautakangas et al., [<reflink idref="bib21" id="ref12">21</reflink>]).</p> <p>Supporting children with autism who have difficulties in these areas is of great importance in terms of them becoming self‐sufficient individuals. For this reason, it is thought that a developmental support programme based on the auditory integration method will positively affect the sensory and self‐regulation skills of children with autism. Based on this idea, the study investigated the impact of a developmental support programme, focused on auditory integration, on the sensory development and self‐regulation skills of children with autism.</p> <hd id="AN0184014411-4">METHOD</hd> <p>This section details the research design, data collection tools, study group, implementation process, validity and reliability studies, data analysis and programme development studies.</p> <hd id="AN0184014411-5">Research design</hd> <p>Due to the limitations arising from research based only on quantitative or qualitative methods and to increase the reliability of the data and findings, a mixed‐methods approach (in which quantitative and qualitative methods are used together) was employed (Venkatesh et al., [<reflink idref="bib50" id="ref13">50</reflink>]). In the quantitative dimension of the study, a single‐subject research model (pretest–post‐test quasi‐experimental design), one of the quasi‐experimental research models (Creswell & Plano Clark, [<reflink idref="bib11" id="ref14">11</reflink>]) was used to examine the programmes effectiveness. Quantitative data were collected through the quasi‐experimental method, and the AB design, one of the single‐subject experimental designs, was used. In phase A, which refers to the initial phase within the scope of the AB design, the dependent variable is observed in its natural environment and stable data are obtained using various measurement tools (Kircaali Iftar et al., [<reflink idref="bib24" id="ref15">24</reflink>]).</p> <p>Qualitative data were collected using phenomenology, a qualitative research method that enables individuals to describe their experiences regarding a given phenomenon or concept by expressing their understanding, feelings, perspectives and perceptions (Creswell & Poth, [<reflink idref="bib10" id="ref16">10</reflink>]; Urcia, [<reflink idref="bib48" id="ref17">48</reflink>]). In addition, various qualitative data collection techniques (video recordings, semi‐structured interviews) were used before, during and after the intervention.</p> <hd id="AN0184014411-6">Study group</hd> <p>The study participants were recruited through Turkey's Ministry of National Education/Department of Special Education after the necessary permissions and consent were obtained. The participants were children diagnosed with autism who had no other health issues or diagnoses, who were assessed as having a high likelihood of autism based on the Turkish version of the Gilliam autism rating scale‐2 (GARS‐2‐T) and the adapted autism behaviour checklist (ABC), who had not previously participated in an auditory or sensory integration programme, who lived with their parents and had various sensory issues as identified by the sense and self‐regulation checklist (SSC) administered by the researcher. The children's mothers were also included.</p> <hd id="AN0184014411-7">Quantitative data collection tools</hd> <p>The quantitative data collection tools used in the study are explained below.</p> <hd id="AN0184014411-8">Generic information form</hd> <p>This form, prepared by the researcher, asked about the child's age, gender, degree of autism, whether the child had a comorbid diagnosis, birth order, number of siblings, parents' age, parents occupations and education level.</p> <hd id="AN0184014411-9">Adapted autism behaviour checklist</hd> <p>The ABC was originally developed to assess autistic spectrum disorder (ASD) in children aged three to twelve years. The ABC consists of 57 items across five scales: language skills, emotional responses, body and object use, relationship building, and social and self‐care skills. The checklist was adapted into Turkish by Özdemir et al. ([<reflink idref="bib36" id="ref18">36</reflink>]). The internal consistency for the ABC is 0.92. The items in the ABC are scored as 0 (none) and 1 (present).</p> <hd id="AN0184014411-10">Gilliam autistic disorder rating scale‐2</hd> <p>Developed in 2005, the GARS‐2‐T evaluates individuals between 3 to 23 years of age who exhibit autism‐specific behaviours in three subscales (communication, social interaction and stereotyped behaviours) scored with a four‐point scale – never observed (0), rarely observed (<reflink idref="bib1" id="ref19">1</reflink>), sometimes observed (<reflink idref="bib2" id="ref20">2</reflink>) and frequently observed (<reflink idref="bib3" id="ref21">3</reflink>). The internal consistency of the tool is 0.94 (Diken et al., [<reflink idref="bib14" id="ref22">14</reflink>]).</p> <hd id="AN0184014411-11">Sense and self‐regulation checklist</hd> <p>Silva and Schalock ([<reflink idref="bib44" id="ref23">44</reflink>]) developed the SSC to identify symptoms related to sensory and self‐regulation accompanying autism. The SSC has a total of 12 sub‐dimensions scored on a four‐point Likert scale – never (0), rarely (<reflink idref="bib1" id="ref24">1</reflink>), sometimes (<reflink idref="bib2" id="ref25">2</reflink>) and frequently (<reflink idref="bib3" id="ref26">3</reflink>). The SSCs internal consistency is 0.87.</p> <hd id="AN0184014411-12">Qualitative data collection tools</hd> <p>The qualitative data collection tools used are listed below.</p> <hd id="AN0184014411-13">Video recordings</hd> <p>Video recordings were taken during the interviews with the families in the pre‐implementation, intervention and post‐implementation phases.</p> <hd id="AN0184014411-14">Semi‐structured interview form</hd> <p>Interview questions were prepared based on the literature, and input was sought from seven experts from different professional fields (special educational needs, child development, occupational therapy, preschool education, and psychology). The researcher conducted a pilot interview to evaluate the questions before implementation.