Comparison of Two Tools to Assess Sensory Features in Children With Autism Spectrum Disorder
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Comparison of Two Tools to Assess Sensory Features in
Children With Autism Spectrum Disorder
Catherine Dugas, Marie-Noëlle Simard, Eric Fombonne,
Mélanie Couture
OBJECTIVE. This article documents the convergent validity of the Sensory Profile (SP) and the Sensory
Processing Measure (SPM)–Home Form for children with autism spectrum disorder (ASD).
METHOD. Parents of 34 children with ASD between ages 5 and 8 yr filled out both measures. Through cor-
relations, x2 tests, and levels of agreement between classifications, the results for the SP and the SPM–Home
Form were compared.
RESULTS. The raw scores were correlated for some sensory domains (hearing, vision, touch, and pro-
prioception) and for social functioning. The classifications showed a significant level of agreement for most
scales (ks 5 .247–.589, p £ .05) and for the total scores (k 5 .324, p £ .01).
CONCLUSION. This study provides further evidence of convergent validity between both tools. The SPM–
Home Form identifies more children with ASD who present with sensory features for every domain
measured by both tools.
Dugas, C., Simard, M.-N., Fombonne, E., & Couture, M. (2018). Comparison of two tools to assess sensory features in
children with autism spectrum disorder. American Journal of Occupational Therapy, 72, 7201195010. https://doi.
org/10.5014/ajot.2018.024604
A
Catherine Dugas, MSc, is Occupational Therapist, utism spectrum disorder (ASD) affects roughly 1% of children (Frieden,
Centre Intégré Universitaire de Santé et Services Sociaux
Jaffe, Cono, Richards, & Iademarco, 2014). The disorder is characterized
du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec,
Canada. by difficulties in communication and social interaction, along with behavioral
rigidity and repetitiveness (American Psychiatric Association, 2013). According
Marie-Noëlle Simard, PhD, is Assistant Professor, to several authors, these characteristics can be partly explained by the sensory
School of Rehabilitation, Faculty of Medicine, Université
de Montréal, Montreal, Quebec, Canada, and Researcher,
features found in 69%–95% of children with ASD (Baranek, David, Poe,
Centre Hospitalier Universitaire Sainte-Justine Research Stone, & Watson, 2006; Glod, Riby, Honey, & Rodgers, 2015; Hazen, Stornelli,
Center, Montreal, Quebec, Canada. O’Rourke, Koesterer, & McDougle, 2014; Schaaf & Lane, 2015; Tomchek &
Dunn, 2007). The high prevalence of these sensory features has led to their in-
Eric Fombonne, MD, PhD, is Autism Research
Director, Institute on Development and Disability, Oregon clusion in the ASD diagnostic criteria in the most recent edition of the Diagnostic
Health and Science University, Portland. and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Asso-
ciation, 2013).
Mélanie Couture, PhD, is Associate Professor, School
In a recent review of the literature, Schaaf and Lane (2015) described sensory
of Rehabilitation, Faculty of Medicine and Health Sciences,
Université de Sherbrooke, Sherbrooke, Quebec, Canada, reactivity and unusual sensory interest as sensory features in children with ASD.
and Researcher, Axe Mère-Enfant, Centre Hospitalier Previous studies have found that children with ASD can present a significant
Universitaire de l’Université de Sherbrooke Research amount of variability in the sensory domains involved in those types of sensory
Center, Sherbrooke, Quebec, Canada; Melanie.M.
Couture@usherbrooke.ca
features (Baranek et al., 2006; Schaaf & Lane, 2015). Nonetheless, some of the
most frequently cited features include atypical hearing reactivity, tactile hyper-
reactivity, gustatory and olfactory hyperreactivity, and a weakness of endurance
and tonicity that could indicate atypical proprioceptive reactivity. Evidence has
also suggested that hyporeactivity, or sensory seeking, may characterize a gener-
alized profile of children with ASD (Baranek et al., 2006; Ben-Sasson et al.,
2009; Lane, Molloy, & Bishop, 2014; Schaaf & Lane, 2015; Schoen, Miller,
The American Journal of Occupational Therapy 7201195010p1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsBrett-Green, & Nielsen, 2009; Tomchek & Dunn, 2007). conducted during the validation process for the SPM–
Together, these sensory features may be responsible for Home Form, before its publication, using 182 children
characteristic ASD behavior, including mouthing, staring, with various diagnoses who were receiving occupational
self-stimulating, and low propensity to respond when one’s therapy (Parham & Ecker, 2007). Parham and Ecker
name is called (Hazen et al., 2014; Kirby, Little, & Baranek, (2007) documented the correlations between the SPM–
2015; Miller-Kuhaneck, 2015). Home Form scales and each of the SP and SSP scales.
