mp-333
print Print Back Back

Sensory Integration Therapy and Auditory Integration Therapy

Policy Number: MP-333

Latest Review Date: March 2019

Category:  Therapy                                                                

Policy Grade: B

Description of Procedure or Service:

Sensory integration (SI) therapy has been proposed as a treatment of developmental disorders in patients with established dysfunction of sensory processing, particularly autism spectrum disorders. SI therapy may be offered by occupational and physical therapists who are certified in SI therapy. Auditory integration (AI) therapy uses gradual exposure to certain types of sounds to improve communication in a variety of developmental disorders, particularly autism.

The goal of sensory integration (SIT) therapy is to improve the way the brain processes and adapts to sensory information, as opposed to teaching specific skills. Therapy usually involves activities that provide vestibular, proprioceptive, and tactile stimuli, which are selected to match specific sensory processing deficits of the child. For example, swings are commonly used to incorporate vestibular input, while trapeze bars and large foam pillows or mats may be used to stimulate somatosensory pathways of proprioception and deep touch. Tactile reception may be addressed through a variety of activities and surface textures involving light touch.

Auditory integration (AIT) therapy (also known as auditory integration training, auditory enhancement training, and audio-psycho-phonology) involves having individuals listen to music modified to remove frequencies to which they are hypersensitive, with the goal of gradually increasing exposure to sensitive frequencies. Although several methods have been developed, the most widely-described is the Berard method, which involves two half-hour sessions per day separated by at least three hours, over ten consecutive days, during which patients listen to recordings. Auditory integration training has been proposed for individuals with a range of developmental and behavioral disorders, including learning disabilities, autism spectrum disorders, pervasive developmental disorder, attention deficit and hyperactivity disorder. Other methods include the Tomatis method, which involves listening to electronically-modified music and speech, and Samonas Sound Therapy, which involves listening to filtered music, voices, and nature sounds.

Policy:

Sensory Integration Therapy (SIT) and auditory integration therapy are considered not medically necessary and investigational.

For constraint induced therapy, please refer to MP #188- Constraint Induced Movement or Language Therapy.

For cognitive/neurobehavioral/neurorestorative rehabilitation, please refer to MP #600- Cognitive/Neurobehavioral/Neurorestorative Rehabilitation.

Key Points:

The most recent literature update was performed through January 6, 2019. This review was informed by a TEC Assessment (1999) that evaluated sensory integration therapy (SIT).

Evidence reviews assess the clinical evidence to determine whether the use of a technology improves the net health outcome. Broadly defined, health outcomes are length of life, quality of life, and ability to function, including benefits and harms. Every clinical condition has specific outcomes that are important to patients and to managing the course of that condition. Validated outcome measures are necessary to ascertain whether a condition improves or worsens; and whether the magnitude of that change is clinically significant. The net health outcome is a balance of benefits and harms.

To assess whether the evidence is sufficient to draw conclusions about the net health outcome of a technology, two domains are examined: the relevance and the quality and credibility. To be relevant, studies must represent one or more intended clinical use of the technology in the intended population and compare an effective and appropriate alternative at a comparable intensity. For some conditions, the alternative will be supportive care or surveillance. The quality and credibility of the evidence depend on study design and conduct, minimizing bias and confounding that can generate incorrect findings. The randomized controlled trial (RCT) is preferred to assess efficacy; however, in some circumstances, nonrandomized studies may be adequate. RCTs are rarely large enough or long enough to capture less common adverse events and long-term effects. Other types of studies can be used for these purposes and to assess generalizability to broader clinical populations and settings of clinical practice.

Sensory Integration Therapy

Clinical Context and Purpose

The purpose of sensory integration therapy in patients who have developmental disorders is to provide a treatment option that is an alternative to or an improvement on existing therapies.

The question addressed in this evidence review is: does the use of sensory integration therapy in patients who have developmental disorders improve net health outcomes?

The following PICOTS were used to select literature to inform this review.

Patients

The relevant population(s) of interest are patients with developmental disorders.

