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Ayres Sensory Integration® Intervention

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International Handbook of Occupational Therapy Interventions


Ayres (1972, p. 11) defined sensory integration as “the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.” The sensory integration process reflects a dynamic, self-organizing interaction between the child and the physical and social environment. This process is believed to be the natural result of a child’s typical sensorimotor development. Sensory integration allows the child to engage in and participate in a wide range of meaningful and purposeful activities.

After ASI, Max’s mother reported. Max started to play trucks and cars with the other kids at school and can focus long enough to play a board game with the family. He will give verbal encouragement to another child who is upset. He is better able to participate in dressing and his sleeping has improved…he is now able to transition to bed with more ease, which was a welcome improvement.

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Author information

Authors and Affiliations


Corresponding author

Correspondence to Teresa A. May-Benson ScD, OTR/L, FAOTA .

Editor information

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The Case Study of: Caroline, a Child with Problems Processing and Integrating Sensory Information


Integration, intervention, praxis, sensory, sensory defensiveness


The theme of this case study concerns provision of Ayres Sensory Integration® (ASI) intervention for a child with problems processing and integrating sensory information.

The students’ tasks include:

  1. 1.

    Finding information about the sensory integration frame of reference.

  2. 2.

    Synthesizing assessment results to identify patterns of sensory integration dysfunction.

  3. 3.

    Determining possible outcome measures, goals, and objectives for intervention.

  4. 4.

    Identifying possible sensory integration activities to address major areas of concern.

  5. 5.

    Synthesizing the case information into a report.

As a starting point, the students should use the following references in addition to the references cited in the text to gather background information:

  • Bundy AC, Lane SJ, Murray EA (2002) Sensory integration: theory and practice, 2nd ed. F.A. Davis Company, Philadelphia

  • Polatajko HJ, Cantin N (2010) Exploring the effectiveness of occupational therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information. Am J Occup Ther 64(3), 415–429

  • Schaaf RC, Schoen SA, Smith Roley S, Lane SJ, Koomar J, May-Benson TA (2010) A frame of reference for sensory integration. In: Kramer P, Hinojosa J (eds) Frames of reference for pediatric occupational therapy, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 99–186

  • Smith-Roley S, Blanche EI, Schaaf RC (eds) (2001) Understanding the nature of sensory integration with diverse populations. Therapy Skill Builders, San Antonio

Overview of the Content

The major goals of ASI intervention are to:

  1. 1.

    Facilitate participation in activities

  2. 2.

    Support self-regulation of behavior as a basis for participation in daily activities

  3. 3.

    Facilitate the development of praxis as a building block for participation in activities

Learning Objectives

By the end of this chapter, the learner will:

  • Be able to understand the theoretical postulates of the sensory integrative approach

  • Apply common terminology in the OT–SI approach

  • Understand the unique features of this approach

  • Outline the process for assessment, intervention and documentation of outcomes in the SI approach

  • Understand the application of the OT–SI approach through a case example

The Background History of the Clinical Case Study

Personal Data

Caroline is an 8-year and 1-month-old female in second grade of school.

Medical Diagnoses and Prognoses

Caroline was born at 25 weeks’ gestation by emergency C-section weighing 1.25 lbs. She was hospitalized in the neonatal intensive care unit for 3 months. Early developmental milestones were within normal limits. She is left-hand dominant. She has diagnoses of learning disability, attention deficit disorder, and language processing problems.

Reason for Seeking Occupational Therapy

Caroline’s parents were concerned about her high state of arousal and over-responsivity to sensations provided by daily activities, such as bathing and hair brushing, which often resulted in extreme emotionality and frequent behavioral outbursts. They expressed that Caroline lacked independence in dressing, self-care, and hygiene and that they were afraid that her social interactions and acceptance by her peers were affected by her poor hygiene and sloppy dress. They believed her poor fine motor skills and handwriting adversely impacted her ability to complete her school work. They wanted Caroline to be less frustrated and more successful in school with an overall better self-esteem . They also wanted home life to be easier and less stressful for the all family members.

Current Circumstances

Caroline was evaluated using the Sensory Integration and Praxis Tests (SIPT), informal clinical observations of posture, motor skills and balance, and a parent-completed developmental/sensory history. Her assessment indicated that Caroline was very defensive to touch and had sensitivities to visual and auditory sensory inputs. She sought proprioceptive input through jumping on beds and chewing on her clothing and other objects as a means of regulating and organizing her behavior. Caroline demonstrated decreased tactile, proprioceptive, and vestibular discrimination which contributed to problems in postural control and praxis . These difficulties resulted in difficulty carrying out motor-based activities, such as dressing and active play on a playground with peers. In the area of praxis, she demonstrated good ideation skills but had difficulties with motor planning, sequencing skills, and bilateral coordination.

Occupational Performance Issues

Caroline had difficulty with many daily living skills and difficulties in social participation. She had problems sleeping alone (often sleeping with her parents), falling asleep, and sleeping through the night. Being sensitive to certain clothing textures, tags in shirts, and socks, she was very particular about her clothing which interfered with her independence in dressing as well as completing her morning routines. She preferred to wear stretch pants and t-shirts because of difficulties dressing herself and managing fasteners. Caroline strongly resisted haircutting and hair brushing, and, with her clothing, often looked unkempt. She was a messy eater, had difficulties handling utensils, often knocked over glasses, and spilled or broke things. She had poor balance which made it hard to learn to ride a bicycle. At school, she often stood at the table instead of sitting, sat on the edge of her seat, and frequently fell out of her chair. Lastly, Caroline had problems organizing herself to clean up her room, do homework, or complete household chores.

The Student’s Report

The following questions are generated from the available literature, references, and our clinical experiences and will guide the student in developing an assessment and intervention plan for Caroline:


  1. 1.

    What assessments are appropriate to identify sensory integration problems for this child?

  2. 2.

    What patterns of sensory integration dysfunction does this child demonstrate?

  3. 3.

    What outcomes would you expect to change?

  4. 4.

    What short- and long-term goals would you set for this child?

  5. 5.

    What are the steps in the clinical reasoning process you would use to assess and treat this child?

  6. 6.

    What type of intervention setting and activities would be useful for this child?

  7. 7.

    What other intervention approaches may be useful to use with this child?

  8. 8.

    What is the research evidence for occupational therapy using a sensory integration approach?

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May-Benson, T., Schaaf, R. (2015). Ayres Sensory Integration® Intervention. In: Söderback, I. (eds) International Handbook of Occupational Therapy Interventions. Springer, Cham.

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