</p> <hd id="AN0184014411-15">Auditory integration‐based developmental support programme</hd> <p></p> <hd id="AN0184014411-16">Purpose of the programme</hd> <p>The auditory integration‐based developmental support programme was developed to support the sensory development and self‐regulation skills of children with autism.</p> <hd id="AN0184014411-17">Programme development</hd> <p>The programme was continuously developed for 12 months. As a result of studies (AbediKoupaeia et al., [<reflink idref="bib1" id="ref27">1</reflink>]; Brbić & Tomić, [<reflink idref="bib6" id="ref28">6</reflink>]; Neysmith‐Roy, [<reflink idref="bib34" id="ref29">34</reflink>]) that emphasise the effectiveness of the Tomatis method in using auditory integration to support sensory development and self‐regulation skills, the Tomatis auditory integration approach was included in the programme. To include the approach, the researcher participated in a Tomatis auditory integration therapy training programme and received a practitioner certificate. The Tomatis method is based on the principle of the transmission of unanticipated sound contrasts through music and voice to constantly surprise the brain. That element of surprise forces the brain to develop automatic mechanisms to detect change, which serves to develop stronger focus and attention, supporting the development of motor, emotional and cognitive skills (Tomatis, [<reflink idref="bib46" id="ref30">46</reflink>]; Tomatis, [<reflink idref="bib47" id="ref31">47</reflink>]).</p> <p>During the programmes development, its scientific basis was determined, a needs analysis was conducted and the programme was presented to the field experts for their opinions.</p> <hd id="AN0184014411-18">Scientific basis of the programme</hd> <p>The programme was based on Jean Ayres's sensory integration theory and Alfred Tomatis's auditory integration approach (Ayres, [<reflink idref="bib3" id="ref32">3</reflink>]; Tomatis, [<reflink idref="bib46" id="ref33">46</reflink>]; Tomatis, [<reflink idref="bib47" id="ref34">47</reflink>]) because autistic children experience sensory problems that negatively affect their daily lives.</p> <hd id="AN0184014411-19">Needs analysis</hd> <p>Literature was reviewed, existing programmes were examined and a study was conducted to understand the children's individual needs. An individual needs assessment form was created for the mothers of three autistic children to identify the children's needs.</p> <p>After the preparation of the programme, 11 experts working in related fields were asked to evaluate it. The programme was presented to a Tomatis method expert; an occupational therapist; an audiologist; a special education teacher; a child development specialist; a preschool teacher; two professors, an associate professor and a lecturer in child development and a preschool education professor.</p> <p>Finally, a pilot study was carried out, which demonstrated that instructions were understandable. No problems occurred when the pilot was implemented. The programme was prepared for implementation over the course of 28 sessions.</p> <hd id="AN0184014411-20">Data collection process</hd> <p>The study was initiated after approval was gained from the Ankara University's ethics committee. Permission and validity and reliability data were collected for the SSC. In the experimental process, three children diagnosed with autism, whose parents gave consent to participate in the study, were included. Due to the research method being a single‐subject study, three children were included for the sustainability of the research and to minimise the risks of a single participant dropping out. The data collection tools were applied to each child to determine their individual characteristics and performance at the initial stage, and the SSC was administered to obtain consistent data before starting the intervention, which began once stable data had been obtained.</p> <p>In line with the AB research design, baseline data was first collected in phase A. Implementation data were collected in phase B, and finally, quantitative and qualitative data collection tools were applied.</p> <hd id="AN0184014411-21">Video recordings</hd> <p>The video recordings were used to examine the children's behaviours, changes in sense and self‐regulation levels and to evaluate the reliability data.</p> <hd id="AN0184014411-22">Programme implementation</hd> <p>The implementation process (phase B) began once satisfactory baseline data had been obtained in phase A within the AB model. In phase B, the programme was applied and data on the dependent variable were collected at the end of each implementation. Prior to the implementation, the environment was arranged and related data were collected. The programme was implemented in 45‐minute sessions for a total of 28 sessions. The applications were mostly carried out in the children's homes or in the special education and rehabilitation centres they attended.</p> <hd id="AN0184014411-23">Data analysis</hd> <p>The research data were analysed using quantitative and qualitative data analysis. Quantitative data were analysed using the graphical analysis method (Kubina Jr. et al., [<reflink idref="bib28" id="ref35">28</reflink>]; Riley‐Tillman et al., [<reflink idref="bib40" id="ref36">40</reflink>]), while qualitative data were analysed using the content analysis method (Kuckartz & Rädiker, [<reflink idref="bib29" id="ref37">29</reflink>]). In the evaluations, the children were coded with the letter C and the mothers with the letter M. The three children and their mothers were represented as C1, C2, C3 and M1, M2, M3, respectively. Because of the importance of validity and reliability in single‐subject studies, social validity data were collected through semi‐structured interviews with the mothers within the scope of validity analysis (Creswell & Poth, [<reflink idref="bib10" id="ref38">10</reflink>]).