Ayres Sensory Integration

Dr. A. Jean Ayres, PhD, OTR, FAOTA, an occupational therapist and psychologist, was the first researcher clinician from the therapy fields to:

Define the impact of sensory processing on learning, emotions and behavior;
Design and standardize assessments that provide a comprehensive understanding of sensory integrative function and dysfunction;
Create a set of intervention principles to address sensory integration deficits for improved function and participation;
Implement a carefully designed research program over time to study and refine knowledge about sensory integration function and dysfunction;
Develop and articulate a theoretical framework that incorporated these concepts, principles and techniques (Ayres, 1972).

Beginning in the 1960’s, Dr. Ayres systematically investigated the nature of the way the brain processes sensory information so that it can be used for learning, emotions and behavior, creating sensory integration theory as it is currently used in occupational therapy practice and applied in pediatrics and childhood education. This approach is known as Ayres Sensory Integration®. Ayres Sensory Integration ® Registered Trademark Ayres Sensory Integration®. includes the theory, assessment, patterns of sensory integration and praxis dysfunction and intervention concepts, principles and techniques articulated by Dr Ayres and applied by therapists trained in this approach worldwide. A summary of these main components of Ayres Sensory Integration® is presented here on the SIGN website for the purpose of protecting and promoting Dr. Ayres’ body of work and to assist in differentiation of this approach from others that might share some similar terminology or techniques. As a registered trademarked, Ayres Sensory Integration® is applied only on applications that reflect the following distinctions.

Sensory Integration Theory

Sensory integration theory proposes that sensory integration is a neurobiological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. Sensory integration is information processing…Praxis and perception are both end products of sensory integration… Practic ability includes knowing what to do as well as how to do it.

Practic skill is fundamental to purposeful activity”(Ayres, 1986 p. 9). The effectiveness of organism-environment transaction in promoting human development is partially dependent up on the inherent plasticity of the central nervous system. The brain, especially the young brain, is naturally malleable; structure and function become more firm and set with age. The formative capacity allows person-environment interaction to promote and enhance neurointegrative efficiency. A deficiency in the individual’s ability to engage effectively in this transaction at critical periods interferes with optimal brain development and consequent overall ability. Identifying the deficient areas at a young age and addressing them therapeutically can enhance the individual’s opportunity for normal development (Ayres, 1986 p.10). “Essentially, the theory holds that disordered sensory integration accounts for some aspects of learning disorders and that enhancing sensory integration will make academic learning easier for those children whose problem lies in that domain. Sensory integration, or the ability to organize sensory information for use, can be improved through controlling its input to active brain mechanisms… Sensory integrative processes result in perception and other types of synthesis of sensory data that enable man to interact effectively with the environment. Disorders of perception have been reasonably well established as concomitants of early academic problems” (Ayres, 1972 p. 1). “It is a provisional theory with continued modifications anticipated as research and clinical knowledge help it evolve” (Ayres, 1986 p. 9).

Evaluating Sensory Integration Dysfunction

Ayres developed 17 standardized tests and many non-standardized observations that contributed to the identification and understanding of the multiple patterns of sensory integration dysfunction. Her original tests, the Southern California Sensory Integration Tests (SCSIT) were revised and expanded and in 1986 published as the Sensory Integration and Praxis Tests (SIPT). Her research beginning in 1962 identified factors that correlated highly with each other such as tactile discrimination and praxis. These patterns consistently emerged time and time again through factor and cluster analyses (see Parham and Mailloux for summary), including confirmatory factor and cluster analyses in a 10,000 n data set by Mulligan (1998). The most common patterns of sensory integration dysfunction include: visual perception deficits; visual motor deficits; visual construction and praxis deficits (visuodyspraxia); tactile discrimination deficits; vestibular processing deficits; proprioceptive processing deficits and poor body scheme; bilateral integration and sequencing deficits including poor postural control (bilateral integration and sequencing); somatosensory-based dyspraxia (somatodyspraxia), language-based dyspraxia (dyspraxia on verbal command), sensory sensitivities especially tactile defensiveness and gravitational insecurity. Patterns of sensory integration dysfunction that include motor incoordination, fine and gross motor delays, deficits in balance, poor praxis are often included in the diagnostic category of Developmental Coordination Disorder. Patterns of sensory integration dysfunction that include unusual over, under or fluctuating responses to sensation may be included in deficits such as Regulatory Disorder or Sensory Processing Disorders. In practice, the SIPT is considered the gold standard for assessing sensory integration dysfunction. It is intended for school-age children without severe motor or mental disorders. Normative data begins at age 4 up to 8 years 11 months. It may be used on older individuals. It is commonly used with children with the diagnosis of high functioning autism or Asperger’s Syndrome. For those individuals for whom the SIPT is not appropriate, other methods and assessments must be used to glean the information. In addition to the SIPT, or evaluations that address these constructs, therapists investigating this disorder will use methods of clinical observations of neuromotor functions (Blanche, 2002) and sensory modulation abilities (responsiveness to sensation) (Parham & Ecker, 2007; Miller-Kuhaneck, Henry & Glennon 2007; Dunn, 1999).

