BRIEF REPORT Test Retest Reliability of the Sensory Profile Caregiver Questionnaire

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1 BRIEF REPORT Test Retest Reliability of the Sensory Profile Caregiver Questionnaire Alisha Ohl, Cheryl Butler, Christina Carney, Erin Jarmel, Marissa Palmieri, Drew Pottheiser, Toniann Smith KEY WORDS caregivers child, preschool questionnaires reproducibility of results sensation disorders OBJECTIVE. We examined the test retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire (SP). METHOD. Fifty-five primary caregivers of children mo old participated in the study. Participants completed the SP on two separate occasions 7 14 days apart. Participant data were analyzed using intraclass correlation coefficients (ICCs) and Cronbach s a coefficients. RESULTS. Test retest reliability was good across quadrant scores (ICC [2, 1] ) and moderate to good across factor (ICC [2, 1] ) and section scores (ICC [2, 1] ). Internal consistency was high across quadrant (as ) and factor scores (as ) and moderate to high across section scores (as ). CONCLUSION. This study suggests the SP has acceptable test retest reliability and internal consistency and supports the use of quadrant scores over factor and section scores to analyze children s sensory processing patterns. Ohl, A., Butler, C., Carney, C., Jarmel, E., Palmieri, M., Pottheiser, D., et al. (2012). Brief Report Test retest reliability of the Sensory Profile Caregiver Questionnaire. American Journal of Occupational Therapy, 66, org/ /ajot Alisha Ohl, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 81, Brooklyn, NY 11203; alisha.ohl@downstate.edu Cheryl Butler, MA, OTR/L, is Early Intervention Therapist, Easter Seals, Wakefield, RI. Christina Carney, Erin Jarmel, Marissa Palmieri, Drew Pottheiser, and Toniann Smith are Master s Students, Occupational Therapy Program, State University of New York Downstate Medical Center, Brooklyn. The Sensory Profile Caregiver Questionnaire (SP; Dunn, 1999) is a widely used pediatric assessment that provides a standard method for professionals to measure the possible contributions of sensory processing to children s daily performance patterns by providing information about their tendencies to respond to stimuli and which sensory systems are likely contributing or creating barriers to functional performance. The SP contains >125 items organized into three main sections: (1) sensory processing, (2) modulation, and (3) behavioral and emotional responses. The sensory processing section contains six item categories that measure children s responses to information taken in through the sensory systems (e.g., auditory, visual, vestibular, tactile, oral). The modulation section contains five item categories that measure children s ability to monitor and regulate information to generate an appropriate response to the situation (Dunn, 1997). The behavioral and emotional responses section contains three item categories that measure children s emotional and behavioral responses to sensory experiences. The SP asks caregivers to record the frequency with which their child displays each item behavior on a 5-point Likert scale (1 5 always, 2 5 frequently, 3 5 occasionally, 4 5 seldom, 5 5 never). For analysis, caregiver responses are totaled on a Summary Score Sheet (Dunn, 1999). In its initial development, the SP produced two types of scores: section and factor. Section scores provided a visual summary of children s sensory processing, modulation, and behavioral and emotional response abilities (Dunn, 1999). Factor scores were developed to capture children s responses to sensory experiences on the basis of not solely their sensory systems but also other aspects of sensory processing (Dunn, 2006). Nine factor scores (Sensory Seeking, The American Journal of Occupational Therapy 483

2 Emotionally Reactive, Low Endurance Tone, Oral Sensory Sensitivity, Inattention Distractibility, Poor Registration, Sensory Sensitivity, Sedentary, and Fine Motor Perceptual), each containing items from multiple sensory systems, were used to characterize children by their responsiveness to sensory input (Dunn, 1999). Both sets of scores were analyzed using a classification system based on the performance of children without disabilities (N 5 1,037). Children scoring ³1 standard deviation below the mean were classified as typical, those with scores >2 standard deviations below the mean were classified as having a probable difference, and those with scores <2 standard deviations below the mean were classified as having