Sensory features of children with ASD may also hinder The results supported the convergent validity of the total
their emotional regulation and willingness to perform tasks scores between the SPM–Home Form and the SSP (r 5
(Samson et al., 2014; Tomchek & Case-Smith, 2009). As .72, p £ .005). Among all sensory domains compared
a result, these features may increase the children’s difficulty between the SPM–Home Form and the SP, the hearing,
with social interaction (Watson et al., 2011). The impact vision, vestibular, and tactile domains showed the
may also extend to families, who are required to organize strongest correlations (rs 5 .48–.56, p £ .005; Parham &
day-to-day routines in response to the children’s sensory Ecker, 2007). In the second study, the targeted popula-
needs (Marquenie, Rodger, Mangohig, & Cronin, 2011). tion was typically developing children (N 5 30; Brown
The important repercussions of these sensory features et al., 2010a). Brown et al. (2010a) created an SP total
are a key area of interest in occupational therapy (Henry & score by adding the results obtained from every scale to
Miller-Kuhaneck, 2009; Tomchek & Case-Smith, 2009). compare them with the SPM–Home Form total score.
Occupational therapy practitioners use various methods The results revealed a correlation of .86 (p < .01) between
to assess sensory features, including interviews with par- the two scores. Finally, Hansen and Jirikowic (2013)
ents, behavioral observations of children, and question- studied the correlation between the SSP and SPM–Home
naires filled out by significant adults in the children’s lives Form total scores for children with fetal alcohol spectrum
(Schaaf & Lane, 2015; Tomchek & Case-Smith, 2009; disorder (N 5 11). In this study, the tools were highly
Watling, Koenig, Davies, & Schaaf, 2011). correlated (r 5 –.93, p < .001). In addition, this study
The Sensory Profile (SP; Dunn, 1999) and the Short found a 90.9% level of agreement regarding the presence
Sensory Profile (SSP; McIntosh, Miller, Shyu, & Dunn, or the absence of sensory features. The authors did,
1999) are among the clinical and research tools most often however, report a 36.6% level of agreement when the
used by occupational therapy practitioners (Ashburner, sensory features were classified within each tool’s three
Rodger, Ziviani, & Jones, 2014; Glod et al., 2015; Tomchek categories of performance. The results of these studies
& Case-Smith, 2009). Using Dunn’s (1999) model of sen- suggest that both the SP, or its shorter version, the SSP,
sory processing, these questionnaires are intended to identify and the SPM–Home Form assess similar constructs.
the sensory processing patterns associated with children’s However, no study has been conducted to determine
functional performance. The SSP was developed from the SP the convergent validity between the SP or the SSP and the
by retaining and refining a pool of items that assess sensory SPM–Home Form specifically with children with ASD.
features. Items measuring social and emotional abilities and Given the high prevalence of sensory features in children
fine motor development were removed because they are re- with ASD and their considerable impact on the day-to-day
lated to but not products of sensory features (McIntosh et al., lives of families, assessing these features with this population
1999). Both instruments collect information that describes is essential. Occupational therapists must choose the most
the children’s behavioral tendencies when responding to relevant tool available for the population with ASD. The
various sensory stimuli (Dunn, 1999). Unlike the SP, a total objective of this study was to compare the SSP total score
score can be calculated for the SSP (McIntosh et al., 1999). and SP subscales scores with scores on the SPM–Home
Another useful tool is the Sensory Processing Measure Form for a cohort of children with ASD to determine the
(SPM), based on Ayres’ sensory integration theory and extent to which both tools identify the same sensory features.
also standardized for children (Parham, Ecker, Miller-
Kuhaneck, Henry, & Glennon, 2007; Tomchek & Case-
Smith, 2009). This assessment tool is intended to document Method
behavior associated with day-to-day sensory features. Three interrelated studies formed the basis of the current
Three studies have addressed the convergent validity study. First, in 2007–2008, parents of children at the
between the SPM–Home Form and either the SP or the autism clinic at the Montreal Children’s Hospital were
SSP with various populations of school-age children invited to participate in a major pan-Canadian longitudinal
(Brown, Morrison, & Stagnitti, 2010a; Hansen & Jirikowic, study, “Pathways for Better Outcomes” (funded by the
2013; Parham & Ecker, 2007). The first study was Canadian Institute of Health Research). If they accepted,
7201195010p2 January/February 2018, Volume 72, Number 1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsparticipation in an ancillary study conducted only in 125 items represent behaviors that can be interpreted as
Montreal was proposed to document sensory–motor diffi- responses to sensory experiences. The parent rates the
culties and their effect on daily functioning. Finally, a observed frequency of these behaviors on a 5-point Likert
Fonds de Recherche du Québec–Culture et Société grant scale (ranging from 1 5 always to 5 5 never). The tool
was obtained to do a 2-yr follow-up on the children from consists of 14 sections that refer to sensory processing,
the sensory–motor study in 2010. The current study in- modulation, and behavioral and emotional responses.
volves a secondary analysis of the untreated data collected at Each raw score is compared with a threshold value to
Time 2 of the sensory–motor study. determine a category of performance: typical performance,
probable difference (1 standard deviation below the mean),
Participants and definite difference (2 standard deviations below the
To be included in the longitudinal study, the children had mean). A lower raw score means a greater difference.
to meet the diagnostic criteria associated with autism, The examiner can also explore the items to determine
Asperger’s syndrome, or pervasive developmental disorder– which of the four Dunn model quadrants the child falls
not otherwise specified, according to the Diagnostic and into: sensory sensitivity, sensory avoidance, low registra-
Statistical Manual (4th ed., text rev.; American Psychiatric tion, or sensory seeking. The tool takes approximately 30
Association, 2000) in effect at the time of the data col- min to complete, and scoring requires 20–30 min (Dunn,
lection. The diagnosis was made by a child psychiatrist on 1999). The tool’s psychometric values have been docu-
the basis of results obtained with the Autism Diagnostic mented and deemed adequate (Brown, Morrison, &
Interview (Le Couteur, Lord, & Rutter, 2003) and the Stagnitti, 2010b; Dunn, 1999; Ohl et al., 2012). The
Autism Diagnostic Observation Schedule–Generic (Lord, SSP contains a subset of 38 items selected from the SP.
