You are on page 1of 6

MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES

RESEARCH REVIEWS 11: 143–148 (2005)

OCCUPATIONAL THERAPY USING A SENSORY


INTEGRATIVE APPROACH FOR CHILDREN WITH
DEVELOPMENTAL DISABILITIES
Roseann C. Schaaf *1 and Lucy Jane Miller2
1
Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
2
University of Colorado, Health Sciences Center, Director of the Sensory Integration Research and Treatment Center,
Denver, Colorado

This article provides an introduction and overview of sensory integration information is an important substrate for adaptive behavior.
theory as it is used in occupational therapy practice for children with develop- Given its focus on adaptive behavior and functional skills, this
mental disabilities. This review of the theoretical tenets of the theory, its histor-
ical foundations, and early research provides the reader with a basis for explor- approach is most frequently utilized by occupational therapists as
ing current uses and applications. The key principles of the sensory integrative part of a total program of occupational therapy. The goal of
approach, including concepts such as “the just right challenge” and “the intervention is to improve the ability to process and integrate
adaptive response” as conceptualized by A. Jean Ayres, the theory’s founder, sensory information and to provide a basis for improved inde-
are presented to familiarize the reader with the approach. The state of research
in this area is presented, including studies underway to further delineate the
pendence and participation in daily life activities, play, and
subtypes of sensory integrative dysfunction, the neurobiological mechanisms school tasks.
of poor sensory processing, advances in theory development, and the devel-
opment of a fidelity measure for use in intervention studies. Finally, this article
reviews the current state of the evidence to support this approach and suggests HISTORICAL PERSPECTIVES AND
that consensual knowledge and empirical research are needed to further elu- NEUROBIOLOGICAL ROOTS
cidate the theory and its utility for a variety of children with developmental Ayres’ work was prompted by her clinical observations of
disabilities. This is especially critical given the public pressure by parents of
children with autism and other developmental disabilities to obtain services and
children with learning disabilities, many of whom she noted
who have anecdotally noted the utility of sensory integration therapy for help- displayed perceptual, sensory, and motor difficulties. Hypothe-
ing their children function more independently. Key limiting factors to research sizing that “learning is a function of the brain [and] learning
include lack of funding, paucity of doctorate trained clinicians and researchers disorders . . . reflect some deviation in neural functions [Ayres,
in occupational therapy, and the inherent heterogeneity of the population of 1972],” Ayres developed a theoretical model, the theory of
children affected by sensory integrative dysfunction. A call to action for occu-
pational therapy researchers, funding agencies, and other professions is made Sensory Integration (SI). This theory; based on principles from
to support ongoing efforts and to develop initiatives that will lead to better neuroscience, biology, psychology, and education, hypothesizes
diagnoses and effective intervention for sensory integrative dysfunction, which that some children with learning disorders experience difficulty
will improve the lives of children and their families. © 2005 Wiley-Liss, Inc.
processing and integrating sensory information and that this, in
MRDD Research Reviews 2005;11:143–148.
turn, affects their behavior and learning. She theorized that the
behavior and learning problems were, in part, due to faulty
Key Words: sensory integrative dysfunction; sensory processing integration of sensory information and inability of higher centers
to modulate and regulate lower brain sensory–motor centers
[Ayres, 1972].
The theory is based on principles from neuroscience,

O
ccupational therapy with a sensory integration ap-
developmental psychology, occupational therapy, and educa-
proach (OT/SI) is designed to guide intervention for
tion: 1) sensorimotor development is an important substrate for
children who have significant difficulty processing sen-
learning; 2) the interaction of the individual with the environ-
sory information, which restricts participation in daily life ac-
ment shapes brain development; 3) the nervous system is capable
tivities. The theory of sensory integration was developed by A.
of change (plasticity); and 4) meaningful sensory–motor activity
Jean Ayres [Ayres, 1972, 1979, 1989], an occupational therapist
with postdoctoral training in educational psychology and neu-
roscience. Guided by her roots in the clinical field of occupa-
*Correspondence to: Roseann Schaaf, Ph.D., OTR/L, FAOTA, Department of
tional therapy (OT), Ayres developed the theory of sensory Occupational Therapy, Thomas Jefferson University 130 South 9th Street, Edison
integration to explicate potential relationships between the neu- 810, Philadelphia, PA 19107. E-mail: Roseann.schaaf@jefferson.edu
ral processes of receiving, modulating, and integrating sensory Received 15 April 2005; Accepted 15 April 2005
Published online in Wiley InterScience (www.interscience.wiley.com).
