Evaluating the Sensory Integrative Functions of Mainstream Schoolchildren with Specific Developmental Disorders

Clinicians and educators are becoming increasingly aware of sensory integrative dysfunctions (SIDs) in mainstream schoolchildren with specific developmental disorders (SDDs). This study was designed (1) to determine whether or not SID occurred significantly in mainstream schoolchildren aged 5–8 years, referred to the Ealing Paediatric Occupational Therapy Service (EPOTS); (2) to explore the patterns and nature of SID found In such a group; and (3) to ascertain any relationships between certain types of SID and specific behavioural traits.

The study adopted a differential research method. The subjects were two groups of children aged 5–8 years. The experimental group (EG) consisted of 25 children referred to EPOTS. The control group (CG) consisted of 18 mainstream schoolchildren with no known dysfunction. All subjects were administered the Sensory Integration and Praxis Tests (SIPT) and Clinical Observations of neurobehavioural and neuromuscular functions. The Conners' Parent Rating Scales – 93 (CPRS-93) was used to evaluate specific behavioural traits in the EG children.

The results of statistical analysis supported that mainstream schoolchildren with SDD (EG, n=25) referred to EPOTS had significantly lower scores (p<.001) in the SIPT than a normal control group of children (CG, n=18) with matched demographic data. The EG children showed significant neurobehavioural and neuromuscular dysfunctions (p<.05) in comparison with the CG in the Clinical Observations. The percentage of EG children with scores similar to the six SIPT clusters was 44%, which is higher than the figure of 29.6% produced by the test publisher. There was no consistent correlation between the SIPT variables and the variables identified in the CPRS-93. Although the findings were not conclusive, some partial pattern could be identified.

Clinical Evaluation of the Effectiveness of Sensory Integrative and Perceptual Motor Therapy in Improving Sensory Integrative Function in Children with Learning Disabilities

After 72 1-hour therapy sessions for 3 hours per week, significantly more subjects, aged 58 to 107 months, receiving sensory integration therapy ( n=35) and perceptual motor training ( n=35) than those receiving no treatment ( n=33) showed improvement in their sensory integrative functioning. The same effect was found for a subgroup of children exhibiting vestibular dysfunction only. Improvement could include an increase of all test scores defining a child's particular dysfunction into the normal range with associated clinical observations indicating no problem, or a reduction in the severity of a child's dysfunction, the number of their dysfunctional systems, or both severity and dysfunctional systems. The groups did not differ in the incidence of any one of these individual types of improvement, but only in their overall improvement represented by the total of all types. Discussion focused on the type and degree of improvement therapists can expect from treatment and problems associated with evaluating outcome.

Verbal Self-Guidance as a Treatment Approach for Children with Developmental Coordination Disorder: A Systematic Replication Study

Children with developmental coordination disorder (DCD) experience many occupational performance difficulties in all areas of daily living. For the most part, research has failed to identify an effective treatment approach for these children. Verbal self-guidance (VSG), a new approach, first explored by Wilcox and Polatajko (1993), appears to have good potential in helping children with DCD become competent in the occupations of their choice. The purpose of this study was to carry out a systematic replication of the first VSG study to determine if a different therapist could achieve similar results. Repeating the VSG procedure with four different children, using a single case study design, a different therapist was able to replicate the earlier findings. This provides further evidence of the potential of VSG as an effective approach for enabling children with DCD to surmount their motor challenges.

Construct Validity of the Sensory Integration and Praxis Tests

The purpose of this study was to examine the construct validity of the praxis tests of the Sensory Integration and Praxis Tests (SIPT) and to determine whether the practic component of sensory integration-based developmental dyspraxia is a unitary or a multidimensional disorder. Developmental dyspraxia is an impaired ability to plan and execute skilled or nonhabitual motor tasks; however, its underlying cause, or even whether praxis is a unitary or multidimensional function, is not yet clarified. In this study, the Rasch model of measurement (Linacre, 1989; Wright & Masters, 1982; Wright & Stone, 1979) was used to explore the underlying construct of developmental dyspraxia. The Rasch model was chosen because its use enabled us to (a) confirm goodness-of-fit of individual items within SIPT praxis tests and (b) examine the hierarchical structure of item difficulties.

The data included the raw scores of the SIPT praxis tests of 210 subjects from Canada and the United States. The results of the Rasch analyses revealed that each of these five SIPT praxis tests measures a single, unidimensional construct. When the items from the five tests were combined to create a single 117-item test, the items continued to define a single practic function. This indicates that a unitary practic component underlies both bilateral integration and sequencing deficits and somatodyspraxia. Finally, examination of the hierarchy of item difficulties resulted in recommendations for the development of a single screening test for developmental dyspraxia. The implications of these results for clinical practice and future research are discussed.

