Introduction to the Evaluation in Ayres Sensory
Zoe Mailloux, L. Diane Parham, Susanne Smith Roley,
Laura Ruzzano, Roseann C. Schaaf
Zoe Mailloux, OTD, OTR/L, FAOTA, is Adjunct
Associate Professor, Department of Occupational Therapy,
Thomas Jefferson University, Philadelphia, PA;
L. Diane Parham, PhD, OTR/L, FAOTA, is Professor,
Occupational Therapy Graduate Program, School of
Medicine, University of New Mexico, Albuquerque.
Susanne Smith Roley, OTD, OTR/L, FAOTA, is
President, Collaborative for Leadership in Ayres Sensory
Integration, Aliso Viejo, CA.
Laura Ruzzano, MSc, OTR/L, was Student, Mrs. T. S.
Chan Division of Occupational Science and Occupational
Therapy, University of Southern California, Los Angeles, at
the time of the study.
Roseann C. Schaaf, PhD, OTR/L, FAOTA, is
Professor and Chair, Department of Occupational Therapy,
Thomas Jefferson University, Philadelphia, PA.
Comprehensive, reliable, and valid assessment is essential for individually tailored, appropriate, and effective
intervention planning and implementation. Research, education, and practice using an Ayres Sensory Integra-
(ASI) approach have a long history of prioritizing comprehensive assessment. To meet the need for a set
of tests that will fully evaluate the constructs of ASI with psychometrically strong, internationally appropriate,
and easily accessible measurement tools, the development of the Evaluation in Ayres Sensory Integration
(EASI) has been initiated. This article introduces the EASI, describes the overarching plan for its development,
and reports the results of promising preliminary analyses of discriminative validity data.
Mailloux, Z., Parham, L. D., Roley, S. S., Ruzzano, L., & Schaaf, R. C. (2018). Introduction to the Evaluation in Ayres Sensory
(EASI). American Journal of Occupational Therapy, 72, 7201195030. https://doi.org/10.5014/ajot.2018.028241
Acomprehensive evaluation of the sensory, motor, and praxis functions that
can inﬂuence occupational performance is critical to evidence-based in-
tervention. A research-informed and thorough assessment process allows for
adequate characterization of a person’s strengths and challenges to plan ap-
propriate and individually tailored interventions.
Reliable and valid assessment tools, especially those standardized for speciﬁc
populations, provide objective and credible procedures for measurement of the
sensory integration (SI) functions that may underlie participation and occu-
pation. Systematic use of assessment data to plan intervention can increase the
likelihood that services are provided in a cost-effective, efﬁcient, and effective
manner to achieve optimal outcomes.
Early in her professional career, A. Jean Ayres recognized the importance of
systematic and comprehensive assessment, as evidenced by her seminal work in the
measurement of sensory, motor, and praxis function and dysfunction. To un-
derstand sensory integration as it related to successful participation in play, self-care,
and schoolwork activities, she designed and adapted standardized tests that evaluated
the constructs of SI. These constructs included sensory perception, praxis, bilateral
integration, and balance, as well as nonstandardized observational measures of
functions such as sensory reactivity and postural mechanisms (e.g., the ability to
assume and maintain a prone extension or supine ﬂexion posture; Ayres, 1971).
Ayres developed individual tests and then published the Southern California
Sensory Integration Tests (SCSIT; Ayres, 1972a), which were later revised and
restandardized to become the Sensory Integration and Praxis Tests (SIPT;
Ayres, 1989). The SIPT, standardized on approximately 2,000 children ages
4 yr through 8 yr 11 mo, is the only published set of tests that collectively
addresses most of the core SI functions identiﬁed by Ayres. The SIPT dem-
onstrates strong reliability and validity (Ayres, 1989) and has been the gold
standard for assessment of sensory integrative functions in children.
The American Journal of Occupational Therapy 7201195030p1
Ayres used the SCSIT, and later the SIPT, in research
with both typically developing children and children with
learning and behavioral difﬁculties to identify key SI
constructs and to gain insight into how SI functions are
related to occupational performance. This body of re-
search (Ayres, 1965, 1966a, 1966b, 1969, 1971, 1972b,
1977, 1989) and her extensive clinical experience pro-
vided the knowledge base for the development of Ayres
(ASI) theory and practice (Smith
Roley, Mailloux, Miller-Kuhaneck, & Glennon, 2007).
ASI assessment and intervention together are designed to
improve the client factors that are affecting participation
in daily occupations.
