Thank you for sharing your 2024 service statement outlining the ICAN Occupational Therapy Service position regarding sensory differences and Ayres’ Sensory Integration (ASI).

We recognise and value your stated commitment to evidence based, participation focused occupational therapy, and to supporting children, families, and settings through collaborative and strengths based approaches. These principles are shared across the profession and align with contemporary occupational therapy values.

However, given that this document is dated December 2024, we feel it is important to note that several statements within it do not fully reflect the current state of the evidence base, contemporary professional consensus, or developments in sensory integration research and practice over the past decade.

Firstly, the characterisation of Ayres’ Sensory Integration as an “impairment oriented approach” is not consistent with current definitions. Contemporary ASI is a participation focused, occupation based intervention grounded in neuroscience, emphasising adaptive responses, engagement, motivation, and functional participation. This is clearly articulated in updated fidelity measures, international consensus statements, and peer reviewed literature published since 2015.

Secondly, while earlier systematic reviews raised methodological concerns, more recent research has significantly strengthened the evidence base for ASI when delivered with fidelity. Randomised controlled trials and rigorous outcome studies published by Schaaf et al. (2014, 2018), Pfeiffer et al. (2018), and subsequent analyses demonstrate positive outcomes in participation, functional performance, and goal attainment for children, particularly autistic children, when ASI is delivered by appropriately trained occupational therapists. These findings are recognised internationally and form the basis of practice guidance in several countries.

It is also important to clarify that the absence of a NICE recommendation does not equate to a recommendation against ASI. NICE guidance does not comprehensively evaluate all occupational therapy interventions, and lack of inclusion reflects scope and prioritisation rather than a judgement of ineffectiveness. Similarly, the Royal College of Occupational Therapists does not prohibit ASI and continues to recognise sensory integration as within the scope of occupational therapy practice when therapists are appropriately trained and practising safely and effectively.

The reference to sensory processing disorder not being included in DSM 5 is accurate, but its inclusion here risks conflating diagnostic classification with intervention validity. Occupational therapy does not require standalone diagnostic labels to justify intervention. Sensory integration differences are widely recognised as transdiagnostic features across neurodevelopmental, mental health, and trauma related presentations, and are increasingly understood as differences in sensory motor integration rather than discrete disorders.

We are also concerned that the framing of sensory integration as something delivered “in isolation” does not reflect how ASI is practised within contemporary occupational therapy. High fidelity ASI explicitly integrates functional goals, family collaboration, environmental understanding, and meaningful occupations. It is not an isolated sensory approach, but a relational, developmental, and occupation centred intervention.

Finally, given the growing recognition of neurodiversity, embodied cognition, and the role of sensory motor foundations in learning, regulation, and participation, it is important that service statements published in 2024 reflect these developments. Current neuroscience and occupational science literature increasingly emphasises that sensory integration underpins participation, praxis, emotional regulation, and adaptive functioning, rather than sitting outside them.

We welcome continued professional dialogue and agree that services must evolve alongside the evidence. We would encourage future service communications to reflect the contemporary evidence base more fully, to avoid inadvertently presenting outdated or partial representations of sensory integration practice, and to support informed choice for families, schools, and commissioners.

We appreciate your openness to monitoring emerging research and hope this contribution supports constructive, evidence informed discussion across services for the benefit of children and families.

You can find out more in our News and Research sections of the website.