Sensory integrative therapy (also known as sensory integration training or Ayres sensory integration) is an intervention designed to help children with poor sensory integration. Sensory integration is the ability to receive, process, and make sense of multiple sensory inputs at the same time.
Poor sensory integration can lead to all sorts of practical difficulties. For example, some people who have poor sensory integration may have a poor awareness of, and control of, their own body. Because of this they may appear to be clumsy as well as socially awkward.
In sensory integrative therapy a therapist assesses a person’s ability to integrate sensory information. They then develop a personalised treatment programme which provides the person with various sensory experiences.
These therapeutic experiences are designed to provide a “just right” challenge that is just above the person’s level of capacity. For example, a child with a poor awareness of their body in space may be encouraged to hold onto a trapeze swing and then drop into a ball pit.
Sensory integrative therapy involves direct one-to-one supervision by a trained professional (such as an occupational therapist or physiotherapist) and is designed to be fun, as well as challenging. It therefore usually takes place in a room with specially designed play equipment (such as trapeze swings, carpeted barrels and trampolines).
There is a very small amount of high quality research evidence (five group studies) and a small amount of low quality research (seven single-case design studies with three or more participants) into the use of sensory integrative therapy for autistic children and young people. There is one, very small single-case design study which looked at autistic adults.
This research is inconclusive, with some studies finding positive results and some studies finding limited or no results. Because of this we cannot determine if sensory integrative therapy provides any benefits to autistic individuals.
There is a need for more research into sensory integrative therapy which uses scientifically robust, experimental methodologies with larger numbers of more diverse participants.
Future research should investigate whether sensory integrative therapy is more or less effective than other interventions designed to reduce or overcome sensory difficulties (such as weighted blankets or therapy balls). It should also investigate whether specific individuals are more likely to benefit from sensory integrative therapy than other individuals.
We believe that a careful assessment of the person’s sensory sensitivities should be carried out by a trained professional before sensory integrative therapy is carried out. That professional should ensure that the therapy follows agreed protocols. They should also define clear outcomes and objectives at the start of therapy and review these on a regular basis.
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The supporters of sensory integrative therapy say that it is appropriate for a wide range of people who have poor sensory integration. For example, according to the Sensory Integration Education website, accessed on 25 January 2018, sensory integrative therapy can be used with the following groups: children and adults with autism; children with early childhood trauma and attachment issues; children with developmental issues; older adults with organic brain disorders such as dementia; adolescents, adults and older adults in acute and secure settings.
- What is sensory integration?
Sensory integration is the ability to receive, process, and make sense of multiple sensory inputs at the same time. Sensory inputs include vision, hearing, smell, taste and touch (tactile) as well as the vestibular (balance and movement) and proprioceptive (feedback from muscles and joints) senses.
People with poor sensory integration often struggle with a range of tasks and behaviours. For example, according to Pollock (2009),
“Ayres hypothesized that some children have an impairment in sensory integration which manifests in difficulties observed in purposeful behaviours. This dysfunction in sensory integration may explain why some children have trouble learning new skills, organizing themselves, regulating their attention, participating in school or play activities, and engaging in positive social experiences.”
- What is sensory integrative therapy designed to do?
Sensory integrative therapy is designed to improve a person's sensory integration by changing the way that the body processes sensory inputs. This may in turn improve their ability to engage in appropriate tasks and behaviours. For example, according to Case-Smith et al (2015),
“… the goal of SIT is to increase the child’s ability to integrate sensory information, thereby demonstrating more organized and adaptive behaviors, including increased joint attention, social skill, motor planning, and perceptual skill. “
There have been various claims made for the use of sensory integrative therapy as an intervention for autistic people. For example,
Sensory integrative therapy (also known as sensory integration training, SI, SIT, Ayres Sensory Integration or ASI) is an intervention designed to help people children with poor sensory integration.
According to Pollock (2009),
“This treatment approach aims to provide the child with various sensory experiences. These experiences are matched during therapy with a “just right” challenge, an activity that requires the child to give an adaptive response. SIT is an active therapy. The child must be motivated and engaged in the choice of activities; hence, play is the medium of choice. Activities usually involve large pieces of equipment such as big rolls and balls, trampolines, and suspended equipment that provide intense proprioceptive, vestibular, and tactile experiences.”
According to Case-Smith et al (2015), sensory integrative therapy has 10 essential elements.
“The 10 essential elements are as follows: (a) ensuring safety, (b) presenting a range of sensory opportunities (specifically tactile, proprioceptive, and vestibular), (c) using activity and arranging the environment to help the child maintain self-regulation and alertness, (d) challenging postural, ocular, oral, or bilateral motor control, (e) is challenging praxis and organization of behavior, (f) collaborating with the child on activity choices, (g) tailoring activities to present the “just-right challenge,” (h) ensuring that activities are successful, (i) supporting the child’s intrinsic motivation to play, and (j) establishing a therapeutic alliance with the child.”