The SIPT, although an excellent set of tests, has limi-
tations. The normative data for the SIPT were collected in
1984–1985. The dramatic surge in use of digital technol-
ogies over the past 30 yr has contributed to changes in
human activity patterns, and so the original normative data
may be different from contemporary norms. Accessibility
and use of the SIPT are limited because of the cost of SIPT
kits (including shipping), the cost of required computer
scoring technology, and lack of translated materials and
validated use of the SIPT outside the United States. The
lack of availability of normative data for populations outside
the United States is an increasing concern as growing
numbers of occupational therapy practitioners across the
globe become educated in sensory integration so that they
can provide high-quality assessment in ASI.
To meet the need for a set of tests that evaluate the
constructs of ASI with psychometrically strong, internationally
appropriate, and easily accessible measurement tools, the
development of the Evaluation in Ayres Sensory Integration
(EASI) was initiated. The purpose of this article is to introduce
the EASI and report ﬁndings from preliminary test analyses.
Overview of EASI Development
The purposes of the EASI are twofold: (1) to provide an
inexpensive, electronically accessible, and practical instrument
for clinical evaluation of SI and related functions in children
ages 3–12 yr and (2) to ensure that the scores provided by
this instrument are reliable, valid, and relevant for the in-
ternational populations being served. The process of devel-
oping the EASI has followed well-established guidelines for
test development from feasibility to psychometrics (e.g.,
Benson & Clark, 1982; Crocker & Algina, 1986). Speciﬁ-
cally, the process for development of the EASI is following
the series of steps shown in Figure 1, including establish-
ment of the overarching aims and constructs of the EASI,
feasibility testing, pilot testing, normative data collection,
and publication and dissemination of the tests. In this article,
we describe Steps 1 and 2, which have been completed.
Step 1: Aims and Constructs of the EASI
The purpose of the EASI is to enable occupational therapy
practitioners across the globe to conduct comprehensive,
Figure 1. Steps in the development of the Evaluation in Ayres Sensory Integration
7201195030p2 January/February 2018, Volume 72, Number 1
rigorous evaluation of SI for children so that precise and
focused therapy can be provided. The speciﬁc aims of the
EASI are that the tests will be aligned with major con-
structs in ASI theory; easily accessible, reliable, and valid;
and standardized and norm referenced for optimal use in
geographically diverse locations.
Open access to these tests will make high-quality
assessment and intervention in ASI widely accessible. By
open access, we mean that appropriately credentialed and
trained users will have free, unrestricted access to down-
loadable links for materials needed to administer and
score the tests (e.g., test manuals, test forms and scoring
test sheets, 3D printed objects such as shapes used for
tactile perception tests, online processes for conversion of
raw scores to standard scores). Other test materials will be
inexpensive items that users can purchase locally (e.g.,
cotton balls, cloth napkins, therapy balls, yoga mats). The
accessibility of the EASI, along with its rigor as a reliable
and valid tool and provision of geographically speciﬁc
normative data, will strengthen the ability of occupational
therapy practitioners to conduct a systematic assessment
of SI and provide individually tailored ASI intervention
within their own countries. In addition, the process for
the development of the EASI may also serve as a model
for development of measures and international norms
needed in other areas of occupational therapy practice.
Constructs measured by the EASI are drawn from ASI
theory and practice. Our selection of constructs was
inﬂuenced by the many studies of SI and related functions
conducted originally by Ayres beginning in the 1960s
(Ayres, 1965, 1966a, 1966b, 1969, 1971, 1972b, 1977,
1989) and more recently by others (Mailloux et al., 2011;
Mulligan, 1998, 2000, 2011; Van Jaarsveld, Mailloux, Smith
Roley, & Raubenheimer, 2015). The sum of these studies
indicates that four distinctive patterns of sensory integrative
function and dysfunction exist: (1) sensory perception in
tactile, proprioceptive, vestibular, and visual systems; (2)
praxis based on somatosensory, language, and visual-based
functions; (3) postural, ocular, and bilateral integration based
on vestibular functions; and (4) sensory over- and under-
reactivity (Mailloux et al., 2011; the core constructs are de-
ﬁned and discussed in detail in Schaaf & Mailloux, 2015).
Twenty-one different tests (one with three parts), as
shown in Table 1, have been designed to measure these four
overarching sensory integration constructs in four domains:
(1) Sensory Perception; (2) Praxis; (3) Ocular, Postural, and
Bilateral Motor Integration; and (4) Sensory Reactivity. The
ﬁrst three authors of this article (Mailloux, Parham, and
Smith Roley) conducted the initial process of item con-
struction. Because the EASI aims to assess children ages 3–
12 yr, each test is designed to contain items with a wide range
of difﬁculty levels, from very easy tasks for the youngest age
groups to much more complex tasks for the oldest age groups.
