Article

Introduction to the Evaluation in Ayres Sensory Integration ® (EASI)

Abstract

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 Integration® (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.
Introduction to the Evaluation in Ayres Sensory
Integration
®
(EASI)
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;
zoemailloux@gmail.com
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-
tion
®
(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
Integration
®
(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.
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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
Sensory Integration
®
(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
®
(EASI).
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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
®
(EASI)
Category Tests
Sensory Perception tests Tactile Perception
Localization (TP:L)
Designs (TP:D)
Shapes (TP:S; 3 parts: TP:
S1, TP:S2 and TP:S Oral
Textures (TP:T)
Proprioception
Joint Positions (Prop:JP)
Force (Prop:F)
Vestibular Function
Ocular Reflex (V:OR)
Visual Perception
Orientation (VP:O)
Search (VP:S)
Auditory Function
Localization (A:L)
Praxis tests Somatosensory-Based Praxis
Positions (Pr:P)
Sequences (Pr:S)
Visual-Based Praxis
Tracing (VPr:T)
Designs (VPr:D)
Construction (VPr:C)
Language-Based Praxis
Following Directions (Pr:FD)
Ideation-Based Praxis
Ideation (Pr:I)
Ocular, Postural, and Bilateral
Motor Integration tests
Ocular Motor and Praxis (O:MP)
Postural Control and Balance (PCB)
Bilateral Integration (BI)
Sensory Reactivity items
and tests
Tactile
Defensiveness (TD)
Tactile Registration Problems (TRP)
Auditory
Defensiveness (AD)
Auditory Registration Problems (ARP)
Olfactory
Defensiveness (OD)
Olfactory Registration Problems (ORP)
Vestibular
Motion Defensiveness (MD)
and Motion Registration
Problems (MRP)
Gravitational Insecurity (GI)
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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
testing.
Method
Participants
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.
Procedures
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
concerns
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
concerns
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.
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Data Analysis
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
scoring.
Results
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
items.
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
EASI Test
Sample
Size
Male:
Female
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*
Designs
a
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
Joint Positions
b
NA NA NA
Vestibular: Ocular Reflex
c
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*
Ideation
b
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
b
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.
a
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.
b
These three tests were not statistically analyzed because of a need to improve the scoring methods.
c
Vestibular: Ocular Reflex was not administered because this
test measures a reflex that has consistently been shown to be highly discriminative (Ayres, 1989).
*a£.05.
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Discussion
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
Therapy Practice
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
Acknowledgments
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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... Therefore, proxy measures (e.g., observations) are recommended (Schaaf & Mailloux, 2015). Other limitations of the SIPTs are that they rely on 40-year-old normative data and their software is incompatible with modern operating systems (Mailloux et al., 2018). The SIPTs are also only suitable as pre-post-test measures for periods in excess of eight months (Mailloux et al., 2018). ...
... Other limitations of the SIPTs are that they rely on 40-year-old normative data and their software is incompatible with modern operating systems (Mailloux et al., 2018). The SIPTs are also only suitable as pre-post-test measures for periods in excess of eight months (Mailloux et al., 2018). In the current study, L could not complete all of the SIPTs; therefore, additional measures were utilized, with GAS completed post-intervention. ...
... Suitably qualified therapists will have open access to the EASI, which will incorporate normative data collected internationally. The EASI will meet the demand for the assessment of ASI constructs with psychometrically validated and internationally applicable measurement tools (Mailloux et al., 2018). ...
