The trial enrolled sixty-three children and randomized them into two groups, with thirty-two children assigned to receive Ayres Sensory Integration in addition to their usual individualized education program, and thirty-one children continuing with their usual care alone. Sixty children completed the study, thirty in each arm, and these completers formed the final analysis sample. Over twelve weeks, the intervention group accumulated approximately thirty-six hours of sensory integration therapy on top of their standard programming. This design is important because it isolates the added value of the sensory intervention rather than simply comparing therapy against nothing, a common weakness in earlier studies of complementary approaches in autism care.

Ayres Sensory Integration, developed by occupational therapist and psychologist A. Jean Ayres in the mid-twentieth century, rests on a specific neurological premise. The theory holds that many difficulties in attention, behavior, and motor coordination stem from inefficient processing and integration of sensory information, particularly input from the vestibular, proprioceptive, and tactile systems. Therapy sessions therefore take place in specially equipped gyms where trained occupational therapists deliberately engineer playful activities, such as swinging, climbing, and tactile exploration, that provide intensified sensory challenges calibrated to each child’s nervous system. Crucially, the child’s active engagement and the therapist’s responsive adjustment of the activity are considered central ingredients, distinguishing the approach from passive sensory stimulation.

Because the approach depends heavily on the skill and consistency of the therapist, the trial incorporated a formal fidelity mechanism. The researchers used the Ayres Sensory Integration Fidelity Measure, a structured instrument designed to verify that delivered sessions actually conform to the essential elements of the original method. Sessions in the study scored a mean of approximately 92.9 on this measure, meeting the criteria recommended for authentic implementation. This detail matters enormously for interpreting the findings. Many past trials of sensory-based interventions have been criticized for delivering diluted or ill-defined versions of the therapy, making it impossible to know whether negative results reflected the method itself or its poor execution. Here, the intervention was demonstrably delivered as intended.

The primary functional outcomes were assessed with the Vineland Adaptive Behavior Scales, Second Edition, a standardized parent-report interview that measures real-world adaptive functioning across domains such as communication, daily living skills, and socialization. After the twelve-week intervention, the clearest between-group difference emerged in the Daily Living Skills domain, where the sensory integration group showed a statistically significant advantage with a p-value of .042. The total adaptive behavior composite approached but did not reach conventional significance, with a p-value of .055. The authors are careful in their framing: the findings suggest that adding sensory integration to usual care may support daily living skills, while other adaptive domains did not demonstrate clear separation between the groups in this sample size.

Perhaps the most striking result came from Goal Attainment Scaling, an individualized outcome method in which each child’s therapy team defines specific, personalized goals at the outset and then quantifies progress toward them on a standardized scale. This approach acknowledges that autism presents heterogeneously and that a single standardized checklist may miss changes that are profoundly important to a particular child and family. On this measure, the sensory integration group posted a mean post-intervention score of 1.65 compared with 0.69 in the usual care group, a difference that was highly significant at p less than .001. The between-group effect size, expressed as r equal to .48, falls in the large range, indicating that children receiving the added therapy made substantially greater progress on their own individually tailored objectives.

The trial also examined changes in sensory processing patterns using the Sensory Profile, a caregiver questionnaire that characterizes how children respond to sensory stimuli in everyday life. Between-group differences were identified in several processing domains, including vestibular processing with a p-value of .004, auditory processing at p equal to .021, and visual processing at p equal to .031, along with differences in multiple factor scores of the instrument. These changes are theoretically coherent with the intervention’s mechanism, since vestibular stimulation is a signature component of Ayres-style sessions. However, the authors present these as observed between-group differences in sensory processing domains rather than as proof of a causal sensory-to-function pathway, an appropriate level of caution given the exploratory nature of secondary outcomes.

Methodological transparency is a notable strength of the report. The trial was registered on ClinicalTrials.gov under identifier NCT07507630, although the registration on 27 March 2026 was retrospective, a limitation that readers should weigh when interpreting outcome selection. The study was single-blind, meaning that while families and therapists necessarily knew which children received the intervention, outcome assessors were blinded to group assignment, reducing bias in the measurement of endpoints. Ethical approval was obtained from a Clinical Research Ethics Committee, the protocol adhered to the Declaration of Helsinki, and written informed consent was secured from the parents or legal guardians of all participating children, including separate consent for video recording. The authors declared no competing interests and received no specific funding for the research.