Interventions

The treatment being considered is the use of sensory integration therapy. The treatment sessions are often provided as part of a comprehensive occupational therapy or cognitive rehabilitation therapy and may last for more than one year.

Comparators

The following practices are currently being used to treat developmental disorders; specialized developmentally appropriate interventions for specific developmental disorders.

Outcomes

The general outcomes of interest are symptoms, change in disease status, functional outcomes and quality of life.

Timing

Follow-up of at least 6 months would be desirable to assess outcomes.

Setting

Treatment sessions are usually delivered in a one-on-one setting by occupational therapists with special training from university curricula, clinical practice, and mentorship in the theory, techniques, and assessment tools unique to SIT. Organizations like Western Psychological Services currently offer certification for SIT.

Study Selection Criteria

Methodologically credible studies were selected using the following principles:

a. To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs;

b. In the absence of such trials, comparative observational studies were sought, with a preference for prospective studies.

c. To assess longer term outcomes and adverse events, single-arm studies that capture longer periods of follow-up and/or larger populations were sought.

Studies with duplicative or overlapping populations were excluded.

In 2014, Schaaf et al (2014) published an overview of current measurement issues in the area of SI. This review highlights the need for the following:

  • “Additional measures… to ensure a comprehensive assessment of the sensory and motor factors that may be influencing function and participation”;

  • “Assessment measures… to address a wider age range”;

  • Neurophysiological studies;

  • “Fidelity to the core principles of sensory integration therapy”;

  • “studies… to evaluate the dosage of therapy to understand the best candidates for intervention and the appropriate intensity/frequency of intervention”;

  • “Outcomes that are meaningful to clients and sensitive to the changes observed after intervention.”

The Sensory Processing Disorders Scientific Workgroup (2007) has discussed the methodologic challenges of conducting intervention effectiveness studies of dynamic interactional processes, the lack of scientific evidence to support current practice, and methods for improving the quality of research in this area.

Systematic Reviews

Several systematic reviews have addressed the use of SI therapy in various clinical conditions. Four of the 6 systematic reviews included in this review include studies evaluating SIT for autism, while the other two include a broader range of developmental disabilities.

The 1999 TEC Assessment compared the outcomes of SI therapy with that of standard occupational/physical therapy among children with autism, cognitive disorders, or learning disabilities. One study was identified that evaluated the use of SI therapy in patients with autism, which was noted to be limited by its lack of a control group. Three studies were identified that evaluated the use of SI therapy in patients with mental retardation, which were noted to be inconsistent in their results regarding the superiority of SI therapy. Eleven studies were identified that evaluated SI therapy in patients with learning disabilities or motor delay, including, in total, more than 600 learning-disabled children. Studies that used random assignment and blinded assessors suggested that SI therapy was not superior to conventional therapy and, in many cases, was not even demonstrably superior to any treatment at all.

In 2015, Case-Smith et al published an updated systematic review of sensory processing interventions, including SI therapy (defined as clinic-based interventions that use sensory-rich, child-directed activities to improve a child’s adaptive responses to sensory experiences) and sensory-based interventions (defined as adult-directed sensory modalities that are applied to the child to improve behaviors associated with modulation disorders), for children with autism spectrum disorders with concurrent sensory processing problems. This review was designed to focus on interventions that activate the somatosensory and vestibular systems for patients with autism with co-occurring sensory processing problems. Nineteen studies published since 2000 were included, 5 of which evaluated SI therapy in patients with autism spectrum disorders and sensory processing disorders. Two studies reviewed were randomized controlled trials (RCTs), which were small (N=20 and N=17 in the sensory integration groups); the authors noted that the studies showed low or low-to-moderate effects and concluded that “It is premature to draw conclusions as to whether SIT [sensory integration therapy] for children with ASD [autism spectrum disorder], which is designed to support a child’s intrinsic motivation and sense of internal control, is ultimately effective.”

