Sensory processing is not something that
can be directly measured, since it is a purely subjective area. We
cannot see how things appear to another person, or hear how different
noises sound. Children often lack the vocabulary and the point of
reference to describe how they are experiencing the world. Therefore,
we are limited to observing responses to different sensations and
looking for evidence of difficulty making good use of sensory input.
For example, if a child has a hard time standing on one foot, we can
theorize that they may not be integrating their sense of gravity's
pull, or of their awareness of their own position in space, or both. We
can then further investigate similar areas through other observed
activities and assemble a picture of ability and difficulty,
"detective-style." There are very few standardized or normative tests
that assess sensory integration or processing:
The
Sensory
Integration and Praxis Test (SIPT) is a standardized battery of
tests to get
an in-depth look at various aspects of sensory processing in order to
assess
sensory integration dysfunction. It can be used on children four 8
years, 11 months of age. It takes several hours to administer the whole
test and
requires extensive and expensive training to learn to administer it.
Therapists who complete this training (through
Western
Psychological Services)
are certified and listed in a database. Because of the commitment
required to become certified, it can be difficult to find a therapist
in your area who is trained to administer this test. Some therapists
use subtests from this tool (or from its precursor, the Southern
California Test of Sensory Integration) as informal tools to look at
specific aspects of sensory processing such as motor planning or
bilateral integration in motor skills.
The
Sensory Profile is a
standardized tool for measuring sensory abilities and the effect those
abilities have on functional performance in children three to
ten. It is a judgment-based
questionnaire that evaluates how a child responds to visual, auditory,
touch, taste, movement, and multi sensory stimuli. A classification
system based on means is used to rate the child’s responses in
comparison to a normative sample of children. It is helpful in
determining whether there is a strong pattern of over- or
under-responsiveness to sensory input in general, as well as in which
areas those atypical responses are most often seen. There is also a
School Companion Sensory Profile
which is
usually given to teachers; it doesn't include a lot of the questions
that would be seen at home but not at school ("exhibits distress during
grooming," for example). Now there is also an
Adult/Adolescent Sensory Profile,
which I sometimes use interview-style with young teens or pre-teens to
assess their awareness and perception of their own sensory preferences,
as well as an
Infant/Toddler Sensory
Profile.
The
Test of Sensory Functions in
Infants was developed by early childhood specialists Georgia
DeGangi, PhD, OTR and Dr. Stanley Greenspan, (well known for his
approach in working with children called "floor time"). It
assesses five areas of sensory function (reactivity to tactile deep
pressure, adaptive motor functions, visual-tactile integration,
ocular-motor control, and reactivity to vestibular stimulation) in
children from four to eighteen months of age. Each item is scored via a
numerical rating scale and results in "normal," "at risk," or
"deficient" scores (an older test with not-so sensitive terms).
In addition, therapists often use standardized motor skills tests such
as the
Peabody Developmental Motor
Scales, 2nd ed. (PDMS-2), for children birth
to six years of age, or the
Bruininks-Oseretsky
Test of Motor
Performance (TMP). The TMP has not been re-normed in many years
and so
is of questionable validity. Unfortunately, there are scarce options
for standardized motor skills tests for children older than six years.
Often, therapists will use informal assessment methods to investigate
sensory processing and integration. These can include
structured
observations, such as asking a child to try to imitate
positions, hand
placements, or gestures without looking at their own body. Or watching
a child navigate an unfamiliar obstacle course while noting how quickly
and adeptly he is able to move himself under/over/through the
equipment. Both of these observations would assess
motor planning, and both would
require familiarity with typical development of motor skills for
comparison. As a guide to assessing sensory integration through
observation, A. Jean Ayres published a form called "Clinical
Observation of Sensory Integration" in 1975. It includes such
observations as eye movements across body midline, holding of trunk
flexion and extension against gravity, and the presence or absence of
tonic neck reflexes. More recently, Winnie Dunn, M.Ed., OTR
incorporated some of these observations and used a normative population
of 263 children to come up with some broad guidelines for
Kindergarten-aged children, published as
A Guide to Testing Clinical Observations in
Kindergarteners.
Other observations could include directly
observing responses to typically
non-aversive sensations. For
example, if a child covers her ears when the bathroom fan goes on,
comments on the ticking of a quiet clock, seems afraid of a fuzzy
stuffed animal, or strongly avoids letting his feet come off the ground
while sitting on a swing, a therapist would note that and look for
patterns.
Finally, an
interview with
caregivers and/or teachers about their observations, concerns, and
reports of typical behaviors and abilities can be an important piece of
the puzzle. No one knows a child better than the people who spend every
day with her. A therapist can help gather information and help with the
detective work of assessing sensory processing.