Does Sensory Integration Therapy Work?

Fidget toys are all the rage these days. You probably know someone who swears they help kids focus. You may even use them yourself. Fidget toys are just one of the many compensatory items that may be recommended for children with sensory processing disorder. If you’ve never heard of sensory processing disorder, here’s what you need to know. In the 1970s, Dr. A. Jean Ayres, occupational therapist, first described sensory processing difficulties. She explained that people make sense of the world through 7 senses: vision, hearing, taste, smell, touch, proprioception (sense of body awareness) and vestibular sense (sense of movement).  A person may be overly (hyper) or under (hypo) sensitive to one or more of the 7 senses.

The Claim:

Sensory integration therapy (SIT) teaches the brain to respond in a more organized (appropriate) way to sensations and movement.

Let’s dig in!

Results from initial search:

A sensory processing disorder (also called sensory integration disorder/dysfunction) diagnosis is usually made by an occupational therapist through a series of checklists by observing the child and interviewing the caregivers. The sensory problems generally affect the child’s ability to learn, interact with others, and participate in daily activities. Most children on the autism spectrum are reported to have sensory processing disorder as well as many children with ADHD and even some children with no other conditions. Here are some examples of what sensory processing disorder might look like:

Hypersensitivity to sound: extreme responses to or fear of common sounds like flushing toilets, coughing, or clanking silverware; inability to tune out background noises

Hypersensitivity to touch: Avoidance of touching or hugging people; refusal to wear many types of clothing or extreme discomfort when tags are not cut from clothing; fear of touching messy things like food, glue or play-doh

Hyposensitive vestibular sense and/or proprioceptive sense: desire to run and crash into furniture or other objects constantly; Constant need to jump or swing; no fear of getting hurt

Sensory processing disorder is not recognized as a mental disorder in the ICD-10 and many doctors do not believe it really exists as a disorder on its own. Most psychologists do recognize that children have sensory challenges, but see them as part of another developmental disorder or delay, such as autism.

Occupational therapists, as well as some other educators and professionals believe sensory processing disorder is at the root of many behavioral and learning challenges and that it can be treated, to some extent, with sensory integration therapy. Sensory integration therapy looks at how a child processes each type of sensory input and recommends things that can be done to help the child normalize the way he or she interprets the input.

They believe they are helping to literally reorganize the sensory system in the brain rather than simply provide coping mechanisms and compensatory strategies.

This is thought to be achieved through a prescribed “sensory diet” individualized for each child. When the sensory diet is followed, the child is expected to become more tolerant of sensory input and more calm, alert and focused. Different activities are assigned depending on whether the sense needs to be heightened or attenuated. Here is an example of a sensory diet:

To help calm and organize the proprioceptive and vestibular senses: rock on a chair or horse, climb stairs, push a grocery cart or something heavy, wear weighted vests or blankets

To help arouse hyposensitive proprioceptive and vestibular senses: use more erratic motion such as running, playing catch, and spinning around

To help organize touch, use textures and deep pressures such as: swaddles, bear hugs, joint compressions, finger paint, glitter glue, putty, rice bins

To organize the auditory sense, use: calming our arousing music, white noise, noise canceling head phones

To organize vision, use: sunglasses, lava lamps, mobiles, drawing, minimal patterns and clutter, non-fluorescent lighting

To organize smell and taste, use: essential oils, candles, warm and cold foods, blow bubbles, suck through straws

Follow-up questions:

1. • How are brains of people with sensory problems different?
   • Does SIT really make changes to the brains of these people? Can we see the changes or measure them indirectly?
   • Even if the brain isn’t actually changing, can sensory diets help children learn, focus, and be more successful in relationships with others?

Reader comments

1. • Most of my readers claim to either: work with or know people with sensory challenges, or have sensory challenges of their own. I would love to hear what’s worked for you! If you are an occupational therapist, your expertise is welcome!

Peer reviewed research:

