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Research is clear: Dr Ayres was certainly visionary ‘Bottom Up’ is relevant!

Sensory integration theory and practice is so often criticised for having a poor evidence base. Yet, here we find clear evidence and support for the theory, and indeed practise of Ayres’ Sensory Integration. That the research team included an Occupational Therapist and assessment included those that are core to our clinical practice speaks clearly. This research adds strength and credibility to Occupational Therapy as a profession and those within in our profession who have curiously explored and discovered the links and relationships between sensory differences and challenges of participating in everyday life.

Brainstem white matter microstructure is associated with hyporesponsiveness and overall sensory features in autistic children

read the abstract;

Elevated or reduced responses to sensory stimuli, known as sensory features, are common in autistic individuals and often impact quality of life. Little is known about the neurobiological basis of sensory features in autistic children. However, the brainstem may offer critical insights as it has been associated with both basic sensory processing and core features of autism.

Diffusion-weighted imaging (DWI) and parent-report of sensory features were acquired from 133 children (61 autistic children with and 72 non-autistic children, 6–11 years-old). Leveraging novel DWI processing techniques, we investigated the relationship between sensory features and white matter microstructure properties (free-water-elimination-corrected fractional anisotropy [FA] and mean diffusivity [MD]) in precisely delineated brainstem white matter tracts. Follow-up analyses assessed relationships between microstructure and sensory response patterns/modalities and analyzed whole brain white matter using voxel-based analysis

Results revealed distinct relationships between brainstem microstructure and sensory features in autistic children compared to non-autistic children. In autistic children, more prominent sensory features were generally associated with lower MD. Further, in autistic children, sensory hyporesponsiveness and tactile responsivity were strongly associated with white matter microstructure in nearly all brainstem tracts. Follow-up voxel-based analyses confirmed that these relationships were more prominent in the brainstem/cerebellum, with additional sensory-brain findings in the autistic group in the white matter of the primary motor and somatosensory cortices, the occipital lobe, the inferior parietal lobe, and the thalamic projections.

All participants communicated via spoken language and acclimated to the sensory environment of an MRI session, which should be considered when assessing the generalizability of this work to the whole of the autism spectrum.

These findings suggest unique brainstem white matter contributions to sensory features in autistic children compared to non-autistic children. The brainstem correlates of sensory features underscore the potential reflex-like nature of behavioral responses to sensory stimuli in autism and have implications for how we conceptualize and address sensory features in autistic populations.

Dr Ayres focussed our attention on the importance of the brainstem and white matter in receiving and integrating sensory input. This article focuses us on the molecular mechanisms that may be creating sensory differences in those who are Autistic.

Research like this will leave our profession with little option but to acknowledge, that like for a great many explorers and innovators, disruption of ideas is not popular and it can take time for others to adopt the new ideas, even with compelling evidence.

It would not be in keeping with our professions humble and quiet ways of working, almost invisibly to enable and empower to exclaim “we told you so”. But, it would be fitting and proper, for recognition of Dr Ayres’ incredible and often much maligned efforts in this field to be recognised, and most especially within our own profession.

The ability of our profession to look in on itself and reflect is something we are asked to do each day in practice; to reflect on and adapt to support the ever changing worlds of our clients, and how we practice within this. Yet, we are seem stuck around this very important and growing area of scientific interest, which is reshaping healthcare practice.

If we do not reflect on, and read the evidence, do not adapt and change the rhetoric about sensory integration, we will undermine or professions reputation as having credible scientists and artful practitioners. We can not continue to ignore the science;

  • the senses are core to and underpin learning, development and function
  • sensory differences can interfere with participation in everyday life
  • addressing underlying sensory challenges, building on and utilising sensory strengths creates opportunities for development of skills and abilities to function and participate.
  • that we can and should work with our clients on their sensory goals to support their participation goals; facilitating their journey to living their life to the fullest.

Without the senses, and adequate processing and integration of sensory input within the body and brain, feelings and emotions, language, cognition, development, learning, movement and actions, connection and participation are compromised or impossible.

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Research Update| Muting, filtering and transforming space

In this 2022 article; “Muting, filtering and transforming space: Autistic children’s sensory ‘tactics’ for navigating mainstream school space following the transition to secondary school.”, the take-home messages are:

There are sensory challenges in mainstream school environments for ASD children.

Working with young people post-transition to secondary school has highlighted these challenges.

Sensory challenges exist across the school environment: Classrooms, lunch halls, playgrounds and even corridors can feel overwhelming.

Muting, filtering and transforming space ‘tactics’ are ways that young people deal with feelings of sensory overload.

Teachers, parents and therapists can use this understanding of these sensory tactics to support the design of more inclusive school spaces.

Read more here:

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Coffee and Chat | Q &A with Chewigem and Sensooli

Join us for coffee and chat this week.

We will be hosting a Q & A session tonight. Come and join us to hear about Sensooli and Chewigem products. We will be joined tonight on the call by Jenny McLaughlan and Loz Young, who will be telling us more about Chewigem and their new initiative Sensooli . They are keen to hear therapist feedback about their products and how this relates to our practice;including what we might like to know more about. For more information please see and their new space

Please post any questions before the session to the ASI in Practice Telegram Group or email through to

This is an open evening session, so please also do bring any others questions or chat about anything related to ASI.

