Ayres Sensory Integration® With Children Ages 0 to 12: A Systematic Review of Randomized Controlled Trials

Abstract

Importance: Debate over the evidence for Ayres Sensory Integration® (ASI) is ongoing; previous reviews have reached mixed conclusions. Objective: To evaluate the efficacy of ASI for children, based on a systematic review of randomized controlled trials (RCTs). Data Sources: Searches of the Cochrane Library, MEDLINE, CINAHL, PsycINFO, and Embase databases. Study Selection and Data Collection: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RCTs were published in peer-reviewed English-language literature and compared implementation of ASI with its Fidelity MeasureTM with children ages 0 to 12 yr with treatment as usual, other treatment, or no treatment. Data were extracted using the Template for Intervention Description and Replication Checklist; risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials. Findings: Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included. RCTs were categorized as Level 1b (well designed) or 2b (low quality); strength of evidence was determined according to U.S. Preventive Services Task Force guidelines. Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability. Bias concerns persist among included studies. Conclusions and Relevance: ASI supports autistic children’s individualized goals related to occupational performance, function, and participation. It is not recommended to address behaviors of concern, such as resistance to change or irritability. More research is needed to determine ASI’s benefits for other child populations.