In 2015, Brondino et al published a systematic review of complementary and alternative therapies for autism, which included SIT and AIT.  For SIT for autism treatment, the authors identified 4 trials, including the 2016 RCT reported by Pfeiffer et al (described below), and additional studies published in 1983, 2008, and 2011, with sample sizes of 18, 30, and 50, respectively. All four studies reported improvements in autistic symptoms, including communication, social reciprocity, and motor activity. However, the systematic review authors noted limitations to the RCTs, including that 2 studies did not use a standardized form of SIT, and 2 did not use standardized outcome measures.

In 2015, Watling et al reported results of a systematic review of Ayres Sensory Integration® (ASI) and sensory-based interventions for individuals with autism spectrum disorder. The authors describe ASI as a play-based method that “uses active engagement in sensory-rich activities to elicit the child’s adaptive responses and improve the child’s ability to successfully perform and meet environmental challenges.”  The therapy is individualized by the therapist in response to an initial assessment. Sensory-based interventions are described as “applying adult-directed sensory modalities to the child with the aim of producing a short-term effect on self-regulation, attention, or behavioral organization.” Twenty-three articles met the authors’ inclusion criteria, 3 of which were systematic reviews and 5 of which were RCTs. Overall, 4 studies evaluated ASI and the remaining 18 evaluated sensory-based interventions. Of the 4 studies evaluating ASI, 3 were RCTs, including the studies by Pfeiffer et al and Schaaf et al described below. Findings from the 1 RCTs included significant improvement in individualized goals, improved sleep, decreased autism mannerisms, and reduced caregiver burden.

In 2008, Case-Smith and Arbesman reviewed the evidence for SI therapy as part of a systematic review of interventions for autism used in occupational therapy in 2008.  The authors identified a level-1 study, which was a systematic review from 2002 that had found only lower quality evidence (levels III and IV, with small sample size and lack of control groups), suggesting that SI intervention was associated with positive changes in social interaction, purposeful play, and decreased sensitivity. It was concluded that “although each of these studies had positive findings, when combined, the evidence remains weak and requires further study.”

May-Benson and Koomar published a systematic review of SI therapy in 2010.  The review identified 27 research studies (13 randomized trials) that met the inclusion criteria. Most of the studies had been performed in children with learning or reading disabilities; there were two case reports/small series on the effect of SI therapy in children with autism. The review concluded that although the SI approach may result in positive outcomes, findings may be limited because of small sample sizes, variable intervention dosage, lack of fidelity to intervention, and selection of outcomes that may not be meaningful or may not change with the treatment provided.

Randomized Controlled Trials

Schaaf et al (2014) reported on results from a randomized trial of a manualized intervention for sensory difficulties in children with ASD. The trial enrolled 32 children from a convenience sample of eligible families with children ages 4 to 8 years who had a diagnosis of ASD and demonstrated difficulty processing and integrating sensory information as measured by the Sensory Profile or the Sensory Integration and Praxis Test. Subjects were randomized to usual care or to an intervention described as following the principles of ASI. The intervention was delivered by three licensed occupational therapists experienced working with children with ASD. The primary outcome was Goal Attainment Scaling, a systematic process for identifying goals relevant to individuals and their families that has been used to evaluate patients with ASD. Sample goals include: “Improve auditory process as a basis for sleeping through the night without getting out of bed for 7-8 h per night” and “Decrease oral sensitivity and will try 5 new foods.” Each goal is associated with a scale for level of attainment. For the primary outcome, the intervention group had a significantly higher goal achievement score than the control group (mean, 56.53 [n=17] vs 42.72 [n=14], p=0.003). Change in functional skills did not differ significantly between groups, but intervention group subjects had significantly greater improvements in the 2 subscales of self-care caregiver assistance (p=0.008) and social function caregiver assistance (p=0.039). The groups did not differ in terms of autistic or adaptive behaviors. Strengths of this trial were its use of a protocolized intervention and its attempt to use an outcome measure relevant to patients and families. However, replication of this trial in a larger sample of patients is required.

