When Jean Ayres died in 1988, sensory integration took some unexpected turns

By E.J. Brown

This is the second installment in a 3-part series. The first story ran in the Oct. 18 edition.

Perhaps Jean Ayres' most famous work was her book Sensory Integration and the Child, published in 1979. By this time her theory was well organized, and she had published the Southern California Sensory Integration Tests, the forerunner of the Sensory Integration and Praxis Tests, the only assessment tool available for SI dysfunction (1972). It is owned and copyrighted by Ayres' publisher, Western Psychological Services (WPS). Therapists who learned how to give and score the test were registered as certified in administration of the SIPT.

Ayres had developed her theory over the course of more than 30 years, between 1954 and 1987. At any given point in time, sensory integration may or may not have included certain precepts. Here's a very simplified version of what Ayres believed about it circa 1968, from her articles that appeared mostly in the American Journal of Occupational Therapy, as reported in Sieg's chapter of Six Perspectives on Theory:

• Learning is a function grounded in the brain's "ability to filter, organize and integrate the masses of sensory information." Our human ability to read is a result of such integration that has actually evolved over time along with adaptive motor responses.

• It is sensory input from the environment that moves the nervous system to modify its responses.

In the decade between 1962 and 1973, Ayres enlarged her theory, as Kay Sieg describes:

• Our brains contain and use both primitive and more modern neural structures. (phylogenetic principle of neurodevelopment)

• Movement organizes the brain, which in turn produces better movement. The motor development of the individual follows a pattern "from cephalad to caudal, proximal to distal, gross to fine, flexion to extension, adduction to abduction, ulnar to radial, movement on a straight plane to rotational movement, and reflexive contraction to voluntary contraction." (ontogenetic principle of neurodevelopment)

• Tactile and visual perception, and prioprioception produce body scheme and motor planning, which in turn produce visual-spatial perception and motor skills that lead to the ability to conceptualize academically.

• The "end products" of a successful sensory integrative process are good balance, posture, muscle tone and gravitational security, plus all levels of coordination, leading to the ability to concentrate, organize, and reason abstractly. SI lateralizes the specialized functions of the cerebral hemispheres and body sides. All of this aids self-control, self-esteem and selfÐconfidence.

Ayres continued to update her theory until she died of cancer in 1988. By that time, occupational therapy was well established in the school system, and SI precepts were in use there to varying degrees.

But the jury was still out on how well it worked, or if it even worked at all. Critics of the theory in the mid 1990s, according to Sieg, said Ayres had made "highly selective interpretations of the neuroscience literature." Since neuroscience is evolving very rapidly, Sieg suggested that further SI theorization would have to include the frequent updating of neuroscience literature.

Though Ayres applied her theory almost exclusively to learning disabled children, it is in itself a most exhaustive theory, linking sensory processing directly to both physical and cognitive development.

After her death, the stage was set for an almost certain clash of opinions as to the meaning and scope of sensory integration theory. Meanwhile, a financial agreement that Ayres had made earlier would complicate the future of sensory integration.

At the time of Ayres' death her clinic actually belonged to Sensory Integration International. She had retired from private practice in 1984, and sold it SSI on December 31 of that year, for $159,750, the balance of which was to be paid by the end of 1991.

Ayres had sold the clinic for two reasons, which she outlined in a letter to then-executive director of SII Wayne Soucy on May 31, 1984, suggesting that he be aware of the inherent risks in running an OT private practice:

"Of major consideration is the lack of public awareness of occupational therapy and of the kinds of problems I am treating. Associated with this—is lack of support and referrals from related professionals. The persistent negativism of physicians is a major hindrance. The center could make a major contribution to society through education and public relations programs, something which I, as an individual, am not able to do effectively."

Ayres would have liked to donate her practice to SII, but could not afford to. "My income has been repeatedly reinvested in my profession, and I must now realize some gain from it," she wrote.

Her intentions were clear: she wanted SI research to continue, and she needed an entity to accomplish the task. Also clear was the risk involved in the venture.

There seemed to be lots of people ready to help. For at least three of the four years following the property transfer, Jean Ayres continued to rent the space at 1518 Cabrillo in Torrance, CA, where she continued to treat patients and to offer in-services in sensory integrative techniques as a paid consultant.

Occupational therapist Zoe Mailloux, who had been Ayres' research assistant from 1978 to 1984, became director of administration of the clinic after Ayres retired in 1984. Lynetta Domke held the post of executive director of SII.

According to sources involved, both SII and the Ayres Clinic went through short-term financial ups and down but they remained solvent up until at least 1992. What happened next is at the heart of an ongoing clash over SI ideologies and management priorities that has literally brought Sensory Integration International to its knees and produced a legal battle over the right to use Jean Ayres' name.

Mailloux is no longer associated with SII. She told ADVANCE that several things happened at once that challenged the future of both organizations.

"Some of us had concerns about the [professional] background of people being brought in to lead the organization (subcontractors, fundraisers, etc.) Also, a number of people had developed, on their own, different kinds of intervention programs that new board members were very invested in, and wanted them to be used at the Ayre's clinic.

