Ayres Sensory Integration (ASI) is a therapeutic approach developed by Dr. Anna Jean Ayres, a psychologist, neuroscientist, and occupational therapist, in the 1960s. The sensory integration (SI) approach is often utilized with children and individuals with sensory processing disorders (SPD), sensory challenges, autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), and other developmental challenges.
The hallmark of ASI is that it allows for individual client-centered intervention methods. Occupational therapists who utilize ASI, perform comprehensive assessments to identify sensory processing challenges, and then can create individualized intervention plans to address specific challenges, such as an individual’s ability to participate and perform in self-care activities, social interactions, play skills, academic and community activities.
What is sensory integration?
Sensory integration is a neurological method by which individuals receive, sort, process, interpret, and apply sensory information from the environment. Sensory information includes auditory, visual, tactile, smell, taste, proprioception, vestibular, and interoception.
Once information or input is received, it is processed, and the brain can then decide what type of information it is, and the body reacts accordingly (an adaptive response).
Sensory processing is a vital component in daily functioning as it influences how an individual perceives and responds to sensory stimuli from the environment. The ability to process and integrate sensory input impacts an individual's physical, cognitive, and social-emotional well-being.
Sensory integration dysfunction (SID) or sensory processing disorder (SPD) are terms that are used interchangeably, and it is a neurological disorder that results from the brain’s inability to integrate specific sensory input received from the body’s sensory systems.
The individual will react negatively to normal stimuli they receive and will avoid or seek out specific sensory input, have emotional-regulation challenges, attention challenges, motor planning difficulties, feeding challenges, and/or social challenges.
In addition, visual-motor, gross motor, and fine motor difficulties can be found with sensory processing difficulties such as issues with balance, eye tracking, or handwriting.
Overall, sensory processing difficulties can impact an individual’s ability to function effectively in daily life. It is important to remember as each person is different, signs can greatly vary among individuals.
Some people may experience sensory processing challenges to a great degree and others to a lesser degree without it impacting them significantly or being diagnosed with the disorder. Some common signs and symptoms can be found below. It is important to remember that this is not an all-encompassing list.
Common signs and symptoms of sensory processing issues
Sensory avoidance
- Tactile sensitivity:
- Avoids clothing or foods of certain textures
- Does not like to get messy
- Difficulty with grooming
- Vestibular sensitivity:
- Avoids playground equipment
- Likes sedentary play
- Fearful of being on moving equipment
- Very cautious of movement activities
- Visual sensitivity:
- Sensitive to bright lights
- Sensitive to busy environments
- Auditory sensitivity:
- Overreaction or distress with loud noises
- Covers ears
Sensory seeking
- Tactile Seeking:
- Constant touching
- Seeking out touch sensations
- Vestibular Seeking:
- Seeks out movement
- Spinning
- Swinging
- Rocking
- Proprioceptive seeking:
- Seeks out deep pressure
- Likes tight hugs
- Crashing
- Jumping
- Difficulty with force-gradation
Evaluation, assessment tools and methods
ASI incorporates many different sensory evaluation assessments which include:
- Sensory Profile (SP),
- Sensory Processing Measure (SPM),
- and structured and skilled sensory play observation.
Sensory profile
The sensory profile is used to assess an individual’s sensory processing patterns and how they respond to various sensory stimuli. It helps clinicians identify sensory processing strengths and areas of growth, as means to understand the individual.
It is a questionnaire that is often given to caregivers including teachers to fill out for the child. There is also an adult version of the SP. It asks a series of questions based on tactile, vestibular, proprioceptive, auditory, visual, and multi-sensory processing. The sensory profile categorizes the sensory processing patterns into quadrants including sensory seeking, sensory avoiding, sensory sensitivity, and low registration.
SIPT
The Sensory Integration Praxis Test (SIPT) is a comprehensive assessment tool that was developed by Dr. A. Jean Ayres. Components of the test include tactile, vestibular, proprioceptive, visual, bilateral motor integration, motor planning, and SI and Praxis Quotient.
The SIPT is utilized for children between the ages of 4 years and 8 months and 8 years and 11 months. Licensed occupational therapists require additional training to perform the assessment, which increases the reliability and validity.
SPM
The Sensory Processing Measure (SPM), is also another questionnaire that is used in clinics and academic settings. It provides insight on how sensory issues impact daily functioning, and how motor planning and praxis is impacted.
Skilled sensory observation refers to meticulously observing an individual’s response to sensory stimuli in a structured setting. Occupational therapists often utilize skilled observation in addition to utilizing the SIPT, SP, and/or SPM during the evaluation process in clinical and/or academic settings.
The focus is on how the individual reacts to sensory stimuli and clinicians are looking for signs of seeking or avoidance behaviors, sensitivity, or other patterns of sensory processing. In addition, occupational therapists may conduct interviews with parents, caregivers, and educators to gain insight on the individual’s sensory behaviors in different settings, as a method to comprehensively understand the sensory profile of the whole individual.
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Interventions and goals
A fundamental part of ASI is that intervention plans are specific to the sensory needs of each individual and treatment plans are tailored to meet those individual needs. Enhancing sensory integration and processing can allow for improved ability for an individual to perform self-care tasks, engage in social interactions, academic environments, play, and overall quality of life. ASI interventions are evidence-based and promote neuroplasticity. SMART goals are key to measure and track progress.
Examples of various sensory goals tied to functional outcomes can be found below.
- Tactile goal: Client will engage in hair washing for 50% of the task without adverse behavioral reactions, in 3 out of 5 days of the week, for increased participation in ADL tasks.
- Emotional regulation goal: Client will independently choose and use a self-regulation tool of their choice when given less than 2 verbal or visual cues, 3 out of 4 trials, as measured by OT data collection and observation.
- Motor planning goal: Client will negotiate a multi-step obstacle course (e.g. balance beam, ramp, stairs, climbing equipment) independently, in 4 out 5 trials to demonstrate age level balance reactions and ability to sequence.
- Attention goal: Client will demonstrate appropriate sensory modulation skills to sit and participate in circle time for 5 minutes, by using sensory strategies, for 3 out of 5 days of the week, as measured by teacher report.
Sensory diets
A sensory diet is a personalized plan of sensory activities designed to help individuals organize, regulate, and modulate their sensory experiences throughout the day. Based on the individual’s sensory profile, it is either to calm an individual or alert an individual to help participate in activities throughout the day.
It is best if the diet is incorporated into the individual’s daily routine including at home, school, and community settings. Regular monitoring and collaboration with educators and caregivers are key to adjust based on the ever-changing needs of an individual.
Pros and cons of ASI
PROS:
- Individualized interventions & client-centered
- Takes into account the whole person and is holistic in nature
- ASI is rooted in theory and research
- Purposeful activities
- Collaboration with parents, caregivers, and educators
CONS:
- Requires additional training
- Variability in data interpretation
- Not universally accepted
- Not applicable to everyone
In conclusion, ASI is a highly valuable and well-established therapeutic approach utilized by many occupational therapy practitioners, specifically for clients with sensory processing difficulties.
ASI interventions are focused on evidence-based practice, neuroplasticity, and purposeful play and activities. Furthermore, it is very client-centered, and considers the person as whole.
Continuous monitoring, re-assessment, and collaboration is key to improve client outcomes. While it is a well-established therapy approach, further research is still warranted to support the overall effectiveness.
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More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
