Ayres Sensory Integration Research Articles

OT Using Ayres Sensory Integration & Behavioral Intervention for Autistic Children: A Comparative Effectiveness Trial

Abstract Date Presented 03/22/24 Findings from a National Institutes of Health–funded comparative effectiveness trial comparing Ayres Sensory Integration (ASI) and applied behavioral analysis (ABA) for children with autism are presented, and their implications for OT practice are discussed. Primary Author and Speaker: Roseann C. Schaaf Additional Authors and Speakers: Zoe Mailloux, Elizabeth Ridgway Contributing Authors: Sophie C. Molholm, Emily Joneshuwer, Joanne Hunt, Rachel L. Dumont, Benjamin C. Leiby, Misung C. Li, Catherine C. Sancimino

Ayres Sensory Integration® Intervention for Autistic Children: A Telehealth Adaptation.

Ayres Sensory Integration® is an evidence-based, manualized occupational therapy intervention for autism that is delivered in person. A telehealth adaptation could bridge service gaps for families who may have challenges accessing services. To create a telehealth adaptation of the evidence-based manualized protocol of Ayres Sensory Integration using best practice for telehealth guidelines and to obtain input on the adaptation from experts. Online survey of U.S. telehealth experts and occupational therapy clinicians in fall and winter 2022. Two telehealth experts and six occupational therapy clinicians. Two Qualtrics surveys focused on perceived feasibility and acceptability, resources included, and clarity of instructions. Telehealth experts and occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. Suggestions for additional adaptations included adding resources for technology troubleshooting, intervention planning, rapport building, and continuing education. Suggested adaptations were made; the manual is ready for feasibility testing. Plain-Language Summary: This report is the first to describe a telehealth adaptation of Ayres Sensory Integration®. The manual provides comprehensive training and resources to support clinicians in delivering sensory integration, telehealth-based interventions to autistic children. Two telehealth experts and six occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. The manual will be available to clinicians after feasibility and pilot testing.

Adaptation of a Sensory Reactivity Assessment for Use With Children in the Western Cape Province, South Africa.

Background: Sensory reactivity (SR) difficulties are characterised by problems regulating an individual's responses to sensory input such that it interferes with occupational performance in daily tasks. South African occupational therapists use assessments developed in the United States to identify SR difficulties in children. These have been found to be inappropriate for the South African context. This study reports on the methodology used to adapt an assessment for use in the Western Cape Province of South Africa. Method: The SPM-2 Child and Preschool caregiver self-report questionnaires and seven tests of the performance-based Evaluation in Ayres Sensory Integration (EASI) that assess SR were identified for adaptation. A qualitative methodology was used to identify challenges using the assessment in a sample of the Western Cape population. Cognitive interviews were conducted with six community members from diverse socioeconomic groupings. Inductive analysis was used to identify and group the emerging themes. The test adaptation was conducted by expert occupational therapists based on these findings. Findings: Challenges were grouped into two themes, namely, language challenges, of which there were three subcategories and inappropriate or threatening assessment tasks. Fifty-three changes were made to the assessment. Conclusion: A detailed methodology was developed to adapt a SR assessment for use in the Western Cape Province. Challenges in using the assessment were elicited primarily from community members rather than professionals.

Adolescents' and Adults' Perceptions of Sensory-Based Interventions: A Qualitative Analysis.

