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This chapter discusses the domains of child’s functioning in a particular domain and
sensory processing, praxis, and motor per- identifies whether there is a need for further
formance. Sensory processing is the organiza- assessment. A professional knowledgeable
tion of sensory input from the body and the about child development from a variety of
environment for use. Praxis is the ability to disciplinary perspectives is capable of con-
plan and sequence unfamiliar actions. Motor ducting a screening. In contrast, when an
performance is the actual execution of the assessment is necessary, a professional with
gross and fine motor coordination. This chap- specialized training in the area of concern is
ter provides general assessment guidelines necessary. For example, a teacher could
that serve as the foundation for observing screen whether a child is having problems in
individual differences in sensory and motor fine motor control and sensory modulation,
functioning. It then presents qualitative and but an occupational therapist would be the
standardized evaluations for each of the three most appropriate professional to complete
domains. The assessment process begins with the comprehensive assessment. The follow-
an initial screening of the child. If findings ing guidelines, summarized in Box 1, estab-
are significant, qualified specialists need to lish important parameters for performing
conduct a more in-depth assessment. quality screening and assessment.
Extensive tables provide descriptions of avail- The key to assessment is to focus on how
able instruments and their sources. This dis- the child processes sensory information and
cussion assumes that the child’s vision and manages environmental challenges and not to
hearing have been previously evaluated for a focus solely on the specific skills or milestones
primary sensory deficit. the child displays. This approach entails a
dynamic process orientation to assessment in
GENERAL SCREENING AND addition to a product focus typical of most
ASSESSMENT GUIDELINES developmental evaluations (Coster, 1998;
Greenspan & Meisels, 1996). For instance,
This section provides general considerations the milestone of building a block tower (prod-
for the screening and assessment of sensory uct) may be analyzed in terms of the child’s
processing, praxis, and motor performance. A attention, task persistence, grasp patterns,
screening provides an overall measure of the problem solving, and other qualitative aspects
156 ICDL Clinical Practice Guidelines
1. Focus on how the child processes sensory information using a dynamic process orien-
tation.
2. Use parent interview and natural observation to gather information regarding sensory
processing.
3. Do not look at the child in isolation, but observe the relationship between the child and
the environment.
4. Remember that the influence of sensory input is not always immediately observable;
there is cumulative effect and a latency of response.
5. Observe for autonomic signs of distress during or after sensory experiences.
6. Expect variability of responses to sensory input and behavior.
7. Keep in mind that sensory-based stereotypic behaviors serve different functions
depending on the child’s current sensory threshold.
8. Design the assessment process to provide the child with opportunities for choice, self-
initiation, creativity, and flexible problem solving.
signs of distress (e.g., yawning, hiccuping, discrete trials when a child has major prob-
sighing, irregular respiration, color change, lems in sensory modulation. In such cases, it
sweating, motor agitation, startling, pupil is a therapeutic error to interpret gaze avoid-
dilation) or changes in sleep/wake patterns ance or tactile defensiveness as willfully non-
(Als, 1986). If the child demonstrates auto- compliant behavior.
nomic signs of distress, the examiner should The examiner should not over-structure
stop the activities immediately and determine the assessment environment. The assessment
the cause for the child’s reaction. process should provide the child with oppor-
Consultation with a knowledgeable therapist tunities for choice, initiation, creativity, and
is helpful for determining an appropriate flexible problem solving. During part of the
course of action for the future. time, the examiner needs to step back and
Variability in a child’s daily performance avoid controlling the environmental condi-
is common. At any time, the consistency of a tions or initiating interactions. Direction
child’s behavior can be influenced by many from the examiner, although necessary for
factors, such as the degree of environmental certain types of testing, can inhibit the child
stimulation, the child’s current emotional from expressing individual differences dur-
state, general level of arousal, coping skills, ing qualitative observation.
