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Sensory Integration Therapy
What is Sensory Integration Therapy?
In order to best explain Sensory Integration Therapy, we should first discuss the disorder that is treats, Sensory Processing Disorder (SPD). Some individuals on the autism spectrum have difficulties processing sensory information, which is simply touch, smell, sight, sound, taste, and movement. Sensory integration dysfunction, sometimes referred to as Sensory Processing Disorder (SPD), is its own neurological disorder, but can also be associated with autism spectrum disorders, dyslexia, developmental, Tourette syndrome, and several others.1 Some of the shared characteristics of ASD and sensory processing disorder include repetitive behaviors, poor motor skills, avoids being cuddled as an infant, stimming (repetitive body movement), failure to respond to name calling, and sensitivities to bright lights or loud/sudden noises.2 Another commonality between ASD and sensory processing disorder is the controversy stemming from what causes the disorder. Much like ASD, some researchers believes sensory processing disorder is hereditary, while others believe environmental toxins play a role in the development of the disorder.3 Individuals on the autism spectrum have experienced success in limiting the detriments of sensory processing disorder by undergoing sensory integration therapy.
A. Jean Ayres, the originator of the theory of sensory integration and author of Sensory Integration and the Child, initially began writing about the topic in the 1950’s.4 In her book, Ayres defined sensory integration as “the organization of sensory information for use.”5 Sensory integration begins in the womb and is the most important type of sensory processing.3 Sensory integration allows individuals to experience the total sensation of everyday activities that many people take for granted. A common example used to illustrate this point is eating an orange. As you peel the orange you feel the texture of the skin, hear it tearing apart, see the fruit inside, smell the orange’s citrus odor, use your muscles and joints to bring the orange to your mouth, and finally taste the nectar from within the peel. The brain works to organize all of these senses and combines them to create the pleasant experience of eating an orange. All of these stimuli are processed by the brain, but individuals with sensory processing dysfunction have brains that aren’t “processing or organizing the flow of sensory impulses in a manner that gives the individual good, precise information about himself or his world.”3
Sensory integration therapy (SIT) is a specialized form of occupational therapy that shares goal of many other interventions, which is to enhance “the child’s ability to participate in the daily occupations which are meaningful and satisfying for that child in their natural context.”5 In the now trademarked Ayres Sensory Integration©, often referred to as classical SIT, the individual is provided various sensory experiences. Classical SIT “typically involves one-to-one direct intervention in an environment that has a variety of specialized equipment.”6 This specialized equipment can consist of swings, hammocks, ladders, bouncers, rock walls, weight blankets, bubble columns and tubes, ball pools, etc. The occupational therapist, through the use of this specialized equipment, “provides opportunities for the child to achieve sensory experiences that he might not get I his home and community environment.”7 The “hallmark of sensory integration is that is done in the context of play, the children love the activities, and the activities are their own reward.”4
Play is the universal medium used by occupational therapists for children undergoing classical SIT. For the therapy to be effective the child must be active, motivated, and engaged.5 According to Autism-Help.org,1 the four main principles of sensory integration are:
- Just Right Challenge: the individual must be able to successfully meet the challenges that are presented through playful activities
- Adaptive Response: The individual adapts their behavior with new and useful strategies in response to the challenges presented
- Active Engagement: the individual will want to participate because the activities are playful
- Child Directed: The individual’s preferences are used to initiate therapeutic experiences within the session
How does Sensory Integration Therapy make a Difference for Individuals with Diagnoses on the Autism Spectrum?
The goal of any occupational therapy is to “support an individual’s ability to engage in every day occupations or activities and acquire skills to promote function.”8 Sensory integration therapy is no different. Occupational therapists utilize specialized equipment to provide sensory stimulation through play. This process helps address a number of sensory issues including hand-eye coordination, overcoming hypersensitivities to movement or to feeling certain objects like fur, carpet, or even human touch, motor planning, and other sensory functions. Classical SIT, as developed by Jean Ayres, works to remediate the underlying impairments of the disorder, which can cause problem behaviors, by exposing the individual to various sensory experiences.5 Parents and teachers find the positive influences of sensory integration therapy include the ability to help calm the child or adult, reinforce positive behaviors, and help with transitioning between activities.9
What do Sensory Integration Therapy Treatment Providers Do?
