4 Modulo

Special Topics in Sensory Integration Intervention
Module 4 – General Principles of SI Intervention for

Individuals with ASD
1
Objectives
• Discuss the use of OT‐SI with individuals with ASD
• Review results of effectiveness studies when using OT‐SI
with individuals with ASD
• Provide recommendations for occupational therapists to
incorporate into intervention when working with
individuals with ASD
• Describe the principles of OT‐SI applied to individuals
with ASD
• Understand the importance of using proximal and distal
objectives to measure the results of intervention
2
Effectiveness of OT-SI
• 95‐99% of OT’s working with children with ASD report using a
SI frame of reference. (Case‐Smith & Miller, 1999; Watling, Cowan & Coffin, 2010; Watling,
Deitz, Kanny & McLaughlin, 1999)
• OT‐SI is considered an evidence‐based practice. (Steinbrenner et al.,

2018)
• OT‐SI is an effective approach for some (but not ALL) children

with ASD. (Schaaf, 2011; Baranek, 2002)
• OTs who felt competent in their use of SI perceived more
improvement in the children with ASD and PDD. (Case‐Smith & Miller,
1999)
• Recent clinical intervention manuals consider SI to be an

evidence based practice. (Steinbrenner et al., 2020)
3
Evidence that Supports the Effectiveness
of OT-SI with Individuals with ASD
4
Challenges in Determining Effectiveness
Challenges in ASD Population
• Heterogeneity in strengths and challenges in ASD population
• Heterogeneity in sensory differences and challenges
• Heterogeneity in how these differences impact functional performance
and participation areas
• Heterogeneity in contexts and supports provided to individuals with ASD
Challenges in Research
• Inconsistencies in use of outcome measures
• Inconsistencies in clinical environments when applying sensory integration
intervention
• Inconsistencies in fidelity to OT‐SI intervention
• Inconsistencies in intervention dosage
• Inconsistencies in knowledge/training of occupational therapists related to
sensory integration
5
Evidence to Support OT-SI
Improvements in functional performance and participation areas
• Individualized goals on Goal Attainment Scaling (Pfeiffer et al., 2011; Watling & Hauer, 2015; Schaaf et
al., 2013)
• Motor skills (Steinbrenner et al., 2020)
• Cognition, pre‐academic, and academic skills (Steinbrenner et al., 2020; May‐Benson
& Koomar, 2010)
• Improved sleep (Watling & Hauer, 2015; Piravej et al., 2009)
• Adaptive behavior and self‐help (Steinbrenner et al., 2020)
• Play skills & social responsiveness (Pfeiffer et al., 2011; Ayres, 1980; Dunbar et al., 2015)
• Decreased self‐stimulatory and self‐injurious behaviors (Watling & Hauer, 2015; Ayres, 1980;
Smith et al., 2005; Roberts et al., 2007, Steinbrenner et al., 2020)
• Reduced caregiver assistance in self‐care and social participation (Pfeiffer et al., 2011;
Watling & Hauer, 2015; Schaaf et al., 2013)
• Improved family participation in community activities and outings (Schaaf & Nightlinger,
2007)
• Improved communication & language (Ayres, 1980, Steinbrenner et al., 2020)