input and the resulting output: adaptive behavior. The theory DOI: 10.1002/mrdd.20067
postulates that adequate processing and integration of sensory
© 2005 Wiley-Liss, Inc.
is a powerful mediator of plasticity. Al-
though new findings and knowledge Table 1. Key Principles of the Sensory Integrative Approach
demonstrate that the nervous system is
Principle Description
even more complex and integrated than
Ayres and others believed at the time, Just Right Challenge The therapist creates playful activities with achievable challenges; the
many of the principles that Ayres built activities incorporate a challenge but the child is always successful.
the theory of sensory integration upon The Adaptive In response to the Just Right Challenge, the child adapts their
Response behavior with new and useful strategies, thus furthering
are still held in high regard. This knowl- development
edge has been strengthened by research Active Engagement The therapist’s artful creation of challenging, yet playful, sensory-
demonstrating that structural, molecular, rich environments entice the child to participate actively in play;
and cellular changes in neural functions the methods of play incorporate new and advanced abilities that
are possible and that meaningful sensory increase the child’s repertoire of skills and processing.
Child Directed The therapist constantly observes the child’s behavior and reads their
motor activities can be mediators of plas- behavioral cues, thus following the child’s lead or suggestions.
ticity [Merzenich et al., 1984; Greenough The therapist uses the child’s cues to create enticing, sensory-rich
et al., 1987; Kandel and Jessell, 1995; Kem- activities.
permann and Gage, 1999; McKenzie, et
al., 2003].
To examine and field test her the-
ory of SI, Ayres created a battery of tests,
the Southern California Sensory Integra- tive sensations. The therapeutic environ- improvement in ability to participate in-
tion tests, which evaluated sensory pro- ment is designed to tap into the child’s dependently in daily life activities. In ad-
cessing, sensory motor, and perceptual inner drive to play. The therapist uses dition to direct intervention with the
motor skills. Using these tests, she con- keen observation skills to observe and child, the therapist interacts and collabo-
ducted a number of cluster and factor interpret the child’s behaviors and inter- rates with parents, teachers, and others
analytic studies to further define the the- ests and then creates a playful environ- who are involved with the child to 1)
ory. She found clusters of symptoms that ment in which the child actively pursues help them understand the child’s behav-
fell into meaningful patterns that de- achievable challenges [Bundy et al., ior from a sensory perspective, 2) adapt
scribed clinical samples of the children, 2002; Kimball, 1993; Smith-Roley and the environment to the needs of the
which served to guide intervention strat- Spitzer, 2001; Schaaf and Smith-Roley, child, 3) create needed sensory and mo-
egies [Ayres, 1979, 1989]. For example, a in press]. For example, occupational tor experiences throughout their day in
factor termed “developmental dyspraxia” therapy using a sensory integrative ap- their natural environments, and 4) assure
was consistently identified in children proach for a child with developmental that therapy is helping the child become
who seemed to have difficulty creating dyspraxia and poor body awareness more functional in their daily life activi-
ideas for, planning, and carrying out new might include facilitating the child ties.
motor activities and processing tactile climbing across a low platform to access a
and other somatosensory information. large area filled with colorful balls (ball USEFUL POPULATIONS FOR
pit), then completing an unfamiliar ob- THE SI APPROACH
THE SENSORY INTEGRATIVE stacle course that consists of climbing up Although the original theory was
APPROACH a rope ladder attached to the wall, jump- developed for children with learning dis-
Professionals who use the sensory ing into large pillows that have a variety abilities, Ayres recognized the utility of
integrative approach follow a set of prin- of textures, and then pulling him/herself the theory for other clinical populations.
ciples, based on sensory integration the- out of the pillows using a rope attached For example, Ayres and Tickle [1980]
ory, that guide the therapists’ clinical rea- to the opposite wall. Thus, the child is applied the theory to children with au-
soning skills. These principles are guided through challenging and fun ac- tism and noted that it helped decrease
operationalized in therapy to include tivities designed to stimulate and inte- tactile and other sensitivities to stimuli
concepts such as “Active Sensory–Motor grate sensory systems, challenge their that interfere with their ability to play,
Experiences,” “the Just Right Chal- motor systems, and facilitate integration learn, and interact. Since that time, sen-
lenge,” “the Adaptive Response,” “Ac- of sensory, motor, cognitive, and percep- sory integrative principles have also been
tive Participation,” and “Child-Direc- tual skills. applied to various populations, including
tion.” These principles are further Astute observation of the child’s infants born at risk and/or with regula-
defined and delineated in Table 1. The ability to process and utilize sensory in- tory disorders, children with autistic
intervention is unique in that it addresses formation during these playful activities is spectrum disorders, fragile X syndrome,
the underlying substrates of dysfunction a key skill of therapists trained in the attention deficit disorder (ADHD) [Og-
rather than just the functional difficulties sensory integrative approach and a fea- nibene, 2002], and children from envi-
itself. Ayres [1972] states: ture that distinguishes this approach from ronmentally deprived situations [Cer-
others. The therapist observes the child’s mack, 2001].
