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. A... more
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. 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. 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 a...
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Mentoring is essential at all stages of a professional career. However, little has been written about the effectiveness of programs for practicing clinicians. This study was designed to address the need for evidence about the... more
Mentoring is essential at all stages of a professional career. However, little has been written about the effectiveness of programs for practicing clinicians. This study was designed to address the need for evidence about the effectiveness of formal mentorship programs by describing the impact of the STAR mentorship program on a group of clinicians specializing in sensory integration and processing challenges. This study utilized an exploratory, retrospective, survey research design. Course evaluations were examined from 240 subjects following participation in a one-week, small group mentorship training program. Qualitative methods were adapted for use in this study. Sixteen codes, with operational definitions, were developed to analyze the surveys. Ninety-six percent indicated that the program met or exceeded their expectations; only 12.5% had a negative comment. Impact on psychosocial function was reflected by 22% of the participants. Comments related to impact on career function ...
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Sensory processing and integration challenges affect as many as 5%-16% of children in the United States. These individuals present with differing types of symptom presentation, and differing disruptions in the organization and processing... more
Sensory processing and integration challenges affect as many as 5%-16% of children in the United States. These individuals present with differing types of symptom presentation, and differing disruptions in the organization and processing of sensory experiences (STAR Institute for Sensory Processing, 2020). While not officially a diagnosis in the DSM V, the behaviors defined and categorized by occupational therapists describe difficulties in one or more of the sensory systems in the body that are not functioning properly.
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Background: A developing area for therapy is teaching children to ride a bicycle. Little has been written about the effectiveness of these programs. This study explored outcomes from participation in a novel bicycle riding program for... more
Background: A developing area for therapy is teaching children to ride a bicycle. Little has been written about the effectiveness of these programs. This study explored outcomes from participation in a novel bicycle riding program for children with a wide array of developmental challenges. Method: Two studies were conducted; a nonconcurrent, multiple baseline design with four participants and a pretest–posttest single group with 15 children. Results: Study 1 participants improved on broad jump. Balance positions showed variable responses. Study 2 participants showed significant improvement on broad jump, and a trend toward significance walking forwards and backwards. Parents reported improvement in following rules, participating in daily routines, interacting with peers, and feeling good about him/herself and a change in child’s participation in community and extracurricular activities. All children improved in glide time or achieved independent riding. Conclusions: Preliminary evid...
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How can measuring children's Electrodermal Activity (EDA) help improve the design of an occupational therapy experience? Twenty-two children with sensory challenges such as Autism and ADHD participated in the study. Children attended... more
How can measuring children's Electrodermal Activity (EDA) help improve the design of an occupational therapy experience? Twenty-two children with sensory challenges such as Autism and ADHD participated in the study. Children attended occupational therapy as usual, while their physiological arousal (i.e., EDA) was measured with a wireless device on the bottom calf. Combining the EDA signal with video, researchers could better understand the emotional experience of therapy. All 22 children were able to wear the portable EDA sensors throughout the vigorous activities with minimal impact. Five insights generated from these observations are described in detail, with emphasis on how therapists used the findings to re-design their therapeutic process. This paper demonstrates how the ambulatory measurement of EDA can directly help with the emotional design of therapeutic services.
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This paper reflects two studies designed to explore feasibility and outcomes of a movement-based trampoline group for children with autism and/or sensory processing challenges. A pre experimental A- B single subject pilot study was used... more
This paper reflects two studies designed to explore feasibility and outcomes of a movement-based trampoline group for children with autism and/or sensory processing challenges. A pre experimental A- B single subject pilot study was used to examine feasibility and sensitivity of outcomes, followed by a single group pretest posttest design to examine outcomes. Each group received eight to ten, 50-minute sessions of trampoline activity. Motor outcomes were administered once a week as well as pre- post- measures of motor function. Measures from Study 1 informed Study 2. Parent report pre- post- measures of social functioning were added to Study 2. All procedures were feasible and sensitive outcome measures were identified. In Study 1, outcomes (e.g. broad jump, heel toe walking, beads in box, beads on rod and hand strength) did not consistently show change. Broad jump and one foot standing balance were suggested for future use. In Study 2 significant improvements were noted in broad jum...
