Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure.

IMPORTANCE: The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. OBJECTIVE: To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. DESIGN: Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. SETTING: Three outpatient clinic sites in the United States. PARTICIPANTS: Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. OUTCOMES AND MEASURES: The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. RESULTS: Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. CONCLUSIONS AND RELEVANCE: The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. WHAT THIS ARTICLE ADDS: This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.

Early Identification of Sensory Processing Difficulties in High-Risk Infants.

OBJECTIVE: Our objective was to determine the extent to which young children at high risk for sensory processing difficulties differed from those who were at low risk. METHOD: We compared high- versus low-risk young children using standardized measures. High-risk participants had older siblings identified as having sensory processing difficulties after a comprehensive occupational therapy evaluation (n = 13); low-risk participants (n = 16) had typically developing siblings and no family history of sensory or other neurological disorders. RESULTS: High-risk infants scored significantly lower on the Language and Cognitive scales of the Bayley Scales of Infant and Toddler Development-Third Edition. The high-risk group presented with more atypical positions on the Toddler and Infant Motor Evaluation and fewer sensation-seeking behaviors on the Toddler Sensory Profile-2. CONCLUSION: Results suggest that sensory, motor, cognitive, and language dimensions may be associated with sensory processing difficulties. Implications exist for the design of future studies and for early intervention.

Phenotypes within sensory modulation dysfunction.

Sensory modulation disorder (SMD) is a severe inability to regulate responses to everyday sensory stimulation to which most people easily adapt. It is estimated to affect 5% to 16% of the general population of children. Although heterogeneity is seen in the presentation clinically, previous research has not empirically investigated whether the clinical heterogeneity of SMD can be classified into subtypes. This study explores a cohort of 98 children identified with SMD at the Department of Pediatric Rehabilitation by a member of the occupational therapy team at The Children's Hospital of Denver. Two subtypes of SMD were identified through cluster analysis based on data from 4 parent-report instruments. The first subtype is characterized by sensory seeking/craving, hyperactive, impulsive, externalizing (eg, delinquent, aggressive), unsocial, inadaptive, and impaired cognitive/social behavior. The second subtype is characterized by movement sensitivity, emotionally withdrawal, and low energy/weak behavior. Findings from this study present a step toward understanding and classifying the complexities of children with SMDs.

Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis.

For more than 50 years, "Sensory Integration" has been a theoretical framework for diagnosing and treating disabilities in children under the umbrella of "sensory integration dysfunction" (SID). More recently, the approach has been reframed as "the dimensions of sensory processing" or SPD in place of SID, so the review herein describes this collective framework as sensory integration/sensory processing treatment (SI/SP-T) for ASD. This review is not focused on diagnosis of SI/SPD. Broadly, the SI/SPD intervention approach views a plethora of disabilities such as ADHD, ASD, and disruptive behavior as being exacerbated by difficulties in modulating and integrating sensory input with a primary focus on contributions from tactile, proprioceptive, and vestibular systems which are hypothesized to contribute to core symptoms of the conditions (e.g., ASD). SI/SP intervention procedures include sensory protocols designed to enhance tactile, proprioceptive, and vestibular experiences. SI/SP-T procedures utilize equipment (e.g., lycra swings, balance beams, climbing walls, and trampolines), specific devices (e.g., weighted vests, sensory brushes) and activities (e.g., placing hands in messy substances such as shaving cream, sequenced movements) hypothesized to enhance sensory integration and sensory processing. The approach is reviewed herein to provide a framework for testing SI/SP-T using widely accepted clinical trials and event coding methods used in applied behavior analysis (ABA) and other behavioral interventions. Also, a related but distinct neuroscientific paradigm, multisensory integration, is presented as an independent test of whether SI/SP-T differentially impacts sensory integration and/or multisensory integration. Finally, because SI/SP-T activities include many incidental behavioral events that are known as developmental facilitators (e.g., contingent verbal models/recasts during verbal interactions), there is a compelling need to control for confounds to study the unique impact of sensory-based interventions. Note that SI/SP-T includes very specific and identifiable procedures and materials, so it is reasonable to expect high treatment fidelity when testing the approach. A patient case is presented that illustrates this confound with a known facilitator (recast intervention) and a method for controlling potential confounds in order to conduct unbiased studies of the effects of SI/SP-T approaches that accurately represent SI/SP-T theories of change.

