Sensory Integration Therapy: What the Research Actually Shows

What is sensory integration therapy?

Sensory integration therapy is an occupational therapy approach for children who have trouble processing sensory input. It was developed in the 1970s by A. Jean Ayres, an occupational therapist, and its sessions are play-oriented, using equipment such as swings, trampolines and slides.⁠¹ Ayres, an occupational therapist and educational psychologist, likened the underlying difficulty to a neurological “traffic jam” that keeps parts of the brain from getting the sensory information they need.⁠¹⁴

Her principles, described in her work from 1972 onward, were later turned into a fidelity measure, which is what lets researchers say whether a study actually delivered her therapy.⁠^4,8 Researchers call that version Ayres Sensory Integration, or ASI, and most of the evidence below is about it.⁠^2,4

What does SI therapy mean?

SI stands for sensory integration, so SI therapy is sensory integration therapy. In research papers the same treatment appears as OT/SI or OT-SI, short for occupational therapy using a sensory integration approach.⁠^15,16 Treatment is usually delivered by an occupational therapist, though the fidelity measure allows qualified physical therapists or speech-language pathologists in some cases.⁠⁷

What is sensory integration?

Sensory integration is the way the nervous system receives messages from the senses and turns them into motor and behavioral responses: biting into a sandwich, riding a bicycle or reading a book all depend on it.⁠¹⁴ The National Clearinghouse on Autism Evidence and Practice defines ASI as interventions that target a person’s ability to integrate visual, auditory, tactile, proprioceptive and vestibular information from the body and the environment, so the person can respond with organized, adaptive behavior.⁠¹⁷

What does a genuine ASI session look like?

In one randomized trial, the therapy took place in a large gym with mats, suspended swings, large balls, a climbing wall, carpeted barrels, inner tubes and foam blocks. The child played actively while the therapist set up sensory-motor activities matched to that child, at a level that was challenging but achievable.⁠¹⁵ The reviews that separate real ASI from other sensory work list the same ingredients:⁠⁴

• Individual tailoring. Activities are chosen for the child’s assessed sensory-motor needs, not drawn from a fixed routine.⁠^4,15
• Active engagement. The child takes part, rather than having sensation applied to them.⁠^4,6
• The just-right challenge. Each activity is hard enough to stretch the child and easy enough to succeed at.⁠^4,15
• Play and a therapeutic alliance. The work happens through play, with a trusting relationship between child and therapist.⁠⁴
• Functional goals. Progress is measured against goals set with the family, such as self-care or joining in with others.⁠^2,15

What it is not: a child wearing a weighted vest in class, being brushed on a schedule, or sitting on a ball chair. Those are sensory-based interventions, which tend to be adult-led and apply sensory input to the child.⁠^5,6 They may appear inside a broader occupational therapy plan, but they are not ASI and do not carry its evidence.⁠⁴

What is the Ayres Sensory Integration Fidelity Measure?

It is a checklist, built for research, of what has to be present for therapy to count as ASI. Its process section, scored by trained raters from video of therapy sessions, proved highly reliable and told ASI apart from four other interventions.⁠⁸ Its structural section rates the setting, and in a survey of 259 occupational therapists from 185 facilities it separated settings that practice ASI from those that do not.⁠⁷

For a family, the measure turns a vague label into things that can be checked: the therapist’s training, the assessment report, the room and the goals set with parents.⁠⁷ Reviews also use it to decide which studies count as ASI at all.⁠^2,9

ASI vs sensory-based interventions: why the difference matters

Because the evidence splits along that line. A 2015 review of 23 studies found moderate evidence for ASI and mixed results for sensory-based methods.⁠¹⁸ A second 2015 review separated clinic-based sensory integration therapy, where two randomized trials found positive effects on goal attainment, from classroom techniques such as weighted vests, where few positive effects were found.⁠⁵

A family offered “sensory integration therapy” may be offered either. Asking what the sessions involve, where they happen and who leads them usually makes clear which one it is.⁠^6,7

How well does sensory integration therapy work?

For autistic children, the best answer is: often for the goals it is designed to target, with real doubts about how strong the evidence is. Three reviews rate the evidence for individual goal attainment as strong.⁠^2,19,20 A large UK trial and a 2026 review that rated study quality more harshly were far less positive.⁠^3,9 For other groups, and for behavior problems, the evidence is thinner.⁠²

Is Ayres Sensory Integration an evidence-based practice?

By two formal standards, yes, for autistic children. A 2019 review applied the Council for Exceptional Children’s standards to research from 2006 to 2017; two randomized trials met 100% and 85% of the criteria, and the authors concluded ASI can be considered an evidence-based practice for autistic children aged 4 to 12.⁠⁴ The review notes its conclusion applies only to children with IQs above 65.⁠⁴

The National Clearinghouse on Autism Evidence and Practice added ASI to its list of evidence-based practices in its 2020 report, on the strength of three studies, and stressed that the label covers Ayres’ model, not the variety of unsupported sensory interventions.⁠¹⁷ An AJOT review of studies from 2015 to 2024 found strong evidence for ASI on individual goal attainment and occupational performance, and moderate evidence for daily living, self-care, social, communication and play skills.⁠²⁰

What do the randomized trials of ASI show?

