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.

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
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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
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Dunn, W. (2014). Sensory Profile 2 Manual. Bloomington, MN: Pearson.
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Pfeiffer, B., Coster, W., & Tucker, C. (2016). Development and content validity of the Sensory
Environment and Participation Questionnaire. Manuscript submitted for publication.
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Promoting participation for children with autism. Bethesda, MD: AOTA Press.
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for children and adolescents with challenges in sensory processing and sensory integration. Bethesda,
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Annie Baltazar Mori, OTD, OTR/L, is an occupational therapist and owner of PlaySense, Inc. in
Redondo Beach, California. She can be reached at [email protected].
Heidi Clippard, MOT, OTR/L, is an occupational therapist at the Cincinnati Children's Hospital
Medical Center in Cincinnati.
Maria del Pilar Saa, OTD, OTR/L, is an occupational therapist and owner of Interplay Therapy in
Palm Beach, Florida.
Beth Pfeiffer, PhD, OTR/L, BCP, is an associate professor in the Department of Rehabilitation
Sciences at Temple University in Philadelphia.
Correction: In the print version of this article, the Sensory Integration and Praxis Tests (SIPT)
were omitted from the table of assessment tools of sensory processing and integration. The
table has been updated to reflect this error. The Sensory Integration Special Interest Section
feels strongly about sound and scientific measurement in occupational therapy. The SIPT, a
significant contributor to our practice area, is considered the gold standard in assessment of
sensory functions as well as occupational therapy's current and only standardized assessment of
pediatric tactile and praxis functions.
https://www.aota.org/Publications-News/SISQuarterly/children-youth-practice-connections/SISIS-8-16.aspx