Ayres Sensory Integration for Infants & Toddlers – Study Notes

Overview and rationale

• Early identification and intervention are advised for all infants and toddlers with suspected difficulties. Early intervention can change developmental trajectories across life.
• Neuroplasticity perspective: exposure to sensory information and environmental experiences in young age leads to specialization and maturation that foster growth and development.
• Recent research on autism spectrum disorder (ASD) in the 0–3 age range emphasizes that children identified and treated earlier have better outcomes (Zwaigenbaum et al., 2015; articles cited as 2015A–D; top 20 most influential autism articles in 2015 according to Interagency Autism Coordinating Committee, 2015).
• Practitioners have an ethical/practical obligation to act swiftly when concerns arise in infants and their families, regardless of whether a formal diagnosis is present.

What is Ayres Sensory Integration (ASI)?

• ASI is a developmental theory that explains how sensory information from the body and the world is integrated to influence actions and interactions.
• Sensory integration and processing involve the management and organization of sensory input from the CNS and PNS to produce adaptive responses.
• Adaptive responses influence performance in daily activities: play, movement, socialization, and learning.
• In typical development, sensory experiences shape internal feelings (e.g., hunger, temperature, elimination) and information about body position/movement from vestibular and proprioceptive systems, plus external sensations (touch, vision, smell, taste, hearing).
• The perceptual knowledge of sensations builds with experience, supporting learning and adaptation to environmental challenges.
• Processing and interpreting sensory information efficiently is essential for successful participation at home, in the community, and at school.
• Differences between typical and atypical development can be subtle; sensory integration difficulties are often mistaken for motor, behavioral, or emotional issues and may be missed.

Developmental foundations and neuroplasticity (summary)

• Young brains rely on rich sensory experiences to mature networks supporting sensation, perception, and motor planning.
• The brain must maintain balance among neural systems to produce adaptive responses for daily activities (e.g., feeding, sleep, movement).
• Sensory experiences shape regulatory processes, perceptual skills, and the ability to engage with the world.
• When infants have limited or atypical sensory experiences, development may follow a different trajectory without timely intervention.

Typical vs atypical sensory processing and development

• Many infants develop robust sensory modulation and perceptual learning naturally, enabling timely milestones.
• Increasing numbers of infants present with sensory integration and praxis challenges that require assessment and intervention.
• There are four classic patterns of sensory integration difficulties identified in infants/toddlers (Mailloux, Mulligan, Smith Roley et al., 2011; consolidated by Roley et al. in practice):
  • The Fussy Baby
  • The Sleepy Baby
  • The Clumsy Baby
  • The Disorganized Baby
• These patterns relate to caregiver reports and clinical observations during interventions.
• Some infants may have co-occurring conditions (e.g., motor, social, cognitive delays, autism) that complicate differentiation.
• Assessment and intervention must consider the baby within the family system, including attachment and caregiver context.

Four patterns of sensory integration difficulties in infants/toddlers

The Fussy Baby

• Modulation difficulties: dysregulated responses to exteroceptive and interoceptive input.
• Sensory modulation is the brain's self-organization to regulate activity in harmony with other nervous system functions.
• Consequences: sleep, feeding, mood disturbances; caregiver stress and potential co-regulation challenges; attachment may be impacted if cues are missed.

The Sleepy Baby

• Diminished perceptual processing for one or more sensations; under-responsiveness to sensation.
• Examples: may under-register hunger or temperature; may become sleepy during feeding; may not wake when cues indicate feeding is needed; reduced visual exploration and social engagement.
• Risk: missing perceptual foundations for social development and later learning.

The Clumsy Baby

• Vestibular–proprioceptive challenges essential for head control, posture, and bilateral motor coordination.
• Common signs: delays in sitting, standing, crawling, walking; poor head control for midline positioning; difficulty tolerating tummy time; frequent falls with initiating movement.

The Disorganized Baby

• Difficulty with motor planning, sequencing, and spatially oriented tasks; requires showing or modeling to complete simple tasks.
• Difficulties with imitating gestures; delays in following verbal instructions as a later consequence.
• May show limited motor repertoire and inflexibility in movement patterns; challenges with transitions (sitting to crawling, crawling to standing).
• Overall: seeks repetitive patterns, may have frustrations when expected actions cannot be completed with preferred patterns.

Note: The above patterns are derived from clinical observations and consolidated into practical patterns used for assessment and intervention planning (Mailloux et al., 2011; Roley et al.).