a definite difference (Dunn, 1999). The factor and section interpretations provided a standardized way to explain children s sensory processing patterns to teachers and caregivers that was previously unavailable. By explaining children s sensory processing problems to teachers, the SP promoted tolerance of children s behaviors and sensitivity to the difficulties children with sensory processing problems experience (Case-Smith, 1997). The SP helped caregivers become more active participants in their child s program, facilitated dialogue between the occupational therapist and caregiver about the child s sensory needs and ways to adapt the environment to meet those needs, and provided caregivers with a greater understanding of their child s behaviors and responses to certain situations and environments (Case- Smith, 1997). Occupational therapists used the factor and section interpretations to provide guideposts for planning interventions that could target which sensory system might be interfering with the child s performance or which daily life tasks might be most difficult (Dunn, 1999). Although the SP proved to be a useful tool for professionals, many questions were raised about how to better understand and interpret its scores (Dunn, 2006). In 2006, the Sensory Profile Supplement User s Manual (Dunn, 2006) was published to add an updated system of analysis that would reflect a more current understanding of sensory processing and provide a better framework from which to speak to families and teachers. This new level of analysis contained four sensory quadrant scores (Registration, Seeking, Sensitivity, and Avoiding) based on Dunn s (1997) Model of Sensory Processing. The quadrants measure the degree to which children miss, obtain, detect, or are bothered by sensory input. Data from the original norming sample were reanalyzed under the new quadrant model, resulting in an expanded classification system. The new classification system uses five categories to describe children s scores along a continuum based on the normal distribution: much less than others, less than others, similar to others, more than others, and much more than others (Dunn, 2006). The SP has undergone extensive psychometric testing to establish its validity and internal consistency (Dunn, 1999, 2006; Ermer & Dunn, 1998; Kientz & Dunn, 1997). Although the SP is frequently used in current practice to examine the sensory processing patterns of children with autism spectrum disorders, traumatic brain injury, and other conditions (Galvin, Froude, & Imms, 2009; Gere, Capps, Mitchell, & Grubbs, 2009; Hilton, Graver, & LaVesser, 2007; Rodger, Brown, & Brown, 2005; Watling, Deitz, & White, 2001; White, Mulligan, Merrill, & Wright, 2007), it is seldom used to examine intervention outcomes (Polatajko & Cantin, 2010). The SP has been found to detect intervention changes using section scores (Hall & Case-Smith, 2007), indicating that it has the potential to provide evidence of practice efficacy. The SP may not be a widely used outcome measure because it has not yet been examined for test retest reliability. Without adequate test retest reliability, practitioners cannotbesureofthestabilityofspresults over time. In this study, we examined the SP s test retest reliability by comparing the section, factor, and quadrant scores after two administrations 7 14 days apart. We also used confirmatory internal consistency analyses to examine the results and compare them with Dunn s (1999) original findings. Method The research was approved by the institutional review board (IRB) of the State University of New York Downstate Medical Center. The IRB approved using an information sheet to obtain implied consent. The information sheet notified prospective participants that by returning the anonymous SP form they were giving Table 1. Classification of Sensory Profile Quadrant Pretest and Posttest Scores (N 5 55) ) Less Than Others (n) More Than Others (n)/ Quadrant Classification Much Less Than Others Less Than Others Similar to Others (n) More Than Others Much More Than Others Registration Pretest N/A Posttest N/A Seeking Pretest N/A Posttest N/A Sensitivity Pretest N/A Posttest N/A Avoiding Pretest Posttest July/August 2012, Volume 66, Number 4

