Assessments of early childhood praxis used in Sensory Integration: a scoping review

Abstract

The brain continuously receives sensory information from different parts of the body and the environment, producing appropriate motor and and behavioral responses that enable the body to learn to move and act functionally. However, when this process does not occur harmoniously, Sensory Integration dysfunctions may arise, including dyspraxia, which refers to difficulty in planning and executing intentional motor actions. This study aims to identify which instruments have been used to assess praxis from the perspective of Sensory Integration, the age groups covered, and to identify assessment instruments for children under three years of age. This is a scoping review, in which the search terms were: “sensory integration and children”, “sensory integration” and “sensorimotor performance”, “sensory integration test and praxis”, and “sensory integration assessment and babies”. The searches were conducted in the PubMed, Web of Science, BVS, Scopus, and CAPES databases. Ninety-five articles were included, identifying 33 instruments used in sensory integration assessment, of which 16 included the assessment of praxis or praxis-related components. Three assessment instruments for children under 36 months of age were identified: one indirect measure instrument and two direct measure instruments intended for the assessment of praxis in young children, both with a minimum application age above one year. Although there are praxis assessment instruments for early childhood, there is an important gap in direct assessment measures for children younger than 36 months, indicating the need for specific instruments for this population.

Keywords:
Occupational Therapy; Child Development; Perception; Psychomotor Performance

Resumo

O cérebro recebe continuamente informações sensoriais de diferentes partes do corpo e do ambiente, produzindo, respostas motoras e comportamentais adequadas para que o corpo possa aprender a mover e agir funcionalmente. No entanto, quando esse processo não ocorre de forma harmoniosa, podem surgir disfunções de Integração Sensorial, entre elas a dispraxia, que se refere à dificuldade de planejar e executar ações motoras intencionais. Esta pesquisa visa identificar quais instrumentos têm sido utilizados para avaliar a práxis sob a perspectiva da Integração Sensorial, as faixas etárias contempladas e busca identificar instrumentos avaliativos para crianças abaixo de três anos. Trata-se de uma revisão de escopo, cujos termos de busca foram: “sensory integration and children”, “sensory integration” and “sensorimotor performance”, “sensory integration test and praxis” e “sensory integration assessment and babies”. As buscas foram realizadas nas bases de dados Pubmed, Web of Science, BVS, Scopus e Capes. Foram incluídos 95 artigos, nos quais foram identificados 33 instrumentos utilizados na avaliação de integração sensorial, dos quais 16 instrumentos contemplam a avaliação da práxis ou de componentes relacionados à práxis. Foram encontrados três instrumentos de avaliação para idades abaixo de 36 meses: um instrumento de medida indireta e dois instrumentos de medida direta destinados à avaliação da práxis em crianças pequenas, ambos com idade mínima de aplicação superior a um ano. Embora, existam instrumentos de avaliação de práxis na primeira infância, há uma importante lacuna na avaliação de medida direta para crianças menores de 36 meses, indicando a necessidade de instrumentos específicos para esta população.

Palavras-chave:
Terapia Ocupacional; Desenvolvimento Infantil; Percepção; Desempenho Psicomotor.

Introduction

According to Ayres (1972, 2004), the brain continuously receives and processes an infinite number of sensory sensations through different organs of the body, producing appropriate motor and behavioral responses, so that the child can move in a functional manner. By detecting sensory information from their own body and the environment, the child is able to respond appropriately to the demands of everyday life (Ayres, 1972, 2004). Ayres Sensory Integration® (ASI) aims to organize the sensations received through the five senses, as well as the proprioceptive and vestibular pathways, so that the child can generate an appropriate adaptive response (Ayres, 1972). However, when this process does not occur harmoniously, a Sensory Integration dysfunction develops. Sensory dysfunctions are classified as modulation dysfunctions and dyspraxia (Bundy & Lane, 2020). Modulation problems involve hyperreactive or hyporeactive responses (Bundy & Lane, 2020; Oliveira & Souza, 2022), and dyspraxia refers to difficulty in ideating and planning new motor actions. (Cermak & May-Benson, 2020; Vives-Vilarroig et al., 2022).

To assess problems related to praxis, Ayres (1972, 2004) developed, in the 1970s, the first instrument for assessing sensory dysfunctions, the Southern California Sensory Integration Tests (SCSIT), which assessed visual, tactile, and kinesthetic perception, as well as perceptual-motor function. Subsequently, she developed the Sensory Integration and Praxis Tests (SIPT), which assess sensory perceptual dysfunctions and praxis, making it possible to understand the learning difficulties presented by children (Ayres, 1989; Ayres & Cermak, 2011). Since then, many Sensory Integration instruments have been developed to assess this condition; however, most of these assessments are intended for preschool- and school-aged children. Therefore, this study aims to conduct a scoping review to identify which instruments are being used to assess praxis in Sensory Integration, which age groups are being covered, and whether there is any instrument for assessing praxis in infants and young children.

