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The Sensory Processing Measure (SPM):Meeting the Needs of School-BasedPractitioners Part One: Description andBackgroundHeather Miller Kuhaneck MS OTR/L a & Diana A. Henry MS OTR/LFAOTA ba Occupational Therapy Department , Sacred Heart University ,Fairfield, CTb Henry OT Services, Inc. , www.ateachabout.comPublished online: 18 Mar 2009.

To cite this article: Heather Miller Kuhaneck MS OTR/L & Diana A. Henry MS OTR/L FAOTA (2009)The Sensory Processing Measure (SPM): Meeting the Needs of School-Based Practitioners Part One:Description and Background, Journal of Occupational Therapy, Schools, & Early Intervention, 2:1,51-57, DOI: 10.1080/19411240902720247

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Journal of Occupational Therapy, Schools, & Early Intervention, 2:51–57, 2009Copyright © Taylor & Francis Group, LLCISSN: 1941-1243 print / 1941-1251 onlineDOI: 10.1080/19411240902720247

WJOT1941-12431941-1251Journal of Occupational Therapy, Schools, & Early Intervention, Vol. 2, No. 1, January 2009: pp. 1–14Journal of Occupational Therapy, Schools, & Early Intervention

The Sensory Processing Measure (SPM): Meeting the Needs of School-Based Practitioners

Part One: Description and Background

Sensory Processing Measure, Part OneH. M. Kuhaneck and D. A. Henry HEATHER MILLER KUHANECK, MS, OTR/L1 AND DIANA A. HENRY, MS, OTR/L, FAOTA2

1Occupational Therapy Department, Sacred Heart University, Fairfield, CT2Henry OT Services, Inc., www.ateachabout.com

Changes in federal legislation guiding occupational therapy practice in educationalenvironments have required modifications in the way therapists evaluate children inthese settings. New methods in turn require new tools. This article will describe onenew tool designed to assist school-based practitioners in their assessment of the impactof sensory processing and praxis difficulties on educational performance. The SensoryProcessing Measure is an assessment tool that promotes team collaboration by exam-ining performance across multiple natural environments and also considers therelationship between sensory processing, praxis and social participation. Part One ofthis paper provides a description of the assessment tool and its proposed uses while inPart Two, examples of the use of the measure will be presented.

Keywords Assessment, school-based practice, sensory processing

Occupational therapy exists as a related service in the educational system by federalmandate, and our practice in that setting is therefore influenced by federal policy. TheIndividuals with Disability Education Act (IDEA) (Public Law 108–448) reauthorizedin 2004 and the No Child Left Behind legislation (Public Law 107–110) passed in 2001both encourage the education of all children within the general education curriculumwith early identification of difficulties, an emphasis on prevention, and the use of spe-cifically designed instruction when prior efforts have been unsuccessful. Conceptsregarding special education have changed since the early mandates for occupationaltherapy in the schools, and occupational therapy practice in the schools has changed inresponse. Specifically, our assessment methods and evaluation processes have altered,requiring the adoption of new assessment tools that meet the new needs of occupationaltherapists in school-based practice.

In the occupational therapy literature over the last decade, one notes a shift fromassessment as a diagnostic procedure to one that is client-centered, focuses on the child’sstrengths and difficulties, and identifies difficulties in occupational performance in thenatural context as opposed to measuring skills and performance components in isolation(Baum & Christiansen, 2004; Dunn, 2000; Law, Baum, & Dunn, 2000; Mancini & Coster,2004; Orr & Schkade, 1997; Stark & Sanford, 2004). Best practice in occupational

Received 26 September 2007; accepted 4 November 2008.Address correspondence to Heather Miller Kuhaneck, Occupational Therapy Department,

Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825. E-mail: hmillerot@yahoo.com

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therapy in school settings is also considered to occur in collaboration with theeducational team (Case-Smith, 1997; Clark & Coster, 1998; Clark & Miller, 1996;Kemmis & Dunn, 1996; Swinth & Muhlenhaupt, 2004). The Sensory ProcessingMeasure’s (SPM) forms for school-based practice, the Main Classroom Form, and theSchool Environments Forms (Miller Kuhaneck, Henry, & Glennon, 2007a, 2007b) weredesigned both to examine the impact of a child’s sensory processing on his or her educa-tional performance across school contexts and to encourage team collaboration and sharing.The Sensory Processing Measure in its entirety (Parham, Ecker, Miller Kuhaneck, Henry,& Glennon, 2007) is one of the new occupational therapy assessment tools available thatcan meet the needs of current school based practice. In this article, the SPM is described,and the authors highlight its use in a collaborative team assessment model that considerscontext and also emphasizes prevention.

