Understanding sensory integration therapy

Sensory integration therapy is a therapeutic approach rooted in the 1950s and 1970s work of occupational therapist (OT) and psychologist A. Jean Ayres, PhD, OTR, FAOTA. She pioneered the theory that the way the brain processes sensory information affects learning, behavior, and function. 

Ayres described sensory integration as the neurological process by which we receive, interpret, and respond to sensory stimuli from our environment.

Over the years, Ayres’ foundational theory evolved into various models, including the Model of Sensory Processing developed by Winnie Dunn, OTR, FAOTA, and the work on sensory processing disorder by Lucy Miller, PhD, OTR/L, which emerged in the late 1970s.

These models all explore how efficiently—or inefficiently—the brain interprets and responds to sensory input.

Summary

• Sensory integration therapy helps clients better process sensory input through structured, individualized, play-based interventions.
• Sensory integration therapy is grounded in neuroscience and often used with individuals who have sensory processing disorder, autism, ADHD, or related challenges.
• There is a distinction between Ayres Sensory Integration® (ASI) and broader sensory-based strategies used in OT.
• Tools such as Sensory Integration and Praxis Tests (SIPT) and the Sensory Profile help assess and inform interventions.
• Adults, and even infants, may benefit from properly applied sensory integration approaches.
• Evidence-based practice is still evolving—OTs should stay informed about what’s supported and what’s not.

What is sensory integration?

Sensory integration refers to the brain’s ability to organize and interpret sensory information to produce appropriate responses. This includes data from eight sensory systems.

The 8 sensory systems

• Sight (visual): Processes what we see (light, color, movement, shape)
• Auditory (hearing): Interprets sounds and how we respond to them
• Tactile (touch): Registers touch sensations such as pressure, texture, and temperature
• Olfactory (smell): Relates to smell and how it impacts behavior and memory
• Gustatory (taste): Involves the sense of taste
• Vestibular (balance and coordination): Helps with balance, spatial orientation, and coordination
• Proprioception (body awareness): Informs body awareness, position, and movement through muscles and joints
• Interoception (internal sensations): Senses internal body signals like hunger, thirst, heart rate, and the need to use the bathroom

When sensory signals are not integrated properly, individuals may develop sensory processing deficits, which can negatively affect motor planning, emotional regulation, focus, and behavior.

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What are sensory difficulties?

Sensory difficulties occur when the brain struggles to filter and respond to sensory input. 

These challenges can be broken down into several categories:

• Hyper-responsivity: Overreaction to sensory input (e.g., distress from light touch or loud sounds)
• Hypo-responsivity: Underreaction or lack of awareness (e.g., not noticing food on the face)
• Sensory seeking: Craving intense sensory experiences (e.g., constant movement, crashing into objects)
• Sensory discrimination difficulties: Trouble interpreting nuances of input (e.g., using too much force when writing)
• Dyspraxia: Difficulty with motor planning (e.g., appearing clumsy or uncoordinated)

These patterns are common in children referred for sensory integration therapy, but they are also occur in adolescents and adults.

The role of sensory integration therapy in clinical care

Sensory integration therapy is commonly provided by occupational therapists in schools, outpatient clinics, or private practice settings. Its goal is to help individuals develop adaptive responses to sensory stimuli through structured, play-based interventions tailored to the client’s specific needs.

This therapeutic approach is especially relevant in light of increased regulation challenges observed in school-aged children. 

As schools and clinics implement more strategies, it's crucial for OTs to distinguish between sensory integration therapy and more general sensory-based supports.

Evidence-based practice and professional responsibility

As clinicians, it's essential to distinguish between Ayres Sensory Integration® (ASI) and generic sensory integration therapy strategies. 

ASI is a research-based, fidelity-driven approach that requires post-professional certification. 

It emphasizes:

• Child-led, play-based therapy
• Individualized sensory activities using specialized equipment
• Clinical reasoning informed by formal assessments like SIPT

In contrast, general sensory integration therapy often includes passive activities such as weighted blankets, brushing, or swinging—but these often lack the evidence base required to be classified as ASI.

