Autism spectrum disorder (ASD) is a common, highly heritable, and heterogeneous neurodevelopmental disorder that encompasses conditions such as autism, Asperger syndrome, and pervasive developmental disorder. These disorders are characterized by underlying cognitive features and frequently co-occur with other conditions (1). The core symptoms of ASD include social communication difficulties and repetitive patterns of behavior, interests, or activities. It is often accompanied by sensory integration disorders, emotional issues, and language communication difficulties (2). The etiology of ASD is complex and not yet fully understood, involving a combination of genetic and environmental factors (3). Early environmental insults may lead to abnormal brain structure and function, affecting neurodevelopmental processes and increasing the risk of ASD (4). At present, the prevalence of ASD is increasing annually, with the World Health Organization (WHO) estimating a global prevalence of 0.76% (5). In 2023, the Centers for Disease Control and Prevention (CDC) reported a prevalence rate of 1 in 36 among 8-year-old children in the United States (6). In China, epidemiological studies indicate that the prevalence of ASD among school-aged children (6–12 years) is 0.7%, suggesting that nearly 700, 000 children in China are affected by ASD (7). The increasing incidence of ASD, with its early and often lifelong onset, places an enormous economic and emotional burden on families and society. The “Analysis of the Current Situation of Autistic Children in China” report highlights that the monthly rehabilitation costs for children with ASD account for half of a family’s total expenditure. Currently, there are no specific pharmacological treatments for ASD, with medications such as risperidone and aripiprazole being used primarily for symptom management. As a result, ASD interventions mainly rely on non-pharmacological approaches, including Applied Behavior Analysis (ABA), the Early Start Denver Model, Ayres Sensory Integration^® (ASI) and so on, which form an essential component of the overall treatment strategy (8, 9).

Sensory integration is a process that involves combining sensory information received from various senses in the human body. After this information is processed and integrated into the central nervous system, it enables individuals to perceive their internal and external environments and triggers appropriate physical responses. However, individuals with sensory integration dysfunction may make errors in processing sensory stimuli accurately. While sensory factors are not specific elements for diagnosing autism, they can affect the vast majority of autistic children (10, 11). Sensory integration dysfunction mainly includes tactile defensive disorder, motor difficulties, auditory language disorders, vestibular balance dysfunction, and spatial and structural perception disorders (12). The sensory system issues in autistic children are significant factors affecting other behavioral problems, such as social skills, social engagement, and academic performance (13). Therefore, improving the sensory system function in autistic children is also a crucial measure to enhance the overall treatment effectiveness.

ASI, developed by A. Jean Ayres, is a therapeutic approach designed to enhance sensory integration functions by influencing the way the brain processes and organizes sensory information through the provision of controlled sensory stimuli in the context of playful and meaningful activities (14). ASI is a clinical-based approach that focuses on the relationship between the therapist and the child, using play-based sensory-motor activities aimed at improving sensory processing and integration (15). Currently, ASI has been widely applied in research involving children with various diseases, with ASD being one of them (16–18). ASI can effectively improve the social skills and self-care abilities of autistic children (19, 20).At the same time, occupational therapy using the principles of ASI is one of the most requested services by parents of autistic children (21). A survey of occupational therapists also showed that 82% of respondents indicated they ‘always’ use sensory integration methods in their treatment when working with autistic children (22). Several systematic reviews have examined the impact of ASI on autistic children, focusing on issues such as the fidelity of intervention implementation, the strength and certainty of the available evidence, and the reproducibility of intervention procedures (23–25). In China, a more commonly used sensory integration approach is referred to as sensory integration-based intervention (SIBI), which was developed based on the ASI framework. However, despite its widespread application, research conducted in China remains limited in both quality and consistency, characterized by relatively small sample sizes and variability in outcome measurement tools. Therefore, our review aims to contribute by providing quantitative evidence specific to Chinese populations, thereby complementing the broader international literature.

Therefore, to address this potential issue, this meta-analysis conducted searches in both Chinese and English databases to supplement the lack of sufficient RCTs, with the hope of providing a theoretical basis for the effects of SIBI interventions on autistic children. This study aims to synthesize published research to analyze the impacts of SIBI on the sensory integration abilities and behaviors of autistic children, exploring the specific effects of SIBI on this population.