Sensory over-responsivity: parent report, direct assessment measures, and neural architecture.

Background: Sensory processing difficulties are common across neurodevelopmental disorders. Thus, reliable measures are needed to understand the biological underpinnings of these differences. This study aimed to define a scoring methodology specific to auditory (AOR) and tactile (TOR) over-responsivity. Second, in a pilot cohort using MRI Diffusion Tensor Imaging, we performed a proof of concept study of whether children with AOR showed measurable differences in their white matter integrity. Methods: This study included children with AOR and TOR from a mixed neurodevelopmental disorder cohort including autism and sensory processing dysfunction (n = 176) as well as neurotypical children (n = 128). We established cohorts based on sensory over-responsivity using parent report (Short Sensory Profile (SSP)) and direct assessment (Sensory Processing-Three Dimensions: Assessment (SP-3D:A)) measures. With a subset of the children (n = 39), group comparisons, based on AOR phenotype, were conducted comparing the white matter fractional anisotropy in 23 regions of interest. Results: Using direct assessment, 31% of the children with neurodevelopmental disorders had AOR and 27% had TOR. The inter-test agreement between SSP and SP-3D:A for AOR was 65% and TOR was 50%. Children with AOR had three white matter tracts showing decreased fractional anisotropy relative to children without AOR. Conclusions: This study identified cut-off scores for AOR and TOR using the SSP parent report and SP-3D:A observation. A combination of questionnaire and direct observation measures should be used in clinical and research settings. The SSP parent report and SP-3D:A direct observation ratings overlapped moderately for sensory related behaviors. Based on these preliminary structural neuroimaging results, we suggest a putative neural network may contribute to AOR.

Pilot study of the Sensory Over-Responsivity Scales: assessment and inventory.

This article describes 3 stages of construction of the Sensory Over-Responsivity (SensOR) Scales: instrument development, reliability and validity analyses, and cross-validation on a new sample. The SensOR Scales include the SensOR Assessment, an examiner-administered performance evaluation, and the SensOR Inventory, a caregiver self-rating scale. Both scales measure sensory overresponsivity in 7 sensory domains. Data were collected from 2 samples consisting of participants who were typically developing (ns = 60 and 44, respectively) and participants with sensory overresponsivity (ns = 65 and 48, respectively), ages 3 to 55. In developing the research edition, items on the pilot version were reviewed for their internal consistency reliability, discriminant validity, and construct validity. Data from both samples on the research edition revealed high internal consistency reliability for domains and the total test and significant discrimination between the overresponsive and the typically responsive groups (p < .05). The preliminary psychometric integrity of the scales, along with continued research efforts, is an important contribution to evidence-based practice.

Sensory reactivity, empathizing and systemizing in autism spectrum conditions and sensory processing disorder.

Although the DSM-5 added sensory symptoms as a criterion for ASC, there is a group of children who display sensory symptoms but do not have ASC; children with sensory processing disorder (SPD). To be able to differentiate these two disorders, our aim was to evaluate whether children with ASC show more sensory symptomatology and/or different cognitive styles in empathy and systemizing compared to children with SPD and typically developing (TD) children. The study included 210 participants: 68 children with ASC, 79 with SPD and 63 TD children. The Sensory Processing Scale Inventory was used to measure sensory symptoms, the Autism Spectrum Quotient (AQ) to measure autistic traits, and the Empathy Quotient (EQ) and Systemizing Quotient (SQ) to measure cognitive styles. Across groups, a greater sensory symptomatology was associated with lower empathy. Further, both the ASC and SPD groups showed more sensory symptoms than TD children. Children with ASC and SPD only differed on sensory under-reactivity. The ASD group did, however, show lower empathy and higher systemizing scores than the SPD group. Together, this suggest that sensory symptoms alone may not be adequate to differentiate children with ASC and SPD but that cognitive style measures could be used for differential diagnosis.

A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder.

OBJECTIVE: A pilot randomized controlled trial (RCT) of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) was conducted with children who had sensory modulation disorders (SMDs). This study evaluated the effectiveness of three treatment groups. In addition, sample size estimates for a large scale, multisite RCT were calculated. METHOD: Twenty-four children with SMD were randomly assigned to one of three treatment conditions; OT-SI, Activity Protocol, and No Treatment. Pretest and posttest measures of behavior, sensory and adaptive functioning, and physiology were administered. RESULTS: The OT-SI group, compared to the other two groups, made significant gains on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised. Compared to the control groups, OT-SI improvement trends on the Short Sensory Profile, Child Behavior Checklist, and electrodermal reactivity were in the hypothesized direction. CONCLUSION: Findings suggest that OT-SI may be effective in ameliorating difficulties of children with SMD.

