Sensory Integration Therapy: Everything You Need to Know

Introduction 

Your pediatrician or your child’s teacher may have suggested that sensory integration therapy could be highly beneficial for your child. If you’re already researching the best treatments for your child, you’ve likely noticed that many experts recommend it. But what is it, exactly?      

This article will provide an in-depth look at sensory integration therapy, exploring its advantages for children. We will highlight some of the most well-known sensory integration therapies currently available. Additionally, we’ll introduce you to Soundsory®, an innovative, home-based auditory program that complements these therapies, allowing your child to engage their senses from the comfort of your home.  

Key Take-Away Messages

What is Sensory Integration Therapy?

Sensory integration therapy (SIT) is a one-on-one intervention program trained occupational therapists provide to children with problems with sensory integration(SI). This program is individually tailored to improve the SI problems that interfere with a child’s participation in everyday activities at home, play, school, and community.     Some of the benefits include [1]:   – better performance and engagement in activities at home, school, and community – reduced inappropriate behaviors, such as self-harming behaviors – better learning, such as improved reading skills and language development

What is Sensory Integration?

Jean Ayres, the occupational therapist and psychologist who developed sensory integration (SI), defined it as the “organization of sensation for use” [2]. In simple terms, it’s how a child selects, organizes, and reacts to (or ignores) sensory information from the environment to accomplish goals and respond appropriately to the demands of everyday life.

Sensory integration can also refer to a theory that guides occupational therapists when assessing and treating children with difficulties with sensory processing. This can include children with autism, attention deficit hyperactivity disorder (ADHD), sensory processing disorder (SPD), or auditory processing disorder (APD).

What is the difference between sensory integration and sensory processing?

Recently, researchers and clinicians have shifted from using the term sensory integration to sensory processing [3]. However, both these terms refer to how the brain receives and makes sense of sensory signals and responds to them appropriately. These terms are now used interchangeably, but clinicians may prefer a particular term based on their training.

Dr. A Jean Ayres coined the former in the 1970s. Meanwhile, the term “sensory processing disorder” was first used in Dr. Lucy Miller’s sensory processing model, drawing heavily on Ayres’ SI theory.  

What do sensory integration and sensory processing difficulties look like?

“Sensory integration difficulties” or “sensory processing difficulties” refer to a spectrum of challenges rather than a single condition [4]. Children with these difficulties may face stress, as processes that are automatic and accurate for others may not be as effortless and precise for them.

When there is a problem in sensory integration, a child may “find it challenging to regulate their responses to everyday situations” [1] and experience stress and frustration. They may demonstrate challenging or maladaptive behaviors [5], avoid or reject certain activities, throw tantrums, disobey, or become aggressive.

Sensory processing difficulties can generally be divided into three categories [6]:

• Sensory modulation problems: a child finds it challenging to respond to a sensory input with a behavior appropriate relative to the grade, degree, or nature of the sensory input. For example, they may react negatively to the sound of an airplane up in the sky or find their clothes too rough.
• Sensory registration problems: a child has difficulty perceiving differences and similarities between stimuli. For instance, a child may confuse the letter b with d.
• Sensory-based motor disorder: a child may struggle with motor planning difficulties, poor postural stability, muscle tone, and balance. These children may appear clumsy, awkward, and poorly coordinated.  

Sensory Processing Difficulties in Children with Autism Spectrum Disorders (ASDs)

Sensory hyper- and hypo-responsiveness is a very common challenge among children with ASD [7]. Children who can’t express themselves often resort to self-injurious or aggressive behaviors. 

Many children also have sensory registration problems, appearing oblivious to sounds, touch, pain, taste, and movement (CM). Meanwhile, the same child who does not register particular sensory input may be overfocused on irrelevant stimuli, such as the placement of toys. 

Sensory Processing Difficulties in Children with Attention Deficit Hyperactivity Disorder (ADHD)

Hyperactivity and impulsivity in children with ADHD may be symptoms of sensory-seeking behaviors, where they crave a particular sensory input [6], prompting them to run, climb, or crash toward things or other people. Meanwhile, another study [8] found a relationship between sensory over-responsiveness and ADHD . This means that children with ADHD tend to have an intense, exaggerated, or prolonged response to sensory stimuli . 