Background

The relationship among poor sensory processing, dyspraxia, and poorer educational perfor-mance has long been hypothesized (Ayres, 1972, 1979) but has been only minimally studiedand supported (Parham, 1998). However, sensory integration theory suggests that childrenwith poor sensory processing and dyspraxia may have difficulties with occupational perfor-mance in the educational setting. If between 5% and 13% of children have sensory process-ing disorders (Ahn, Miller, Milberger, & McIntosh, 2004) as has been suggested by earlyprevalence studies, the impact of these difficulties on educational settings might be quitelarge. Though the sensory integration frame of reference is used in the schools only when astudent’s sensory processing difficulties contribute to his or her educational difficulties(Roley, Clark, Bissell, & Brayman, 2003), it is a frame of reference that has been frequentlyreported to be used in the schools (Storch & Eskow, 1996), and it is one that therapists reportusing to identify a possible cause for a behavior or difficulty (Case-Smith, 1997). Until thepublication of the SPM, there were no assessment tools available to assist practitioners inexamining the impact of sensory processing difficulties, including dyspraxia, on educationalperformance specifically and across various school environments.

The SPM (Parham et al, 2007) is the combination of two earlier tools: the SchoolAssessment of Sensory Integration (SASI) and the Evaluation of Sensory Processing(ESP). The ESP was initially begun in 1993 but reached the format merged with the SASIin 2000 (Parham & Ecker, 2000). The SPM school forms in combination (which wereoriginally called the SASI) were initially created in 1999–2000. Information regarding theearly development of this tool is provided elsewhere (Miller Kuhaneck, Henry, Glennon, &Mu, 2007). In 2005, the two tools were combined by Western Psychological Services tocreate the SPM (Parham et al, 2007).

Description of the Sensory Processing Measure

The SPM is a behavioral rating scale for children ages 5 to 12, that is composed of threedifferent forms. One form is the Home Form (Parham & Ecker, 2007) that is filled out bythe child’s parent or guardian; a second is the Main Classroom Form (Miller Kuhaneck,Henry, & Glennon, 2007a) that is filled out by the child’s primary classroom teacher orclassroom aide; and the third set of forms are the School Environments Forms that are filledout by appropriate educational personnel in each of the following environments: Art, Music,Physical Education, Recess, Cafeteria, and Bus. See Figure 1 for a sample of SPM items.

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Sensory Processing Measure, Part One 53

For each form, a rater within each of the environments listed earlier considers thechild’s performance over at least 1 month and rates the child’s usual behaviors, over time,not in one instant in time. Behaviors are rated in context, within each of the individualenvironments allowing comparison between and among environments. Each item isscored with a 4-point Likert Scale from Never to Always.

The Home and Main Classroom Forms are preprinted autoscore forms making theprocess of scoring very easy and of plotting the scores on the profile sheet very quick. TheSchool Environments forms come on a CD so that they can be printed out as needed, asnot every child participates in each of the school environments included in the measure.For example, the student being rated may not participate in art or may not ride the schoolbus. Although the Home and Main Classroom Forms can be used independently, theSchool Environments Forms must be used with the Main Classroom Form, and the authorsdo recommend use of all three sets of forms to obtain a complete picture of the child.

Typical administration time is approximately 15 to 20 minutes each for the Home andMain Classroom Forms and approximately 5 minutes each for the School Environments

Figure 1. Sample items from the SPM.

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Forms. Scoring time is typically 5 to 10 minutes for the Home and Main Classroom Formsand 5 minutes or less for the School Environments Forms. The Home Form consists of 75items, the Main Classroom Forms consists of 62 items, and the School EnvironmentsForms all have 15 items with the exception of the Bus Form, which is only 10 items.

The scores obtained for the Home and Main Classroom Forms include norm- referencedstandard scores in eight areas; Social Participation, Praxis, five sensory systems (visual,auditory, tactile, vestibular, and proprioceptive); and a total sensory systems score thatincludes all of the sensory systems plus items related to taste and smell that do not havetheir own separate scale. With the SPM scoring, a higher raw score is suggestive of greaterdysfunction. Raw scores are converted to standard scores; T-scores and percentile scoresthat can fall into three ranges: Typical (T-score range, 40–59) can indicate that a child’sbehavioral and sensory functioning is similar to that of typical children; Some Problems(T-score range, 60–69) can indicate mild-to moderate difficulties in behavioral or sensoryfunctioning; or Definite Dysfunction (T-score range, 70–80) can indicate a significant sen-sory processing problem that may have a noticeable effect on the child’s daily functioning.Total home and main classroom performance can be directly compared with a score calledthe environmental difference score, which examines whether the child scores significantlydifferently between the home and main classroom and in which area the child performsbetter.