• Improved occupational performance (May‐Benson & Koomar, 2010; Weaver, 2015)
6
Ayres, J. A., Tickle, L. S. (1980). Hyper‐responsivity to touch and
vestibular stimuli as a predictor of positive response to sensory
integration procedures by autistic children. American Journal of
Occupational Therapy, 34(6), 375‐381.
Clients with hyper‐responsive patterns responded better to
intervention than clients with hypo‐responsivity.
Improved Outcomes
• Language & communication
• Increased awareness of and interaction with the environment
• Social relatedness
• Engagement in purposeful activity
• Decreased self‐stimulatory behavior 7
Blanche, E. I. , & Reinoso, G. (2007). Literature review: Sensory processing deficits in the autism spectrum.
Chilean Journal of Occupational Therapy, 7 pp. 59 ‐ 68. doi:10.5354/0717‐5346.2007.79
Lang, R., O’Reilly, M., Healy, O., Rispoli, M., Lydon, H., Streusand, W., Davis, T., Kang, S., Sigafoos, J., Lancioni, G.,
Didden, R., & Giesbers, S. (2012). Sensory integration therapy for autism spectrum disorders: A systematic
review. Res Autism Spectr Disord, 6(3), 1004‐1018. https://doi.org/https://doi.org/10.1016/j.rasd.2012.01.006
Case‐Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing interventions for
children with autism spectrum disorders. Autism: The international journal of research and practice, 19(2), 133–
148. https://doi.org/10.1177/1362361313517762
Watling, R.L., Hauer, S. (2015). Effectiveness of Ayres Sensory Integration and Sensory‐Based Interventions for
People with Autism Spectrum Disorder: A Systematic Review. American Journal of Occupational Therapy, 69(5),
1‐12.
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May‐Benson, T. A. (2018). Efficacy of Occupational Therapy Using
Ayres Sensory Integration®: A Systematic Review. The American Journal of occupational therapy: Official
publication of the American Occupational Therapy Association, 72(1), 7201190010p1–7201190010p10.
https://doi.org/10.5014/ajot.2018.028431
Schoen, S. A., Lane, S. J., Mailloux, Z., May‐Benson, T., Parham, L. D., Smith Roley, S., & Schaaf, R. C. (2019). A
systematic review of Ayres sensory integration intervention for children with autism. Autism research: Official
journal of the International Society for Autism Research, 12(1), 6–19. https://doi.org/10.1002/aur.2046
8
Recommendations for Clinicians
Working with Individuals with ASD
I. General practice with individuals with ASD
II. Occupational therapy intervention for individuals

with ASD
III. OT‐SI for individuals with ASD
9
Recommendations for General Practice with Individuals with ASD
Shift attention from inward focus to outward engagement with the
environment and others
Provide reinforcement and motivation for attending to and engaging with
others
Provide an enriched environment
Provide opportunities for an increased number of trials to practice skills

Provide compensatory strategies to learn key skills
Teach skills explicitly
Redirect interfering behaviors
Reduce stress and stabilize arousal
Support intervention success with biomedical interventions
10
(Helt et al., 2008)
Recommendations for OT Intervention for Individuals with ASD
Utilize visual supports (picture schedules, video modeling, PECS, color
coding) (Flippin, Reszka & Watson, 2010; Ganz, Davis, Lund, Goodwyn & Simpson, 2012)
Use focused interests as a starting point (Hough & Koenig, 2014; Koenig & Williams, 2017; Spitzer, 2008;
Winter‐Messiers et al., 2007; Kryzak & Jones, 2015)
Break down tasks and activities into small steps
Allow for choice & control to support self‐determination and self‐advocacy

(Toussaint, Kodak, Vladescu, 2015)
Simplify verbal directions and allow time for processing

Incorporate goal‐setting and self‐monitoring
Utilize priming & previewing strategies (Quirmbach, Lincoln, Feinberg‐Gizzo, Ingersoll & Andrews, 2009)
Incorporate intervention strategies to support family coping and resiliency
and participation in family routines and activities
11
Video: Visual Supports & Strategies
Video courtesy of Linsey Grunes 12

Visual Supports and Strategies
Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission. 13

The uniqueness of intervention
based on Sensory Integration
SI Sensory Highest level of

= + the Adaptive
Intervention Experience Response
Occurring in the Context of Play

Nurtured by Context of Therapeutic Alliance
Sensory Enriched Physical Environment to Support
Sensory Experiences
Sensory Integration Patterns of Dysfunction
Tactile Tactile Defensiveness

Overresponsive
Modulation of (TD)
Sensory Input Gravitational
Impacting Proprioceptive Underresponsive
Insecurity (GI)
Arousal
Vestibular Overresponsive Aversiveness to
Movement
Sensory
Integration Underresponsive
Patterns of
Dysfunction Vestibular é Postural/
Ocular Deficits
Registration and
Discrimination Proprioception Vestibular Bilateral
of Sensory Input Integration Deficits
Impacting
Perception & Tactile Somatodyspraxia
Motor Control
Visual Visuodyspraxia
Sensory Integration Intervention
General Concepts
Type of Issue Sensory Experience Adaptive Response
Gravitational Insecurity • Start with anterior/posterior pelvic tilt • Stay in the optimal band
• Linear vertical experiences with prop • Grade experiences so that you do
• Practice falling into space with not see anxiety, sweating, or crying
deep touch or prop after the
Modulation Based Concerns
experience
Aversion To Movement • Start with linear inputs • Stay in the optimal

