Sensory integration: analyses of patterns of dysfunction and clinical application with children with mild disabilities

Abstract

The aim of this dissertation was to examine sensory integration (SI) as a frame of reference for the assessment and intervention of children with mild disabilities. A description of SI and SI dysfunction is provided, and SI is compared with other approaches used in the remediation of children with learning disabilities (LD). Controversial issues regarding the application of SI are discussed, SI research is critiqued, and the current practice of occupational therapists using SI is described.Models of SI dysfunction based on scores of children on the Sensory Integration and Praxis Tests (SIPT; Ayres, 1989) were examined by exploratory and confirmatory factor analyses (CFA). The initial, hypothesized model tested was derived from previous multivariate analyses and consisted of five patterns of dysfunction including: (a) Bilateral Integration and Sequencing; (b) Somatosensory; (c) Somatopraxis; (d) Visuopraxis; and (e) Postural-ocular-motor patterns. An existing data base including the scores of 10,475 children was used in the analyses, along with a sub-group of 995 children with LD. Using LISREL 8 (linear structural relations; Joreskog & Sorbom, 1993), CFA of the hypothesized model indicated a number of weaknesses with the model, and it was therefore rejected. Further analyses aimed towards identifying a better fitting, more parsimonious model of SI dysfunction were then performed. A second-order, 4-factor model which consisted of a general SI Dysfunction second-order factor, and Dyspraxia, Bilateral Integration and Sequencing Deficit, Visual Perceptual Deficit, and Somatosensory Deficit as first-order factors was believed to represent the best fitting model. The results of the CFA with this model indicated that it was a good fit for the data, and substantially improved upon the initial model. The second-order, 4-factor model also held true when tested with the sub-sample of children with LD. Finally, interpretation of SIPT scores based on the new, proposed model of SI dysfunction is demonstrated through the presentation of a case study of a child with LD. Specific SI intervention strategies that can be used by occupational therapists to promote motor skills, appropriate behavior and the academic success of children with SI dysfunction working in both school and clinic settings are presented.