</p> <p>The analysis of data in single‐subject research is usually done through graphical analysis. A line graph –the most‐used graph type in single‐subject research – is defined as the line formed by the combination of data points and the line formed by the combination of data points is the graph line (Tekin İftar, [<reflink idref="bib45" id="ref39">45</reflink>]). In this research, line graphs were used to analyse the data. The X‐axis expresses the value of the dependent variable over time, while the Y‐axis refers to the quantitative value of the dependent variable. To obtain the data points, the SSC was administered, and the results are illustrated by the line graph.</p> <p>During the implementation, the sensory and self‐regulation levels of the autistic children were regularly assessed every two days using the SSC. After the implementation, the data collection tools were reapplied and final evaluations were conducted. In the line graph created according to the AB model of the research, the X axis displays the application times of the SSC for the baseline level (A) and the programme application times (B), while the Y axis includes each participant's SSC scores.</p> <p>The research data are interpreted graphically because using graphics provides a clear view of the subjects performances (Tekin Iftar, 2018). Examining the data this way questions the existence of a functional relationship between the dependent and independent variables (Krasny Pacini & Evans, [<reflink idref="bib27" id="ref40">27</reflink>]).</p> <p>Qualitative data were obtained through semi‐structured interviews conducted with the child participants' mothers using a social validity form (the semi‐structured interview form). Social validity is defined as the social relevance of intervention goals, the social acceptability of intervention processes and the social value of the outcomes. Social validity is utilised as a programmatic method to guarantee that socially relevant objectives are chosen, that programmes are socially acceptable and that socially important outcomes are achieved. The primary strategies for determining the social validity of an intervention are subjective evaluation and social comparison. In this study, the subjective evaluation method was applied. This method requires identifying the qualitative views of people whose knowledge and opinions are to be consulted about the aims, methods and effects (Fawcett, [<reflink idref="bib16" id="ref41">16</reflink>]; Luiselli, [<reflink idref="bib33" id="ref42">33</reflink>]; Wolf, [<reflink idref="bib49" id="ref43">49</reflink>]). The mothers were informed about the social validity form, and social validity data were collected through semi‐structured interviews to evaluate the programme by explaining some questions face‐to‐face according to the mothers' requests. The data obtained from the interviews were recorded verbatim without any modifications or interpretations.</p> <p>Content analysis was used to examine this data. Content analysis, which is frequently used in social sciences, aims to explain human behaviour and nature with non‐direct methods. It is a systematic technique in which texts are summarised by coding and categorising (Creswell & Poth, [<reflink idref="bib10" id="ref44">10</reflink>]; Kuckartz & Rädiker, [<reflink idref="bib29" id="ref45">29</reflink>]). The written documents obtained in the analysis of the qualitative data were read and reviewed multiple times by the researcher and two special education experts for reliability, and categories and sub‐categories were created. The categories that emerged include programme, changes among children, changes within the family, strengths and weaknesses, while the sub‐categories included increased attention, reduced sensory sensitivity, increased awareness level and learning new skills.</p> <hd id="AN0184014411-24">FINDINGS</hd> <p>Each child was evaluated independently to examine the effect of the auditory integration‐based developmental support programme on sensory development and self‐regulation skills. The quantitative findings regarding the effectiveness of the interventions were presented in line graphs in the form of pre‐assessment, baseline (phase A), interim evaluations during the implementation process (phase B) and post‐assessment findings. Qualitative data were presented in the form of social validity data obtained from face‐to‐face interviews with the participants' mothers in the final evaluation and video recordings of each child, which were analysed through inter‐observer reliability and implication reliability.</p> <hd id="AN0184014411-25">Quantitative findings</hd> <p>To determine each participant's individual level and performance, the results of the ABC, GARS‐2‐T and SSC were used to establish their baseline level, and the results of the intervention were examined. The post‐intervention individual scores of the participants are presented in Table 1. A high score suggests significant issues in the pertinent areas, whereas a low score indicates fewer issues.</p> <p>1 TABLE Participants' post‐intervention individual scores.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Child</th><th align="left">SSC</th><th align="left">GARS‐2‐T</th><th align="left">ABC</th></tr></thead><tbody valign="top"><tr><td align="left">C1</td><td align="char" char="(">−4 (64–60)</td><td align="char" char="(">−2 (90–88)</td><td align="char" char="(">−1 (19–18)</td></tr><tr><td align="left">C2</td><td align="char" char="(">−3 (71–68)</td><td align="char" char="(">0 (94–94)</td><td align="char" char="(">−1 (22–21)</td></tr><tr><td align="left">C3</td><td align="char" char="(">−7 (80–73)</td><td align="char" char="(">−2 (127–125)</td><td align="char" char="(">−2 (39–37)</td></tr></tbody></table> </ephtml> </p> <p>Table 1 shows the pre‐and post‐intervention scores gained from each research tool. C1's ABC score, which was 19 in the pre‐assessment, decreased by one point to 18, while their GARS‐2‐T post‐assessment score, which was 90 in the pre‐assessment, decreased by two points to 88. Similarly, there was a difference between C1's pre‐ and post‐assessment SSC scores; C1 scored 64 points on the SSC in the pre‐assessment, but his score decreased by four points to 60 points after the intervention. C1's scores imply that the programme had a positive effect.