• Slowly build from arc into orbital band
inputs • Grade experiences –
no nausea
Under‐responsiveness Intense angular inputs in various Activity level should either decrease
positions or increase, depending on child.
Change in activity level reflects
movement into the optimal band.
Tactile Defensiveness • Start with inhibitory inputs such as • Stay in the optimal band
vestibular, deep touch experiences or • Grade experiences to avoid
prop flight, fright or flight
• Explore increasing complexities of responses
tactile input with inhibitory inputs
Blanche & Bodison, 2016

Sensory Integration Intervention General Concepts (Cont.)
Type of Issue Sensory Experience Adaptive Response
Inadequate Vestibular Postural • Everything is on a bungee • Increased postural responses

Responses: otoliths • Increased static postural control
• Graded linear vertical inputs
Inadequate Vestibular Postural Intense rotary inputs in various head • Increased postural responses
Patterns Related to Problems in Perception and
Responses: semicircular canals positions related to angular inputs

• to explore all areas of canals • Increased dynamic postural control
• to improve postural responses • Improved spatial awareness
Sensorimotor Integration
Inadequate Vestibular Ocular While swinging, facilitate coordination of head Increased automatic and conscious eye
Responses and eye movements movements
• static person to moving person
• static environment to moving
environment
Inadequate Vestibular Bilateral While moving on suspended equipment, Better coordinated movements
Integration assist child in pushing & pulling in a
coordinated way.
Inadequate Proprioceptive • Heavy work activities Better grading of force and use of muscle
Processing o lifting, carrying, pulling, hanging synergies
• Be aware of biomechanical alignment
• Encourage muscle synergies
Inadequate Tactile • Enhanced full body tactile inputs Improved body schema and awareness of
Discrimination while the child is navigating 3D space body relationship to objects
• Increase the complexity of tactile inputs.
Combine textures.
Blanche & Bodison, 2016

Sensory Experiences & Adaptive
Responses
18
Photo courtesy of Linsey Grunes
Sensory Experiences
• The sensory experiences, the combination of sensory
information, and the way in which we engage individuals with
ASD can be very different depending on…
• The opportunities provided within the environment,
therapeutic equipment, and the creativity of the therapist
• Individualized evaluation and analysis of the assessment data
• Improvement in function and participation
• The importance of play and fun
• The constant search for increasingly complex adaptive
responses
• Engaging the individual’s interests/inner drive; child “led” and
“shaped” by OT
19
Examples of Sensory Experiences
Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission

20
Photo courtesy of Linsey Grunes & Joan Surfus 21

22

23
24
Photo courtesy of Gustavo Reinoso, 2022
25
Photo courtesy of Gustavo Reinoso and Janet Gunter 26

©Copyright, do not reproduce without permission
Assignment: Sensory Experience
A. Link client’s reason for referral with identified pattern(s) of dysfunction
B. Describe 1 treatment activity based on sensory integration theory and intervention principles
C. Clearly identify the components of your sensory integration treatment activity

Sensory Adaptive Context/theme of Physical What will you do to
experience(s) response(s) you will play environment that establish and
related to the be promoting will be used (e.g., maintain the
pattern(s) of specialized clinic, therapeutic
dysfunction home, school, park, alliance?
natural
environment, etc.)
Assignment: Complete and submit this assignment through the Assignments tool. 27
Assignment: Sensory Experience
1 2 3
5 6
4
28
Photo courtesy ofJanet Gunter & Gustavo Reinoso, 2022
Adaptive Responses
An effective response or interaction with the environment
• A challenge that can be met successfully
• Promotes personal growth
• Promotes mastery over the environment
• Utilizes and organizes the sensory information in the
environment
• Range in complexity:
– Simpler adaptive responses can be innate
– More complex require initiative and cognition
– Long‐term increase in repertoire of activities and health
29
Adaptive Responses
• The child’s ability to obtain and maintain the optimal level of
arousal and prepare the central nervous system to engage in
the highest level of an adaptive response
• Perception, discrimination and motor skills
• Integration and organization of sensory information in the