The Practice Smart guidelines published by AOTA advise OTs to be cautious about using non-evidence-based sensory interventions. While many therapists observe benefits from these strategies, their use should be carefully evaluated and documented within the scope of clinical reasoning.

Treatment for sensory processing disorder

There is no one-size-fits-all treatment for sensory processing disorder, but sensory integration therapy—when applied correctly—can significantly improve daily functioning.

Typically, sensory integration includes:

• Assessment using SIPT, Sensory Profile 2, or the Sensory Processing Measure
• Individualized sensory diets based on specific input needs
• Environmental modifications to reduce sensory triggers
• Parent and teacher education to support generalization of skills

While sensory integration therapy is commonly used, OTs must ensure interventions are rooted in the client’s specific sensory profile and align with clinical best practices.

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Diagnosing sensory processing disorder

Although widely recognized by therapists and educators, sensory processing disorder is not currently included in the DSM-5, which continues to be a point of debate among medical professionals.

OTs do not diagnose SPD, but they can perform assessments that inform a diagnosis by a medical or mental health provider.

What is sensory integration for adults?

A growing number of adults are reporting sensory processing challenges related to anxiety, work environments, or trauma history. So, what is sensory integration for adults?

In adults, sensory integration therapy may involve:

• Mindfulness and self-regulation strategies
• Occupational routines to support sensory needs (e.g., breaks for movement or quiet)
• Cognitive-behavioral techniques to address sensory overwhelm
• Interdisciplinary referrals when needed (e.g., for trauma treatment)

Many adults have learned to cope or mask their sensory challenges, but therapy can help improve function, reduce stress, and increase quality of life.

SPD in infants

Although harder to identify, symptoms of SPD in infants can include:

• Trouble self-soothing or sleeping
• Excessive crying when held or touched
• Difficulty with breastfeeding or solid foods
• Delayed developmental milestones
• Poor attachment or bonding with caregivers

Early detection is vital. If an OT suspects sensory processing disorder in an infant, thorough evaluation and family-centered education should follow.

Related condition: Auditory processing disorder

Auditory processing disorder is often confused with or considered part of sensory processing disorder, but they are distinct. 

APD specifically affects how the brain interprets sound, which impacts speech understanding but does not affect other sensory systems.

OTs and speech-language pathologists should collaborate when evaluating clients with auditory and broader sensory issues to ensure a comprehensive treatment plan.

Final thoughts on using sensory integration therapy

OTs play a critical role in helping clients with sensory integration difficulties lead healthier, more functional lives. 

Whether you're working with children, teens, adults, or infants, sensory integration therapy can be a powerful intervention when used correctly and ethically. 

By distinguishing between evidence-based ASI® and more generalized sensory strategies, clinicians can support regulation, participation, and learning with integrity and effectiveness.

Sources

• Arky, B. (2024). The Debate Over Sensory Processing.
• Ayres, A. J. (1969). Deficits in sensory integration in educationally handicapped children.
• Ayres, A. J. (1971). Characteristics of types of sensory integrative dysfunction.
• Battin et. al., (2020). Effectiveness of Occupational Therapy Sensory Interventions for Children and Adolescents: A Systematic Review.
• Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review.
• Collaborative Leadership for Ayers Sensory Integration. (n.d.).
• Costa-López B, Ferrer-Cascales R, Ruiz-Robledillo N, Albaladejo-Blázquez N, Baryła-Matejczuk M. (2021). Relationship between Sensory Processing and Quality of Life: A Systematic Review. 
• Metz AE, Boling D, DeVore A, Holladay H, Liao JF, Vlutch KV. (2019). Dunn's Model of Sensory Processing: An Investigation of the Axes of the Four-Quadrant Model in Healthy Adults.
• Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration intervention research.
• Trick, Kristin. SimplePractice Blog (2025) “What is sensory processing disorder (SPD)?”
• The National Clearinghouse on Autism, Evidence & Practice, Ayres Sensory

Integration®: A Companion to the NCAEP Report 2020.

• Wong C, Odom SL, Hume KA, Cox AW, Fettig A, et al. (2015). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review.

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