Quick Notes: Sensory Integration

Sensory Integration Theory was formulated by A. Jean Ayres, Ph.D., OTR, an occupational therapist who practiced from the mid-1950s until 1988. Based on neuroscience principles, the theory describes an underlying rationale for the diagnosis and treatment approach that Dr. Ayres founded to evaluate and intervene with children who have particular sets of sensory and/or motor symptoms and who may have learning disabilities. Her basic concept was that the individual had a deficit in the central nervous system's ability to receive, filter, organize, and integrate stimuli, which resulted in a non-adaptive response.

Sensory Integration Dysfunction (DSI) was the term used by Dr. Ayres to refer to this broad theory, as well as the diagnosis and the treatment (e.g., sensory integration treatment) of children who have the dysfunction.

These terms and the relationships between them have been clarified for the purposes of this web site. The current terminology is explained below.

Sensory Integration is now recommended for use only to refer to Dr. Ayres' theories about mechanisms of the disorder and the intervention. Intervention is now referred to as "occupational therapy (OT) with a sensory-based (or sensory integration) approach," or "OT using Ayres' sensory-based (or sensory integration) approach."

Sensory Processing Disorder (SPD) is the label used to denote the diagnosis of difficulty in processing sensory input in an efficient and accurate manner, and includes the accompanying behavioral, attentional, motoric, and functional manifestations.

Sensory Modulation Disorder (SMD) is one of the three primary subtypes of Sensory Processing Disorder. Individuals with SMD have difficulty adjusting their responses to match the needs of the situation. They often have patterns of over-responsivity, under-responsivity, or sensory-seeking (or a combination of those patterns) in response to levels of stimulation that typically developing individuals respond to with a brief orienting response (noticing the new stimulus) and then habitation (ignoring the new stimuli) once it is interpreted as non-threatening.

Arguments against

Arguments for

Few, if any, studies looking at effectiveness of SI have used strict research methods, e.g. none have used RCT's

• Lots of research showing the effect of treatment (41-80 studies)
• RCT's are inherently difficult to produce esp in clinical setting

Despite advances in developmental cognitive neuroscience and large body of research on SI, there have been no major changes in theory of SI since Ayres 1979 book.

Today "best practice" uses a global intervention: Occupational Therapy. Intervention is focused on 'occupation' rather than treatment using specific techniques.

OT is about maximising potential and life satisfaction rather than curing individuals

Although OT may intervene at the impairment level (e.g. to address specific sensory problems in processing tactile, Proprioceptive or other sensory stimuli) these interventions are always embedded in occupational functioning.

Does SI therapy work? No. Samples used in studies are not homogenous.

The question is naïve. A more learned question is : "What effects are evident for a specific group of individuals receiving a specifically defined intervention compared to another intervention?" Making a statement based upon studies with different criteria and samples is inaccurate.

Psychomotor patterning? There are many similarities between SI and psychomotor patterning that are also disturbing. Psychomotor patterning, popularized by Doman and Delacato, is a method that suggests the child has not effectively acquired neurodevelopmental and evolutionary motor patterns (i.e., the assumption that ontogeny recapitulates phylogeny). A diet of sensory input, appropriate nutrition, breathing exercises and series of patterned motor movements are proposed to cure learning disabilities, mental retardation, brain injury and autism. The diet of sensory input and motor movements are quite similar to those now used in SI. Psychomotor patterning has been dismissed on two occasions by the American Academy of Pediatrics (1982; 1999) as completely ineffective. (see here for more)

• beginning with a spectacular and emotionally appealing hypothesis and only acknowledging supporting items ignoring all other evidence
• deliberately creating mysteries and mysterious new constructs (i.e. Si theorists invented the concept of "near senses" and refers to the plasticity of the CNS without explanation of how SI uses neural plasticity toward a restructuring of brain structure);
• the literature is aimed at the general public rather than the academic or clinical community
• convinces people by appeals to hope and faith in cases where the scientific and academic community have no scientifically accepted answers

A lab based approach has been created to measure physiologic responses to sensory stimuli using electrodermal reactivity (EDR). EDR assesses responses to sensory stimuli by measuring electrical changes in the skin. Skin conducts electricity when eccrine sweat glands are activated cholinergic fibers of the sympathetic nervous system. EDR of children with severe SID (i.e. those with fragile x) differs significantly from the EDR of typically developing children after sensory stimulation.

Vagal tone (VT) has also been used to measure sympathetic nervous functioning. SID children are seen to show significantly lower vagal tone than typically developing children.

"The sensory profile", a measure with high reliability that is used to discriminate children with SID from typically developing children.

So if no research why is that so many parents, professional and teachers swear by SI?

Answer: Placebo effect. If someone believes a therapy works and invests personal energy into making it work then to some degree it will work. In SI a therapist is spending 1:1 time with a child, coaching parents on how to interact with their child, supplying answers to parents and giving parents hope. Parents are empowered and become hopeful and involved. However a professional could give the same positive messages by giving the child a massage or playing chess with a child and there would be the perception of positive outcomes.

See comment on RCT's - there are indeed a lot of poorly formed research - just like a whole range of researched areas, but equally there is the beginnings of research that is striving to produce reliable non-biased studies.

Using SI due to the Placebo affect may not be that bad: it is estimated that 30% of Medical treatment is due to placebo affect. SI should be disregarded as an option when the diagnosis of SID and subsequent treatments interfere with a more appropriate diagnosis with a potential to result in an effective treatment plan. However this is highly debatable - should a (often expensive) treatment be used at all if it is purely the placebo effect taking place?

Its dangerous to prescribe treatment that hasn't been proven - using children and their families as guinea pigs.

Parents and children cannot wait for definitive research evidence

There is research stating that intervention works and some that state it doesn't - conclusion: it is neither proven nor unproven. Not that is "ineffective"

Serious scientific debate should be objective. emotional uses of terms such as "guinea pigs" and "deliberately creating mysteries" have no role to play in appraising extant data in social science research. Much remains to be accomplished in SI and SI therapy. Further systematic inquiry requires elminating emotion and belief from professional dialogues.