environment
• An attentive/nurturing therapist who is able to present and/or

adjust experiences to the “just right challenge”
30
Adaptive Responses
• Initiates, plans, and completes a novel, complex
activity that includes novel motor planning, timing,
and multiple adaptive response within one activity
• Initiates and maintains a simple 2‐3 step activity that
requires novel or complex motor planning
• Initiates and maintains an activity that requires
known and simple movements
• Initiates an activity the requires simple and familiar
movements, but cannot maintain them
• Alternates between use of contractions and
relaxation of muscle groups
• Holds on and stays still
• Responds to passive stimuli
31
Ayres, 1980 Image source: https://freesvg.org/1465450581
Adaptive Responses in Functional
Performance Areas
• Increase in language & functional communication
• Improved social skills
• Decrease in stereotyped & repetitive behaviors
• Improved imitation
• Decrease in aggressive and/or self‐injurious behaviors
• Increased engagement (with you or others in environment)
• Regulation (co‐regulation, self‐regulation)
• Decreased behavioral rigidity, increased flexibility
• Improved ideation, attention & organization
• Decreased levels of support and direction required for successful
participation
32
Exercise: Adaptive Responses 1 Table

natural
environment, etc.)
Download the forms for this exercise from the “Download Lecture” link near the top right corner of this screen. 33
Please complete this exercise on your own before downloading the answers.
Exercise: Adaptive Response 1 Photo
34
Exercise: Adaptive Responses 1 Possible
Responses
Sensory Adaptive response(s) you will be promoting Context/ Physical What will you
experience(s theme of environment that do to
) related to play will be used (e.g., establish and
the specialized clinic, maintain the
pattern(s) of home, school, park, therapeutic
dysfunction natural alliance?
environment, etc.)
1. Flexion against gravity
2. Vestibular (because it is probably on a rotary
device)
3. Proprioception when holding on (if therapist
emphasizes client holding on)
4. Feedback motor planning (getting on and off)
5. Feedforward motor planning (interacting with
stable or moving objects, while the equipment is
in motion)
6. Ocular stability if while the swing is moving
the child must reach for objects or throw at a
target 35

natural
environment, etc.)
Exercise: Adaptive Responses 2 Photo
37
Exercise: Adaptive Responses 2 Possible
Responses
Sensory Adaptive response(s) you will be Context/ Physical environment What will you do
experience(s) promoting theme of that will be used (e.g., to establish and
related to the play specialized clinic, maintain the
pattern(s) of home, school, park, therapeutic
dysfunction natural environment, alliance?
etc.)
1. Feedback motor planning when

climbing to enter the ball
2. Feedback motor planning and
when trying to move it in different
directions
3. Feedforward motor planning
(moving the ball to hit or bump into
a target)
4. Improve tolerance of movement
as the child moves around in the ball
5. Improved proximal and postural
stability as the child moves the ball 38
natural
environment, etc.)
Exercise: Adaptive Responses 3 Photo
40
Exercise: Adaptive Responses 3
Possible Responses
Sensory Adaptive response(s) you will be Context/ Physical What will you do to
experience(s) promoting theme of environment that establish and
related to the play will be used (e.g., maintain the
natural
environment, etc.)
1. Extension against gravity

2. Increasing arousal level with use
of rotary vestibular input
3. Feedforward motor planning:
have child throw to a target while
moving
4. BMC: Have child propel self by
pulling on a rope
41
Context of Play
• Honor differences in play preferences, meaning, and intrinsic
motivation
• Build on play skills – imitation, symbolic and constructional
play
• Teach parts of activities first to engage in a whole play
activity
• Balance preferences and need for repetitive play with
redirection and introduction of novelty
• Utilize yourself and peers to build social and collaborative
play, consider as adaptive responses
42
Video: Context of Play 1
Use focused interests as a starting point
Video courtesy of Linsey Grunes & Joan Surfus 43

Context of Play 1
Sensory experience(s) Adaptive response(s) you will Context/theme Physical What will you
related to the pattern(s) be promoting of play environment that do to establish
of dysfunction will be used (e.g., and maintain
specialized clinic, the
home, school, therapeutic
park, natural alliance?
environment, etc.)
The sensory experiences The following adaptive In this video, we
emphasized in this activity responses can be observed: see the therapist
include uneven vestibular Increased activity level and using this child’s
input (when challenging affect, increase in use of focused interest
postural language, increased motivation and
accommodations), for play and engagement with perseveration on
increased proprioceptive task, increased interaction with trains as a
input (when changing environment and novel use of starting point for
positions on the swing, objects, higher complexity in the desired
during co‐contractions, play, improved motor planning, sensory
when pushing, pulling, use of co‐contractions, and his experience and
lifting equipment) ability to maintain his balance on play scheme.
the swing while changing
positions. 44
Video: Context of Play 2
Don’t assume an unexpected change is off‐task
Video courtesy of Linsey Grunes & Joan Surfus 45