• A 2014 trial. 32 autistic children aged 4 to 8; those who had 30 sessions scored higher on their individual goals (effect size 1.2), needed less caregiver help with self-care (0.9) and scored better on socialization (0.7) than children in usual care.⁠¹⁵
• Brazil, 2022. 17 autistic children aged 5 to 8; the therapy group scored higher on self-care, social function and parent-identified goals.⁠²¹
• Sensory modulation disorder, 2007. A pilot of 24 children, compared with an activity protocol and no treatment; the therapy group made larger gains in goal attainment and in attention.⁠¹⁶
• The 2025 review. Nine trials with 344 children: strong evidence from five trials that ASI helps autistic children meet individualized goals, moderate evidence from three that it does not help behaviors of concern, and continuing concerns about bias.⁠²
• The 2026 meta-analysis. 23 trials of sensory integration therapy in children: improvements in motor skills, daily functioning and individualized goals, but not in balance, visual construction or sensory processing itself.⁠²²

An earlier review of 19 studies had already found that the two randomized trials of clinic-based sensory integration therapy reported effect sizes of 0.72 to 1.62 on Goal Attainment Scaling, and called for larger trials using manualized protocols.⁠⁵

What did the SenITA trial find?

SenITA, a UK trial published in 2022, randomized 138 autistic children with sensory processing difficulties in mainstream primary schools in Wales and England to manualized sensory integration therapy or usual care. The therapy group had 24 clinic sessions over 26 weeks, delivered with good fidelity and no adverse effects.⁠³

There were no significant effects on the main outcome, problem behaviors including irritability, at 6 or 12 months, and the economic analysis found the therapy was not cost-effective compared with usual care. Parents and therapists reported improvement in daily functioning, and parent-rated goal performance rose across sessions, but the trial did not measure goal performance in the usual-care group, so it cannot say whether that gain came from the therapy.⁠³

Which sensory techniques lack evidence?

Many products and routines sold under the sensory integration name have been tested on their own. Most have not held up, with one notable exception, deep pressure delivered through weighted items or massage.⁠⁶

The American Academy of Pediatrics’ parent site adds that neither auditory integration training nor behavioral optometry has proved scientifically valid.⁠¹ A 2017 review of 24 studies in autism likewise found that auditory integration approaches did not improve language.⁠²⁴

What is still uncertain about sensory integration therapy?

• Study quality. A 2026 review of ten studies that reported following the fidelity measure rated only four at low risk of bias; those four had mixed results, and goal scaling was poorly done in the studies with positive results.⁠⁹
• Single case studies. A review of 17 single case studies found the better-designed ones tended to be negative, and that functional analysis-based behavior approaches did better for challenging behavior.⁠²⁵
• Durability. A 2017 review of 24 studies found only 3 at low risk of bias and possible short-term gains, with no clear evidence on whether they last.⁠²⁴
• How much therapy. Studies in the 2019 review used 18 to 40 sessions, and there are no definitive guidelines on how much is enough.⁠⁴
• Who it helps. Most trials studied autistic children; more research is needed for other groups of children.⁠²

How to hold all this. For an autistic child with assessed sensory difficulties, ASI delivered properly is a reasonable option aimed at specific daily-life goals.⁠^2,20 It is not a treatment for behaviors of concern, its evidence base still has quality problems, and several techniques sold under its name have been tested and found wanting.⁠^2,9,11

What does the AAP say about sensory integration therapy?

The AAP’s 2012 policy statement says occupational therapy using sensory-based therapies may be acceptable as one component of a comprehensive treatment plan, but that parents should be told the research on sensory integration therapy is limited and inconclusive.⁠¹⁰ It suggests that clinicians discuss a trial period of therapy and teach families how to judge whether a therapy is working.⁠¹⁰

The statement also questions the diagnosis itself: it is unclear whether children with sensory-based problems have a disorder of the sensory pathways or traits that belong to other developmental conditions, and because there is no universally accepted framework, it advises that sensory processing disorder generally should not be diagnosed.⁠¹⁰ The AAP’s parent site, last updated in 2019, still describes the evidence for autism as limited and inconclusive, while noting that this does not mean the therapy cannot help some children.⁠¹

The statement predates most of the trials above, which were published from 2014 onward, and the reviews that followed it reach more positive conclusions for autistic children’s individual goals.⁠^2,10,15 Its practical advice, a trial period and a clear way for the family to judge it, sits well with AOTA’s call for goals agreed with the family before therapy starts.⁠^10,26

What is sensory integration disorder?