Adolescents and adults report that their sensory integration and processing differences affect their occupational performance and quality of life, thus requiring effective sensory-focused interventions. Researchers have yet to investigate this population's experience of occupational therapy interventions designed to remediate these challenges. To explore the perceived experience of adolescents and adults with respect to (1) response to intervention, (2) strategies offered to manage sensory differences, and (3) need for services on completion of an intervention. Retrospective, qualitative study. Zoom or phone call. Eleven adolescents and adults with sensory integration and processing differences who had previously completed occupational therapy interventions. Sensory-based intervention based on the principles of Ayres Sensory Integration® (ASI) and the Sensory Therapies and Research Frame of Reference. A semistructured interview to obtain data, followed by an in-depth analysis using an inductive coding process to group initial open codes into themes and common subthemes Results: Open codes were grouped into three core themes: (1) therapist-related factors (what the therapist did in treatment); (2) client-related factors (what the client experienced); and (3) follow-up (future needs of the clients). Four main subthemes of the client-therapist relationship emerged: (1) therapeutic alliance; (2) education and knowledge; (3) strategies, tools, and resources; and (4) future needs. This study provides a perspective on the experience of adolescents and adults specific to the impact of a sensory-focused occupational therapy intervention on their daily lives. This will help occupational therapists when designing interventions for current and future clients. What This Article Adds: This study highlights the need for further research addressing effective sensory-based interventions for adolescents and adults. It also captures which components of intervention clients deemed helpful and identifies potential targets for future intervention.

Sensory Integration Therapy as a Management of Sensory Deficits in Autistic Spectrum Disorders

Abstract Background Sensory integration therapy (SIT) has been used for the management of sensory processing deficits associated with autism spectrum disorders (ASD). This work presents an overview of these sensory processing deficits and the SIT. This study aims to provide an evidencebased practice regarding the effectiveness of the SIT in the management of such sensory processing disorders in children with ASD. Objective To evaluate the effectiveness of the SIT as a therapy for the sensory processing symptoms associated with autism spectrum disorders in children. This will be made by conducting a systematic review of the literature in this topic area. Material and Method Search for any RCTs or retrospective studies that were in English language only. Study participants were not less than 5 children 3-12 yrs aged diagnosed with ASD. The intervention was validated by Ayres Sensory Integration® Fidelity Measure© (ASIFM) to ensure treatment integrity and effectiveness was measured by outcome measures such as SPM or SP. Data Sources PubMed, Cochrane Central Register of Controlled Trials, ScienceDirect, and all materials available on the Internet till 2020. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information, and defined assessment measures. Conclusion The current systematic review has not concluded that SIT may have a positive effect on improving sensory processing defects that are found in children with ASD. We suggest that more literature review would be effective in giving attention to the limitations of this study.

Evaluation in Ayres Sensory Integration® Praxis Tests: Construct Validity and Internal Reliability.

Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. To evaluate evidence of construct validity and internal reliability of data gathered with four newly developed praxis tests. Comparative descriptive design. Homes, schools, and therapy practices across the United States. A control group consisting of 163 children without any concerns or diagnoses and a case group of 145 children with sensory integration difficulties, ages 3 to 12 yr. Rasch analyses to evaluate construct validity, and Student's t tests to evaluate group differences. Total test scores and most item scores conformed to Rasch model expectations. Group differences were significant; the control group scored higher. Internal reliability was strong. Findings support the validity and internal reliability of the four praxis tests. What This Article Adds: This study adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® tests.

Creating Sensitive, Objective Measurements to Demonstrate Positive Outcomes of Ayres Sensory Integration

Abstract Date Presented 04/20/2023 Preparations for a single-subject design study to examine the impact of Ayres Sensory ntegration on motor coordination and self-confidence are described. Outcome measures that are objective, are sensitive to change, and control for a practice effect were developed. Primary Author and Speaker: Stacey E. Szklut Contributing Authors: Kerry Burokas, Barry James

Assessment of Sensory Integration in Early Childhood: A Systematic Review to Identify Tools Compatible with Family-Centred Approach and Daily Routines

ABSTRACT This systematic review aims to verify whether tools designed to assess Ayres Sensory Integration constructs take into account the basic principles of current early childhood intervention approaches, namely the family-centered approach, child and family routines, and natural contexts. This systematic review was based on a standard protocol constructed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement and included 323 publications. From these publications, we identified seven sensory integration assessment instruments for children up to 6 years old which are compatible with recommended early intervention practice. This study identified the instruments for sensory integration assessment in young children and related them with current principles of early childhood approaches. The findings may help researchers and clinicians choose instruments.