Sensory Processing Difficulties in Children with Auditory Processing Disorder (APD)

Children with auditory processing disorder have problems discriminating sounds, such as listening to people speaking in places with high background noise. They may also become easily distracted by sudden or loud sounds or follow long instructions when given verbally.

How common are sensory integration problems?

It is difficult to figure out the prevalence of SI problems because they tend to co-occur with other conditions. However, it is estimated that around 5 to 16.5% [9] of the general population have some form of sensory processing difficulty. However, the numbers are higher for those with clinical conditions like ASD and ADHD. In fact, around 90 to 95% of children with autism have sensory processing difficulties [10]. Meanwhile, up to 40% of children with ADHD also have SPD [11]. 

What is Sensory Integration Therapy (SIT)?

Sensory integration therapy (SIT), an intervention approach now trademarked as Ayres Sensory Integration (ASI), is an intervention mainly led and performed by trained occupational therapists to help children with developmental and behavioral disorders improve their ability to process, organize, and integrate sensory input and respond appropriately to everyday stimuli. 

How does Sensory Integration Therapy work?

Sensory integration therapy is incorporated to play. OTs provide children with sensory-motor activities that provide them with just the right challenge (not overwhelming but challenging enough) to help them “successfully meet the challenges presented by their environment” [4]. 

The activities done during sensory integration therapy provide auditory, vestibular, tactile, and vestibular input, which are believed to organize the sensory system. The activities aim to target particular areas or sensory systems that interfere with the child’s ability to participate in day-to-day life [1]. An OT can target several sensory systems at a time.

These can include:

• using equipment like balance beams, trampolines, and swings
• using devices like sensory brushes and weighted vests
• using activities like playing with shaving cream 
• oral motor exercises

Who may benefit from Sensory Integration Therapy (SIT)?

Sensory integration therapy can benefit children with behavioral, developmental, and learning issues caused by underlying sensory processing difficulties. These include children with ASD, ADHD, and APD. Here’s a summary of research evidence of SIT for these populations:

Population	Children with ASD	Children with ADHD	Children with APD
Research evidence	A 2015 study [12] aimed to determine the effectiveness of sensory integration programs in children with autism. A 2013 study [13] checked the effectiveness of SIR in children with ASD (18 treatments of 45 min, for 6 weeks) A 2023 study [14] investigated the effectiveness of SIT in enhancing balance and executive functions in children with ASD	A 2017 study [15] aimed to examine the effectiveness of combination therapy based on executive function and sensory integration child-centered on ADHD A 2023 study [16] aimed to see the effects of sensory integrative intervention on the motor, cognitive, and social skills of children with ADHD. A 2022 study [17] wanted to evaluate the effect of a family-centered sensory diet program on impulsivity in children with attention deficit hyperactivity disorder (ADHD).	A 2018 study [18] investigated the effect of a sound-based intervention while performing physically active movements in a child with APD.
Potential Benefits	–  help kids become more independent and participate in daily activities [12]-  improved ability to process sensory stimuli as evidenced by a reduction in mannerisms/stereotypic behaviors [12] [13]-  progress towards individualized goals [13][14]-  improved balance and executive functions (cognitive flexibility, working memory, inhibitory control, attentional control)	–  combining executive function and SI therapies reduced attention deficit and hyperactivity [15]- Reduced functional impairments (better attention to family members, fewer quarrels with siblings, more responsive to completing homework, improved performance of daily activities [16]- Implementing a sensory diet reduced impulsivity among children with ADHD. [17]	–  A 12-week sound-based program reduced auditory sensitivity in a child with APD [18]

Who provides Sensory Integration Therapy?

Only specially trained occupational therapists can provide sensory integration therapy. OTs use interviews, observations, and standardized tools to evaluate a child’s sensory integration and develop an individualized program tailored to improve specific SI problems that interfere with the child’s performance.

Is Sensory Integration Therapy evidence based?