Seesensory processing disorderhow SPD is diagnosed

Who is sensory integration therapy for?

The strongest evidence is for autistic children with assessed sensory processing difficulties. The 2019 review applies to autistic children aged 4 to 12 with IQs above 65, and six of the nine trials in the 2025 review studied autistic children.⁠^2,4 Evidence for other groups is emerging: a pilot trial in children with sensory modulation disorder was positive, and the 2025 review calls for more research in other child populations.⁠^2,16

Occupational therapists work on sensory integration and processing across the lifespan, and sensory processing difficulties can affect adults.⁠^27,28 The trials, though, are almost all in children, and the 2025 review of sensory-based interventions calls for research across the lifespan.⁠^2,6

For home strategies, school services and adult options, see sensory processing disorder treatment options.

How many sessions does sensory integration therapy take?

Trials have used very different amounts. Three studies in the 2019 review ran three sessions a week for 6 weeks, three a week for 10 weeks, and once a week for 36 to 40 weeks, from 18 to 40 sessions in all, and the authors note there are no definitive guidelines.⁠⁴ The 2014 trial gave 30 sessions over 10 weeks; SenITA gave 24 sessions over 26 weeks, followed by two phone calls with the parent.⁠^3,15

A course with no stated length and no review point is out of step with this research. The AAP suggests a trial period, and the trials themselves were time-limited with outcomes measured at the end.⁠^10,15

How is progress in sensory integration therapy measured?

Most trials used Goal Attainment Scaling: before therapy, an evaluator meets the parents and sets a handful of specific goals, and progress on each is scored at the end.⁠¹⁵ That suits a therapy aimed at daily life, but the scale has to be used carefully; the 2026 review found goal scaling was poorly done in the studies that reported positive outcomes.⁠⁹

AOTA’s Practice Smart recommendations say occupational therapists should not start intervention without the client’s occupational profile and collaborative goals, and should not use sensory-based interventions without documented assessment results.⁠²⁶ A good plan therefore names its goals in plain terms, such as getting dressed with less help, and says when they are reviewed.⁠^15,26

Is sensory integration therapy worth the cost?

The SenITA trial put a price on it: its health economic evaluation found sensory integration therapy was not cost-effective compared with usual care alone, which matters because the therapy group also showed no clear benefit on the trial’s main outcome.⁠³ That trial measured behavior, though, and the reviews place ASI’s value in individual functional goals, which a family may weigh differently.⁠^2,3

What a family pays depends on how the therapy is billed. Sensory integration is billed under CPT code 97533, and insurers’ policies differ: AOTA reports that Blue Cross Blue Shield of Michigan, which had excluded it, began covering Ayres Sensory Integration for patients with an autism diagnosis on March 1, 2026.⁠²⁹ Cleveland Clinic suggests asking the provider for help finding out whether your insurance covers sensory processing therapy.⁠²⁷ For a young child, an early intervention program may be a route to occupational therapy at little or no cost.⁠^30,31

What should you ask a sensory integration therapy provider?

• Do you deliver Ayres Sensory Integration, and what training do you have in it? The fidelity measure expects postprofessional training and supervised experience.⁠⁷
• What did the assessment find? AOTA advises against sensory-based interventions without documented assessment results.⁠²⁶
• What are the goals, in daily-life terms? ASI’s best evidence is for individualized functional goals.⁠²
• When do we review progress, and what would make you change course? The AAP recommends a trial period and a way to judge it.⁠¹⁰
• Is the therapy aimed at behavior? Reviews find no benefit for behaviors of concern such as irritability.⁠²
• If weighted vests, brushing or listening programs are suggested, what is the evidence for those? For each, it is weak or absent.⁠^11,12,13
• How do you involve us? Communication with parents and teachers is part of the fidelity measure, and caregiver training has strong evidence.⁠^6,7