Article
Full-text available
Background : Ayres Sensory Integration (ASI) is widely employed by occupational therapists working with clients who experience challenges in sensory integration, including those with autism spectrum disorder (ASD). However, there is a dearth of research examining the feasibility of ASI outside of Western nations. This study documented the barriers associated with ASI in Saudi Arabia and assessed whether the intervention could improve process and participation skills. Methods : A pre-test/post-test case study design was used. The participant was a 4-year-old girl with ASD from Saudi Arabia. Data were gathered on sensory processing, motor skills, and participation in activities of daily living. The study used semi-structured interviews and assessments (Sensory Integration and Praxis Tests, the Sensory Processing Measure-Preschool, and the Peabody Developmental Motor Scale-2) to develop goals, identify outcome measures, and plan an ASI intervention. Results : Despite the limited availability of resources (e.g., toys, treatment spaces) and Arabic measures, improvements were observed on motor and sensory tasks and in occupational performance. Conclusion : ASI that adheres to the ASI fidelity tool can be of value for Saudi Arabian children with ASD. Additionally, the study provides a stepping-stone to further research for occupational therapists in Saudi Arabia working with children with ASD.
... (The World Health Organization [n.d.] and UNICEF [2019] have defined adolescence as a phase of life that begins at age 10 yr.) The EASI tests are under development, and international normative data collection is underway (G andara-Gafo et al., 2021;Holmlund & Orban, 2020;Mailloux et al., 2018Mailloux et al., , 2021. The EASI includes four tests that measure distinct aspects of praxis: Praxis: Ideation (Pr: I; the ability to generate novel ideas for action), Praxis: Positions (Pr: P; the ability to accurately imitate static, unfamiliar body positions), Praxis: Sequences (Pr: S; the ability to accurately imitate a novel series of actions), and Praxis: Following Directions (Pr: FD; the ability to follow spoken verbal directions for performing a novel series of actions). ...
... The tests are designed for a broader age range (3-12 yr) than the SIPT (4-8 yr), which is the current gold standard for assessment of sensory integration. The primary aims of this study were to examine the internal consistency of the EASI Praxis tests (Mailloux et al., 2018) and to evaluate the validity of these tests as measures of developmental change in praxis from childhood through early adolescence. Our findings indicated moderate to high internal consistency for the EASI Praxis tests in children and young adolescents ages 6 to 12 yr. ...
Article
Importance: Ayres Sensory Integration® is an evidence-based practice that requires a comprehensive assessment before intervention. The Evaluation in Ayres Sensory Integration (EASI) is intended for this purpose, and psychometric data are needed to determine its validity and reliability. Objective: To evaluate the internal consistency of four EASI Praxis tests and their validity as developmental measures. Design: Cross-sectional developmental design. Setting: Participants’ homes. Participants: Typically developing children and young adolescents, ages 6 to 12 yr (N = 234). Outcomes and Measures: We analyzed four EASI Praxis tests using Cronbach’s α, Pearson correlation coefficients, and one-way analysis of variance to explore internal consistency and developmental trends. Results: The findings indicate moderate to high internal consistency for all tests. Significant correlations between age and praxis scores indicate that the EASI Praxis tests are sensitive to developmental changes. Conclusions and Relevance: Occupational therapists can have confidence in the internal consistency and sensitivity to developmental changes of these praxis scores through early adolescence. What This Article Adds: Occupational therapists administering EASI Praxis tests can have confidence that they consistently measure praxis ability and are sensitive to developmental changes across ages 6 to 12 yr. The results suggest that praxis continues to develop into early adolescence, and adolescents may benefit from assessment and intervention targeting praxis ability.
... Although some tests of the SIPT (Ayres, 1989) measure functions that are included on other tests of balance and bilateral coordination (Bruininks & Bruininks, 2005;Henderson et al., 2007) SIPT. However, therapists commonly report issues that limit use of the SIPT, such as cost, age of normative data, and concerns related to applicability for groups outside the United States (Mailloux et al., 2018;Schaaf et al., 2014). ...
... To address these difficulties, Mailloux et al. (2018) developed the Evaluation in Ayres Sensory Integration V R (EASI), which includes measures of vestibular-proprioceptive functions within a set of 20 tests of sensory perception, ocular and postural control, bilateral integration, praxis, and sensory reactivity. An important aspect of standardized testing is the degree to which therapists feel confident in the value of a test. ...
