Dr. Jane Case-Smith is a professor and is director of occupational therapy at the Ohio State University. She has 30 years of experience in working with children and currently is a member of a diagnostic team that sees primarily children with autism. She recently completed a research review of autism interventions used by occupational therapists for the American Occupational Therapy Association and is a co-author of the AOTA Autism Guidelines. She is also the editor for Occupational Therapy for Children, now in its sixth edition. Her interests are primarily young children, children with autism and cerebral palsy, fine motor interventions, and intervention efficacy. In this webcast, Dr. Case-Smith introduces the Sensory Profile. The Sensory Profile is a caregiver questionnaire, designed to determine how well children process sensory information.
Hello. My name is Jane Case-Smith and I am the Director of Occupational Therapy at the Ohio State University. I was also a recent co-author of the published guidelines for occupational therapy interventions for children with autism. I also participate in a weekly clinic that provides an initial diagnostic assessment for children who are on the spectrum. It's widely recognized that children with autism spectrum disorder have difficulty with sensory processing. They often have hypersensitivity of the auditory and tactile systems. Occupational therapists assess sensory processing in children with autism and other developmental disabilities. By assessing children's sensory preferences and aversions, families and the intervention team can come to an understanding of what situations will be difficult for the child and what accommodations are needed.
I will be introducing the Sensory Profile by Winnie Dunn. This tool is available through the OCALI Lending Library. The Infant/toddler Sensory Profile, Adult/ Adolescent Sensory Profile and the Sensory Profile School Companion assessments are all available through OCALI, although today I will only be describing the Sensory Profile. These tools are very similar in purpose and structure and give you options for assessing children and youth across age ranges.
Given the pervasive and subtle nature of sensory processing problems, they cannot always be identified by simply observing the child and by administering specific items. Therefore to understand a child's sensory preferences and aversions, therapists must gain information about the child's behavioral responses to a variety of sensory experiences over time. The parent or primary caregiver is the natural informant for the child's sensory preferences and responses. The Sensory Profile is a caregiver questionnaire in which the caregiver reports the frequency with which certain behaviors occur. The therapist can interpret a particular pattern of responses that suggests the child's sensory processing.
Two versions of the original Sensory Profile are available, the full Caregiver Questionnaire that is 125 items and the Short Sensory Profile that is 38 items. For both versions, the items are scored according to the frequency of the child's responses (Always, Frequently, Occasionally, Seldom, or Never). The scoring system is set up so that more frequent behaviors receive a lower score, that is, always is scored a 1, frequently 2, occasionally 3, seldom 4 and never 5. Therefore the child with more sensory processing difficulties would score lower on the Sensory Profile. When the full Caregiver Questionnaire is used, the scores can be interpreted using nine factors. A Summary Score Sheet is available to compute and interpret the child's score using these factors. The scores are entered and summed for each factor.
The Sensory Profile is most appropriate for children 5 to 10 years of age. It can also be used with 3 and 4 year olds. The manual explains that 3 and 4 year old children are more likely to be sensory seeking and they are less reactive and distractible. Three items don't apply to very young children: putting puzzles together; legible handwriting; and staying between the lines.
Therefore, therapists are encouraged to adjust how the scores are interpreted given that it's developmentally appropriate that a young child would show difficulty with these skills. You can also use the Infant/Toddler scale with 3 year olds which might be a better option.
All that's needed to administer the Sensory Profile is the parent or caregiver, the questionnaire and a pencil. The therapists can interview the caregiver or ask the caregiver to complete the profile independently by reading the items. Although the items are fairly easy to understand, therapists report that they believe the results are more valid when they interview the parent. Also the interview gives therapists and parents the opportunity to discuss the child's behavior and to explain sensory processing issues beyond the scale items. Therefore, I would encourage you to interview the parent when feasible.
The items on the long form of the caregiver questionnaire are grouped in the following sections: Sensory Processing, Modulation, and Behavioral and Emotional responses. The sensory processing section assesses the child's responses to auditory, visual, vestibular, and touch sensations. It also has subsections for multi-sensory and oral sensory processing. The modulation section has five subsections: Sensory processing related to endurance and tone; modulation related to body position and movement; modulation of movement affecting activity level; modulation of sensory input affecting emotional responses; and modulation of visual input. The third section assesses behaviors that indicate emotional/social responses.
