An Examination of the Relationships Between Motor and Process Skills and Scores on the Sensory Profile. 154 March/April 2007, Volume 61, Number 2

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1 An Examination of the Relationships Between Motor and Process Skills and Scores on the Sensory Profile Barbara Prudhomme White, Shelley Mulligan, Kristen Merrill, Janet Wright KEY WORDS Assessment of Motor Process Skills (AMPS) motor skills pediatric process skills sensory integration sensory processing Sensory Profile OBJECTIVE. This quasi-experimental study sought to determine whether children with possible sensory processing deficits, as measured by the Sensory Profile, performed less well on an occupational performance measure compared to children with typical Sensory Profile scores. METHOD. Sixty-eight children were administered both the Assessment of Motor Process Skills (AMPS) and the Sensory Profile. After the assessments were completed, children were divided into two groups based on their Sensory Profile scores. RESULTS. Independent t tests indicated statistically significant differences between groups on the AMPS ADL [Activities of Daily Living] Motor and ADL Process measures (p <.05), with the children with atypical Sensory Profile scores showing more functional difficulties. Correlations revealed significant relationships among the measures. CONCLUSION. The results suggest that children identified with sensory processing deficits on the Sensory Profile are likely to experience some challenges in performing everyday occupations. White, B. P., Mulligan, S., Merrill, K., & Wright, J. (2007). An examination of the relationships between motor and process skills and scores on the Sensory Profile. American Journal of Occupational Therapy, 61, Barbara Prudhomme White, PhD, OTR/L, is Associate Professor, University of New Hampshire, Durham. Shelley Mulligan, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Hewitt Hall, 4 Library Way, University of New Hampshire, Durham, NH 03824; shelley.mulligan@unh.edu. Kristen Merrill, MS, OTR/L, is Early Intervention Therapist Easter Seals, Manchester, NH. Janet Wright, MS, OTR/L, is Director, KidzPlay Developmental Therapy, Londonderry, NH. Pediatric occupational therapists routinely administer sensory history questionnaires, or measures of behaviors associated with sensory processing, when evaluating children who have school-related problems, difficulties with activities of daily living (ADLs), or problems related to underlying neurodevelopmental processes (Johnson-Ecker & Parham, 2000). In clinical practice, assumptions are often made that sensory processing problems contribute to difficulties in functional performance at home, school, or other community settings. However, little evidence is available in the literature regarding the relationships between behaviors associated with sensory processing abilities and functional skills (Dunn, 2001; Dunn & Westman, 1997). Therefore, the purposes of this study were (a) to determine whether children with behaviors associated with atypical sensory processing as measured by the Sensory Profile (Dunn, 1999) differed from children who were typically developing on a measure of functional occupational performance, the Assessment of Motor and Process Skills (AMPS; Fisher, 2003), and (b) to explore possible relationships between the occupational performance measure and an assessment of sensory processing behaviors. Sensory processing involves the registration and modulation of sensory information, as well as the internal organization of the sensory input, so human beings can execute successful adaptive responses to situational demands and thus engage meaningfully in daily occupations (Humphry, 2002). Adaptive behaviors are purposeful and goal-directed and enable individuals to overcome challenges and to learn new skills. One assumption of sensory integration theory is that producing an 154 March/April 2007, Volume 61, Number 2

2 adaptive behavior enhances sensory integration in an individual (Bundy & Murray, 2002) and therefore promotes one s ability to meet environmental demands and increase functional performance. When children demonstrate behaviors associated with sensory integration dysfunction, it is hypothesized that they encounter sensory experiences from the environment through a brain that is disorganized or limited in its ability to process and integrate the sensory information (Bundy & Murray, 2002). Therefore, as children with sensory processing deficits engage in school tasks, play, or ADLs, they may experience difficulty, an awareness of personal inefficacy, lack of control, or dissatisfaction with their performance (Mulligan, 1996). Prevalence of sensory processing disorders (SPD) has recently been estimated to