Occupational therapists who specialize in sensory integration therapy conduct one-on-one play sessions designed to gradually enhance the individual’s ability to process sensory information. These play sessions are centered around specialized equipment like swings, trampolines, balls, tubes, etc. that help develop sensory skills, which can result in improved hand-eye coordination, motor planning, organizational skills, and a reduction in problem behaviors. Some individuals with sensory processing disorder have hypersensitivity to movement or touch, in which case the occupational therapist will gradually work their way up to swinging and other activities that require a great deal of movement.10 Occupational therapists certified in sensory integration are qualified to administer the Sensory Integration and Praxis Test (SIPT).8 The Sensory Integration and Praxis Test was developed by A. Jean Ayres in 1989, and it is used to assess sensory processing and motor function for children aged 4 to 8 years and 11 months of age.11 Unfortunately, a child with autism may have other motor, behavioral, and language challenges that make it difficult to interpret their responses to the SIPT assessment.12 Although the majority of the focus on diagnosis and treatment of SPD is centered on children and adolescents, the goal of independence remains consistent through adulthood and occupational therapists are equipped with various intervention strategies to help adult individuals with SPD to have success in the workplace as well as socially.8
Who is Qualified as a Sensory Integration Therapist?
Western Psychological Services (WPS), the only organization currently offering SIT certification, requires the completion of four 5-day courses in order to be qualified to administer the Sensory Integration and Praxis Test (SIPT), but certification is not required to practice sensory integration therapy. WPS works in conjunction with the University of Southern California Division of Occupational Science and Occupational Therapy to present these courses. The courses teach individuals about the theoretical foundations of sensory integration, how to administer and understand the Sensory Integration and Praxis Test, and how to use assessment data to plan intervention strategies.13 Individuals certified in sensory integration therapy are entered into Western Psychological Services’ global database. Further information on Western Psychological Services’ Sensory Integration Certification Courses can be found here.
What research is there to Support Sensory Integration Therapy?
Initially, studies conducted on the efficacy of sensory integration therapy’s efficacy were quite promising, but beyond the 1970’s and 80’s, research results have been less favorable for SIT.6 Many of these studies focus on classical SIT and focus on the intervention’s ability to improve motor skills, academic performance, sensory and perceptual skills, and behavioral performance in children with developmental disabilities. The lack of evidence for the support of SIT is not a result of a lack of trying, as there have been more than 80 studies conducted that address the effectiveness of the approach, making it the most researched of “any other intervention in the field of occupational therapy.”5 In addition to these research studies, there have been multiple meta-analyses conducted, which focus on past research concerning SIT. One meta-analysis was conducted in 1999, and found the treatment had no positive effect, but the study was riddled with methodological flaws, while another meta-analysis included only studies before 1980, a time when research methodologies were less rigorous, and therefore less substantial.14 In 2012, a meta-analysis of 25 studies related to sensory integration therapy found that there is very little to support the use of this intervention for children with ASD. In fact, of the 25 studies that were analyzed, only three were found to have positive results.15 Furthermore, many of the studies have substantial methodological flaws, including the three studies that yielded positive results. The conclusion of the abstract of this study insists that “practitioners and agencies serving children with ASD that endeavor, or are mandated, to use research-based, or scientifically-based, interventions should not use SIT outside of carefully controlled research.”15 Temple Grandin, an individual with high-functioning autism and a renowned author on the subject of ASD, has written about the difficulties of designing and conducting double-blind research studies centered on sensory integration dysfunction.1 More research studies that do not have the methodological limitations seen in past research studies, such as parent participation, small sample size, single-subject design, and other research design flaws, are necessary.
The National Standards Project, an organization that works to review the scientific literature regarding various behavioral treatments for autism spectrum disorder, defined sensory integrative treatments as “unestablished.”16 Treatments that fall under this category do not have research to support them as efficacious or the research that has been conducted does not allow the NSP to draw firm conclusions about the treatment’s effectiveness.16 Treatments that fall under this category should only be considered after additional quality research is conducted.
Where Can I find a Practitioner of Sensory Integration Therapy?
There are practitioners of sensory integration therapy all over the globe. To find one closest to your location, visit the S.I. Certified Therapist Directory of Western Psychological Services.