5/1/2017 A Review of Pediatric Assessment Tools for Sensory Integration - AOTA

PUBLICATIONS & NEWS SIS QUARTERLY SENSORY INTEGRATION

A Review of Pediatric Assessment Tools for Sensory Integration

Baltazar Mori, A., Clippard, H., del Pilar Saa, M., & Pfeiffer, B. (2016). A review of pediatric assessment tools for sensory
integration.  SIS Quarterly Practice Connections.  1(3), 7–9.

By Annie Baltazar Mori, OTD, OTR/L; Heidi Clippard, MOT, OTR/L; Maria del Pilar Saa, OTD, OTR/L; and Beth Pfeiffer,
PhD, OTR/L, BCP

The original work of Jean Ayres provided a strong foundation for assessing specific areas related to sensory integration
and their effect on occupational performance and participation (Ayres, 1979, 1989). Her work has continued to evolve over
the past few decades through the inquiry and efforts of several occupational therapy researchers (Blanche, 2010; Blanche,
Bodison, Chang, & Reinoso, 2012; Dunn, 2014; May-Benson & Cermak, 2007; Parham & Ecker, 2007; Pfeiffer, Coster, &
Tucker, 2016).

One goal of these collective research efforts is to place appropriate measurement tools in the hands of therapists for sound
clinical application. A comprehensive evaluation of the occupational effect sensory integration deficits have on participation
and performance requires both proximal and distal measures that directly and indirectly identify these deficits.
Comprehensive evaluations are inclusive of non-standardized assessments such as interview and clinical observations, as
well as standardized assessments with established psychometric properties. The interpretation of the comprehensive
evaluation is essential in guiding a clinician’s treatment plan and subsequent intervention (Parham & Mailloux, 2014;
Watling, Koenig, Davies, & Schaaf, 2011). Careful consideration and selection of tools to use at initial assessment, as well
as pre- and post-intervention, is crucial for determining outcomes. Accurate evaluation and clear communication of these
outcomes advance the existing body of evidence and justify further development and revision of interventions in sensory
integration theory and practice (Mailloux et al., 2007; Parham et al., 2011; Schaaf et al., 2014; Watling & Hauer, 2015).

The purpose of this work is to provide clinicians with a current, comprehensive list of robust pediatric assessment tools
specific to sensory integration. Information about available tools, as well as those in development, is included. A case
example is embedded to demonstrate clinical selection and application of the tools. An overview is provided of tools that
assess the impact of sensory integration on performance or participation of children (see Tables 1 and 2).

Clinical Case Application

The following case example provides a description of the clinical reasoning process of assessment selection. Ella, a 7-year,
3-month-old girl, was referred for an occupational therapy evaluation at a private pediatric clinic because of issues with
sensory processing affecting performance and participation in daily activities. She refused to wear socks and closed-toe
shoes, a safety requirement at her school. Her intense reaction to the feel of socks and shoes affected her independence
in daily morning routines in preparation for school. Additionally, Ella’s play and social skills were identified as a major
concern. Her parents reported that she seemed to engage in play that is typical for a younger child, and this affected her
friendships with other children her age. Based on referral information, a comprehensive occupational history questionnaire
adapted from Schaaf and Mailloux (2015) and the Sensory Processing Measure (SPM) Home Form (Parham & Ecker,
2007) were selected for completion by Ella’s parents. Clinical observations and standardized testing with the Sensory
Integration and Praxis Tests (SIPT; Mailloux, 1990) were used during evaluation by the occupational therapist. With the
SIPT Ella showed average scores with visual perception (i.e., space visualization, figure–ground perception) and visual-
motor skills (i.e., design copying, motor accuracy). Ella had below average scores in areas of tactile perception (i.e.,
manual form perception, graphesthesia), praxis (i.e., constructional praxis, oral praxis, postural praxis), and on the Post
Rotary Nystagmus test. Additional review of Ella’s SIPT testing identified below average time scores on visual tests and
part scores (e.g., jogs, segmentations, right-left, rotation) on design copying and constructional praxis tests, respectively.
Results of these tests are correlated with vestibular spatial functions. Tests of tactile functions also share a relationship
with visual spatial orientation functions. Ella’s SIPT scores were consistent with responses on the SPM, which identified
some problems or definite dysfunction in the areas of tactile, body awareness, planning and ideas, and social participation.

