Why "Sensory Integration Disorder" Is a Dubious Diagnosis

Peter L. Heilbroner, MD, PhD

"Sensory integration" refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound, and gravity. It has been postulated that certain behavioral and emotional problems result from the malfunctioning of this process. The term "sensory integration disorder (SID)" is used to characterize children who exhibit exaggerated sensitivity to sensory stimuli. The term was coined during the 1970s by A. Jean Ayres, PhD, OTR, an occupational therapist and licensed clinical psychologist who operated a private clinic and taught graduate students at the University of Southern California [1]. Ayres died in 1989, but the clinic she founded has been maintained [1].

Parents of children alleged to have SID typically describe an aversion to loud noises, coarse clothing textures, and particular tastes and textures of food. Many of these children are also clumsy and have a history of late attainment of developmental milestones (i.e., were late to learn to walk or talk). Others exhibit coordination and fine motor problems. These children also tend to have behavioral and social problems.

The methods used to treat these children include brushing the skin, using weighted clothing and special shoes, various exercises intended to improve coordination (“vestibular training”), and other techniques claimed to to “desensitize” or fine-tune the patient’s nervous system. The therapies typically are expensive, involve months to years of weekly or more-frequent sessions, and imply to parents and children that there is, in fact, a problem that requires treatment.

Few pediatric neurologists believe that SID is a real diagnostic entity. We note that children with a range of neurodevelopmental and behavioral disorders, including attention-deficit/hyperactivity disorder, autism, and anxiety disorders also have “sensory issues” such as oversensitivity to touch. Many neurologists therefore feel that “sensory symptoms” are a nonspecific indicator of neurodevelopmental immaturity, not a sign of a distinct disorder. Yet thousands of children are sent for these therapies by their parents, at no small expense. Aetna considers sensory integration therapy experimental and does not pay for it [2]. However, a few insurance companies do cover it, and some school districts provide it.

Anecdotal evidence from parents is often used to support the existence of SID and the effectiveness of treatment. A review of the literature on sensory integration disorder reveals mostly poorly designed studies and flawed methodology. Studies with tiny sample sizes (as small as one patient!) are common [3-7]. Other studies investigate sensory symptoms in children with a serious underlying disorder such as autism [8-12], or mental retardation [13-16], and are therefore unlikely to be especially relevant to more normal children. Still other research assesses sensory therapies in the treatment of tangentially related conditions, like learning disability [17-23] or neuromotor delays [24-27]. In some cases where treatment appears to benefit, the therapies may simply be a calming influence on a nervous child. However, there are no adequate controlled studies either supporting the existence of SID as a distinct and definable entity, or clearly demonstrating the effectiveness of the therapies used for SID compared to no treatment at all [28-30]. In my experience, children diagnosed with "SID" are simply very anxious and come from a family that includes others who suffer from an anxiety disorder.

It should be remembered that most children develop and improve their behavior spontaneously. Given the fact that few (if any) adult patients have sensory integration disorder, it is reasonable to question whether costly interventions are really necessary for what is a most likely a self-limiting problem of neurodevelopmental immaturity and anxiety. I also believe that children or families whose behavioral or anxiety disorders could benefit treatment would be better off seeking standard treatment than wasting time and money on unproven or irrational approaches.

Well-designed scientific studies are needed to determine whether or not SID is indeed a disorder, and even if so, whether the treatments currently prescribed are effective or necessary. Until studies along these lines are conducted, the diagnosis of SID should prompt a healthy degree of skepticism.


  1. About the Ayres Clinic. Sensory Integration International Web site, accessed May 1, 2005.
  2. Sensory and auditory integration therapy. Aetna Clinical Policy Bulletin Number 0256, May 11, 2004.
  3. Magrun M and others. Effects of vestibular stimulation on spontaneous use of verbal language in developmentally delayed children. American Journal of Occupational Therapy 35:101-104, 1981.
  4. Sandler A, Coren A. Relative effectiveness of sensory integrative therapy and overcorrection in the treatment of stereotyped behavior: An exploratory study. Training Quarterly on Developmental Disabilities 1:17-24, 1980.
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  24. Ayres AJ. Effect of sensory integrative therapy on the coordination of children with choreathetoid movements. American Journal of Occupational Therapy 31:291-293, 1977.
  25. Jenkins JR and others. Comparison of sensory integrative therapy and motor programming. American Journal of Mental Deficiency 88:221-224, 1983.
  26. Burns YR. Sensory integration or the role of sensation in movement. American Journal on Mental Retardation 92;412, 1988.
  27. American Academy of Pediatrics Committee on Children with Disabilities. School-aged children with motor disabilities. Pediatrics 76:648-649, 1985.
  28. Hoehn TP, Baumeister AA. A critique of the application of sensory integration therapy to children with learning disabilities. Journal of Learning Disabilities 27:338-350, 1994.
  29. Description of sensory integration. Association for Science in Autism Treatment Web site, accessed April 30, 2005.
  30. Dawson G, Watling R. Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence. Journal of Autism and Developmental Disorders 30:415-421, 2000.

General References

Dr. Heilbroner practices pediatric neurology at The Valley Hospital in Ridgewood, New Jersey.

This article was posted on May 1, 2005.

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