These items are scored using the same method as the SP.
Rutter, DiLavore, & Risi, 1999). Clinicians and research
An SSP total score can be calculated and interpreted ac-
assistants with extensive experience had previously admin-
cording to norms (McIntosh et al., 1999).
istered these tools; interrater reliability was estimated at .90.
Sensory Processing Measure. The SPM is a standardized
The remaining inclusion criteria were a mental age of
assessment tool based on Ayres’ sensory integration theory
³18 mo and parental ability to read and complete ques-
(Parham et al., 2007; Schaaf et al., 2010) that assesses the
tionnaires in English. Excluded from the study were
behaviors involved in sensory processing for children ages
children who displayed one or more of the following:
5–12 yr. It combines several forms, including the Home
visual, hearing, or physical impairment; cerebral palsy;
Form, the Main Classroom Form, and various School
childhood disintegrative disorder; Rett syndrome; or ge-
Environments Forms. The SPM–Home Form was used in
netic disease, such as fragile X syndrome.
this study because it is most like the SP in terms of re-
Procedure spondent and setting. On the SPM–Home Form, a parent
rates the observed frequency of 75 behaviors on a 4-point
One parent of each child completed both the SP and the Likert scale (never, occasionally, frequently, and always). Raw
SPM–Home Form. The questionnaires were sent by mail scores are calculated across eight scales: Social Participation,
or completed in the clinic during the assessment for the Vision, Hearing, Touch, Body Awareness, Balance and
longitudinal study. After receiving the completed ques- Motion, Planning and Ideas, and Total Sensory Systems.
tionnaires, the research assistant verified that each ques- The child’s functioning is then classified according to three
tion was answered. If data were missing, a phone call was categories: typical, some problems (1 standard deviation be-
made to the parent to complete the questionnaire. Only low the mean), and definite dysfunction (2 standard devia-
questionnaires that were entirely completed were kept for tions below the mean). A higher raw score means a greater
data analysis (N 5 34). The questionnaires were then scored difference. The tool can be filled out in 15–20 min, and the
by an occupational therapist with the appropriate training. scoring can be completed in 5–10 min (Parham & Ecker,
The project was approved by the McGill University Ethics 2007). This tool also offers adequate psychometric prop-
Committee, and all parents signed a consent form before erties (Brown et al., 2010b; Parham et al., 2007).
data collection.
Data Analysis
Instruments Descriptive statistics were used to document the socio-
Sensory Profile. The SP is a standardized parent-completed demographic characteristics of the families involved in
questionnaire that assesses sensory processing and its the study and to summarize the results obtained on each
impact on the functioning of children ages 3–10 yr. The scale of the SP and SPM–Home Form. The SP and
The American Journal of Occupational Therapy 7201195010p3
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsSPM–Home Form scales intended for comparison were Table 1. Sociodemographic Characteristics of Participants
chosen because of their similar content, in contrast to Characteristic n (%)
previous studies, which compared only the total scores or all Child (N 5 34)
the scales from each tool without any regard to their content. Gender
The selected scales were those that assess the sensory fea- Male 28 (82.4)
tures involved in each sensory domain and those that assess Female 6 (17.6)
the impact of sensory features on social functioning. We Diagnosis
Autism 28 (82.4)
used the SSP total score for comparison with the SPM–
PDD–NOS 6 (17.6)
Home Form Total Sensory Systems scale because it is M age, mo (SD) 72.91 (4.50)
derived from the SP and validated as a unidimensional
Parent (N 5 34)
construct (McIntosh et al., 1999).
Gender: female (mothers) 34 (100)
Pearson correlation coefficients were used to measure
Ethnicity
the relationship between the scales’ raw scores. A x2 test White 23 (67.6)
on the proportion of children classified in each category Other 11 (32.4)
was then conducted, and Cohen’s k coefficient was cal- Language
culated to determine the level of agreement between the English 23 (67.6)
classifications. Both tests were repeated while merging the French 4 (11.8)
Other 7 (20.6)
“1 standard deviation below the mean” and “2 standard
Marital status
deviations below the mean” categories for both tools. In a relationship 29 (85.3)
All statistical analyses were conducted using IBM SPSS Single 5 (14.7)
Statistics (Version 20; IBM Corp., Armonk, NY). The Education: attended university 23 (67.6)
results were considered statistically significant using Income
p £ .05. CAN$40,000 26 (76.5)
Note. M 5 mean; PDD–NOS 5 pervasive developmental disorder–not other-
Results wise specified; SD 5 standard deviation.
