Adolescents' and Adults' Perceptions of Sensory-Based Interventions: A Qualitative Analysis.

IMPORTANCE: Adolescents and adults report that their sensory integration and processing differences affect their occupational performance and quality of life, thus requiring effective sensory-focused interventions. Researchers have yet to investigate this population's experience of occupational therapy interventions designed to remediate these challenges. OBJECTIVE: To explore the perceived experience of adolescents and adults with respect to (1) response to intervention, (2) strategies offered to manage sensory differences, and (3) need for services on completion of an intervention. DESIGN: Retrospective, qualitative study. SETTING: Zoom or phone call. PARTICIPANTS: Eleven adolescents and adults with sensory integration and processing differences who had previously completed occupational therapy interventions. INTERVENTION: Sensory-based intervention based on the principles of Ayres Sensory Integration® (ASI) and the Sensory Therapies and Research Frame of Reference. OUTCOMES AND MEASURES: A semistructured interview to obtain data, followed by an in-depth analysis using an inductive coding process to group initial open codes into themes and common subthemes Results: Open codes were grouped into three core themes: (1) therapist-related factors (what the therapist did in treatment); (2) client-related factors (what the client experienced); and (3) follow-up (future needs of the clients). Four main subthemes of the client-therapist relationship emerged: (1) therapeutic alliance; (2) education and knowledge; (3) strategies, tools, and resources; and (4) future needs. CONCLUSIONS AND RELEVANCE: This study provides a perspective on the experience of adolescents and adults specific to the impact of a sensory-focused occupational therapy intervention on their daily lives. This will help occupational therapists when designing interventions for current and future clients. What This Article Adds: This study highlights the need for further research addressing effective sensory-based interventions for adolescents and adults. It also captures which components of intervention clients deemed helpful and identifies potential targets for future intervention.

A Pilot Study of Idiopathic Toe Walking: Measures and Outcomes.

This pilot study sought to determine the feasibility of quantifying sensory processing, postural control, motor skill development and participation in daily life in children with idiopathic toe walking (ITW) compared to children without ITW. A nonrandomized, prospective case-control design was employed. Twenty participants were recruited. Computerized weight bearing and postural control data was successfully collected. Differences were found in forefoot/rearfoot weight bearing, balance, sensory-motor abilities and parent reported participation challenges. Sensory processing results were inconclusive. Findings can inform standardized assessment and treatment of ITW.

A Sensory Integration Intervention in the School Setting to Support Performance and Participation: A Multiple-Baseline Study.

IMPORTANCE: There is a paucity of research that explores the effectiveness of sensory integration interventions in the school setting. OBJECTIVE: To test the effectiveness of a sensory integration intervention paired with teacher consultation, aligned with the principles of Ayres Sensory Integration® and the Sensory Therapies and Research Frame of Reference, to improve functional regulation and active participation in school for students with sensory integration and processing differences. DESIGN: Concurrent, multiple-baseline, single-subject design. SETTING: Public elementary school in the United States. PARTICIPANTS: Students (N = 3; ages 5-8 yr) whose sensory integration and processing differences were affecting their school occupational performance and were not remediated by integrated support. INTERVENTION: For 15 wk, each student had one-to-one sensory integration intervention 2×/wk for 30 min and a consultation between the occupational therapist and teacher weekly for 10 min. OUTCOMES AND MEASURES: The dependent variables, functional regulation and active participation, were measured weekly. The Short Child Occupational Profile and Behavior Assessment System for Children, Third Edition, were given before and after intervention. Goal Attainment Scaling and semistructured interviews with the teachers and participants were completed after intervention. RESULTS: All 3 students showed meaningful improvement in functional regulation and active participation in the classroom during the intervention period as demonstrated by a 2-SD band method or celeration line analysis. All additional measures noted positive change. CONCLUSIONS AND RELEVANCE: Findings suggest that sensory integration intervention with consultation in the education setting can improve school performance and participation for children with sensory integration and processing challenges. What This Article Adds: This study offers an evidence-based model of service delivery for the school setting that is effective in improving the functional regulation and active participation of students whose sensory integration and processing challenges interfere with occupational engagement and are not mitigated by embedded supports.

