Answers provided by: Barbara Hanft, MA, OTR, FAOTA and Lucy Jane Miller, PhD, OTR
Ms. Hanft is an occupational therapist with more than 25 years of clinical and policy experience in pediatrics, early intervention, and special education. Ms Miller is executive director of the SPD Foundation.
Reprinted with the express permission of SPD, Sensory Processing Disorders Foundation as originally published on their website.
Q: How are sensory integration theory, sensory integration dysfunction, Sensory Processing Disorder, and Sensory Modulation Disorder related?
A: Sensory integration theory was formulated by A. Jean Ayres, PhD, OTR, an occupational therapist who practiced from the mid-1950s until 1988. Based on neuroscience principles, the theory describes an underlying rationale for the diagnosis and treatment approach that Dr. Ayres founded to evaluate and intervene with children who have particular sets of sensory and/or motor symptoms and who may have learning disabilities. Her basic concept was that the individual had a deficit in the central nervous system’s ability to receive, filter, organize, and integrate stimuli, which resulted in a non-adaptive response.
Sensory integration dysfunction (DSI) was the term used by Dr. Ayres to refer to this broad theory, as well as to the diagnosis and the treatment (e.g., sensory integration treatment) of children who have the dysfunction.
These terms and the relationships between them have been clarified for the purposes of this web site. The current terminology is explained below.
“Sensory integration” is now recommended for use only to refer to Dr. Ayres’ theories about mechanisms of the disorder and their intervention. Intervention is now referred to as “occupational therapy (OT) with a sensory-based (or SI, sensory integration) approach,” or “OT using Ayres’ sensory-based (or sensory integration) approach.”
Sensory Processing Disorder (SPD) is the label used on this web site to denote the diagnosis of difficulty in processing sensory input in an efficient and accurate manner, and includes the accompanying behavioral, attentional, motor, and functional manifestations.
Sensory Modulation Disorder (SMD) is one of the three primary subtypes of Sensory Processing Disorder. Individuals with SMD have difficulty adjusting their responses to match the needs of the situation. They often have patterns of over-responsivity, under-responsivity, or sensory-seeking (or a combination of those patterns) in response to levels of stimulation that typically developing individuals respond to with a brief orienting response (noticing the new stimulus) and then habitation (ignoring the new stimuli) once it is interpreted as non-threatening.
For more information, see Defining SPD and its subtypes
Sources

• Ayres AJ. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.
• Roley SS, Wilbarger J. (1994). What is sensory integration? A series of interviews on the scope, limitations, and evolution of sensory integration theory. Sensory Integration Special Interest Section Newsletter, 17(2), 1-7.

Q: How can I assess Sensory Processing Disorder if I’m not certified in administration of the Sensory Integration and Praxis Tests (SIPT)?
A: The basis of all occupational therapy assessment is to evaluate the impact of underlying components, including sensory integrative function, that affect an individual’s functional performance in the context of specific settings in which the individual must perform.
In addition to the Sensory Integration and Praxis Tests (whose use may be limited due to a child’s age or ability to understand the test directions), clinical observations and sensory history questionnaires can provide information about sensory integration (see Cook, 1991; Dunn & Westman, 1997; Royeen & Fortune, 1990). Many standardized perceptual and motor tests (see Carrasco, 1993) also provide an opportunity to observe aspects of sensory integrative function.
For advanced clinicians who desire to develop or enhance their diagnostic skills, the SPD Foundation offers a five-day mentorship program that includes training in choosing appropriate tools to evaluate children with SPD;
Administering, scoring, interpreting ,and writing up standardized scales reliably; and interpreting findings from evaluations for treatment planning. The program is AOTA-approved for continuing education credit. Learn more about the program atAdvanced Mentorship Program.
See also “Guidelines for Competency in the Application of Sensory Integration Theory” also from the SPD Foundation’s library.
Sources

• Carrasco R. (1993). Key components of sensory integration evaluation. Sensory Integration Special Interest Section Newsletter, 16(2), 1-7.
• Cook D. (1991). The assessment process. In W. Dunn (Ed.), Pediatric occupational therapy. Thorofare, NJ: Slack, Inc. (includes a functional behavior assessment for children with Sensory Processing Disorder).
• Dunn W, Westman W. (1997). The sensory profile: The performance of a national sample of children without disabilities. American Journal of Occupational Therapy, 51, 25-34.
• Royeen C, Fortune J. (1990). TIE: Touch Inventory for School-aged Children, American Journal of Occupational Therapy, 44, 155-160.