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Sensory integration, now trademarked as Ayres Sensory Integration® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The... more
Sensory integration, now trademarked as Ayres Sensory Integration® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres’ propositions by describing functions of the vestibular, proprioceptive, and tactile sensory systems, and exploring their relationships to ocular, postural, bilateral integration, praxis, and sensory modulation. We close by proposing neuroplasticity as the mechanisms underlying change as a result of ASI intervention.
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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... more
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 und...
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This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the... more
This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.
Research Interests: Psychology, Occupational Therapy, Evidence Based Practice, Medicine, Humans, and 8 moreBiomedical Research, Engineering Ethics, Clinical Sciences, Public health systems and services research, Guidance and Counseling Intervention Programs, service Business, Pillar, and American Occupational Therapy Association
OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups... more
OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups and for clinical work in guiding treatment planning. We thus evaluated the new Sensory Processing Scale (SPS) Assessment. METHOD. Research included item development, behavioral scoring system development, test administration, and item analyses to evaluate reliability and validity across sensory domains. RESULTS. Items with adequate reliability (internal reliability >.4) and discriminant validity (p < .01) were retained. Feedback from the expert panel also contributed to decisions about retaining items in the scale. CONCLUSION. The SPS Assessment appears to be a reliable and valid measure of sensory modulation (scale reliability >.90; discrimination between group effect sizes >1.00). This scale has the potential to aid in differential diag...
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This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome... more
This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.
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Research Interests: Psychology, Occupational Therapy, Rehabilitation, Adolescent, Medicine, and 15 moreEmotions, Child Behavior, Humans, Child, Female, Male, Checklist, Cluster Analysis, Phenotype, Clinical Sciences, Comprehensive, Social Behavior, General Population, Psychiatric Status Rating Scales, and Child preschool
Research Interests: Cognitive Science, Electrophysiology, Audiology, Cognition, Information Integration, and 15 moreAdolescent, Medicine, Information Processing, Brain Mapping, Brain, Humans, Child, Multisensory Integration, Female, Male, Age Factors, Median Nerve, Functional Laterality, Acoustic Stimulation, and Child preschool
Anecdotal reports and empirical evidence suggest that sensory processing issues are a key feature of autism spectrum conditions. This study set out to investigate whether adults with autism spectrum conditions report more sensory... more
Anecdotal reports and empirical evidence suggest that sensory processing issues are a key feature of autism spectrum conditions. This study set out to investigate whether adults with autism spectrum conditions report more sensory over-responsivity than adults without autism spectrum conditions. Another goal of the study was to identify whether autistic traits in adults with and without autism spectrum conditions were associated with sensory over-responsivity. Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient, the Raven Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across various sensory domains (visual, auditory, tactile, olfactory, gustatory and proprioceptive). Sensory over-responsivity correlated positively with autistic traits (Autism Spectrum Quotient) at a s...
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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... more
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 typic...
Research Interests: Psychology, Adolescent, Medicine, Activities of Daily Living, Performance Evaluation, and 15 moreHumans, Child, Construct Validity, Clinical Sciences, Rating Scale, Middle Aged, Internal Consistency, Pilot study, Adult, Instrument Development, Discriminant Validity, Pilot Projects, Severity of Illness Index, Child preschool, and Reliability and validity
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... more
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 ...
Research Interests: Psychology, Occupational Therapy, Treatment Outcome, Medicine, Humans, and 15 moreChild, Sensory processing, Female, Sensory Integration, Male, Sample Size, Clinical Sciences, Colorado, Public health systems and services research, Randomized Controlled Trial, Pilot Projects, Goal Attainment Scaling, The American, Child preschool, and Somatosensory disorders
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... more
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 stud...
Research Interests: Psychology, Occupational Therapy, Medicine, Humans, Group Process, and 13 moreIntervention, United States, Sensory Integration, American, Clinical Sciences, Outcomes Research, Public health systems and services research, Intervention study, Fidelity, Guidance and Counseling Intervention Programs, Processing Element, Somatosensory disorders, and Outcome assessment (Health care)
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Research Interests: Assessment, Autism, Auditory Perception, Magnetic Resonance Imaging, Diffusion Tensor Imaging, and 15 moreMedicine, Brain, Humans, Child, Sensation, Sensory processing, Female, Male, Clinical Sciences, Parents, Fractional Anisotropy, Neurosciences, Sensory Processing Disorder, Case Control Studies, and Autistic disorder
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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... more
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 effe...
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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... more
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 associa...