accumulated sensory build-up, and the avail-
ability of a familiar caregiver. Children with Sensory Processing
sensory processing problems are more often
variable than predictable in their performance It is important to evaluate two compo-
day by day. Therefore, any assessment must nents of sensory processing as part of the
allow for repeated observations over time. assessment (Ayres, 1972; Fisher, Murray, &
Stereotypic and repetitive sensory-based Bundy, 1991). First is sensory modulation,
behaviors serve different functions, based on which is the ability to register, orient, and ini-
the child’s current sensory threshold tially react to sensory stimuli. Second is the
(Anzalone & Williamson, 2000). A child who actual perception and discrimination of that
is hyperreactive at a given moment (i.e., with input. Perception is the interpretation of sen-
a low threshold for sensory input) may use sory input in light of prior experiences and
hand-flapping to gain selective focus and to learning. Important to both modulation and
screen out the rest of the visual environment. perceptual discrimination are the sensory
The outcome can be calming and organizing. modalities and properties inherent in the
The child who is hyporeactive (i.e., with a stimuli themselves. Sensory modalities
high threshold for sensory input) may use include the environmental senses (vision,
this same behavior to increase arousal and hearing, smell, taste) and the body senses
activation. A third child may use hand-flap- (vestibular, proprioception, touch). Proprio-
ping to discharge tension. Practitioners must ception is sensation from the muscles and
use their knowledge of sensory processing to joints that provide information about the pos-
understand these stereotypical mannerisms ture and movement of the body. Vestibular
and rituals. Behavioral techniques that do not receptors in the inner ear are responsive to
consider sensory needs may result in stereo- movement of the body in relation to gravity.
typies that resurface in a different form. When assessing sensory processing, it is
Inappropriate behavioral intervention would essential to evaluate the child within the envi-
involve intrusive, highly adult-directed ronment. The examiner must evaluate the
158 ICDL Clinical Practice Guidelines
situational demands, goodness-of-fit between through a global effect on behavior (e.g., the
the child and the environment, and the senso- excitement of a child who has just gotten off
ry properties of the environment (Schaaf & a swing). Finally, action, which is the ability
Anzalone, in press). Such sensory properties to engage in adaptive goal-directed behavior,
include intensity and duration. Intensity is dependent upon sensory integration.
refers to how powerful or arousing the stimu- A child’s ability to self regulate these
lus is. For example, light touch is more processes depends upon the child’s initial
intense than firm touch, and touch on the registration of sensory stimuli. Registration
face is more intense than on the arm. is the point at which novel sensory informa-
Duration encompasses both the length of the tion is initially detected and the central nerv-
actual stimulus (e.g., how long a sound per- ous system activated. This point is considered
sists) and the lasting effect of that stimulus the sensory threshold. Some children have a
within the central nervous system (e.g., rapid low threshold that results in hyperreactivity
spinning resulting in motion sickness or a or sensory defensiveness. Their behavior is
prolonged increase in activity level). Since frequently characterized by high arousal, an
each child experiences sensory input in a inability to focus attention, negative or fear-
unique way, an individualized approach to ful affect, and impulsive or defensive action.
assessment is indicated. The examiner must Other children have a threshold that is very
evaluate both the stimulus (i.e., the objective high, causing them to be hyporeactive to sen-
sensory input) and the sensation (i.e., a spe- sory input. Their state of arousal is usually
cific child’s subjective appraisal of that decreased with a prolonged latency or an
input). Sensation is influenced by the task inability to attain focussed attention. Affect is
demands and the child’s prior sensory experi- typically flat, with a restricted expression of
ences, current state of arousal, and affective emotion that may interfere with social
state. For example, a light touch perceived as engagement. Their action tends to be passive
pleasant by one child might be considered and sedentary.
threatening or painful by another. Perceptual discrimination is based upon the
The assessment process considers the child’s sensory modulation and higher order
behavioral expression of sensory processing cognitive processes. The primary perceptual
in terms of the child’s self-regulation of functions to be assessed in young children
arousal, attention, affect, and action include visual, auditory, and tactile discrimina-
(Williamson & Anzalone, 1997). The child’s tion. Sample higher order perceptual skills
sensory status moderates, and is moderated include visual or auditory figure ground per-
by, the child’s state of arousal. Arousal is a ception, visual-spatial relations, auditory mem-
child’s level of alertness and the ability to ory, tactile localization, and stereognosis.
maintain and transition between different Assessment of these functions is beyond the
sleep and wake states. The sensory status also scope of this chapter, but is discussed in the
influences the child’s attention, which is the clinical literature (e.g., Lezak, 1995; Schneck,
ability to focus selectively on a desired stim- 1996; Wetherby & Prizant, 2000).
