The Sensory Integration and Praxis Tests: A Comprehensive Guide to Understanding Sensory Processing in Children

Imagine a child who covers their ears during classroom activities, refuses to wear certain clothing textures, or struggles to catch a ball despite adequate vision and motor strength. These behaviors might signal sensory integration difficulties—challenges in how the brain processes and organizes sensory information from the environment. For occupational therapists seeking to understand and address these complex issues, the Sensory Integration and Praxis Tests (SIPT) has long been considered the gold standard assessment tool.

What Is the Sensory Integration and Praxis Tests?

The Sensory Integration and Praxis Tests (SIPT) is a comprehensive battery of 17 standardized tests designed to measure the sensory integration processes that underlie learning and behavior in children. Developed by pioneering occupational therapist Dr. A. Jean Ayres and published in 1989 by Western Psychological Services, the SIPT evaluates visual, tactile, and kinesthetic perception, as well as motor performance.

Originally standardized for children between 4 years and 8 years 11 months, the SIPT helps clinicians pinpoint specific organic problems associated with learning disabilities, emotional disorders, and minimal brain dysfunction. While the test was designed for this age range, clinicians increasingly use it with older children, teenagers, and even adults when mindful clinical reasoning suggests sensory processing difficulties may have impacted development and participation in daily life.

The Pioneer Behind the Test: Dr. A. Jean Ayres

Understanding the SIPT requires appreciating the remarkable woman who created it. Anna Jean Ayres (1920-1988) was an occupational therapist, educational psychologist, and neuroscientist who revolutionized our understanding of how sensory experiences shape human behavior and learning.

Born on a walnut farm in Visalia, California, Ayres claimed to have experienced symptoms similar to the dysfunctions she would later study. After earning her B.A., M.A., and Ph.D. from the University of Southern California, she conducted post-doctoral work at UCLA's Brain Research Institute. Between 1955 and 1984, she served as a faculty member in occupational therapy and special education at USC.

Building on the work of neurologist Charles Sherrington and others, Ayres began developing sensory integration theory in the 1950s by examining the relationship between brain function and behavior. By the 1960s, she recognized and described "hidden disabilities" or "dysfunction in sensory integrative processes"—conditions that weren't immediately visible but profoundly affected children's ability to learn and interact with their world.

Her groundbreaking work resulted in multiple publications and the development of two assessment batteries: the Southern California Sensory Integration Tests (SCSIT; 1975) and later the revised and expanded Sensory Integration and Praxis Tests (SIPT; 1989). Through factor analyses of assessment findings, she identified distinct patterns of sensory integrative dysfunction, which subsequent researchers have confirmed and expanded upon.

The Foundation: Sensory Integration Theory

Sensory integration refers to how the brain takes in information through all our senses—sight, sound, taste, touch, movement, and body position—and organizes this information to produce appropriate behavioral responses. This neurological process helps us understand who we are, where we are, and what's happening around us.

Ayres' theory emphasized three critical sensory systems that form the foundation for all learning and behavior:

1. Vestibular System: Processes movement and gravitational information, contributing to balance, spatial orientation, and coordination
2. Proprioceptive System: Provides awareness of body position and movement through muscles and joints
3. Tactile System: Processes touch information, contributing to body awareness, motor planning, and emotional security

When these systems function smoothly together, children develop age-appropriate motor skills, learn efficiently, regulate their emotions, and engage confidently in daily activities. When integration is disrupted, children may exhibit a range of challenges that interfere with learning, behavior, and social participation.

The 17 Tests: A Comprehensive Assessment Battery

The SIPT comprises 17 individual tests, each measuring specific aspects of sensory processing and praxis (motor planning). Here's a detailed look at what each test evaluates:

Visual Perception Tests

1. Space Visualization (SV): A puzzle-like test where children indicate which of two forms will fit a formboard, measuring visual perception and mental rotation of objects.
2. Figure-Ground Perception (FG): Children point to pictures hidden among other pictures, assessing how well they visually perceive a figure against a rival background.
3. Design Copying (DC): Children copy increasingly complex line drawings following detailed instructions, measuring two-dimensional constructional praxis and visuomotor coordination.

