Ayres Sensory Integration Therapy, Reflex Integration Therapy, and the Efficacy When Used in Conjunction

Dominique Blanche Kiefer, OTD, OTR/L, BCP

Introduction

Evidence-based practice (EBP) integrates clinical expertise with the best available external evidence, ensuring that interventions are both effective and supported by research (Sackett et al., 1996). In pediatric occupational therapy, understanding the evidence behind popular interventions, such as Ayres Sensory Integration (ASI) and Reflex Integration Therapy (RIT), is critical to informed decision-making. This paper examines these approaches, their theoretical foundations, the strength of the scientific evidence supporting each as an evidence-based practice, and the American Occupational Therapy Association’s (AOTA) position on their use in pediatric clinical practice. The aims of this paper are to provide practical clinical insights and examine the rationale behind intervention selection to enhance functional performance based on assessment data interpretation.

Background on Ayres Sensory Integration (ASI) Therapy

Ayres Sensory Integration (ASI) or Sensory Integration Treatment is a therapeutic approach designed to enhance children's sensory processing and adaptive responses (Ayres, 2005). Developed by Dr. A. Jean Ayres, SIT (or as it is now referred to as ASI) is based on the theory that the brain processes and organizes sensory input to produce appropriate motor and behavioral responses. Children with sensory processing difficulties often struggle with coordination, emotional regulation, attention and daily functioning due to inefficient sensory processing (Ayres, 2005). 

ASI therapy typically involves engaging children in sensory-targeted activities that challenge their sensory and adaptive skills, such as swinging, climbing, and interacting with tactile media in play. Research has demonstrated that ASI can improve motor planning, attention, social participation, and self-regulation and ultimately improve functional performance (Schoen et al., 2019). Several standardized assessments, including the Sensory Integration and Praxis Tests (SIPT) and the Structured Observations of Sensory Integration-Motor (SOSI-M), can be used to measure the effectiveness of ASI interventions (Blanche et al., 2025). At the present time, ASI is considered to be an evidenced-based approach (Hume et al., 2021; Steinbrenner et al., 2020). 

Background on Reflex Integration Therapy (RIT)

Reflex Integration Therapy is an approach that address retained primitive reflexes, which are believed to affect motor and cognitive development. Primitive reflexes, such as the Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Moro Reflex, and Tonic Labyrinthine Reflex (TLR), play a foundational role in early movement and development. Proponents of Reflex Integration Therapy suggest that retained reflexes contribute to learning and behavioral difficulties and that targeted interventions can mitigate these issues (Berg et al., 2022).

RIT typically involves specific repetitive movement exercises, manual techniques, and sensory stimulation to facilitate reflex integration. Various programs, such as Masgutova Neurosensorimotor Reflex Integration (MNRI) and Rhythmic Movement Training (RMT), claim that targeting retained reflexes can improve balance, coordination, and cognitive function. Some proponents argue that RIT enhances neural connectivity and supports higher-order cognitive and motor skills (Masgutova et al., 2016). However, research on RIT remains limited, with most evidence being anecdotal or based on small-scale studies. In addition, there are no widely accepted standardized assessment tools to measure the direct impact of RIT interventions (Berg et al., 2022).

Despite its popularity in some therapeutic communities, the scientific evidence supporting RIT is limited. While some studies indicate that persistent primitive reflexes may be associated with motor and learning difficulties, there is little evidence to suggest that integrating these reflexes through targeted therapy leads to significant functional improvements. Stallings-Sahler et al. (2019) reported that while reflex retention can be observed in some children with neurodevelopmental challenges, the direct link between reflex integration and functional impairments remains unclear. Additionally, many studies on RIT lack rigorous methodologies, such as control groups and large sample sizes, which weakens its reliability.

AOTA’s Position on Ayres Sensory Integration (ASI) and Reflex Integration Therapy (RIT)

The American Occupational Therapy Association (AOTA) supports the use of Ayres Sensory Integration as an evidence-based approach for addressing sensory processing challenges in children. AOTA recognizes ASI as a valid intervention when applied by trained occupational therapists and within the framework of clinical reasoning and individualized assessment. ASI is included within the broader scope of occupational therapy practice and has been incorporated into various professional guidelines for pediatric intervention.

Conversely, AOTA has issued cautionary guidance regarding the use of reflex integration programs. According to AOTA’s Choosing Wisely initiative (2018), reflex integration techniques should not be used in isolation without a clear link to occupational outcomes. The organization advises against relying solely on reflex integration techniques due to the lack of substantial empirical evidence supporting their efficacy. Interventions must be evidence-based and aimed at improving participation in meaningful activities rather than solely focusing on inhibiting reflexes.

AOTA emphasizes the importance of establishing a clear connection between retained reflexes and functional impairments before implementing such interventions. While some occupational therapists may incorporate aspects of RIT into broader interventions, AOTA stresses that any approach used must be aligned with evidence-based practice principles and directly linked to improving occupational performance and daily function (AOTA, 2018).

Examining the Efficacy of Combining RIT with ASI
Some clinicians integrate RIT techniques into ASI sessions, hypothesizing that addressing retained reflexes may enhance sensory processing and motor outcomes. Proponents suggest that RIT can help remove foundational motor barriers, allowing ASI techniques to be more effective. However, there is little research to support the additive benefits of combining these approaches. While interventions based on the theory of Sensory Integration are grounded in neuroplasticity and have established protocols for intervention, RIT’s mechanisms and effectiveness remain debated (Berg et al., 2022).

Conclusion

Occupational therapy interventions should align with AOTA guidelines, ensuring that all strategies used are evidence-based and directly linked to meaningful functional outcomes.

While ASI has strong empirical support in improving sensory and motor function, RIT still needs  rigorous research studies to support its use. Using RIT alongside ASI may offer theoretical benefits, but without substantial research, it is difficult to justify its widespread use. Occupational therapists should prioritize evidence-based interventions while remaining open to emerging research that may further clarify the role of RIT in clinical practice. AOTA’s stance reinforces the importance of applying only evidence-based methods within occupational therapy and advises caution when integrating interventions that lack empirical support. Future research should focus on large-scale, controlled studies to determine whether RIT has measurable benefits for pediatric populations.

References

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