</p> <p>Regarding C2, their SSC score was 71 before the intervention and 68 after. Their GARS‐2‐T score remained unchanged at 94, and their ABC score decreased by one point to 21. These scores indicate good progress in the field of sensory and self‐regulation but no change in autism status, though there was a one‐point increase in autism‐specific behaviours in a positive direction.</p> <p>Meanwhile, C3's SSC score decreased from 80 points to 73 points. Their GARS‐2‐T and ABC pre‐assessment and post‐assessment scores both fell by two points, decreasing from 127 to 125 and 39 to 37, respectively. C3's results indicate a decrease in autism‐specific behaviours, an improvement in the level of autistic disorder and a significant increase in sensory and self‐regulation skills after the intervention.</p> <p>Scores for the baseline and implementation process of the SSC are presented below in Table 2.</p> <p>2 TABLE Scores for the baseline and implementation process of the SSC.</p> <p> <ephtml> <table><tbody valign="top"><tr><td align="left">Intervention period for C1<graphic href="" /></td><td align="left">Intervention period for C2<graphic href="" /></td><td align="left">Intervention period for C3<graphic href="" /></td></tr></tbody></table> </ephtml> </p> <p>Table 2 explains the scores for the baseline and implementation phases of the intervention. Since C1 consistently obtained 64 points at baseline (phase A), the implementation phase (phase B) was started. In the first 12 sessions of the implementation phase, there was no change in C1's scores, but in the fourteenth session, C1's score decreased by one point to 63 and then continued decreasing gradually, finally decreasing by three points in total to 60 in the last session. During phase B, C1's SSC scores decreased by four points in total. This indicates a positive increase in C1's sensory and self‐regulation skills after the programmes implementation.</p> <p>C2 consistently obtained 71 points at baseline (phase A), so the implementation phase (phase B) was started. In phase B, there was no change in C2's scores for the first 14 sessions, but after the fourteenth session, their score gradually decreased and dropped to 68 points in the last session. C2's SSC scores decreased by three points in total during phase B. This situation can be considered as an indicator of a positive increase in C2's sensory development and self‐regulation skills because of the programme.</p> <p>C3's baseline score was 80. There was no change in C3's scores in the first eight sessions during phase B; however, C3's score decreased by one point to 79 in the tenth session and dropped again to 73 points by the last session. Their SSC scores decreased by seven points in total during phase B. These findings suggest that the programme had a positive effect on C3's sensory and self‐regulation skills.</p> <hd id="AN0184014411-26">Qualitative findings</hd> <p>Social validity data were collected through semi‐structured interviews with the children's mothers, and content analysis of the data was conducted. The mothers' opinions regarding social validity were generally positive. As a result of the analyses, the findings regarding the mothers' opinions are explained below.</p> <p>When mothers were asked what changes they observed in their children after participating in the study, they reported that their child's attention span had increased, they could engage in activities without getting bored, they were less afraid of noises than before and they were less fearful of strangers. Additionally, the children started playing with different toys, were more willing to touch various objects and could hold different items in their hands without fear. Before the intervention, C2 had been unable to walk barefoot, but after the training, he could do so more comfortably. M2 shared:</p> <p>'<emph>My son wasn't walking around without socks, and sometimes he didn't want to take off his shoes. After you came and massaged his feet with different materials, he started to change, and now he has no problem with his socks off. I have benefited from my son's change and so should everyone else. In the past, he would never come close. Now he is a little bit used to it</emph>.'</p> <p>When the mothers were asked what kind of changes occurred in their children after the programme, they stated that they had learned different things from the research, as they did not know about auditory integration therapy before. They were happy with the implementation of the programme, and their children would participate in such programmes if there were any in the nearby areas. M3 shared:</p> <p>'<emph>I did not know how to educate or help my child at home before. After you came to us, I watched what you did, and I learnt how to help my child by doing the things you recommended. I wish such training was given at schools, five days a week. I have gained self‐confidence now</emph>.'</p> <p>When asked for their opinions about the method used in the intervention, the mothers mentioned that they had heard about it from a friend living in another city but could not send their children to similar programmes because they were unavailable in their region (Central Anatolia). They noted that it was their first time seeing this method and that they found it very useful. They reported changes in their children because of the intervention. M2 said:</p> <p>'<emph>I did not know about the Tomatis method. In fact, after you met with us, I was quite sceptical that it would work. I'm glad I accepted; we learned a lot from you. My son has changed a lot, and his development seems to have accelerated. I wish it had lasted longer. It was very useful</emph>.'</p> <p>When the mothers were asked to evaluate the researcher, they expressed that they were very satisfied with her. They noted that the researcher was highly experienced and knowledgeable; they appreciated her approach to the children; everyone in the family liked her and they felt comfortable with her.