Paralytic shellfish toxins associated with Arctic Tern mortalities in Alaska.

Harmful algal blooms produce biotoxins that can injure or kill fish, wildlife, and humans. These blooms occur naturally but have intensified in many locations globally due to recent climatic changes, including ocean warming. Such changes are especially pronounced in northern regions, where the effects of paralytic shellfish toxins (PSTs) on marine wildlife are of growing concern. In Alaska, seabird mortality events have increased in frequency, magnitude, and duration since 2015 alongside anomalously high ocean temperatures. Although starvation has been implicated as the apparent cause of death in many of these die-offs, saxitoxin (STX) and other PSTs have been identified as possible contributing factors. Here, we describe a mortality event at a nesting colony of Arctic Terns (Sterna paradisaea) near Juneau, Alaska in 2019 and report elevated concentrations of PSTs in bird, forage fish, and mussel samples. Concentrations of STX and other PSTs in tern tissues (2.5-51.2 µg 100g-1 STX-equivalents [STX-eq]) were of similar magnitude to those reported from other PST-induced bird die-offs. We documented high PST concentrations in blue mussels (>11,000 µg 100g-1 STX-eq; Mytilus edulis spp.) collected from nearby beaches, as well as in forage fish (up to 494 µg 100g-1 STX-eq) retrieved from Arctic Tern nests, thereby providing direct evidence of PST exposure via the terns' prey. At maximum concentrations measured in this study, a single 5 g Pacific Sand Lance (Ammodytes personatus) could exceed the median lethal STX dose (LD50) currently estimated for birds, offering strong support for PSTs as a likely source of tern mortality. In addition to describing this localized bird mortality event, we used existing energetics data from adult and nestling Arctic Terns to calculate estimated cumulative daily PST exposure based on ecologically relevant concentrations in forage fish. Our estimates revealed potentially lethal levels of PST exposure even at relatively low (≤30 ug 100g-1 STX-eq) toxin concentrations in prey. These findings suggest that PSTs present a significant hazard to Arctic Terns and other northern seabirds and should be included in future investigations of avian mortality events as well as assessments of population health.

It's Not Just about Bicycle Riding: Sensory-Motor, Social and Emotional Benefits for Children with and without Developmental Disabilities.

BACKGROUND: A developing area for therapy is teaching children to ride a bicycle. Little has been written about the effectiveness of these programs. This study explored outcomes from participation in a novel bicycle riding program for children with a wide array of developmental challenges. METHOD: Two studies were conducted; a nonconcurrent, multiple baseline design with four participants and a pretest-posttest single group with 15 children. RESULTS: Study 1 participants improved on broad jump. Balance positions showed variable responses. Study 2 participants showed significant improvement on broad jump, and a trend toward significance walking forwards and backwards. Parents reported improvement in following rules, participating in daily routines, interacting with peers, and feeling good about him/herself and a change in child's participation in community and extracurricular activities. All children improved in glide time or achieved independent riding. CONCLUSIONS: Preliminary evidence was found for the effectiveness of one approach for developing motor and social skills within the context of learning to ride a bicycle. Children over the age of 6 years were able to ride a two-wheeled bicycle at the end of the program. Participation suggested improvement in motor coordination and dynamic balance as well as changes in measures of social interaction and self-esteem.

Interoception: A Multi-Sensory Foundation of Participation in Daily Life.

The purpose of this article is to examine evidence that broadens the clinical perspective on interoception as an imperative consideration for individuals with mental health and sensory processing challenges. The central supposition is that interoception is broader than just signals from the viscera. Rather, interoception refers to perceptions of bodily signals and bodily states that construct a subjective representation of the experience. These representations are then utilized for categorizing the sensory attributes and constructing meaning. Thus, this updated conceptualization presents interoception as a complex multidimensional system, with bidirectional features. The interplay between the brain and the body is necessary to maintain homeostasis as well as respond adaptively to the changes in one's internal and external environment. As a sensory capacity, interoceptive information must be processed and interpreted before it can be integrated into a personal experiential history. Interoception supports both body and mental functions and as such, interoceptive processes support health and wellness by establishing a felt sense of psychological and physiological safety that is foundational to meaningful participation in life. The information presented in this article is central to the pursuit of evidence-based best practices for any professional wishing to integrate consideration of interoception into their clinical practice.