A sensory integrative approach to treating learning
disorders differs from many other approaches in that responses during the activity and in- A high frequency (80 –90%) of
it does not teach specific skills. . . . Rather, the creases or decreases the sensory and mo- sensory processing problems are reported
objective is to enhance the brain’s . . . capacity to tor demands to create a challenging and in children with autism spectrum disor-
perceive, remember, and motor plan [as a basis for therapeutic environment. In keeping ders [Ornitz; 1974; O’Neill and Jones,
learning]. . . Therapy is considered a supplement,
not a substitute to formal classroom instruction. . .
with the theory, goals and progress are 1997; Kientz and Dunn, 1997; Huebner,
recorded in the observable changes in the 2001]. Poor sensory processing may con-
Therapy provides opportunities for child’s ability to participate in sensory- tribute to the maladaptive behavioral
engagement in sensory motor activities based activities, regulate arousal level, profile of these children and impact on
rich in tactile, vestibular, and propriocep- improvement in sensory motor skills, and their ability to participate in social,
144 MRDD RESEARCH REVIEWS ● SENSORY INTEGRATIVE THERAPY FOR CHILDREN WITH AUTISM ● SCHAAF & MILLER
school, and home activities [Anzalone
and Williamson, 2000; DeGangi, 2000;
Schaaf et al., 2002]. Children with autism
often demonstrate extreme aversion to or
excessive seeking of sensory stimuli,
avoidance of noisy situations, unusual
preoccupation with smells or visual stim-
uli, or fearfulness of typical activities that
involve touch, sounds, and movement
[Kientz and Dunn, 1997; Huebner,
2001; Mailloux, 2001; Mailloux and
Smith Roley, 2001]. Whether these ab-
errant behaviors arise as a mechanism to Fig. 1. Proposed patterns of sensory processing disorder [Miller, 2004]. [Color figure can be
viewed in the online issue, which is available at www.interscience.wiley.com].
maintain arousal [Ayres, 1979; Ornitz,
1989], to limit distraction to other stim-
uli, or because the children are self-ab-
sorbed by sensation, the net effect is lim- problem in the capacity to regulate . . . with about two-thirds of the sample
itation of the child’s ability to participate response to sensory input in a graded . . . showing symptoms of poor sensory pro-
in school, home, and play activities with manner. . . [that] disrupts ability to cessing [Mangeot et al., 2001]. Approxi-
their family and peers. Self-reports from achieve and maintain and an optimal mately 40% of the sample of children
individuals on the autistic spectrum con- range of performance necessary to adapt with poor sensory modulation also had
firm these findings and are powerful in to challenges in life” [Miller and Lane, symptoms of attentional deficits [Ahn et
terms of describing the impact of sensory 2000], children with poor sensory mod- al., 2004]. This population had different
dysfunction on participation in daily life ulation are reported to over or underre- sympathetic markers of sensory reactivity
activities [Williams, 1992, 1994; spond to normal levels of stimuli in their [Roley, et al., 2005] and decreased re-
Grandin, 1995; O’Neill and Jones, 1997]. environment. Efforts at screening for sponse inhibition in the presence of nor-
These descriptions portray how over- or poor sensory modulation have been mal sensory habituation [Ognibene,
underresponsiveness to the typical sensa- made easier by the Sensory Profile 2002].