ulus or task. Affect, which is the emotional Children with autistic spectrum disorders
component of behavior, is also influenced by have sensory modulation problems present in
sensory input through either the emotional two primary patterns: hyperreactive and
response to a specific input (e.g., fearfulness hyporeactive. The profiles of each of these
in response to unexpected light touch) or patterns provide a helpful framework for
Chapter 8. Assessment of Sensory Processing, Praxis, and Motor Performance 159
understanding the behavioral patterns of that often serves to control sensory input.
these children. A specific child, however, Some of these children show little or no initi-
may have a combination of symptoms and ation of engagement. Others demonstrate
not fit clearly into any one category repetitive actions; still others display surpris-
(Anzalone & Williamson, 2000). ing competence in very specific skills.
Children with hyperreactivity may be very
Hyperreactivity concerned about becoming disorganized and
Children with hyperreactivity tend to have develop rigid routines, compulsions, and
a low sensory threshold and a bias toward a stereotypic patterns that help them maintain
sympathetic nervous system reaction. self-control. All these behaviors can be seen
(Sympathetic responses are those that indicate as adaptive at some level, as they are ways in
activation of the central nervous system, such which the children are trying to monitor and
as increased heart rate and respiration.) These manage their registration and interpretation
children have a restricted range of optimal of sensory input so that they can maintain a
arousal. Their arousal level tends to be high level of comfort. These behaviors often inter-
with a narrow, rigid control of sensory input. fere with interaction rather than foster it.
It is important to note that the observable Certain types of everyday sensation are actu-
behavioral arousal is not always the same as ally painful for these children. The sound of a
physiological arousal as reflected by meas- door slamming, unexpected laughter on a tel-
ures such as heart rate and respiration. Some evision soundtrack, or thunder can be so
hyperreactive children may appear to be non- uncomfortable that the children will do
responsive or under- aroused when, in fact, everything they can to avoid experiencing the
they are physiologically over-aroused (e.g., sensation again. Their rigid, controlling
they may have either high levels of cortisol or behaviors and rituals are understandable
elevated heart rate while appearing behav- attempts to limit noxious sensory input, or at
iorally inactive) (Miller & McIntosh, 1998; least to make the input predictable.
Porges, McCabe, & Yongue, 1982; Wilbarger
& Wilbarger, 1991). In some children, this Hyporeactivity
sensory overload becomes so threatening that Children with hyporeactivity tend to have
they respond with an involuntary behavioral a high sensory threshold; that is, they require a
and physiological shutdown. lot of sensory input to achieve arousal and
Children with hyperreactivity may over- activation. These children often have not regis-
focus their attention on detail (Kinsboume, tered novel sensory input; thus, they only have
1983). This phenomenon serves a gate-keep- minimal information on which to base any
ing or screening function, excluding a more interpretation. They do not learn from the
generalized sensory awareness of the envi- environment because they have not noticed it.
ronment. The affective range of these chil- Their state of arousal is usually low or unmod-
dren is usually limited, varying from ulated. Attention is unfocussed or narrowly
disconnection to sensory input to negative targeted to a specific type of sensory seeking
withdrawal. An exception is the positive to meet inner needs. Affect may be flat or
effect often associated with spinning of self uninvested, but may brighten with vestibular
or objects. Action in children with hyperreac- input. Action tends to be passive, aimless, and
tivity tends to be narrowly focused, with lim- wandering. However, some children with
ited elaboration and inflexibility of behavior hyporeactivity may have an insatiable craving
160 ICDL Clinical Practice Guidelines
for a preferred type of sensory input and may hyporeactive to low-frequency sounds). A child
seek it out in order to be “fueled.” Spinning can also be inconsistent over time in respond-
(rotary vestibular activity) is a favorite type of ing to the same stimulus. Variability among
stimulation. Frequently, children with bland, and within sensory systems is frequently linked
disconnected affects become delighted once to the child’s shifting state of arousal, attention,
they start to spin. It should be noted that the and previous sensory experiences.