3 Table 2. Descriptive Data, ICCs, and Cronbach s a Coefficients for the Quadrant Scores Quadrant Pretest, M (SD) Postttest, M (SD) ICC Cronbach s a Registration (7.87) (8.67) Seeking (13.83) (13.92) Sensitivity (11.11) (11.72) Avoiding (14.26) (14.69) consent for their information to be used in this study. Prospective participants who were not interested in participating were instructed to not fill out or return the SP form. Participants were recruited from six nursery schools and child care centers in the New York metropolitan area. Inclusion criteria for the study included (1) primary caregivers of children ranging in age from 36 to 72 mo and (2) the completion of the SP on two separate occasions 7 14 days apart. Procedures Recruitment for the study was conducted in two phases. During the first phase, flyers were posted and sent home with children attending preschool and child care center recruitment sites. During the second phase, research packets were sent home with children at the recruitment sites. Each packet contained an information sheet, a direction sheet, and two SP forms. Interested participants were asked to complete the two SP forms 7 14 days apart. Participants were also asked to write on each SP form their child s age in months and the date of completion. After completing both SP forms, participants were asked to enclose them in the envelope provided and return them to their child s preschool or child care center. The data were analyzed using SPSS Version (SPSS Inc., Chicago). Test retest reliability was estimated using intraclass correlation coefficients (ICCs), and internal consistency was estimated using Cronbach s a coefficients. According to Portney and Watkins (2008) guidelines, ICCs ³.75 are considered good, values between.50 and.74 are considered moderate, and ICCs <.50 are considered poor. Results Fifty-five caregivers of children ranging inagefrom36to72mo(m , SD ) participated in the study. A cross-tabulation of children s classifications across the four sensory quadrants during the pretest and posttest conditions depict a normal distribution with minimal skew (Table 1). Descriptive data on the quadrant, factor, and section pretest and posttest scores, ICCs, and Cronbach s a coefficients are provided in Tables 2, 3, and 4. ICCs for the four quadrants were all in the good range (ICC [2, 1] ). ICCs for the factor scores (ICC [2, 1] ) and section scores (ICC [2, 1] ) ranged from moderatetogood.cronbach sa coefficients were high across the four quadrants (as ) and factors (as ) and moderate to high across the sections (as ). Discussion We examined the test retest reliability and internal consistency of the SP quadrant, factor, and section scores. Test retest and internal consistency analyses revealed higher psychometric indexes across the four quadrants (ICCs [2, 1] , as ) than across the factors (ICCs [2, 1] , as ) and sections (ICCs [2, 1] , as ), suggesting that a quadrant-level analysis captures children s sensory processing patterns more consistently than do factor- or section-level analyses. Compared with previous internal consistency analyses (a Quadrants , a Factors , a Sections ; Dunn, 1999, 2006), ours found higher a coefficients across all three types of scores. The higher a coefficients found in this study may be the result of a unique quality of the sample. Our sample was smaller in size (N 5 55) than Dunn s (1999) original sample (N 5 1,037) and consisted of children in a narrower age range ( yr) than Dunn s ( yr, 11 mo). The lowest ICCs were estimated for the visual processing (ICC 5.50) and auditory processing (ICC 5.67) sections and the sedentary (ICC 5.69) factor. Lower scores on these two sections and factor suggest that certain behaviors may be observed or conceptualized differently by caregivers over a short period of time. Alternatively, the larger difference in these scores may be explained byaslightmaturationinthechildover Scoring and Data Analysis The completed SP forms were scored according to the guidelines in the Sensory Profile User s Manual (Dunn, 1999). Factor and section scores were calculated from SP forms, and quadrant scores were calculated from summary score sheets. To ensure accuracy, all forms were scored twice by occupational therapy graduate students who were trained by an experienced occupational therapist and demonstrated >.80 scorer agreement. Table 3. Descriptive Data, ICCs, and Cronbach s a Coefficients for the Factor Scores Factor Pretest, M (SD) Posttest, M (SD) ICC Cronbach s a Sensory Seeking (10.15) (9.98) Emotionally Reactive (12.11) (11.89) Low Endurance Tone (5.18) (6.03) Oral Sensory Sensitivity (7.74) (8.26) Inattention Distractibility (5.05) (4.60) Poor Registration (3.62) (3.57) Sensory Sensitivity (2.43) (2.54) Sedentary (3.03) (2.83) Fine Motor Perceptual 9.96 (3.36) (2.91) The American Journal of Occupational Therapy 485