Q: Are children entitled to Sensory Processing Disorder therapy in school by law?
A: The Individuals with Disabilities Education Act (IDEA) guarantees a free and appropriate public education with peers, to the maximum extent appropriate, to all eligible children with disabilities (ages 3-21) who need special education and related services in order to learn in school. Children with disabilities can receive occupational therapy (OT) if they qualify for special education. In addition, a school team, including the parents, must decide if the therapy is necessary. (Some school districts will provide OT in other instances, e.g., to give teachers suggestions before referring a child to special education, called a pre-referral.)
There are no provisions in state or federal law that specify how OT, once recommended by the team, must be provided. This includes the service model, frequency of intervention, and the frame of reference.
In due process hearings and the courts, the issue of theory base or frame of reference has been referred to as a methodology decision. One of the latest court decisions regarding methodology centered around individual instruction for a student with dyslexia using the Ortho-Gillingham method (E.S. v. Independent Sch. Dist. No. 196). The district court disallowed the parent’s request for this kind of reading instruction, stating that schools have discretion over methodology decisions as long as the program provides a free and appropriate public education.
Therapists who recommend school-based sensory integration therapy must show how the student needs this kind of occupational therapy in order to benefit from participation in the curriculum and specific school activities. Important issues to address (in jargon-free language) include:
The student’s performance levels in educationally relevant areas
How OT services using sensory integration would support team goals
The specific instructional methods and materials (including those based on sensory integration principles) needed to assist the student in reaching specified educational goals
Sources

• AOTA (1997). OT services for children and youth under the IDEA. Bethesda MD.
• AOTA (1997). Statement-Sensory integration evaluation and intervention in school-based occupational therapy. Bethesda MD. (Available from FAX-on-Request from the AOTA National Office, 800-701-7735, document #903)
• E.S. v. Independent Sch. Dist. No.196, 27 Individuals with Disabilities Education Act Law Review 503, 96-4214, 8th Cir. 1998.

Q: How can I best apply Sensory Processing Disorder principles in school settings?
A: The effective application of Sensory Processing Disorder (SPD) principles in school settings is an important role for occupational therapists. When you are in this situation, try to focus on articulating the educational benefit for the student and planning interventions that will improve outcomes related to the student’s role in a school setting (e.g., develop goals and objectives for increasing attention for school tasks versus reducing sensory defensiveness).
Use consultation and integrated therapy within the classroom to help teachers and parents reframe their perspectives about the student’s behavior and abilities as well as adapt the school environment, the educational task, and specific materials used in lessons. Mailloux (1997) states “..it is also the job of the occupational therapists to educate the team about how sensory integrative disorders are affecting the child’s educational performance and how appropriate intervention based on sensory integrative concepts can be incorporated into all aspects of their educational program.”
Sources

• Sarracino T. (1997). Applying a sensory integrative frame of reference in school practice. Sensory Integration Special Interest Section Newsletter, 20(3), 1-2.
• Mailloux Z. (1997). Sensory integration and role performance in students. Sensory Integration Special Interest Section Newsletter, 20(3), 3-4.
• Bundy A. (1991). Consultation and sensory integration theory. In Fisher, Murray, Bundy (Eds.), Sensory integration: Theory and practice (pp. 318-332). Philadelphia: F.A. Davis.

Q: How can I assess the sensory integrative function of children from birth to 3 years of age?
A: Gather your information from several sources. Most important are the child’s parents and child care provider. Interview them to find out how processing of sensory information affects the child’s interaction with others, sleep/wake cycles, and play and eating behaviors (DeGangi et al, 1995; Jirgal, Bouma, 1989).
Clinical observation and a thorough knowledge of sensory integration theory and typical and atypical development are also essential. Although formal tests may be difficult to administer to very young children, DeGangi and Greenspan (1989) have a test of sensory integration function, and Miller (1994) has developed assessments of the quality of movement based on SI and neurodevelopmental therapy principles for this age group. Many other developmental tests also contain items that provide information about an infant’s sensory processing, coordination, and motor planning abilities (see Stallings, 1993, for a description of items for birth-3 in these tests).
The SPD Foundation offers a five-day mentorship program in advanced clinical assessment and treatment of SPD. The program is AOTA-approved for continuing education credit. Learn more about the program at Advanced Mentorship Program.
Sources

• DeGangi G, Greenspan S. (1989). Test of sensory functions in infancy. Los Angeles CA: Western Psychological Services.
• DeGangi G, Poisson S, Sickel R, Wiener A. (1995). Infant/toddler symptom checklist: A screening tool for parents. San Antonio, TX: The Psychological Corps/Therapy Skill Builders.
• Jirgal D, Bouma K. (1989). Sensory integration interview guide for infants. Sensory Integration Special Interest Section Newsletter, 12(2), 5.
• Miller L. (1994) The T.I.M.E. Toddler and Infant Motor Evaluation. San Antonio TX: The Psychological Corps/Therapy Skill Builders.
• Stallings S. (1993). Assessment of sensory integrative dysfunction. In J. Case-Smith (Ed.), Pediatric occupational therapy and early intervention (pp. 309-341). Boston: Andover Medical Publishers.

Featured Organization: Sensory Processing Disorder Foundation
The SPD Foundation is a world leader in research, education, and advocacy for Sensory Processing Disorder, a neurological condition that disrupts the daily lives of an estimated 1 in 20 children and adults. Originally called the KID Foundation, SPDF has been providing hope and help to individuals and families living with SPD since 1979.
Please support our contributing Organizations and visit SPD Foundation