A 2010 systematic review that used the Council for Exceptional Children (CEC) Standards for Evidence‐based Practices in Special Education to evaluate ASI intervention research from 2006 to 2017 found that SIT is an evidence-based practice [19]. While the American Academy of Pediatrics (AAP) said that the effectiveness of SIT in children with autism is inconclusive and limited, ASI has already been “included as an evidence-based intervention for children with ASD in the National Clearinghouse on Autism Evidence and Practice” [20].

What are examples of Sensory Integration Therapies to choose from?

There are a myriad of sensory-based programs that use sensory integration principles to help children with a range of conditions, including those with ASD, ADHD, learning disorders, and sensory processing disorders.     

These programs train the brain and improve skills like memory, attention, speech, emotional regulation, cognition, motor planning, and sequencing. These are:  

• Masgutova Neurosensorimotor Reflex Integration program MNRI®
• Brain Balance program
• Interactive metronome®
• Brain Gym® program
• Play Attention Program
• Forbrain^®

The table below summarizes what the program aims to do, who it is for, how it is done, and other relevant information

Type of sensory integration therapy	Masgutova Neurosensorimotor Reflex Integration program MNRI®	Brain Balance program	Interactive metronome®
Purpose	Aims to facilitate proper maturation or integration of primary reflex motor patterns to improve daily functioning	Aims to build and strengthen brain connections and pathways to boost brain function, including attention, mood, memory, and problem-solving.	Aims to improve motor and sensory skills and cognitive skills like attention, focus, and executive functioning.
Method	Uses a combination of hands-on manual techniques and sensory stimulation by the therapist, and active movements by the child	Uses a combination of sensory, motor, and cognitive exercises, coaching, and personalized nutrition to help build stronger brain connections	Involves doing whole-body exercises that follow metronome beats.
Targeted Population	All conditions and ages, particularly those with neurological and developmental disorders	Kids and adults of all ages, including those with ADHD, ASD,  dyslexia, SPD, anxiety	People of all ages, including those who want to improve specific skills, and pediatric and adult patients, including ASD, ADHD, SPD, learning disabilities, stroke, spinal cord injury, etc.
Research evidence	Limited studies; A 2020 study [21] found the MNRI improved emotional regulation, decreased hypervigilance, and enhanced stress resilience in individuals with various conditions.	Limited studies; A 2023 study [22] found that Brain Balance significantly improved reading/writing, emotionality, behavior, academic engagement, and social participation in BB participants.	Limited studies; A 2022 review and meta-analysis [23] found that interactive metronome training improved motor function across healthy individuals, athletes, and patients with neurological function
Cost	$200-$500 per session	$29-$49 for an online assessment, and $199-$299 for a full assessment, depending based on location	Cost per session varies on the provider, but equipment costs around $6,000 for professionals
Accessibility	Limited availability due to few number of trained professionals	Can be done at home or in a Brain Balance center across the USA	Can be done in different settings but requires a trained professional; requires adherence to the program
Duration	60 minutes per session	>1 hr per day, 5 days a week, with a program that lasts 3 months minimum	12 or 15 one-hour sessions
Pros & Cons	Pros ✅ personalized ✅ comprehensive approach ✅ suitable for different stages and ages  Cons ❌ requires training and deep understanding ❌ limited availability in certain areas ❌ time-intensive	Pros ✅ individualized holistic approach ✅ can be done online or in person  Cons ❌ Requires a three-month commitment to frequent sessions ❌ limited availability ❌ can be costly	Pros ✅ playful, game-based interface Cons ❌ Requires a set of equipment ❌ expensive ❌ not user-friendly