Relatedsensory processing and autismsensory diet strategiesinteroception

Frequently Asked Questions

RelatedOccupational therapy

Sources

1. American Academy of Pediatrics, HealthyChildren.org. Sensory Integration Therapy. Last updated October 7, 2019; from Autism Spectrum Disorders: What Every Parent Needs to Know (2012). Checked October 11, 2026.
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   “Sensory integration therapy, which was developed in the 1970s by an OT, A. Jean Ayres, is designed to help children with sensory-processing problems (including possibly those with ASDs) cope with the difficulties they have processing sensory input. Therapy sessions are play-oriented and may include using equipment such as swings, trampolines, and slides.” “the effectiveness of sensory integration therapy as a therapy for ASDs is limited and inconclusive. While this does not mean that the therapy might not be helpful in some children, effectiveness so far is mainly based on personal experiences.” On auditory integration training and behavioral optometry: “neither method has proved to be scientifically valid”.
2. Acuna C, Gallegos-Berrios S, Barfoot J, Meredith P, Hill J. Ayres Sensory Integration® with children ages 0 to 12: a systematic review of randomized controlled trials. American Journal of Occupational Therapy. 2025;79(3):7903205180. PMID 40193295. Checked October 11, 2026.
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   The abstract: “Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included.” “Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability. Bias concerns persist among included studies.” “It is not recommended to address behaviors of concern, such as resistance to change or irritability. More research is needed to determine ASI’s benefits for other child populations.” The trials “compared implementation of ASI with its Fidelity Measure with children ages 0 to 12 yr”.
3. Randell E, Wright M, Milosevic S, Gillespie D, Brookes-Howell L, Busse-Morris M, Hastings R, Maboshe W, Williams-Thomas R, Mills L, Romeo R, Yaziji N, McKigney AM, Ahuja A, Warren G, Glarou E, Delport S, McNamara R. Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT. Health Technology Assessment. 2022;26(29):1–140. PMID 35766242. Checked October 11, 2026.
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   The abstract: “The intervention was manualised sensory integration therapy delivered over 26 weeks and the comparator was usual care.” “A total of 138 participants were randomised (n = 69 per group).” The therapy “was delivered with good fidelity and adherence and minimal contamination, and was associated with no adverse effects”; “There were no significant main effects of the intervention at 6 or 12 months.” “Health economic evaluation suggests that sensory integration therapy is not cost-effective compared with usual care alone.” “The intervention did not demonstrate clinical benefit above standard care. Subgroup effects are hypothesis-generating only. The intervention is likely to be effective for individualised performance goals, although it is unclear whether effects were in addition to standard care or were maintained.” “Carers and therapists reported improvement in daily functioning.” “Carer-rated goal performance and satisfaction increased across sessions”; limitations included “no measurement of comparator arm goal performance”. Plain language summary: “The sensory integration therapy involved 24 face-to-face sessions in an occupational therapy clinic, followed by two telephone calls with the carer.” The primary outcome was problem behaviors on the Aberrant Behavior Checklist; sensory processing was measured with “the Sensory Processing Measure at screening”.
4. Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, Schaaf RC. A systematic review of Ayres Sensory Integration intervention for children with autism. Autism Research. 2019;12(1):6–19 (online December 12, 2018). PMID 30548827. Checked October 11, 2026.
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   The abstract: the review used “the Council for Exceptional Children (CEC) Standards for Evidence-based Practices in Special Education to evaluate the effectiveness research from 2006 to 2017 on Ayres Sensory Integration (ASI) intervention for children with autism”; “Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items”; “Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4–12 years old.” Lay summary: “This intervention has specific requirements for therapist qualifications and the process of therapy.” Sensory-based interventions “are largely characterized as protocols that are passively applied to the child and have been found to have few positive effects” and “lack many of the key ingredients of the ASI such as individual-tailoring, active engagement of the child, the establishment of a therapeutic alliance between the child and therapist, targeting the just right challenge and provided within the context of play”; the principles are those “described by Ayres [Ayres, 1972, 1979, 1989; Ayres & Robbins, 2005] and operationalized in the Ayres Sensory Integration Fidelity Measure”. Discussion: the results “apply only to children with ASD who have IQs above 65”; “This range, from 18 to 40 sessions, is not uncommon in pediatric occupational therapy practice as there are no definitive guidelines to guide dosage.”
5. Case-Smith J, Weaver LL, Fristad MA. A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism. 2015;19(2):133–148. PMID 24477447. Checked October 11, 2026.
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   The abstract: “A total of 19 studies were reviewed: 5 examined the effects of sensory integration therapy and 14 sensory-based intervention.” Sensory integration therapies were defined “as clinic-based interventions that use sensory-rich, child-directed activities to improve a child’s adaptive responses to sensory experiences. Two randomized controlled trials found positive effects for sensory integration therapy on child performance using Goal Attainment Scaling (effect sizes ranging from .72 to 1.62)”. “Sensory-based interventions are characterized as classroom-based interventions that use single-sensory strategies, for example, weighted vests or therapy balls, to influence a child’s state of arousal. Few positive effects were found in sensory-based intervention studies.” They “did not follow recommended protocols or target sensory processing problems”.