Tactile and Kinesthetic Tests

4. Manual Form Perception (MFP): Children identify unusual shapes held in the hand without visual cues, measuring tactile and visual perception integration.
5. Kinesthesia (KIN): Children attempt to place their finger where the therapist previously placed it, assessing the sense of arm position and movement.
6. Finger Identification (FI): Children point to the finger the therapist touched, measuring tactile perception and body awareness.
7. Graphesthesia (GRA): Children draw with a finger the same simple design the therapist drew on the back of their hand, assessing tactile perception and motor planning.
8. Localization of Tactile Stimuli (LTS): Children point to where the therapist lightly touched their arm or hand, measuring tactile perception and discrimination.

Praxis and Motor Planning Tests

9. Praxis on Verbal Command (PrVC): Children execute coordinated movements described verbally, assessing ability to translate verbal descriptions into various postures.
10. Constructional Praxis (CPr): Children build with blocks using structures built by the therapist as models, measuring three-dimensional constructional praxis and spatial abilities.
11. Postural Praxis (PPr): Children imitate unusual body postures demonstrated by the therapist, assessing the ability to conceptualize, plan, and execute movements.
12. Oral Praxis (OPr): Children imitate movements of the tongue, lips, and jaw, measuring the ability to plan and execute facial movements.
13. Sequencing Praxis (SPr): Children imitate a series of simple hand and finger movements, measuring bilateral coordination and sequential movement planning.

Bilateral Integration and Balance Tests

14. Bilateral Motor Coordination (BMC): Children imitate a series of arm and foot movements, evaluating the ability to coordinate the two sides of the body.
15. Standing and Walking Balance (SWB): Children hold various standing and walking postures with eyes open and closed, assessing vestibular function and balance.
16. Motor Accuracy (Mac): Children draw a line on top of a long, curving printed line, measuring visuomotor coordination and motor planning.

Vestibular Function Test

17. Postrotary Nystagmus (PRN): Children are rotated clockwise and counterclockwise on a rotation board while the examiner observes eye movements, measuring vestibular system function. Note: This test requires special precautions and should not be administered to children with a history of seizures.

Administration: Time, Training, and Technique

Time Requirements

The complete SIPT battery takes approximately 2 to 2.5 hours to administer, though this varies depending on the child's age, attention span, and ability level. Each individual test can be completed in about 10 minutes, allowing clinicians flexibility to:

• Administer the full battery over multiple sessions
• Select specific tests based on clinical concerns
• Adjust testing schedules to accommodate children with attention difficulties

For children with disabilities, particularly those with autism spectrum disorder or attention deficits, completing the entire battery in a single session may not be feasible or appropriate.

Required Training

SIPT administration, scoring, and interpretation require specialized professional training in sensory integration theory. Originally, the University of Southern California offered an intensive certification program (USC/WPS SIPT certification) that was phased out in 2015. Currently, clinicians can pursue several training pathways:

• USC Sensory Integration Continuing Education Certificate Program: Primarily for occupational therapists, but also available to speech and physical therapists
• Collaborative for Leadership in Ayres Sensory Integration (CLASI): Comprehensive training and certification program
• STAR Institute Intensive Mentorship Programs: Specialized training in sensory integration assessment and intervention

These programs ensure clinicians understand not just how to administer the tests, but how to interpret results within the broader context of sensory integration theory and translate findings into meaningful intervention plans.