sensory input that is the most arousing for Some children have jumbling or distortion
these children is not necessarily the most of sensory input and do not fit into the
organizing. described clinical profiles. There is an erratic
There are two important caveats in under- fluctuation in the registration of sensory input,
standing the sensory modulation profiles of somewhat like a volume switch being turned
children with autistic spectrum disorders. up and down repeatedly. For example, these
First, a child who appears flat and unavailable children may hear only parts of words (e.g.,
may not be hyporeactive. As previously men- the first part, the last part, or no consonants) or
tioned, some of these children are actually find that auditory or visual signals are inter-
physiologically hyperreactive, and their meshed. Some adults with autism report see-
behavioral shutdown is the opposite of their ing vibrations around a television set when it is
internal state. During an assessment, the on (Grandin, 1995; Williams, 1994).
examiner can differentiate between these two
profiles by systematically decreasing sensory Assessment of Sensory Processing
input, providing organizing activity, and As previously described, sensory process-
observing behavioral responses over time. ing encompasses sensory modulation and
With decreased sensory input, the child who perception. Sensory modulation precedes the
is truly hyperreactive will become calmer and more cognitive component of perception.
more attentive, whereas the truly hyporeac- This discussion focuses primarily on sensory
tive child may become more lethargic. modulation—the ability to register and orient
Second, not all sensory seeking behaviors are to sensory stimuli. Assessment of sensory
associated with hyporeactivity. Some chil- processing includes three complementary
dren with hyperreactivity or sensory defen- strategies: qualitative observation; parent
siveness may engage in sensory seeking as a interview; and, possibly, the administration of
way to modulate their reactions to sensation standardized instruments. Observation and
(i.e., discharging tension or refocusing atten- parent interview are particularly important
tion to organize themselves). for screening, for enabling the practitioner to
identify potential problems as well as the
Mixed Patterns need for more in-depth assessment. A com-
A child with autism or pervasive devel- plete evaluation may require the skills of an
opmental disorder (PDD) can have a mixed occupational therapist with specialized train-
pattern of being hypersensitive in certain ing in sensory processing.
modalities (often auditory or tactile) and
hyposensitive in others (frequently proprio- Qualitative Observation
ceptive or vestibular). Likewise, a child may Observation is the primary mode the
have variability of responses within a single examiner uses to identify problems and plan
sensory modality (e.g., a child may be interventions for children who have difficul-
hyperreactive to high-frequency sounds and ties in sensory processing. Examiners depend
Chapter 8. Assessment of Sensory Processing, Praxis, and Motor Performance 161
Williams & Shellenberger, 1996). The sensory The examiner can supplement semi-struc-
diet is the profile of naturally occurring activi- tured interviews with standardized question-
ties that occur throughout the day that provide naires regarding the child’s sensory and
sensory input and influence the child’s regula- self-regulatory performance. The Infant
tion of arousal, attention, affect, and action. The Toddler Symptom Checklist (DeGangi &
profile provides data about the child’s sensory Poisson, 1995) addresses such areas as self
tolerances and preferences as they are reflected regulation, attention, sleeping, eating, dress-
in daily activity. It also identifies periods of ing, bathing, movement, language, vision, and
behavioral organization and disorganization emotional functioning in children between
during the day and relates it to ongoing sensory 7 and 30 months of age. The Sensorimotor
experiences and environmental demands. Some History Questionnaire for Preschoolers
situations that provide valuable insight into sen- (DeGangi & Balzer-Martin, in press) is a 51-
sory modulation are bathing, mealtimes, dis- item questionnaire that has been validated as
ruptions in typical routines, and preferences in a screening tool for 3-to 4-year-olds (see
clothing or play. The following questions may chapter appendix). This questionnaire catego-
generate a productive discussion with the parent rizes behavior in terms of self-regulation, sen-
or caregiver regarding a child’s sensory pro- sory processing of touch, sensory processing
cessing and how it influences child and family of movement, emotional maturity, and motor
functioning. These questions are designed to maturity. The Sensory Profile (Dunn, 2000 is
provide a starting point for an interview. They a parent questionnaire appropriate for assess-
should be used selectively based on the present- ing sensory processing of children 3 to 10
ing needs of the child and family. years of age. Its 125 items address different
sensory systems, activity level, movement,
Parent/Caregiver Observations and emotional-social functioning. This ques-
• What is a typical day like? tionnaire has been extensively studied with
• What types of sensory activities does normative and clinical populations (Dunn &
your child like and dislike? Brown, 1997; Dunn & Westman, 1997;
• How does your child manage transitions Kientz & Dunn, 1997). The Short Sensory
and changes in daily routines? Profile (McIntosh, Miller, & Shyu, 2000) is an
• Is there a predictable time of day or type abbreviated version of the Sensory Profile with
of activity when your child is most or sound psychometric properties. The Short
least organized? Sensory Profile has only 38 items in 7 sub-
• Are your child’s activities of daily living scales: tactile sensitivity, taste/smell sensitivity,
and self-care tasks limited by sensory or under-responsive/seeks sensation, auditory fil-
motor problems (e.g., does not tolerate tering, visual/auditory sensitivity, low ener-
textured foods, fearful during bathing)? gy/weak, and movement sensitivity. The
• Does your child have habits and routines Functional Behavior Assessment for Children
that support daily functioning? with Sensory Integrative Dysfunction (Cook,
• How does your child respond to affec- 1991) provides a way to use parent interviews
tionate physical touch or handling? to gather data regarding sensory-related activi-
• Does your child initiate exploration of ties of daily living.