</p> <p>'<emph>We were very pleased ... you came to our house at convenient hours in such hot weather and you worked voluntarily. You brought tools and materials that we could never afford. Without you, we would not have known about these materials and equipment. Your approach to my child was very good. You understood him. You made him happy</emph>' (M1).</p> <p>When the mothers were asked to briefly explain the aspects of the study they liked, they stated individual training; doing fun things; the researcher coming to the house every day, including during the weekend; using an expensive device that is not available locally; receiving training for free; and bringing different materials that attract the child's interest every day. M2 stated:</p> <p>'<emph>I liked your communication with my son the most. You were very patient. I also liked the fact that this training was held every day, seven days a week. I think it was more useful because it was held one after the other. I wish this training could be continuous. The tool you used in the training was also interesting, I think it was very useful</emph>.'</p> <p>When the mothers were asked what aspects of the study they did not like, they stated that they liked everything and had nothing negative to say. They would have liked the researcher to have stayed longer or to live locally, and they thought that a longer duration would be beneficial for their children.</p> <p>'<emph>I can say that there was nothing I disliked. Everything was very good. My child is excited for the first time. He is very curious about the tools and materials you used but it would be more useful if it took a little longer</emph>' (M1).</p> <p>When the mothers were asked whether the duration of the training was sufficient, they stated that it was not sufficient. It was too short and would be better if it lasted at least six months or even one to two years. They wanted this training to be given at their children's school.</p> <p>'<emph>I wish it had lasted longer; my child would have learnt more. Even in such a short time, I saw that some things changed in my child's behaviour. It would have been much better if it had lasted a little longer</emph>' (M3).</p> <p>When the social validity data obtained from the video‐recorded interviews with the mothers were examined, it was seen that they expressed positive opinions. All the mothers answered 'yes' to all questions in the interview form at a rate of 100% and stated that they were pleased to participate in the study. Stating that the programme significantly contributed to their children's development, the mothers said that their children used the skills they gained in different environments and that they cared about the importance of auditory integration practices in special education. The mothers stated that they wanted to participate in the programme again and recommended the programme to other families. The mothers were satisfied with the programme and their children made different gains. Considering these results, it can be said that the social validity of the research is high.</p> <hd id="AN0184014411-27">DISCUSSION</hd> <p>Both qualitative and quantitative data were collected to examine the effect of the auditory integration‐based developmental support programme on the sensory development and self‐regulation skills of children with autism. The developmental support programme, carried out as a single‐subject experimental AB study, consisted of 28 sessions in total and was applied individually. The AB design is frequently used in special education research (Çakıroğlu, [<reflink idref="bib8" id="ref46">8</reflink>]; Kuru & Güneş, [<reflink idref="bib30" id="ref47">30</reflink>]) because the design entails individual implementation. It was thought that this method could be used effectively in interventions for children with autism as they may have intense problems related to auditory integration, sensory development and self‐regulation in connection with these problems (Kopp, [<reflink idref="bib26" id="ref48">26</reflink>]; O'Connor, [<reflink idref="bib35" id="ref49">35</reflink>]; Posar & Visconti, [<reflink idref="bib37" id="ref50">37</reflink>]; Robertson & Baron‐Cohen, [<reflink idref="bib42" id="ref51">42</reflink>]). The findings obtained from the study were interpreted with the support of the literature. The data of each child was discussed separately since it was a single‐subject study, and the results of the childrens data and the social validity data obtained from the mothers were integrated and are discussed below.</p> <p>There is a positive differentiation in the scores obtained from the measurement tools for C1. The differentiation determined in C1's ABC, GARS‐2‐T and SSC scores means that C1's problems regarding sensory and self‐regulation were alleviated, potentially indicating that the programme is effective. Similar findings have also been reported in different studies (AbediKoupaeia et al., [<reflink idref="bib1" id="ref52">1</reflink>]; Brockett et al., [<reflink idref="bib7" id="ref53">7</reflink>]; Fu et al., [<reflink idref="bib17" id="ref54">17</reflink>]). As stated in these studies, it is known that the effect of the programme on the child's development is related to the child's autistic symptoms and the level of support needed. It is thought that the moderate level of support offered to C1 was effective in him benefitting from the programme.</p> <p>M1, C1's mother, stated that the programme benefitted both C1, herself and other family members, and overall, she was satisfied with the programme. She added that C1 used the skills acquired in different environments. At the end of the programme, M1 described the changes in C1 thus:</p> <p>'<emph>I think my son's attention span has increased. He used to be afraid of loud and sudden noises, used to get restless and cover his ears, but after your training, he is not afraid of noises as before</emph>.'</p> <p>In addition, she discussed changes in herself as follows:</p> <p>'<emph>I learned different activities from you. For example, I never thought I could make a lot of things from different materials at home</emph>.'