A pilot study by Pfeiffer et al (2011), randomized 37 children with a sensory processing disorder (21 with autism and 16 with pervasive developmental disorder not otherwise specified) to SI interventions or to fine motor interventions (18 treatments over six weeks). Fidelity to SI interventions was verified with a fidelity measure developed for research by Parham et al. Blinded evaluation at the conclusion of the intervention found no significant difference between the two groups on the Quick Neurological Screening Test (QNST) or sensory processing scores except for Autistic Mannerisms (e.g., stereotyped or self-stimulatory behavior) subscale. The SI group demonstrated greater improvement than the fine motor group on individualized Goal Attainment Scaling. Post hoc analysis found that more children in the SI group were able to complete parts of the standardized QNST after the intervention. This finding is limited by the post hoc analysis and the difference in the 2 groups at baseline.

In 2007, members of the Sensory Processing Disorders Scientific Workgroup also reported results from a single institution randomized pilot study for a proposed multicenter trial. Thirty families (of approximately 140 who met the inclusion/exclusion criteria) agreed to participate over a three year period. The children had a clinical diagnosis of sensory modulation disorder following a comprehensive evaluation with standardized and clinical testing (including responses to sensory stimuli, attempts by the child to self-regulate, behavioral disorganization, and somatic responses to the testing situations). The 24 children who began treatment were randomly assigned to one of three groups consisting of occupational therapy with SI (two times per week for ten weeks, n=7), equivalent activity control sessions (n=10), or a waiting-list control group (n=7). Functional improvements were assessed by five validated/standardized parental rating scales. Significant improvements relative to both control groups were obtained for Goal Attainment Scaling (37 vs. 14 vs. 7, consecutively). A number of the other outcome measures (Leitner International Performance Scale, Short Sensory Profile, and Internalizing on the Child Behavior Checklist) showed trends for improvement.

Uyanik et al (2003) reported on a study of 45 children with Down’s syndrome divided into three treatment groups (sensory integrative therapy alone, vestibular stimulation combined with sensory integrative therapy, and neurodevelopmental therapy). Greater improvements in outcomes in the vestibular stimulation with SI therapy group and in the neurodevelopmental therapy group than for the SIT alone group were reported.  Outcomes assessed were the Ayres Southern California Sensory Integration Test, Pivot Prone Test, Gravitational Insecurity Test, and Pegboard Test along with physical assessment. The authors concluded all methods of treatment should be considered when planning rehabilitation therapies for children with Down’s syndrome, even though sensory integrative therapy alone was not shown to be superior to the other therapy groups.

Section Summary:  Sensory Integration Therapy

The most direct evidence related to outcomes from SI therapy comes from randomized trials and systematic reviews of these trials. Although some of the studies demonstrated some improvements on subsets of the outcomes measured, the studies are limited by small sizes, heterogeneous patient populations, and variable outcome measures. As a result, the evidence is insufficient to draw conclusions about the effects of and the most appropriate patient populations for SI therapy.

Auditory Integration Therapy

Clinical Context and Purpose

The purpose of auditory integration therapy (AIT) in patients who have developmental disorders is to provide a treatment option that is an alternative to or an improvement on existing therapies.

The question addressed in this evidence review is; does the use of auditory integration therapy in patients who have developmental disorders improve net health outcomes?

The following PICOTS were used to select literature to inform this review.

Patients

The relevant population(s) of interest are patients with developmental disorders. Although AIT has been proposed as a therapy for a number of neurobehavioral disorders, the largest body of evidence, including systematic reviews, relates to its use in ASD.

Interventions

The treatment being considered is the use of auditory integration therapy.

Comparators

The following practices are currently being used to treat developmental disorders; specialized interventions for specific developmental disorders.

Outcomes

The general outcomes of interest are symptoms, change in disease status, functional outcomes and quality of life.

Timing

Follow-up of at least 6 months would be desirable to assess outcomes.

Setting

Treatment sessions are usually delivered in a one-on-one setting by therapists with special training.

Study Selection Criteria

Methodologically credible studies were selected using the following principles:

a. To assess efficacy outcomes, comparative controlled prospective trials were sought, with a preference for RCTs;

b. In the absence of such trials, comparative observational studies were sought, with a preference for prospective studies.

c. To assess longer term outcomes and adverse events, single-arm studies that capture longer periods of follow-up and/or larger populations were sought.

