From Kath's Desk

Is it ever too late for sensory integration?

Reflections from 1978 to today

Sensory integration is a vital consideration for adolescents, adults, and older adults alike.

I still remember the first time I heard this legendary quote from that 1978 AOTA interview. It made me laugh at Dr Ayres’ clear way of addressing this question, but it also struck a deep truth that has shaped much of my professional life.

“Is it ever too late to use a sensory integrative approach?”
“I suppose after you are dead, it will not work.”

That short exchange from the 1978 AOTA interview is funny, but it is also deeply serious. It captures a central truth that has taken the wider health and education world decades to catch up with: as long as the nervous system is alive, it can change. Sensation continually shapes us throughout our entire lives.

From clinic rooms in the 1970s to today’s practice

When that interview was recorded, sensory integration was most often spoken about in relation to children with learning or developmental difficulties. The dominant picture was of paediatric clinic rooms with suspended equipment and carefully graded play. Adults, mental health, dementia, trauma, learning disability services and community development were rarely considered part of the same story.

Yet the comment about “after you are dead” quietly disrupts that narrow view. It assumes that a sensory integrative approach is about something far more fundamental than age or diagnosis. It is about how the brain and body use sensory information to make sense of the world and to act in it. That process does not stop at eight, eighteen, or eighty.

Fast forward to contemporary practice, and many therapists are now rediscovering what that answer hinted at. Sensory integration and processing matters in community mental health teams, in perinatal services, in prisons, in supported housing, in intensive care, in schools and universities, in dementia care and in palliative care. Wherever there is a living nervous system trying to participate in life, there is a place for sensory-informed practice.

Lifelong sensory change and the power of participation

The 1978 quote aligns beautifully with what we now know about neuroplasticity. Brains remain responsive to experience throughout life. The quality, intensity, and pattern of sensory input continue to sculpt neural networks and behaviour. Even in the context of long-term conditions or acquired brain injury, meaningful sensory experiences can still support comfort, regulation, connection, and sometimes remarkable functional change.

Crucially, contemporary practice has moved beyond an idea of “fixing deficits” to a focus on participation. The question is not only “can we improve sensory processing” but also:

• How can we use the senses to help this person feel safe enough to engage?
• How can we support them to do the things that matter to them in the environments that actually exist in their life?
• How can we co-create tools and routines that they can own and adapt over time?

This sits very comfortably with the spirit of that 1978 answer. It assumes potential. It assumes the person is not “too late,” “too complex,” or “too stuck” to benefit from carefully thought-through sensory experiences.

Beyond childhood: sensory integration in adult and mental health services

In many adult services, people present with patterns that were never recognised as sensory in childhood. They may have learnt to mask, avoid, control, or push through overwhelming sensations. Over time, those survival strategies can become embedded in ways that look like “non-engagement,” “demand avoidance,” “emotional dysregulation,” “personality disorder,” or “challenging behaviour.”

Returning to that 1978 conversation invites us to ask a different question:

What happens if we treat these patterns as expressions of lived sensory experience, rather than as fixed traits or moral failings?

When we do this, contemporary practice begins to echo that early integrative spirit:

• We listen to people’s stories of sound, touch, movement, light, space and social contact.
• We recognise how sleep, pain, trauma, culture, medication, and environment influence the functioning of the nervous system.
• We co-produce sensory ladders, profiles, spaces, and routines that help people name their own states and choose what might help.

The approach may look very different from a paediatric clinic in 1978. It might be a quiet walk around the block before a ward round. It might be a sensory aware timetable in a school. It might be a carefully graded return to shopping after a psychosis. It might be creating a safer sensory corner in supported accommodation. The thread that links it back is the faith that the nervous system can still respond.

How this shaped ASI Wise and The Sensory Project

For me, that faith in lifelong sensory change has never been theoretical; it has been a lived experience. It has driven my work across more than twenty years in the NHS and in independent practice, and it is the foundation of what we now do through ASI Wise and The Sensory Project.

Long before it was fashionable to talk about sensory integration and processing in adult mental health, our teams were quietly developing sensory-informed care pathways in learning disability and mental health services. We were working with people whose lives had been shaped by labels like “personality disorder,” “complex trauma,” “challenging behaviour,” or “treatment resistant.” What we saw, again and again, was that when we took time to understand their sensory histories and present-day experiences, participation started to shift.

Out of this work grew tools such as Sensory Ladders, Sensory Spiders and Sensory Grids. These were never meant to be top-down programmes imposed on people, as criticised by some. They were and are co-produced ways of mapping lived states, making sense of “what my body is doing now,” and identifying what helped. They bridged Ayres Sensory Integration with occupational science, trauma-informed practice, and what is now being called precision medicine. Most importantly, they gave people language, images, and routines that belonged to them, not to a service.

