Sensory integration for children with autism spectrum disorder: examining the divergence between research and practice

Abstract

Background. Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects 2.24% of American children. Sensory processing difficulties have been linked to ASD and can restrict a child's participation in daily living activities and impact social engagement. The sensory integration approach is widely used by occupational therapists to address these sensory processing difficulties and improve function, participation and engagement for children with ASD. Sensory interventions can be separated into two categories, Ayres Sensory Integration® (ASI) and Sensory Based Interventions (SBI). In the past, research has grouped both ASI and SBI under the rubric of sensory integration, which has resulted in controversy regarding the efficacy of sensory integrative practice. However, with the development of the ASI fidelity measure, there has been an increase in studies that aim to evaluate the effectiveness of ASI treatment. There is a need to synthesise and critique these studies to determine the efficacy of ASI as an intervention for children with ASD. Purpose. This literature review intends to 1) outline the current context of the sensory integration approach for children with ASD, 2) critically appraise the evidence related to ASI for children with ASD and 3) explore possible reasons for the divide between research and practice. Methods. A literature search was conducted using four scholarly databases. Articles identified through the literature were evaluated against inclusion/exclusion criteria and critically appraised. Conclusions. There are multiple studies showing that ASI continues to be a popular intervention for children with ASD; parents and therapists seem to find ASI to be very effective. However, research on the efficacy of ASI for children with ASD is largely inconsistent. There is a clear divide between research and practice. Various reasons exist to explain this divide. Reasons discussed in this review are the heterogeneity of the ASD population, inappropriateness of outcomes and outcomes measures, and the multiple evidence sources of occupational therapy. While more research is necessary to support the efficacy of this preferred approach, occupational therapists must also better integrate the science of 'best evidence' with the art of person-centred practice when using ASI for children with ASD.