Method

Initially, a scoping review – methodology that aims to map and explore the available literature on a specific topic to verify the existence of Sensory Integration instruments capable of assessing praxis in infants and young children. The review question was formulated based on the PCC (Population, Concept, and Context) strategy as follows: “Which assessment instruments are used in the field of Sensory Integration to assess praxis in children under three years of age?”

The search terms were: “sensory integration and children”, “sensory integration and sensorimotor performance”, “sensory integration test and praxis”, and “sensory integration assessment and babies”, and the databases searched were: PubMed, Web of Science, BVS (LILACS, MEDLINE, and PsycINFO), Scopus, and CAPES. The search was conducted between July 2023 and May 2024, with the articles stored on the Rayyan platform. The selection was conducted by two independent reviewers in blind-on mode. The inclusion criteria were articles published in scientific journals, written in English, Spanish, or Portuguese, with the full text available through university providers or on the internet, addressing praxis in the assessment of Sensory Integration in children from birth to 12 years of age, and including at least one occupational therapist among the authors.

After duplicate records were removed, the studies were assessed and selected according to the eligibility criteria by two independent reviewers through the reading of the titles and abstracts (Phase 1), followed by the full-text reading of the studies selected in Phase 1 (Phase 2). Any disagreements during the study selection process were resolved by a third reviewer.

A total of 8,485 articles were identified across the following databases: PubMed (n = 1,006), Web of Science (n = 1,476), BVS (n = 4,444), Scopus (n = 1,011), and CAPES (n = 548). After the exclusion of 3,449 duplicate articles, 5,036 articles remained for analysis. Following the initial screening, conducted through the reading of titles and abstracts in blind-on mode, 343 articles were selected for full-text review. Of these, 327 articles were excluded because they did not include standardized instruments or questionnaires on praxis, 16 articles could not be retrieved, and, ultimately, 95 articles were included in the analysis.

As this was a review of assessment instruments, the ethical principles of research and academic integrity were observed throughout data extraction and analysis, as well as the appropriate acknowledgment of the authorship of the included instruments. The flowchart of this process is presented in Figure 1.

Figure 1
Flowchart.

Results

Of the 95 scientific articles analyzed, it was observed that some used praxis assessment instruments, while others associated the assessment of praxis with sensory modulation questionnaires. In this review, neither the level of evidence of the articles nor the psychometric rigor of the instruments was analyzed, since only the topics addressed were considered. The Sensory Integration assessments identified were classified into two categories: 1) direct measures – comprehensive tests administered directly to the child; and 2) indirect measures – questionnaires intended for parents or caregivers to assess sensory integration. These categories are presented in Tables 1 and 2, which describe the age range of application, the purpose of the instruments, and the frequency with which they were used in the analyzed studies.

Table 1
Direct measure instruments that assess children under three years of age.

Year/author(s)	Instrument	Age	Objective	Frequency	Articles
Mailloux et al. (2014)	Postrotary Nystagmus Test - PNT (1989 Ayres, J. A)	2 months to 47 months	To assess the integrity of the vestibular system	n=2	Lucas et al. (2023); Mailloux et al. (2014)
Vanvuchelen et al. (2011)	Preschool Imitation and Praxis Scale – PIPS	1 year and 5 months old up to 4 years old up to 9 months old	To measure bodily and procedural imitation aptitude in young children.	n=3	Lucas et al. (2023); Lucas et al. (2022); Vanvuchelen et al. (2011)
Baranek (2010)	Tactile Defensiveness and Discrimination Test-Revised – TDDT	2 to 14 years old	To measure responses to light touch stimuli.	n=1	Lucas et al. (2023)
May-Benson & Koomar (2007)	Gravitational Insecurity Assessment - GIA	2 to 10 years old	To assess and detect children with gravitational insecurity	n=1	Lucas et al. (2023)
De Gangi & Greenspan (1989)	Test of Sensory Functions in Infants - TSFI	4 months to 18 months old	To assess deep pressure touch reactivity, visual-motor integration, oculomotor control, and vestibular reactivity.	n=9	Lucas et al. (2023); Moosa et al. (2023); Lucas et al. (2022); Beltrame et al. (2021); Wuang et al. (2020)Niutanen et al. (2019); Jorquera-Cabrera et al. (2017); Lin et al. (2013)Alves et al. (2010)
Royeen (1987)	Touch Inventory for Preschoolers - TIp	2 to 4 years old	To identify tactile defensiveness	n=2	Jorquera-Cabrera et al. (2017); Parush et al. (2006)
Miller (1985)	Miller Assessment for Preschoolers - MAP	2 years and 9 months old to 5 years and 8 months old	To assess sensorimotor skills involving basic gross and fine motor tasks, sensory awareness, and oral motor skills.	n=10	Lucas et al. (2023); Moosa et al. (2023); Niutanen et al. (2019); Schoen et al. (2019a); Schaaf et al. (2018); Jorquera-Cabrera et al. (2017); Iwanaga et al. (2014); Alves et al. (2010); Schaaf & Miller. (2005); Paul et al. (2003)

Table 2
Direct measurement instruments for assessing children over three years of age.