Context of Play 3 Video
• Watch child first to understand intention and planning in play, from their
perspective
• Balance structure and organization with opportunities for creative, free play
46
Video courtesy of Janet Gunter
Context of Play 3
Possible Responses
Sensory Adaptive response(s) you Context/theme of Physical What will you do to
experience(s) will be promoting play environment that establish and maintain
related to the will be used (e.g., the therapeutic
pattern(s) of specialized clinic, alliance?
dysfunction home, school, park,
natural environment,
etc.)
The sensory Although he had trouble with Opportunities for Specialized clinic The OT balances the
experiences in this task, particularly the creative free play and structure and organization
this activity imitation part, adaptive trial and error. Th OT of the session with
includes: responses included his brings materials from opportunities for creative
vestibular and spontaneous initiation of the previous play free play and trial and error.
proprioceptive appropriate use of the blocks to activity to the next to
input, continue stacking, participation encourage him to She watches first as James
in the car activity a second time, expand his ideation changes the play trajectory
pushing the car up and use of this object to understand his intention
independently , and motor in different play instead of immediately
planning to get into the car. schemes. redirecting him back to the
structured task.
47
Therapeutic Alliance
Ensure Physical Safety
• Be alert and prepare for unexpected and dramatic changes in
regulation, unpredictable movements and behaviors, lack of
awareness of environment
• Structure environment according to increased potential safety risks

(remove equipment, modify placement of equipment)
• Place yourself/your body

strategically
• Be explicit about safety rules, and
why (include visuals)
• Adjust your pace and energy level
to stay one step ahead
48
Photo courtesy of Linsey Grunes and Joan Surfus
Therapeutic Alliance and
Relationship Based Intervention

49
Physical Safety
Photo courtesy of Gustavo Reinoso, 2022 50

Physical Safety

51
Scaffold:
• Break activities into very small segments
• Provide more guidance and reassurance
• May require increased structure & direction towards
sensory experiences (consider amount of direction as
adaptive response)
• Provide simple, specific feedback and reinforcement
• Introduce novelty very gradually
Use of Language:
• Amount of words
• Time for processing & response
• Frequency of verbal information or cueing
• Choices vs. open ended 52
Exercise: Therapeutic Alliance 1 Table
Sensory Adaptive Context/theme Physical environment What will you do to establish
experience(s) response(s) you of play that will be used (e.g., and maintain the therapeutic
related to the will be specialized clinic, alliance?
pattern(s) of promoting home, school, park,
dysfunction natural environment,
etc.)
Exercise: Therapeutic Alliance 1 Video
54
Exercise: Therapeutic Alliance 1
Possible Responses
Sensory Adaptive Context/ Physical What will you do to establish and maintain the
experience(s) response(s) theme of environment that therapeutic alliance?
related to the you will be play will be used (e.g.,
pattern(s) of promoting specialized clinic,
natural
environment, etc.)
1. Scaffolds the activity and direction
2. Invites his engagement and allows time for a
response
3. Provides verbal direction, and allows time for a
response
4. Models the task and allows time for a response
5. Allows increased time for processing
6. Elicits language and problem solving through
asking questions and providing choices
7. Offers alternative responses to verbal/language
8. Uses affect to increase arousal
55
56
Video courtesy of Linsey Grunes
etc.)
Possible Responses
Sensory Adaptive Context Physical environment What will you do to establish and maintain the
experience(s) response(s) /theme that will be used (e.g., therapeutic alliance?
related to the you will be of play specialized clinic, home,
pattern(s) of promoting school, park, natural
dysfunction environment, etc.)
1. Increased structure and direction towards a

regulating sensory experience
2. Controlled for other sensory aspects of the
environment
3. Utilized self to co‐regulate, slowing movements
and lower voice volume
4. Modelled task to allow for decreased verbal
prompting
5. Giving him control over time/length of activity
6. Encouraged imaginative play
58
59
Video courtesy of Linsey Grunes & Joan Surfus
etc.)
Possible Responses
Sensory Adaptive Context Physical What will you do to establish and maintain the
experience(s) response(s) /theme of environment that therapeutic alliance?
dysfunction home, school,
park, natural
environment, etc.)
1. Breaks the activity into very small segments