Düşük Kas Tonusu ve Konuşma Bozukluğu Olan 3 Yaşındaki Bir Çocukta Ayres Duyu Bütünleme İçeren Fizyoterapi Programının Etkileri: Tek Vaka Çalışması

This case report describes how a physiotherapy program with Ayres Sensory Integration was associated with changes in a 3 years old child with low muscle tone and speech disorders. To see how the Ayres Sensory Integration Physiotherapy Program affects muscle tone, speech, and the relation between muscle tone and speech, a 24-week physiotherapy program with Ayres Sensory Integration was initiated. Before and after the therapy, Development Screening Test, speech, muscle tone, and Antigravity Test were assessed and recorded. Muscle tone, speech, Development Screening Test and Antigravity Test results have all improved. Children with low muscle tone and speech difficulties can benefit from physiotherapy programs involving Ayres Sensory Integration. In addition to speech therapy, children with speech issues should get sensory integration therapy

Adherence to the Ayres Sensory Integration® Fidelity Measures: Malaysian Occupational Therapists’ Practices

Introduction: A popular intervention for paediatric clients, Ayres Sensory Integration® (ASI) must adhere to sensory integration (SI) fidelity. This study describes fidelity adherence in ASI intervention by occupational therapy practitioners in Malaysia. Methods: A questionnaire on ASI fidelity was developed before being tested for its validity by seven experts and for its internal consistency and test-retest reliability by 30 occupational therapists. The questionnaire was then used nationally to collect data on ASI practitioners. Data were collected from 161 occupational therapists working in various settings. Results: The mean of the sub-scales I-CVI was excellent, ranging between 0.97 and 1.00. The total S-CVI/Ave of the form was also reported as excellent, at 0.98, with subscales S-CVI ranging between 0.75 and 1.00. Cronbach’s alpha was 0.80 for the questionnaire’s internal consistency and the ICC for test-retest reliability ranged from 0.80 to 0.95. The survey received 161 responses, indicating that most respondents perceived themselves as having ‘moderate competence’ and showing ‘high interest’ in ASI implementation. Most fidelity aspects were addressed in their practices. Majority of the respondents adhered to the process elements. It was indicated that three aspects of physical space under the structural elements could not be provided by most occupational therapists in the study. Conclusion: To implement evidence-based practice, adherence to fidelity when providing ASI is important to ascertain its effectiveness. Improvements to ensure optimal space, ASI certification, and more related training are the first steps that can be taken by the related agencies to ensure effective ASI intervention could be delivered.

Ayres Sensory Integration® for Addressing Play in Autistic Children: A Multiple-Baseline Examination

Play is an area of difficulty for autistic children, and occupational therapy practitioners need evidence to guide interventions to improve play for this population. Ayres Sensory Integration® (ASI) intervention has not yet been studied for its impact on play outcomes. To examine the impact of ASI intervention on play types in autistic children. Nonconcurrent, multiple-baseline design across subjects. Outpatient occupational therapy clinic in New England. Three autistic children, ages 5, 6, and 6 yr. Twenty-four ASI sessions. Frequency of play type was coded using partial interval coding. Progress monitoring used Goal Attainment Scaling. All three participants demonstrated changes in the frequency of specific types of play, but changes varied among them. Findings suggest that ASI intervention may alter a child's patterns of play. What This Article Adds: This study is the first to examine the impact of ASI on play and the third that documents the feasibility of single-subject research for studying ASI. If confirmed in future studies, ASI could become an evidence-based intervention for improving play, an important outcome for autistic children and the profession of occupational therapy. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016).

Father-Child Playfulness: A Secondary Analysis of a Multiple-Baseline Single-Subject Study of Three Children With Autism Spectrum Disorder.