include approximately 5% to 13% of children in the United States, based on a large sample of kindergarten children (Ahn, Miller, Milberger, & McIntosh, 2004). Sensory processing disturbances also have been associated with common neurodevelopmental and behavioral disorders such as attention disorders (Mulligan, 1996) and pervasive developmental disorders (Kientz & Dunn, 1997). Numerous assessments have been designed specifically to measure behaviors and skills associated with sensory processing or sensory integration functions, such as the Sensory Integration and Praxis Tests (Ayres, 1989) and the Sensory Profile (Dunn, 1999). The Sensory Profile was selected for the current study because it is psychometrically sound; quick to administer, score, and interpret; and, most important, because it was designed specifically to measure children s sensory processing abilities that support or interfere with functional performance (Dunn, 1999, p. 3). Because sensory processing is a neurological process that cannot be measured directly, caregivers are asked to rate child behaviors believed to be associated with sensory processing. Use of the Sensory Profile, then, reflects our assumption that the behaviors rated (whether typical or atypical) are associated with sensory processing. However, these behaviors also may result from emotional factors such as anxiety or temperament rather than, or in addition to, sensory processing problems (Miller, Reisman, McIntosh, & Simon, 2001). Occupational performance can be defined as one s ability to engage in meaningful actions related to work, play, and daily living tasks, in relevant contexts (Fisher, 2003). Occupational therapy theories emphasize the importance for us as humans to engage in meaningful occupations and establish satisfying roles and routines. Thus, occupational therapists evaluate the occupational performance of their clients and provide intervention in the context of what is meaningful to clients as individuals. Relatively few studies have documented and specifically described relations between occupational performance and sensory processing abilities, although this connection appears to be well accepted clinically (Dunn, 1997). Parham and Mailloux (2005) reported that sensory processing problems often are associated with decreased social skills, immature play skills, impaired self-concept, decreased fine and gross motor skills, and difficulties performing daily living skills. Bundy (2002); Burleigh, McIntosh, and Thompson (2002); and Dunn (1999) described the difficulties of children with sensory processing problems at school. Yochman, Parush, and Ornoy (2004) suggested that successful occupational performance of children with attention disorders often is adversely affected by the comorbidity of what they interpret as atypical sensory processing. A case report by Dunbar (1999) described the challenges of a 3- year-old child with SPD as including difficulties with performing daily living skills and with participating successfully at preschool. Dunbar stressed the importance of early detection of sensory processing problems because of the potential impact they may have on the development of selfhelp and other functional skills. Baranek et al. (2002) studied children with Fragile X syndrome and also found that within this population there were relationships between sensory processing abilities and occupational performance. Occupational therapists have assumed that behaviors commonly associated with sensory processing dysfunction affect a child s occupational performance and have developed specific treatment strategies based on this assumption. This study was designed to examine this assumption. The specific hypotheses were that (a) children with atypical sensory processing behaviors as measured by the Sensory Profile would perform less competently in ADL Process and ADL Motor measures, as measured by the AMPS, when compared with same-age peers without sensory processing concerns, and (b) relationships exist between AMPS performance measures and Sensory Profile scores of children with and without atypical sensory processing. Study Methods Participants The investigators recruited, primarily through convenience sampling, 68 children between ages 5 and 13 years. Participants were recruited from personal contacts of the researchers and from two private occupational therapy clinics to obtain a sample consisting of approximately equal numbers of children who were typically developing and children with SPD. Children with considerable physical or cognitive disabilities were excluded from this study. Parents who expressed interest in participating were contacted by one of three researchers and screened for exclusion criteria. The American Journal of Occupational Therapy 155