2. Scaffolds therapist direction for each part of the
activity
3. Providing increased encouragement for initiation &
attention
4. Adjusts her pace
5. Allows for trial and error
61
62
Video courtesy of Linsey Grunes & Joan Surfus
etc.)
Possible Responses

Sensory Adaptive Context/ Physical What will you do to establish and maintain the
experience(s) response(s) theme of environment that therapeutic alliance?
natural
environment, etc.)
Provided choices vs. open ended – to allow for a sense

of control over the session while also providing more
structure as a therapist, here in particular to challenge
his praxis/increased novelty and ideation for new ideas
Priming for transition from preferred activity
64
Relationship-Based Intervention
• Observe & identify subtle social and engagement cues (i.e. follow gaze and
body orientation, sensory cues) these may be more subtle due to differences
in communication & processing
• Keep in mind that signals and cues can be very subtle due to differences in
communication and processing (e.g., use of eye gaze to show intent/choices,
slight changes in facial expression or body language, etc.)
• Experiment with various ways to communicate (use visual strategies, body and
environmental cues, simple auditory cues)
• Allow for increased time to establish therapeutic connection and develop trust
• Adjust your pace for synchrony, follow the child’s rhythm and temporal cues
• Therapeutic use of self for co‐regulation and in grading social demands of
activity
• Incorporate peer relationships to facilitate social skill development, social
communication and for opportunities for imitation
65
Relationship-Based Intervention
Collaboration in Activity Choices:
• Use strengths and focused interests as a starting point
• Shape and direct choices to encourage active engagement with the

environment
• Priming, previewing and visual strategies to manage transitions

from highly preferred activities
• Consider social and cognitive demands inherent in sensory

experiences, activities, and cues and how these may impact
regulation, performance, and intrinsic motivation
66
Assignment: Identifying Core Principles
of SI Intervention

Assignment: Identifying Core Principles
of SI Intervention

natural
environment, etc.)
Measuring Outcomes
How can we systematically measure our client’s
progress in a way where we can both identify gains
in functional performance, while also identifying
improvements in underlying sensory factors?
Incorporate tools to measure BOTH proximal

and distal outcomes
69
Measuring Outcomes
Proximal Outcomes Distal Outcomes
“The identified factors “The skills, abilities, and behaviors
that affect participation” that are expected to change in
(Faller et al., 2016, p. 2)
response to the intervention”
(Faller et al., 2016, p.2)
Example: changes in
responsivity to tactile input Example: decreased anxiety and
increased independence in
bathing/showering routine
Why is this important?

• Linking progress specifically to OT‐SI
• Highlights importance of OT in team intervention
• Buy‐in from parents and other team members by systematically linking
participation challenges to sensory processing factors (Schaaf, 2015) 70
Generalization & Carryover
Communication & collaboration with parents/caregivers,
teachers and other team members
• Language & terminology choice
• Modeling
• Coaching and mutual information‐sharing
– Validate parent experience
– Increase parent competency and reduce stress
– Point out specific, observable improvements in
performance and participation
– Collaborate on goals
• Home and school programs
(Ashburner, 2014; Cohn, 2001)
71
Knowledge Check 1
In recent manuals that identify current clinical practices
used with individuals with ASD, sensory integration is
considered to be which of the following:
A. An experimental intervention approach

B. An evidence‐based approach
C. An intervention that only works for those with ASD
D. An intervention that should be combined with
other intervention approaches
72
Knowelege Check 2
Occupational therapists who feel confident in their use
of sensory integration perceived greater progress in
children with ASD
A. True
B. False
73
Knowledge Check 3
One of the challenges faced in the investigation and
generalization of evidence to support the use of SI with
individuals with ASD is that they present with which of the
following:
A. Heterogeneity in sensory challenges and pattern(s) of