For the broader field, the trial lands in the middle of a long-running scientific argument. Systematic reviews of sensory integration therapy for autism have historically been divided, with some analyses finding insufficient evidence and others identifying promising signals when fidelity-monitored protocols are used. This study strengthens the case that when the intervention is delivered by trained therapists under fidelity monitoring, added to rather than replacing standard educational programming, measurable functional benefits can be detected in young children. At the same time, the modest sample of sixty completers, the retrospective registration, and the mixed pattern of significance across the Vineland domains mean the results should be read as encouraging rather than definitive. Replication in larger, multi-site cohorts with long-term follow-up remains the essential next step.

The practical implications for families and clinicians are nonetheless tangible. The combination of a significant gain in daily living skills, a large effect on individually set goals, and converging changes across several sensory domains offers a coherent, internally consistent picture: a twelve-week, roughly thirty-six-hour course of authentic Ayres Sensory Integration, layered onto existing individualized education, helped these preschoolers function more independently and reach targets their own care teams considered meaningful. As pressure grows for evidence-based early intervention in autism, trials of this kind, with fidelity measurement, blinded assessment, and individualized outcome metrics, provide the methodological rigor needed to move the sensory integration debate from ideology toward data.

Subject of Research: Ayres Sensory Integration therapy for preschool children with autism spectrum disorder

Article Title: Effectiveness of Ayres Sensory Integration® in autism spectrum disorder: randomized controlled trial

Article References: Cangi, A. F., & Bumin, G. (2026). Effectiveness of Ayres Sensory Integration® in autism spectrum disorder: randomized controlled trial. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07777-4

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07777-4

Keywords: Ayres Sensory Integration, autism spectrum disorder, randomized controlled trial, occupational therapy, sensory processing, preschool children, Vineland Adaptive Behavior Scales, Goal Attainment Scaling, adaptive behavior, pediatric rehabilitation, vestibular processing, BMC Pediatrics

The study, led by Vita Hagelskjær and colleagues from the Parker Institute at Copenhagen University Hospital Bispebjerg-Frederiksberg, the University of Southern Denmark, and VIA University College, evaluated the content and delivery of ABLE 2.0, an eight-week, individualized occupational therapy intervention designed for adults with chronic somatic conditions. The evaluation was conducted alongside a randomized controlled trial in a Danish municipality, with data collected between August 2020 and July 2021. Of 38 clients allocated to the ABLE arm of the trial, 29 completed the program, and the results paint a picture of an intervention that works largely as intended, with goal attainment achieved in 55 of 64 cases—an impressive 86 percent success rate.

ABLE 2.0 is the product of nearly a decade of systematic development within the A Better Everyday research programme, established in 2015 and guided by the United Kingdom Medical Research Council’s framework for developing and evaluating complex interventions. The first version, ABLE 1.0, was developed and feasibility-tested between 2015 and 2018. Feedback from that phase prompted targeted refinements: the mandatory number of sessions was reduced, standardized evaluation of activities of daily living (ADL) ability and collaborative goal setting were emphasized, and recent occupational therapy theory was incorporated to strengthen occupation-centered reasoning. The result was ABLE 2.0, a program structured by the Occupational Therapy Intervention Process Model (OTIPM), which provides a systematic framework for client-centered, occupation-based practice.

The technical architecture of the intervention is worth examining closely because it illustrates how modern rehabilitation science translates theory into practice. In the first session, clients undergo standardized evaluation of both self-reported and observed ADL ability using the ADL Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS), a validated observational instrument that measures the motor and process skills a person enacts while performing chosen everyday tasks. This session also involves determining any discrepancy between what clients report about their ability and what structured observation reveals. The second session centers on collaborative goal setting using Goal Attainment Scaling (GAS), a measurement approach in which goals are scaled across levels of expected attainment, alongside an analysis of the underlying reasons for task performance problems using the Person-Environment-Occupation model or the Transactional Model of Occupation.

Sessions three through seven then offer an individualized combination of nine intervention components, ranging from changing habits related to task performance and changing attitude, to modifying the physical or social environment, using tools and assistive technology, dividing tasks into smaller steps, and simplifying task processes. The program builds on a compensatory intervention model, applying adaptational strategies—changes to the environment, assistive devices, adjusted routines—rather than attempting to restore impaired performance skills directly. The final session includes re-evaluation of goal attainment. Sessions one, two, and the final session are mandatory, establishing a minimum dose of three contacts, and the program can be delivered face-to-face or by telephone, with homework assigned between sessions in more than 71 percent of cases. Examples of such homework included practicing to vacuum using new body positions, taking out the waste with a walker, and sitting down while dressing.