To address the aim of making the EASI an open-access
test, the required test materials must be either common
objects or materials that are readily available internationally
(e.g., pipe cleaners or chenille craft sticks) or items that can be
3D printed. Veriﬁcation of material availability worldwide
was accomplished through social media responses from more
than 100 countries. The feasibility of consistency in 3D
printing has since also been veriﬁed in several countries.
Table 1. Tests in the Evaluation in Ayres Sensory Integration
Sensory Perception tests Tactile Perception
Shapes (TP:S; 3 parts: TP:
S1, TP:S2 and TP:S Oral
Joint Positions (Prop:JP)
Ocular Reﬂex (V:OR)
Praxis tests Somatosensory-Based Praxis
Following Directions (Pr:FD)
Ocular, Postural, and Bilateral
Motor Integration tests
Ocular Motor and Praxis (O:MP)
Postural Control and Balance (PCB)
Bilateral Integration (BI)
Sensory Reactivity items
Tactile Registration Problems (TRP)
Auditory Registration Problems (ARP)
Olfactory Registration Problems (ORP)
Motion Defensiveness (MD)
and Motion Registration
Gravitational Insecurity (GI)
The American Journal of Occupational Therapy 7201195030p3
Step 2: Feasibility Testing
Feasibility and pilot testing was conducted using U.S.
samples because it seemed prudent to ensure that the tests
could be administered and scored in a feasible manner and
that materials were manageable before collecting interna-
tional normative data. In addition, the university internal
review board that reviewed and approved these studies did
not allow data collection outside the United States. More-
over, conducting the initial studies in the United States would
provide needed data for shortening the test, thus reducing the
amount of translation and test materials that would be re-
quired for international samples.
A group of approximately 15 occupational therapists,
5 of whom trained and worked with Ayres during the
development of the SIPT, conducted the feasibility test-
ing. Two occupational therapists acted as the feasibility
project coordinators. Feasibility testing included the de-
velopment and trying out of test sheets and forms, verbal
directions, materials management, administration tech-
niques, and scoring procedures. Revisions were made on
the basis of feedback from the group.
Feasibility testing culminated in a preliminary analysis
to determine discriminative validity of the tests. This
aspect of feasibility testing was called a “20 120” project
with a plan to test two children at each age year (3 yr
through 12 yr, making 10 age groups) from both typi-
cally developing (TYP) and SI concerns (SI) groups on
each of the tests, yielding 20 participants in each group.
Results of the 20 120 projects are reported in the Re-
sults section. After data analyses, some items were elim-
inated and others revised. In addition, feedback from
feasibility testers about the logistics and ease of admin-
istration and scoring led to some alterations in test pro-
cedures, materials, and scoring, in preparation for pilot
The feasibility project coordinators and testers recruited
children through their contacts and clinical practices. The
children ranged in age from 3 to 12 yr and were selected on
the basis of the inclusion and exclusion criteria for the project
(see Table 2). The children were also closely matched on
age and ratio of boys to girls. For convenience, all children
were selected from communities in Southern California.
Ethnicity and socioeconomic status were not tracked for this
phase of test development. The EASI tests were divided into
four sets, and a separate 20 120 project was conducted for
each set. The 20 120 data collection and analyses have
been completed on the ﬁrst three sets of tests, and the fourth
is in process. This grouping process resulted in a new sample
of children for each set of tests; therefore, sample charac-
teristics are shown for each grouping in Table 3.
Before the 20 120 data collection, the tests were ad-
ministered to a few children of various ages by the feasibility
project coordinators. Approximately 15–20 feasibility tes-
ters, including the feasibility project coordinators, who were
licensed occupational therapists with advanced training in
sensory integration, prepared for test administration by re-
viewing and discussing administration and scoring instruc-
tions. The testers communicated frequently to review and
clarify the testing procedures. For each set of tests, the test
administration process took 2–6 mo.
Table 2. Participant Inclusion and Exclusion Criteria
Criteria Type Typically Developing Children Children With Known or Suspected Sensory Integration Concerns
Inclusion Children ages 3 yr 0 mo to 12 yr 11 mo who are generally considered to be
developing and performing within age expectations and who have no
known medical, educational, mental health, or other developmental
Children with known or suspected problems in learning or
behavior who have been identiﬁed as having sensory integration
concerns by a sensory integration–trained occupational therapist,
physical therapist, or speech–language pathologist. Children with
diagnoses such as learning disorders, autism, attention deﬁcit
disorder, speech and language delays, problems with anxiety,
regulatory issues, hypotonia as a standalone diagnosis, and
developmental coordination disorder may be included as long
as they have also been identiﬁed as having some sensory
integration concerns and do not meet exclusion criteria.