Through the Sensory Project, we shared knowledge and learning, later in partnership with another organisation, and since 2017, now as ASI Wise & Sensory Project. We have spent over two decades teaching Ayres’ Sensory Integration across the Lifespan. We have supported therapists to bring this lens into acute wards, early intervention teams, perinatal services, eating disorder services, community learning disability teams, schools, prisons, residential homes and community projects. Our education programmes have always included adult mental health and complex presentations, not as an afterthought but as a core part of practice.

The formal establishment of The Sensory Project in Cornwall

Alongside this, The Sensory Project was formally established in Cornwall as an organisation dedicated to sensory integration beyond the lifespan. Its purpose was clear from the beginning. To bring accessible, research-informed, co-produced sensory knowledge into everyday spaces. To ensure that people, families, and services had practical tools to understand how the senses shape participation. And to keep championing the truth that sensory integration is not just for children. It is a lifelong framework for living.

Cornwall became the home of this work partly because it allowed us to create community-centred learning environments, blending clinic, coast, woodland, culture, and lived experience. The Sensory Project evolved into a space where practitioners, families, educators, artists, community workers, and healthcare teams could explore sensory integration not as a narrow intervention, but as an integral part of everyday life.

Today, The Sensory Project continues to evolve, building resources, training, partnerships, and open-access tools that reach far beyond the county. Its foundation remains rooted in those early truths of the 1978 interview. Change is possible throughout life, and sensory integration belongs everywhere people live, learn, work, heal, and connect.

Holding on to curiosity in a pressured system

Another way the 1978 quote speaks to contemporary practice is its refusal to be confined by neat service boundaries. Today, therapists work in systems that can feel risk-averse, target-driven, and constrained by short episodes of care. It is easy to start believing there is no time for sensory integration, or that it is a “specialist add-on” only available in certain teams.

The line “after you are dead, it will not work” is a gentle challenge to that thinking. It invites us to hold on to curiosity, even when the system around us is busy and stretched. A sensory integrative approach does not always require a fully equipped gym or a lengthy intervention block. It begins with noticing and asking:

• What are the sensory invitations and demands in this moment?
• How might this person’s nervous system be experiencing this interaction?
• What small sensory change could make this task or environment more possible?

Those questions can live in a ten-minute conversation, a ward review, a home visit, or a phone call. They can sit alongside medication, talking therapies, social work, and medical care. They can be shared with families, teachers, support workers, and community groups.

At ASI Wise and The Sensory Project, we hear, over and over again, that these “small” sensory questions change practice. Staff tell us that once they have a sensory lens, they cannot unsee it. They notice lighting, sound, posture, predictability, clutter, clothing, smells, routines, and transitions. They become more able to explain behaviour in terms of nervous system survival, rather than compliance or defiance. They feel more equipped to offer compassionate, practical adjustments rather than just policy or procedure.

From one voice to many

In 1978, that interview captured the voice of one pioneering occupational therapist speaking into a relatively sceptical professional world. Today, contemporary practice is enriched by a multitude of voices. People with lived experience are leading conversations about sensory-informed environments in schools, mental health services, and workplaces. Parents and carers share their own experiments with movement, touch, rhythm, sound, and nature. Multidisciplinary teams are combining neuroscience, embodiment, and co-production in innovative ways.

Yet the heart of the message is the same. It is not too late. Change is possible. Sensory experience matters.

For over twenty years, ASI Wise and The Sensory Project have tried to honour that message in very practical ways. We have:

• Trained thousands of therapists and people, locally, across our region and now worldwide, about Ayres Sensory Integration with a Lifespan focus, and the difference it can make to healthcare delivery in services that include inpatient mental health, psychiatric units, forensic services and in prisons.
• Co-created resources with the people we serve, those who care for and support them, working with people and their families to help them map and communicate their sensory worlds.
• Supported services to embed sensory-informed care pathways, policies, and environments.
• Advocated for sensory integration to be recognised as central to participation, not an optional extra.

None of this has been about perfect gyms or ideal conditions. It has been about walking alongside people in the real contexts of their lives and work, holding on to that simple, radical belief that the nervous system can still respond.

What this means for us now

Linking that 1978 moment to our work today invites a simple but profound commitment:

As long as a person is alive and present with us, we will not assume that their story is set in stone. We will remain open to the possibility that new sensory experiences, offered with respect and collaboration, can have a transformative effect. It might be a tiny easing of anxiety, an increase in tolerance for daily tasks, a renewed sense of agency, or a rediscovered joy in movement or creativity.

In that sense, each time we bring a sensory integrative lens into a ward round, a classroom, a family living room, a prison visit, a community group or a care home, we are quietly continuing the conversation that the interview started. We are saying, in our own practice:

No, it is not too late. You are still here. Your nervous system is still listening. Let us work together with your senses so that participation in life can feel more possible, more comfortable, and more your own.

And for us at ASI Wise and The Sensory Project, that is the work we remain committed to. After more than two decades, we are still learning, still listening, and we remain convinced that sensory integration plays a vital role wherever people strive to live, learn, love, and belong.

Kath Smith
Occupational Therapist
ASI Wise & The Sensory Project