6. Piller A, McHugh Conlin J, Glennon TJ, Andelin L, Auld-Wright K, Teng K, Tarver T. Systematic review of sensory-based interventions for children and youth (2015–2024). Frontiers in Pediatrics. 2025;13:1720179 (November 13, 2025). PMID 41321460. Checked October 11, 2026.
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   The abstract: “Twenty-one studies were included. Strong strength of evidence supported use of deep pressure tactile input and caregiver training on the use of sensory strategies. Moderate strength of evidence supported that alternative seating did not improve attention. Additionally moderate strength of evidence supported targeting a variety of sensory systems is more effective than targeting only one system. There is a lack of evidence on the impact of sensory environmental modifications.” SBIs “tend to be practitioner or adult-led interventions, involving passive sensory input applied to the child, and can include sensory techniques, such as massage, wearing earmuffs, passive swinging, caregiver sensory training, and sensory environmental modifications”. Deep pressure: “Four studies supported the use of deep pressure tactile stimulation, two of which examined weighted items and two of which examined massage.” One “demonstrated statistically significant improvements in motor skills for young children who received massage in addition to routine rehabilitation”; another “utilized massage with joint compressions prior to bedtime. Participants had significant improvements in overall sleep and a decrease in daytime sleepiness.” “Weighted vest wearing did not significantly improve attention, body perception, coping skills or learning when worn in the school setting”; a weighted blanket study “yielded statistically significant results for improved sleep for children with ADHD”. Seating: stability balls at school “found no significant improvements in productivity or seatwork”; cube chairs or T-stools, no significant improvement in attention. “A third Level II (38) SSD study using sensory diets as part of the regular school day showed three of four participants improving behavior.” The environmental modification study “demonstrated significant improvements in participation within a dental environment”. Implications: “The evidence indicates that caregiver training or coaching should be considered as part of any sensory intervention.” “SBIs may be more effective when implemented as part of a larger intervention plan, rather than as a standalone intervention.” “a clear assessment of sensory processing as part of a comprehensive evaluation to identify the client’s needs should be performed by a trained practitioner”. Introduction: differences “are estimated to affect 5%–25% of children in the United States”; “Occupational therapists are widely recognized as leaders in the evaluation and treatment of SI/SP challenges”. “Research is needed across environments and the lifespan.”
7. May-Benson TA, Roley SS, Mailloux Z, Parham LD, Koomar J, Schaaf RC, Van Jaarsveld A, Cohn E. Interrater reliability and discriminative validity of the structural elements of the Ayres Sensory Integration® Fidelity Measure. American Journal of Occupational Therapy. 2014;68(5):506–513. PMID 25184462. Checked October 11, 2026.
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   The structural elements cover “(1) therapist qualifications, including postprofessional training in sensory integration and clinical experience or supervision in OT–SI; (2) components of the occupational therapy assessment report, including history, occupational profile, and evaluation of sensory integration functions; (3) physical environment and equipment, including space for vigorous as well as quiet activity; (4) provisions for safety of therapeutic equipment; and (5) communication with parents and teachers, including collaborative goal setting and family or teacher education.” Assessment reports contain “Interpretation of results in relation to child’s life” and, “As appropriate, intervention plan and collaborative goals related to participation.” Sample items: “Ceiling hooks, rotational devices, and bungee cords for suspended equipment”; “Therapists routinely meet with parents and teachers regarding course of intervention as related to child’s occupational performance.” “The process elements address the dynamics of therapist–child interaction during occupational therapy sessions.” Ratings “by 259 occupational therapists from 185 different facilities” showed the structural section “significantly differentiates between settings in which therapists reportedly do and do not practice OT–SI”.
8. Parham LD, Roley SS, May-Benson TA, Koomar J, Brett-Green B, Burke JP, Cohn ES, Mailloux Z, Miller LJ, Schaaf RC. Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. American Journal of Occupational Therapy. 2011;65(2):133–142. PMID 21476360. Checked October 11, 2026.
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   The abstract: “We designed a fidelity instrument to measure structural and process aspects of ASI intervention.” “Raters were trained to score therapist strategies observed in video recordings of adult-child dyads.” “Reliability of the process section was strong for total fidelity score (ICC = .99, Cronbach’s alpha = .99) and acceptable for most items. Total score significantly differentiated ASI from four alternative interventions.”
9. Kishida Y, Stephenson J, Kemp C, Salisbury C. Efficacy of interventions adhering to the revised Ayres Sensory Integration® Fidelity Measure: a systematic review. Journal of Autism and Developmental Disorders. 2026;Online March 28, 2026, ahead of print. PMID 41903087. Checked October 11, 2026.