</p> <p>The differentiation observed in the quantitative and qualitative data is consistent with M1's responses. The quantitative findings obtained with the scales overlapped with the social validity findings. Considering these results, the study had very high social validity according to M1's views.</p> <p>C2's pre‐assessment scores indicate a high probability of autism, with moderate support needs and sensory and self‐regulation problems necessitating developmental support. The fact that there was no difference between the pre‐ and post‐assessment scores for the GARS‐2‐T can be explained by the high probability of autism. The behaviours accompanying autism may be an indicator that C2 did not benefit from the programme sufficiently. Schreck and Mulick ([<reflink idref="bib43" id="ref55">43</reflink>]) used the GARS and found that children with autism had more sleep problems and benefited less from support programmes compared to children with intellectual disability or typical development. It is known that time is important in the formation of behaviour change in all children, including those with autism, and some behaviours require a long time to change. Arguably, the duration of the programme was not sufficient for C2, who needed a high level of support.</p> <p>C2's ABC score decreased slightly after the intervention, and this indicates a decrease in autism‐specific symptoms. There are studies showing that the ABC is limited in detecting autism‐specific problems compared to other measurement tools. Rellini et al. ([<reflink idref="bib39" id="ref56">39</reflink>]) studied 65 children aged between 18 months and 11 years to determine the compatibility of the ABC and the childhood autism rating scale (CARS) with the DSM‐IV criteria for autism. It was stated that the CARS overlapped with DSM‐IV criteria, whereas the ABC was not successful in differentiating children with autism from those with other developmental problems.</p> <p>However, the decrease in C2's SSC score may indicate that C2 benefited from the programme since it implies a positive contribution to sensory and self‐regulation skills. The line graph analysis revealed that C2's SSC score decreased by three points in total. In phase B, C2's score decreased gradually after the fourteenth session and decreased to 68 points by the last session. Since this change means the alleviation of sensory and self‐regulation problems, it is possible that the programme positively affected the child. This finding is consistent with those of other studies in which intervention programmes for children with autism were implemented (AbediKoupaeia et al., [<reflink idref="bib1" id="ref57">1</reflink>]; Bazyk et al., [<reflink idref="bib4" id="ref58">4</reflink>]; Brockett et al., [<reflink idref="bib7" id="ref59">7</reflink>]).</p> <p>The social validity data obtained by interviewing M2 supported the quantitative data. M2 explained the changes she observed in her child:</p> <p>'<emph>It seems like he is less afraid of loud noises. He is also less afraid when he sees strangers and starts to play with different toys</emph>.'</p> <p>M2 also stated that the programme contributed positively to C2 and that she was satisfied with the programme but the implementation period was insufficient:</p> <p>'<emph>I think it was inadequate. I wish it had been longer. My suggestion would be one to two years, and I wish they could do it at the school</emph>.'</p> <p>The differentiation observed in the quantitative data was reflected in the qualitative data, consistent with M2's responses. In this context, the quantitative findings obtained from the scales aligned with the social validity findings. Based on these results, the social validity of the study was deemed high according to M2's views.</p> <p>There was a two‐point difference in C3's pre‐ and post‐assessment GARS‐2‐T scores. A low score on the scale means a decrease in the likelihood of autism and an alleviation of the degree of autism; thus, the programme can be said to have had a positive effect on C3. Adamson et al. ([<reflink idref="bib2" id="ref60">2</reflink>]) examined sensory modulation disorder in children with autism and determined that all children affected by autism also have sensory problems. In this context, it is thought that our finding concurs with the literature.</p> <p>C3's ABC assessment score decreased by two points over the course of the intervention. Since a decrease in the score indicates a reduced likelihood of autism or a lower level of need, this drop suggests that the programme had a positive effect on C3. Another study examined the effects of auditory integration therapy on children with autism using the ABC. The therapy, consisting of 30‐minute sessions over ten days, was applied to nine children aged three to 16 years. While no change in their autism levels was observed, there was a slight decrease in sensory problems (Gillberg et al., [<reflink idref="bib20" id="ref61">20</reflink>]). When compared with the results of different studies this finding is consistent with the literature (AbediKoupaeia et al., [<reflink idref="bib1" id="ref62">1</reflink>]; Bazyk et al., [<reflink idref="bib4" id="ref63">4</reflink>]; Brockett et al., [<reflink idref="bib7" id="ref64">7</reflink>]).</p> <p>C3's SSC score was 80 before the implementation, decreasing to 73 afterwards. This significant difference implies that the programme positively impacted C3's sensory and self‐regulation skills. Other studies aimed at supporting sensory and self‐regulation skills support developmental progress in children with autism (Case‐Smith & Bryan, [<reflink idref="bib9" id="ref65">9</reflink>]; Roberts et al., [<reflink idref="bib41" id="ref66">41</reflink>]). The difference in C3's ABC, GARS‐2‐T and SSC scores for C3 reflects the alleviation of the problems related to sensory and self‐regulation, indicating that the programme was effective. Various studies in the literature support the research findings. Consequently, it was determined that auditory integration therapies had a positive effect on children with autism, were effective in reducing autism‐specific symptoms and behavioural problems and had benefitted social communication and interaction skills (AbediKoupaeia et al., [<reflink idref="bib1" id="ref67">1</reflink>]; Bazyk et al., [<reflink idref="bib4" id="ref68">4</reflink>]; Blythe et al., [<reflink idref="bib5" id="ref69">5</reflink>]).