Article
Importance: Vestibular and proprioceptive functions play a critical role in occupational performance and participation. Assessment of these functions in a reliable and valid manner is part of a comprehensive assessment in the Ayres Sensory Integration® frame of reference, commonly applied in pediatric occupational therapy. Objective: To report on reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration (EASI). Design: We used Rasch analyses to examine and modify the number of items and scoring categories on the six tests and known-groups analysis to examine group differences. We evaluated internal consistency using Cronbach's α and Rasch person reliability. Participants: The sample contained typically developing children (n = 150) and children with sensory integration concerns (n = 84); all participated voluntarily. Outcomes and Measures: The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr. The six tests of vestibular and proprioceptive functions were analyzed in this study. Results: Data from >96% of items conformed to the expectations of the model. We found statistically significant group differences (ps < .001-.128; ds = 0.20-1.31), with the typically developing children group scoring significantly higher on all but one test, and moderate to strong evidence of internal consistency (Rasch person-reliability indices ≥ 0.80; strata > 3) for five of six tests. Conclusions and relevance: The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability, indicating that they are psychometrically sound clinical measures. What This Article Adds: The development of occupational therapy assessments with strong psychometric properties, such as the EASI tests of vestibular and proprioceptive functions, enhances clinical practice and research by elucidating the factors affecting participation in accurate and dependable ways so that occupational therapy interventions can be focused and effective.
... There are a variety of standardized assessments that include praxis tasks, including the Sensory Integration and Praxis Tests (SIPT: Ayres, 1989), and the Miller Assessment for Preschoolers (MAP: Miller, 1982). Upcoming assessments such as the Evaluation of Ayres Sensory Integration (EASI: Mailloux, Parham, Roley, Ruzzano, & Schaaf, 2018) and the Sensory Processing Disorder -3 Dimensions (SP-3D: Mulligan et al., 2019) also include praxis assessment. Since dyspraxia is thought to impact participation in play and occupational performance, praxis assessment should take holistic approach. ...
Article
Introduction: Praxis difficulties impact individuals' occupations across environments. It is believed that avocational skills, or skills necessary for participation in leisure, are impacted by praxis skills. Praxis skills may be identified in a variety of ways but there is little research about possible relationships between praxis, avocational skills and occupational participation. Purpose: This study examined the relationship among objective assessment, therapist judgment, and caregiver report of children's praxis skills and children's participation in leisure activities. Methods: Two studies were conducted, an initial small pilot study (Study 1) and a second larger study (Study 2). Children with dyspraxia who received sensory integration-based occupational therapy services at a private occupational therapy clinic participated (Study 1, N = 52; Study 2, N = 200). Children were assessed with the Sensory Integration and Praxis Tests (SIPT), Praxis Inventory, Child Behavior Checklist-Activity Scale (CACT) and the OTA the Koomar Center Sensory History (SXHX). Results: Comparison of measures found a significant relationship between the SIPT and both parent-report and therapist ratings of praxis. Therapist judgment ratings of praxis were significantly related to parent ratings of children's avocational skills. There was no significant relationship between parent report and therapist judgment ratings of praxis. There was a marginal relationship between parent report of praxis and parent ratings of children's avocational skills. Conclusion: This study provides evidence that dysfunction in praxis is related to decreased skills and/or participation in avocational activities. In settings where assessment with standardized tools such as the SIPT is not feasible, clinical assessment of praxis using therapist judgment may be useful in identifying children at risk for difficulties in performance areas such as avocational activities. This study also supports the value and unique information that both objective and subjective measures bring to assessing praxis and avocational skills in children.