3 Forty-six (68%) of the children were boys; 22 (32%) were girls. Ninety-five percent of the children were Caucasian. All lived in the northeastern United States, within a 50-mile radius of each other, and within middle-class to uppermiddle-class neighborhoods. The study was approved by an institutional review board for human subject participation, and all participants signed informed consent or assent forms. Demographic data by group assignment are presented in Table 1. A slightly greater number of children fell into the Atypical Sensory Processing group (n = 38) than the Typical Sensory Processing group (n = 30), and a slightly greater number of participants were boys (68%). There were no significant age differences between groups. Instrumentation Sensory Profile The Sensory Profile (Dunn, 1999) was used to measure behaviors associated with sensory processing abilities. The Sensory Profile s normative data was based on a sample of 1,115 children who were typically developing. The tool has been researched with children and adults (Dunn, 1999), with acceptable measures for internal inconsistency and interrater reliability. Studies supporting its construct and content validity are reported in the test manual. Using a 5- point Likert scale ranging from never to always, parents or caregivers rate the frequency of their child s behavior in response to 125 items or behavioral statements perceived to represent 14 different sensory processing functions (Dunn, 1999). The Sensory Profile quantifies behaviors associated with sensory processing problems and provides a tool for consistent measurement of parental perception of these behaviors (Kientz & Dunn, 1997). Six of the categories defined by Dunn relate to sensory processing areas: Auditory Processing, Visual Processing, Vestibular Processing, Touch Processing, Multi-Sensory Processing, and Oral Sensory Processing. Five categories relate to sensory modulation: Modulation Related to Body Position and Movement, Modulation of Movement Affecting Activity Level, Modulation of Sensory Input Affecting Emotional Responses, Modulation of Visual Input Affecting Emotional Table 1. Participant Characteristics Groups Boys Girls Mean Age (SD) Total Group (N = 68) 46 (68%) 22 (32%) 7.9 (2.25) Range 4 13 years Atypical Sensory Processing (2.42) Group (n = 38) Range 4 13 years Typical Sensory Processing (2.09) Group (n = 30) Range 5 12 years Responses, and Sensory Processing Related to Endurance/ Tone. The last three categories reflect social emotional responses related to sensory processing: Emotional/Social Responses, Behavioral Outcomes of Sensory Processing, and Thresholds for Response. In addition to scores generated for these categories, the test provides 9 Sensory Profile Factor scores that represent sensory processing styles: Sensory Seeking, Emotional Reactivity, Low Endurance/Tone, Oral Sensory Sensitivity, Inattention/Distractibility, Poor Registration, Sensory Sensitivity, Sedentary, and Fine Motor/Perceptual (Dunn, 1999). Sensory category and factor scores are interpreted based on the normative data as being either typical performance (within 1 standard deviation from the mean), probable difference (between 1 and 2 standard deviations below the mean), or within the definite difference range (more than 2 standard deviations below the mean) (Dunn, 1999). Assessment of Motor and Process Skills The AMPS (Fisher, 2003) is a standardized, performancebased assessment that evaluates the quality of an individual s performance of real-life tasks and guides intervention. Occupational therapists using the AMPS assume that a person s motivation or purpose to perform tasks is based on meaning and cultural relevancy; therefore, the person s function is maximized when performing a chosen task. Meaning can be defined as the significance to the individual of a task that provides a source of motivation for performance. Purpose relates to a person s intended goal and reason for doing a task, which helps organize performance (Fisher, 2003). The AMPS contains 83 different standardized personal and domestic ADLs, which range in difficulty from simple to complex, and is appropriate for persons from ages 3 to 99 years (Fisher, 2003). ADL tasks include self-care or personal activities of daily living (PADLs) and domestic or instrumental activities of daily living (IADLs) (e.g., home maintenance, meal preparation, laundry management). Typically, PADL tasks are easier and are reserved for children younger than age 6 years, or persons who are frail or have physical disabilities (Fisher, 2003). Examples of both PADL and IADL tasks include making a sandwich with meat, cheese, or peanut butter and jelly; making one s bed; vacuuming; and donning socks and shoes. The AMPS currently has normative data on more than 100,000 individuals, including children (personal communication from AMPS International, May 2005). Moreover, the AMPS has been researched extensively with various population groups and has been found to be sensitive in detecting problems with efficiency, safety, and quality of performance in ADLs (Bray, Fisher, & Duran, 2001; Fisher, 2003; Puderbaugh & 156 March/April 2007, Volume 61, Number 2