tions of daily life pervade behavior and [Dunn, 1999a, 1999b], The Infant Tod- The most recent contribution to
limit the individual’s ability to participate dler Sensory Profile [Dunn, 2002], and practice and to advance research is the
fully in society. For example, Grandin the Adult Sensory Profile [Brown and efforts of the Sensory Processing Disor-
[1995], a high-functioning individual di- Dunn, 2002]. These tools are parent/self ders Scientific Workgroup [SPD, 2004],
agnosed with autism, articulates how her questionnaires that describe responses to a multidisciplinary group of established
unusual processing of auditory, visual, sensation during daily life activities. leaders in developmental psychobiology
and tactile information makes it difficult In an effort to identify the under- research. The group is studying diverse
for her process more than one stimulus lying mechanisms of poor sensory mod- aspects of atypical sensory processing, in-
simultaneously, which impacts her ability ulation, Miller, et al. [2005] completed a cluding central metabolic differences us-
to socially interact. As a result, she does series of studies examining autonomic ing proton magnetic spectroscopy, phys-
not enjoy or participate in many typical nervous system functioning in children iological correlates of early perceptual
activities with others. with poor sensory modulation. They processing, sensory gating evoked poten-
have shown that children with severe tial (P50) discrimination, and genetic fac-
UPDATES IN THEORY AND hyperresponsivity and Fragile X syn- tors that relate to the etiology, for exam-
PRACTICE drome have markers of sympathetic dys- ple. Additional research questions posed
Since its conception in the late function evidenced by electrodermal ac- by this workgroup relate to differences in
1960s, Ayres’ original theoretical princi- tivity with significantly increased dopamine D2 receptor binding availabil-
ples have been extended, updated, and amplitudes, more frequent responses, and ity, presynaptic dopamine synthesis, and
advanced based on advancements in sci- less habituation than matched controls serotonin receptor availability in SMD,
ence and clinical practice. One recent [Miller et al., 1999]. They also studied and pharmacological agents for treatment
development is the proposed grouping of children with poor sensory modulation of children with poor sensory processing.
SI into three classic patterns, each of and no other developmental diagnosis
which consist of several subtypes: Sen- identified clinically. These children also PREVALENCE
sory Modulation Disorder, Sensory Dis- showed significant markers of sympa- Although clinicians and educators
crimination Disorder, and Sensory-based thetic dysfunction [McIntosh et al., have speculated that the prevalence of
Motor Disorders as demonstrated in Fig- 1999]. In addition to sympathetic mark- children affected by poor sensory modu-
ure 1. The authors suggest that delineat- ers of sensory dysfunction, parasympa- lation is high, the true numbers have only
ing these subtypes is crucial so that ho- thetic markers have been evaluated recently been appreciated. Miller and
mogenous groups may be identified to [Schaaf et al., 2003], suggesting that the colleagues conducted a survey to estimate
guide intervention and research related to functioning of the sympathetic and para- rates of sensory processing disorders in
describing the phenotypes of sensory sympathetic systems should be consid- incoming kindergartners from one sub-
processing disorder and evaluating the ef- ered together when trying to understand urban U.S. public school district [Ahn et
fectiveness of intervention with this pop- the contribution of the autonomic ner- al., 2004]. The Short Sensory Profile, a
ulation. vous system to poor sensory modulation. carefully researched version [McIntosh et
The pattern of poor sensory mod- Studies of children diagnosed with atten- al., 1999] of the Sensory Profile parent-
ulation has been most frequently dis- tion deficit disorders showed a range of report screening tool, was utilized. A
cussed in the literature. Defined as “a responses in regard to sensory processing conservative estimate of prevalence was
MRDD RESEARCH REVIEWS ● SENSORY INTEGRATIVE THERAPY FOR CHILDREN WITH AUTISM ● SCHAAF & MILLER 145
made, assuming that all nonrespondents Grandin, 1995]. These verbal individuals planning grant. This group completed a
failed to meet positive criteria for SMD. provided new insight into how sensory thorough review of existing treatment
Approximately 5% of the kindergarten over- or underresponsiveness limits their resources and developed a treatment pro-
enrollment met screening criteria for sen- own ability to function effectively in tocol and a “Fidelity to Treatment Mea-
sory processing disorders. their various roles and daily life activities. sure” to evaluate whether the therapy
They report the importance of interven- that is administered is true to the princi-
EVIDENCE SUPPORTING THE tion strategies to address their own atyp- ples established in the literature for the
THEORY, PRINCIPLES, AND ical sensory processing. Second, the pop- treatment. The Fidelity Scale evaluates
PRACTICE OF SI ular best seller, The Out of Sync Child constructs related to the intervention
General knowledge and empirical [Kranowitz, 1998], rekindled interest in provided, details the training of the per-
research are needed to validate a new area OT using a sensory integration approach. sons administering the intervention, and
of clinical investigation. To develop con- Parents identified with the descriptions specifies the environment in which the
sensus, a state of “equipoise” (Kuhn provided in the Kranowitz book and be- treatment is conducted.