Effectiveness of Occupational Therapy Using a Sensory Integration Approach: A Multiple-Baseline Design Study.

IMPORTANCE: Occupational therapy using an Ayres Sensory Integration® (ASI) approach is a common intervention that has not been extensively studied in children with idiopathic sensory processing and integration challenges (e.g., without a diagnosis of autism). OBJECTIVE: To test the effectiveness of ASI using measures related to motor coordination and functional performance in children with a sensory-based motor disorder (SBMD). DESIGN: Nonconcurrent, multiple baseline, single subject. SETTING: Outpatient clinic that was part of a children's hospital in an urban setting. PARTICIPANTS: Three boys (ages 5-8 yr) with an SBMD. INTERVENTION: Each participant received ASI 3 times per week for 10 wk. Outcomes and Measures: Three motor probes were measured weekly. Pre- and posttest assessments included goal attainment scaling (GAS) and the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2). RESULTS: All 3 participants showed improvements in motor probes during the intervention period on the basis of a 2 SD band method of analysis. Statistically significant improvements were noted across GAS goals, and positive changes were found on the BOT-2, with large effect sizes. CONCLUSIONS AND RELEVANCE: Findings suggest improved motor performance and high goal achievement using ASI for children with idiopathic sensory processing and integration challenges. What This Article Adds: This study adds to a body of literature suggesting that ASI is effective in increasing functional performance in children with sensory processing and integration challenges. Future studies using multiple baseline designs are feasible in the clinic setting and can help build the evidence base for ASI.

Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure.

IMPORTANCE: The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. OBJECTIVE: To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. DESIGN: Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. SETTING: Three outpatient clinic sites in the United States. PARTICIPANTS: Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. OUTCOMES AND MEASURES: The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. RESULTS: Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. CONCLUSIONS AND RELEVANCE: The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. WHAT THIS ARTICLE ADDS: This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.

Heatwave-induced synchrony within forage fish portfolio disrupts energy flow to top pelagic predators.

During the Pacific marine heatwave of 2014-2016, abundance and quality of several key forage fish species in the Gulf of Alaska were simultaneously reduced throughout the system. Capelin (Mallotus catervarius), sand lance (Ammodytes personatus), and herring (Clupea pallasii) populations were at historically low levels, and within this community abrupt declines in portfolio effects identify trophic instability at the onset of the heatwave. Although compensatory changes in age structure, size, growth or energy content of forage fish were observed to varying degrees among all these forage fish, none were able to fully mitigate adverse impacts of the heatwave, which likely included both top-down and bottom-up forcing. Notably, changes to the demographic structure of forage fish suggested size-selective removals typical of top-down regulation. At the same time, changes in zooplankton communities may have driven bottom-up regulation as copepod community structure shifted toward smaller, warm water species, and euphausiid biomass was reduced owing to the loss of cold-water species. Mediated by these impacts on the forage fish community, an unprecedented disruption of the normal pelagic food web was signaled by higher trophic level disruptions during 2015-2016, when seabirds, marine mammals, and groundfish experienced shifts in distribution, mass mortalities, and reproductive failures. Unlike decadal-scale variability underlying ecosystem regime shifts, the heatwave appeared to temporarily overwhelm the ability of the forage fish community to buffer against changes imposed by warm water anomalies, thereby eliminating any ecological advantages that may have accrued from having a suite of coexisting forage species with differing life-history compensations.

Preparing Advanced Clinicians and Practitioners: A Model for Mentorship in Occupational Therapy Practice.