• https://www.ncbi.nlm.nih.gov/pubmed/22641765 Sensory integration therapies for children with developmental and behavioral disorders. (2012)
  • Summary of report: 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.
• https://www.ncbi.nlm.nih.gov/pubmed/22318118 Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study. (2012)
  • Ten children diagnosed with autism spectrum disorder ages 4-8 years received intensive occupational therapy intervention using sensory integration principles following a manualized protocol. Measures of feasibility, acceptability and safety were collected from parents and interveners, and fidelity was measured using a valid and reliable fidelity instrument.
  • The intervention is safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocol with adequate fidelity.
  • This study did not measure whether the therapy actual worked as purported.
• https://www.ncbi.nlm.nih.gov/pubmed/23893373 Pilot study: efficacy of sensory integration therapy for Japanese children with high-functioning autism spectrum disorder. (2014)
  • 20 children with high functioning autism (IQ of 70 or above) who had previously received therapy were studied. 8 children had received individualized sensory integration therapy and 12 children had received traditional group therapy.
  • The Miller Assessment for Preschoolers (Japanese version) was given to each child before and after 8-10 months of treatment. The results showed that Total score and all Index scores except for Verbal Index increased significantly in the SIT group, while only Total score increased in the GT group. Furthermore, the SIT group showed more improvement compared with the GT group in Total score and on Coordination, Non-verbal, and Complex Index scores.
  • The study had several limitations including testing group vs. individual therapy and being an analysis of previously collected data. Evidence for the efficacy of sensory integration therapy based on this study is present, but weak.
• https://www.ncbi.nlm.nih.gov/pubmed/25005509 Parents’ explanatory models and hopes for outcomes of occupational therapy using a sensory integration approach. (2014)
  • Summary: 275 Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways. They specifically wished for improvements in: self-regulation, interaction with peers, improvement in skilled motor activities, and self-confidence.
  • This study did not test whether sensory integration therapy worked; only what outcomes parents hoped for.
• https://www.ncbi.nlm.nih.gov/pubmed/25184475 State of measurement in occupational therapy using sensory integration. (2014)
  • This article discussed how sensory integration therapy is being measured. The authors stated the need for additional measurement tools that take into account: descriptions of the child, how well the therapist or patient adhered to the treatment, dosage of treatment, outcome measurements with qualitative and quantitative data.
  • This article basically stated that sensory integration therapy needs to be measured more accurately.
• https://www.ncbi.nlm.nih.gov/pubmed/24214165 An intervention for sensory difficulties in children with autism: a randomized trial. (2014)
  • 32 children ages 4-8 with autism and IQ greater than 65 were divided into treatment and control groups. The treatment group received sensory integration therapy and the control group did not. Some members of both groups received other types of therapy too, such as ABA.
  • The sensory integration group scored significantly better than the control group on several measures of the Goal Attainment Scale including self-care, social activities, and decreased caregiver assistance.
  • This study used more rigorous methods than most others, but still had flaws. The number of participants was small and all patients had a relatively high IQ.
• https://www.ncbi.nlm.nih.gov/pubmed/25460221 A systematic review of sensory-based treatments for children with disabilities. (2015)
  • Thirty studies involving 856 participants met our inclusion criteria and were included in this review. Considerable heterogeneity was noted across studies in implementation, measurement, and study rigor. This means the studies were very different in quality and how the therapy was carried out.
  • The research on sensory-based treatments is limited due to insubstantial treatment outcomes, weak experimental designs, or high risk of bias.
  • The systematic review concluded that there is insufficient evidence to support the use of sensory integration therapy.
• https://www.ncbi.nlm.nih.gov/pubmed/24477447 A systematic review of sensory processing interventions for children with autism spectrum disorders. (2015)
  • This systematic review examined the research evidence (2000-2012) of two forms of sensory interventions, sensory integration therapy and sensory-based intervention, for children with autism spectrum disorders and concurrent sensory processing problems.
  • “Sensory integration therapy” was defined as clinic-based interventions that use sensory-rich, child-directed activities to improve a child’s adaptive responses to sensory experiences. “Sensory-based interventions were 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.
  • 5 studies used sensory integration therapy and 14 studies used sensory-based intervention. Two randomized control trials using sensory integration therapy found positive effects using Goal Attainment Scaling (a popular and reliable way test to measure progress). The other 3 studies found positive effects for reducing behaviors linked to sensory problems. Few positive effects were found in sensory-based intervention studies.
  • This study also emphasized the need for more rigorous trials and better measurements.

What we know and don’t know:

• These 8 articles were the only relevant studies I could find when searching PubMed. I would imagine there may be more research out there in journals specific to occupational therapy. I’m not sure why my search didn’t yield more results, especially since some of the studies I found were reviews of several others.
• From what I found, it seems like the way SIT is implemented varies greatly and is hard to measure. Many measurements are subjective (looking at results such as whether the parents think the intervention is working). It may also be hard to tease out whether the SIT was what helped the child make progress or whether it might have been something else like behavior modification or maturity.
• None of the research I found attempted to prove that children with sensory processing disorder had real neurological differences. They also did not attempt to show that after treatment, the children’s brains looked more like those of children without sensory processing disorder.
• A few studies had promising results. Here’s what they had in common:
  • They measured pre and post treatment via the goal attainment scales which breaks down precisely how proficient a child is at a task/skill and how much help they need.
  • Therapy was provided to each child individually and not in a group setting.
  • Progress was reported in terms of the child getting better at functional skills, not having a more “normal” sensory processing system.

Conclusions and applications:

• So, does sensory integration therapy change the brain? I wasn’t able to find any evidence that this is true. Does sensory integration therapy work? Maybe. From what I’ve learned, it seems that some children get better at things like self-care skills, social skills, and compliant behavior when they have SIT. My inclination is that the sensory diet can help get a child’s body and mind in a state more ready to learn. For example, some people are able to focus on school work better when Mozart is playing in the background while other people need complete silence. Many children are able to sit at their desks and focus much better after an hour of recess than without. I may be wrong, but right now, the theory that sensory integration therapy changes the sensory system neurologically is more of a hypothesis. There is not any evidence to support that notion.
• Should occupational therapists continue using SIT? There definitely needs to be more high quality research in this area. For now, though, I think SIT should be used as a strategy or technique to help children improve other skills. This is the way I see SIT used most commonly today. Therapists often use sensory organizing strategies like brushing or weighted vests to help a child calm down and focus on a task. So, indirectly, it’s probably making a difference, at least for some kids. However, if the therapist, for example, said they were having a child swing in order to organize the child’s vestibular system, there may be a problem. There isn’t any evidence to support that swinging (or any other activity) can change the vestibular system.

That’s my 2 cents based on what I found in the research so far. I’m always open to learn more. What do my OT friends think about SIT and how it should be used?

 

 

 

 

 

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