Lessons learned: a pilot study on occupational therapy effectiveness for children with sensory modulation disorder.

OBJECTIVE: The purpose of this pilot study was to prepare for a randomized controlled study of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) with children who have sensory processing disorders (SPD). METHOD: A one-group pretest, posttest design with 30 children was completed with a subset of children with SPD, those with sensory modulation disorder. RESULTS: Lessons learned relate to (a) identifying a homogeneous sample with quantifiable inclusion criteria, (b) developing an intervention manual for study replication and a fidelity to treatment measure, (c) determining which outcomes are sensitive to change and relate to parents' priorities, and (d) clarifying rigorous methodologies (e.g., blinded examiners, randomization, power). CONCLUSION: A comprehensive program of research is needed, including multiple pilot studies to develop enough knowledge that high-quality effectiveness research in occupational therapy can be completed. Previous effectiveness studies in OT-SI have been single projects not based on a unified long-term program of research.

How does sensory processing dysfunction affect play?

OBJECTIVE: This study investigated sensory processing dysfunction (SPD) and playfulness and the effect of intervention on playfulness. METHOD: Twenty children with SPD and 20 children who were typically developing took the Short Sensory Profile (SSP) and Test of Playfulness (ToP). Children with SPD took the praxis tests from the Sensory Integration and Praxis Tests (SIPT) and received 20 intervention sessions. Correlations among measures and differences between mean scores of groups and pre-intervention and post-intervention were examined. RESULTS: Group ToP scores differed significantly; ToP did not increase post-intervention. Correlations among ToP and SSP ranged from .36 to .72; ToP and SIPT, from -0.1 to -0.46. CONCLUSION: Modulation affects playfulness. Although intervention was not effective, both groups had high scores initially, making the finding difficult to interpret.

Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders.

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies.

Fidelity in sensory integration intervention research.

OBJECTIVE: We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles). METHOD: We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements. RESULTS: Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration. CONCLUSION: Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.

Exploring the Influence of an E-Learning Sensory Processing-Based Module for Graduate Level Occupational Therapy Students on Clinical Reasoning: A Pilot Study.

The purpose of this study was to explore the effectiveness of a series of online, module-based instructional reusable learning objects (RLOs) targeted at entry-level, 1st year, Master of Occupational Therapy students. The content of the RLOs addressed knowledge and implementation of A SECRET, a parental reasoning approach for children with a sensory processing disorder, specifically sensory over responsiveness. Nine RLOs were developed and embedded within a commonly used learning management system. Participants (n = 8) were evaluated regarding their ability to discriminate between appropriate and inappropriate A SECRET strategies using a selected-response assessment. The participants' overall average score was 68%, a positive finding given the novelty of the instruction, assessment, and the content.

The Development of a Measurement Tool Evaluating Knowledge Related to Sensory Processing among Graduate Occupational Therapy Students: A Process Description.

With an increased demand arising from stake holders to provide more complex clinical experiences and to have students better prepared for clinical rotations, educators need to develop instructional tasks and measures to teach and assess clinical reasoning. The purpose of this article is to highlight a clinical simulation measure revolving around the A SECRET reasoning approach, which is also generalizable to other conditions and interventions. Preliminary findings of 1st year Master of Occupational Therapy students (n = 8) who took part in a pilot of the A SECRET case scenario reported positive, yet not strong, attitudes toward the A SECRET assessment and the sensory processing related content delivered in an online format as a part of a larger study. Overall the student perceptions and the processes of the measure development suggest an inherent value of using the proposed type of simulated case scenarios in assisting occupational therapy students in their program's first year with the development of clinical reasoning.

Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study.