Mentoring is essential at all stages of a professional career. However, little has been written about the effectiveness of programs for practicing clinicians. This study was designed to address the need for evidence about the effectiveness of formal mentorship programs by describing the impact of the STAR mentorship program on a group of clinicians specializing in sensory integration and processing challenges. This study utilized an exploratory, retrospective, survey research design. Course evaluations were examined from 240 subjects following participation in a one-week, small group mentorship training program. Qualitative methods were adapted for use in this study. Sixteen codes, with operational definitions, were developed to analyze the surveys. Ninety-six percent indicated that the program met or exceeded their expectations; only 12.5% had a negative comment. Impact on psychosocial function was reflected by 22% of the participants. Comments related to impact on career function were indicated by 45% of the participants. Ninety-four percent provided positive comments about the program structure, and 74% responded with positive comments regarding content of the program. Positive outcomes were associated with this one mentorship program, suggesting a need for more in-person, structured mentored learning experiences. Mentorship is recommended as a method to address the growing need within the profession to support career development, build knowledge, skill and attitudes, and aspirations/commitment as well as enhance professionalism/professional development.

Wireless Measurement of Sympathetic Arousal During in vivo Occupational Therapy Sessions.

PURPOSE: One goal of occupational therapists working with children who have sensory processing challenges is the regulation of arousal. Regulation strategies have not been evaluated using an empirical measure of physiological arousal. OBJECTIVE: To establish the feasibility of using an objective physiologic measure of sympathetic arousal in therapeutic settings and explore the relation between therapeutic activities and sympathetic arousal. To evaluate changes in electrodermal activity (EDA) during occupational therapy sessions. METHODS: Twenty-two children identified with sensory modulation dysfunction (SMD) wore a wireless EDA sensor during 50 min occupational therapy sessions (n = 77 sessions). RESULTS: All children were able to wear the sensor on the lower calf without being distracted by the device. The five insights below are based on a comparison of EDA recordings in relation to therapists' reflections describing how sympathetic arousal might correspond to therapeutic activities. CONCLUSION: Objective physiological assessment of a child's sympathetic arousal during therapy is possible using a wireless EDA measurement system. Changes in EDA may correspond directly with therapeutic activities. The article provides a foundation for designing future therapeutic studies that include continuous measures of EDA.

Algal toxins in Alaskan seabirds: Evaluating the role of saxitoxin and domoic acid in a large-scale die-off of Common Murres.

Elevated seawater temperatures are linked to the development of harmful algal blooms (HABs), which pose a growing threat to marine birds and other wildlife. During late 2015 and early 2016, a massive die-off of Common Murres (Uria aalge; hereafter, murres) was observed in the Gulf of Alaska coincident with a strong marine heat wave. Previous studies have documented illness and death among seabirds resulting from exposure to the HAB neurotoxins saxitoxin (STX) and domoic acid (DA). Given the unusual mortality event, corresponding warm water anomalies, and recent detection of STX and DA throughout coastal Alaskan waters, HABs were identified as a possible factor of concern. To evaluate whether algal toxins may have contributed to murre deaths, we tested for STX and DA in a suite of tissues obtained from beach-cast murre carcasses associated with the die-off as well as from apparently healthy murres and Black-legged Kittiwakes (Rissa tridactyla; hereafter, kittiwakes) sampled in the preceding and following summers. We also tested forage fish and marine invertebrates collected in the Gulf of Alaska in 2015-2017 to evaluate potential sources of HAB toxin exposure for seabirds. Saxitoxin was present in multiple tissue types of both die-off (36.4 %) and healthy (41.7 %) murres and healthy kittiwakes (54.2 %). Among birds, we detected the highest concentrations of STX in liver tissues (range 1.4-10.8 µg 100 g-1) of die-off murres. Saxitoxin was relatively common in forage fish (20.3 %) and invertebrates (53.8 %). No established toxicity limits currently exist for seabirds, but concentrations of STX in birds and forage fish in our study were lower than values reported from most other bird die-offs in which STX intoxication was causally linked. We detected low concentrations of DA in a single bird sample and in 33.3 % of invertebrates and 4.0 % of forage fish samples. Although these results do not support the hypothesis that acute exposure to STX or DA was a primary factor in the 2015-2016 mortality event, additional information about the sensitivity of murres to these toxins is needed before we can discount their potential role in the die-off. The widespread occurrence of STX in seabirds, forage fish, and invertebrates in the Gulf of Alaska indicates that algal toxins should be considered in future assessments of seabird health, especially given the potential for greater occurrence of HABs in the future.