"These were more passive types of approaches; and in general, the kinds of programs that the board members presented, we [at the clinic] did not feel were representative of the core of Dr. Ayres' work."

Most of these were and are modalities that incorporate sensory components, such as the Wilbarger Brushing Technique, now a popular sensory tool in many places. And indeed, Patricia Wilbarger was a colleague of Jean Ayres and a founder of the organization that became SII.

Most of these approaches were lumped together with a "sensory" label but had not been researched individually beyond anecdotal evidence and case studies.

Mailloux says Ayres would have wanted primary research, as is done on the university level, to consider approaches as being part of the SI theoretical framework.

"Sensory integration had very well spelled out principles," she said. "We were concerned when an approach did not adhere to these nor have any research to justify working outside these principles."

But she denies that she and her team were close-minded. "We worked with a lot with people around the country," she said. "Shelley Mulligan did further analysis on SIPT scores—we welcomed the opportunity to work with her. Grace Baranek at UNC-Chapel Hill was researching tactile defensiveness in autism. Sharon Cermak in Boston and Mary Schneider in Wisconsin published work with careful research."

Eileen Richter, founder and owner of Professional Development Programs/PDP Products in Stillwater, MN, however, saw a negative attitude toward people coming in from outside the tight-knit southern California sensory integration community.

"The first meeting I attended as an SII board member was the research committee," she told ADVANCE. "It was headed by a non-OT member of the board. He was really anxious to promote the organization and get the word out, and I, too, had all these ideas of things we could be doing, but every time we tried to put them forth, all we heard was 'no, that won't work,' or 'that's been tried before,' or it was too expensive."

Clinically speaking, Richer says, one example of the "new ideas" that became the focus of such intense debate was sensory defensiveness.

"Jean had the basics down," she said. "but she always said there were many possibilities. If you're firmly convinced that you're limited, then you're going to be limited. There was this 'un-Ayres like' attachment to a limited view of SI."

Mailloux still disagrees.

"They (new board members) kept calling us 'old school'—that we wouldn't move forward. But I don't think anyone who worked at the Ayres Clinic would have said, 'no, we want Dr. Ayres' work to be just what it was and never change it.' We just wanted it to develop in a credible way, with a framework that one can refer back to."

Mailloux is currently director of administration of the Pediatric Therapy Network, a clinic that she and the other therapists from the Ayres Clinic founded in the fall of 1996.

Both sides agree that SII was in bad financial straits that year, although they don't agree on how it got there. Each side blames the other for instituting failing policies, hiring the wrong people or making bad decisions.

Richter is still a supporter of SII. She was on the board in August 1996 when all 40 Ayres Clinic employees resigned, driving SII almost to the sinking point, especially since many of the clinic's children followed their therapists to PTN.

Mailloux doesn't deny the impact of the move, but says she and her colleagues had no choice but to leave because they were afraid of the clinic's impending financial collapse and closure.

That summer, she said, "I saw every monthly statement that came through, and it was obvious that the threat was real." The therapists wanted to make sure their young patients had the same therapy options they were used to getting.

Mailloux and some staff actually offered to form a new non-profit organization that could purchase the clinic. SII turned them down.

"There was no intention at all of closing the clinic," says Richter, despite the financial situation. "If necessary, we would've sold it before we thought of closing it! One reason the board decided not to separate was that the clinic was essential in carrying out the mission of SII, and there was a financial value to the clinic; those wishing to separate hadn't offered [what we felt was] a meaningful amount of money for it. Actually, we were trying to get the staff involved in trying to turn finances around."

But it was difficult to track spending because SII and the Ayres Clinic did separate bookkeeping. The clinic basically supported itself from treatment, but had to ask the SII board's permission to spend its money.

There were two problems occurring, Richter remembers.

"A major problem was the lack of revenues from the education department. We had scheduled a lot of courses, and enrollments were down in the fall of 1995. There just wasn't much interest out there for courses in the spring of 1996."

The organization was still reeling from having overextended itself in a major SI symposium that year that did not draw the crowd it had hoped.

Meanwhile, in a conference call meeting of what Richter calls the "Temporary SII Recovery Committee" on July 19, 1996, she notated, "The productivity [of the clinic], as measured by wages for treatment, is dropping drastically."

Clinic sources told the board that was because of vacations, a naturally occurring event anywhere in summer months.

But at the end of 1996, the Ayres clinic was empty, and Sensory Integration International was left to ponder its fate. It has overextended all its resources for several years, and badly needed to retool if it was to survive.

Soon two men would be locked in a fierce battle over the future of Jean Ayres' legacy.

In the final installment of this series, Nov. 15, we'll take a look at the current status of SII and examine the claims of Ayres nephew Brian Erwin and SII executive director Anthony Wells to the Jean Ayres name and what they want to do with it.

E.J. Brown is editor of ADVANCE. She can be reached at ebrown@merion.com.