4 Fisher, 1992). Recently, White and Mulligan (2005) used the AMPS with children from ages 5 to 13 years and found it sensitive to detecting behaviors associated with attentional problems. Standardized ability measures are obtained for ADL Motor Skills and ADL Process Skills and are interpreted based on a normative range for different age groups. Evaluation Procedures Approximately 80% of the children were assessed in their homes, and 20% were assessed in a kitchen area designed to approximate a home environment located at either a university clinic or a private clinic setting. Approximately equal numbers of children with and without sensory processing differences were assessed in each location. Assessment locations were based on participant choice and proximity to one of the three examiners. All three examiners were AMPS trained and calibrated and were licensed occupational therapists with 6 to more than 20 years of clinical experience with this population. One examiner worked at a private clinic and contributed 40% of the assessments to the study, another worked in a school and contributed 50% of the assessments, and the third examiner worked in a university setting and contributed 10%. Each examiner assessed nearly equal numbers of children with and without atypical sensory processing behaviors. To remain as unbiased as possible, parents were asked not to discuss any child concerns with each examiner before the assessment. While a parent completed the Sensory Profile questionnaire, the child participated in the AMPS, which was administered according to the standardized protocol described in the AMPS manual. Each child, along with his or her parent, was interviewed before evaluation to determine which AMPS tasks were most familiar and most often a part of the child s daily routines. Once 5 to 6 tasks were established, the child was asked to choose 2 tasks on which he or she agreed to be assessed. Each AMPS assessment period lasted about min, or min per task. Once data were collected, Sensory Profiles were scored by the examiner or a trained research assistant and entered into the database. The AMPS was scored by each therapist separately using AMPS scoring software, and resulting ability measures were placed in the database. Data were combined and children were assigned to one of two groups after the scoring of the assessments, based on their Sensory Profile scores. Group 1 (Sensory Profile Atypical) included children who had at least 4/14 sensory areas scored as Probable Difference (which are scores falling between 1 and 2 standard deviations below the mean) or at least 2/14 areas scored as Definite Difference (scores falling more than 2 standard deviation below the mean). All other children were placed in Group 2 (Sensory Profile Typical). Criteria for the Sensory Profile Atypical group were largely based on the clinical expertise and judgment of the researchers, who believed that such scores would reflect children with sensory processing differences, and from supporting data available on the Sensory Profile related to scores of children with and without disabilities. Currently no specific diagnostic criteria exist for children with SPD. Results Statistical analyses were computed using SPSS 9.0 software (SPSS Inc., Chicago). Results were considered significant a priori at p = <.05. The mean age for Group 1 (n = 38 atypical Sensory Processing group) was 7.76 years (SD = 2.42), and the mean age for Group 2 (n = 30 typical Sensory Processing group) was 7.9 years (SD = 2.09). An independent t test revealed no significant differences between the groups regarding age. To address the first purpose of the study, a group comparison analysis was conducted using a one-tailed independent t test. Justification for a one-tailed t test was based on theory and clinical evidence that lower Sensory Profile scores in children would be associated with more functional difficulties. As expected, the atypical group scored significantly lower (mean Logit =.08, SD =.68) on the AMPS ADL Process measure than the typical group (mean Logit =.45, SD =.28), t(66) = 2.11, p =.024. The atypical group also scored significantly lower (mean Logit = 1.29, SD =.52) on the AMPS ADL Motor measure than the typical group (mean Logit = 1.58, SD =.29), t(66) = 2.08, p =.025. To examine possible relations among the 14 Sensory Profile