Sensory integration therapy

Some children have difficulty processing and organising sensory information — touch, movement, body position, sound. The result is over-reaction or under-reaction to ordinary input, which shows up as difficulty with clothing textures, food, noise, playground equipment, or as constant seeking of movement and pressure.

This is distinguishable from a motor problem, and the distinction matters: a child who avoids climbing because the movement is distressing needs different treatment from a child who avoids it because their legs are weak.

Through play, in an environment with equipment providing controlled vestibular, proprioceptive and tactile input — swings, climbing, deep pressure, textured materials. The therapist grades the challenge so the child stays engaged and regulated rather than overwhelmed.

Parents are taught a sensory strategy for home and school, because the therapy hour matters less than what happens in the other hundred and sixty-seven.

The evidence base for sensory integration therapy is small and mixed, and how long any effect lasts is unclear 1. Small trials in autistic children report progress on individual goals with the Ayres Sensory Integration protocol, although concerns about bias remain 2. A larger UK trial, in 138 autistic children, found no benefit over usual care at 6 or 12 months 3. Broader claims about improving academic performance, language or core autism features are not supported.

We use it for the sensory difficulties themselves and for participation goals, and we will not present it as a treatment for autism or for learning difficulty. Where a child needs speech therapy or motor rehabilitation, they need those, not more sensory work.

Children with sensory processing difficulty, including many autistic children, children with developmental coordination difficulty, and children with attention difficulties where sensory regulation contributes.

Assessment first: it establishes whether sensory processing is genuinely the barrier, or whether the difficulty is motor, communicative or behavioural. Those need different programmes and look similar from outside.

Play-based and child-led, using swings, textures, resistance and movement equipment, with the therapist grading the challenge rather than directing a drill. To a parent watching it looks like play, and that is deliberate — a child engaged in play tolerates far more repetition.

Parents are shown how to build the same input into the day at home, because an hour a week changes little compared with the routine around it.

The evidence base is mixed and weaker than for several other paediatric approaches. It is reasonable for specific sensory-processing difficulties and it is not a treatment for autism, developmental delay or learning difficulty as conditions.

We say which goals it is being used for and how they will be judged, and we stop if those are not moving.