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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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Coffee and Chat | Sensory Integration, ARFID and Travel

FREE| Wednesday 2 March 7.30 pm GMT

Book Here:

Dr Yana Wengel is an associate professor at Hainan University. Yana takes a critical approach to tourism studies; her interests include volunteer tourism, tourism in developing economies and nature-based tourism. Her dissertation examined the social construction of host-guest experiences in volunteer farm tourism. Her current projects are focused on nature-based tourism and leisure and travel experiences of patients with an eating disorder. Yana is interested in creative methodologies for data collection and stakeholder engagement. She is a co-founder of the LEGO® SERIOUS PLAY® research community.



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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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The Teenage Brain – a great new resource

Looking forward to following this new organisation, who appear to have some amazing resources from my first drop onto their website today.

From their Founder…

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Research Update: Examining overlap and homogeneity in ASD, ADHD, and OCD: a data-driven, diagnosis-agnostic approach

“Our results motivate a paradigm shift to challenge how ASD, ADHD, and OCD are currently defined, diagnosed, and treated. In particular, this paper adds to the evidence that these diagnoses may not exist as uniquely-defined diagnostic constructs, and highlights the need to discover other groupings that may be more closely aligned with biology and/or response to treatment.”

So, this study by Kushki et al 2019 is by no means simple. However, the results support our clinical experience of the overlap and common features seen in practice. We see similar overlap is the assessment data we gather, particularly when we SIPT our clients with these diagnoses. The study uses state of the art technology and research methodologies, statistical calculations, and techniques I had never heard of. I had to look them up. However, the research appears to support what we see in clinical practice. I look forward to reading more by these researchers in Canada.

“…we used a data-driven, diagnosis-agnostic approach to examine overlap across three neurodevelopmental disorders (ASD, ADHD, and OCD)…we observed that differences in the domains primarily affected in these disorders may exist along a continuum that includes typical development.”

“The majority of the data-driven clusters contained participants from multiple diagnostic categories, highlighting shared phenotypes and neurobiologies among the diagnostic groups.”

“Social difficulties and inattention are commonly reported as shared features of ASD, ADHD, and OCD….our results support the emerging recognition that the existing behaviorally-defined diagnostic labels may not capture etiologically, biologically, and phenomenologically homogeneous groups.

“…our results are consistent with the notion that that the ASD-like features, and to some extent inattention traits, exist across a continuum that includes typical development”

Read more here: