Sensory processing appears to be at the forefront of school-based OT evaluations these days, leaving therapists wondering if and how to integrate it into their practice. Sensory integration is a subject briefly touched upon during OT school, but the subject is more than just brief or simple. With the increasing demand in referrals in schools for sensory integration evaluations, OT’s are often left searching and questioning, “what sensory regulation strategies can I use to help my students to be more successful in school?”

One of the pioneers of sensory processing in the OT world is Jean Ayres, PhD, OTR, FAOTA, an OT, psychologist and neuroscientist. Through her research and education, she has developed the Ayres Sensory Integration (ASI®) model which is “designed to improve sensory perceptual abilities, self-regulation, motor skills and praxis” It is a “specific, theory-driven, evidence-based therapeutic approach designed to help children process and organize sensory information more effectively so they can participate successfully in daily activities.” (About ASI: Ayres Sensory Integration®, n.d.).

When working with students on sensory regulation, OT’s may draw from their education, previous knowledge from continuing education courses, or more often internet searches, on sensory strategies that they think might work. Let’s take a look at ASI and determine if it is practical, and possible, to use in school-based occupational therapy. In the 2025 issue of the American Journal of Occupational Therapy (AJOT), there is a call to action supporting the use of ASI in school-based practice. (Whiting et al., 2024)

So, what are the basics of ASI and how does it differ from what you may already be integrating into your practice, or what we commonly refer to as sensory-based interventions? This table below summarizes some of the key differences.

“With ASI, the goal is to improve how the brain processes and organizes sensory input so the child can respond appropriately and participate more effectively in everyday activities” (Current Views on ASI in School-Based Practice, n.d.). ASI has been found to be effective with learning disabilities, ADHD, dyspraxia and as an evidence-based practice for children with autism. With sensory-based interventions, the goal is to use specific sensory input (movement, touch, deep pressure, etc.) to help a child achieve regulation or attention for functional participation. This is often the model that school-based practitioners are using. It can look like using fidgets, weighted lap pads or noise-canceling headphones, creation of sensory diets, movement breaks, heavy work before transitions and adaptive seating. With this model, OT’s help guide teachers, aides or caregivers with the focus on functional regulation and attention, not neurological change.

When looking at this table it may appear like ASI is more fitting for the outpatient setting and doesn’t have a place in school-based therapy, but what if we take the concept broader and apply our knowledge of sensory integration to the Multi-Tiered Systems of Support (MTSS) in schools. Is that possible? Can OT’s be effective in implementing this to the broader population, or is it just too much work on top of already full workloads?

As we are all sensory beings with unique sensory needs, OT can apply our knowledge and expertise around sensory integration to all students at school. Recent changes in education legislation encourages promotion and prevention, placing OT’s at the forefront of asking, but how? How can OT integrate into MTSS with meaningful intervention of sensory strategies?

(Current Views on ASI in School-Based Practice, n.d.)

According to the Center on Multi-Tiered System of Support website, MTSS is a “proactive and preventative framework that integrates data and instruction to maximize student success from a strengths-based perspective” (Essential Components of MTSS | MTSS Center, n.d.). As a school-based OT, the mandate for least-restrictive environment is always at the forefront when considering eligibility and continuation of OT services. MTSS within schools provides the framework to look globally and leverage our knowledge before students are referred to special education services, therefore being proactive.

So what are some examples of ASI in each tier?

As stated in the AJOT article and through research on ASI, to deliver ASI, regardless of context or environment, the OT must be trained in sensory integration. Through comprehensive evaluations, OT’s can differentiate how sensory processing is affecting occupational performance at school and will use evidence-based strategies driven by ASI theory (AOTA, 2023). OT’s are uniquely poised to implement sensory integration strategies in schools as they have the necessary education and lens through which they can implement across all tiers.

Typically, what we currently see in schools for sensory intervention is sensory-based strategies versus true sensory integration, such as ASI. Below are some examples of the differences between how an OT may use sensory-based strategies versus ASI when addressing sensory regulation.

It’s clear to see, and ongoing evidence supports that OT involvement in the school setting for sensory regulation is important and necessary. Implementing and integrating into the MTSS is a great way to meet the needs of many students! Referrals will come in for sensory only evaluations, but what data and strategies have been trialed before jumping to tier 3 interventions? With large OT caseloads and work demands, the idea of fitting in one more area of focus that is so large can feel daunting. Taking it one step at a time and through integrating into MTSS, you are reaching students who may need support and will receive it therefore improving their sensory regulation to attend better in class. We are giving students, teachers, and administrators tools to use while providing a framework within MTSS to support sensory regulation. Below is a list of ways OT can start integrating this into their practice to create change within their schools.

• Educate your school administrators on the importance of OT working with school staff on all tiers of MTSS.
• Look to become trained in ASI to provide this service with fidelity.
• Design and provide a framework for schools to follow regarding sensory integration.
• Offer education to school staff regarding the differences between ASI and sensory-based strategies and how OT can implement both.
• Collaborate with teaching staff to determine the needs of their classroom and implement whole classroom strategies to benefit all students.
• Advocate for equipment and space within your school to provide ASI, if trained, and sensory based strategies.

For more information on becoming trained and certified in ASI, click on this link ASI Certificate (ASI Certificate, n.d.).