Year/author(s)	Instrument	Age	Objective	Frequency	Articles
Miller et al. (2020)	Sensory Processing 3-Dimensions Scale - SP3D	3 to 13 years old	To assess sensory processing skills and challenges, including modulation, sensory discrimination, and sensory-based motor disorders.	n=3	Lucas et al. (2023); Mulligan et al. (2019); Schoen et al., 2019b)
Mailloux et al. (2018)	Evaluation in Ayres Sensory Integration - EASI	Ages 3 to 12 years old	To measure sensory perception, bilateral postural/oculomotor integration, praxis, and sensory reactivity.	n=6	Schaaf et al. (2023); Lamash et al. (2022); Gándara-Gafo et al. (2021); Mailloux, et al. (2021); Holmlund e Orban. (2020)Mailloux, et al. (2018)
De Gangi & Berk (1983b)	De Gangi-Berk Test of Sensory Integration - TSI	3 to 5 years old	To assess postural control, bilateral motor integration, and reflex integration.	n=4	Moosa et al. (2023); Jorquera-Cabrera et al. (2017); Lin et al. (2012); Paul et al. (2003)

1. Direct Measure Instruments: Comprehensive tests administered directly to the child, which are presented below:Of the 22 instruments identified in this category, nine assess the child's sensory modulation, while 14 measure sensory discrimination and/or praxis difficulties.

Regarding the age range, the instruments identified for children under three years of age were: Postrotary Nystagmus Test (Lucas et al., 2023; Mailloux et al., 2014, 2018); Preschool Imitation and Praxis Scale (PIPS) (Lucas et al., 2022, 2023; Vanvuchelen et al., 2011); Tactile Defensiveness and Discrimination Test–Revised (Baranek, 2010; Lucas et al., 2023); Gravitational Insecurity Assessment (Lucas et al., 2023; May-Benson & Koomar, 2007); Test of Sensory Functions in Infants (TSFI) (DeGangi & Greenspan, 1989; Alves et al., 2010; Beltrame et al., 2021; Wuang et al., 2020; Jorquera-Cabrera et al., 2017; Lin et al., 2013; Lucas et al., 2022, 2023; Moosa et al., 2023; Niutanen et al., 2019); Touch Inventory for Preschoolers (Jorquera-Cabrera et al., 2017; Parush et al., 2006; Royeen, 1987); and Miller Assessment for Preschoolers (MAP) (Miller, 1985; Alves et al., 2010; Iwanaga et al., 2014; Jorquera-Cabrera et al., 2017; Lucas et al., 2023; Moosa et al., 2023; Niutanen et al., 2019; Paul et al., 2003; Schaaf & Miller, 2005; Schaaf et al., 2018; Schoen et al., 2019a. The instruments that contain praxis-related items are presented in Table 1 and are highlighted in gray.

The identified tests for children aged three years and older were: Sensory Processing 3-Dimensions Scale (SP3D) (Miller et al., 2020; Lucas et al., 2023; Mulligan et al., 2019; Schoen et al., 2019b); Evaluation in Ayres Sensory Integration (EASI) (Mailloux et al., 2018; Gándara-Gafo et al., 2021; Lamash et al., 2022; Mailloux et al., 2021; Schaaf et al., 2023); and DeGangi–Berk Test of Sensory Integration (TSI) (DeGangi & Berk, 1983b; Jorquera-Cabrera et al., 2017; Lin et al., 2012; Moosa et al., 2023; Paul et al., 2003). The three instruments include praxis-related items.. The instruments that assess praxis are presented in Table 2 and highlighted in gray.