Children with known or suspected problems with sensory
integration are the highest priority for inclusion.
Exclusion Children with any known medical, educational, mental health, or other
developmental concerns and children about whom there are any
suspected problems in sensory integration, including those who have
been referred for or who have received therapy for sensory integration
Children who have physical disabilities (e.g., cerebral palsy, spina biﬁda,
spinal cord injury), signiﬁcant cognitive deﬁcits (i.e., IQ <70 or
diagnosis of a developmental delay or cognitive disability), visual or
hearing impairments, or other conditions that include as symptoms
sensory or motor impairments and children for whom English is
not a primary language. Children who have not been identiﬁed as
having sensory integration concerns should also be excluded.
7201195030p4 January/February 2018, Volume 72, Number 1
Field testing and 20 120 projects were completed on 14
tests (1 with 3 parts) in this analysis. For each test included
in this analysis, participant characteristics and indepen-
dent samples ttests were compared to determine similarity
of the TYP and SI groups, and independent samples
ttests were used to compare total performance scores
between the groups. Before the performance comparison,
some items were omitted because of difﬁculty level (too
easy or too difﬁcult for most ages), discrepancies in scoring
across examiners, or other difﬁculties in administration or
Results are shown in Table 3. All tests analyzed thus far,
except for Tactile Perception: Shapes and Proprioception:
Force, yielded signiﬁcantly higher scores among the TYP
group than the SI group, suggesting that the tests are trending
toward discriminating between the two samples of children.
For those tests that did not discriminate between groups
(i.e., Tactile Perception: Shapes and Proprioception: Force),
we deliberated among the feasibility testers on test charac-
teristics such as feasibility of administration, scoring meth-
ods, and other options for measurement of the speciﬁc SI
construct. On the basis of this deliberation, we made ad-
justments to the tests in preparation for the pilot phase. For
example, we eliminated some too-easy or too-difﬁcult items,
added greater speciﬁcity in scoring, and generated new
Additional scores (e.g., time scores, sensory reactivity
scores) and other factors (e.g., age effects, item analyses)
were not statistically analyzed during the 20 120 proj-
ects, given the small sample size and purpose of this phase
of test development. However, we visually analyzed data
for trends. Consistently across tests and groups, the
youngest children showed distinctly lower accuracy scores
than the older children. Sensory reactivity to tactile test
items appeared higher among children in the SI group
compared with the TYP group. In addition, the amount of
time the children took in making choices (time scores)
appeared to be an important distinguishing factor between
groups and will be further assessed in the pilot study and in
future phases of test development.
Table 3. Preliminary Results for Discriminative Validity
Ratio Age, yr, M(SD) Accuracy Scores, M(SD)
Group Comparison ResultsSI TYP SI TYP SI TYP SI TYP
Tactile Perception tests 21 20 16:5 15:5 7.8 (2.5) 7.8 (2.9)
Localization 34.6 (8.5) 42.8 (5.6) t(26) 523.4, p< .01*
29.5 (15.5) 46.7 (13.9) t(34) 523.6, p< .001*
Textures 7.4 (2.5) 8.8 (1) t(22) 522.2, p< .05*
Shapes: Part 1 10.4 (3.2) 11.9 (2.1) t(31) 51.8, p> .05
Shapes: Part 2 10.9 (3.1) 12.1 (2.7) t(27) 521.2, p> .05
Shapes: Oral 3.9 (3.2) 5.5 (3) t(36) 521.6, p> .05
Proprioception tests 16 16 9:7 10:6 6.5(2.3) 7.6(3.0)
Force 70.9 (35.5) 62.1 (34.9) t(25) 520.7, p> .05
NA NA NA
Vestibular: Ocular Reﬂex
Praxis tests 19 19 13:6 13:6 6.9 (2.7) 7.9 (2.7)
Positions 55.9 (18.9) 74.7 (17.4) t(32) 523.2, p< .01*
Sequences 42.9 (20.2) 63.8 (14) t(24) 523.4, p< .01*
Following Directions 55 (22.4) 70.8 (10.1) t(21) 522.7, p< .01*
NA NA NA
Ocular, Postural, and Bilateral Motor tests 16 16 9:7 10:6 6.5(2.3) 7.6(3.0)
Bilateral Integration 20.2 (9.2) 29.5 (7.4) t(21) 52.8, p< .01*
Ocular Motor and Praxis 40.1 (26.7) 69.1 (30.9) t(28) 522.8, p< .001*
Postural Control and Balance
NA NA NA
Note. M 5mean; NA 5not analyzed; SD 5standard deviation; SI 5sample of children with known or suspected sensory integration concerns; TYP 5sample of
typically developing children.