category scores, the 9 Sensory Profile Factor scores, and the AMPS ADL Process and Motor measures, Spearman s rho correlation coefficients were computed. The purpose of this analysis was to explore possible links that would help interpret how different sensory tendencies might influence motor and process skills associated with occupation. Because of the small number of participants, any conclusions from this analysis should be interpreted as preliminary. The correlations are reported in Tables 2 and 3. Of the Sensory Profile Factor scores, the AMPS ADL Motor measure correlated most highly with the Fine Motor/Perceptual Factor (r =.5), the Sensory Sensitivity Factor (r =.44), and the Low Endurance/Tone Factor (r =.39). Of the Sensory Processing Areas, the AMPS ADL Motor measure correlated significantly with all sensory areas except Oral Sensory, although all of the correlations were weak, with r values ranging from.28 to.31. Of these, The American Journal of Occupational Therapy 157

5 Table 2. Correlations Among AMPS ADL Motor and Process Measures and Sensory Profile Factor Scores Sensory Profile Factors ADL Motor ADL Process Factor 1 Sensory Seeking NS NS Factor 2 Emotionally Reactive NS NS Factor 3 Low Endurance/Tone.39** NS Factor 4 Oral Sensitivity NS NS Factor 5 Inattention/Distractibility.30*.23 (p =.06) Factor 6 Poor Registration.30* NS Factor 7 Sensory Sensitivity.44* NS Factor 8 Sedentary NS NS Factor 9 Fine Motor/Perceptual.5* NS Note. AMPS = Assessment of Motor and Process Skills (Fisher, 2003); ADL = activities of daily living; NS = not significant. *p <.05. **p <.01. the strongest relation was with the vestibular area, as would be expected, because this sensory system is most closely associated with movement and motor performance (Bundy & Murray, 2002; Mulligan, 1996). Six of eight Sensory Modulation and Behavior and Emotional Response variables correlated significantly with the AMPS ADL Motor measure. The strongest relations were among Modulation of Endurance/Tone (r =.39), Modulation of Body Position and Movement (r =.40), Visual Input Affecting Emotional Responses and Activity Level (r =.35), and Behavioral Outcomes (r =.35). Fewer significant relationships were identified between the AMPS ADL Process measure and the Sensory Profile variables. No significant correlations were obtained between the Sensory Processing Factor scores and the AMPS ADL process measure, although the Inattention/Distractibility factor the factor that theoretically seems to be most closely related to process skills (White & Mulligan, 2005) yielded the highest r value (.23) and approached statistical significance. Two Sensory Processing areas yielded significant correlations with the AMPS ADL Process measure, although the relationships were weak: Visual (r =.25) and Multi-Sensory (r =.29). Possibly these sensory processing areas include a higher-level cognitive, mental, or executive component than does the processing of more primitive sensory systems such as the tactile and vestibular systems. Therefore, it was not surprising that Visual and Multi-Sensory were the areas more closely associated with the AMPS ADL Process skill measure, which presumably measures a degree of executive function ability (White & Mulligan, 2005). Discussion Table 3. Correlations: AMPS ADL Motor and Process Measures and Sensory Profile Area Scores Sensory Profile Factors ADL Motor ADL Process Sensory Processing Areas A Auditory.28* NS B Visual.28*.25* C Vestibular.31* NS D Touch.28* NS E Multi-Sensory.29*.29* F Oral Sensory NS NS Sensory Modulation Areas G Endurance/Tone.39** NS H Body Position and Movement.40** NS I Movement Affecting Activity Level NS NS J Sensory Input Affecting Emotional Responses.30* NS K Visual Input Affecting Emotional Responses and Activity Level.35* NS Behavior and Emotional Responses L Emotional/Social NS NS M Behavioral Outcomes.35** NS N Items Indicating Thresholds for Responses.33** NS Note. AMPS = Assessment of Motor and Process Skills (Fisher, 2003); ADL = activities of daily living; NS = not significant. *p <.05. **p <.01. The findings of this study support the hypothesis that behaviors thought to reflect sensory processing abilities are associated with everyday occupational performance. This study also suggests that children who exhibit atypical sensory processing behaviors as assessed by the Sensory Profile appear likely to demonstrate difficulties with occupational performance, at least regarding their ability to perform PADLs and IADLs. Therefore, clinically, occupational therapists impressions and concerns regarding the impact of sensory processing skills on performance may indeed be valid. These results suggest that it is important for children with possible atypical sensory processing to be assessed for