Structure of Scientific Revolution) must gan to seek treatment approaches that A second key challenge to inter-
be reached. Equipoise is a state of agree- addressed sensory issues. They began preting existing research that evaluates
ment within the community for whom pushing from the consumer side for ser- the effectiveness of OT using a sensory
the issue has meaning, such as families vices based on a desire to help their child integrative approach is 1) dependent
with children affected, researchers, clini- rather than waiting for analysis of scien- measures used in previous research were
cians, and scholars. To achieve this state, tific evidence. not related to the purpose of the inter-
empirical research must be conducted Although public awareness and ac- vention; 2) researchers did not utilize a
and findings must be generalized to the ceptance of OT using a sensory integra- theoretical base to explain the how the
people who are stakeholders. The re- tive approach increased, a tension be- putative mechanisms of the treatment are
searchers and stakeholders build a com- tween the push for services and empirical measured by the specific outcomes uti-
munity based on a consensus of beliefs. science supporting this approach re- lized; and 3) multiple outcomes were uti-
An excellent method to generate confi- mained. Until empirical consensus is lized instead of specifically targeted out-
dence in a new methodology is by rep- reached about the effectiveness of this comes to the surmised mechanisms of
lication of treatment effects. approach, the practice will not be widely treatment.
Currently, efforts to facilitate con- accepted by the broader scientific com- In addition, research has been con-
sensus regarding the merits of OT using a munity, and the consensus will be limited
ducted on ”sensory integration“ as an
sensory integrative approach are under- to the therapeutic community. Fortu-
isolated modality rather than embedding
way. One reason for the lag in this area is nately, the efforts described in this article
it in the context of a full OT program
that the science of OT is relatively new are actively working to close the gap
[Polatajko et al., 1992] as was originally
compared to fields such as psychology between practice and research.
intended. Ayres always used an occupa-
and medicine with longer traditions of It is interesting to note that, al-
tional frame of reference in providing
research and trained scientists. OT is his- though controversy regarding the effec-
torically a field of service provision, so tiveness of OT using a sensory integra- intervention [Ayres, 1972, 1979, 1989].
efforts have mainly focused on practice tion approach exists, over 80 studies have This means that the goals of therapy are
issues. Many case studies detailing the use been conducted that measure some as- always functional abilities and routines,
and effectiveness of OT using a sensory pect of the effectiveness of this approach include “occupations” of early childhood
integrative approach have been published for intervention. About half of the studies such as sleeping, eating, dressing, playing,
in the peer-reviewed literature with ex- demonstrate some type of treatment ef- interacting with others, learning, and so
amples of strategies that might have util- fectiveness. Two metaanalyses [Otten- on, and embody key concepts such as
ity for clinicians and for generating hy- bacher, 1982; Vargas and Camilli, 1999] active participation and the just right
potheses [Schaaf, et al., 1987; Case-Smith and four research reports [Palatojko, et al. challenge. Thus, these studies, while in-
and Bryan, 1999; Linderman and Stew- 1992; Arendt et al., 1988; Hoehn and teresting, are not informing the public
art, 1999; Baranek, 2002; Mulligan, Baumeister, 1994] have been published about OT using a sensory integrative ap-
2003a, 2003b]. As the number of occu- summarizing these outcome studies. proach. Next, few studies establish a the-
pational therapists with doctoral level Some of the syntheses concluded that the oretical basis for their hypotheses, citing
training increases, the availability of re- approach is effective and other syntheses instead the question, “Does sensory inte-
search scholars who can implement inde- suggest the intervention was equally ef- grative treatment work?,” which is a sim-
pendent research grows, and the funding fective as other approaches. plistic and atheoretical question. Finally,
for this type of research is expanded, new At this point in time, interpretation in existing research many studies use
research to facilitate consensus will ex- of the findings of these 80 studies is dif- multiple outcome measures with no
pand. ficult due to three methodological limi- good explanation of how the outcomes
The best route to establishing a tations. The first key challenge for OT relate to the suspected effects of treat-
consensus is convergence of results from researchers is defining the independent ment and utilize [Densem et al., 1989] a
multiple studies and replication [Ziman, variable (the treatment) in a manner that “fishing expedition” approach hoping to
1968]. Public acceptance of the princi- is replicable. As this intervention ap- find something that might be statistically
ples of SI also encourages empirical re- proach is individualized (often compared significant. The statistical result of this
search. For OT/SI this has been sup- to the way psychotherapy is individual- type of study is that the strength of the
ported by several factors. First, ized), standardization of treatment has treatment is likely to be reduced because
individuals affected by autism began to been a challenge to outcome research. there is no hypothesis about the relation
verbalize the impact of poor sensory pro- Recent progress to define the interven- between the treatment and outcomes.
