Ayres Sensory Integration (ASI) is an occupational therapy approach for children with sensory processing differences. The evidence is genuinely mixed: some systematic reviews and randomised controlled trials report benefits for individually chosen goals, while a large, well-conducted trial found no benefit over usual care for behaviour. Outcomes depend heavily on treatment fidelity and how goals are set, so honest, individualised framing matters.
Key takeaways
- Ayres Sensory Integration is a specific, manualised clinic-based approach; it is not the same as general "sensory activities" or sensory-based strategies like weighted vests.
- A 2018 systematic review found strong evidence for ASI on individually generated goals and moderate evidence for some self-care outcomes in autistic children aged 4–12.
- A large 2022 randomised controlled trial (SenITA) found ASI did not produce clinical benefit over usual care on its primary behaviour outcome.
- Treatment fidelity — delivering ASI as designed — is essential; results from poorly delivered or non-ASI "sensory" programmes should not be read as evidence for ASI.
- Occupational therapists should frame ASI cautiously, tie it to measurable functional goals, and avoid promising specific outcomes.
What is Ayres Sensory Integration?
Ayres Sensory Integration is a specific occupational therapy intervention, not a loose category of sensory activities. Developed from the work of occupational therapist A. Jean Ayres, ASI is delivered one-to-one by a trained therapist in a clinic environment with specialised equipment, using play-based, child-directed activities that provide controlled sensory challenges (such as movement, touch, and "heavy work") matched to the child's responses.
ASI is distinct from sensory-based interventions, which are simpler adjuncts applied to a person or environment — for example weighted vests, brushing protocols, or sound-based programmes. This distinction is important because the evidence for these two groups differs, and conflating them is a common source of confusion. ASI also has a defined fidelity measure, meaning there is an agreed standard for what counts as "real" ASI versus a watered-down version.
Who might ASI suit?
ASI is most often considered for children with sensory processing difficulties, including some autistic children, where sensory responses are getting in the way of everyday participation. It is one of the most frequently requested and used paediatric occupational therapy approaches, but high demand is not the same as strong evidence, and it is not appropriate or necessary for every child. The decision should rest on a thorough occupational therapy assessment of how sensory differences affect the individual's daily activities and goals.
What does the evidence say?
The evidence for ASI is mixed, and an honest summary has to hold two findings at once: some studies show benefits for individualised goals, while a large trial found no benefit on a standardised behaviour measure. Both are true, and the difference is informative.
Where the evidence is supportive
A 2018 systematic review found strong evidence for ASI on individually chosen goals. , published in the American Journal of Occupational Therapy, reviewed studies using ASI delivered with fidelity and concluded there was strong evidence for positive outcomes on individually generated goals, moderate evidence for improvements in autistic behaviours and reduced caregiver assistance with self-care, and emerging but insufficient evidence for play, sensory-motor, language, and social outcomes.
A separate 2018 systematic review reached a similar conclusion for a defined age band. , published in Autism Research (DOI: 10.1002/aur.2046), reviewed two randomised controlled trials meeting rigorous methodological standards (Pfeiffer et al. 2011 and Schaaf et al. 2014, with 69 combined participants) and concluded that "ASI can be considered an evidence-based practice for children with autism ages 4–12 years old". The strongest effects were on goal attainment for individually set goals.
A common thread in the supportive evidence is the outcome measure. Benefits tend to show up when goals are individualised — for example using Goal Attainment Scaling — rather than on broad standardised scales.
Where the evidence is contested
A large, well-conducted 2022 randomised controlled trial found no benefit over usual care on its primary outcome. The , funded by the UK's National Institute for Health and Care Research, compared manualised sensory integration therapy with usual care for primary-school-aged children with autism and sensory processing difficulties. Its primary outcome was problem behaviour (the Aberrant Behavior Checklist), and the trial found no significant effect: the adjusted mean difference on the irritability subscale at six months was 0.40 (95% confidence interval −2.33 to 3.14; p = 0.77), with no significant effects at 6 or 12 months. The trial concluded that sensory integration therapy did not demonstrate clinical benefit above standard care on this measure.