Meta-analysis is performed according to the preferred reporting items in the System Review and Meta-analysis (PRISMA) guide (26).(CRD420250639991).

This meta-analysis investigated the impact of SIBI on sensory processing abilities and autism-related behaviors in autistic children. The analysis provides empirical evidence regarding the efficacy of SIBI in enhancing sensory processing capabilities and ameliorating autism-related behaviors.

Our research findings indicate that SIBI can effectively enhance the sensory integration abilities of autistic children in three aspects: balance, tactile defensiveness, and proprioception. Additionally, the heterogeneity test results show that the improvement of the total SIS score for autistic children through SIBI is robust (I²<50%). In normally developing children, sensory integration dysfunction significantly impacts learning, behavior, and social communication. This phenomenon can be ameliorated through targeted interventions (47). SIBI is a method that helps individuals regulate their neurological functions and promotes the integration and processing of environmental information through systematic intervention. This approach is based on the principles of neuroplasticity, facilitating the brain’s hierarchical processing of multisensory signals by integrating information received from different sensory modalities (19). As a result, it coordinates the body’s adaptive responses to external environmental stimuli and internal physiological states. By reinforcing the information integration capabilities of the nervous system through targeted training, SIBI can effectively enhance children’s behavioral organization levels, specifically reflected in improvements in joint attention, increased proactivity in social interactions, enhanced motor coordination, and improved sensory discrimination skills (48). The SIS scale encompasses sensory integration ability assessments across three dimensions: balance, tactile defensiveness, and proprioception. Maintaining balance necessitates the integration of diverse information from the vestibular, visual, and proprioceptive systems to effectively sustain equilibrium (49). Individuals with autism face greater challenges in balance (50). Further research indicates that postural and balance difficulties are related to other autistic characteristics, such as social communication deficiencies and repetitive behaviors (51, 52). SIBI appears to have a compensatory effect on sensory input deficits in children with ASD, particularly in the areas of visual, vestibular perception, and proprioception. SIBI can enhance the balance abilities of children with ASD by modulating the corresponding posture control mechanisms in different brain regions (25). Moreover, fNIRS evidence indicates that the enhanced neural activation in specific regions of the PFC highlights the role of SIBI in cognitive improvement, including inhibitory control and cognitive flexibility (53). However, this emerging compensatory effect deserves further exploration in future studies utilizing more sophisticated neuroscientific instruments.

Sensory integration disorder is not exclusive to individuals with ASD, but it is crucial to study SIBI in ASD children because this anomaly is commonly found in ASD patients and has a relatively high prevalence. Some atypical sensory behaviors can be clearly observed in autistic children in the early stages of life (around 1 year old), and these behaviors are more common in infancy and childhood than in adulthood (54). Research has shown that children with ASD exhibit several different atypical sensory patterns, including hyperresponsiveness (HYPER), hyporesponsiveness (HYPO), and sensory interests, repetitions, and seeking behaviors (SIRS), as well as the potential role of sensory processing as a crucial component of higher social and cognitive functions. Additionally, the atypical sensory behaviors displayed by individuals with sensory integration disorder are also part of the diagnostic criteria for core symptoms of autism spectrum disorder in DSM-5. Individuals with ASD exhibit abnormalities in central sensory processing, and these atypical characteristics related to the integration of somatosensory information are associated with an increase in autistic traits, further supported by the neurobiological characteristics of ASD (55, 56). The sensory processing abnormalities in children with ASD not only impair their sensory integration abilities but also have a significant impact on their behavioral issues, including core symptoms (12). Therefore, improving the sensory integration abilities of individuals with ASD may have significant benefits for the improvement of their core symptoms.