4 Table 4. Descriptive Data, ICCs, and Cronbach s a Coefficients for the Section Summary Scores Item Categories Pretest, M (SD) Postttest, M (SD) ICC Cronbach s a Sensory processing Auditory processing (5.04) (5.09) Visual processing (4.74) (4.78) Vestibular processing (4.25) (4.40) Touch processing (7.78) (9.94) Multisensory processing (4.23) (3.70) Oral sensory processing (10.43) (9.20) Modulation Sensory processing related to endurance/tone (5.03) (6.36) Modulation related to body position and movement (5.62) (6.22) Modulation of movement affecting activity level (4.27) (4.36) Modulation of sensory input affecting emotional responses (3.19) (3.06) Modulation of visual input affecting emotional responses and activity level (2.58) (2.72) Behavioral and emotional responses Emotional social responses (10.58) (11.25) Behavioral outcomes of sensory processing (5.03) (4.26) Items indicating thresholds for response (1.89) (1.97) the 2-wk testing period, interventions, or modifications. Our findings are helpful in considering the use of the SP to measure intervention outcomes. Analysis at the quadrant level suggests acceptable test retest reliability and internal consistency, indicating that caregivers observations of their children arestableovertime.whenusingthespas an outcome measure, practitioners can have more confidence that changes detectedaremorelikelytheresultofintervention than of measurement error or maturation;however,givenseverallimitations of this study, use of the SP to measure intervention changes should be done with caution. Implications for Occupational Therapy Practice In this study, the SP quadrant scores were more reliable than section or factor scores and, thus, may be more clinically useful when using the SP as an outcome measure. Further study is required. Limitations and Future Research This study was limited by a small sample size of geographic convenience and a lack of demographic information about the study participants. More research is needed to further examine the SP s test retest reliability and its utility as an outcome measure. Future studies should include a larger sample with greater demographic representation. s Acknowledgments We are grateful to all participating caregivers, nursery schools, and child care centers. We especially thank Joyce Sabari for her guidance and knowledge throughout the research process. References Case-Smith, J. (1997). Clinical interpretations of factor analysis on the Sensory Profile from a national sample of children without disabilities. American Journal of Occupational Therapy, 51, 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, doi.org/ / Dunn, W. (1999). Sensory Profile user s manual. San Antonio, TX: Psychological Corporation. Dunn, W. (2006). Sensory Profile Supplement user s manual. San Antonio, TX: Psychological Corporation. Ermer, J., & Dunn, W. (1998). The Sensory Profile: A discriminant analysis of children with and without disabilities. American Journal of Occupational Therapy, 52, Galvin, J., Froude, E. H., & Imms, C. (2009). Sensory processing abilities of children who have sustained traumatic brain injuries. American Journal of Occupational Therapy, 63, /ajot Gere, D. R., Capps, S. C., Mitchell, D. W., & Grubbs, E. (2009). Sensory sensitivities of gifted children. American Journal of Occupational Therapy, 63, Hall, L., & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. American JournalofOccupationalTherapy,61, Hilton, C., Graver, K., & LaVesser, P. (2007). Relationship between social competence and sensory processing in children with high functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 1, /j.rasd 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, ajot Polatajko, H. J., & Cantin, N. (2010). Exploring the effectiveness of occupational 486 July/August 2012, Volume 66, Number 4

5 therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information. American Journal of Occupational Therapy, 64, Portney, L. G., & Watkins, M. P. (2008). Foundations of clinical research: Applications to practice (3rd ed.). Upper Saddle River, NJ: Prentice Hall Health. Rodger, S., Brown, G. T., & Brown, A. (2005). Profile of paediatric occupational therapy practice in Australia. Australian Occupational Therapy Journal, 52, x Watling, R. L., Deitz, J., & White, O. (2001). Comparison of Sensory Profile scores of young children with and without autism spectrum disorders. American Journal of Occupational Therapy, 55, doi.org/ /ajot 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, The American Journal of Occupational Therapy 487