The sociodemographic characteristics of the participants The x2 tests reveal that classifying children into three
are presented in Table 1. This study presents data for the categories led to similar results for both tools for most pairs
34 children who participated at Time 2 of the longitu- of scales, with the exception of Visual Processing–Vision and
dinal study. Sensory Processing Related to Endurance/Tone–Body
Awareness (see Table 4). According to Landis and Koch’s
Results Obtained With the Assessment Tools for
(1977) interpretation of the k coefficients, a moderate
Sensory Features
level of agreement emerged between the classifications of
The mean scores for each SP and SPM–Home Form scale two scale pairs (Modulation Related to Body Position
are presented in Table 2, and the number of children per and Movement–Body Awareness, Auditory Processing–
category is presented in Table 3. Compared with the SP, Hearing), and four pairs of scales had a fair or low level of
the SPM–Home Form classified more children as atypical agreement (Touch Processing–Touch, SSP Total Score–Total
in every domain assessed. Sensory Systems, Vestibular Processing–Balance and Motion,
and Emotional/Social Responses–Social Participation).
Convergent Validity Between the Sensory Profile and
The level of agreement increased for most pairs of
the SPM–Home Form
scales when combining the “1 standard deviation below
Table 4 presents the correlations between the raw scores the mean” and “2 standard deviations below the mean”
for the SP and SPM–Home Form scales. The pairs that categories (see Table 4). Only the k coefficient for the
were most strongly correlated were Visual Processing– Auditory Processing–Hearing pair decreased slightly, but
Vision and SSP Total Score–Total Sensory Systems. All its level of agreement remained moderate. The other pairs
other significant correlations were moderate according to were not statistically similar.
Cohen’s (1998) conventions of effect size interpretation.
Three pairs of scales (Vestibular Processing–Balance and
Motion, Oral Sensory Processing–Taste and Smell, and Sen- Discussion
sory Processing Related to Endurance/Tone–Body Awareness) The objective of this study was to document the con-
were not correlated. vergent validity of the SP and the SPM–Home Form
7201195010p4 January/February 2018, Volume 72, Number 1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsTable 2. Descriptive Statistics for Raw Scores on the Sensory Profile and the Sensory Processing Measure–Home Form Scales
Scale M (SD) Range Maximum Possible Score
Sensory Profile
Auditory Processing 29.91 (5.15) 18–39 40
Visual Processing 38.38 (5.12) 26–45 45
Vestibular Processing 47.50 (5.86) 35–55 55
Touch Processing 74.24 (10.64) 52–89 90
Oral Sensory Processing 44.68 (11.43) 17–60 60
Sensory Processing Related to Endurance/Tone 40.12 (5.53) 25–45 45
Modulation Related to Body Position and Movement 42.35 (5.63) 31–50 50
Emotional/Social Responses 64.56 (8.98) 41–83 85
SSP Total Scorea 151.42 (16.40) 124–182 190
Sensory Processing Measure
Social Participation 24.32 (6.36) 11–38 40
Vision 16.24 (3.66) 11–27 44
Hearing 13.41 (4.77) 7–24 32
Touch 17.94 (6.74) 11–41 44
Body Awareness 18.03 (6.93) 10–39 40
Balance and Motion 18.50 (6.83) 11–44 44
Taste and Smell (Items 41–45) 8.56 (4.05) 5–20 20
Total Sensory Systems 93.71 (26.09) 59–167 224
Note. N 5 34. SSP 5 Short Sensory Profile.
a
N 5 33.
using a sample of children with ASD. Because the SP and The classification differences could be partly explained
SPM–Home Form are largely used in clinics, these results by certain differences in the tools’ characteristics. For in-
could help occupational therapists make informed and stance, the Likert scales are not structured the same way—
evidence-based decisions about their evaluation practices the SP has five levels and the SPM has four—which could
with children with ASD. In fact, clinicians should be have an impact on the scoring and interpretation of the
aware that their understanding of the sensory features of results.
these children could differ depending on their choice of With that being said, the main difference remains the
assessment tool. This could have an impact on the in- theoretical model used to construct the tools, which is re-
tervention plan for a specific child and on communication flected in the questions asked by each. The SP is based on
across sites using different assessment tools. Ultimately, Dunn’s (1999) model, which hypothesized that there is a
these findings emphasize the importance of using several relationship between a person’s responsivity and a person’s
sources of information when documenting sensory features responding or self-regulation strategies and that the inter-
in children with ASD. action of these functions creates four basic patterns of
For 11 of 16 comparisons, the level of agreement sensory processing. The SPM relies on Ayres’ sensory in-
between the SP and the SPM–Home Form scales was tegration theory (Parham et al., 2007; Schaaf et al., 2010).