The process evaluation, structured according to the framework proposed by O’Cathain and colleagues, examined five dimensions: intervention development and components, mechanisms of action, perceived value and unintended consequences, feasibility and acceptability in practice, and fidelity, reach, and dose. Data came from registration forms completed independently by clients and occupational therapists after every session, with clients submitting their forms in sealed envelopes to avoid influence from the treating therapist. All nine intervention components were applied during the study period, with changing habits the most frequently implemented (34 instances), followed by changing attitude (32) and the use of tools, technology, and assistive devices (23). Session duration varied considerably, from a median of 42.5 minutes in session four to 120 minutes in the evaluation-heavy first session, underscoring the individualized nature of the delivery.

Perhaps the most striking findings concern the mechanisms of action. Both clients and therapists reported that the standardized ADL evaluations in the first session provided new insights into the client’s ability, clarified the focus of the intervention, and established a solid foundation for the collaborative relationship. This is notable because data from the parallel effectiveness trial showed that clients receiving usual occupational therapy in the municipality were typically not offered standardized evaluations at all, and their goals were usually set by the referral service rather than negotiated with the client. The 86 percent goal attainment rate in the present study also represents a substantial improvement over the 52 percent achieved in the earlier ABLE 1.0 feasibility study, suggesting that the refinements to the manual and the enhanced training—particularly the emphasis on collaborative goal setting—paid off. Occupational therapists themselves reported feeling skilled to a high or very high degree and found delivering the sessions satisfying, and no side effects were reported at all.

The findings do, however, reveal persistent friction points. A small number of deviations from the manual occurred: the AMPS evaluation was omitted for two clients, and one client expressed no goals, making GAS-based goal setting impossible. Therapists noted challenges with goal setting, and one remarked on doubt about whether a client fully understood the discrepancy dialogue. The authors argue these difficulties reflect limited routine in conducting standardized evaluations and collaborative goal setting within Danish municipal practice—a concern echoed by recent Swedish and Danish studies documenting sparse use of standardized assessment tools in primary healthcare and assistive technology services. Because collaborative goal setting was identified in the companion realist evaluation as a core mechanism of change in ABLE, the researchers recommend further refinement of the manual and training course on this specific aspect before wider implementation.

Retention also emerged as a key consideration for future rollout. Five clients dropped out before the first session, mainly due to hospitalization, and four more left before the second session, citing lack of motivation, bereavement, or no perceived need for intervention. Those who dropped out were slightly younger and had somewhat higher baseline ADL motor ability than completers, hinting that the program may be most beneficial for older adults with lower ADL ability—a conclusion supported by the effectiveness trial, which found clinically relevant and statistically significant improvements in observed ADL motor ability at both ten and twenty-six weeks among ABLE recipients, though no significant changes in self-reported ADL ability. The gap between observed and self-reported outcomes remains an intriguing puzzle for the field, but the observed gains translate into clients performing daily tasks with greater efficiency, less physical effort, and improved safety.

Taken together, the process evaluation confirms that ABLE 2.0 is feasible, acceptable, and deliverable with high fidelity within real-world municipal rehabilitation services. Its essential ingredients—standardized evaluation of ADL ability, collaborative goal setting, identification of the reasons behind task performance problems, and client engagement in trying out adaptational strategies at home—form a coherent, evidence-based template for helping people with chronic conditions reclaim their everyday lives. The authors emphasize that future implementation efforts should prioritize embedding standardized evaluation into clinical routines, optimizing training in collaborative goal setting, and treating recruitment as a central uncertainty. With a cost-effectiveness evaluation still in progress and an implementation strategy on the research agenda, the ABLE programme is steadily building the comprehensive evidence base needed to move from promising trial results to routine clinical practice across Danish municipalities and beyond.

Subject of Research: Feasibility and delivery of a home-based, occupation-centred problem-solving occupational therapy intervention for adults with chronic somatic conditions

Article Title: Content and delivery of occupation-centred problem-solving occupational therapy for people with chronic somatic conditions: A process evaluation of ABLE 2.0

Article References: Hagelskjær, V., Nielsen, K. T., Frilev, T. R., von Bülow, C., & Wæhrens, E. E. (2025). Content and delivery of occupation-centred problem-solving occupational therapy for people with chronic somatic conditions: A process evaluation of ABLE 2.0. Scandinavian Journal of Occupational Therapy, 32(1), 1-16. https://doi.org/10.1080/11038128.2026.2619344

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2619344

Keywords: occupational therapy, ABLE 2.0, activities of daily living, chronic conditions, process evaluation, goal attainment scaling, AMPS, rehabilitation, home-based intervention, adaptational strategies, municipal health services, Denmark