Why Clinical Observations Are Not Sufficient For a Valid Diagnosis

AUTOMATED TRANSLATION - NOT YET EDITED

The clinical observations described by Dr. Ayres in her "blue bible," the SI textbook "Sensory Integration & Learning Disorders," are an indispensable tool in occupational therapy assessment from an SI perspective. Mind you, Dr. Ayres developed them as a supplement to her standardized testing procedures—originally SCSIT, then SIPT.

What is the difference between clinical observations and these tests?

Clinical intuition is valuable, but it's not enough. Those who rely on Ayres Sensory Integration® (ASI) in their occupational therapy work with children know how important observations are in everyday practice . But science clearly shows us: A well-founded, reliable diagnosis requires more than just a trained eye. It requires systematic measurement , precise instruments, and an evidence-based approach.

Clinical Observations Are Subjective

In the early days, Ayres also used non-standardized procedures to assess, for example, tactile defense or extension against gravity. However, she quickly realized that without reliable measurements, many observations remain vague or elusive . The disadvantages of observations, even systematic ones, are:

• Subjective – influenced by the therapist’s experience, expectations and interpretation.

• Not comparable – without standardization and norms, objective comparison values are missing.

• Not objective – two observers can come to different conclusions.

However, for complex phenomena such as sensory hypersensitivity and hyposensitivity, visuo- or somatodyspraxic patterns, an objective data basis is needed in order to be able to draw valid conclusions.

Valid Data Collection Using Objective Measurement Methods

Collecting data as objectively as possible has always been a core element of SI. Dr. Ayres developed her own tests early on – in the 1960s – such as the "Ayres Space Test" and the "Tactile Perception Test" and tested their validity using scientific methods. She then compiled her individual tests into a test battery, which was published in 1972 as the Southern California Sensory Integration Tests (SCSIT) . This test battery was a milestone in the standardized assessment of sensory processing abilities in children and for the standard of assessment in occupational therapy. It is important to note that the SCSIT was only normed on a small sample of 250 Californian children. Until the end of her life, Dr. Ayres worked with Zoe Mailloux on developing a new test battery, which would now also include praxis. At the end of the 1980s, the SCSIT was replaced by this new test battery, the Sensory Integration and Praxis Tests (SIPT) . The SIPT consisted of 17 subtests that allowed for a more comprehensive assessment of sensory and praxis performance.

For a long time, the SIPT was considered the gold standard for occupational therapy assessment from an ASI perspective. Unfortunately, it was never re-standardized by the publisher. (The usual timeframe for psychological tests is 8-10 years.)

In response to the need for current and culturally relevant assessments, the Evaluation in Ayres Sensory Integration (EASI) was developed. In 2014, a group of SI experts gathered around Zoe Mailloux, Dr. Ayres' former research assistant, who had previously contributed to the development of the SIPT. Over years of work, including numerous pretests and with the involvement of the global SI community, they developed a new test battery similar to the SIPT but expanded to include, for example, the measurement of sensory reactivity. The EASI is characterized by the following quality features:

• International standardization : Data from different countries and cultures are incorporated into the standards, which increases cultural relevance.

• Cost-effective test material: the test is not distributed through a publisher, but can be compiled by the individual therapist.

• Free availability : The test evaluation is accessible almost free of charge (50 USD annual fee), which facilitates worldwide dissemination and application.

• Relevance : The EASI is based on the latest scientific findings and was developed using modern psychometric methods (e.g., Rasch analysis). There are plans to expand it into a computer-adaptive procedure.

Published in 2022, the EASI is currently the only valid performance test of sensory-integrative functions. It is a direct procedure with which we can measure all functions that, according to Dr. Ayres' theory, are relevant for activity and daily functioning:

• Sensitivity to stimuli or reactivity

• vestibular functions and postural control, ocular functions and bilateral integration

• Perceptual abilities, especially tactile, proprioceptive, visual and auditory

• Practice in various aspects

In addition, we use sensory questionnaires such as the WN-FBG (semi-standardized) or the Sensory Processing Measure (spm-2, not available in German) or the Sensory Profile (SP-2, available in German, but does not correspond to ASI®).

For a valid diagnosis that also stands up to other specialists, institutions, and funding agencies, standardized, reliable, and valid measurement instruments are needed . Only then can we achieve what Ayres began with her work: making sensory integration not only tangible, but also measurable and comprehensible .

For Responsible And Evidence-Based Practice

Systematic behavioral observations remain a valuable tool in occupational therapy practice, either as a supplement to standardized tests or in all those cases where standardized tests cannot be used (children who are too young or too severely impaired).

The importance of testing has spread, but the responsible use of testing procedures, unfortunately, less so. It seems to be common practice in the German occupational therapy world to use completely outdated tests—I'm talking about 50-year-old procedures here—just to ensure that testing is actually being done. It is ethically completely unacceptable for therapists to make decisions based on outdated and invalid tests. This practice not only damages the reputation of occupational therapy, but in individual cases also leads to inaccurate diagnoses and ineffective interventions. The use of outdated tests such as the SIPT or even the SCSIT raises ethical concerns and undermines the credibility of the profession.

With the EASI we have a cost-effective , globally applicable, A contemporary solution is available that meets the current requirements of evidence-based and ethically responsible practice . Without this test—and possibly future equivalent testing procedures—it is hardly possible to precisely assess the sensory-integrative foundations of action capacity and daily functioning and to plan effective, individualized interventions based on a sound assessment.

The only materials you need to purchase for the EASI are the 3D-printed molds for the tactile tests. For EASI courses in German-speaking countries, you can order them here in the GSIÖ webshop! You'll collect all the other materials in your everyday life.

How Can You Learn The EASI?

Applying the EASI requires a lot of practice—after all, it comprises 20 different tests. The owner and developer of the EASI, CLASI from California, has developed a two-part training course for this purpose:

• Part 1 is a webinar in which you will learn about and practice the 20 tests through self-study using videos and quizzes.

• For Part 2, we meet in person and the course participants continue to practice with practice partners, receive feedback, clarify their questions and develop initial routine in conducting the tests.