Why Sensory Processing Questionnaires Are Incomplete
The most common way to assess sensory processing in children is through questionnaires given to adults. Although some of these measures are standardized, they don’t fully capture the child’s sensory symptoms because they are only based on what can be observed. However, not all sensory symptoms can be observed.
Occupational therapists typically also include observations in their sensory processing evaluations, However, despite our expertise in this area, observing sensory differences can be very challenging. First, we are often only catching children for a small moment of their day. Also, in a clinic setting we tend to have a sensory-friendly environment that may keep us from seeing sensory symptoms. In addition, if we are seeing them in their natural environment they may have some sensory supports in place that are working for them that we may not be aware of.
Common Sensory Questionnaires
Pros: standardized, relatively simple for therapists and parents to understand
Cons: can over identify sensory issues at times. Several items with “occasionally” as a response will indicate a sensory difference
Pros: standardized, more detailed than other measures
Cons: can be difficult to interpret and relate to function
Sensory Symptom Checklist (like these school and home versions from Sensational Brain)
Pros: cover a wide range of sensory areas
Cons: not standardized, hard to distinguish between normal sensory differences from a sensory issue
Not All Sensory Symptoms Can Be Seen
Often not considered is how the quiet child may perceive sensory input. Just because they don’t complain about the lighting or smells in their environment, does not mean they aren’t bothered by them, or that they don’t affect how they function during the day. For example, I am extremely sensitive to smells and can’t focus if there is someone near me with a strong perfume. It takes a lot of cognitive effort for me to stay focused on what I’m doing. Most people wouldn’t know that because I keep it to myself since I can’t do anything about it. There are likely children who are having a similar reaction and response. What learning are they missing as a result?
In addition, some children have differences with interoception. A child with difficulty understanding internal cues from their body, or those who are overly aware of their internal cues, may not share or understand what those signals mean. I worked with a teen once who was overly aware of her sensations to the point where the very thought of touching sand would result in distraction and a feeling of discomfort in her body. Observations of this child may not identify the significance of her sensory processing.
Some Sensory Signs May be Incorrectly Attributed to Sensory Processing
Although we may see signs, such as eye rubbing or frequent blinking, that may indicate a child is sensitive to lights in the classroom, this may be something that isn’t on the radar of a teacher to even notice and may not be identified as an issue on a sensory questionnaire. In addition, this particular issue may be a sign of oculomotor difficulties rather than a sensory reaction.
What is Missing
To be the most effective helping children with sensory processing differences we need more information. This is why the The Stress Detective Clue Cards are so helpful.
The Clue Cards help children share their sensory experiences. Not only can they rate a variety of sensory items, they can identify other possible stressors that may contribute to their behavior that may rule out sensory processing issues. The color coding of the cards can help identify patterns, such as whether their difficulties are related to social anxiety or social challenges or a lack of flexibility.
Observations alone don’t always help us understand when sensory processing differences are affecting a child. We need to get their perspective whenever possible. The Clue Cards can make an assessment more comprehensive. This ultimately helps us help children more effectively.