The instruments identified for assessing children aged four years and older were: Sensory Adventure Measure (SAM) (Liberman et al., 2021; Lucas et al., 2023); Sensory Integration Clinical Observations (Lucas et al., 2023; May-Benson & Teasdale, 2020); Sensory Processing Scale Assessment 2.0 (SPS Assessment 2.0) (Jorquera-Cabrera et al., 2017; Lucas et al., 2023; Schoen et al., 2014); Observations Based on Sensory Integration Theory (Alves et al., 2010; Blanche & Reinoso, 2008; Zambruno, 2020); Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) (Crowe et al., 2009; Jorquera-Cabrera et al., 2017); Sensory Integration and Praxis Tests (SIPT) (Alkhalifah et al., 2022; Alves et al., 2010; Asher et al., 2008; Blanche & Reinoso, 2008; Bodison & Mailloux, 2006; Bundy et al., 2007; Cermak & Murray, 1990; Cermak et al., 1990; Chang & Yu, 2018; Hurst et al., 2006; van Jaarsveld et al., 2012; Jorquera-Cabrera et al., 2017; Kilroy et al., 2022; Lane et al., 2019; Lennox et al., 1988; Lin et al., 2005, 2012; Lin & Wu, 2014; Lucas et al., 2023; Mailloux et al., 2011; May-Benson & Koomar, 2010; Moosa et al., 2023; Mulligan, 1996, ; Mulligan, 1998; Mulligan, 2000; Mulligan, 2011; Niutanen et al., 2019; Omairi et al., 2022; Parham et al., 2019; Parush et al., 2006; Reeves, 1998; Reynolds et al., 2016; Siaperas et al., 2012; Roley et al., 2015a, Roley et al., 2015b; Romero-Ayuso et al., 2020; Schaaf et al., 2012, 2014; Schoen et al., 2019b; Alvarez et al., 2020); Southern California Sensory Integration Tests (SCSIT) (Alves et al., 2010; Atwood & Cermak, 1986; Cermak et al., 1980, 1986; Kimball, 1977; Lin et al., 2012; Lindquist et al., 1982; Schaaf & Miller, 2005; Tran et al., 2022); and Ayres Clinical Observations (Alves et al., 2010; Lindquist et al., 1982). Of these, five instruments assess praxis. These instruments are presented in Table 3 and highlighted in gray.

Table 3
Direct measurement instruments for assessing children over four years of age.

Year/author(s)	Instrument	Age	Objective	Frequency	Articles
Liberman et al. (2021)	Sensory Adventure Measure - SAM	4 years to 6 years and 11 months	To assess sensory modulation in children.	n=1	Lucas et al. (2023)
May-Benson (2015)	Sensory integration Clinical Observations	4 to 11 years old	To assess sensory processing (vestibular and proprioceptive), postural and ocular control, reflex integration, bilateral motor coordination, projected action sequences, and praxis.	n=2	Lucas et al. (2023); May-Benson & Teasdale. (2020)
Schoen et al. (2014)	Sensory Processing Scale Assessment 2.0	4 to 19 years old	To assess sensory reactivity across seven domains: tactile, auditory, visual, olfactory, gustatory, and vestibulo-proprioception.	n=3	Lucas et al. (2023); Jorquera Cabrera et al. (2017); Schoen et al. (2014)
Blanche (2002)	Observations Based on Sensory Integration Theory	4 to 15 years old	To assess oculomotor and postural functions, motor planning, and sensory processing.	n=2	Alves et al. (2010); Blanche & Reinoso (2008); Zambruno, 2020)
Crowe et al. (2009)	Pediatric Clinical Test of Sensory Interaction for Balance - CTSIB	4 to 6 years old	To evaluate the contributions of the child's visual, somatosensory (proprioceptive/tactile), and vestibular functions to the maintenance of standing balance.	n=1	Jorquera-Cabrera et al. (2017)
Ayres (1989)	Sensory Integration and Praxis Tests - SIPT	4 years old and 8 years and 11 months old	To assess visual, tactile, kinesthetic, and motor discriminations.	n=42	Lucas et al ( 2023); Moosa et al. (2023); Alkhalifah et al. (2022); Kilroy et al. (2022); Omairi et al. (2022); Alvarez et al. (2020);
					Romero-Ayuso et al. (2020); Niutanen et al. (2019); Parham et al. (2019); Lane et al. (2019); Schoen et al., (2019b); Chang & Yu (2018); Jorquera-Cabrera et al. (2017); Reynolds et al. (2016); Roley et al. (2015a); Roley et al. (2015b); Lin & Wu (2014); Schaaf et al. (2014); van Jaarsveld et al., (2012); Lin et al. (2012); Schaaf et al. (2012); Mailloux et al. (2011); Mulligan (2011); Siaperas et al. (2012); Alves et al (2010); May-Benson & Koomar (2010); Asher et al. (2008); Blanche & Reinoso (2008); Bundy et al. (2007); Bodison & Mailloux (2006); Hurst et al. (2006); Parush et al. (2006); Lin et al. (2005); Mulligan, (2000); Mulligan, (1998); Reeves, (1998); Mulligan, (1996); Cermak & Murray (1990); Cermak et al. (1990); Murray et al. (1989); Lennox et al. (1988)Lennox et al. (1988)
Ayres (1975)	Southern California Sensory Integration Tests - SCSIT	4 years old up to 8 years and 11 months old	To assess praxis (motor planning) and postural and bilateral integration. Form and spatial perception.	n=9	Tran et al. (2022); Lin et al. (2012); Alves et al. ( 2010); Schaaf & Miller (2005); Cermak et al. (1986); Atwood & Cermark (1986); Lindquist et al. (1982); Cermak et al., 1980; Kimball ( 1977)
Ayres (1972)	Ayre’s clinical observations	4 years old up to 8–10 years old	Primitive postural reflexes, muscle co-contraction, muscle tone, extraocular muscle control, vestibular system function, integration of functions on both sides of the body, praxic skills.	n=2	Alves et al. (2010); Lindquist et al. (1982)
The instruments identified for the assessment of children aged five years and older were: Comprehensive Observations of Proprioception–Revised (COP-R) (Blanche et al., 2012, 2021; Jorquera-Cabrera et al., 2017; Lucas et al., 2023); Motor Planning Maze Assessment (MPMA) (Jorquera-Cabrera et al., 2017; May-Benson, 2006); Test of Ideational Praxis (TIP) (May-Benson & Cermak, 2007; Jorquera-Cabrera et al., 2017; Lane et al., 2014, 2019; Hagihara et al., 2016; Lucas et al., 2023; Serrada-Tejeda et al., 2021); and Observaciones Clínicas Sensorio-Motoras (Blanche et al., 2016; Jorquera-Cabrera et al., 2017). Of these, three instruments assess praxis. These instruments are presented in Table 4 and highlighted in gray.