cessing on behavior and function tion has been made by a multisite re- Researchers run the risk of nonsignificant
[Grandin, 1986; Williams, 1992, 1994; search group funded by an NIH R21 and uninterpretable results [Ottenbacher,
146 MRDD RESEARCH REVIEWS ● SENSORY INTEGRATIVE THERAPY FOR CHILDREN WITH AUTISM ● SCHAAF & MILLER
1991], hence some of the findings of exciting challenge to action. The field program for children with perceptual–motor
nonsignificance are difficult to interpret. offers tremendous promise. Studies are deficits. J Learn Disabil 22:221–229.
Dunn W. 1999a. The Sensory Profile. San Anto-
The multisite R21 research team underway to elucidate the underlying nio: The Psychological Corporation.
working on the challenge of treatment mechanisms of the impairment, to define Dunn W. 1999b. Sensory Profile: User’s Manual. San
replication is also working on a system- the phenotypic characteristics of the dis- Antonio, TX: The Psychological Corporation.
atic way to apply goal attainment scaling order, to discriminate the disorder from Dunn W. 2002. The Infant/ Toddler Sensory Pro-
(GAS) as a primary outcome measure for other developmental disorders (e.g., file. San Antonio, TX: The Psychological
Corporation.
effectiveness studies. GAS provides a ADHD and autism), and to evaluate the Grandin T. 1986. Emergence: Labeled Autistic.
means to establish intervention goals that effectiveness of OT services in remediat- Novato, CA: Arena Press.
are specifically relevant to individuals and ing the dysfunction. New research with Grandin T. 1995. Thinking in Pictures. New York:
their families and that allow comparison stronger empirical standards is forthcom- Doubleday.
of achievement across diverse desired ing. We are on the cusp of an explosion Greenough WT, Black JE, Wallace CS. 1987. Ex-
perience and brain development. Child Dev
functional outcomes. GAS in combina- of knowledge in this area providing rig- 58:539 –559.
tion with physiological outcome mea- orous scientific data to move the field Hoehn TP, Baumeister AA. 1994. A critique of the
sures will provide a method for measur- forward. Scientists and practitioners alike application of sensory integration therapy to
ing effectiveness that will increase the must promote research that leads to bet- children with learning disabilities. J Learn
integrity, strength, and replicability of fu- ter diagnoses and effective interventions, Disabil 27:338 –350.
Huebner RA. 2001. Autism: A Sensorimotor Ap-
ture effectiveness studies. improving the lives of children and their proach to Management. Gaithersburg, MD:
The third key challenge relates to families. f Aspen Publishers Inc.
the homogeneity of the samples studied. Kandel ER, Jessell T. 1995. Early experience and
A limitation of previous studies was the the fine tuning of synaptic connections. In
REFERENCES E.R. Kandel, J.H. Schwartz, & T. Jessell
difficulty in defining a homogenous Ahn RR, Miller LJ, Milberger S, et al. 2004. Prev- (Eds.). Essentials of Neural Science and Be-
group. The heterogeneity of samples in alence of parents’ perceptions of sensory pro- havior, Norwalk, CT: Appleton & Lange, p
previous research increased within-group cessing disorders among kindergarten chil- 1247–1279.
variability and reduced the probability of dren. Am J Occup Ther 58:287–293. Kempermann G, Gage FH. 1999. New nerve cells
finding significant group differences. Anzalone ME, Williamson GG. 2000. Sensory pro- for the adult brain. Sci Am 280:48 –53.
cessing and motor performance in autism Kientz MA, Dunn W. 1997. A comparison of the
Now with the publication of the Sensory spectrum disorders. In: Wetherby AM, Pri- performance of children with and without
Profiles and the physiological paradigm, zant BM, editors. Autism Spectrum Disor- autism on the sensory profile. Am J Occup
the Sensory Challenge Protocol [Miller ders: A Transactional Developmental Ap- Ther 51:530 –537.
et al., 1999], which suggests electroder- proach. 9th ed. Baltimore: Brooks Publishing Kimball JG. 1993. Sensory integrative frame of
Company. p 143–166. reference. In: Kramer P, Hinajosa J, editors.
mal activity criteria for inclusion in spe- Arendt RE, MacLean WE, Baumeister AA. 1988.
cific sensory processing subtypes, future Sensory Integration Frame of Reference. Bal-
Critique of sensory integration therapy and its timore: Williams and Wilkins. p 87–167.