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Sensory features are part of the diagnostic criteria for autism and include sensory hypo/hyper reactivity and unusual sensory interest; however, additional sensory differences, namely differences in sensory integration, have not been routinely explored. This study characterized sensory integration differences in a cohort of children (n = 93) with a confirmed diagnosis of autism (5–9 years) using a standardized, norm-referenced battery. Mean z scores, autism diagnostic scores, and IQ are reported. Participants showed substantial deficits in tactile perception, praxis, balance, visual perception, and visual-motor skills. Relationship with autism diagnostic test scores were weak or absent. Findings suggest additional sensory difficulties that are not typically assessed or considered when characterizing sensory features in autism. These data have implications for a greater understanding of the sensory features in the autism phenotype and the development of personalized treatments.
Article
Full-text available
Background : Ayres Sensory Integration (ASI) is widely employed by occupational therapists working with clients who experience challenges in sensory integration, including those with autism spectrum disorder (ASD). However, there is a dearth of research examining the feasibility of ASI outside of Western nations. This study documented the barriers associated with ASI in Saudi Arabia and assessed whether the intervention could improve process and participation skills. Methods : Single-Subject experimental design was used. The participant was a 4-year-old girl with ASD from Saudi Arabia. Data were gathered on sensory processing, motor skills, and participation in activities of daily living. The study used semi-structured interviews and assessments (Sensory Integration and Praxis Tests, the Sensory Processing Measure-Preschool, and the Peabody Developmental Motor Scale-2) to develop goals, identify outcome measures, and plan an ASI intervention. Results : Despite the limited availability of resources (e.g., toys, treatment spaces) and Arabic measures, improvements were observed on motor and sensory tasks and in occupational performance. Conclusion : ASI that adheres to the ASI fidelity tool can be of value for Saudi Arabian children with ASD. Additionally, the study provides a stepping-stone to further research for occupational therapists in Saudi Arabia working with children with ASD.
Article
Importance: Spanish-speaking populations represent a significant percentage of occupational therapy clientele globally. Culturally appropriate Spanish translations of assessments are therefore imperative. This study describes the process of a culturally adapted translation of a set of tests for use with Spanish-speaking pediatric populations. Objective: To produce a culturally adapted Spanish translation of the Evaluation in Ayres Sensory Integration® (EASI) for international use. Method: We used cultural adaptation methodology that included direct and back translations of the EASI by bilingual translators and interviews with pediatric occupational therapists and children ages 3–6 yr from Spain. Linguistic experts helped revise the translations, and pediatric occupational therapy leaders in five Spanish-speaking North and South American countries reviewed the translations for comprehensibility and cultural appropriateness. Results: Back translations demonstrated equivalence with the original EASI tests except for a few test instructions and scoring criteria. Interviews with occupational therapists and children in Spain revealed some comprehension difficulties for several tests, which were revised in consultation with a linguistic expert. Additional adaptations were made on the basis of recommendations to address cultural differences by occupational therapy leaders from five North and South American countries. Most changes in wording were made in one EASI test (Praxis: Following Directions) that is heavily dependent on language comprehension. Conclusions and Relevance: We used currently recommended methodologies to develop and adapt a Spanish translation of the EASI for use across diverse cultures. What This Article Adds: A Spanish translation of the EASI has been developed for use in culturally diverse Spanish-speaking countries around the world.
Chapter
Sensory integration is an automatic neurological process that occurs throughout life. Our brain receives information from our senses and organise it so that we are able to respond adaptively to particular situations and environmental demands.
Article
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Objectives: processing disorder (SPD) is a neurodevelopmental disorder that can negatively affect objective, emotional, and behavioral functioning. Therefore, assessing sensory processing is critical in children. This study aimed to provide a current comprehensive list of assessment instruments special about sensory processing in children aged between 0 and 14 years. Materials & methods: This systematic review focused on pediatric assessment of sensory processing. Three electronic databases (Google Scholar, Web of Science, Scopus, PubMed, and ProQuest) were comprehensively searched for eligible studies, and language restriction (English) was applied.The search strategy consisted of keywords and medical subordinate headings for sensory processing and various pediatric assessment tools. Results: Thirty-four assessment tools were identified, of which nine met the predefined inclusion criteria. The test of ideational praxis, clinical observations of proprioception, and pediatric clinical test of sensory interaction for balance were clinical observational assessment tools.The final tool was a caregiver or teacher reported questionnaire. The obtained studies evaluated the clinical use and psychometric properties of these nine assessment tools. Conclusion: The result of this study indicated that each of the sensory processing assessment tools considered various aspects of sensory processing.Selecting the most appropriate assessment tools to measure sensory processing function in children depends on specific components of sensory processing that need to be evaluated.