Assessment framework for infants and toddlers

General considerations

• OT evaluators must understand typical and atypical development across motor, social, cognitive, sensory regulatory, and perceptual domains.
• Family-centered approach is essential; assessment must consider social, environmental, cultural, and socioeconomic contexts.
• Caregiver feedback is critical during assessment, intervention planning, and home follow-up.

Assessment tools commonly used with young children

• Sensory Integration and Praxis Tests (SIPT) – for ages 4 ext{ years} ext{ to } 8 ext{ years }11 ext{ months} (Ayres, 1989).
• Postrotary Nystagmus Test – ages 9 ext{ months} ext{ to } 4 ext{ years} (Mailloux et al., 2014).
• Preschool Imitation and Praxis Scale – ages 1.5 ext{ to } 4.9 ext{ years} (Vanvuchelen et al., 2011).
• Sensory Processing Measure – Preschool Form (SPM-P) – ages 2 ext{ to } 5 ext{ years} (Parham & Ecker, 2010).
• Test of Sensory Functions in Infants – ages 4 ext{ months} ext{ to } 18 ext{ months} (DeGangi & Greenspan, 1989).
• Infant/Toddler Sensory Profile – ages 0 ext{ to } 3 ext{ years} (Dunn, 2002).
• DeGangi-Berk Test of Sensory Integration – ages 3 ext{ to } 5 ext{ years} (DeGangi, 1983).
• Miller Function and Participation Scales (M-F&PS) – ages 2.6 ext{ to } 3:11 and 4 ext{ to } 7:11 (Miller, 2006).
• Miller Assessment for Preschoolers – ages 2.9 ext{ to } 5.8 (Miller, 1988).

Key clinical observations informing understanding

1) Goodness-of-fit between caregiver and child

• Consider caregiver sensory preferences and how they align with the child’s needs.

2) Signs of autonomic instability (dysregulation indicators)

• Examples: flushing or color changes, sweating, gagging, turning/arching away from stimuli, digestive changes (spitting up, bowel changes, hiccups), changes in heart rate, respiratory rate, or oxygen saturation.

3) Regulation of arousal states, state changes, activity level, emotion, and attention

• Dysregulation examples: difficulty with sleep/eat/elimination cycles; maintaining calm/alert state; over- or under-reactivity to typical sensations (hugs, clothing, bathing);
  • Difficulty waking or soothing; dislike of movement or changes in head position.

4) Sensory perceptual skills

• Unusual enjoyment or dislike of sensations; attention to environment; missed cues (e.g., not responding when name is called).

5) Vestibular–postural–ocular and motor control

• Head position and lag; righting responses; dynamic equilibrium; postural adjustments; labyrinthine responses; disassociated movements; bilateral coordination; emergent laterality.

6) Praxis (motor planning and use of environment)

• Ability to plan and sequence movements; imitation; tool use; exploration of space; construction; symbolic play; ideation.

Practical considerations in assessment

• Use multiple sources of information (caregiver interview, observation in play, structured tasks, and family context).
• Recognize that differentiating sensory integration from other neuromotor or sensory diagnoses can be challenging; comorbidity is common (e.g., visual/hearing impairment, autism).

When to refer for OT (referral guidelines)

• Refer when there are concerns about development or suspected sensory integration or praxis difficulties beyond what parents can address with typical sensory enrichment.
• Early OT consultation can support families in understanding patterns, implementing strategies, and coordinating care, especially when concerns persist despite caregiver efforts.

Table 1: Senses and foundational sensory information (infants and early development)

• Hearing: spatial orientation and response to verbal/gestural language cues.
• Touch (exteroception and interoception): affective and tactile experiences; forms the language of love and safety.
• Proprioception: sense of body position/movement; supports intentional movement and body awareness.
• Vestibular: sense of head position, movement, and arousal regulation; supports balance and postural control.
• Vision: orientation, anticipation, recognition, decoding social cues.
• Interoception: internal bodily states (hunger, thirst, needs); informs caregiving and regulatory responses.
• Context: the integration of these senses forms a basis for praxis and social participation.

@@ Table 1 content notes: The above summarizes how early sensory experiences shape the developing baby's perceptions and subsequent learning and behavior.@@

Table 2: Four patterns of sensory integration to recognize in infants/toddlers (summarized)

• FUSSY BABY: Sensory over-responsive/defensive; high reactivity; seeks to avoid tactile, auditory, or other stimuli; signs include pushing away, crankiness with textures, and ritualized responses.
• SLEEPY BABY: Sensory under-responsiveness; low arousal; slow to wake; may have lethargy and reduced engagement; risk for feeding and growth issues.
• CLUMSY BABY: Poor posture ocular–motor control; weak muscle tone; slow to develop motor milestones; difficulty with head control and midline orientation; poor coordination and imitation.
• DISORGANISED BABY: Poor praxis and sequencing; difficulty with novel tasks; imitation deficits; limited play repertoire; rigid motor patterns; struggles with transitions and following verbal directions.