studies can define their samples in a man- application to mental retardation. Am J Ment Kranowitz CS. 1998. The Out-of-Sync Child:
ner that allows replication across sties. Retard 92:401– 411. Recognizing and Coping with Sensory Inte-
The limitations in previous studies Ayres AJ. 1972. Sensory Integration and Learning gration Dysfunction. New York: Berkley
Disorders. Los Angeles: Western Psychologi- Publishing Group.
result in the absence of consensus in the cal Services.
field regarding the effectiveness of SI in- Linderman TM, Stewart KB. 1999. Sensory inte-
Ayres AJ. 1979. Sensory Integration and the Child.
grative-based occupational therapy and func-
terventions. The field is using lessons Los Angeles: Western Psychological Services.
tional outcomes in young children with
learned to improve future studies, mov- Ayres AJ. 1989. Sensory Integration and Praxis
PDD: A single subject study. Am J Occup
Tests. Los Angeles: Western Psychological
ing the research forward. Careful exam- Services.
Ther 53:208 –213.
ination of the approximately 80 previous Mailloux Z. 2001. Sensory integrative principles in
Ayres AJ, Tickle LS. 1980. Hyper-responsivity to
studies reveals that important contribu- intervention with children with autistic dis-
touch and vestibular stimuli as a predictor of
order. In: Smith-Roley S, Imperatore-
tions to the study of sensory processing positive response to sensory integration pro-
Blanche E, Schaaf RC, editors. Understand-
disorder have been made. Given the cur- cedures by autistic children. Am J Occup
Ther 34:375–381. ing the Nature of Sensory Integration with
rent level of research, diverse findings are Baranek GT. 2002. Efficacy of sensory and motor Diverse Populations. San Antonio, TX: The
not surprising. This inconsistency is pre- interventions for children with autism. J Au- Psychological Corporation. p 365–382.
dictable, given the variation in sample tism Dev Disord 32:397– 422. Mailloux Z, Smith-Roley S. 2001. Sensory inte-
Brown CE, Dunn W. 2002. Adolescent/Adult gration. In: Miller-Kuhaneck H, editor. Au-
characteristics, intervention methods and tism: A Comprehensive Occupational Ther-
Sensory Profile: User’s Manual. Antonia, TX:
duration, and outcomes measured. The The Psychological Corporation. apy Approach. Bethesda, MD: American
knowledge base in this field is in its in- Bundy AC, Lane SJ, Fisher AG, et al. 2002. Sensory Occupational Therapy Association.
fancy and substantial work is needed be- Integration: Theory and Practice. Philadel- Mangeot SD, Miller LJ, McIntosh DN, et al. 2001.
fore enough rigorous empirical data are phia: F.A. Davis. Sensory modulation dysfunction in children
Case-Smith J, Bryan T. 1999. The effects of occu- with attention-deficit-hyperactivity disorder.
available to proffer valid conclusions Dev Med Child Neurol 43:399 – 406.
pational therapy with sensory integration em-
about the effectiveness of this interven- phasis on preschool-age children with autism. McIntosh, DN, Miller, LJ, Shyu V, et al. 1999.
tion approach. Am J Occup Ther 53:489 – 497. Overview of the short sensory profile. In:
In conclusion, significant progress Cermack SA. 2001. The effects of deprivation on Dunn W, editor. The Sensory Profile: Exam-
has been made in defining homogenous processing, play, and praxis. In: Smith-Roley iner’s Manual. San Antonio, Tx: The Psycho-
S, Blanche E, Schaaf R, editors. Understand- logical Corporation. p 59 –73.
subgroups for analysis, in describing a ing the Nature of Sensory Integration with McKenzie AL, Nagarajan SS, Roberts TP, et al.
replicable treatment, and in choosing Diverse Populations. San Antonio, TX: 2003. Somatosensory representation of the
valid outcome measures. However, gaps Therapy Skill Builders. digits and clinical performance in patients
exist in knowledge related to sensory DeGangi GA. 2000. Pediatric Disorders of Regu- with focal hand dystonia. Am J Phys Med
processing disorder and the effectiveness lation in Affect and Behavior: A Therapist’s Rehabil 82:737–749.
Guide to Assessment and Treatment. San Di- Merzenich MM, Nelson RJ, Stryker MP, et al.
of occupational therapy in ameliorating ego, CA: Academic Press. 1984. Somatosensory cortical map changes
this condition. Hence, in the field of Densem JF, Nuthall GA, Bushnell J, et al. 1989. following digit amputation in adult monkeys.
occupational therapy, we have a clear and Effectiveness of a sensory integrative therapy J Comp Neurol 224:591– 605.

