Letter to the Editor

Thank you for the opportunity to respond to Benfield et al.’s (2025) Letter to the Editor regarding Whiting et al. (2025), “Occupational Therapy Using Ayres Sensory Integration^® in School-Based Practice: A Call to Action.” We appreciate the opportunity to dispel misconceptions about Ayres Sensory Integration (ASI) and describe its use as an evidence-based approach.

The American Occupational Therapy Association (AOTA, 2017) mandates that school-based occupational therapy practitioners focus their interventions on participation in the school setting. The primary purpose of our article was to show how occupational therapy using the principles and practices of ASI satisfies that mandate.

There is ample evidence that challenges in processing and integrating sensation influences access to, and participation in, school occupations (Gonçalves & Abreu, 2023). The Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020) includes sensory functions as an important aspect of occupational therapy practice. Moreover, AOTA’s 2023 Position Statement, “Sensory Integration Approaches for Children and Youth Within Occupational Therapy Practice,” recognizes the applicability of ASI in schools.

The main goal of ASI is to improve participation in daily life (Schaaf & Mailloux, 2015). This is well established in the effectiveness literature; individualized goals of parents, families, and the educational team reflect outcomes related to occupational performance and occupational engagement (Andelin et al., 2021; Schaaf et al., 2015, 2018; Whiting et al., 2023). Thus, there is evidence to support the fact that improved participation is achieved by addressing underlying sensory and motor impairments that are affecting function.

To clarify, there is no mandate embedded in Laverdure and Beisbier’s (2021) article, or any other literature, that occupational therapy practitioners must use top-down, occupation-based approaches; instead, the literature clearly indicates that an array of interventions can be used as long as they are part of a comprehensive plan designed to increase occupational engagement (AOTA, 2023, 2024). ASI intervention uses individually tailored, sensorimotor activities that support the development of functional skills necessary for academic participation (Schaaf & Mailloux, 2015). ASI approaches in schools make this intervention part of the comprehensive plan for educational success.

The intervention approach for each child is determined by the occupational therapy practitioner, who evaluates the child on the basis of existing evidence to determine what is best for that child within that setting. Recent literature (Kuhaneck et al., 2023; McQuiddy et al., 2024; Whiting et al., 2023) suggests that ASI produces meaningful, long-term changes in children’s lives and improves occupational performance across settings. Occupational outcomes noted in these articles include participation in self-care and the classroom, transitioning between activities and environments, following directions, and play and social participation.

Research evidence that supports ASI as an effective intervention (Chan et al., 2023; Kuhaneck et al., 2023; Odom et al., 2021; Steinbrenner et al., 2020), and that it is a multifaceted approach that includes parent and teacher education and consultation to support the child’s participation across contexts, has been growing (Bundy & Bulkeley, 2020; Reynolds et al., 2017). Consultation strengthens the direct application of ASI strategies because it helps teachers and parents understand the child's needs and tailor the environment to meet those needs.

The following are specific to the concerns delineated in Benfield et al.’s (2025) Letter to the Editor regarding Whiting et al. (2025):

Whiting et al. (2025) articulated strategies for building the capacity of school-based occupational therapy practitioners and supporting the educational team by applying ASI principles.

Finally, and importantly, each of the present authors have based this opinion and perspective on the science, not their personal financial benefit. Impartiality and objectivity are central to the peer review process and are inherently assessed before any manuscript is published.