Ayres Sensory Integration® (ASI) is commonly used with children on the autism spectrum to promote sensory processing and improved occupational performance, including play. To date, there has been no explicit effort to examine improvements in playfulness through ASI. To explore whether ASI, coupled with parent training, improves child playfulness and fathers' support of child playfulness. Single-subject A-B-BC design secondary analysis of a nonconcurrent multiple-baseline study. Occupational therapy clinic. Three father-child dyads; children were ages 3 to 6 yr, with autism spectrum disorder (ASD) and documented sensory processing concerns. After a baseline phase, each child received at least 24 sessions of ASI, and fathers received parent training focusing on sensory processing issues and play via an online presentation. The Parent/Caregiver's Support of Children's Playfulness and the Test of Playfulness. Visual analysis of the baseline phase, ASI phase, and ASI with parent training phase shows that all 3 fathers demonstrated an increase in the way they supported their child's playfulness; however, this change was not maintained. Children's playfulness fluctuated, reaching a peak after fathers received training, but none of the children maintained that change. Additional support by the therapist is required for fathers to learn and use new strategies to promote consistent change in child playfulness during play. Pilot data can be used to inform future studies. What This Article Adds: Occupation- and family-centered frameworks may be useful in guiding practice when working with families of children with ASD.

A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study.

There is a paucity of research that explores the effectiveness of sensory integration interventions in the school setting. To test the effectiveness of a sensory integration intervention paired with teacher consultation, aligned with the principles of Ayres Sensory Integration® and the Sensory Therapies and Research Frame of Reference, to improve functional regulation and active participation in school for students with sensory integration and processing differences. Concurrent, multiple-baseline, single-subject design. Public elementary school in the United States. Students (N = 3; ages 5-8 yr) whose sensory integration and processing differences were affecting their school occupational performance and were not remediated by integrated support. For 15 wk, each student had one-to-one sensory integration intervention 2×/wk for 30 min and a consultation between the occupational therapist and teacher weekly for 10 min. The dependent variables, functional regulation and active participation, were measured weekly. The Short Child Occupational Profile and Behavior Assessment System for Children, Third Edition, were given before and after intervention. Goal Attainment Scaling and semistructured interviews with the teachers and participants were completed after intervention. All 3 students showed meaningful improvement in functional regulation and active participation in the classroom during the intervention period as demonstrated by a 2-SD band method or celeration line analysis. All additional measures noted positive change. Findings suggest that sensory integration intervention with consultation in the education setting can improve school performance and participation for children with sensory integration and processing challenges. What This Article Adds: This study offers an evidence-based model of service delivery for the school setting that is effective in improving the functional regulation and active participation of students whose sensory integration and processing challenges interfere with occupational engagement and are not mitigated by embedded supports.

Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests: Construct Validity and Internal Reliability

Assessment of tactile perception is foundational for addressing aspects of occupational performance. To evaluate the construct validity and internal reliability of four new tactile perception tests. Causal comparative groups design. Homes, schools, and therapy practices across the United States. Children ages 3 to 12 yr: typically developing (n = 174) and those with sensory integration concerns (n = 153). Rasch analyses to evaluate construct validity; analysis of covariance to evaluate group differences. The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests (η2p = .040-.105, p < .001). Person reliability indices and strata indicated moderate to strong internal reliability (Rasch person reliability indices = .69-.87; strata = 2.33-3.82). The Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr. Findings suggest that these tests are likely to be clinically useful and appropriate for children in this age range and may provide critical information regarding underlying sensory functions necessary for optimal occupational performance. What This Article Adds: This article provides data supporting the reliability and validity of the EASI Tactile Perception Tests in a U.S. These assessments can be used by therapists trained in their administration to assess tactile functions that may affect participation in activities, tasks, and occupations.