Table 4
Direct measurement instruments assessing children over five years of age.

Year/author(s)	Instrument	Age	Objective	Frequency	Articles
Blanche et al. (2021)	Comprehensive Observations of Proprioception - COP-R	5 to 14 years old	To provide information on motor and behavioral skills related to proprioceptive processing.	n=3	Lucas et al. (2023); Jorquera-Cabrera et al. (2017); Blanche et al. (2012)
May-Benson (2006)	Motor Planning Maze Assessment - MPMA	5 to 12 years old	To identify motor planning difficulties.	n=1	Jorquera-Cabrera et al. (2017)
May-Benson & Cermak (2007)	Test of Ideational Praxis – TIP	5 to 8 years old	To identify the need to assess the ideational aspect of praxis.	n=7	Lucas et al. (2023); Serrada-Tejeda et al. (2021); Lane et al. (2019); Jorquera-Cabrera et al. (2017); Hagihara et al. (2016); Lane et al. (2014); May-Benson & Cermak. (2007)
Blanche et al. (2016)	Observaciones Clínicas Sensorio-Motoras	5 years old up to 7 years and 11 months old	To evaluate aspects of postural control, motor planning, and motor control related to sensory processing.	n=2	Jorquera-Cabrera et al. (2017); Blanche et al. (2016)

1. Indirect Measurement Instruments: (Sensory Integration Questionnaire for parents/caregivers) Of the eleven instruments in this category, eight assess the child's sensory modulation, while three measure sensory discrimination and/or praxis difficulties. Regarding age range, the instruments identified for children under one year of age were: Sensory Integration Infant Routines Questionnaire (SIIRQ) (Lucas et al., 2022); Sensory Processing Measure–2 (SPM-2) (Parham et al., 2021; Brown et al., 2023; Gándara-Gafo & Beaudry-Bellefeuille, 2023; Narzisi et al., 2022; Parham et al., 2019); Sensory Profile 2 (SP2) (Dunn, 2014; Asher et al., 2008; Brown et al., 2010; Bundy et al., 2007; Polatajko & Cantin, 2010; Schaaf & Miller, 2005; Schaaf et al., 2012, 2014; Roley et al., 2015a; Jorquera-Cabrera et al., 2017; Schoen et al., 2019a; Niutanen et al., 2019; Huang et al., 2020; Beltrame et al., 2021; Tran et al., 2022; Lucas et al., 2022, 2023; Moosa et al., 2023; Balikci et al., 2023); and Sensory Rating Scale (Provost & Oetter, 1994; Lucas et al., 2022).. The instruments that assess praxis are presented in Table 5 and are highlighted in gray.

   Table 5
   Indirect measurement instruments that assess children under one year of age.
   

