Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study.

Early et al. (2012) ran a small case series to test a step-by-step OT program built on Ayres Sensory Integration.

All kids had autism and were 4-8 years old. Therapists followed a written manual and checked every step for fidelity.

Parents and therapists then rated how safe, doable, and acceptable the program felt.

Every child finished every session. No one got hurt or dropped out.

Therapists scored high on fidelity, meaning they did the protocol as written.

Parents and therapists both said the program was acceptable and worth using again.

MacFarland et al. (2025) later ran an RCT with the same OT manual. Both OT and ABA beat no treatment on parent goals, showing the protocol works outside a pilot.

Park et al. (2026) pooled 23 RCTs in a meta-analysis. They found small-to-large gains in motor skills and daily living, but weak effects on balance and sensory scores. The 2012 study is inside that pool, so its safety data helped shape the larger picture.

Wan Yunus et al. (2015) reviewed 14 studies and called evidence for sensory-based interventions “inconclusive.” That sounds like a clash, but their bar was “strong RCT proof.” The 2012 paper never claimed strong proof; it only asked, “Can we run this safely?” Once that box was checked, later RCTs like MacFarland et al. (2025) supplied the stronger evidence the review wanted.

You now have a ready-to-use manual for sensory-integration OT that passed safety and fidelity checks. If a family wants a sensory approach, you can offer it with confidence while you collect data. Pair it with ABA or use it alone—both paths show similar gains on parent-set goals.