statistically significant (p £ .02) and varied from 24.7% to Both models provide different insights into the under-
58.9% when classifying the scores of children into three standing of sensory features of children with ASD. On one
categories and from 41.8% to 64.1% when grouping them hand, Dunn’s model highlights the self-regulation strate-
into two categories. A fair level of agreement emerged for gies adopted by children on the basis of their neurologi-
the total scores (32.4%, p £ .01) in the three-category cal threshold for each sensory domain. These neurological
classification, and a moderate level of agreement emerged thresholds can vary according to the child’s level of
(55.3%, p £ .001) in the two-category classification. The awareness throughout the day, but also according to the
SPM–Home Form appears to identify more children with environmental stimuli involved. On the other hand, Ayres’
ASD who display sensory features in every domain assessed sensory integration theory was originally based strictly on
by both tools. The overall results suggest moderate con- neurological concepts such as perception, modulation, and
vergent validity between the SP and the SPM–Home integration to explain the concepts of praxis and motor
Form for children with ASD. Moreover, the likelihood of learning as well as adaptive and maladaptive behavior
obtaining the same conclusion for both tools increases when (Ayres, 2005; Fisher, Murray, & Bundy, 2002). Over the
classifying children in only two categories. years, the concept of social participation came to enhance
The American Journal of Occupational Therapy 7201195010p5
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsTable 3. Participant Distribution According to the Sensory Profile Ayres’ theory and development of the SPM by taking the
and Sensory Processing Measure–Home Form Categorizations evolution of occupational therapy practices into account.
SPM To understand the classification similarities and dif-
SP Typical 21 SD 22 SD Total ferences between the two tools for a given child, we
Hearing analyzed the content of the scales for each sensory domain.
Auditory Processing First, the analysis of the hearing and touch items con-
Typical 11 6 1 18 firmed that the SP and SPM–Home Form assess similar
21 SD 3 7 0 10
content for both sensory domains. In addition, they in-
22 SD 0 2 4 6
Total 14 15 5 34
clude items that point to characteristic ASD behaviors,
which supports their relevance to this specific population.
Vision
The SP and SPM–Home Form vision-related scales
Visual Processing
Typical 26 5 0 31
did not provide a statistically significant level of agree-
21 SD 1 1 0 2 ment. An analysis of the items highlights the differences
22 SD 1 0 0 1 that may explain the result: Most items on the SP Visual
Total 28 6 0 34 Processing scale assess hyperreactivity to visual stimuli,
Balance and Motion and the SPM Vision scale contains more items that
Vestibular Processing represent behaviors associated with hyporeactivity or
Typical 13 5 2 20 sensory seeking. Furthermore, these scales include items
21 SD 0 3 0 3
on visual perception, which could lead to confusion when
22 SD 1 9 1 11
Total 14 17 3 34
identifying difficulties in processing visual information in
children with ASD, because these children are known to
Touch
display specificities regarding visual attention and dis-
Touch Processing
Typical 13 6 2 21
crimination skills (Simmons et al., 2009). Therefore,
21 SD 1 5 0 6 their visual–perceptual abilities could mask hypo- or
22 SD 1 4 2 7 hyperreactivity to visual stimuli.
Total 15 15 4 34 Neither tool can provide a specific and comprehensive
Body Awareness assessment for the gustatory and olfactory domains. The
Sensory Processing Related to SP has a scale that measures oral sensory features, and the
Endurance/Tone
SPM–Home Form does not. For the SPM–Home Form,
Typical 14 3 5 22
21 SD 2 1 0 3
Items 41–45 were lumped together to create a score to
22 SD 2 5 2 9 compare with the SP scale. However, the SP Oral Sensory
Total 18 9 7 34 Processing scale includes items on texture reactivity,
Body Awareness which is not specific to the gustatory and olfactory do-
Modulation Related to Body mains. Considering the significant impact of feeding
Position and Movement difficulties in children with ASD, a more specific tool is
Typical 17 1 4 22
required to assess gustative and olfactory hypersensitivity
21 SD 1 6 0 7
22 SD 0 2 3 5
in children with ASD (Lane et al., 2014; Martins, Young,
Total 18 9 7 34 & Robson, 2008).
Social Participation A significant but weak level of agreement was dem-
Emotional/Social Responses
onstrated between the SP’s Vestibular Processing and the
Typical 8 11 3 22 SPM–Home Form’s Balance and Motion scales because
21 SD 2 6 0 8 of varying content. Unlike the SP’s Vestibular Processing
22 SD 0 1 3 4 scale, the SPM’s Balance and Motion scale includes some
Total 10 18 6 34
items that refer to motor responses such as balance and
Total Sensory Systems coordination.
SSP Total Score The SPM–Home Form’s Body Awareness scale was
Typical 9 4 1 14
compared with two SP scales, the Modulation Related to
21 SD 2 6 1 9
22 SD 0 7 3 10
Body Position and Movement scale and the Sensory
Total 11 17 5 33 Processing Related to Endurance/Tone scale. The results
Note. SD 5 standard deviation; SP 5 Sensory Profile; SPM 5 Sensory show that only the Modulation Related to Body Position
Processing Measure; SSP 5 Short Sensory Profile. and Movement scale can be linked to the Body Awareness
7201195010p6 January/February 2018, Volume 72, Number 1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsTable 4. Raw Scores Correlations and Levels of Agreement Between Classifications of the Sensory Profile and Sensory Processing
Measure–Home Form
Classification
Fields In 3 Categoriesa In 2 Categoriesb
SP SPM Raw Score r x2 k x2(1) k
Auditory Processing Hearing 2.461** 20.17*** .436*** 6.28* .418*
Visual Processing Vision 2.581*** 1.70 .138 0.56 .119
Vestibular Processing Balance and Motion 2.270 13.27** .270** 11.38*** .544***
Touch Processing Touch 2.459** 9.93* .342** 7.05** .428**
Oral Sensory Processing Taste and Smell (Items 41–45)b 2.270
Sensory Processing Related to Endurance/Tone Body Awareness 2.244 7.16 .137 2.86 .282
Modulation Related to Body Position and Movement Body Awareness 2.383* 25.98*** .589*** 14.81*** .641***
Emotional/Social Responses Social Participation 2.474** 12.02* .247* 1.45 .160
SSP Total Scorec Total Sensory Systems 2.533*** 12.33* .324** 10.43*** .553***
Note. SP 5 Sensory Profile; SPM 5 Sensory Processing Measure; SSP 5 Short Sensory Profile. N 5 34.