   Year/Authors	Instrument	Age	Objective	Frequency	Articles
   Lucas et al. (2022)	Sensory Integration Infant Routines Questionnaire - SIIRQ	8 months old up to 24 months old	To consider possible sensory integration concerns in children.	n=1	Lucas et al. (2022)
   Parham et al. (2021)	Sensory Processing Measure 2 - SPM-2	4 months old up to 87 years old	Sensory integration and processing difficulties across various environments (modulation and praxis)	n=4	Brown et al. (2023); Gándara-Gafo & Beaudry Bellefeuille, (2023); Narzisi et al. (2022); Parham et al. (2019)
   Dunn (2014)	Sensory Profile 2 - SP2	Newborn to 14 years/11 months	To assess sensory processing.	n=17	Balikci et al. (2023); Lucas et al. (2023); Moosa et al. (2023); Lucas et al. (2022); Tran et al. (2022); Beltrame et al. (2021); Huang et al. (2020); Niutanen et al. (2019); Schoen et al. (2019a); Jorquera-Cabrera et al. (2017); Roley et al. (2015a); Schaaf et al. (2014); Schaaf et al. (2012); Polatajko & Cantin, (2010); Brown et al. (2010); Asher et al. (2008); Bundy et al. (2007); Schaaf & Miller. (2005)
   Provost & Oetter (1994)	Sensory Rating Scale - SRS	Newborn to 3 years old	To identify and quantify the variety of responses to sensory experiences.	n=1	Lucas et al. (2022)

For children aged two years and older, the instruments identified were: Sensory Processing Measure–Preschool (SPM-P) (Ecker & Parham, 2010; Alkhalifah et al., 2022; Balikci et al., 2023; Kuhaneck et al., 2023; Lucas et al., 2022); and Sensory Experiences Questionnaire (SEQ) (Baranek, 1999; Jorquera-Cabrera et al., 2017; Schaaf et al., 2012; Lucas et al., 2022, 2023). The instruments that assess praxis are presented in Table 6 and highlighted in gray.

Table 6
Indirect measurement instruments for assessing children over two years of age.

Year/Authors	Instrument	Age	Objectives	Frequency	Articles
Ecker & Parham (2010)	Sensory Processing Measure - Preschool - SPM-P	2 years old up to 5 years old	To assess the child's sensory processing, praxis, and social participation issues.	n=5	Balikci et al. (2023); Kuhaneck et al. (2023); Alkhalifah et al. (2022); Lucas et al. (2022)
Baranek (1999)	Sensory Experiences Questionnaire - SEQ	2 to 12 years old	To measure the frequency of sensory response patterns (hypo-responsiveness; hyper-responsiveness; sensory interests, repetitions, and seeking behaviors; and enhanced perception), as well as modalities (i.e., auditory, visual, tactile, gustatory, vestibular) in social or non-social contexts.	n=4	Lucas et al. (2023); Lucas et al. (2022); Jorquera-Cabrera et al. (2017); Schaaf et al. (2012)

For children aged three and older, the instruments identified were: Behavioral Observation on Sensory Stimuli Questionnaire for Parents (BOSS-P) (Barrios-Fernández et al., 2020); Sensory Profile (SP) (Dunn, 1999; Alves et al., 2010; Alvarez et al., 2020; Seri Oh et al., 2024); Sensory Sensitivity Questionnaire–Revised (SSQ-R) (Jorquera-Cabrera et al., 2017; Talay-Ongan & Wood, 2000); Developmental and Sensory Processing Questionnaire (DSPQ) (Cermak & Miller, 1993; Lin et al., 2005); and Sensory Processing Measure (SPM) (Parham et al., 2007; Miller-Kuhaneck et al., 2007; Asher et al., 2008; Brown et al., 2010; Mailloux et al., 2011; Schaaf et al., 2011; Roley et al., 2015a, 2015b; van Jaarsveld et al., 2016; Allen & Casey, 2017; Jorquera-Cabrera et al., 2017; Schaaf et al., 2018; Parham et al., 2019; Dadson et al., 2020; Hen-Herbst et al., 2020; Zambruno, 2020; Omairi et al., 2022; Yela-González et al., 2021). The instruments that assess praxis are presented in Table 7 and are highlighted in gray.

Table 7
Indirect measurement instruments that assess children over three years of age.

Year/Authors	Instrument	Age	Objectives	Frequency	Articles
Barrios-Fernández et al. (2020)	Behavioral Observation on Sensory Stimuli Questionnaire for Parents - BOSS-P	3 years up to 19 years old	To characterize children and adolescents with ASD regarding the three new sensory dimensions of Rivière's Autism Spectrum Inventory, based on Miller's model.	n=1	Barrios-Fernandez et al. (2020)
Dunn (1999)	Sensory Profile - SP	3 years to 10 years old	To understand a child's sensory processing patterns in everyday situations.	n=3	Oh et al. (2024); Alvarez et al. (2020); Alves et al. (2010)
Talay-Ongan & Wood (2000)	Sensory Sensitivity Questionnaire-Revised - SSQ-R	4 to 14 years old	To measure sensory hyper and hyposensitivity in children with autism across six sensory domains: auditory, visual, tactile, gustatory, vestibular, and olfactory.	n=1	Jorquera-Cabrera et al. (2017)
Cermak & Miller (1993)	The Developmental and Sensory Processing Questionnaire - DSPQ	4 years old	To assess sensory sensitivity, emotions, and various life experiences.	n=1	Lin et al. (2005)
Parham et al. (2007)	Sensory Processing Measure - SPM	Ages 5 to 12 years old	To assess the child's problems, sensory processing, praxis, and social participation.	n=17	Omairi et al. (2022); Yela-González et al. (2021); Dadson et al. (2020); Hen-Herbst, et al. (2020); Zambruno (2020)Parham et al. (2019); Schaaf et al. (2018); Allen & Casey. (2017); Jorquera-Cabrera et al. (2017); van Jaarsveld et al. (2016); Roley et al. (2015a); Roley et al. (2015b); Mailloux et al. (2011); Schaaf et al. (2011); Brown et al. (2010); Asher et al. (2008); Miller-Kuhaneck et al. (2007)

