Fidelity-OT Report Card

Therapist following fidelity protocol in session with a child

Therapist following fidelity protocol in session with a child

Pediatric Occupational Therapy has a specific purpose and system for treating children experiencing Sensory Integration dysfunction.  Over the years since A. Jean Ayres advanced the field of Occupational Therapy with her theory of Sensory Integration, there have been gradual deviations from her original work to the extent that it has become necessary to clearly define and crystallize research practices and therapeutic protocols that can be endorsed by the American Occupational Therapy Association and the Sensory Integration Global Network.  Fidelity to these practices and protocols lends legitimacy to research and treatment practitioners and excludes pretenders and hangers-on who do not adhere to the Ayres Model of Sensory Integration. Fidelity in research provides a baseline for scientific progress and research breakthroughs.  Fidelity in therapy (read ‘Sensory Integration Intervention Process’) provides reliability of outcomes based on research, Evidence Based Practice.

The therapeutic approach of sensory integration was originally developed by A. Jean Ayres, PhD, OTR, and is formally known as Ayres Sensory Integration® (ASI; Ayres, 1989). ASI® includes:

Table 1. Core Elements of Sensory Integration Intervention Process
Core Process Elements Description of Therapist’s Behavior and Attitude
Provide sensory opportunities Presents the child with opportunities for various sensory experiences, which include tactile, vestibular, and/or proprioceptive experiences; intervention involves more than one sensory modality.
Provide just-right challenges Tailors activities so as to present challenges to the child that are neither too difficult nor too easy, to evoke the child’s adaptive responses to sensory and praxis challenges.
Collaborate on activity choice Treats the child as an active collaborator in the therapy process, allowing the child to actively exert some control over activity choice; does not predetermine a schedule of activities independently of the child.
Guide self-organization Supports and guides the child’s self-organization of behavior to make choices and plan own behavior to the extent the child is capable; encourages the child to initiate and develop ideas and plans for activities.
Support optimal arousal Ensures that the therapy situation is conducive to attaining or sustaining the child’s optimal level of arousal by making changes to environment or activity to support the child’s attention, engagement, and comfort.
Create play context Creates a context of play by building on the child’s intrinsic motivation and enjoyment of activities; facilitates or expands on social, motor, imaginative, or object play.
Maximize child’s success Presents or modifies activities so that the child can experience success in doing part or all of an activity that involves a response to a challenge.
Ensure physical safety Ensures that the child is physically safe either through placement of protective and therapeutic equipment or through the therapist’s physical proximity and actions.
Arrange room to engage child Arranges the room and equipment in the room to motivate the child to choose and engage in an activity.
Foster therapeutic alliance Respects the child’s emotions, conveys positive regard toward the child, seems to connect with the child, and creates a climate of trust and emotional safety
March/April 2007, Volume 61, Number 2 Fidelity in Sensory Integration Intervention Research

What does fidelity mean for you?

As a parent, fidelity means you can understand and confirm that the therapeutic treatment your child is getting is backed by research and meets official standards and will produce the results based on that research. As an OT, fidelity means you can rely on its protocols and practices and that certification confirms your knowledge of fidelity.  As a researcher, fidelity means your work will further the knowledge and understanding of Sensory Integration Theory and your results build on A. Jean Ayres model.



About Emily Lauren

Jenny Clark, OTR/L, BCP (AOTA Board Certification in Pediatrics), is a licensed pediatric occupational therapist with over 22 years experience working as a school-based occupational therapist, independent contractor for early intervention services, private practitioner, speaker, consultant, author, and inventor. Jenny currently owns a pediatric therapy private practice, Jenny’s Kids, Inc. Jenny Clark Jenny is the author of the best-selling book on sensory processing entitled Learn to Move, Move to Learn: Sensorimotor Early Childhood Activity Themes(AAPC 2004), (Starter Kit available) More recently Ms Clark has written a sequel Learn to Move, Moving Up! Sensorimotor Elementary School Activity Themes (AAPC 2009). In addition, she has published two DVD’s Learn to Move: Dinosaurs (AAPC 2005), a companion to her first book, and Sensory Processing Disorder Kit: Simulations and Solutions for Parents, Teachers, and Therapists (AAPC 2006), which won the 2007 media in excellence video award from Autism Society of America. Jenny’s newest publication is a music CD, Sing, Move, Learn (AAPC 2010), which accompanies the songs in her first book. Ms. Clark is a contributing author for the book Autism Spectrum Disorders: A Handbook for Parents and Professionals (Greenwood Publishing Group 2007), as well as a chapter author for Autism Spectrum Disorders: Foundations, Characteristics, and Effective Strategies. (Pearson Publishing 2011 by Boutot & Myles). Jenny is the inventor of the Patent-Pending “Weigh” Cool Bracelet. Jenny has spoken both nationally and internationally on a variety of topics, including sensory integration/processing. She received her bachelor’s degree in Occupational Therapy and graduated with distinction from the University of Kansas.
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