SIBI is a program that can enhance their sensory integration abilities. In individuals with autism, SIBI can reduce stereotypical behaviors, improve self-care and social interaction abilities, and positively influence motor skills, socialization, attention, behavior control, reading skills, participation in play activities, and the achievement of personal goals (16, 20). The meta-analysis results also found similar outcomes. SIBI not only improves sensory integration abilities in autistic children but also alleviates their autistic behaviors. SIBI can effectively reduce the total scores of the ATEC scale and the ABC scale in autistic children. The ATEC scale includes four dimensions: perception/cognitive ability, social ability, behavior, and communication. The results show that SIBI can effectively reduce both the total score and the symptom scores of each sub-dimension on the ATEC scale, and importantly, the results are robust (I2 < 50%). Additionally, the ABC scale, which is an autistic behavior assessment scale that can be used by parents, includes 5 dimensions: Sensory, Somatic Movement, Social Skills, Self-Care, and Language. The meta-analysis also found that the SIBI can reduce the total score of the ABC scale and the scores of each sub-dimension for autistic children. However, the results of the meta-analysis showed high heterogeneity. We then used meta-regression to examine the sources of heterogeneity, and the results indicated that the intervention cycle of SIBI is a source of heterogeneity affecting the overall score of the ABC scale. At the same time, this result highlights that a longer intervention cycle is associated with better improvement effects on the total score of the ABC. These results indicate that SIBI can not only directly improve the sensory integration ability of children with autism but also enhance their social cognitive function by reinforcing these fundamental abilities, thereby improving their social skills, language skills, and self-care abilities. The potential mechanism underlying these results may be due to the continuous SIBI providing comfortable sensory stimulation for children with autism, enabling them to reach an appropriate level of arousal through sensory input, and that SIBI stimulation can develop their visual processing abilities, influencing changes in their psychological and social functions through changes in physical abilities (57, 58).

These findings underscore the importance of SIBI in enhancing sensory integration processing abilities and improving autism-related behaviors, providing support for non-pharmacological interventions in autism treatment based on neuroplasticity. However, there are still some difficulties in the implementation of SIBI for ASD currently, such as the distinction between SIBI and sensory-based interventions in practical applications. SIBI is an important rehabilitation approach for ASD and must be strictly performed according to ASI principles to ensure the effectiveness of the intervention.

Recent international systematic reviews and empirical studies on ASI have provided increasing evidence that this intervention can improve social participation, communication, and sensory processing in autistic children across different cultural contexts (23). Our findings based on Chinese studies are generally consistent with these outcomes, particularly in demonstrating improvements in core autistic behaviors and sensory integration function. However, several differences are noteworthy. First, the version of SIBI applied in China is an adaptation developed by Professor Wen-De Chen in collaboration with Peking Medical University, based on ASI and modified to fit the Chinese cultural context. Next, compared with international studies, Chinese trials often focus on symptom reduction scales such as the ABC or SIS rather than on functional outcomes. In contrast, contemporary international research has increasingly emphasized ecologically valid measures, including Goal Attainment Scaling (GAS), activities of daily living (ADLs), social skills, and reductions in caregiver burden. These similarities and differences suggest that while ASI holds promise in the Chinese context, future research would benefit from adopting internationally recognized fidelity measures and incorporating more functional outcome indicators. Such efforts would not only enhance the comparability of Chinese studies with global evidence but also provide stronger guidance for clinical practice.

Current guidelines for ASI research emphasize that assessment of ASI concerns should be conducted prior to intervention to ensure appropriate participant inclusion and accurate evaluation of treatment effects. However, in this review, we found that several included studies did not perform formal SI assessments before intervention, and some provided insufficient information regarding assessment procedures. This inconsistency reflects the fact that a number of studies were conducted before such standards were widely adopted. The absence of standardized pre-intervention SI assessment represents a major limitation of the present review and highlights the need for future studies to implement rigorous assessment protocols to enhance the validity of intervention outcomes. Although praxis difficulties are known to occur in a large proportion of children with autism and represent a core aspect of sensory integration, most of the studies included in this review did not specifically assess or report praxis-related outcomes. Consequently, the absence of praxis assessment limits the ability to fully evaluate the intervention’s effectiveness, and future studies should incorporate standardized measures of praxis to provide a more comprehensive understanding of sensory integration-based interventions in children with autism.

This study aims to provide theoretical evidence for the effectiveness of SIBI by exploring its impact on children with autism. The results indicate that SIBI can effectively improve the sensory integration ability and autism-related behaviors of autistic children. Furthermore, the intervention effects gradually increase with the duration of SIBI. Additionally, this study has some limitations, including that the sample comprised only Chinese children with autism, the number of studies included is relatively small, and dissertations were excluded. Future research needs to include larger samples and high-quality RCT experiments from an international perspective to support these findings.

All randomized controlled trials were conducted in China. Therefore, these findings may have limited generalizability to other regions and cultural backgrounds.