RATIONALE: This study explored subtypes of sensory processing disorder (SPD) by examining the clinical presentations of cluster groups that emerged from scores of children with SPD on the Sensory Processing 3-Dimension (SP-3D) Inventory. METHOD: A nonexperimental design was used involving data extraction from the records of 252 children with SPD. Exploratory cluster analyses were conducted with scores from the SP-3D Inventory which measures sensory overresponsivity (SOR), sensory underresponsivity (SUR), sensory craving (SC), postural disorder, dyspraxia, and sensory discrimination. Scores related to adaptive behavior, social-emotional functioning, and attention among children with different sensory modulation patterns were then examined and compared. RESULTS: Three distinct cluster groups emerged from the data: High SOR only, High SUR with SOR, and High SC with SOR. All groups showed low performance within multiple domains of adaptive behavior. Atypical behaviors associated with social-emotional functioning and attention varied among the groups. IMPLICATIONS: The SP-3D Inventory shows promise as a tool for assisting in identifying patterns of sensory dysfunction and for guiding intervention. Better characterization can guide intervention precision and facilitate homogenous samples for research.

Prevalence of parents' perceptions of sensory processing disorders among kindergarten children.

This study is the first to systematically examine estimated rates of sensory processing disorders using survey data. Parents of incoming kindergartners from one suburban U.S. public school district were surveyed using the Short Sensory Profile, a parent-report screening tool that evaluates parents' perceptions of functional correlates of sensory processing disorders (McIntosh, Miller, Shyu, & Dunn, 1999a). A total of 703 completed surveys were returned, which represents 39% of the kindergarten enrollment (n = 1,796) in the district for the 1999-2000 school year. Of the 703 children represented by the surveys, 96 children (13.7% of 703) met criteria for sensory processing disorders based upon parental perceptions. A more conservative prevalence estimate of children having sensory processing disorders based on parental perceptions was calculated by assuming that all non-respondents failed to meet screening criteria. This cautious estimate suggests that based on parents' perceptions, 5.3% (96 of 1796) of the kindergarten enrollment met screening criteria for sensory processing disorders. These percentages are consistent with hypothesized estimates published in the literature. Findings suggest a need for rigorous epidemiological studies of sensory processing disorders.

Children with disturbances in sensory processing: a pilot study examining the role of the parasympathetic nervous system.

This study was a preliminary investigation of parasympathetic nervous system (PNS) functioning in children with disturbances in sensory processing. The specific aims of this study were to (1) provide preliminary data about group differences in parasympathetic functions, as measured by the vagal tone index, between children with disturbances in sensory processing and those without; (2) determine effect size and power needed for future studies; and (3) to lay the foundation for further examination of the relations of parasympathetic functioning and functional behavior in children with disturbances in sensory processing. Participants were 15 children, nine with disturbances in sensory processing and six typically developing children. Heart period data were continuously collected for a 2-minute baseline and during administration of the 15-minute Sensory Challenge Protocol, a unique laboratory protocol designed to measure sensory reactivity (Miller, Reisman, McIntosh, & Simon, 2001). Groups were compared on vagal tone index, heart period, and heart rate using two-tailed, independent sample t tests. Children with disturbances in sensory processing had significantly lower vagal tone than the typically developing sample (t(13) = 2.4, p = .05). Statistical power analysis indicated that, for future studies, a sample size of 20 in each group would yield adequate statistical power. Although the number of subjects in this pilot study is small, the results from this study support further investigations of parasympathetic functions and functional behavior in children with disturbances in sensory processing.

Prediction of school performance using the Miller Assessment for Preschoolers (MAP): a validity study.

OBJECTIVE: The purpose of this study was to examine the ability of the Miller Assessment for Preschoolers (MAP) to predict academic performance of Israeli preschoolers after a period of 5 to 7 years. METHOD: Thirty children who were classified according to the MAP as preschoolers at risk (n= 15) and not at risk (n= 15) for pre-academic problems were tracked after 5 to 7 years. Follow-up evaluations were done on motor, visual-motor integrative, and cognitive performance components; reading and handwriting academic performance areas; and a variety of measures taken to establish overall school functional status. RESULTS: Results indicate that children classified by the MAP as preschoolers at risk performed significantly worse 5 to 7 years later on visual-motor, cognitive, and reading and handwriting tests than those preschoolers classified not at risk and demonstrated reduced overall school functional status. CONCLUSION: The findings indicate that the MAP can predict academic performance even over a 5-year to 7-year interval. Furthermore, by linking academic performance data to performance components of children in different cultures, our investigation contributes to the overall understanding of children's functioning.