Sensory integration and sensory-based interventions – children & young people

Introduction and Overview 

Sensory integration (SI) theory originates from the work of A. Jean Ayres, who published two key texts in the 1970s, and has subsequently been built upon by other theorists. SI is based on a conceptualisation of how the brain organises and interprets sensory information, with dysfunction occurring when the brain (in the absence of clear neurological damage) does not become properly organised for processing and integrating this information (Kielhofner 2009). 

Occupational therapists offer a range of approaches when working with children and young people with sensory processing issues. These include: Ayres Sensory Integration® (ASI) a play-based method, usually carried out in a clinic using specific equipment, which aims to change neurophysiological processing of sensation; and sensory-based interventions (SBIs) such as use of weighted vests or bouncing on a ball, which typically occur in the child/young person’s natural environment and aim to have an effect on self-regulation, attention, or behavioural organisation (Watling and Hauer 2015). However, there is ongoing debate within the occupational therapy profession about sensory integration/sensory-based interventions and their effectiveness. 

It should also be noted that ‘Sensory Processing Disorder’ is not recognised as an independent diagnosis in the Diagnostic and Statistical Manual of Mental Disorders 5 (American Psychiatric Association 2013). A 2012 American Academy of Pediatrics (AAP) Policy Statement cautioned ‘it is unclear whether children who present with sensory-based problems have an actual “disorder” of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders' (AAP 2012, p1186.). 

Occupational therapists working with children and young people who present with sensory issues should use their professional skills and expertise to carry out a thorough assessment, in collaboration with colleagues from the multidisciplinary team as appropriate. They should be clear about their rationale for using ASI/sensorybased interventions and set well defined goals alongside parameters for evaluating these, ideally using validated and reliable outcome measures. As with any intervention, it is important to critically consider key research, to ensure practice is evidence-informed. This Evidence Spotlight includes a broad but not exhaustive range of research papers, selected by RCOT to provide a starting point for critically considering the evidence base.