a
The degree of freedom (df) for the x2 test for most scales is 4. The df for the Visual Processing–Vision pair is 2. bBecause of the impossibility of classifying this
raw score in the performance categories, only the correlation was calculated with the SP scale. cN 5 33.
*p £ .05. **p £ .01. ***p £ .001.
scale. These two scales have several items in common recipient, but the actual completion order was not con-
regarding behavior that seeks movement and proprioceptive trolled for. Also, the computation of the SSP total score
stimulation. However, certain proprioceptive features of may have introduced some bias, because it was never
children with ASD are found in the items of the SP’s validated this way. However, the significant correlation
Sensory Processing Related to Endurance/Tone scale, as between the two total scores seems to support its validity.
demonstrated in a study by Lane et al. (2014), in which a Furthermore, the socioeconomic characteristics of the
subgroup of children with ASD presented a significant mothers who took part in the study may have limited the
difference in the SSP Low Energy Weak category that representativeness of the sample and influenced the gen-
addresses low tonicity and lack of endurance. Considering eralizability of results. Indeed, most of the participants had
that the SP’s Sensory Processing Related to Endurance/ a spouse, a postsecondary diploma, and middle to upper
Tone scale was not correlated with the SPM–Home Form’s income. This profile, however, remains similar to that of
Body Awareness scale in the current study, it would there- mothers of children with ASD typically represented in
fore seem that the SPM–Home Form does not cover certain past research (Baranek et al., 2006; Brown et al., 2010a;
difficulties specific to children with ASD. Watson et al., 2011).
The SP’s Emotional and Social Responses scale The Sensory Profile 2 (SP2; Dunn, 2014) has been
mainly assesses aspects linked to the child’s temperament published since the data collection for this study. The
and emotional regulation, such as anxiety or tolerance of main differences between the versions consist of a re-
frustration. The SPM–Home Form’s Social Participation finement of the items included in the sensory do-
scale contains items that assess the child’s level of in- mains scales and a new classification of children into five
teraction and ability to participate in family conversa- categories of performance according to the normal dis-
tions and other day-to-day activities. Despite two relatively tribution. This new classification has a minor impact on
different constructs, a moderate and significant correlation the results obtained by children with ASD because they
was observed between both scales. However, a low level of are generally classified into the categories “more than
agreement was noted, which could be explained by their others” or “much more than others” (Dunn, 2014), just
varying content. as they are on the SP. Moreover, despite the changes made
to the items, most of the sensory domain scales remain
similar on the two versions. On this basis, occupational
Limitations and Future Research therapists could use the results of the current study to in-
This study compares two assessment tools completed by form their choice between the SP2 and the SPM–Home
the same person at the same time. Responses given to the Form while evaluating children with ASD. However, one
first questionnaire may have influenced responses given to important change in the SP2 is the creation of a scale
the second. They were placed in the same order for each specific to the sensory processing of proprioception. Some
The American Journal of Occupational Therapy 7201195010p7
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsof the items used to create this scale were originally in the (FRQSC-121463). We offer our sincere gratitude to the
SP Modulation Related to Body Position and Movement families who took part in the study, along with Natasha
and Sensory Processing Related to Endurance/Tone scales. Rouleau, occupational therapist and lecturer at the Uni-
It would be interesting in future studies to investigate the versité de Montréal, for her comments.
correlation and level of agreement between this new scale
and the SPM–Home Form Body Awareness scale. References
American Psychiatric Association. (2000). Diagnostic and sta-
Implications for Occupational tistical manual of mental disorders (4th ed., text rev.).
Washington, DC: Author.
Therapy Practice American Psychiatric Association. (2013). Diagnostic and sta-
Regarding the assessment of sensory features in school-age tistical manual of mental disorders (5th ed.). Arlington, VA:
children with ASD, American Psychiatric Publishing.
Ashburner, J., Rodger, S., Ziviani, J., & Jones, J. (2014). Oc-
• The SP and the SPM–Home Form have moderate
cupational therapy services for people with autism spectrum
convergent validity, and the level of agreement is disorders: Current state of play, use of evidence and future
greater when detecting only the presence or absence learning priorities. Australian Occupational Therapy Journal,
of sensory features. The SPM–Home Form seems to 61, 110–120. https://doi.org/10.1111/1440-1630.12083
identify more children with ASD who display sensory Ayres, J. (2005). Sensory integration and the child: Understand-
features in every domain assessed by both tools. ing hidden challenges (25th anniversary ed., rev. and up-
• Regardless of the tool used, occupational therapy dated). Los Angeles: Pediatric Therapy Network.