On the Short Sensory Profile, the most important score is the total score. However, it does have subsections on tactile sensitivity, taste/smell sensitivity, movement sensitivity, under-responsive/seeks sensation, auditory filtering, low energy/weak, and visual/auditory sensitivity.
Caregivers report that it takes 30 minutes to complete the full Caregiver Questionnaire and 10 minutes to complete the Short Sensory Profile.
Use of the Sensory Profile is not restricted to any particular professional. Although it is often administered by an occupational therapist, it can be administered by teachers, speech language pathologists or psychologists. It's helpful to understand sensory processing problems when interpreting the results. It's also helpful to know some of the Sensory Profile research that's been completed. The tool shows the ability to discriminate children with ADHD, autism, and other disability groups.
Each subsection of the Sensory Profile can be scored and these scores can be interpreted using cut off scores that judge the child's sensory processing as typical, probably different or definitely different. Typical Performance refers to scores that are at 1 standard deviation below the mean. Probable difference refers to scores that are at or above 2 standard deviations below the mean. And, scores that fall below 2 standard deviations below the mean are designated as definite difference.
The factors that can be scored in the Sensory Profile are sensory seeking, emotionally reactive, low endurance/tone, oral sensory, inattention/distractibility, poor registration, sensory sensitivity, sedentary, and fine motor/perceptual.
The Sensory Profile is a useful tool for children with autism, particularly if the parents report hypersensitivities or if they appear to be sensory seeking. The scale can add to the school team's understanding of the child's sensory processing because it gives a picture of the child's behaviors at home and it reveals the parent's interpretation of the child's behaviors. It can also reveal a particular pattern of sensory responses. Because the school team only sees the child for a portion of the day, the parents' description of the child's behaviors throughout the day is quite useful. The scale can also be helpful to parents, enabling them to understand a child's sensory processing problems and to have alternative explanations for certain behaviors. Sometimes the Sensory Profile can identify that the child's behavior is quite different at home and at school. At other times, it enables the team to see that certain behaviors are consistent across environments.
The primary findings lead to an understanding of the sensations that cause aversive responses in the child and the sensations that the child seeks. Often children with autism have auditory sensitivities. These can manifest as hypersensitivity to loud sounds or hypersensitivity to typical sounds in the everyday environment. A child with autism can also show both sensitivity to auditory input and delayed or no response to auditory input. Although this pattern of responsiveness is confusing to a parent, it's not unusual and suggests a problem in sensory modulation.
Similarly, the child may show both tactile sensitivity and a craving for certain types of touch such as deep pressure. Certain types of sensory input can have a therapeutic effect and other types can have an aversive effect. The Sensory Profile helps the team understand the child's behavioral responses to sensation. It's also important to recognize that observations of the child in different environments can be just as important as the Sensory Profile scores. The Sensory Profile scores should not be used in isolation of other assessment information based on informal observation and administration of other standardized tests. Although some children may score low on the Sensory Profile, they may show functional and typical behaviors.
Also it's been my experience that the child's performance on the Sensory Profile can change over time, particularly if the scale is administered when the child is 3 or 4. Young children tend to score lower because they have more over-responsiveness and these scores tend to increase when the child enters school.
The Sensory Profile has been used with children with autism in research studies. It was found that children with autism scored significantly different on 90% of the items when compared to typical children. Children with ADHD also exhibited more frequent behaviors to sensory input, scoring a difference on 113 of 125 items. These score differences mean that children with autism and ADHD often have sensory processing problems. It also implies that scores for these groups can be expected to be low and that sensory processing difficulties often are a part of these diagnoses.
A School version of the Sensory Profile is now available. This version can be completed by therapists and teachers based on observations of the child across school environments. The infant and adolescent versions of the scale also provide assessment of sensory processing across a wide age range. Software is available to assist in scoring all of the scales. This software program also produces a technical report of the scale results.