potential problems regarding their ability to perform daily occupations and functional tasks. Further, the AMPS appears to be an effective occupational performance measure for children with sensory integration or sensory processing deficits and one that could be used both in research and clinically as a functional outcome measure after intervention. It is important to note, however, that children with behaviors reflective of sensory processing problems are often complex and have coexisting conditions such as motor coordination or attention problems. Therefore, problems with occupational performance are likely due to a combination of factors rather than solely sensory processing concerns or differences. Correlation analyses identified statistically significant relations between some aspects of sensory processing and areas of occupational performance. In particular, motor skills that enable successful completion of meaningful, functional tasks appear to be related more to sensory processing abilities than do process skills such as attention and organization. Skills that tap into the physical aspects between person and objects for example, bending, stabilizing, hand 158 March/April 2007, Volume 61, Number 2

6 grasping, holding, coordinating, and manipulating, as well as modulating movement and force are most likely supported by efficient sensory processing and the integration of basic sensory systems such as the visual, vestibular, and tactile systems. Some limitations must be considered in the interpretations of this study s results. First, a relatively small, convenient sample of primarily Caucasian children was used; therefore, the sample may not adequately represent the population of children with and without sensory processing dysfunction. Thus, generalizability of the study results is limited. Second, the categorization of children as typical versus atypical sensory processors was made based on clinical judgment of the Sensory Profile scores because, at the time this study was conducted, no specific diagnostic cutoff criteria existed on the Sensory Profile for children with sensory integration disorders. Further research is necessary to develop and confirm specific diagnostic criteria, guidelines, and protocols to properly diagnose children with SPD for both clinical and research purposes. This research is currently under way (see Miller, Cermak, Lane, Anzalone, & Koomar, 2004). Despite these limitations, the results suggest that an evaluation of a child s behaviors reflective of sensory processing skills may indicate the degree to which the child can also successfully perform everyday PADL and IADL occupations and vice versa. Furthermore, the results suggest that motor skills enabling children to perform functional tasks may possibly be related to some underlying sensory processing abilities. It follows then, that for many children who are experiencing difficulty with daily occupations (e.g., completing schoolwork and basic self-care tasks), occupational therapy interventions to address underlying sensory processing concerns may be a useful strategy. Finally, because the AMPS could detect subtle differences in occupational performances between children with and without sensory processing concerns, the effects of intervention for behaviors associated with sensory processing deficits may possibly be measured using the AMPS. The AMPS is designed for repeated evaluation and is sensitive to detecting change in performance. In occupational therapy, few options exist for documenting changes in functional performance in people with sensory processing problems. The AMPS used in this study, as well as its school version the School AMPS (Fisher, Bryze, Hume, & Griswold, 2005), which measures performance in school-related tasks in the classroom may be useful for clinicians wanting an objective, functional measure of occupational performance for documentation purposes, as well as for researchers interested in conducting efficacy studies of occupational therapy interventions. Acknowledgments The authors thank the children and families who participated in this study. A portion of this study was completed in partial fulfillment of a master s degree from the University of New Hampshire (third author). References Ahn, R. R., Miller, L. J., Milberger, S., & McIntosh, D. (2004). Prevalence of parents perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy, 58, Ayres, A. J. (1989). Sensory Integration and Praxis Tests. Los Angeles: Western Psychological Services. Baranek, G. T., Chin, Y. H., Hess, L. M. G., Yankee, J. G., Hatton, D. D., & Hooper, S. R. (2002). Sensory processing correlates of occupational performance in children with Fragile X syndrome: Preliminary findings. American Journal of Occupational Therapy, 