novel as well as familiar situations?
• Does your child enjoy playing with other Standardized Instruments. In addition
children? to observation and parent interview, an
164 ICDL Clinical Practice Guidelines
examiner can use standardized instruments to functioning. Sensory modulation is not direct-
assess sensory modulation. Table 1 describes ly measured on this instrument but can be
the relatively few standardized tools that are inferred from qualitative observation. This
available. The Test of Sensory Functions in battery requires extensive formal training for
Infants (DeGangi & Greenspan, 1989) is a reliable administration and is dependent on the
diagnostic, criterion-referenced test adminis- child having receptive language skills at the 4-
tered by professionals trained in child devel- year-old age level. It is typically not used for
opment and sensory processing. It is children with autistic spectrum disorders.
designed to assess infants and toddlers with
regulatory disorders, developmental delay, PRAXIS
and those at risk for learning disorders. The
Early Coping Inventory (Zeitlin, Williamson, Praxis is the ability to plan and sequence
& Szczepanski, 1988) assesses the coping unfamiliar actions. It evolves from the inter-
style of children 4 to 36 months of age. The action between the child and the environment
coping behaviors of the children are observed and reflects the quality of sensory integration
over time in a variety of situations. This psy- (Ayres,1985; Cermak, 1991). Praxis consists
chometrically sound tool is particularly sensi- of three different components: (1) ideation,
tive to measuring sensory-based self-regulation (2) motor planning, and (3) execution.
and adaptation. The Sensory Integration and Ideation is the ability to formulate a goal for
Praxis Tests (Ayres, 1989) are a diagnostic, action. It is the cognitive step of recognizing
norm-referenced test battery designed for the multiple ways that toys, objects, or one’s
school-aged children who are relatively high body can be used in play and learning
Test of Sensory 4–18 months Subtests include reactivity to DeGangi, G. A., &
Functions in tactile deep pressure and Greenspan, S. I. (1989)
Infants vestibular stimulation, adaptive Western Psychological
motor functions, visual-tactile Corporation
integration, and ocular-motor 12031Wilshire Blvd.
control. Los Angeles, CA 90025
Early Coping 4–36 months The instrument addresses Zeitlin, S., Williamson,
Inventory sensorimotor organization, G. G., & Szczepanski, M.,
reactivity, and self initiation as (1988)
the child copes with daily Scholastic Testing Service
living. 480 Meyer Road
Bensonville, IL 60106
situations. For example, the child appreciates in activity, they may perseverate and tend to
that there are a number of ways to play with prefer the familiar. Self-esteem is often poor
a toy truck. Motor planning involves figuring as a result of frustration and repeated failure.
out how to get one’s body to carry out the They may be judged at times as manipulative
goal for action. This step of planning and and controlling. These behaviors reflect the
sequencing of motor tasks is based on the child’s use of language to compensate for the
child’s body scheme; that is, an internal sen- dyspraxia (e.g., distracting and redirecting
sory awareness of body parts, how they fit attention away from the motor disorder).
together, and how they move through space. Problems in sequencing can include lan-
Motor planning is active problem solving and guage, in which case organizational and edu-
reflects an inner, sensory awareness of one’s cational deficits are generally present.