Type of sensory integration therapy	Brain Gym® program	Play Attention Program	Forbrain®
Purpose	Aims to improve brain function to help individuals reach their peak performance	Aims to boost attention, executive function, emotional regulation, impulse control, behavior, etc.	Aims to improve auditory processing, enhance speech, memory, and attention
Method	Involves performing 26 physical movements and related techniques	Uses a computer-based training software	Uses a patented Auditory feedback system with bone-conduction headphone
Targeted Population	Children and adults of all ages; suitable for children with learning disabilities and adults who want to improve their skills	Children with ADHD	Individuals of all ages, such as students, children with speech and language difficulties or ADHD, and singers
Research evidence	Limited studies; Several studies published found no significant results from Brain Gym	Limited studies; according to a 2014 randomized control trial [24] linked from the Play Attention site, children with ADHD who received neurofeedback showed improvements in ADHD symptoms	Small-scale studies published; A 2023 study [25] found that using bone-conduction earphones like Forbrain can reduce vocal fatigue; meanwhile, another study [26] found that sound therapy improved reading skills among children with reading difficulties.
Cost	Cost for sessions, classes, or workshops vary on the instructor/ consultants	Basic package is $995; professional package is $2,495	$299
Accessibility	Can be done as a session, class, or workshop	Anywhere where you can use your computer with the software	Small, lightweight design makes it highly portable; can be bought on Forbrain site
Duration	Typically short; integrated into movement breaks and routines	10 minutes daily	Recommended to be incorporated into one’s daily routine, but a typical program includes 20 minutes daily for 6 weeks
Pros & Cons	Pros ✅ fun, playful exercises ✅ suitable for individuals of all ages  Cons ❌ limited research to back up effectiveness ❌ no auditory stimulation  ❌ requires consistency	Pros ✅ gives real-time feedback ✅ interactive game-based ✅ specifically designed to address attention-related challenges Cons ❌ costly limited ❌ scientific evidence ❌ not a standalone solution	Pros ✅ cost-effective ✅ can be used at home by end user ✅ suitable for all age groups Cons ❌ limited focus on speech, attention, and memory ❌ consistent use is necessary

Other Methods 

Soundsory® is a structured program that integrates music therapy and movement exercises. It is based on the principles of the Tomatis® Method. It employs user-friendly, cost-effective equipment featuring a dynamic filter and bone conduction technology to stimulate both the auditory and vestibular systems.

The program includes rhythmic sounds and specially composed music tracks enhanced neuro-acoustically to target the auditory and vestibular systems. In addition to these auditory elements, Soundsory incorporates movement exercises to engage the tactile, vestibular, and proprioceptive systems.

The primary objective of Soundsory® is to achieve sensory integration, which is essential for developing a strong foundation in cognitive and sensorimotor processing. This integration is vital for enhancing coordination, balance, motor skills, and cognitive abilities.  Soundsory® involves a 40-day regimen, where participants engage in daily 30-minute music listening sessions combined with movement exercises. The program is structured into two segments, each lasting 20 days.  

Conclusion

Sensory integration plays a vital role in a child’s ability to engage with their environment and develop various skills. Sensory integration therapy is a specialized intervention designed to address sensory processing challenges that may prevent children from participating effectively in everyday activities.    

Many children with developmental disorders like ASD and ADHD also have sensory processing difficulties, making sensory integration therapy an ideal intervention for them. Despite its widespread use, conclusive large-scale evidence of its effectiveness is limited.

Various multisensory and brain development programs with similar targets and clientele as sensory integration therapy exist. These programs often focus on stimulating one or more sensory systems to achieve a range of goals, like focus, attention, memory, and coordination. While they may complement sensory integration therapy, consulting an occupational therapist for tailored advice is recommended.  