56, Bray, K., Fisher, A. G., & Duran, L. (2001). The validity of adding new tasks to the Assessment of Motor and Process Skills. American Journal of Occupational Therapy, 55, Bundy, A. (2002). Using sensory integration theory in schools: Sensory integration and consultation. In A. C. Bundy, S. J. Lane, & E. A. Murray (Eds.), Sensory integration: Theory and practice (2nd ed., pp ). Philadelphia: F. A. Davis. Bundy, A. C., & Murray, E. A. (2002). Sensory integration: A. Jean Ayres theory revisited. In A. C. Bundy, S. J. Lane, & E. A. Murray (Eds.), Sensory integration: Theory and practice (2nd ed., pp. 3 33). Philadelphia: F. A. Davis. Burleigh, J. M., McIntosh, K. W., & Thompson, M. W. (2002). Central auditory processing problems. In A. C. Bundy, S. J. Lane, & E. A. Murray (Eds.), Sensory integration theory and practice (2nd ed., pp ). Philadelphia: F. A. Davis. Dunbar, S. B. (1999). Case Report A child s occupational performance: Considerations of sensory processing and family context. American Journal of Occupational Therapy, 53, Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9(4), Dunn, W. (1999). The Sensory Profile: Examiner s manual. San Antonio, TX: Psychological Corporation. Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 55, Dunn, W., & Westman, K. (1997). The Sensory Profile: The performance of a national sample of children without disabilities. American Journal of Occupational Therapy, 51, Fisher, A. G. (2003). The Assessment of Motor and Process Skills (5th ed., Vols. 1 2). Fort Collins, CO: Three Star Press. Fisher, A. G., Bryze, K., Hume, V., & Griswold, L. A. (2005). School AMPS: School version of the assessment of motor and process skills. Fort Collins, CO: Three Star Press. The American Journal of Occupational Therapy 159

7 Humphry, R. (2002). Young children s occupations: Explicating the dynamics of developmental processes. American Journal of Occupational Therapy, 56, Johnson-Ecker, C. L., & Parham, L. D. (2000). The Evaluation of Sensory Processing: A validity study using contrasting groups. American Journal of Occupational Therapy, 54, Kientz, M. A., & Dunn, W. (1997). A comparison of the performance of children with and without autism on the Sensory Profile. American Journal of Occupational Therapy, 51, Miller, L. J., Cermak, S., Lane, S., Anzalone, M., & Koomar, J. (2004). Defining SPD and its subtypes: Position Statement on terminology related to sensory integration dysfunction. Retrieved January 25, 2006, from aboutspd/defining.html. Miller, L. J., Reisman, J., McIntosh, D. N., & Simon, J. (2001). An ecological model of sensory modulation. In S. Smith Roley, E. Blanche, & R. Schaaf (Eds.), Sensory integration with diverse populations (pp ). San Antonio, TX: Therapy Skill Builders. Mulligan, S. (1996). An analysis of score patterns of children with attention disorders on the Sensory Integration and Praxis tests. American Journal of Occupational Therapy, 50, Parham, L. D., & Mailloux, Z. (2005). Sensory integration. In J. Case-Smith (Ed.), Occupational therapy for children (5th ed., pp ). St. Louis, MO: Mosby. Puderbaugh, J. K., & Fisher, A. G. (1992). Assessment of Motor and Process Skills in normal young children and children with dyspraxia. Occupational Therapy Journal of Research, 12, White, B. P., & Mulligan, S. E. (2005). Behavioral and physiological response measures of occupational task performance: A preliminary comparison between typical children and children with attention disorder. American Journal of Occupational Therapy, 59, Yochman, A., Parush, S., & Ornoy, A. (2004). Responses of preschool children with and without ADHD to sensory events in daily life. American Journal of Occupational Therapy, 58, AOTA Online Course! Understanding and Applying the OCCUPATIONAL THERAPY PRACTICE FRAMEWORK: Domain & Process By Mary Jane Youngstrom, MS, OTR, FAOTA Applies user-friendly interactive technology to orient you to the concepts and language presented in the Framework. Case studies provide opportunities to apply these concepts to common practice situations. Learn to differentiate the various aspects included in the occupational therapy domain; recognize the content addressed and actions taken in each step of the occupational therapy process; identify how the Framework s domain aspects and terminology can be applied during the occupational therapy process; and more. The text Occupational Therapy Practice Framework: Domain and Process is required for taking this course. Earn.5 AOTA CEUs (5 NBCOT PDUs/5 contact hours). Course only: Order # OL29-J $90 AOTA Members $128 Nonmembers Better Together! Save 15%! Course and Text: Order #OL29K-J $ AOTA Members $ Nonmembers Please call for group discounts! Call AOTA Shop (Books, Products, & CE) CO March/April 2007, Volume 61, Number 2