Extreme mortality and reproductive failure of common murres resulting from the northeast Pacific marine heatwave of 2014-2016.

About 62,000 dead or dying common murres (Uria aalge), the trophically dominant fish-eating seabird of the North Pacific, washed ashore between summer 2015 and spring 2016 on beaches from California to Alaska. Most birds were severely emaciated and, so far, no evidence for anything other than starvation was found to explain this mass mortality. Three-quarters of murres were found in the Gulf of Alaska and the remainder along the West Coast. Studies show that only a fraction of birds that die at sea typically wash ashore, and we estimate that total mortality approached 1 million birds. About two-thirds of murres killed were adults, a substantial blow to breeding populations. Additionally, 22 complete reproductive failures were observed at multiple colonies region-wide during (2015) and after (2016-2017) the mass mortality event. Die-offs and breeding failures occur sporadically in murres, but the magnitude, duration and spatial extent of this die-off, associated with multi-colony and multi-year reproductive failures, is unprecedented and astonishing. These events co-occurred with the most powerful marine heatwave on record that persisted through 2014-2016 and created an enormous volume of ocean water (the "Blob") from California to Alaska with temperatures that exceeded average by 2-3 standard deviations. Other studies indicate that this prolonged heatwave reduced phytoplankton biomass and restructured zooplankton communities in favor of lower-calorie species, while it simultaneously increased metabolically driven food demands of ectothermic forage fish. In response, forage fish quality and quantity diminished. Similarly, large ectothermic groundfish were thought to have increased their demand for forage fish, resulting in greater top-predator demands for diminished forage fish resources. We hypothesize that these bottom-up and top-down forces created an "ectothermic vise" on forage species leading to their system-wide scarcity and resulting in mass mortality of murres and many other fish, bird and mammal species in the region during 2014-2017.

Neural Foundations of Ayres Sensory Integration®.

Sensory integration, now trademarked as Ayres Sensory Integration® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres' propositions by describing functions of the vestibular, proprioceptive, and tactile sensory systems, and exploring their relationships to ocular, postural, bilateral integration, praxis, and sensory modulation. We close by proposing neuroplasticity as the mechanisms underlying change as a result of ASI intervention.

Early Identification of Sensory Processing Difficulties in High-Risk Infants.

OBJECTIVE: Our objective was to determine the extent to which young children at high risk for sensory processing difficulties differed from those who were at low risk. METHOD: We compared high- versus low-risk young children using standardized measures. High-risk participants had older siblings identified as having sensory processing difficulties after a comprehensive occupational therapy evaluation (n = 13); low-risk participants (n = 16) had typically developing siblings and no family history of sensory or other neurological disorders. RESULTS: High-risk infants scored significantly lower on the Language and Cognitive scales of the Bayley Scales of Infant and Toddler Development-Third Edition. The high-risk group presented with more atypical positions on the Toddler and Infant Motor Evaluation and fewer sensation-seeking behaviors on the Toddler Sensory Profile-2. CONCLUSION: Results suggest that sensory, motor, cognitive, and language dimensions may be associated with sensory processing difficulties. Implications exist for the design of future studies and for early intervention.

Sensory over-responsivity: parent report, direct assessment measures, and neural architecture.