physical self. Execution is the actual per-
formance of the planned action. It involves Observation of Praxis
gross and fine motor coordination to accom-
plish the task. The major means of assessing praxis is
Children with dyspraxia may have diffi- through observation of the child during novel
culty with any one or a combination of these gross and fine motor tasks. It is often
three components. A lack of ideation is noted observed that the child uses visual monitor-
if the child is unable to formulate new goals ing of movements to accomplish the skill.
specific to situational demands. The child
The examiner must provide a range of activi-
does not have an idea of what to do or is rigid
ties that require the control of large muscles
or inflexible in goal formulation. With a
as well as fine manipulation. Since children
deficit in motor planning, the child knows the
with dyspraxia often rely on familiar, over-
purpose of the object or task but cannot
learned activities, it is essential that any
organize motor patterns to interact effective-
observation of praxis provide unexpected,
ly with the environment or solve the problem.
Children may tend to be inactive or play in a flexible, and novel situations that challenge
limited, perseverative pattern (e.g., lining up the child’s ability to problem solve motor
toys). Children with autistic spectrum disor- tasks. Observation focuses on how the child
ders tend to have a primary deficit in ideation plans and sequences these tasks. The examin-
and a secondary one in motor planning. er should screen for the following behaviors
Impairment in execution is relatively less during several observation periods.
common in children with autism.
Children with dyspraxia are typically Dyspraxia Indicators
clumsy with a poor body scheme. They do • Inflexibility—perseverates on one aspect
not know where their body is in space and of the task and has difficulty in making
have difficulty judging their relationship to transitions
objects and people. As a result, they are acci- • Lack of sensorimotor exploration
dent-prone and tend to stumble, bump into • Limited complexity of play
furniture or others, and break toys. They are • Restricted problem solving of new tasks
generally poor in athletics. Since these chil- • Low frustration tolerance
dren have difficulty in sequencing daily • Presence of “crash” solutions to termi-
activities, they tend to be disorganized and nate demanding activities (e.g., knocking
disheveled looking. Due to their inflexibility down or throwing)
166 ICDL Clinical Practice Guidelines
muscles, whereas fine motor function is each of these four components of motor per-
dependent on the small muscles of the arms formance.
and hands. Oral-motor function is based upon There is more to assessment of motor
actions of the facial musculature for speech and performance than establishing the presence
eating. Table 3 provides further descriptions of or absence of milestones and determining a
Component Description
Neuromotor Processes
Muscle tone Muscle tension, ranging from hyper-to hypotonic, for main-
taining posture and position of arms/legs for specific tasks
Postural stability and mobility Holding positions and moving body parts to accomplish task
(e.g., stabilize trunk and shoulders to squeeze toy with
hands)
Symmetry Use of both sides of the body in simultaneous or reciprocal
action appropriate to the task at hand
Quality of movement Degree to which child’s actions are fluid and coordinated
Functional mobility Patterns of locomotion to move self from one point to anoth-
er (e.g., rolling, crawling, creeping, walking, running)
Hand preference and bilateral Using two hands together, for stability and skilled manipula-
coordination tion (e.g., manipulatory exploration, using a fork, buttoning,
writing with a pencil)
Oral-Motor Function
Actions of the tongue, lips, cheeks Coordination of sucking, swallowing, breathing, chewing,
biting for eating, speaking, and self-exploratory play
168 ICDL Clinical Practice Guidelines
• Does the child fatigue easily and demon- neuromotor processes helps one to appreciate
strate poor endurance, especially during the reasons for a developmental delay or
activities and gross motor play? functional limitation in motor performance.
Test of Infant 32 weeks Assesses the influence of Campbell, S., Osten, E., Kolobe,
Motor gestation– postural control on head, T. & Fisher, A. (1993).
Performance 4 months trunk, arm, and leg Development of the Test of Infant
movements Motor Performance.
In C. Granger, G. Gresham (Eds.),
New developments in functional
Assessment. Philadelphia: W. B.
Saunders
Alberta Infant 0–18 months Observational and naturalistic Piper, M., Darrah, J. (1994).