Data-Driven Decision Making (DDDM) sob a perspectiva da Integração Sensorial de Ayres®

Abstract Introduction The Ayres Sensory Integration® (ASI) method has been standing out within Occupational Therapy when implementing its evidence-based practice and, for this reason, it has had great notoriety in Brazil and in the world. To ensure the quality of the services provided, Ayres Sensory Integration® training programs follow some minimum standards, including the use of the Fidelity Measure© and the interpretation of evaluation data to inform clinical reasoning, which can be carried out through the Data-Driven Decision Making (DDDM). Objective Since DDDM is a tool that is still little discussed in Brazil, it is proposed to present its main contributions to the clinical and professional reasoning of occupational therapists and to the generation of evidence. Method This is an integrative and narrative literature review with a quali-quantitative approach, the sample period being the years from 2012 to March 2022. Among the 22 titles found, 13 scientific articles were included in this Review. Results DDDM proved to be a safe and viable tool for use in clinical practice in ASI®, with several contributions such as: client-centered practice, generation of hypotheses, development of personalized activities and intervention, elaboration of appropriate goals for each case and quantification of intervention effectiveness. Conclusion It is a tool that supports evidence-based practice as well as guides the clinical reasoning of occupational therapists through a focus on the use of data-based decision making.

A Parent Guidebook for Occupational Therapy Using Ayres Sensory Integration®.

Occupational therapy using Ayres Sensory Integration® (ASI) is an evidence-based intervention that includes parent education and participation to support outcomes. However, guidelines for this parent component have not been published. To obtain input from stakeholders on a revised guidebook for parent education during ASI intervention. Cross-sectional survey design. Online surveys. Experts in ASI, occupational therapy practitioners who use this approach, and parents of children with autism who received occupational therapy using this intervention. Surveys designed and vetted to obtain input on content and usability. Experts rated the guidebook as consistent with ASI principles, practitioners rated it as clinically useful, and parents rated it as useful and clear. The parent guidebook for ASI is ready for further testing and use. What This Article Adds: This report adds knowledge translation and best practice strategies in parent education to the parent guidebook for ASI and provides evidence that it is acceptable by experts, parents, and clinicians.

Relationship Between Childhood Sensory Processing Differences and Quality of Life as Adults.

Research suggests a relationship between sensory processing, motor skills and quality of life (QOL) in a variety of clinical populations of adults and children. There have been no studies which investigated the relationship of childhood sensory processing and integration and related motor performance (sensori-motor) patterns identified using an Ayres Sensory Integration® (ASI) frame of reference and later QOL of those children as adults. This longitudinal follow-up study examined this relationship. Adult QOL was also examined in relation to current adult sensori-motor patterns. Fifty-three adults who received occupational therapy services as children, were identified as having sensori-motor difficulties at that time and completed a sensory history and a quality-of-life measure as adults participated. Measures included the OTA the Koomar Center Sensory History (SXHX), Adult/Adolescent Sensory History (ASH), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF). MANCOVA found that Total childhood sensori-motor scores had a small relationship to Physical Health QOL as adults that approached significance. Pearson Correlations found that adults with childhood sensori-motor challenges who report sensori-motor challenges as adults had a moderate significant relationship among overall sensori-motor functioning and Physical Health (r = −0.56, p = 0.018). Visual (r = −0.76, p = 0.001), movement (vestibular; r = −0.48, p = 0.042) and tactile processing (r = −0.63, p = 0.008) had moderate to large significant relationships with Physical Health. Visual processing (r = −0.54, p = 0.024) was also significantly related to Psychological Health. Motor Coordination trended to significance for Physical Health (r = −0.42) and Psychological Health (r = −0.41). Conversely, adults who reported typical sensori-motor scores as adults, despite childhood sensori-motor challenges, had a good QOL. Furthermore, similar to previous research, there was a relationship between current visual, movement (vestibular) and tactile (touch) sensory processing and adult Physical and Psychological Health. A multivariate linear regression found Sensory Discrimination and Modulation accounted for one-quarter of the variance in QOL in adults with only Discrimination being statistically significant. Therefore, it is important to consider childhood sensori-motor function as well as adult functioning when examining QOL. Further, heretofore unexamined Sensory Discrimination was found to play a role in adult QOL.

