Sunday, June 19, 2011

Types of Sensory Integration/Processing Evaluations

I recently received a letter from a special education teacher; she wrote:

I am a Special Education Teacher and one of my students diagnosed with autism was "tested" (and I use the word tested loosely) for sensory issues by our Occupational Therapist using the Sensory Integration Inventory-Revised test.  The OT reported that the results indicated that there was insufficient evidence showing any sensory issues and her suggestion was for the student with autism in a life skills classroom not to be placed on a sensory diet. She did not suggest additional testing, which is quite odd to me being the SII-R showed insufficient evidence. In addition, according to what I’ve read, the SII-R is a non-standardized check list that is used when clients cannot participate in standardized test. This student is more than capable to participate in a standardized test. Also the SII-R value depends on interpretive skills of the OT. The OT that works for our district has only practiced for a little over a year and in my opinion is inexperienced dealing with sensory issues.

Now that you are aware of the background in this situation, when we go back to the IEP meeting, what type of testing should I or the parent request? I ask because this child is clearly having sensory issues and I need help in knowing what to do to help him meet his educational programming and his mother reports that this child is having difficulties at home too.  When we ask for this assessment, who should perform the testing? I am aware of an OT in our area that specializes (additional CEUs taken) in Sensory Processing Disorders and testing for sensory dysfunction. Is there any difference in what type of test each respective OT can give?


I wrote back:
Dear Mrs. Smith -
As you noted in your email, the SII-R is a non-standardized checklist and one that was published in 1992 and has not been revised since.  Luckily the profession does have some excellent standardized assessment tools and I'm summarizing them below into two categories:

Discriminant Tests:
  • Sensory Integration & Praxis Test (SIPT) (1995): This is the gold standard test for sensory integration/processing disorder and an occupational or physical therapist must be certified to give this test (certification can be obtained from Western Psychological Corporation).  It is a well-standardized test (standardized on 2000 children across the US).  It is meant for a specific group of children however: Children with average to above average intelligence, aged 4 years 0 months to 8 years 11 months and the child must be able to understand directional concepts (in front of, on top of, behind, etc.) and able to draw and move both sides of the body and all extremities and stand independently.  It is not an appropriate test for a child with mental/intellectual impairment or a child with physical impairment.  It is also not standardized for children on the autism spectrum but given that most children on the autism spectrum have sensory issues, I and others have used it with this group with the disclaimer that the scores cannot be used to determine eligibility but are invaluable in providing indicators of a child’s difficulties.
  • Sensory Profile (1999): A Caregiver Questionnaire in which parents/caregivers would answer 125 questions about the child's sensory reactions and behaviors.  Standardized for children aged 3 years 0 months to 10 years 11 months and children of with mild to moderate variability in physical, mental/intellectual abilities/disabilities including moderate to mild autism (i.e.: PDD, Autism, High Functioning, Asperger’s).  Administered, scored and interpreted by an occupational therapist with additional training and expertise in Sensory Processing Disorders (SPD).  There is also a Sensory Profile for Infants/Toddlers (caregiver completes like the original Sensory Profile) and a Sensory Profile for the Adolescent/Adult (answered by the child either by he/she completing the form or via an interview with the OT).  This is a discriminant test so it cannot be used to measure progress - only to determine if a child has differing behaviors/sensory reactions than the average child.
  • School Companion (2006): Similar to the Sensory Profile.  In this standardized test, the teacher of the child answers questions regarding the child's sensory reactions and behaviors.  Standardized for elementary-aged children and children of with mild to moderate variability in physical, mental/intellectual abilities/disabilities including moderate to mild autism (i.e.: PDD, Autism, High Functioning, Asperger’s).  Administered, scored and interpreted by an occupational therapist with additional training and expertise in Sensory Processing Disorders (SPD).  Although this test was developed by the same author as the Sensory Profile, it will yield different results than the Sensory Profile and thus the child's performance between home and school cannot be compared; this variability in results between the two tests sometimes makes a bit more difficult to interpret at times.  This is a discriminant test so it cannot be used to measure progress - only to determine if a child has differing behaviors/sensory reactions than the average child.


*Special Note: Discriminant tests measure permanent characteristics.  IQ tests are discriminant in nature.  If you administer a discriminant test today and again in 3 years, you will likely get very similar results.  This is why discriminant tests cannot be used to measure progress.