</p> <p>When the social validity data from the interview with C3's mother were examined, M3 stated that the programme contributed positively and that C3 was using the skills acquired during the programme in different environments. M3 was satisfied with the study. She described the changes in C3 thus:</p> <p>'<emph>She does not hesitate when touching something. She can hold different things in her hand without fear. For example, she could not step barefoot before, but now she is more comfortable</emph>.'</p> <p>M3 also described the changes in family members, saying:</p> <p>'<emph>They are trying to teach my daughter the things you have taught them. We all learned something from you</emph>.'</p> <p>M3 claimed that she had not known about the method before but that it helped keep her child constantly engaged, allowing the child to learn. She expressed her views on the method as follows:</p> <p>'<emph>I did not know there was such a method, but then the children researched it online to learn more. I have already noticed some changes in my daughter</emph>.'</p> <p>The differentiation observed in both the quantitative and qualitative data aligned with M3's responses. In this context, the quantitative findings from the scales were consistent with the social validity results. Therefore, the social validity of the study was very high according to M3's views.</p> <p>At the end of the research, the auditory integration‐based developmental support programme was deemed to have had a positive effect on both the child participants and their parents. In addition, it was seen that the parents expressed their opinions positively about the programme. Other studies in the literature support the conclusion that auditory integration‐based programmes positively contribute to the development of children with autism (Fu et al., [<reflink idref="bib17" id="ref70">17</reflink>]; Li et al., [<reflink idref="bib32" id="ref71">32</reflink>]; Neysmith‐Roy, [<reflink idref="bib34" id="ref72">34</reflink>]; Yashwant et al., [<reflink idref="bib51" id="ref73">51</reflink>]).</p> <p>Considering all the quantitative and qualitative findings obtained within the scope of the research, the increase in the sensory and self‐regulation skills of autistic children and positive changes in these areas were due to the auditory integration‐based developmental support programme, limited to the three participants.</p> <hd id="AN0184014411-28">Study limitations</hd> <p>This research is limited to the data obtained from three children – who were aged between three and five years and who had been diagnosed with autism – and their mothers. All the participants lived in Turkey. The study evaluated the implementation of a developmental support programme and its effect on related variables. The sample size is small, focusing on only one city in Turkey with just three pairs of participants; therefore, the findings cannot be generalised. Quantitative data were collected through quasi‐experimental methods, and an AB design, − one of the single‐subject experimental designs – was used. The AB model was selected because it forms the basis of all single‐subject research and is easily applicable. Although this model cannot establish experimental control, it is beneficial in terms of answering various questions in environments such as schools and clinics. The AB design is the weakest quasi‐experimental model among all designs in terms of experimental control. The AB model is dysfunctional in revealing the relationship between the dependent and independent variables. There may not be a cause‐and‐effect relationship between the dependent variable and the independent variable. Therefore, changes in the process may not be due to the dependent or independent variable but may only indicate a change in the level or trend of the dependent variable. This model is open to factors affecting internal validity and cannot be replicated across participants. Its external validity is quite weak since it is studied on only one participant and one behaviour (Tekin İftar, [<reflink idref="bib45" id="ref74">45</reflink>]).</p> <p>One potential risk factor of this study is that the researcher both developed and implemented the programme, which may have influenced the results. Another possible source of bias is that the children were also attending special education and rehabilitation centres during the intervention period, which could have impacted their scores. Individual differences, different needs and different levels of parental support might have also influenced the research findings.</p> <p>Although the research results indicate that the developmental support programme based on auditory integration benefitted the participant's sensory development and self‐regulation skills, this finding is limited to these three children and cannot be generalised to a larger population.</p> <hd id="AN0184014411-29">CONCLUSION</hd> <p>This study aimed to determine the effect of a developmental support programme based on auditory integration on the sensory and self‐regulation skills of children with autism in Turkey. Our findings showed improvements in the child participants' SSC scores following the programme, indicating its potential benefits despite limitations, such as the small sample size and the use of a single‐subject design approach. The programme's wider influence was further highlighted by the child participants' mothers, who noted improvements in their personal experiences and their children's behaviour. The results presented in this study make a significant contribution to the academic field by illustrating the efficacy of auditory integration methods in improving the sensory and self‐regulation skills of autistic children within the Turkish context. Future studies might examine the efficacy of implementing programmes on a larger scale, the long‐term consequences and the programme elements that produce favourable results.