Motor Scale assessment of ability within Motor assessment of the developing
prone, supine, sitting, and infant. Philadelphia: W. B. Saunders.
standing positions
Cupps, 1993; Bly, 1994). Table 5 identifies Assessment of Fine Motor Function
measures of gross motor function commonly
used by occupational and physical therapists. Fine motor skills affect how children use
There also are global developmental their eyes and hands to manipulate objects,
assessments that include major sections tools, and toys to engage in self-help and play
addressing gross motor development that are activities, such as eating with a spoon, button-
used by interdisciplinary professionals, but ing clothing, turning the pages of a book, and
which are not referenced in this discussion. combing a doll’s hair. Fine visual-motor skill
Peabody 0-83 Two scales measure gross motor DLM Teaching Resources
Developmental months skills (reflexes, balance, non- One DLM Park
Motor Scales locomotor, locomotor, receipt/ Allen, TX 75002
(PDMS) (revision propulsion of objects) and fine
underway) motor skills (grasping, hand use,
eye-hand coordination and,
manual dexterity)
Pediatric Evaluation 6 months– Assesses functional abilities and PEDI Research Group
of Disability 7.5 years performance in three domains: Dept. of Rehab Medicine
Inventory (PEDI) self-care, mobility, and social New England Medical Center
function #75 K/R750 Washington St.
Boston, MA 02111
Test of Visual Motor 2–13 years Measures ability to copy 26 Children’s Hospital of
Skills (1986) different designs. Yields motor San Francisco
ages, standard scores, percentiles, Publications Dept.
and stanine scores OPR-110
PO Box 3805
San Francisco, CA 94119
Note: See also the following tests, as reviewed in the previous section on assessing fine motor function: Peabody
Developmental Motor Scales (PDMS), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), Functional
Independence Measure for Children (WEEFIM), Pediatric Evaluation of Disability Inventory (PEDI), and
School Function Assessment (SFA).
Clinical Feeding 0-3 years Clinical observations of the state Wolf, L., & Glass, R. (1992).
Evaluation of Infants of affect; motor control; oral- Feeding and swallowing disor-
motor structures; suck, swallow, ders in infancy. San Antonio.
breathe; physiological control TX: Therapy Skill Builders
Pre-feeding skills Early years Nonstandardized qualitative Morris. S., & Klein, M.
assessment of structural and (1987). Pre-feeding skills. San
functional oral motor coordina- Antonio, AZ: Therapy Skill
tion and skills in the context of Builders
feeding
Neonatal oral-motor Neonate Examines tongue and jaw move- Braun, M. & Palmer, M.
assessment scale ments during both nutritive and (1985). A pilot study of oral
non-nutritive sucking motor dysfunction in “at-risk”
infants. Physical and
Occupational Therapy in
Pediatrics, 5, 13-25.
Note: Also see the following tests reviewed in the section on assessing gross motor functions: Functional
Independence Measure for Children (WEEFIM), Pediatric Evaluation of Disability Inventory (PEDI), and
School Function Assessment (SFA)
Chapter 8. Assessment of Sensory Processing, Praxis, and Motor Performance 173
REFERENCES
Greenspan, S. I., & Meisels, S. J. (1996). Oetter, P., Richter, E., & Frick, S. (1988).
Toward a new vision for the developmental M.O.R.E.: Integrating the mouth with sen-
assessment of infants and young children. sory and postural functions. Oak Park
In S. J. Meisels & E. Fenichel (Eds.), New Heights, MN: Professional Developmental
visions for the developmental assessment of Programs.
infants and young children (pp. 11-26). Piper, M., & Darrah J. (1994). Motor assess-
Washington, D.C.: Zero-To-Three. ment of the developing infant. Philadelphia:
Hanft, B. E. & Place, P. A. (1996). The con- W.B. Saunders.
sulting therapist: A guide for OTs and PTs Porges, S. W., McCabe, P. M., & Yongue, B.
in schools. San Antonio: Therapy Skill G. (1982). Respiratory-heart rate interac-
Builders. tions: Psychophysiological implications for
Henderson, A., & Pehoski, C. (1995). Hand pathophysiology and behavior. In J.
function in the child: Foundations for reme- Cacioppo, & R. Petty (Eds.), Perspectives
diation. St. Louis, MO: Mosby. in cardiovascular psychophysiology (pp.
Kientz, M. A., & Dunn, W. (1997). A compar- 223-264). New York: Guilford Press.
ison of the performance of children with Schaaf, R. C., & Anzalone, M. E. (in press).
and without autism on the sensory profile. Sensory integration with high risk infants
American Journal of Occupational Therapy, and young children. In E. Blanche, S.
51, 530-537.