FAQs

References 

1. Guardado, K. E., & Sergent S. R. (2023). Sensory integration. https://www.ncbi.nlm.nih.gov/books/NBK559155/
2. Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western  Psychological Services.
3. Camarata, S, Miller, L. J., & Wallace, M. T. (2020). Evaluating sensory integration/sensory processing treatment: issues and analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726187/
4. Case-Smith, J., O’Brien, J. C. (Eds.), Occupational therapy for children, (6th Edition). Mosby Elsevier, Maryland Heights, MO
5. Will, E. A., Daunhauer, L. A., Fidler, D. J., Lee, N. R., Rosenberg, C. R., & Hepburn, S. L. (2019). Sensory processing and maladaptive behavior: Profiles within the down syndrome phenotype. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011957/
6. Miller, L.J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. https://pubmed.ncbi.nlm.nih.gov/17436834/
7. Marco, E. J., Leighton, B. N. H., Hill, S. S., & Nagarajan, S. S. (2011). Sensory processing in autism: a review of neurophysiologic findings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086654/
8. Lane, S. J., Reynolds, S., & Thacker, L. (2010). Sensory over-responsivity and ADHD: differentiating using electrodermal responses, cortisol, and anxiety. https://www.frontiersin.org/articles/10.3389/fnint.2010.00008/full
9. Miller, L. J., Schoen, S, Mulligan, S. & Sullivan, J. (2017). Identification of sensory processing and integration symptom clusters: a preliminary study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733937
10. Randell, E., et al. (2019). Sensory integration therapy versus usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised controlled trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371421/
11. Ochsenbein, M. (n.d.). Is it sensory processing disorder or ADHD? https://sensoryhealth.org/node/1114
12. Karim, A. A. & Mohammed, A. H. (2015). Effectiveness of sensory integration program in motor skills in children with autism. https://www.sciencedirect.com/science/article/pii/S1110863015000038?via%3Dihub
13. Pfeiffer, B. A., et al. (2013). Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708964/
14. Deng, J., Lei, T., & Du, X. (2023). Effects of sensory integration training on balance function and executive function in children with autism spectrum disorder: evidence from footscan and fNIRS. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1269462/full
15. Salami, F., Esteki, M., Ashayeri, H. & Farzad, W. (2017). Studying the effectiveness of combination therapy (based on executive function and sensory integration) child-centered on the symptoms of attention deficit/hyperactivity disorder (ADHD). https://www.researchgate.net/publication/315987676
16. Barakat, A. H. A., El-Salihen, F. A. A., Khalifa, A. M., & Ibrahim, F. M. (2023). Sensory Integrative intervention: Outcomes of motor, cognitive and social skills among children with attention deficit hyperactivity disorders. https://journals.ekb.eg/article_321172_2328bf42588a61494479ec33a0a6e540.pdf
17. Shabdini S., Azizi. M. P., & Peymani, J. (2022). The effect of sensory diet on the impulsivity of children with attention deficit hyperactivity disorder. https://jmr.tums.ac.ir/index.php/jmr/article/view/639
18. Zachry, A. H., Lancaster, S., & Robertson, E. M. (2018). Effect of a sound-based intervention on a 7-year-old child diagnosed with auditory processing disorder. https://journals.healio.com/doi/full/10.3928/24761222-20181116-02
19. Schoen, S. A., et al. (2019). A systematic review of ayres sensory integration intervention for children with autism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590432/
20. Omairi C., Mailoux, Z., Antoniuk, S. A., & Schaaf, R. (2022). Occupational therapy using Ayres sensory integration®: a randomized controlled trial in Brazil. https://research.aota.org/ajot/article/76/4/7604205160/23325/Occupational-Therapy-Using-Ayres-Sensory#
21. Tatarinova, T. V., Deiss, T., Franckle, L., Beaven, S., & Davis, J. (2020). The impact of MNRI therapy on the levels of neurotransmitters associated with inflammatory processes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7072967/
22. Jackson, R. & Jordan, J. T. (2023). Reliable change in developmental outcomes of brain balance® participants stratified by baseline severity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10478577/
23. Lee, H. K., Kim, H. J., Kim, S. B., & Kang, N. (2022). A review and meta-analysis of interactive Metronome training: positive effects for motor functioning. https://pubmed.ncbi.nlm.nih.gov/35762351/
24. Steiner, N. J., et al. (2014). In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial. https://publications.aap.org/pediatrics/article-abstract/133/3/483/32343/In-School-Neurofeedback-Training-for-ADHD
25. Nudelman, C., Udd, D., Ahlander, V. L., & Bottalico, P. (2023). Reducing vocal fatigue with bone conduction devices: comparing Forbrain and sidetone amplification. https://pubmed.ncbi.nlm.nih.gov/37844616/
26. Torabi, Z., Estaki, M., Entezar, R., & Sharifi, N. (2018). The effect of sound therapy on reading skills of students with reading difficulties. https://jgu.garmian.edu.krd/article_67379.html