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   The abstract: “Ten studies that involved children younger than 10 years were identified. Positive outcomes were reported in higher risk of bias studies and case studies. Only four studies were rated as having a low risk of bias. No study directly measured both proximal and distal outcomes, used blind assessors, and reported intervention fidelity data. Mixed results were reported in low risk of bias studies. The quality of the GAS used was poor in studies where positive outcomes were identified.” “There is limited current evidence to support the positive effect of interventions adhering to the ASI fidelity measure.” Recommendations include “modifying environments to support individuals who present with sensory difficulties”.
10. Section on Complementary and Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics; Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186–1189. PMID 22641765. Checked October 11, 2026.
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    The abstract: “Brushes, swings, balls, and other specially designed therapeutic or recreational equipment are used to provide these inputs. However, it is unclear whether children who present with sensory-based problems have an actual ‘disorder’ of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders. Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. Other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed. Difficulty tolerating or processing sensory information is a characteristic that may be seen in many developmental behavioral disorders, including autism spectrum disorders, attention-deficit/hyperactivity disorder, developmental coordination disorders, and childhood anxiety disorders.” “Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan. However, parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive. Important roles for pediatricians and other clinicians may include discussing these limitations with parents, talking with families about a trial period of sensory integration therapy, and teaching families how to evaluate the effectiveness of a therapy.”
11. Stephenson J, Carter M. The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disorders. 2009;39(1):105–114. PMID 18592366. Checked October 11, 2026.
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    The abstract: vests are claimed to help with “inattentiveness, hyperactivity, stereotypic behaviors and clumsiness”; “Seven studies examining weighted vests are reviewed. While there is only a limited body of research and a number of methodological weaknesses, on balance, indications are that weighted vests are ineffective.” “weighted vests cannot be recommended for clinical application at this point”.
12. Sinha Y, Silove N, Hayen A, Williams K. Auditory integration training and other sound therapies for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. 2011;(12):CD003681. PMID 22161380. Checked October 11, 2026.
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    Authors’ conclusions: “There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders.” “of the seven studies including 182 participants that have been reported to date, only two (with an author in common), involving a total of 35 participants, report statistically significant improvements in the auditory intergration therapy group and for only two outcome measures”. Other sound therapies “include the Tomatis Method and Samonas Sound Therapy”.
13. Weeks S, Boshoff K, Stewart H. Systematic review of the effectiveness of the Wilbarger protocol with children. Pediatric Health, Medicine and Therapeutics. 2012;3:79–89. doi:10.2147/PHMT.S37173. Checked October 11, 2026.
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    The abstract: “The Wilbarger protocol is the most prescriptive program used to treat sensory overresponsivity in children aged 2–12 years.” “Four level IV intervention (case series with pretest/posttest) studies were included for indepth review. All four studies had very small sample sizes, exhibited low methodological quality, differed in outcome measures used, and lacked homogeneity of samples and treatment fidelity.” “A lack of high quality evidence currently exists to support or refute the use of the Wilbarger protocol with children.” The grade of recommendation “suggests that the Wilbarger protocol should be applied with caution”.
14. STAR Institute for Sensory Processing. About SPD. Sensoryhealth.org, undated. Checked October 11, 2026.
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    “When differences in sensory integration and processing are this extreme this is often referred to as sensory processing disorder (SPD) or ‘sensory integration dysfunction’.” “Pioneering occupational therapist, educational psychologist, and neuroscientist A. Jean Ayres, PhD, likened SPD to a neurological ‘traffic jam’”. “Sensory integration and processing refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses.” “people who reach adulthood without treatment also may experience significant symptoms”; “These ‘sensational adults’ may have difficulty performing routines and activities involved in work, close relationships, and recreation.” “We also have a vision of a world where SPD is an accepted diagnosis, is included in diagnostic manuals such as the DSM and ICD, and where treatment is covered by insurance.”
15. Schaaf RC, Benevides T, Mailloux Z, Faller P, Hunt J, van Hooydonk E, Freeman R, Leiby B, Sendecki J, Kelly D. An intervention for sensory difficulties in children with autism: a randomized trial. Journal of Autism and Developmental Disorders. 2014;44(7):1493–1506 (online November 10, 2013). PMID 24214165. Checked October 11, 2026.
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    The abstract: children “ages 4–8 years”; “the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) than the Usual Care control group (n = 15).” The setting: “a large gym equipped with mats, a variety of suspended swings, large balls, a climbing wall, carpeted barrels, large inner tubes and foam blocks with opportunities for active, guided, sensory motor play”; “The treatment utilizes individually tailored sensory motor activities at the just right challenge with a playful approach”. Entry required difficulty “as measured by the Sensory Profile” or “the Sensory Integration and Praxis Test”; evaluators “met with the parents to identify five goals”. Sensory features (“hyper- or hypo reactivity to sensory input or unusual interest in the sensory aspects of the environment”) “are now included as one of four possible manifestations of ‘Restricted, Repetitive Patterns of Behavior, Interests, or Activities’ (American Psychiatric Association 2013)”.