Occupational therapy using an Ayres Sensory integration® approach for school-age children – a randomized controlled trial

ABSTRACT Sensory-based interventions, for children with problems regarding sensory integration (SI), have become recognised by the public in recent years; many advertised intervention programmes do not truly reflect the principles of Ayres Sensory Integration approach (ASI®). Furthermore, there is still a lack of evidence-based practice to support its clinical application in Hong Kong. This study aims to investigate the effectiveness of occupational therapy (OT), with ASI® interventions, for school-age children with SI problems through randomised controlled trials. Fifty-two subjects were randomly assigned to an experimental or control group; 27 participants in the experimental group received 16 sessions (45 min each) of ASI® intervention. Pretest/posttest changes in scores for goal attainment scaling, the Sensory Integration and Praxis Test (SIPT), and the Chinese Sensory Profile showed significant improvement in the experimental group. The results indicate that the ASI® intervention is effective in treating children with SI problems.

Occupational Therapy Using Ayres Sensory Integration®: A Randomized Controlled Trial in Brazil.

Research conducted in the United States has found that occupational therapy using Ayres Sensory Integration® is an effective evidence-based intervention for children with autism spectrum disorder (ASD). Replication of this research in other cultures is needed. To evaluate the outcomes of occupational therapy using Ayres Sensory Integration in a sample of Brazilian children with ASD. Prospective randomized controlled trial. Occupational therapy clinic. Seventeen children with ASD ages 5-8 yr (n = 9 in the intervention group, n = 8 in the usual-care control group) recruited from a local hospital via flyers and word-of-mouth. Completed pretreatment characterization and baseline measurement. The intervention group received occupational therapy using Ayres Sensory Integration, and the control group received usual therapeutic and educational services only. We conducted a pre-post assessment of self-care and socialization using the Pediatric Evaluation of Disability Inventory and individualized goal ratings. Participants in the intervention group scored significantly higher on outcome measures of self-care (p = .046, rb = .57), social function (p = .036, rb = .61), and parent-identified goal attainment (p < .001, rb = .94) compared with the control group. Occupational therapy using Ayres Sensory Integration was effective in enhancing self-care, socialization, and goal attainment for children with ASD in a Brazilian cohort. What This Article Adds: This study contributes further support from outside the United States that occupational therapy using Ayres Sensory Integration is an effective evidence-based intervention to improve self-care, socialization, and parent-identified goal attainment in children with ASD.

Ayres Sensory Integration ® Implementation in Malaysian Occupational Therapists: Challenges and Limitations

One of the most popular interventions provided by occupational therapists for pediatric clients is Ayres Sensory Integration® (ASI). Strict fidelity measures consisting of procedural and structural elements must be adhered to when using it. These fidelity measures distinguish Ayres Sensory Integration® from other sensory-based interventions. This study involved the development of a survey instrument and outlined the challenges that Malaysian occupational therapists face when using Ayres sensory integration® (ASI). The questionnaire development involved the processes of assessing its validity and reliability. A total of 161 occupational therapists working in various healthcare settings responded to the survey by answering a self-administered questionnaire. The results identified eight themes or issues: (1) Inadequate Training, (2) Resource Issues, (3) Physical Constraints, (4) Time Constraints, (5) Limited Information/ Support Provided By Family, (6) Limited Support From Management, (7) Limited Information/Support Provided By Suppliers, and (8) Issues in Implementing Evidence-Based Practice. Identifying the challenges of implementing ASI is an important aspect of improving occupational therapy assessments and interventions, which would establish the effectiveness of the interventions provided. Keywords: Ayres sensory integration; occupational therapy intervention; fidelity measures; sensory processing issues