# Sensory Integration > Occupational Therapy notes on sensory integration: Ayres' theory, hidden senses, modulation, praxis, sensory diets and the SIPT. - Canonical URL: https://prepelephant.com/topics/allied/occupational-therapy/sensory-integration-ot - Exam / course: Allied Health · Subject: Occupational Therapy - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Sensory Integration", PrepElephant, https://prepelephant.com/topics/allied/occupational-therapy/sensory-integration-ot ## Direct answer A. Jean Ayres, occupational therapist and psychologist, gave this field its theory in 1972 with her book Sensory Integration and Learning Disorders: the brain must organise sensation from the body and the world before it can learn, behave and move. Beyond the five familiar senses, integration depends on the hidden senses — vestibular (gravity and head movement), proprioceptive (muscle and joint position) and interoception — and when processing fails, children show modulation problems (over-responsivity, under-responsivity, seeking), discrimination problems or dyspraxia. Therapy delivers controlled, sensory-rich, play-based challenges — the sensory diet and Ayres Sensory Integration intervention — that demand an adaptive response, not merely pleasant stimulation. ## What you must remember - Ayres Sensory Integration (ASI): therapeutic, play-based sensory challenges requiring the child to produce an adaptive response; fidelity criteria define what qualifies as true ASI. - Eight sensory systems: the classic five plus vestibular, proprioceptive and interoceptive input. - Processing hierarchy: registration (noticing input) → modulation (regulating its intensity) → discrimination (interpreting its qualities) → praxis (ideating, planning and executing motor actions). - Modulation presentations: over-responsive (avoids, fights clothing seams and noise), under-responsive (misses input, appears sleepy), seeker (crashes, chews, spins), plus sensory discrimination difficulty. - Dyspraxia in SI terms: poor ideation, motor planning and execution — the "what can I do with this?" failure, not weakness. - Assessment: the Sensory Integration and Praxis Tests (SIPT) — 17 tests, standardised for ages 4–8 years; the Sensory Profile caregiver questionnaire; and Ayres' clinical observations (prone extension and supine flexion postures, ocular pursuits, bilateral coordination). - Sensory diet: a scheduled, individualised menu of sensory input across the day — heavy work before seated tasks, alerting vestibular input to raise arousal, deep pressure to calm. - The Wilbarger protocol (deep-pressure brushing with joint compressions) is an intensive technique requiring trained administration, not a handout. ## A sensory diet for a seven-year-old seeker A seven-year-old in a mainstream Pune classroom is under every desk, chewing his collar, and by lunchtime his workbook is torn. Assessment — Sensory Profile plus classroom observation — reads him as a sensory seeker with poor modulation: his nervous system under-registers input, so he manufactures it. His day is then rebuilt as a diet of scheduled sensations. Morning assembly is preceded by ten wall push-ups and carrying the class water bottles — heavy, proprioceptive work that organises him for the next forty minutes. Mid-morning break includes a crash-mat jump and a chewy snack, chewing itself being regulating. Before handwriting he does chair push-ups and palm pressing; during the task he sits on a wedge cushion that feeds constant vestibular-proprioceptive signal. The teacher's script changes too: instructions with a hand on his shoulder (deep touch) instead of shouted across the room, because shouting into an under-registered system merely joins the noise. At home, evening roller-blading and joint-compression games before homework, and a heavy blanket for the first twenty minutes of sleep. Eight weeks on, the notebook is intact — not because the seeking was suppressed, but because the seeking was fed at planned moments so it stopped writing the timetable itself. ## Where students slip Sensory seeking is confused with hyperactivity — the seeker's crashing is registration-driven, and ADHD is an attention disorder; the two can coexist but are not the same diagnosis. Vestibular and proprioceptive effects are swapped in exams: swinging and spinning are typically alerting, heavy work and deep pressure typically organising or calming. The deepest misunderstanding is treating SI therapy as "fun with balls": without a demand for an adaptive response there is no integration happening, only a pleasant afternoon. And the Wilbarger brushing protocol must never be prescribed casually in an answer — training, skin integrity checks and a prescribed schedule are the expected details. ## Frequently asked questions ### Who developed sensory integration theory, and when? A. Jean Ayres, an occupational therapist and psychologist, publishing her theory in 1972 in Sensory Integration and Learning Disorders. ### Which are the hidden senses? Vestibular (gravity and head movement), proprioceptive (muscle and joint position) and interoception (internal body signals), beyond the classic five. ### What is a sensory diet? An individualised daily schedule of sensory input — heavy work, movement, deep pressure — timed to keep arousal and attention regulated across the day. ### What is the SIPT and for which ages? The Sensory Integration and Praxis Tests: 17 standardised tests of sensory processing and praxis for children aged 4 to 8 years. ### How do modulation and discrimination problems differ? Modulation is about regulating response intensity (over-, under-responsive, seeking); discrimination is about interpreting sensory qualities accurately, such as telling two points apart. ### What does the Wilbarger protocol involve? Deep-pressure brushing with a soft surgical brush followed by joint compressions, on a prescribed schedule — administered only by trained personnel.