RECONCEPTUALIZING SENSORY REGULATION IN AUTISM SPECTRUM DISORDER: A COMPARATIVE AND INTEGRATIVE ANALYSIS OF OCCUPATIONAL THERAPY AND ENVIRONMENTAL MODIFICATIONS

Abstract

Sensory processing differences constitute a central and functionally significant dimension of Autism Spectrum Disorder (ASD), shaping children’s behavioural regulation, participation, and adaptive functioning. Despite extensive use of Occupational Therapy (OT) and Environmental Modifications (EM) to address these challenges, existing research has largely examined these approaches in isolation, limiting understanding of their comparative and integrative effects. This study investigates the differential and complementary efficacy of OT and EM through a mixed-methods randomized controlled design with longitudinal follow-up involving children aged 3–12 years diagnosed with ASD. Quantitative findings indicate that OT produces significant improvements in sensory integration, adaptive functioning, and participation through individualized, activity-based interventions. In contrast, EM contributes to immediate reductions in sensory overload and behavioural dysregulation by restructuring environmental demands. However, the most substantial and sustained outcomes emerge from the alignment of these approaches, highlighting their complementary mechanisms. Qualitative analysis further reveals that intervention effectiveness is shaped by contextual and systemic factors, including socioeconomic conditions, implementation barriers, and the congruence between professional practices and family experiences. Drawing on a person environment interaction perspective, the study reconceptualizes sensory regulation as a dynamic, relational process rather than a solely intrinsic deficit. It advances an integrative framework in which optimal outcomes are achieved through the alignment of internal regulatory capacities and external environmental supports. The findings contribute to intervention science by bridging the gap between clinical efficacy and real-world applicability, offering implications for practice, interdisciplinary collaboration, and policy development in autism care.