providing controlled sensory experiences to produce adaptive motor responses. The hypothesis is that, with these experiences, the nervous system better modulates, organizes, and integrates information from the environment, which in turn provides a foundation for further adaptive responses and higher-order learning. Other components of the classical sensory integration model include a child-centered approach, providing a just-right challenge (scaffolding) with progressively more sophisticated adaptive motor responses and engaging the child in meaningful and appropriate play interactions.

There is a paucity of research concerning sensory integration treatments in autism. In one retrospective study, children with autism who had average to hyperresponse patterns to sensory stimuli tended to have better outcomes from sensory integration therapy than did those with a hyporesponsive pattern (Ayres and Tickle, 1980). Recently, some children with autistic spectrum disorders studied prospectively during sensory integration therapy showed significant improvements in play and demonstrated less “non-engaged” play. Only one child had significant improvements with adult interactions, and none had improved peer interactions (Case-Smith and Bryan, 1999).

Other approaches based on sensory integration therapy include the “sensory diet,” in which the environment is filled with sensory-based activities to satisfy a child’s sensory needs. The “alert program’” (usually with higher-functioning individuals) combines sensory integration with a cognitive-behavioral approach to give a child additional strategies to improve arousal modulation. No empirical studies of these approaches were identified for children with autism or related populations.

Sensory stimulation techniques vary but usually involve passive sensory stimulation; they are incorporated within the broader sensory integration programs or used in isolation. The underlying proviso is that a given sensory experience may facilitate or inhibit the nervous system and produce behavioral changes, such as arousal modulation. Examples of this approach include “deep pressure” to provide calming input by massage or joint compression or using an apparatus such as a weighted vest. Vestibular stimulation, another example, is often used to modulate arousal, facilitate postural tone, or increase vocalizations. These interventions have also not yet been supported by empirical studies.

Auditory Integration Therapy

Auditory integration therapy for autism has received much media attention in recent years. Proponents of auditory integration therapy suggest that music can “massage” the middle ear (hair cells in the cochlea), reduce hypersensitivities and improve overall auditory processing ability. Two philosophical approaches to auditory integration therapy



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