Article
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Occupational therapists and occupational therapy assistants rely on knowledge and skills to guide their intervention planning as they help clients who are experiencing difficulties with engaging in occupation. Sensory integration theory, with its rich history grounded in the science of human growth and development, offers occupational therapy practitioners specific intervention strategies to remediate the underlying sensory issues that affect functional performance. This article articulates the core principles of sensory integration as originally developed by Dr. A. Jean Ayres, explains the rationale for developing a trademark specifically linked to these core principles, and identifies the impact that this trademark can have on practice.
Article
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While patterns ofsensory integration (SI) function and dysfunction have been studied in the USfor more than 50 years 1, 2, 3, 4,9, 10,11, 12, 13, 14 exploration of whether ornot similar patterns exist in cultures and communities outside of this countryhas been limited, with no studies conducted in South Africa to date. Thepurpose of this paper was to investigate and describe the similarities anddifferences of patterns of SI dysfunction between children in South Africa andthose in the US. A quantitative, analytical study was conducted on aconvenience sample of 223 of children who were identified as experiencingsensory integration difficulties. The Sensory Integration and Praxis Tests (SIPT)1 were used as measuring instrument and correlation and factoranalysis were applied in order to describe similarities and differences. Consistenciesin tests loading on patterns of Visuodyspraxia, Somatodyspraxia, BilateralIntegration and Sequencing dysfunctions and Tactile and Visual Discriminationdysfunctions were found. Therefore, this research confirmed similarities in thepatterns of dysfunction in children in South Africa and confirmed the value ofthe SIPT in identifying sensory integration dysfunctions cross-culturally.
Article
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To realize the American Occupational Therapy Association's Centennial Vision, occupational therapy practitioners must embrace practices that are not only evidence based but also systematic, theoretically grounded, and driven by data related to outcomes. This article presents a framework, the Data-Driven Decision Making (DDDM) process, to guide clinicians' occupational therapy practice using systematic clinical reasoning with a focus on data. Examples are provided of DDDM in pediatrics and adult rehabilitation to guide practitioners in using data-driven practices to create evidence for occupational therapy. Copyright © 2015 by the American Occupational Therapy Association, Inc.
Article
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Building on established relationships between the constructs of sensory integration in typical and special needs populations, in this retrospective study we examined patterns of sensory integrative dysfunction in 273 children ages 4-9 who had received occupational therapy evaluations in two private practice settings. Test results on the Sensory Integration and Praxis Tests, portions of the Sensory Processing Measure representing tactile overresponsiveness, and parent report of attention and activity level were included in the analyses. Exploratory factor analysis identified patterns similar to those found in early studies by Ayres (1965, 1966a, 1966b, 1969, 1972b, 1977, & 1989), namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention. Findings reinforce associations between constructs of sensory integration and assist with understanding sensory integration disorders that may affect childhood occupation. Limitations include the potential for subjective interpretation in factor analysis and inability to adjust measures available in charts in a retrospective research.
