Categorizing Sensory Processing and Integration Challenges: The First Step in Evidence-Based Practice

PURPOSE: This study addresses an important need to define the phenotype of sensory processing and integration disorder subtypes essential to intervention planning and creation of homogenous samples for research (Schaaf et al., 2014).

RATIONALE: Proper assessment and categorization of sensory processing and integration challenges add clarity within the profession and are of particular importance for designing targeted interventions. Criticism exists that subtypes lack consistently agreed upon operational definitions (Koziol, Budding, & Chidekel, 2011), which has impaired evidence-based research.

DESIGN AND METHOD: An anonymous retrospective chart review was conducted and all data were collected during routine clinical care. The sample consisted of 252 children ages 4–14 yr (M = 6.9 yr, SD = 2.05) who had sensory processing and integration symptoms but did not meet criteria for autism. Participants were representative of a clinical sample of children referred due to behavioral challenges that interfere with daily functioning at home, school, and/or in the community. Measures included standardized assessment of motor functioning; parent rating scales of sensory, adaptive, and problem behaviors; and clinical observations of sensory processing, postural control, and motor performance (e.g., Sensory Processing Three Dimensions scale [SP–3D], Adaptive Behavior Assessment System, Behavior Assessment System for Children).

Cluster analysis grouped children based on their scores on the three modulation subscales of the SP–3D. A Ward’s agglomerative hierarchical cluster analysis was first conducted to assess the ideal number of clusters based on squared Euclidean values in a distance matrix (Gore, 2000). Next, a K-means clustering algorithm based on the results from the hierarchical analysis was conducted to derive the final clusters (Mandara, 2003). One-way analyses of variance assessed cluster group differences with Games–Howell post hoc tests.

RESULTS: The three cluster variables provided support for a three-cluster solution. The three-cluster solution produced groups that significantly differed in their scores on the Sensory Over-Responsivity (SOR) subscale, F(2, 249) = 3.45, p = .033; Sensory Under-Responsivity (SUR) subscale, F(2, 249) = 142.89, p < .001); and Sensory Craving (SC) subscale, F(2, 249) = 326.93, p < .001), producing mutually exclusive clusters. SOR was the only cluster group that did not have significant symptoms of posture, praxis, and discrimination symptoms. Both SUR and SC cluster groups had differential symptomatology related to posture, praxis, and discrimination impairments. Behavioral–emotional symptoms in the SUR and SC cluster groups were significant for atypical mannerisms and inattention, whereas the SC cluster group had more hyperactivity, aggression, anxiety, and depression. All three cluster groups had deficits in adaptive behavior, particularly in self-care, home living, social skills, and self-direction. The SUR and SC cluster had more significant challenges in communication, participation in leisure activities, and health and safety.

CONCLUSION: This study contributes important information to the discussion of categorization and terminology used to describe sensory processing and integration subtypes in children who do not meet criteria for another clinical diagnosis. Cluster groups were differentiated by social, emotional, and behavioral symptomatology.

IMPACT STATEMENT: Identifying clinically meaningful patterns of sensory, emotional, and functional deficits provides clarity both within and outside the profession and can be used to guide intervention as well as examine differential responses to treatment.

References

Gore, P. A. J. (2000). Handbook of applied multivariate statistics and mathematical modeling. In H. E. A. Tinsley & S. D. Brown (Eds.), Handbook of applied multivariate and mathematical modeling (pp. 298–318). Cambridge, MA: Academic Press.

Koziol, L. F., Budding, D. E., & Chidekel, D. (2011). Sensory integration, sensory processing, and sensory modulation disorders: Putative functional neuroanatomic underpinnings. Cerebellum, 10, 770–792. https://doi.org/10.1007/s12311-011-0288-8

Mandara, J. (2003). The typological approach in child and family psychology: A review of theory, methods, and research. Clinical Child and Family Psychology Review, 6, 129–146.

Schaaf, R. C., Benevides, T., Mailloux, Z., Faller, P., Hunt, J., van Hooydonk, E., . . . Kelly, D. (2014). An intervention for sensory difficulties in children with autism: A randomized trial. Journal of Autism and Developmental Disorders, 44, 1493–1506. https://doi.org/10.1007/s10803-013-1983-8