Eleven indirect assessment tools were identified, in the form of questionnaires for parents or caregivers, that aim to identify aspects of sensory processing. Of these, eight assess the child's sensory modulation at home and/or at school. Only three instruments include items related to praxis: the Sensory Processing Measure (SPM), the Sensory Processing Measure – Preschool (SPM-P), and the Sensory Processing Measure-2 (SPM-2).

Discussion

Currently, within Ayres Sensory Integration, praxis is defined as ideational praxis, visuodyspraxia, and somatodyspraxia (Cermak & May-Benson, 2020; Mailloux, et al., 2018). However, the first praxis assessment instruments did not encompass all forms of dyspraxia, such as the Southern California Sensory Integration Tests (SCSIT), identified in nine articles, and the Sensory Integration and Praxis Tests (SIPT), identified in 42 articles. Although the SIPT is considered the gold standard (Ayres, 1989), its use is limited by the high costs of acquisition and scoring, as well as the lack of validation and cross-cultural adaptation for several countries (Mailloux et al., 2018). To increase accessibility and facilitate its application across different cultural contexts, the Evaluation in Ayres Sensory Integration (EASI) was developed to assess ideational praxis, as well as sensory perception, postural, ocular, and bilateral motor integration, praxis skills, and sensory reactivity (Mailloux et al., 2018). Although it is a recently developed instrument, it was cited in six articles included in this review. Despite the EASI presenting advantages related to cost-effectiveness and cross-cultural adaptation in several countries, including Brazil (Massoqueto, 2023), the instrument is still undergoing validation. The SIPT is considered the gold standard instrument, with high psychometric rigor; however, it has been validated only for North American children. In contrast, the EASI is still under development, and its publications have focused on psychometric studies and cross-cultural adaptations. No articles were identified that employed the EASI in clinical assessments or therapeutic interventions. Conversely, the SIPT has been widely used in research involving both assessment and intervention, including in Brazil, as demonstrated by a randomized controlled clinical trial (Omairi et al., 2022). Considering that, of the 95 articles analyzed, 53 were conducted in the United States and only three were Brazilian, these findings highlight the scarcity of Brazilian scientific production in the field of Sensory Integration and reinforce the need to expand national research on this topic.

The Miller Assessment for Preschoolers (MAP), which is infrequently used in Brazil, was identified in ten articles and assesses sensory discrimination skills, postural foundations, and praxis, in addition to detecting visual, perceptual, and language delays (Miller, 1985). The Test of Ideational Praxis (TIP), identified in seven studies, is an instrument for assessing ideational praxis that is not widely disseminated in Brazil, and training for its administration is available only abroad (May-Benson & Cermak, 2007). The DeGangi-Berk Test of Sensory Integration (TSI), also infrequently used in Brazil, was identified in five articles and assesses postural control, bilateral coordination, and motor integration (De Gangi & Berk, 1983a). The Preschool Imitation and Praxis Scale (PIPS), likewise rarely used in Brazil, was identified in three articles and assesses imitation patterns (Vanvuchelen et al., 2011). The Sensory Processing 3-Dimensions Scale (SP3D), which is still undergoing validation in the United States and was identified in three studies, assesses sensory abilities, sensory processing challenges related to modulation, discrimination, motor skills, and praxis (Mailloux et al., (2018). Finally, the Sensory Processing Measure-2 (SPM-2), identified in four articles, was the only instrument identified that assesses children from four months of age and includes functions related to praxis (Parham et al., 2021). However, it is an indirect measure, and the instrument has not yet undergone cross-cultural adaptation for Brazil.

In some studies, the Ayres Clinical Observations were identified. Originally composed of eleven clinical observations examining cerebellar and vestibular functions, they were designed to complement information obtained through standardized tests (Ayres, 1972). The Ayres Clinical Observations, identified in two articles (Ayres, 1972), consist of a set of structured motor tasks used to assess primitive postural reflexes, co-contraction of antagonist muscles, muscle tone, extraocular muscle control, vestibular system function, integration of bilateral body functions, and praxis skills (May-Benson & Teasdale, 2020). Other clinical observation protocols have also been developed, including the Observations Based on Sensory Integration Theory (Blanche, 2002), identified in three articles; and the Sensorimotor Clinical Observations (Blanche et al., 2017), identified in two articles. However, these instruments are applicable only to children aged four and/or five years and older.