Article
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The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioral symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. TAP involves 8 sessions for a period of 4 months. Interventionists identify preserved capabilities, previous roles, habits, and interests of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. The TAP assessment, a combination of neuropsychological tests, standardized performance-based observations, and clinical interviewing, yielded information on capabilities from which to identify and tailor activities. Assessments were easy to administer, taking an average of two 1-hr sessions. Of 170 prescribed activities, 81.5% were used, for an average of 4 times for 23 min by families between treatment sessions for a period of months. Caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%). Interventionists observed enhanced engagement (100%) and pleasure (98%) in individuals with dementia during sessions. TAP offers families knowledge of their relative's capabilities and easy-to-use activities. The program was well received by caregivers. Prescribed activities appeared to be pleasurable and engaging to individuals with dementia. TAP merits further evaluation to establish efficacy with larger more diverse populations and consideration as a nonpharmacological approach to manage behavioral symptoms.
Article
A cluster analysis of scores of 1961 children on the Sensory Integration and Praxis (SIPT) tests was performed to explore subgroupings of children referred for SIPT testing, and to provide information concerning the validity of the six profiles currently used in the SIPT interpretation process. The results yielded a five rather than a six cluster solution, including the following profiles: Low-average Bilateral Integration and Sequencing; Dyspraxia; Generalized Sensory Integration Dysfunction and Dyspraxia-Severe; Generalized Sensory Integration Dysfunction and Dyspraxia-Moderate, and Average Sensory Integration and Praxis. Clinical implications of the results of this study related to SIPT interpretation are discussed.
Article
Objective. This study evaluated a five factor model of sensory integration dysfunction on the basis of scores of children on the Sensory Integration and Praxis Tests (SIPT).The purpose of the study was to determine a plausible model for understanding sensory integration dysfunction. Method. The hypothesized model of sensory integration dysfunction tested was derived from previous multivariate analyses and consisted of five patterns of dysfunction, including: bilateral integration and sequencing, somatosensory, somatopraxis, visuopraxis, and postural ocular motor. Confirmatory factor analysis (CFA) of the SIPT scores of 10,475 children and the scores of a subgroup of 995 children with learning disabilities were used to evaluate the model. Results. The CFA of the hypothesized model indicated numerous weaknesses with it and, therefore, was rejected. Exploratory factor analysis (EFA) was then performed with the same data set to identify a better-fitting, more parsimonious model o/sensory integration dysfunction. A second-order, four-factor model using generalized practic dysfunction as the second-order factor and four first-order factors (dyspraxia, bilateral integration and sequencing deficit, visuoperceptual deficit, somatosensory deficit) were pro-posed. The CFA supported this model as the better-fitting model. The proposed model held true when tested with the subgroup of children with learning disabilities. Conclusions. The modified model of sensory integration dysfunction proposed indicated that it was a good fit for the data and improved on the initial model. Clinical implications of the findings relate to the interpretation of SIPT scores and provide suggestions for test development measuring sensory integration functions. The proposed model has applications for occupational therapy intervention using sensory integration as the primary frame of reference.
Article
Sixty-four neuromuscular, perceptual, and cognitive measurements made on 36 children with educational handicaps were subjected to Q-technique factor analysis. The two major patterns of deficits associated with low academic achievement were (1) auditory, language, and sequencing, and (2) postural and bilateral integration. Both of these syndromes were differentiated from syndromes of apraxia and tactile defensiveness.
Article
This study examined the validity of the Postrotary Nystagmus (PRN) test as a measure of vestibular functioning by examining the relations of scores from the PRN test with those from other variables measuring similar functions and through conducting a group comparison study. The PRN test is one of 17 tests included in the Sensory Integration and Praxis Tests (SIPT). Using SIPT scores from 575 children, sensory motor performance among children with depressed, average duration, and prolonged nystagmus was compared. The results indicated that children with low-duration postrotary nystagmus scored more poorly than children with average or prolonged postrotary nystagmus on other SIPT tests measuring aspects of vestibular function. Statistically significant, although weak correlation, coefficients were also obtained, demonstrating low-duration postrotary nystagmus may be associated with sensory motor deficits. The results of this study contribute to evidence supporting the PRN test's validity as a measure of some aspects of vestibular functioning.