An Integrated Ayres Sensory Integration® and CO-OP Approach for Children with Autism: A Randomized Controlled Trial

Objective: Ayres Sensory Integration® (ASI®) and the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach address different but potentially complementary factors affecting participation in children with autism. This study examined whether adding CO-OP to ASI® produced greater improvements in executive function and participation outcomes than ASI®-only. Methods: This two-arm randomized controlled trial included 26 children with autism aged 7–11 years, who were allocated to an integrated ASI® and CO-OP group (n = 13) or an ASI®-only group (n = 13). Both groups received 90 min of intervention per week for 10 weeks. Outcomes were assessed at baseline, immediately after the intervention, and at the one-month follow-up using the Behavior Rating Inventory of Executive Function (BRIEF), Executive Function and Occupational Routines Scale (EFORTS), Short Child Occupational Profile (SCOPE), and Canadian Occupational Performance Measure (COPM). The Performance Quality Rating Scale (PQRS) was administered only to the integrated group. Between-group differences were examined using improvement-oriented change scores. Results: All randomized participants completed the study. Compared with the ASI®-only group, the integrated group demonstrated greater improvements in EFORTS Factor 1 from baseline to post-intervention (p = 0.002, r = 0.612) and follow-up (p < 0.001, r = 0.731) and in COPM performance at post-intervention (p = 0.005, r = 0.547) and follow-up (p < 0.001, r = 0.661). From baseline to follow-up, between-group differences also favored the integrated group for the BRIEF Metacognition Index (p = 0.037, r = 0.409), Global Executive Composite (p = 0.027, r = 0.434), and COPM satisfaction (p = 0.003, r = 0.587). No significant between-group difference was observed in the SCOPE total score. Within the integrated group, PQRS scores improved significantly over time (χ2 = 24.133, p < 0.001, Kendall’s W = 0.928). Conclusions: These exploratory findings suggest that adding CO-OP to ASI® may provide additional benefits for selected executive function, routine-related, and occupational performance outcomes in children with autism. However, no between-group advantage was demonstrated for overall participation measured by SCOPE. Larger trials with longer follow-up periods and independent outcome assessment are needed to confirm these findings.