Cluster Analysis of Scores of Children on the Sensory Integration and Praxis Tests

A cluster analysis of scores of 1961 children on the Sensory Integration and Praxis (SIPT) tests was performed to explore subgroupings of children referred for SIPT testing, and to provide information concerning the validity of the six profiles currently used in the SIPT interpretation process. The results yielded a five rather than a six cluster solution, including the following profiles: Low-average Bilateral Integration and Sequencing; Dyspraxia; Generalized Sensory Integration Dysfunction and Dyspraxia-Severe; Generalized Sensory Integration Dysfunction and Dyspraxia-Moderate, and Average Sensory Integration and Praxis. Clinical implications of the results of this study related to SIPT interpretation are discussed.

Williams syndrome: a surprising deficit in oromotor praxis in a population with proficient language production

Williams Syndrome (WS) is a neurodevelopmental disorder of known genetic origin, characterized by serious delays in language onset yet relatively verbose, intelligible and fluent speech in late childhood and adulthood. How do motor abilities relate to language in this group? We investigated planning and co-ordination of the movement of the speech articulators (oromotor praxis) in 28 fluent-speaking individuals with WS, aged between 12 and 30 years. Results indicate that, despite their fluent language, oromotor praxis was impaired in WS relative to two groups of typically-developing children, matched on either vocabulary or visuospatial ability. These findings suggest that the ability to plan, co-ordinate and execute complex sensorimotor movements contribute to an explanation of the delay in expressive language early in development in this neurodevelopmental disorder. In the discussion, we turn to more general issues of how individual variation in oromotor praxis may account for differences in speech/language production abilities across developmental language disorders.

Clinical description of children with developmental coordination disorder

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Is Sensory Integration Effective for Children With Language-Learning Disorders?

Sensory integration therapy has become widely accepted as an intervention for enhancing language-learning disorders and academic difficulties in hildren. However, much controversy surrounds this approach because of the small amount of empirical evidence to support its application to this clinical population. The purpose of this article is threefold: review the relevant research pertaining to treatment efficacy studies involving sensory integration conducted over the last three decades, discuss the perspectives from which various researchers and clinicians view language disorders in children, and discuss parameters for evaluating efficacy studies and the clinical use of sensory integration, suggesting directions for future research.

Developmental dyspraxia and developmental coordination disorder

This article discusses the role developmental dyspraxia plays in developmental coordination disorder (DCD), based upon a review of literature on apraxia, developmental dyspraxia, and DCD. Apraxia and dyspraxia have often been equated with DCD. However, it is argued that apraxia and dyspraxia primarily refer to the problems of motor sequencing and selection, which not all children with DCD exhibit. The author proposes to distinguish developmental dyspraxia from DCD. Other issues discussed include the assessment, etiology, and treatment of developmental dyspraxia and DCD, and the relationship between DCD and learning disabilities. A research agenda is offered regarding future directions to overcome current limitation.

Developmental differences in praxis in learning-disabled and normal children and adults

Gestures made on tasks in response to verbal command or to imitation and on tasks involving axial and distal movements were compared for groups of learning-disabled and normal children and adults. The 15 learning-disabled children and 15 adults scored lower than the 15 normal children and 15 adults on all tasks. All groups scored higher on imitation than on verbal command and scored similarly on the axial and distal tasks. The findings from this study suggest that it would be worthwhile to test the hypothesis that dyspraxic behaviors may persist into adulthood.

A critique of the application of sensory integration therapy to children with learning disabilities

Sensory integration (SI) therapy is a controversial--though popular--treatment for the remediation of motor and academic problems. It has been applied primarily to children with learning disabilities, under the assumption that such children (or at least a subgroup of them) have problems in sensory integration to which some or all of their learning difficulties can be ascribed. The present article critically examines the related issues of whether children with learning disabilities differentially exhibit concomitant problems in sensory integration, and whether such children are helped in any way by means specific to SI therapy. An overview of theoretical contentions and empirical findings pertaining to the first issue is presented, followed by a detailed review of recent studies in the SI therapy research literature, in an effort to resolve the second issue. Results of this critique raise serious doubts as to the validity or utility of SI therapy as an appropriate, indicated treatment for the clinical population in question--and, by extension, for any other groups diagnosed as having "sensory integrative dysfunction." It is concluded that the current fund of research findings may well be sufficient to declare SI therapy not merely an unproven, but a demonstrably ineffective, primary or adjunctive remedial treatment for learning disabilities and other disorders.