dysfunction
B. Heterogeneity in regard to the impact of sensory
processing on function and participation
C. Heterogeneity in diagnostic criteria
D. A and B
E. All of the above
74
Knowledge Check 4
Literature reviews that include various studies related
to OT‐SI intervention with individuals with ASD
generally show which of the following:
A. Negative results
B. Mixed results
C. Positive results only related to motor skills
D. Positive results
75
Knowledge Check 5
A 4‐year‐old client with a diagnosis of ASD was referred due to problems with dressing
and grooming routines. Results of their OT‐SI evaluation indicate that many of their
difficulties appear to be related to a pattern of dysfunction related to tactile hyper‐
responsiveness. During their intervention you try to incorporate the following sensory
experiences:
A. Deep pressure, loud tone of voice, and positive affect to the increase in the level
of arousal
B. Light touch to decrease over‐responsivity and get them used to light touch
C. Slow, rhythmic linear vestibular input, deep pressure, and proprioception to

decrease the level of arousal
D. Fast, rotary vestibular input followed by 10 minutes of soft auditory input while
applying deep pressure with pillows covered in different fabric/materials
76
Additional References
• Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski,
B.,Szendrey, S., McIntyre, N. S., Yücesoy‐Özkan, S., & Savage, M. N. (2020). Evidence‐based
practices for children, youth, and young adults with Autism. The University of North Carolina
at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on
Autism Evidence and Practice Review Team.
• Kashefimehr, B., Kayihan, H., & Huri, M. (2018). The effect of sensory integration therapy on
occupational performance in children with autism. OTJR: Occupation, Participation, and
Health, 38(2), 75‐83. https://doi.org/10.1177/1539449217743456
• Schoen, S. A., Lane, S. J., Mailloux, Z., May‐Benson, T., Parham, L. D., Smith Roley, S., &
Schaaf, R. C. (2019). A systematic review of ayres sensory integration intervention for
children with autism. Autism research : official journal of the International Society for Autism
Research, 12(1), 6–19. https://doi.org/10.1002/aur.2046
77

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Special Topics in Sensory Integration Intervention

Module 4 – General Principles of SI Intervention for

• OT‐SI is considered an evidence‐based practice. (Steinbrenner et al.,

• OT‐SI is an effective approach for some (but not ALL) children

• Recent clinical intervention manuals consider SI to be an

• Improved communication & language (Ayres, 1980, Steinbrenner et al., 2020)

I. General practice with individuals with ASD

II. Occupational therapy intervention for individuals

III. OT‐SI for individuals with ASD

Provide opportunities for an increased number of trials to practice skills

Break down tasks and activities into small steps

Allow for choice & control to support self‐determination and self‐advocacy

Simplify verbal directions and allow time for processing

Video courtesy of Linsey Grunes 12

Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission. 13

SI Sensory Highest level of

Occurring in the Context of Play

Tactile Tactile Defensiveness

Aversion To Movement • Start with linear inputs • Stay in the optimal

Blanche & Bodison, 2016

Inadequate Vestibular Postural • Everything is on a bungee • Increased postural responses

Responses: semicircular canals positions related to angular inputs

Blanche & Bodison, 2016

Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission

Photo courtesy of Linsey Grunes & Joan Surfus 21

Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission

Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission

Photo courtesy of Gustavo Reinoso. ©Copyright, do not reproduce without permission

Photo courtesy of Gustavo Reinoso and Janet Gunter 26

C. Clearly identify the components of your sensory integration treatment activity

• Perception, discrimination and motor skills

• Integration and organization of sensory information in the

• An attentive/nurturing therapist who is able to present and/or

Sensory Adaptive Context/theme of Physical What will you do to

Sensory Adaptive Context/theme of Physical What will you do to

1. Feedback motor planning when

1. Extension against gravity

Video courtesy of Linsey Grunes & Joan Surfus 43

Video courtesy of Linsey Grunes & Joan Surfus 45

• Structure environment according to increased potential safety risks

• Place yourself/your body

Photo courtesy of Gustavo Reinoso, 2022

Photo courtesy of Gustavo Reinoso, 2022 50

Photo courtesy of Gustavo Reinoso, 2022

1. Increased structure and direction towards a

1. Breaks the activity into very small segments

C. Clearly identify the components of your sensory integration treatment activity

Provided choices vs. open ended – to allow for a sense

• Shape and direct choices to encourage active engagement with the

• Priming, previewing and visual strategies to manage transitions

• Consider social and cognitive demands inherent in sensory

Video courtesy of Janet Gunter

Sensory Adaptive Context/theme of Physical What will you do to

Incorporate tools to measure BOTH proximal

Why is this important?

A. An experimental intervention approach

A. Heterogeneity in sensory challenges and pattern(s) of

C. Slow, rhythmic linear vestibular input, deep pressure, and proprioception to

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