Table 3: Tips for supporting sensory integration, self-regulation, and praxis in infants and young children

• Fussy Baby
  • Use calming and organizing sensory tools to support self-regulation.
  • Teach parents STOP SIGNS (color changes, looking away, jerky movements, fussing) indicating dysregulation; pause social demands and apply calming activities until regulation returns.
  • Emphasize co-regulation to strengthen caregiver–baby attachment.
  • Strategies include baby massage, swaddling, gentle rocking, head/torso support changes; monitor for outbreaks of fussiness.
• Sleepy Baby
  • Monitor wakefulness for feeding; ensure weight gain and development; avoid over-stimulation that can mask underlying needs.
  • Use baby massage; stimulate engagement to promote alertness; observe responses to social interaction to support attachment.
• Clumsy Baby
  • Provide frequent vestibular and proprioceptive input (swinging, carrying, dancing with caregiver).
  • Support head control and midline orientation; move through space to enhance motor coordination; encourage transitions and practice sequencing.
• Disorganized Baby
  • Support motor planning and praxis through guided, sequential activities; provide opportunities for imitation; gradually introduce novel tasks with caregiver modeling.
  • Balance challenging tasks with successes; reduce overwhelming environmental features; provide predictable routines and visual cues.

Practical activity ideas and daily routines (environmental adaptation)

• Create opportunities throughout the day for movement, exploration, and social interaction.
• Use ball play, bouncing, and rolling to promote head control, trunk stability, and eye tracking.
• Provide larger objects to grasp and manipulate; use toys and objects that promote bilateral coordination.
• Display visual schedules and prepare the child for transitions (time-based cues and simple prompts).
• Encourage baby massage and skin-to-skin contact to support regulation and growth.
• Use soothing sounds and gentle vestibular input to gradually increase tolerance to movement and environmental stimuli.
• Check health-related conditions (e.g., reflux, gastrointestinal issues) that may affect regulation and movement; adjust positioning and routines accordingly.
• Consider environmental modifications (reduced ambient noise, calmer lighting) to support regulation, especially in Fussy or Sleepy babies.
• Promote safe exploration of space and objects with caregiver support; prevent overstimulation by pacing activities with STOP SIGNS.

When guidance is needed and parental support

• Parents/caregivers should seek OT consultation when concerns persist or when they feel overwhelmed by their baby’s regulation, feeding, or motor patterns.
• OT can help confirm whether a full evaluation is beneficial or provide practical advice for home strategies.
• The goal is to support typical development, praxis, and social participation through evidence-based sensory strategies.

PARENT RESOURCES and references (high-level)

• Acknowledge accessible resources cited in the article, including references to sensory strategy resources for parents and evidence-based practices for early intervention.
• Examples provided include references to sensory strategy programs, parent education, and professional guidelines related to ASD screening and early intervention.

Conclusion

• Babies learn to enjoy, explore, and navigate the world through accurate and multi-sensory information, which is essential for praxis and social participation.
• Sensory strategies support typical development; occupational therapy using a sensory integration approach is advised when dysregulated behaviors or motor delays persist despite caregiver-enrichment efforts.

Notes on sources and context

• The content reflects a 2016 publication with references to foundational works by Ayres and others (e.g., Ayres 1979, 1989; Mailloux et al.; DeGangi & Greenspan; Miller; Parham & Ecker).
• The article includes a broad list of references to ASD identification/research (Zwaigenbaum et al., 2015a–d) and to sensory processing measures and normative data.
• A caution is included that views expressed reflect the article authors and not necessarily the entire SAISI position.

Key terms and definitions (glossary-style quick reference)

• Sensory modulation: the nervous system’s process of increasing or decreasing neural activity to maintain homeostasis and regulate behavior.
• Praxis: the ability to plan and execute purposeful, coordinated movements; motor planning and sequencing.
• Vestibular: sense related to head movement and balance; influences postural control and arousal.
• Proprioception: sense of body position and movement, essential for coordinated action.
• Interoception: perception of internal bodily states (hunger, fullness, thirst, discomfort).
• SIPT: Sensory Integration and Praxis Tests; standardized assessment battery for certain age ranges.
• STOP SIGNS: caregiver-identified cues signaling dysregulation, used to trigger calming interventions.