The provides the full results. Earlier evidence syntheses, including those informing the , have also noted methodological limitations in the supportive studies, uncertainty about how the therapy works, and that some studies reported adverse effects such as overstimulation or distress.
How can both be true?
The apparent contradiction largely reflects what was measured and how the therapy was delivered. Supportive studies tend to measure individually chosen functional goals, where ASI can show change; SenITA measured behaviour on a standardised scale, where it did not outperform usual care. The reasonable reading is that ASI may help some children reach specific, individually set participation goals, but it should not be presented as a treatment for autism, behaviour, or any condition, and benefits on broad standardised outcomes are not established.
How do OTs frame ASI within NDIS goals?
Occupational therapists frame ASI as one possible, time-limited support tied to specific functional goals, never as a guaranteed treatment. Within an NDIS context, that means starting from the person's goals and the — a support must relate to the disability, be value for money, and be effective and beneficial. The NDIS considers current good practice and the evidence base when judging whether a support is effective and beneficial, so cautious, evidence-aligned framing is appropriate.
Good practice for an report or plan that involves ASI usually includes:
- a clear assessment of how sensory differences affect daily participation;
- specific, measurable functional goals (for example, tolerating dressing or participating in a mealtime), often tracked with Goal Attainment Scaling;
- an explicit statement that ASI will be delivered with fidelity by a trained therapist;
- a defined review point to check whether the goals are being met, and a plan to change approach if they are not; and
- balanced language that describes potential benefit with appropriate uncertainty and does not promise outcomes.
Where sensory differences are driving distress or behaviours of concern, ASI may sit alongside other supports such as environmental adjustments, communication support, or , rather than being used in isolation.
Evidence at a glance
- — strong evidence for ASI on individually generated goals; moderate evidence for some autistic behaviours and self-care; emerging/insufficient evidence elsewhere.
- — based on two rigorous RCTs (69 participants), concluded ASI can be considered an evidence-based practice for autistic children aged 4–12, with strongest effects on goal attainment.
- and — found no significant benefit of sensory integration therapy over usual care on behaviour (ABC-irritability adjusted mean difference 0.40, 95% CI −2.33 to 3.14, p = 0.77).
- — notes study design limitations, uncertainty about mechanism, and that some studies reported negative effects.
Frequently asked questions
Is sensory integration therapy proven to work?
It is mixed. Some systematic reviews, such as , report benefits for individually set goals in autistic children, while the large found no benefit over usual care on behaviour. ASI is best considered for specific functional goals, with outcomes monitored, rather than as a proven treatment.
Is ASI the same as sensory toys, weighted blankets, or "sensory diets"?
No. Ayres Sensory Integration is a specific, fidelity-defined clinical approach delivered by a trained therapist. Weighted vests, brushing, and similar sensory-based strategies are different interventions with their own, generally weaker, evidence. Evidence for ASI does not transfer to these tools.
Does the NDIS fund sensory integration therapy?
The NDIS funds supports that meet the , including being effective and beneficial in line with current good practice. Whether ASI is funded depends on an individual's assessed needs and goals; an occupational therapist links any recommended therapy to measurable functional outcomes.
Can sensory integration therapy have negative effects?
Some studies have reported adverse effects such as overstimulation or distress, as noted by the . This is one reason therapy should be individualised, delivered with fidelity, monitored, and stopped or changed if it is not helping.
How long should a child try ASI before reviewing it?
There is no single fixed period, but good practice is to set specific goals at the start and review progress at a defined point. If the agreed functional goals are not being met, the occupational therapist should discuss changing the approach rather than continuing indefinitely.
Align Network's occupational therapists assess sensory and functional needs, set measurable goals, and describe the evidence for any recommended approach honestly and with appropriate uncertainty. To discuss whether sensory-focused occupational therapy fits your goals, speak with Align Network's speech pathology and occupational therapy team via our .
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