According to the American Occupational Therapy Association (2008), it is important to carry out an evaluation of the specific needs of each child before beginning a sensory integrative therapy programme.
“When a child is referred for an occupational therapy evaluation, the occupational therapist will rely on a variety of strategies to assess the issues underlying the expressed concerns. If sensory processing problems are suspected, the therapist may use specific ASI evaluation methods including observation of the child in the natural setting, caregiver and teacher interviews, standardized testing, and structured clinical observations to determine the specific ways in which disordered use of sensation is interfering with the child’s functional performance.”
A key element of sensory integrative therapy is the use of a personalised treatment plan based on the evaluation. For example, according to Schaaf et al (2014),
“…. if assessment data [show] that the goal of ‘participate in a play activity with a peer for 10 min’ may be related to poor tactile processing and praxis (hypothesis), individually-tailored sensory motor activities [are] designed to address tactile discrimination and improve praxis. Individually-tailored treatment activities might include activities such as using a carpeted scooter board while in the prone position to pull oneself up a ramp, then working to turn the scooter board around to ride down the ramp and land in a cushioned area of mats and pillows that are covered with various textures. In this activity, the child is experiencing total body tactile and proprioceptive sensations (from scooter board texture, actively moving muscles against resistance, and landing in textured mats and pillows) to increase body awareness and using this enhanced sensory input to plan body movements during the scooter board activity. Of note, the intervention is contextualized in play with active involvement of the child and conducted in a large gym equipped with mats, a variety of suspended swings, large balls, a climbing wall, carpeted barrels, large inner tubes and foam blocks with opportunities for active, guided, sensory motor play. The therapist facilitates the child’s ability to participate in the sensory-motor experiences in adaptive ways (e.g.: use a trapeze swing to experience proprioceptive and vestibular sensations to increase body awareness and then organize the body to hold onto the swing and jump into a large ball pit).”
According to Pollock (2009), there are a number of interventions (such as sensory diets) which are based on the Ayres theory of sensory integration but which differ from “classical” sensory integrative therapy.
“Occupational therapists use other forms of intervention which are based on sensory integration theory, but which differ from classical SIT. These approaches use a sensory integration framework to help understand and explain children’s behaviour, but rather than trying to remediate an underlying impairment, these methods are embedded in the child’s daily routines and focus on working with the children, parents, and educators to adapt the child’s environment in ways that will facilitate the child’s ability to participate. This approach may include such things as modifications to the child’s clothing, altering room configurations, noise or light levels, experimenting with food textures, adapting tools and materials, changing program demands, and so on. These approaches are designed to help children function to the best of their ability given their sensory processing capabilities as opposed to trying to change their underlying neurological functioning. In this way, they are distinct from classical SIT.”
In practice, sensory integrative therapy is sometimes carried out alongside other sensory-based interventions (such as sensory diets), as well as alongside other types of intervention (such as behavioural programmes).
Bilateral (two sides of the body); ocular (relating to the eyes); oral (relating to the ears); postural (relating to body position); praxis (the ability by which we work out how to use our hands and body in skilled tasks like playing with toys); proprioceptive (sense related to position and movement of the body); tactile (relating to touch); vestibular (sense related to balance and spatial orientation).
The cost of sensory integrative therapy will depend on a number of factors including the choice of supplier, the overall length of treatment, the frequency of sessions, the length of individual sessions, as well as the needs of the individual client.
Sensory integrative therapy is usually undertaken by professionals (such as occupational therapists). In the UK and some other countries, health care services such as occupational therapy are sometimes provided free of charge via the National Health Service at the point of delivery to affected individuals and their families.
In the USA and other countries the costs may sometimes by covered by schemes such as Medicare, Medicaid, workers’ compensation, vocational programmes, behavioural health programmes, early intervention, and school programmes.
Services also may be covered through Social Security, state mental health or learning disability agencies, health and human services agencies, private foundations, and grants.
The amount of time it takes to use sensory integrative therapy will depend on a number of factors including the needs of the individual client, the overall length of treatment, the frequency of sessions and the length of individual sessions.
In the UK, most occupational or physical therapy sessions will last about 45 to 60 minutes and most will be held on a regular basis, often weekly. In the studies we looked at, the sensory integrative therapy programmes lasted anywhere between four weeks and one year and individual sessions lasted anywhere between 10-60 minutes.
There are no known hazards for sensory integrative therapy, although there may be some risks when undertaking movement activities (such as jumping, swinging or trampolining). The safety of the equipment (for example, annual reviews of suspension equipment), experience of the therapist and environmental issues are important factors for consideration as many activities involve physical risks.
There may be some contraindications (something which makes a particular treatment or procedure potentially inadvisable for some people) for sensory integrative therapy. For example, some elements of sensory integrative therapy (such as jumping, swinging or trampolining) may not be appropriate for some individuals with motor disorders.
If you have concerns about whether sensory integrative therapy is appropriate for your or your child, you should seek advice from a responsible health professional (such as an occupational therapist).