Smith-Roley, & R. Schaaf (Eds.), Sensory
Kinsboume, M. (1983). Toward a model of
integration and developmental disabilities.
attention deficit disorder. In M. Perimutter
San Antonio, TX: Therapy Skill Builders.
(Ed.), The Minnesota Symposium on Child
Schneck, C. M. (1996). Visual Perception. In
Psychology, Vol. 16: Development and pol-
J. Case-Smith, A. S. Allen, & P. N. Pratt
icy concerning children with special needs.
(Eds.), Occupational therapy for children
Hillsdale, NJ: Erlbaum.
Lezak, M. D. (1995). Neuropschological (3rd ed.). St. Louis, MO: Mosby.
assessment (3rd ed.). New York: Oxford Wetherby, A., & Prizant, B. (Eds.) (2000).
University Press. Communication and language issues in
McIntosh, D. N., Miller, L. J., & Shyu, V. autism and pervasive developmental dis-
(2000). Development and validation of the abilities: A transactional developmental
Short Sensory Profile. In W. Dunn (Ed.), perspective. Baltimore, MD: Paul H.
The sensory profile examiner’s manual. San Brookes.
Antonio, TX: Psychological Corporation. Wilbarger, P. (1995). The sensory diet: Activity
Miller, L. J. (1988). Miller assessment of programs based on sensory processing theo-
preschoolers. San Antonio, TX: Psycho- ry. American Occupational Therapy
logical Corporation. Association Sensory-Integration Special
Miller, L. J., & McIntosh, D. N. (1998). The Interest Section Quarterly, 18(2), 1-4.
diagnosis, treatment and etiology of sensory Wilbarger, P., & Wilbarger, J. L. (1991).
modulation disorder. American Occupational Sensory defensiveness in children aged 2-
Therapy Association Sensory Integration 12: An intervention guide for parents and
Special Interest Section Quarterly, 21, 1-3. other caretakers. Santa Barbara, CA:
Morris, S., & Klein, M. (1987). Pre-feeding Avanti Education Programs.
skills. San Antonio, TX: Therapy Skill Williams, D. (1994). Somebody somewhere.
Builders. New York: Times Books.
Chapter 8. Assessment of Sensory Processing, Praxis, and Motor Performance 175
Appendix A
Appendix B
TOTAL:__________________
B. Sensory Processing of Touch
Does your child:
1. Dislike being bathed or having his
hands, face, or hair washed? YES (1) NO (0)
2. Complain that other people “bump” into him? YES (1) NO (0)
3. Dislike textured foods (chewy, crunchy)
and avoid new food textures? YES (1) NO (0)
4. Prefer certain clothing and complain about
tags in clothing or that some clothes are
too tight or itchy? YES (1) NO (0)
5. Frequently bump or push other children
and may play too rough? YES (1) NO (0)
6. Prefer as little clothing as possible or
prefer long sleeves and pants, even in
warm weather? YES (1) NO (0)
7. Seem excessively ticklish? YES (1) NO (0)
8. Overreact or underreact to physically
painful experiences? (Circle which one) YES (1) NO (0)
9. Tend to withdraw from a group or
seem irritable in close quarters? YES (1) NO (0)
TOTAL:__________________
TOTAL:__________________
TOTAL:__________________
D. Emotional Maturity
Does your child:
1. Play pretend games with dolls, cars, etc.,
with sequences or plots to the game (e.g., the
doll gets up, gets dressed, eats breakfast)? YES (0) NO (1)
2. Engage you in games that he makes up
or wants to play? YES (0) NO (1)
3. Seek you out for affection and play pretend
games during which she will take care of a doll? YES (0) NO (1)
4. Play pretend games that involve assertiveness,
exploration, or aggression (car races, soldiers
fighting, or a trip to grandma’s house)? YES (0) NO (1)
5. Understand rules such as to wait for you to
say it is safe to cross the street? YES (0) NO (1)
6. Understand that there are consequences to his
behavior (if he behaves nicely, you are pleased;
if naughty, he will be punished)? YES (0) NO (1)
184 ICDL Clinical Practice Guidelines
TOTAL:__________________
TOTAL:__________________
1 Reprinted with permission from DeGangi, G. A., & Balzer-Martin, L. A. (in press). The sensorimotor
history questionnaire for preschoolers. Journal of Developmental and Learning Disorders, 2.