MRDD RESEARCH REVIEWS ● SENSORY INTEGRATIVE THERAPY FOR CHILDREN WITH AUTISM ● SCHAAF & MILLER 147
Miller LJ, Lane SJ. 2000. Toward a consensus in O’Neill M, Jones RS. 1997. Sensory-perceptual Performance in Children with Sensory Mod-
terminology in sensory integration theory and abnormalities in autism: A case for more re- ulation Dysfunction. American Occupational
practice. Part 1: Taxonomy of neurophysio- search? J Autism Dev Disabil 27:283–293. Therapy Association 82nd Annual Confer-
logical processes. Sens Integr Special Interest Ornitz EM. 1974. The modulation of sensory input ence and Exposition, Miami Beach, FL.
Sect Q 23:1– 4. and motor output in autistic children. J Au- Schaaf RC, Miller LJ, Seawell D, et al. 2003. Chil-
Miller LJ, McIntosh DN, McGrath J, et al. 1999. tism Child Schizophr 4:197–205. dren with disturbances in sensory processing:
Electrodermal responses to sensory stimuli in Ornitz EM. 1989. Autism at the interface between A pilot study examining the role of the para-
individuals with fragile X syndrome: A pre- sensory and information processing. In: Daw- sympathetic nervous system. Am J Occup
son G, editor. Autism: Nature of Diagnosis Ther 57:442– 449.
liminary report. Am J Med Genet 83:268 –
and Treatment. New York: Guilford. p 174 – Smith-Roley S, Spitzer SL. 2001. Sensory integration
279.
207. revisited: A philosophy of practice. In: Smith-
Miller LJ, Schoen S. 2005. Sensory Responsivity Ottenbacher K. 1991. Research in sensory integra- Roley S, Blanche E, Schaaf R, editors. Under-
Scales, 2nd edition: Research manual for ex- tion: Empirical perceptions and progress. In: standing the Nature of Sensory Integration with
aminers. Littleton, CO: Developmental Fisher AG, Murray EA, Bundy AC, editors. Diverse Populations Therapy Skill Builders. San
Technologies. Sensory Integration: Theory and Practice. Phil- Antonio, TX: Harcourt & Brace.
Mulligan S. 2003a. Examining the evidence for adelphia: F.A. Davis Company. p 385–399. The SPD Network. 2004. SPD-SWG Research Ab-
occupational therapy using a sensory integra- Polatajko HJ, Kaplan BJ, Wilson BN. 1992. Sen- stracts. Website. Available . Accessed March 22,
tion framework with children: Part 1. Sens sory integration treatment for children with 2005.
Integr Special Interest Sect Q 26:1– 4. learning disabilities: Its status 20 years later. Vargas S, Camilli G. 1999. A meta-analysis of re-
Mulligan S. 2003b. Examining the evidence for Occup Ther J Res 12:323–341. search on sensory integration treatment. Am J
occupational therapy using a sensory integra- Roley SS, Burke JP, Cohn ES, et al. 2005. A Occup Ther 53:189 –198.
tion framework with children: Part 2. Sens strategic plan for research. Sensor Integration Williams D. 1992. Nobody Nowhere: The Ex-
Integr Special Interest Sect Q 26:1– 4. Special Interest Section Quaterly 28:1–3. traordinary Autobiography of an Autistic.
Ognibene TC. 2002. Distinguishing sensory mod- Schaaf RC, Merrill SC, Kinsella N. 1987. Sensory New York: Times Books.
ulation dysfunction form attention-deficit/ integration and play behavior: A case study of Williams D. 1994. Somebody Somewhere: Break-
hyperactivity disorder: Sensory habituation the effectiveness of occupational therapy us- ing Free from the World of Autism. New
and response inhibition processes. Personal ing sensory integrative techniques. Occup York: Times Books.
Ther Health Care 4:61–75. Ziman JM. 1968. Public knowledge: An Essay
communication, Unpublished doctoral dis-
Schaaf RC, Miller LJ, Martello T, et al. 2002. Concerning the Social Dimension of Science.
sertation, University of Denver, Denver, CO.
Parasympathetic Function and Occupational Cambridge: Cambridge University.

148 MRDD RESEARCH REVIEWS ● SENSORY INTEGRATIVE THERAPY FOR CHILDREN WITH AUTISM ● SCHAAF & MILLER

You might also like