16. Miller LJ, Coll JR, Schoen SA. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy. 2007;61(2):228–238. PMID 17436845. Checked October 11, 2026.
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    The abstract: “Twenty-four children with SMD were randomly assigned to one of three treatment conditions; OT-SI, Activity Protocol, and No Treatment.” “The OT-SI group, compared to the other two groups, made significant gains on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised.” “Findings suggest that OT-SI may be effective in ameliorating difficulties of children with SMD.”
17. National Clearinghouse on Autism Evidence and Practice. Evidence-Based Practices for Children, Youth, and Young Adults with Autism. Checked October 11, 2026.
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    Steinbrenner JR, Hume K, Odom SL, Morin KL, Nowell SW, Tomaszewski B, Szendrey S, McIntyre NS, Yucesoy-Ozkan S, Savage MN. University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, 2020 (PDF). Ayres Sensory Integration is defined as “Interventions that target a person’s ability to integrate sensory information (visual, auditory, tactile, proprioceptive, and vestibular) from their body and environment in order to respond using organized and adaptive behavior”, supported by 1 article from 1990 to 2011 and 2 from 2012 to 2017. It is one of four practices that “were previously identified as ‘interventions with some evidence,’ and now meet the evidence-based criteria”; “Ayres Sensory Integration® refers explicitly to the model developed by Jean Ayers (2005) and not to a variety of unsupported interventions that address sensory issues”.
18. Watling R, Hauer S. Effectiveness of Ayres Sensory Integration® and sensory-based interventions for people with autism spectrum disorder: a systematic review. American Journal of Occupational Therapy. 2015;69(5):6905180030p1–12. PMID 26356655. Checked October 11, 2026.
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    The abstract: the review covered “the literature published from January 2006 through April 2013”; “Of the 368 abstracts screened, 23 met the inclusion criteria and were reviewed. Moderate evidence was found to support the use of ASI. The results for sensory-based methods were mixed.” Recommendations include “using the Fidelity Measure in studies of ASI”.
19. Schaaf RC, Dumont RL, Arbesman M, May-Benson TA. Efficacy of occupational therapy using Ayres Sensory Integration®: a systematic review. American Journal of Occupational Therapy. 2018;72(1):7201190010p1–7201190010p10. PMID 29280711. Checked October 11, 2026.
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    The abstract: “Three randomized controlled trials, 1 retroactive analysis, and 1 single-subject ABA design published from 2007 to 2015, all of which happened to study children with autism, met inclusion criteria. The evidence is strong that ASI intervention demonstrates positive outcomes for improving individually generated goals of functioning and participation as measured by Goal Attainment Scaling for children with autism. Moderate evidence supported improvements in impairment-level outcomes of improvement in autistic behaviors and skills-based outcomes of reduction in caregiver assistance with self-care activities.”
20. Piller A, Glennon TJ, Andelin L, Auld-Wright K, McHugh Conlin J, Teng K, Tarver T. Occupational therapy interventions using Ayres Sensory Integration® for children and youth (2015–2024): a systematic review. American Journal of Occupational Therapy. 2026;80(1):8001185030. PMID 41324442. Checked October 11, 2026.
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    The abstract: inclusion covered “studies published in English between May 2015 and January 2024 with participants ages 0-21 yr with sensory processing challenges”; “Twelve studies (four randomized controlled trials, four nonrandomized group designs, and four single-subject designs) met the inclusion criteria. Strong strength of evidence supports ASI for individual goal attainment and occupational performance. Moderate strength of evidence supports ASI in improving daily living and self-care skills and social, communication, and play skills.”
21. Omairi C, Mailloux Z, Antoniuk SA, Schaaf R. Occupational therapy using Ayres Sensory Integration®: a randomized controlled trial in Brazil. American Journal of Occupational Therapy. 2022;76(4):7604205160. PMID 35849051. Checked October 11, 2026.
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    The abstract: “Seventeen children with ASD ages 5-8 yr (n = 9 in the intervention group, n = 8 in the usual-care control group)”; “Participants in the intervention group scored significantly higher on outcome measures of self-care (p = .046, rb = .57), social function (p = .036, rb = .61), and parent-identified goal attainment (p < .001, rb = .94) compared with the control group.”
22. Park SH, Kim EY. Effects of sensory integration therapy in children: a systematic review and meta-analysis of randomized controlled trials. Research in Developmental Disabilities. 2026;172:105269. PMID 41935430. Checked October 11, 2026.
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    The abstract: “Twenty-three RCTs out of 1406 articles were included.” “SIT produced significant improvements in motor skills (standardized mean difference [SMD] = 0.46, 95% CI = 0.03-0.89). Furthermore, SIT enhanced daily functioning (SMD = 0.62, 95% CI = 0.16-1.08) and individualized goals (SMD = 1.71, 95% CI = 0.80-2.62). Balance, visual construction, and sensory processing did not demonstrate statistically significant effects.”
23. Gringras P, Green D, Wright B, Rush C, Sparrowhawk M, Pratt K, Allgar V, Hooke N, Moore D, Zaiwalla Z, Wiggs L. Weighted blankets and sleep in autistic children: a randomized controlled trial. Pediatrics. 2014;134(2):298–306. PMID 25022743. Checked October 11, 2026.
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    The abstract: “Seventy-three children were randomized and analysis conducted on 67 children who completed the study.” “The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents, and blankets were well tolerated over this period.”