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Ella’s initiation and approach in play skills were observed in a novel clinic setting. Structured clinical observations of
sensory integration were conducted. Results from clinical observations identified that Ella exhibited strong excited emotional
reactions to vestibular sensation. She sought proprioceptive input through climbing and jumping. Her tactile play was
characterized by brief initial hesitance followed by appropriate engagement and play. Observations of Ella’s play skills were
consistent with testing results identifying concerns in the area of praxis and reports on the SPM of difficulties in planning
and ideas. Her play was simplistic for her age, consisting of one-step activities. Ella donned socks and shoes and was
observed to grimace without verbal complaints. Ella was observed to consistently tap her feet on the floor until she was
asked to remove her socks and shoes. Results from the evaluation identified concerns in sensory reactivity, praxis, and
body and spatial awareness because of poor tactile and vestibular processing, resulting in specific clothing and play
choices that limited her ease in transitions and social participation. Treatment addressing the concerns identified in the
evaluation process resulted in Ella’s use of more complex play schemes and increased engagement in play with her peers,
as well as an increase comfort in wearing shoes and socks.

This case provides an example of assessment selection and implementation to direct the treatment process based on the
child’s unique needs and characteristics. Appropriate assessment selection based on the expertise of the evaluator and
service delivery model is essential to direct precision treatment and identifies subsequent outcomes of interventions.

References

Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.
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Ayres, A.
J. (1989).
Sensory
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and Praxis
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Psychological Services.

Blanche, E. I. (2010). Observations based on sensory integration theory. Torrance, CA: Pediatric Therapy Network.

Blanche, E. I., Bodison, S., Chang, M. C., & Reinoso, G. (2012). Development of the Comprehensive Observations of
Proprioception (COP): Validity, reliability, and factor analysis. American Journal of Occupational Therapy, 66, 691–698.
http://dx.doi.org/10.5014/ajot.2012.003608

Dunn, W. (2014). Sensory Profile 2 Manual. Bloomington, MN: Pearson.

Little, L. M., Freuler, A. C., Houser, M. B., Guckian, L., Carbine, K., David, F. J., & Baranek, G. T. (2011). Psychometric
validation of the sensory experiences questionnaire. American Journal of Occupational Therapy, 65, 207–210.
http://dx.doi.org/10.5014/ajot.2011.000844

Mailloux, Z. (1990). An overview of the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy,
44, 589–594. http://dx.doi.org/10.5014/ajot.44.7.589

Mailloux, Z., May-Benson, T. A., Summers, C. A., Miller, L. J., Brett-Green, B., Burke, J. P., … Schoen, S. A. (2007). Goal
attainment scaling as a measurement of meaningful outcomes for children with sensory integration disorders. American
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May-Benson, T. A., & Cermak, S. A. (2007). Development of an assessment for ideational praxis. American Journal of
Occupational Therapy, 61, 142–147.

Miller, L. J. (2013). Goal-Oriented Assessment of Life Skills (GOAL). Los Angeles: Western Psychological Services.

Parham, D., & Ecker, C. (2007). Sensory Processing Measure manual. Los Angeles: Western Psychological Services.

Parham, L. D., Smith Roley, S., May-Benson, T. A., Koomar, J. A., Brett-Green, B., Burke, J. P., … Schaaf, R. C. (2011).
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Journal of Occupational Therapy, 65, 133–142. http://dx.doi.org/10.5014/ajot.2011.000745

Parham, L. D., & Mailloux, Z. (2014). Sensory integration. In J. Case-Smith & J. C. O’Brien (Eds.), Occupational therapy for
children and adolescents (7th ed., pp. 258–303). St. Louis: Mosby/Elsevier.

Pfeiffer, B., Coster, W., & Tucker, C. (2016). Development and content validity of the Sensory Environment and
Participation Questionnaire. Manuscript submitted for publication.

Schaaf, R. C., Burke, J. P., Cohn, E., May-Benson, T. A., Schoen, S. A., Smith Roley, S., … Mailloux, Z. (2014). State of
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Schaaf, R. & Mailloux, Z. (2015). A clinician’s guide for implementing Ayres Sensory Integration®: Promoting participation
for children with autism. Bethesda, MD: AOTA Press.

Watling, R., Koenig, K. P., Davies, P. L., Schaaf, R. C. (2011). Occupational therapy practice guidelines for children and
adolescents with challenges in sensory processing and sensory integration. Bethesda, MD: AOTA Press.

Watling, R., & Hauer, S. (2015). Effectiveness of Ayres Sensory Integration® and sensory-based interventions for people
with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180030p1–
6905180030p12. http://dx.doi.org/10.5014/ajot.2015.018051
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