Intervention Principles Based on Sensory Integration Theory

In 2002, occupational therapy experts from various sites across the United States together identified and defined the core principles of sensory integration intervention as used in professional practice such as occupational therapy. The rationale for this fidelity project emerged from the need for an instrument to validate the methods reported in research as “sensory integration” (Parham et.al, 2007). The following principles are deemed essential to the delivery of intervention using a sensory integration approach (Parham et. al., in preparation):

Qualified professional, occupational therapist, physical therapist or speech and language pathologist;
Intervention plan is family-centered, based on a complete assessment and interpretation based on the patterns of sensory integrative dysfunction, collaboration with significant people in the individual’s life, adherence to ethical and professional standards of practice.
Safe environment that includes equipment that will provide vestibular, proprioceptive and tactile sensations and opportunities for praxis.
Activities rich in sensation especially those that provide vestibular, tactile and proprioceptive sensations and opportunities for integrating that information with other sensations such as visual and auditory.
Activities that promote regulation of affect and alertness and provide the basis for attending to salient learning opportunities.
Activities that promote optimal postural control in the body, oral-motor, ocular motor areas and bilateral motor control sustaining control while holding against gravity and maintaining control while moving through space.
Activities that promote praxis including organization of activities and self in time and space.
Intervention strategies that provide the “just-right challenge”
Opportunities for the client to make adaptive responses to changing and increasingly complex environmental demands. Highlighted in Ayres Sensory Integration ® intervention principles is the “Somato-motor adaptive response” which means that the individual is adaptive with the whole body, moving and interacting with people and things in the 3-dimensional space.
Intrinsic motivation and drive to interact through pleasurable activities, in other words, play.
Therapist engenders an atmosphere of trust and respect through contingent interactions with the client. That is the activities are negotiated, not pre-planned, and the therapist is responsive to altering the task, interaction and environment based on the client’s responses.
The activities are their own reward and the therapist ensures the child’s success in whatever activities are attempted by altering them to meet the child’s abilities.

While over 80 studies have been published on evidence in the effectiveness of sensory integration methods sensory integration, many have methodological flaws. Most do not report fidelity and those that do have minimally adhered to the fidelity principles that define Ayres Sensory Integration®.. The current application of Ayres Sensory Integration® is based on evidence from some carefully designed studies that do adhere to the intended principles, as well as from extensive related neurobiological psychological and therapeutic research. However, further research is clearly needed.

Ongoing Development of Sensory Integration in Practice

"if I have been productive, it is partly because I have had the advantage of contact with those with the courage as well as the ability to think independently and along unorthodox lines. It has not been easy for the helping professions to conceive of human behavior as an express of the brain, and they are still struggling to do so… The employing of neural mechanisms to enhance motor development is now well established; the current area of major growth and controversy lies in the use of neurological constructs to aid in understanding and ameliorating cognitive functions such as learning disabilities; the next step may well be a more fruitful attack on emotional and behavior disorders.” Jean Ayres Ph.D (1974, p. xi). The need for ongoing research and development this theory is great, driven by the scores of children and families who live with these difficulties. The possibilities for improving their quality of life now and in the future through the application of these principles demand that additional efforts be made. Researchers, scholars and practitioners will continue to refine and develop Ayres Sensory Integration® theory and applications in therapeutic practice through innovations and refinements in knowledge and science. “The amount of change in thinking from early papers to later papers reminds one that even greater change in thought will occur in the years to come, especially if based on the rapidly growing amount of neurobiological research” (A. Jean Ayres, 1974, p. xii). And so it continues…

Prepared by:

Susanne Smith Roley M.S., OTR/L, FAOTA

Zoe Mailloux M.A., OTR/L, FAOTA

Brian Erwin