24. Weitlauf AS, Sathe N, McPheeters ML, Warren ZE. Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics. 2017;139(6):e20170347. PMID 28562287. Checked October 11, 2026.
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    The abstract: “Twenty-four studies, including 20 randomized controlled trials (RCTs), were included. Only 3 studies had low risk of bias.” “sensory integration-based approaches improved sensory and motor skills-related measures (low SOE)”; “Studies of auditory integration-based approaches did not improve language (low SOE). Massage improved symptom severity and sensory challenges in studies with likely overlapping participants (low SOE).” “Some interventions may yield modest short-term (<6 months) improvements in sensory- and ASD symptom severity-related outcomes; the evidence base is small, and the durability of the effects is unclear.”
25. Leong HM, Carter M, Stephenson J. Systematic review of sensory integration therapy for individuals with disabilities: single case design studies. Research in Developmental Disabilities. 2015;47:334–351. PMID 26476485. Checked October 11, 2026.
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    The abstract: the review analyzed “the outcomes of 17 single case design studies”; “most used weak designs and poor methodology, with a tendency for higher quality studies to produce negative results. Based on limited comparative evidence, functional analysis-based interventions for challenging behavior were more effective that SIT. Overall the studies do not provide convincing evidence for the efficacy of sensory integration therapy.” “it is advised that the use of SIT be limited to experimental contexts”.
26. American Occupational Therapy Association. Practice Smart! Recommendations carried over from AOTA’s Choosing Wisely list (2018 to 2021), undated page. Checked October 11, 2026.
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    “2. Don’t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information.” “6. Don’t initiate occupational therapy interventions without completion of the client’s occupational profile and setting collaborative goals.” “7. Don’t provide interventions for autistic persons to reduce or eliminate “restricted and repetitive patterns of behavior, activities, or interests” without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.” “8. Don’t use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes.”
27. Cleveland Clinic. Sensory Processing Disorder (SPD). Health Library, last updated March 20, 2025. Checked October 11, 2026.
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    “Healthcare providers and parents typically identify SPD in children. But it can also affect adults.” “Currently, SPD isn’t an official medical diagnosis.” “your child’s pediatrician may refer you to an occupational therapist. These professionals can assess your child for SPD by watching them interact with certain sensory experiences. They’ll also ask about your child’s symptoms, behavior and medical history to help in the diagnosis.” “There’s no cure for sensory processing disorder. But various types of occupational therapy can help manage the symptoms of SPD”. At school a child may need “Access to headphones to block out background noises while they work”, “Access to fidget toys” and “A designated break to do a sensory activity, like walking, spinning or swinging”; “Occupational therapists offer strategies for coping with sensory challenges for all ages.” “As children age, their environments and learning challenges change, so their therapy may need to change as well.” Questions to ask include “Can you help me find out if my insurance will cover SPD therapy?”
28. American Occupational Therapy Association. Sensory Integration & Processing. Clinical topic page, undated. Checked October 11, 2026.
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    “Occupational therapy practitioners play a central role in identifying and addressing sensory integration and processing challenges with clients across the lifespan. OTPs collaborate with clients, caregivers, educators, and other professionals to develop and implement individualized sensory interventions, supporting people’s participation in desired activities in home, school, and community settings.”
29. American Occupational Therapy Association. AOTA advocacy leads to BCBS Michigan coverage of Ayres Sensory Integration® for autism. Lenhardt J. Advocacy news, February 26, 2026. Checked October 11, 2026.
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    “Blue Cross Blue Shield of Michigan (BCBSM) will begin covering Ayres Sensory Integration® (ASI) for individuals with an autism diagnosis, effective March 1, 2026.” “In 2025, AOTA received concerns from members in Michigan regarding BCBSM’s policy language, which excluded coverage of sensory integration interventions under CPT® code 97533.”
30. Centers for Disease Control and Prevention. Early Intervention. Learn the Signs. Act Early., undated. Checked October 11, 2026.
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    “These publicly funded programs provide services for free or at reduced cost for any child who is eligible.” “Eligibility for early intervention services is based on an evaluation of your child’s skills and abilities.” “If your doctor is not able to connect you, you can reach out yourself. A doctor’s referral is not necessary.” “If your child is under age 3: Call your state or territory’s early intervention program”; “If your child is age 3 or older: call any local public elementary school (even if your child does not go to school there)” to ask for an evaluation “through the school system for preschool special education services”.
31. Electronic Code of Federal Regulations. 34 CFR 303.13 Early intervention services. IDEA Part C regulations. “Occupational therapy includes services to address the functional needs of an infant or toddler with a disability related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development.” It includes “Adaptation of the environment”. Checked October 11, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. It does not discourage seeking occupational therapy support. Always consult a qualified healthcare provider about your child.