Baranek, G. T., David, F. J., Poe, M. D., Stone, W. L., &
practitioners must remain alert to the presence of Watson, L. R. (2006). Sensory Experiences Questionnaire:
certain sensory features specific to children with ASD, Discriminating sensory features in young children with
including hyporeactive and sensory-seeking profiles, autism, developmental delays, and typical development.
along with difficulties in the hearing, tactile, gustatory, Journal of Child Psychology and Psychiatry, and Allied
olfactory, and proprioceptive domains. Disciplines, 47, 591–601. https://doi.org/10.1111/j.1469-
• To complement the selected questionnaire, occupa- 7610.2005.01546.x
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B.,
tional therapy practitioners should use several other
& Gal, E. (2009). A meta-analysis of sensory modulation
sources of information when documenting sensory symptoms in individuals with autism spectrum disorders.
features in children with ASD, including interviews Journal of Autism and Developmental Disorders, 39, 1–11.
with parents and teachers along with behavioral https://doi.org/10.1007/s10803-008-0593-3
observations. Brown, T., Morrison, I. C., & Stagnitti, K. (2010a). The
convergent validity of two sensory processing scales used
with school-age children: Comparing the Sensory Profile
Conclusion and the Sensory Processing Measure. New Zealand Journal
of Occupational Therapy, 57, 56–65.
This cross-sectional study compared the use of the SP and
Brown, T., Morrison, I. C., & Stagnitti, K. (2010b). The reliabil-
the SPM–Home Form using a cohort of children with ity of two sensory processing scales used with school-age chil-
ASD. The results support the convergent validity of the dren: Comparing the response consistency of mothers,
SP with the SPM–Home Form. Although both tools are fathers, and classroom teachers rating the same child. Journal
based on distinct theoretical models that explain sensory of Occupational Therapy, Schools, and Early Intervention, 3,
331–347. https://doi.org/10.1080/19411243.2010.541775
processing, neither tool targets every step involved in this
Cohen, J. (1998). Statistical power analysis for the behavioral
processing. Thus, the identification of the basic phe- sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
nomenon of sensory features remains limited. Conse- Dunn, W. (1999). Sensory Profile—User’s manual. Minneapo-
quently, occupational therapy interventions based on lis: Pearson.
Dunn, W. (2014). Sensory Profile 2—User’s manual. Minneap-
hypotheses that address the underlying causes of sensory
olis: Pearson.
features must be validated in the child’s day-to-day life. To Fisher, A. G., Murray, E. A., & Bundy, A. C. (2002). Sensory
better support these interventions, a tool must be developed integration: Theory and practice (2nd ed.). Philadelphia:
to address every step involved in sensory processing. s F. A. Davis. https://doi.org/10.1007/978-3-662-09864-6
Frieden, T. R., Jaffe, H. W., Cono, J., Richards, C. L., &
Acknowledgments Iademarco, M. F.; Developmental Disabilities Monitoring
Network Surveillance Year 2010 Principal Investigators;
The data were extracted from a longitudinal study funded Centers for Disease Control and Prevention. (2014). Prev-
by the Fonds de Recherche du Québec–Culture et Société alence of autism spectrum disorder among children aged 8
7201195010p8 January/February 2018, Volume 72, Number 1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/936623/ on 03/09/2018 Terms of Use: http://AOTA.org/termsyears—Autism and developmental disabilities monitoring for children and adolescents (7th ed., pp. 766–792). St. Louis:
network, 11 sites, United States, 2010. MMWR Surveil- Mosby/Elsevier.
lance Summaries, 63, 1–21. Ohl, A., Butler, C., Carney, C., Jarmel, E., Palmieri, M.,
Glod, M., Riby, D. M., Honey, E., & Rodgers, J. (2015). Pottheiser, D., & Smith, T. (2012). Test–retest reliability
Psychological correlates of sensory processing patterns in in- of the Sensory Profile Caregiver Questionnaire. American
dividuals with autism spectrum disorder: A systematic review. Journal of Occupational Therapy, 66, 483–487. https://doi.
Review Journal of Autism and Developmental Disorders, 2, org/10.5014/ajot.2012.003517
199–221. https://doi.org/10.1007/s40489-015-0047-8 Parham, L. D., & Ecker, C. (2007). Sensory Processing Measure
Hansen, K. D., & Jirikowic, T. (2013). A comparison of the (SPM) Home Form. Los Angeles: Western Psychological
Sensory Profile and Sensory Processing Measure Home Services.
Form for children with fetal alcohol spectrum disorders. Parham, L. D., Ecker, C., Miller-Kuhaneck, H., Henry, D. A.,
Physical and Occupational Therapy in Pediatrics, 33, & Glennon, T. J. (2007). Sensory Processing Measure (SPM):
440–452. https://doi.org/10.3109/01942638.2013.791914 Manual. Los Angeles: Western Psychological Services.