Designs was initially scored as 0 or 1; however, after discussion and analysis, scoring was modiﬁed to 0, 1, or 2. Results reﬂect the modiﬁed scoring method.
These three tests were not statistically analyzed because of a need to improve the scoring methods.
Vestibular: Ocular Reﬂex was not administered because this
test measures a reﬂex that has consistently been shown to be highly discriminative (Ayres, 1989).
The American Journal of Occupational Therapy 7201195030p5
The EASI is still at an early phase in the test development
process; however, on the basis of results from the feasibility
testing, its usefulness appears promising. All tests analyzed
to date, except for Tactile Perception: Shapes and Pro-
prioception: Force, were found to differentiate the TYP
and SI groups, even in these relatively small feasibility
samples. Those two tests were revised on the basis of the
feasibility results before pilot testing. The pilot testing will
be used to determine whether the revised tests demonstrate
discriminative validity before we ﬁnalize the tests for in-
ternational normative data collection.
Although we chose the age range of 3–12 yr to cover
as wide a range of needs as possible, it is likely that some
items or tests will be too easy or too difﬁcult for the end
age ranges. On the SIPT, several aspects of the tests (e.g.,
Constructional Praxis Part 2, Manual Form Perception
Part 2, Sequencing Praxis Finger Items) are not adminis-
tered to 4-yr-olds because these aspects did not demon-
strate discriminative validity at a sufﬁcient level. The wider
scale pilot testing and eventual normative data collection
on the EASI will allow for item selection, as well as basal
and ceiling levels by age, to ensure that only necessary and
meaningful items remain in the ﬁnal version of the tests.
The development of the EASI, through grassroots,
volunteer efforts and fueled by social media resources,
potentially provides a new model for test construction in
ﬁelds such as occupational therapy and other health and
education services, which face ongoing ﬁnancial support
challenges. The open-access nature of the EASI also holds
potential for ongoing test development and reﬁnement.
With the possibility of a worldwide shared data repository,
administration, scoring, and interpretation of the EASI
will be open to continual improvement and expansion.
Implications for Occupational
Tailored interventions use person-speciﬁc characteristics to
design treatment that is specialized to an individual or a
group to improve health or change behavior (Gitlin et al.,
2009; Schaaf, 2015). As such, tailoring is akin to the
process used to target treatments in precision medicine.
Precision medicine is an emerging approach for disease
treatment and prevention that considers individual vari-
ability in genes, environment, and lifestyle for each per-
son (National Institutes of Health, 2017).
In occupational therapy, precision therapy can be viewed
as an approach that considers the individual’s unique
characteristics in relation to culture, family characteristics,
environmental supports and barriers, needs, and goals
when planning interventions (Schaaf, 2015). The appli-
cation of precision therapy in occupational therapy for
children aims to increase the likelihood that intervention
will directly address speciﬁc needs, priorities, and envi-
ronments, thus increasing the potential for meaningful
and favorable outcomes.
The results of this research have the following im-
plications for occupational therapy practice:
•When the presenting problems suggest that a child’s
participation difﬁculties may be related to sensory or
motor difﬁculties, a comprehensive assessment of sen-
sory integration is necessary to obtain the data needed
to design precision therapy (Schaaf & Mailloux, 2015).
•An appropriate and comprehensive assessment, which
includes the way in which a person processes and inte-
grates information from his or her body and the environ-
ment and uses it to plan and organize actions, ensures that
services provided center on the life situation of the indi-
vidual being served with consideration of personal char-
acteristics, lifestyle, family priorities, context, and culture.
•The EASI is being developed to provide occupational
therapy practitioners who serve clients with SI needs
an appropriate and comprehensive assessment to en-
sure that appropriate and effective intervention can be
planned and implemented. s
We acknowledge the contributions of ﬁeld test coordi-
nators Gina Geppert Coleman and Sue Trautman, test
materials coordinator Shay McAtee, communications
coordinator Annie Mori Baltazar, all the ﬁeld testers who
tested participants and submitted data, and the children
and families who participated in this project.
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