Background: Sensory processing difficulties are common across neurodevelopmental disorders. Thus, reliable measures are needed to understand the biological underpinnings of these differences. This study aimed to define a scoring methodology specific to auditory (AOR) and tactile (TOR) over-responsivity. Second, in a pilot cohort using MRI Diffusion Tensor Imaging, we performed a proof of concept study of whether children with AOR showed measurable differences in their white matter integrity. Methods: This study included children with AOR and TOR from a mixed neurodevelopmental disorder cohort including autism and sensory processing dysfunction (n = 176) as well as neurotypical children (n = 128). We established cohorts based on sensory over-responsivity using parent report (Short Sensory Profile (SSP)) and direct assessment (Sensory Processing-Three Dimensions: Assessment (SP-3D:A)) measures. With a subset of the children (n = 39), group comparisons, based on AOR phenotype, were conducted comparing the white matter fractional anisotropy in 23 regions of interest. Results: Using direct assessment, 31% of the children with neurodevelopmental disorders had AOR and 27% had TOR. The inter-test agreement between SSP and SP-3D:A for AOR was 65% and TOR was 50%. Children with AOR had three white matter tracts showing decreased fractional anisotropy relative to children without AOR. Conclusions: This study identified cut-off scores for AOR and TOR using the SSP parent report and SP-3D:A observation. A combination of questionnaire and direct observation measures should be used in clinical and research settings. The SSP parent report and SP-3D:A direct observation ratings overlapped moderately for sensory related behaviors. Based on these preliminary structural neuroimaging results, we suggest a putative neural network may contribute to AOR.

Initial Studies of Validity of the Sensory Processing 3-Dimensions Scale.

AIMS: This study examined the validity of a new measure of sensory processing for children, the Sensory Processing 3-Dimensions Scale (SP-3D). The SP-3D is a performance-based measure for children ages three to thirteen years, designed to assess sensory processing abilities, and identify the three patterns of sensory processing disorder (SPD) and related subtypes, including sensory modulation, sensory discrimination, and sensory-based motor disorders. METHODS: Age trends were explored using descriptive statistics and graphing techniques with a sample of children with and without SPD. SP-3D scores were correlated with scores from the Sensory Processing Measure (SPM) to examine criterion-related validity. Discriminant validity was assessed by comparing SP-3D scores from children with and without SPD. RESULTS: Age trends of SP-3D scores supported sensory discrimination, praxis and postural functions as developmental constructs. Several mild to moderate correlations were found between the scores of the SP-3D and the SPM, indicating that the tools are measuring similar constructs, and supporting the SP-3D as a measure of sensory processing. Modulation and Motor Behavior Scores from the SP-3D discriminated typically developing children from those with SPD, while results from subtests measuring sensory discrimination, postural and praxis were mixed regarding capacity for discrimination suggesting revision to several items. CONCLUSION: The study provides preliminary evidence of the SP-3D as a valid measure of sensory processing abilities and dysfunction. Further research regarding the reliability and validity of the SP-3D are needed.

A systematic review of ayres sensory integration intervention for children with autism.

Sensory integration is one of the most highly utilized interventions in autism, however, a lack of consensus exists regarding its evidence base. An increasing number of studies are investigating the effectiveness of this approach. This study used the Council for Exceptional Children (CEC) Standards for Evidence-based Practices in Special Education to evaluate the effectiveness research from 2006 to 2017 on Ayres Sensory Integration (ASI) intervention for children with autism. A systematic review was conducted in three stages. Stage 1 involved an extensive database search for relevant studies using search terms related to sensory integration and autism, interventions suggesting a sensory integration approach, and high-quality study designs. Searches yielded 19 studies that were evaluated in Stage 2. Six of these met inclusion criteria of being peer-reviewed, written in English, description of intervention this is consistent with ASI intervention, and comparison group design or single subject method employed. Prior to analysis using CEC standards, three articles were excluded because intervention details were not consistent with the core principles of ASI, or because of major methodological flaws. In Stage 3, the remaining three studies were rated using the CEC quality indicators and standards for an evidence-based practice. Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items. One additional study met more than 50% of the criteria. Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4-12 years old. Autism Research 2019, 12: 6-19. © 2018 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY: Ayres Sensory Integration intervention is one of the most frequently requested and highly utilized interventions in autism. This intervention has specific requirements for therapist qualifications and the process of therapy. This systematic review of studies providing Ayres Sensory Integration therapy to children with autism indicates that it is an evidence-based practice according to the criteria of the Council for Exceptional Children.