Sensory Integration Needs to Evolve

Following its initial development by A. J. Ayres, Sensory Integration Intervention has been slowly evolving.   As a result of this slow evolution, two major problems threaten the sensory integration frame of reference. First is the problematic discrediting of sensory integration research by some behaviorists and pediatricians who favor interventions that are too rigid or medication based to optimally help children.  Second is intervention borrowing sensory integration terminology with out adequate expertise in carrying out the strategies.  Increasing use of “brushing, sensory diets, sensory equipment, and comfort rooms” developed and used by teachers and mental health therapists with out adequate guidance from therapists trained in sensory integration significantly dilute the effectiveness of sensory integration intervention.
Luckily, many well trained therapists continue the evolution of sensory integration intervention.  While these excellent contributions are too vast to cover fully, I want to review three major areas of evolution in sensory integration intervention that serve as a foundation for further expansion.  Related to each evolution I will mention and provide links to clinicians who have built on sensory integration in a way that has been most helpful to me in my intervention as an occupational therapist working with children and adolescents who have behavioral, psychiatric, early trauma, Autism Spectrum Disorders, and other developmental challenges.
The first evolution contributes sound research, theory, and standardized sensory integration terminology to clinical sensory integration intervention.  This evolution is led by Lucy Jane Miller and her colleagues at the Sensory Processing Disorder SPD Network www.spdnetwork.org  While the therapists significantly contributing to the SPD Network are too numerous to mention fully, I want to describe two that greatly contribute to my practice in child and adolescent psychiatry.  Diana Henry www.ateachabout.com offers many helpful clinical intervention strategies.  The late Jane Koomar, Teresa May-Benson and her associates at OTA Watertown www.otawatertown.com and the Spiral Foundation conduct research and teach clinical sensory integration strategies that enhance attachment and the development of children with early trauma challenges.
The second evolution is the brief valid assessment of sensory modulation problems and their treatment through adaptive equipment and techniques.  Winnie Dunn has led this evolution through her research and development of the Sensory Profile and sensory integration based consultation strategies.  Others that have greatly helped my practice through environmental adaptations include Tina Champagne www.ot-innovations.com whose work with sensory coping rooms and adaptive equipment has helped psychiatric hospitals significantly reduce the use of restraint, replacing it with sensory coping rooms and equipment that empowers clients to learn effective coping strategies.  The adaptive sensory strategies developed through the Alert Program by Sherry Shellenberger and Mary Sue Williams www.alertprogram.com have also helped empower children with behavioral challenges to actively learn coping strategies.  Mention also needs to be made of Patricia & Julia Wilbarger’s  development of the sensory diet www.avanti-ed.com  Problems with misuse of the sensory diet by untrained individuals while significant are contrary to how the Wilbarger’s instructed it be used.
The third evolution is the development of touch pressure strategies as an individualized component of Ayres’ Sensory Integration that was initially expanded on by Knickerbocker.  The Wilbarger Protocol (brushing) is brilliant despite problems resulting from its misuse that are contrary with how it was taught by the Wilbargers.  Two other helpful contributions to this evolution are research efficacy of touch pressure through massage from Tiffany Field http://www6.miami.edu/touch-research and Qigong Sensory Treatment (QST) touch pressure based on Tui Na massage.  QST is developed and research validated by Dr. Silva www.qsti.org
QST was found through repeated research to significantly improve behavior and sensory processing in preschoolers with Pervasive Developmental Disorders.  QST research and my clinical experiences suggest the use of QST touch pressure offers great promise as a touch pressure strategy done as a component of Sensory Integration Intervention, particularly for youngsters with Autism Spectrum Disorders and/or an early trauma history.  Research suggests that young children with Autism Spectrum Disorders who are hyper-responsive to touch benefit from sensory processing intervention, while both hyper and hypo-responsive preschoolers with Autism Spectrum Disorders show significantly improved behavior and sensory processing skills following firm pressure touch.  I adapted the work of Knickerbocker, Tiffany Field, and QST to develop FAB Pressure Touch Strategies.   A major difference of FAB Pressure Touch Strategies is that therapists individualize it to reach the child’s functional goals as one component of comprehensive intervention.
The three evolutions of clinical, environmental adaptation, and pressure touch strategies in sensory integration provide a solid foundation for the development of Sensory Integration Intervention, and it is important to stay updated on this clinical and research work. Although proponents of the three evolutions conflict at times, these disagreements are insignificant given the contribution that all these intervention methods offer in conjunction with one another.  Sensory integration is now ready to further evolve into a solid research based frame of reference that is a specialized component of occupational, physical, and speech therapy practice.  Critics of sensory integration have used their objections to this frame of reference to advocate against children receiving occupational therapy services.  Sensory integration intervention is not all of occupational therapy, but is an important frame of reference for the profession.
My development of FAB Strategies offers an example of ways therapists can knowledgeably include sensory integration intervention as one goal directed component of a comprehensive intervention strategy for children and adolescents with behavioral, developmental, and sensory processing challenges. FAB Functionally Alert Behavior STRATEGIES While a written format of strategies is described, interventions including the use of touch pressure strategies are individualized by trained therapists to attain their client’s goals.  In FAB Strategies the goal is used to guide development of intervention composed of environmental adaptations, sensory modulation, positive behavioral support, and physical self-regulation strategies.  I urge other occupational therapists to continue the evolution led by Ayres and her initial followers to further help and guide their clients.
References:
Ayres, A. J. (2005). Sensory integration and the child: 25^th Anniversary Edition.  Los  Angeles, CA: Western Psychological Services.
Higbee, T.S., Chang, S., Endicott, K. (2005).  Noncontingent access to preferred sensory stimuli as a treatment for automatically reinforced stereotypy.  Behavioral Interventions, 20, 177-184.
Kimball, J. G., Lynch, K. M., Stewart, K. C., Williams, N. E., Thomas, M. A. & Atwood, K. D. (2007).  Using salivary cortisol to measure the effects of a Wilbarger protocol-based procedure on sympathetic arousal: A pilot study.  American Journal of Occupational Therapy, 61(4), 406-413.
McClafferty, H., Sahler, O. J., Wiley, S. E. (2012).  Sensory Integration therapies for children with developmental and behavioral disorders.  Pediatrics, 129(6), 1186-1189.
Schaaf, R.C., & Miller, L.J. (2005).  Occupational therapy using a sensory integrative approach for children with developmental disabilities.  Mental Retardation and Developmental Disabilities Research Reviews, 11, 143-148.
Silva, L. M., Schalock, M. (2013).Prevalence and significance of abnormal tactile responses in young children with Autism.  North American Journal of Medicine and Science, 6(3), 121-127.