Performance-Focused Tests:
  • Sensory Processing Measure (2007): Contains three parts - Home Form, Main Classroom Form, and School Environments Forms.  All three can be administered or just the Home form alone, or just the Main Classroom form alone, or the Main Classroom and School Environments together, or the Home and Main Classroom forms together.  Standardized questionnaires for parent and teachers to complete on the behaviors or performance observed at home (on the Home Form) and in the classroom (Main Classroom and the School Environments Forms) as well as the child's ability to participate in activities at home/in the community and at school.  The Home and Main Classroom forms only contain about 60 questions.  The best feature of this assessment tool is that it allows the OT to compare performance at home vs. that at school; another great feature is that the School Environments forms include 15 questions about behaviors on the Bus, in Art, in Music, In PE/Adaptive PE, on the playground/recess, and in the Cafeteria (these forms can be completed by the Main Classroom teachers or the individual teachers of Art, Music, PE and the Playground/Recess, Cafeteria supervisors and the bus driver).  This assessment tool is much more team focused and considers the child in all his/her usual environments/contexts.  This test is standardized for elementary-aged children and children of wider (than the Sensory Profile/School Companion) varying physical, mental/intellectual abilities/disabilities including severe to mild autism (i.e.: significant Autism, PDD, Autism, High Functioning, Asperger’s).  It is highly reliable and easy to administer, score and interpret.  Administered, scored and interpreted by an occupational therapist and others (i.e.: psychologist, speech pathologist, etc.) with additional training and expertise in Sensory Processing Disorders (SPD).  Because this test is performance-focused (rather than discriminant), it can be used to determine if a child has differing behaviors/sensory reactions than the average child AND can be used to measure progress.  (There is also a Preschool Sensory Processing Measure with much of the same components as the original Sensory Processing Measure.)

*Special Note: Performance-focused tests measure fluid characteristics.  Achievement, criterion-referenced or some developmental tests are performance-focused in nature.  If you administer a performance-focused test today and again in 1, 2 or 3 years, you will likely get different results (that hopefully indicate progress).  This is why performance-focused tests can be used to measure progress.

There are other checklists and screening tools for SPD but the above are the best tools and the only ones that are standardized.  Given that this child is in a life skills classroom, I would guesstimate that the SIPT would not be appropriate but the Sensory Processing Measure or the Sensory Profile/School Companion could be appropriate.  In the IEP meeting, I would ask for an OT with additional training/CEUs and expertise in SPD and who could administer the Sensory Processing Measure or the Sensory Profile/School Companion.

Please let me know if you need any additional information or if I need to clarify any of the above.  :)
DeLana Honaker, PhD, OTR

As I noted in my reply to Mrs. Smith, it is critical to use the appropriate assessment tool that is standardized and appropriate for the child.  I can’t tell you how many times I’ve seen the SIPT used for children with Cerebral Palsy, with mental impairments or who were too old for the test.  Prior to the publication of the School Companion, I saw many therapists ask teachers to complete the Sensory Profile (which is standardized for parents/caregivers to complete – not teachers). 

I think it is exciting that we have so many standardized assessment choices today.  I have been asked in my workshops which test is the best one to use.  In my opinion, for the school-aged child, I tend to use (in the order listed):
  • Sensory Processing Measure (SPM) as it is performance-focused, so very easy to administer and score, is team-focused, and because I can re-administer and determine if my intervention is effecting progress.  I also love that the Home Form and Main Classroom Forms are virtually the same and this makes it the ONLY test in which I can truly compare school performance with home performance.  I use the analogy that in all the tests I’ve noted above, we are comparing apples to apples (they are all about sensory integration/processing) but given that the Sensory Profile and the School Companion ask different questions and yield different results (i.e.: a child may be found to be “Sensory Seeking” by the Sensory Profile and ‘Requires Attention” on the School Companion; each are different diagnoses) so it is like comparing red delicious apples to Fuji apples – they are both apples but different in texture, taste and sweetness.  With the Sensory Processing Measure, I believe I am comparing red delicious apples to red delicious apples and thus I have more confidence in the results as well as my interpretation of the results.
  • Sensory Integration & Praxis Test (SIPT): If I were not able to get a handle on the child’s sensory issues and how they are affecting occupational performance with the Sensory Processing Measure, then I would most likely use the SIPT (as long as it is appropriate for the child) because it is the gold standard and in-depth and is an excellent and comprehensive test.
  • Sensory Profiles and School Companion: For the reasons cited in this post.  Both are well-standardized tests and illuminating but only look at sensory modulation issues and given that sensory processing considers sensory modulation disorder, sensory discrimination and sensory-based motor disorder, I must also consider postural and praxis issues (which are evaluated by the SIPT and addressed in the SPM).

What are your thoughts about sensory integration/processing assessments?

DeLana

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