Evaluating Sensory Processing

When I was new to pediatrics I was very confused about how to evaluate sensory processing. I had transitioned from working with adults and there wasn’t really a standard methodology that I could follow. I don’t remember there being standardized questionnaires available at my first school-based job either. The Sensory Profile was available at my next one, but I still felt fairly clueless trying to find a way to assess it beyond a questionnaire. 

One year the Autism Team for my school district decided that every child being considered for autism eligibility should have a sensory evaluation.  As the OT on the team I was responsible for this. I did an observation for every student and had teachers complete the Sensory Profile. But I still felt like something was missing. So I created a simple questionnaire for the children who could fill it out. That was a start to help me feel like I had a little more information than what I could get with a questionnaire completed by adults. 

Can You Truly Assess Sensory Processing?

At the time the only thing I was aware of that was a specific evaluation for sensory processing that wasn’t a questionnaire was the Sensory Integration and Praxis Test (SIPT). This was not accessible to many OTs because the training took weeks, was only in California, and the test was very expensive to purchase. It was very confusing; if I couldn’t give that assessment then could I even actually assess sensory processing?

Many years after that my state made the same decision, that every child should have a sensory processing evaluation if autism eligibility was being considered. As a result, sensory processing evaluation referrals skyrocketed. The SIPT wasn’t even an option anymore and there was little consistency for methods to assess this among therapists and school districts. 

Should We Call it Sensory Processing Disorder?

Prior to the state mandate I had reached the conclusion that sensory processing signs were a symptom of something else (autism, ADHD, etc.), and not something that stood alone. There are more OTs who agree with this now, but still many who don’t and who continue to refer to “Sensory Processing Disorder” as though it’s an actual diagnosis. The American Psychiatric Association, who creates the DSM, also concluded that there was not only no such thing as “sensory processing disorder” (despite a lot of advocacy from OT organizations to include it in the DSM), but that there was not even enough evidence to wait on more research so it could be considered for the next edition.* This only reinforces that there are not clear cut criteria to identify sensory disorders as a separate diagnosis and helps explain why I have found it challenging to assess.

How to Evaluate Sensory Processing 

So, here we are with limited ways to assess sensory processing. But I feel better about evaluations now that I have the Clue Cards. Here is my process now in the schools:

• Classroom observation(s). Ideally I’d love to do a few, but this is rarely practical on a tight timeline.
• Sensory-based questionnaire. I use the SPM-2 currently, but also created a Google form for teachers of middle and high school students so I can get a variety of perspectives. You can see it here: Sample Sensory Feedback Form
• Interview children with the Clue Cards.
• Observations when meeting with the child when I can provide a variety of sensory input. Often this is very difficult as we tend to do evaluations in quiet environments where we likely limit the sensory input. 

I also use a self-regulation questionnaire for children. (You’ll get this automatically when you get on our email list.) 

We Need Input from Those Who Experience the Sensations

Being able to interview children about their stressors, which includes sensory areas as well as many other things, has made a huge difference in my sensory processing evaluations. I have evaluated students who show typical sensory processing on the SPM and no issues when being observed yet report many sensory areas that bother them because they mask at school. That child may not have received services that they need because of this discrepancy. 

On the other hand, I have also learned that a sensory processing questionnaire may show many significant areas, but a child may not report any sensory areas as being a problem. This is usually because they have sensory supports in place that are working for them. That child often does not need sensory interventions or support from OT on their IEP. 

In private practice, being able to get feedback from a child has been particularly invaluable also because I am not able to do an observation. 

Finally, I’d like to mention that there are many factors that can affect whether a child has sensory signs. We often don’t include those things in our evaluations, often because they are out of our scope or we don’t have access to them (particularly in the schools). For example, a sleep-deprived child may be more impulsive and fidgety as they attempt to keep themselves alert. Here is a copy of the blurb I use in my sensory evaluation summary: 

I then describe whether I think sensory processing plays a part in their ability to self-regulate. 

We often recognize a “sensory kid” when we see them, but sensory-based questionnaires for adults are often insufficient and may miss important sensory information, especially for a child who may be masking. Getting input from the child should be a standard part of our sensory processing evaluations when possible. 

If you’re an occupational therapist how do you evaluate sensory processing? 

(*While there are issues with the DSM, the point here is really about the lack of clearcut criteria to define “Sensory Processing Disorder” as an actual issue.)