A 2011 Cochrane review evaluated AI training along with other sound therapies for ASDs. Included were 6 randomized controlled trials of AI therapy and one of Tomatis therapy, involving a total of 182 subjects aged 3 to 39 years. For most of the studies, the control condition consisted of listening to unmodified music for the same time as the active treatment group. Allocation concealment was inadequate for all studies, and 5 of the trials had fewer than 20 participants. Meta-analysis could not be conducted. Three studies did not demonstrate any benefit of AI therapy over control conditions, and three studies had outcomes of questionable validity or outcomes that did not achieve statistical significance. The review found no evidence that AI therapy is an effective treatment for ASDs; however, evidence was not sufficient to prove that it is not effective.

In the systematic review examining complementary and alternative therapies for ASD, Brondino et al (2015; described above) identified the same 6 RCTs of AIT included in the 2011 Cochrane review. Like the Cochrane review, Brondino et al concluded that the largest studies did not report improvements with AIT.

A 2010 systematic review of therapies for autism evaluated the evidence for AIT training in the treatment of autism. The author identified a 2002 systematic review (an early version of the 2011 Cochrane review by Sinha et al referenced above), which identified no RCTs meeting the author’s inclusion criteria, and no subsequent RCTs or cohort studies comparing auditory integration therapy to usual care.

In 2009, Rossignol conducted a systematic review of novel and emerging treatments for ASDs, including AI therapy. The authors identified one 3-month double-blind, controlled study of auditory integration therapy in 17 individuals with autism, which demonstrated significant improvements in irritability, stereotypy, hyperactivity, and excessive speech in patients in the therapy group. The study also reviewed an earlier version of the 2011 Cochrane review by Sinha et al referenced above. Overall, the authors concluded that there was Grade C evidence related to the use of auditory integration therapy in autism.

Section Summary: Auditory Integration Therapy

The largest body of evidence related to the use of AI therapy is in the treatment of autism. A 2011 Cochrane review and several earlier systematic reviews generally found that studies of auditory integration therapy failed to demonstrate meaningful clinical improvements. No subsequent comparative studies of auditory integration therapy were identified.

Summary of Evidence

For individuals who have developmental disorders who receive SIT, the evidence includes randomized controlled trials, systematic reviews of these trials, and case series. Relevant outcomes are functional outcomes and quality of life. Due to the individual approach to SI therapy and the large variation in patient’s disorders, large multicenter randomized controlled trials (RCTs) are needed to evaluate the efficacy of this intervention. The most direct evidence related to outcomes from SI therapy comes from several randomized trials. Although some of the studies demonstrated some improvements on subsets of the outcomes measured, the studies are limited by small sizes, heterogeneous patient populations, and variable outcome measures. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have developmental disorders who receive AIT, the evidence includes several randomized controlled trials (RCTs) and systematic reviews of these trials. Relevant outcomes are functional outcomes and quality of life. For AIT therapy, the largest body of literature relates to its use in autism. Several systematic reviews of AI therapy in the treatment of autism found limited evidence to support its use. No comparative studies were identified that evaluate the use of AI therapy for other conditions. The evidence is insufficient to determine the effects of the technology on health outcomes.

Practice Guidelines and Position Statements

Sensory Integration Therapy

American Academy of Pediatrics

A 2012 policy statement by the AAP on SIT therapies for children with developmental and behavioral disorders states that “occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan. However, parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive.” The AAP indicates that these limitations should be discussed with parents, along with instruction on how to evaluate the effectiveness of a trial period of SI therapy.

American Occupational Therapy Association

In 2009, the American Occupational Therapy Association (AOTA) stated that the AOTA recognizes sensory integration (SIT) as one of several theories and methods used by occupational therapists and occupational therapy assistants working with children in public and private schools to improve a child’s ability to access the general education curriculum and to participate in school-related activities. 