Book here now:

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Coffee and Chat: The ABC’s of Sleep with Jan Jenner

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Coffee and Chat: Ayres’ SI and Learning Disabilities

Tonight’s Coffee and Chat is all about Ayres’ SI and Learning Disabilities with special guest working in the field of learning disabilities across the lifespan.

Come and Listen to our practising therapists and experts explore assessment tools, the role of consultation and how to deliver services that draw on the theory and practice of Ayres’ Sensory Integration.

Join us tonight 3 March 2021 at 7.30pm.

Book your FREE place now on Eventbrite.

Read about the application of Ayres’ SI in Learning Disabilities on this reference and reading list below.

Papers here include from therapists, Ros Urwin, whose Master’s in 2005  was the first UK study to investigate ASI with adults with learning disabilities in the UK, our colleague Rachel Daniels, whose work in this field was the focus of a research project and Ciara McGill, who we had the pleasure to teach on the journey that led to her Master’s Study publication with Ulster University.

  1. Cahill, S.M. and J. Pagano. 2015. Reducing restraint and seclusion: the benefit and role of occupational therapy. American Occupational Therapy Association.

  2. Champagne, T. and N. Stromberg. 2004. Sensory approaches in an-patient psychiatric settings: Innovative alternatives to seclusion and restraint. Journal of Psychosocial Nursing 42(9): 35–44.

  3. Daniels, R. 2015. Community occupational therapy for learning disabilities: The process of providing Ayres sensory integration therapy and approaches to this population. Birmingham: European Sensory Integration Conference. www.iceasi-org

  4. Department of Health. 2012a. Department of Health review: Winterbourne View hospital interim report. London: Department of Health.

  5. Department of Health. 2012b. Transforming care: A national response to Winterbourne View Hospital: Department of Health review final report. London: Department of Health.

  6. Department of Health. 2014. Positive and proactive care: reducing the need for restrictive interventions. London: Department of Health.

  7. Gay, J. 2012. Positive solutions in practice: using sensory focused activities to help reduce restraint and seclusion. Victoria: Office of the Senior Practitioner.

  8. Green, D., Beaton, L., Moore, D., Warren, L., Wick, V., Sanford, J. E., & Santosh, P. (2003). Clinical Incidence of Sensory Integration Difficulties in Adults with Learning Disabilities and Illustration of Management. British Journal of Occupational Therapy, 66(10), 454–463

  9. Lillywhite, A. and D. Haines. 2010. Occupational therapy and people with learning disabilities: Findings from a research study. London: College of Occupational Therapists.

  10. Leong, H. M., Carter, M., & Stephenson, J. (2015). A systematic review of sensory integration therapy for individuals with disabilities: Single case design studies. Research in developmental disabilities, 47, 334–351.

  11. McGill, C & Breen, C. 2020. Can sensory integration have a role in the multi‐element behavioural intervention? An evaluation of factors associated with the management of behaviours that challenge in community adult learning disability services. British Journal of Learning Disabilities.

  12. Royal College of Psychiatrists. 2013. People with a learning disability and mental health, behavioural or forensic problems: The role of inpatient services. London: Royal College of Psychiatrists.

  13. Transforming Care and Commissioning Steering Group. 2014. Winterbourne View – Time for change: Transforming the commissioning of services for people with learning disabilities [Bubb Report]. London: NHS England.

  14. Urwin, R., & Ballinger, C. (2005). The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs. British Journal of Occupational Therapy, 68(2), 56–66. 

sensory integration leanring disabilities Ciara McGIll
Ciara McGill, Occupational Therapist

Click to access Reducing-Restraint-and-Seclusion-20150218.pdf

The effectiveness of sensory integration therapy to improve functional behaviour in adults with learning disabilities: five single-case experimental designs

Urwin, Rosalind and Ballinger, Claire (2005) The effectiveness of sensory integration therapy to improve functional behaviour in adults with learning disabilities: five single-case experimental designs. British Journal of Occupational Therapy68 (2)56-66.


This paper describes a research project using a single-case experimental design (A-B-A), which aimed to explore the impact of sensory integration therapy (SIT) on level of engagement and maladaptive behaviour (measured through timed scores) and function (using Goal Attainment Scaling, GAS) for five learning disabled adults with tactile sensory modulation disorder.

Each phase lasted 4 weeks and consisted of 24 measurements in total. Individually tailored SIT was given twice weekly for 4 weeks during the intervention phase (B), immediately prior to each individual’s participation in his or her prescribed horticulture task. The changes between phases in engagement, maladaptive behaviours and function scores, measured as the difference between baselines and intervention, were analysed visually and statistically for each participant.

The intervention produced significant improvements in engagement for participant four, with a highly significant deterioration in scores for all five participants on withdrawal of SIT. All the participants’ maladaptive behaviour decreased significantly on the introduction of SIT. Although there was no significant change to GAS scores for four participants, participant four’s score improved significantly with SIT. The withdrawal of SIT resulted in a highly significant deterioration in GAS scores for participants one, two, four and five. This study may be the first to suggest that SIT is effective in improving functional performance in adults with a learning disability with a tactile sensory modulation disorder.

Click to access Resource-OT-and-Learning-Disabilities_0.pdf