In the UK, sensory integrative therapy is usually undertaken by healthcare professionals (such as occupational therapists) who may work for the National Health Service and/or be in private practice. However we have not been able to identify how many of these actually offer sensory integrative therapy.
According to Schaaf et al (2015), sensory integrative therapy is widely used within the USA. “SI as a practice area is routinely used by 85% to 93% of pediatric occupational therapists as well as a growing number of occupational therapists practicing in the field of mental health.”
According to Parham et al (2011), therapists delivering sensory integrative therapy which meets their protocols require
“Postprofessional training in sensory integration—certification in SI/SIPT (minimum of 50 education hr in SI theory and practice, e.g., postprofessional SI or SIPT certification or university course)”plus “Supervision (minimum of 1 hr/mo by an expert or 5 yrs of experience providing occupational therapy using SI intervention)"
In practice, many providers of sensory integrative therapy will be qualified in their own fields (such as occupational therapy) but it is unclear how many of them will be trained to the level demanded by Parham et al.
Many providers of sensory integrative therapy in the UK will be members of professionals’ organisations (such as the Sensory Integration Network of the UK and Ireland, which is affiliated to the US-based organisation, Sensory Integration International).
In the USA advanced training for SI certification is administered jointly by the University of Southern California and Western Psychological Services as the USC/WPS Sensory Integration Certification Program.
According to the American Academy of Pediatrics Council on Children with Disabilities (2012),
“Sensory integration is a framework first described by occupational therapist A. Jean Ayres, PhD, in the 1970s.
“Since Ayres described sensory integration dysfunction in the 1970s, sensory-based therapies have been used increasingly, mainly by occupational therapists (but sometimes other health professionals) to treat a range of symptoms seen in children presenting from across a variety of settings, including the home, community organizations, clinics, and schools. Sensory integration, sensory “diets,” and other sensory-based therapies typically are based on classic sensory integration theory but often do not use all of the originally described sensory integration protocols.
We have identified 13* studies of sensory integrative therapy for autistic people published in English-language, peer-reviewed journals.
These studies included more than 150 individuals aged from 3 years old to 48 years old but the vast majority looked at primary school-age children. The length of treatment varied considerably, with most studies lasting several weeks and one study lasting more than a year. Most of the studies were conducted in a clinic fitted with appropriate equipment (such as big rolls and balls, trampolines, and suspended equipment).
Most of the studies looked at sensory integrative therapy as a standalone intervention, while a small number of the studies looked at sensory integrative therapy compared to other interventions (such as treatment as usual, group-based activities or table-top activities). One study compared sensory integrative therapy with sensory integrative therapy plus traditional Thai massage.
*Please note: We have not included studies with less than three autistic participants, studies which looked at only one specific technique or piece of equipment used within sensory integrative therapy or studies which did not appear to follow the protocols for sensory integrative therapy established by Ayres (1972) and by Parham et al (2010).
There are a number of limitations to all of the research studies published to date. For example
For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’
We have identified the following studies into sensory integrative therapy that are currently underway. If you know of any other studies we should include please email info@researchautism.net with the details.
There is a very small amount of high quality research evidence (five group studies) and a small amount of low quality research (seven single-case design studies with three or more participants) into the use of sensory integrative therapy for autistic children and young people. There is one, very small single-case design study which looked at autistic adults.
This research is inconclusive, with some studies finding positive results and some studies finding limited or no results. Because of this we cannot determine if sensory integrative therapy provides any benefits to autistic individuals.
There is a need for more research into sensory integrative therapy for autistic people. That research should
This section provides details of scientific studies into the effectiveness of this intervention for people with autism which have been published in English-language, peer-reviewed journals.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
The College of Occupational Therapists (2015) summarised its position on sensory integration as follows:
“In the climate which values evidence based practice, those who are funding occupational therapy services are increasingly requesting information about effectiveness and efficiencies of interventions. Evidence for Ayres Sensory Integration Therapy and sensory-based strategies remains inconclusive and hence may not be considered justifiable and cost-effective. Moreover, some families reported that intensive sensory programmes can be overly burdensome or have concerns about the social stigma associated with carrying them out in school or community settings.
“Occupational therapists do, however, have a key role to play in supporting people with sensory processing issues. This can be done by enabling a better ‘fit’ between the person, his/her occupations and the environment. An occupational therapists’ knowledge of sensory processing can be used to offer insight for families and carers into the sensory needs of a person which facilitates a better understanding of behaviour.
“Occupational therapists focus on the needs of a person in relation to the occupations they want to, need to, or are expected to do. If a person with sensory processing challenges has functional needs then there is a legitimate role for the occupational therapist. If their sensory needs are impacting on functional performance, this would be alongside the impact of the environment and skills of the person.
“In conclusion, Rodger et al summarised that occupational therapy…must not be seen as synonymous with sensory integration therapy… if as a profession we persist with offering child-specific interventions that focus only on a narrow sensory perspective, we will have failed to deliver the breadth of interventions that occupational therapists have the expertise to provide. These are interventions that focus directly on occupational performance and enable optimal participation for children."