In 2011, the AOTA published evidence-based occupational therapy practice guidelines for children and adolescents with challenges in sensory processing and sensory integration.  AOTA gave a level C recommendation for sensory integration therapy for individual functional goals for children, for parent-centered goals, and for participation in active play in children with sensory processing disorder, and to address play skills and engagement in children with autism. A level C recommendation is based on weak evidence that the intervention can improve outcomes, and the balance of the benefits and harms may result either in a recommendation that occupational therapy practitioners routinely provide the intervention or in no recommendation because the balance of the benefits and harms is too close to justify a general recommendation. Specific performance skills evaluated were motor and praxis skills, sensory-perceptual skills, emotional regulation, and communication and social skills. There was insufficient evidence to provide a recommendation on sensory integration for academic and psychoeducational performance (e.g., math, reading, written performance).

U.S. Preventive Services Task Force Recommendations

Not applicable.

Key Words:

Sensory integration therapy (SIT), auditory integration therapy (AIT), facilitated communication (FC) therapy, Integrated Listening System Therapy, iLs

Approved by Governing Bodies:

Sensory integration therapy is a procedure and, as such, is not subject to regulation by the US Food and Drug Administration (FDA). There are no devices designed to provide auditory integration therapy that have clearance for marketing from FDA.

Benefit Application:

Coverage is subject to member’s specific benefits.  Group specific policy will supersede this policy when applicable.

ITS: Home Policy provisions apply

FEP contracts:  FEP does not consider investigational if FDA approved and will be reviewed for medical necessity.

Coding:

CPT Codes:

97533

Sensory integrative technique to enhance sensory processing and promote adaptive responses to environmental demand, direct (one-on-one) patients contact by the provider, each 15 minutes

The code above may also be used for auditory integration therapy.

References:

  1. American Speech-Language-Hearing Association. Auditory integration training [Technical Report]. 2004; www.asha.org/policy/TR2004-00260.htm#sec1.5.

  2. American Academy of Pediatrics Committee on Children with Disabilities. Auditory Integration Training and Facilitated Communication for Autism. Pediatrics. August 1, 1998 1998; 102(2):431-433.

  3. Baranek GT. Efficacy of sensory and motor interventions for children with autism. J Autism Dev Disord 2002; 32(5):397-422.

  4. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Sensory integration therapy. TEC Assessment. 1999;Volume 14, Tab 22.

  5. Brondino N, Fusar-Poli L, Rocchetti M, et al. Complementary and Alternative Therapies for Autism Spectrum Disorder. Evid Based Complement Alternat Med. 2015; 2015:258589.

  6. Case-Smith J, Arbesman M. Evidence-based review of interventions for autism used in or of relevance to occupational therapy. Am J Occup Ther 2008; 62(4):416-29.

  7. Case-Smith J, Weaver LL, Fristad MA. A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism. Jan 29 2014.

  8. Committee on Children with Disabilities. Auditory integration training and facilitated communication for autism. American Academy of Pediatrics. Committee on Children with Disabilities. Pediatrics. Aug 1998; 102(2 Pt 1):431-433.

  9. Kratz SV. Sensory integration intervention: historical concepts, treatment strategies and clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH) deficiency. J Inherit Metab Dis 2009; 32(3):353-60.

10. Mailloux Z, May-Benson TA, Summers CA et al. Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. Am J Occup Ther 2007; 61(2):254-9.

11. May-Benson TA, Koomar JA. Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. Am J Occup Ther 2010; 64(3):403-14.

12. Miller LJ, Coll JR, Schoen SA. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. Am J Occup Ther 2007; 61(2):228-38.

13. Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics 2007; 120(5):1162-82.

14. Parham LD, Cohn ES, Spitzer S et al. Fidelity in sensory integration intervention research. Am J Occup Ther 2007; 61(2):216-27.

15. Parr J. Autism. Clin Evid (Online). 2010; 2010.

16. Pfeiffer BA, Koenig K, Kinnealey M et al. Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. Am J Occup Ther 2011; 65(1):76-85.