</p> <hd id="AN0184014411-30">FUNDING INFORMATION</hd> <p>This research received no specific grant from any funding agency from the public, commercial or not‐for‐profit sectors.</p> <hd id="AN0184014411-31">CONFLICT OF INTEREST STATEMENT</hd> <p>The authors declare that they have no conflict of interest.</p> <hd id="AN0184014411-32">DATA AVAILABILITY STATEMENT</hd> <p>Due to the nature of the research, the supporting data are not available.</p> <hd id="AN0184014411-33">ETHICS STATEMENT</hd> <p>Ankara University Ethical Committee approval was received for the research, and the informed consent of all participating subjects was obtained.</p> <ref id="AN0184014411-34"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref19" type="bt">1</bibl> <bibtext> AbediKoupaeia, M., Poushanehb, K., Mohammadic, A.Z. & Siampour, N. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Effectiveness of an Auditory Integration-Based Developmental Support Programme on the Sensory Development and Self-Regulation Skills of Autistic Children in Turkey
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Saliha+Cetin-Sultanoglu%22">Saliha Cetin-Sultanoglu</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-1374-2399">0000-0003-1374-2399</externalLink>)<br /><searchLink fieldCode="AR" term="%22Neriman+Aral%22">Neriman Aral</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22British+Journal+of+Special+Education%22"><i>British Journal of Special Education</i></searchLink>. 2025 52(1):100-110.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Auditory+Training%22">Auditory Training</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Integration%22">Sensory Integration</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Training%22">Sensory Training</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Aids%22">Sensory Aids</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Management%22">Self Management</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Children%22">Preschool Children</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Development%22">Program Development</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Evaluation%22">Program Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Implementation%22">Program Implementation</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Development%22">Behavior Development</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Turkey%22">Turkey</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/1467-8578.12576
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0952-3383<br />1467-8578
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study examines the impact of an auditory integration-based developmental support programme on the sensory development and self-regulation skills of children with autism aged three to five years in Turkey. This mixed-methodology research combined quantitative and qualitative methods, and data were collected using a general information form, the individual needs determination form, the adapted autism behaviour checklist (ABC), the Gilliam autism rating scale-2-Turkish version (GARS-2-T), the sense and self-regulation checklist (SSC) and semi-structured interviews. An AB model was used to determine the effectiveness of the auditory integration programme in supporting the sensory and self-regulation skills of children with autism. The quantitative data were graphically analysed, while the qualitative data underwent content analysis. The findings establish that the children's final evaluation results were lower than their initial assessments, signifying that the intervention had a positive impact. The qualitative data obtained from interviews with the participating children's mothers concurred with the quantitative results, and the mothers expressed favourable views regarding the programme.
– Name: AbstractInfo
  Label: Abstractor
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1461756
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1461756
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1467-8578.12576
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 100
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Auditory Training
        Type: general
      – SubjectFull: Sensory Integration
        Type: general
      – SubjectFull: Sensory Training
        Type: general
      – SubjectFull: Sensory Aids
        Type: general
      – SubjectFull: Self Management
        Type: general
      – SubjectFull: Preschool Children
        Type: general
      – SubjectFull: Program Development
        Type: general
      – SubjectFull: Program Evaluation
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Program Implementation
        Type: general
      – SubjectFull: Behavior Development
        Type: general
      – SubjectFull: Child Development
        Type: general
      – SubjectFull: Turkey
        Type: general
    Titles:
      – TitleFull: The Effectiveness of an Auditory Integration-Based Developmental Support Programme on the Sensory Development and Self-Regulation Skills of Autistic Children in Turkey
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Saliha Cetin-Sultanoglu
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          Name:
            NameFull: Neriman Aral
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          Dates:
            – D: 01
              M: 03
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0952-3383
            – Type: issn-electronic
              Value: 1467-8578
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            – Type: volume
              Value: 52
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              Value: 1
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            – TitleFull: British Journal of Special Education
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