In several studies, assessment instruments such as the Sensory Integration and Praxis Tests (SIPT) and/or the Ayres Clinical Observations were used in combination with parent-report questionnaires on sensory modulation, including the Sensory Processing Measure (SPM) (Parham et al., 2007), identified in 18 articles in its Home and School versions, and the Sensory Profile 2 (SP2) (Dunn, 2014, identified in 17 articles.

Ayres Clinical Observations were disseminated in Brazil by the occupational therapists Blanche, Reinoso, and May-Benson. These observational assessments are widely used in the country because they are free of charge, easily accessible, and simple to administer. However, they all share the limitation of a minimum application age, as they are intended for children aged four years and older. In Brazil, the first Sensory Integration instruments used by occupational therapists were the SP1 and the SIPT, neither of which had undergone cross-cultural adaptation or validation for the Brazilian population. Currently, instruments with cross-cultural adaptation and validation for the Brazilian population are being disseminated, including the SP2 (Almohalha, 2018), the SosiM/COP (Ovando, 2023), and the EASI (Massoqueto, 2023). Among the instruments mentioned, only the SP2 has been validated for use in Brazil and includes the youngest infant age groups. However, although it is a Sensory Integration instrument, it does not assess praxis.

Three assessment instruments intended for children younger than 36 months of age were identified. Among the direct measures, two instruments designed to assess praxis in young children with minimum ages above one year were identified. The earliest minimum age identified in this review corresponded to the Preschool Imitation and Praxis Scale (PIPS), applicable from 1 year and 5 months of age, followed by the Miller Assessment for Preschoolers (MAP), whose minimum administration age is 2 years and 9 months. Among the indirect measures, the Sensory Processing Measure-2 (SPM-2) was the only instrument that assesses ideation and planning in children aged 4 to 30 months.

The absence of national instruments or instruments that have been appropriately cross-culturally adapted to assess this construct compromises both the assessment process and therapeutic interventions, which should be grounded in scientific evidence. Assessments developed in other countries reflect cultural, familial, and contextual characteristics specific to their populations of origin. Considering Brazil's continental dimensions and considerable sociocultural diversity, validated instruments are needed for the country's different regions and sociocultural contexts. Therefore, simple linguistic translation is insufficient to ensure the conceptual, functional, and semantic equivalence of assessment instruments (Beaton et al., 2000). This review clearly demonstrated the scarcity of robust instruments capable of directly assessing praxis or its components in children younger than three years of age from the perspective of Ayres Sensory Integration (ASI). Furthermore, there is a lack of studies addressing the development of praxis components in this population, as well as the emergence of praxis skills during early childhood.

Given this scenario, there is a clear need to develop a national instrument to assess praxis in Brazilian children that is sensitive to the country's sociocultural context and capable of representing the meaningful and unique experiences related to the development of praxis skills in this population, thereby enabling more reliable clinical interpretations.

Conclusion

This review aimed to identify the earliest ages of children included in the analyzed instruments and to verify the existence of praxis assessment instruments for infants and young children. Few assessment instruments and/or studies addressing the clinical assessment of praxis in early childhood were identified, and many of the instruments identified were reported in systematic review and literature review articles.

Although there has been a growing number of cross-cultural adaptations of Ayres Sensory Integration (ASI) instruments in Brazil, all adapted instruments have a minimum administration age above 36 months. The age range from birth to 1 year and 5 months deserves greater attention, as there is a scarcity of research focusing on this population and, consequently, scientific knowledge regarding Sensory Integration and the development of praxis during this stage of life remains limited. Therefore, the findings of this review highlight the need for further research involving children from birth to 36 months of age.

How to cite:

Silva, K. C., Scofield, R. S., & Pfeifer, L. I. (2026). Assessments of early childhood praxis used in Sensory Integration: a scoping review. Cadernos Brasileiros de Terapia Ocupacional, 34, e4227. https://doi.org/10.1590/2526-8910.cto427042272

Data availability

The data supporting the results of this study are available from the corresponding author upon request.

Funding Source

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

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Correspondence

Corresponding author Kátia Cezário da Silva e-mail: [e-mail]

Section editor

Profa. Dra. Iza de Faria-Fortini

Publication Dates

• Publication in this collection
  18 Sept 2026
• Date of issue
  2026

History

• Received
  05 Sept 2025
• Reviewed
  27 Nov 2025
• Reviewed
  09 Apr 2026
• Accepted
  20 May 2026