17. Roley SS, Bissell J, Clark GF. Providing occupational therapy using sensory integration theory and methods in school-based practice. Am J Occup Ther 2009; 63(6):823-42.

18. Rossignol DA. Novel and emerging treatments for autism spectrum disorders: a systematic review. Ann Clin Psychiatry. Oct-Dec 2009; 21(4):213-236.

19. Schaaf RC, Benevides T, Mailloux Z, et al. An intervention for sensory difficulties in children with autism: a randomized trial. J Autism Dev Disord. Jul 2014; 44(7):1493-1506.

20. Schaaf RC, Burke JP, Cohn E, et al. State of measurement in occupational therapy using sensory integration. Am J Occup Ther. Sep-Oct 2014;68(5):e149-153.

21. Sinha Y, Silove N, Hayen A et al. Auditory integration training and other sound therapies for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; (12):CD003681.

22. Uyanik M, Bumin G, Kayihan H. Comparison of different therapy approaches in children with Down syndrome. Pediatr Int 2003; 45(1):68-73.

23. Watling R, Hauer S. Effectiveness of Ayres Sensory Integration(R) and Sensory-Based Interventions for People with Autism Spectrum Disorder: A Systematic Review. Am J Occup Ther. Sep-Oct 2015; 69(5):6905180030p6905180031-6905180012.

24. Watling R, Koenig KP, Davies PL et al. Occupational therapy practice guidelines for children and adolescents with challenges in sensory processing and sensory integration. Bethesda, MD: American Occupational Therapy Association Press; 2011. Guideline summary available online at: www.guidelines.gov/content.aspx?id=34041. Last accessed December 2013.

25. Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics 2012; 129(6):1186-9.

Policy History:

Medical Policy Group, October 2008 (3)

Medical Policy Administration Committee, November 2008

Available for comment November 20, 2008-January 5, 2009

Medical Policy Group, October 2010 (1): Key points update, no policy statement change

Medical Policy Group, October 2011 (1): Update to Key Points and References related to SIT; no change to policy statement.

Medical Policy Panel, October 2013.

Medical Policy Group, December 2013 (2): Deleted “Auditory Integration Therapy and Facilitated Communication” from title, description, and policy statement.   Key Points and References updated to reflect findings from literature search through September 2013

Medical Policy Panel, November 2014

Medical Policy Group, November 2014 (4): Added “and Auditory Integration Therapy” back to title and policy statement.  Updates to Description, Key Points, and References

Medical Policy Group, October 2015 (4): Added “refer to” statements under policy section for MP# 188 and 600.

Medical Policy Group, November 2015 (4): Added integrated listening therapy to Key Words

Medical Policy Panel, March 2016

Medical Policy Group, March 2016 (6):  Updates to Description, Key Points and References; no change to policy statement.

Medical Policy Panel, March 2017

Medical Policy Group, March 2017 (6): Updates to Key Points and References. No change to policy statement.

Medical Policy Panel, March 2018

Medical Policy Group, March 2018 (6): Updates to Description and Key Points. No change to policy statement.

Medical Policy Panel, March 2019

Medical Policy Group, March 2019 (6):  Updates to Key Points.  No change to policy statement.


This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i) research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.

This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure review) in Blue Cross and Blue Shield’s administration of plan contracts.

The plan does not approve or deny procedures, services, testing, or equipment for our members. Our decisions concern coverage only. The decision of whether or not to have a certain test, treatment or procedure is one made between the physician and his/her patient. The plan administers benefits based on the member’s contract and corporate medical policies. Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.

As a general rule, benefits are payable under health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:

1. The technology must have final approval from the appropriate government regulatory bodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;

3. The technology must improve the net health outcome;

4. The technology must be as beneficial as any established alternatives;

5. The improvement must be attainable outside the investigational setting.

Medical Necessity means that health care services (e.g., procedures, treatments, supplies, devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that are:

1. In accordance with generally accepted standards of medical practice; and

2. Clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and

3. Not primarily for the convenience of the patient, physician or other health care provider; and

4. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.