The scores obtained for the school environments forms are total scores that can becompared to a cutoff criterion referenced score. One can determine whether the childhas excessive difficulties in that environment as compared to the sub-sample of 306 ofthe children from the standardization sample who were used to determine the cutscores.

Information on the psychometrics of the tool is included in detail in the manual, butreaders may examine the tools test-re-test reliability, internal consistency, and discrimi-nant validity figures in Table 1. Factor analysis completed with the tool has generallydemonstrated that the items group together well within scales, and these analyses aredescribed in detail in the manual (Parham et al, 2007).

Proposed Uses

The SPM authors believe the tool can be used in multiple ways to assist school-basedpractitioners. First, the SPM may be used during the pre-referral process to assist the teamin examining the possible contributions difficulties with sensory processing could bemaking to a child’s occupational performance and educational difficulties. Response tointervention (RtI), a general education initiative, could encourage “all members of theschool community to design, implement, collect data on how it is working and alter theimplementation in response to what is working and what is not” (Chandler, 2007 p. 7).

Table 1Reliability and validity measures for the sensory processing measure

Main classroom Home

Two-week test re-test reliability .95 to .98 .94 to .98Internal consistency .75 to .95 .77 to .95Sensitivity with T-score of 70 .16 .18Specificity with T-score of 70 .98 .98

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Sensory Processing Measure, Part One 55

The SPM can be used to facilitate the development of school-wide approaches. Using thetool with the entire team and including all environments may generate discussions amongteam members regarding the environmental issues that are triggering difficulties (i.e., “Heseems to be having this behavior across environments and it seems to be triggered whenthere are really loud noises”) and the contextual features that are supporting performance(i.e., “He doesn’t do that in my class, but I do XYZ which I think helps”). Interpreting achild’s scores can assist the occupational therapist in helping the team to reframe a child’sbehaviors in light of sensory integration theory, leading to better understanding of thechild’s behaviors by all, and a coordinated team effort to alter environments to make themmore tolerable and/or more sensory-rich as needed. These efforts can all occur before achild enters the special education system, and many of the suggestions can be used inwhole-school or whole-classroom approaches and with occupational therapy consultationonly.

A second use of the tool is during a child’s initial occupational therapy evaluation.Using the tool during an evaluation, the occupational therapist can assist the team in gen-erating realistic goals and curriculum modifications and environmental alterations thatwill support the child’s special education program. Team collaboration and team membereducation can occur similarly as when the tool is used in pre-referral.

A third use of the tool is to measure change after a period of treatment, again supportingthe principles of RtI. The SPM, a valid and reliable assessment, provides the opportunityto make data-based behavioral decisions for monitoring student progress following assess-ment and re-assessment . . .

A fourth use of the tool is for research. The authors expect that the SPM will beused to describe and compare sensory processing and praxis difficulties in specificdiagnostic populations and that it will be able to used to demonstrate changes afterintervention.

The Future

The current version of the SPM is for children ages 5 to 12 (elementary school–age). Thepublishers and authors expect to continue work on this project to complete versions of thetool that will be applicable to the preschool population, the high school–age student, andalso for children from birth to 3 years of age. Research is also underway to further exam-ine SI theory by using the SPM and the SIPT (Ayres, 1989) with the same population ofchildren to further examine the relationships among sensory modulation, praxis, andsocial participation.

Conclusion

The SPM provides the school-based practitioner with information not previously avail-able from a standardized assessment tool. Uniquely, the SPM considers sensory pro-cessing in relation to praxis and social participation in home and school and allowsdirect comparison between home and classroom performance. In using the SPM in itsentirety, the practitioner supports a team-based assessment and team-based approach totreatment planning and promotes discussion about sensory aspects of specific environ-ments that could be impacting a student’s performance in those environments. The SPMauthors and publisher have worked hard to create a user-friendly and useful tool, and wewelcome any feedback from practitioners via the publisher’s SPM Web site: www.sensoryprocessingmeasure.com

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