News: Critiquing the Evidence – Addressing the Novak and Honan ‘Traffic Light’ Systematic Review

Novak’s paper “Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review” suggests Ayres’ Sensory Integration is a red light intervention. Ref: Iona Novak Ph.D., MSc (Hons), BAppSc Ingrid Honan Ph.D., BPysch(Hons) First published: 10 April 2019. This paper is increasingly being used by local authorities to justify why Ayres’ Sensory Integration Therapy lacks evidence and therefore, should not be funded.

We held a webinar in September 2019 to consider and plan ways to address the growing concerns raised by therapists across the UK and Ireland about this paper, and its impacts on people with sensory integration and processing difficulties.

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Recent studies and literature recognise that Ayres’ Sensory Integration is evidence-based and relevant in many areas of clinical practice;

“Active, individually-tailored, sensory-motor activities contextualised in play at the just-right challenge that target adaptive responses for participation in activities and tasks.”

Schaaf, ISIC 2018

Many arguments can be made as a rebuttal to this paper by Novak. We have established a working group that has corresponded with occupational therapy researchers and lecturers around the globe, considering and publicising initial responses and replies to this paper. We are now in contact with CYPF(RCOT) regarding ASI and now need to gather further comments from therapists to co-ordinate additional comments for RCOT from therapists. We are currently working to support individual cases where the Novak and Honan 2019 publication is causing immediate difficulties with service provision and commissioning. We are working with our members in the UK and Ireland to deliver a formal response to questions this paper has raised, with consideration of Letter to the Editor from Mills et al. 2019. We will share this response online so that there is open access for parents, educators and local authorities.

You can help by completing the form posted below and sharing it with others.

Here are the slides that guided our first ever open online Webinar discussion, for those who were not able to join the discussion and debate.

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We love this quote from Dr Susanne Smith Roley

“In their recent publication, AOTA (2018) recommends that practitioners using an SIT approach use clinical reasoning, existing evidence, and outcomes to create a comprehensive, individualized approach for each client, rather than using isolated, specific sensory strategies”.

Quote taken from lecture and cited in M6 CLASI CASI Leanring materials, 2019.

This quote from Schaaf is in support of Ayres’ Sensory Integration and in stark contrast to the recommendations in Novak’s paper.

“Active, individually-tailored, sensory-motor activities contextualized in play at the just right challenge that target adaptive responses for participation in activities and tasks.”

Schaaf, ISIC 2018



A Systematic Review of Ayres’ Sensory Integration Intervention for Children with Autism. Schoen SA, et al. Autism Res. 2019.

Ayres Theories of Autism and Sensory Integration Revisited: What Contemporary Neuroscience Has to Say Kilroy et al., Brain Sci. 20199(3), 68;

Neural Foundations of Ayres Sensory Integration®, Lane et al., Brain Sci. 2019, 9(7), 153;

Examining the Neuroscience Evidence for Sensory-Driven Neuroplasticity: Implications for Sensory-Based Occupational Therapy for Children and AdolescentsShelly J. LaneRoseann C. Schaaf, American Journal of Occupational Therapy, May/June 2010, Vol. 64, 375-390. 

Please note: Recent advances in neuroscience supports the application of the theory of Ayres’ Sensory Integration (ASI) as a treatment approach for children, adolescents, adults and older adults.

Statement regarding conflict of interest:

ASI Wise is a not for profit organisation dedicated to providing therapists with access to high-quality, word-class post-graduate education in the application of Ayres’ Sensory Integration, in line with recommendations by ICEASI. This includes ensuring therapists have access to the hands-on practical learning opportunities, that are considered essential to the safe practise of this very hands-on interactive therapy by leading researchers and practitioners.

Our values and principles extend far beyond therapist education. They include providing tutoring in peer groups, with access to ongoing networking opportunities, peer support, and mentoring as part of continuing professional development.

We are committed to ensuring that therapists practising Ayres’ Sensory Integration have not just the knowledge, but also the skills necessary to practice. This ensures clients receive therapy and practice that is fit for purpose and adheres to best practice guidelines.

Currently,* ICEASI recommends that education in Ayres’ Sensory Integration includes:

Theoretical foundations of ASI – Ayres SI Theory

About this seminal theory proposed by Dr A. Jean Ayres (Ayres, 1972), theoretical assumptions, and basic and applied science informing the knowledge of sensory integration and related constructs, including updates in neuroscience. [Minimum of 20 hours of training.]

Evaluation of Sensory Integration Function and Dysfunction

Detailed instruction in the administration and scoring of reliable and valid assessment tools designed to evaluate sensory perception, praxis and related motor functions (currently SIPT, though other assessment tools will be considered as they become available); Caregiver questionnaires (such as Sensory Processing Measure; Parham et al., 2017); observational methods to supplement these tools; Evaluation tools that measure baseline participation in occupation. [Minimum of 44 hours of training with at least 50% of the training onsite.] 

Interpretation of Assessment Data to inform Clinical Reasoning

Review of research informing the understanding of SI patterns; Use of systematic methods of clinical reasoning and hypothesis generation based on assessment data to link participation issues to SI challenges (such as Data-Driven Decision Making and ASI Assessment® and Interpretation Tool, Schaaf & Mailloux, 2015); Establish measurable goals. (Participants must prepare a case study (#1). [Minimum of 24 hours of training with at least 50% of the training onsite OR individual supervision and feedback of case study #1 by a qualified instructor.]

ASI Intervention

Design and implementation of intervention based on assessment data; detailed instruction in therapeutic activities, adaptive response, dynamic assessment to inform moment-to-moment clinical reasoning; at least 3 demonstrations of intervention in a space equipped as per ASI Fidelity Measure specifications; review of the principles of the ASI Fidelity Measure (Parham et al.) [Minimum of 32 hours of training with at least 50% of the hours of the training onsite. Participants must prepare a case study (#2).]

(*ICEASI Education Standards (version October 2019) are in development so may be subject to change)

Novak Update

Novak and Best Practice Guidelines