Hazen, E. P., Stornelli, J. L., O’Rourke, J. A., Koesterer, K., & Samson, A. C., Phillips, J. M., Parker, K. J., Shah, S., Gross,
McDougle, C. J. (2014). Sensory symptoms in autism spec- J. J., & Hardan, A. Y. (2014). Emotion dysregulation and
trum disorders. Harvard Review of Psychiatry, 22, 112–124. the core features of autism spectrum disorder. Journal
https://doi.org/10.1097/01.HRP.0000445143.08773.58 of Autism and Developmental Disorders, 44, 1766–1772.
Henry, D. A., & Miller-Kuhaneck, H. (2009). The Sensory https://doi.org/10.1007/s10803-013-2022-5
Processing Measure (SPM): Meeting the needs of school- Schaaf, R. C., & Lane, A. E. (2015). Toward a best-practice
based practitioners part two: Case example and practical protocol for assessment of sensory features in ASD. Journal
applications. Journal of Occupational Therapy, Schools, of Autism and Developmental Disorders, 45, 1380–1395.
and Early Intervention, 2, 58–63. https://doi.org/10. https://doi.org/10.1007/s10803-014-2299-z
1080/19411240902720288 Schaaf, R. C., Schoen, S. A., Roley, S. S., Lane, S. J., Koomar,
Kirby, A. V., Little, L. M., & Baranek, G. T. (2015). Observa- J., & May-Benson, T. A. (2010). A frame of reference for
tional characterization of sensory interests, repetitions, and sensory integration. In P. Kramer & J. Hinojosa (Eds.),
seeking behaviors. American Journal of Occupational Therapy, Frames of reference for pediatric occupational therapy (3rd
69, 6903220010. https://doi.org/10.5014/ajot.2015.015081 ed., pp. 99–186). Philadelphia: Lippincott Williams &
Landis, J. R., & Koch, G. G. (1977). The measurement of Wilkins.
observer agreement for categorical data. Biometrics, 33, Schoen, S. A., Miller, L. J., Brett-Green, B. A., & Nielsen,
159–174. https://doi.org/10.2307/2529310 D. M. (2009). Physiological and behavioral differences
Lane, A. E., Molloy, C. A., & Bishop, S. L. (2014). Classifica- in sensory processing: A comparison of children with au-
tion of children with autism spectrum disorder by sensory tism spectrum disorder and sensory modulation disorder.
subtype: A case for sensory-based phenotypes. Autism Re- Frontiers in Integrative Neuroscience, 3, 29. https://doi.org/
search: Official Journal of the International Society for Autism 10.3389/neuro.07.029.2009
Research, 7, 322–333. https://doi.org/10.1002/aur.1368 Simmons, D. R., Robertson, A. E., McKay, L. S., Toal, E.,
Le Couteur, A., Lord, C., & Rutter, M. (2003). The Autism McAleer, P., & Pollick, F. E. (2009). Vision in autism
Diagnostic Interview–Revised (ADI–R). Los Angeles: spectrum disorders. Vision Research, 49, 2705–2739.
Western Psychological Services. https://doi.org/10.1016/j.visres.2009.08.005
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Tomchek, S. D., & Case-Smith, J. (2009). Occupational ther-
Autism Diagnostic Observation Schedule–WPS (ADOS– apy practice guidelines for children and adolescents with au-
WPS). Los Angeles: Western Psychological Services. tism. Bethesda, MD: AOTA Press.
Marquenie, K., Rodger, S., Mangohig, K., & Cronin, A. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in
(2011). Dinnertime and bedtime routines and rituals in fam- children with and without autism: A comparative study using
ilies with a young child with an autism spectrum disorder. the Short Sensory Profile. American Journal of Occupational
Australian Occupational Therapy Journal, 58, 145–154. https:// Therapy, 61, 190–200. https://doi.org/10.5014/ajot.61.2.190
doi.org/10.1111/j.1440-1630.2010.00896.x Watling, R., Koenig, K. P., Davies, P. L., & Schaaf, R. C.
Martins, Y., Young, R. L., & Robson, D. C. (2008). Feeding (2011). Occupational therapy practice guidelines for children
and eating behaviors in children with autism and typically and adolescents with challenges in sensory processing and sen-
developing children. Journal of Autism and Developmental sory integration. Bethesda, MD: AOTA Press.
Disorders, 38, 1878–1887. https://doi.org/10.1007/s10803- Watson, L. R., Patten, E., Baranek, G. T., Poe, M., Boyd,
008-0583-5 B. A., Freuler, A., & Lorenzi, J. (2011). Differential asso-
McIntosh, D. N., Miller, L. J., Shyu, V., & Dunn, W. (1999). ciations between sensory response patterns and language,
Overview of the Short Sensory Profile Sensory Profile—User’s social, and communication measures in children with au-
manual. Minneapolis: Pearson. tism or other developmental disabilities. Journal of Speech,
Miller-Kuhaneck, H. (2015). Autism spectrum disorder. In Language, and Hearing Research, 54, 1562–1576. https://
J. Case-Smith & J. C. O’Brien (Eds.), Occupational therapy doi.org/10.1044/1092-4388(2011/10-0029)
The American Journal of Occupational Therapy 7201195010p9
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