Child Requirements

For optimal assessment, children should be able to:

• Focus and attend to tasks
• Follow demonstration and verbal instructions
• Participate without needing verbal responses (the tests don't require children to explain their actions)

Scoring: Computer-Based Interpretation

All SIPT tests are computer-scored using specialized software from Western Psychological Services. The scoring system operates on a credit-based model:

• Each test administered uses one scoring credit
• A complete 17-test battery uses only 15 credits (efficient bulk scoring)
• Scoring packages available: 10-use (150 credits) or 25-use (375 credits)
• Clinicians can score any combination of tests without administering the full battery

The computer-generated report provides:

• Z-scores for each test (Mean = 0, Standard Deviation = 1)
• Standard error of measurement bands
• Comparison to normative data from over 2,000 children
• Detailed interpretive information
• ChromaGraphs showing visual patterns of strengths and weaknesses

This immediate, computerized scoring replaced the previous system where therapists mailed answer sheets to California and waited for results—a process particularly problematic for international practitioners.

Understanding the Results: Patterns of Dysfunction

Ayres' extensive factor analysis research identified distinct patterns of sensory integrative dysfunction that clinicians still recognize today:

1. Vestibular-Proprioceptive Bilateral Integration and Sequencing Disorder

Children with this pattern struggle with:

• Coordinating the two sides of the body
• Balance and postural control
• Sequential movement patterns
• Rhythmic activities

2. Tactile and Visual Discrimination Disorder

Characterized by difficulties in:

• Distinguishing between similar tactile sensations
• Visual figure-ground perception
• Fine motor precision tasks
• Form and space perception

3. Somatodyspraxia (Body-Based Dyspraxia)

Children show challenges with:

• Planning and executing novel movements
• Body awareness and position sense
• Motor learning and skill acquisition
• Coordinating complex movement sequences

4. Visuopraxis Difficulties

Involving problems with:

• Visual-motor coordination
• Copying designs and forms
• Spatial construction tasks
• Visual planning of motor actions

More recent research, including work by Dr. Shelly Mulligan, has refined these categories, identifying groups such as generalized sensory integration dysfunction and varying degrees of dyspraxia severity.

Clinical Applications: Who Benefits from SIPT Assessment?

The SIPT serves as a valuable diagnostic and intervention planning tool for various pediatric populations:

Autism Spectrum Disorder

Research consistently shows that over 90% of children with autism exhibit sensory processing abnormalities. Studies using the SIPT with children on the autism spectrum reveal:

• Relative strengths in visual praxis
• Marked difficulties in imitation praxis
• Challenges with vestibular bilateral integration
• Somatosensory perception deficits
• Sensory reactivity issues that significantly affect social participation

These findings help therapists design targeted interventions addressing specific sensory processing patterns rather than generic "sensory" treatments.

Learning Disabilities

The SIPT was originally developed to help understand children with learning difficulties whose challenges couldn't be explained by intelligence or educational factors alone. The assessment helps identify:

• Underlying sensory processing issues affecting academic performance
• Specific areas of strength that can support learning
• Praxis difficulties impacting handwriting, tool use, and skill acquisition

Cerebral Palsy

While children with cerebral palsy have obvious motor challenges, the SIPT can reveal:

• Sensory discrimination abilities that may be intact despite motor limitations
• Specific sensory processing strengths to leverage in therapy
• Praxis capabilities independent of motor execution

Developmental Disabilities

Children with Down syndrome, developmental coordination disorder, and other developmental disabilities benefit from SIPT assessment to:

• Differentiate sensory processing issues from cognitive limitations
• Identify intervention targets for occupational therapy
• Track changes over time with sensory integration intervention

ADHD and Behavioral Concerns

Many children with attention and behavioral challenges have underlying sensory processing difficulties. The SIPT helps distinguish:

• Sensory modulation problems contributing to inattention
• Vestibular-proprioceptive deficits affecting activity level and impulse control
• Praxis difficulties leading to frustration and behavioral responses

The SIPT as an Outcome Measure

Beyond diagnosis, the SIPT can document change following intervention. A landmark pilot study with 19 boys aged 6-8 who received six months of twice-weekly sensory integration therapy showed:

• Significant improvement in grouped data on tests of praxis
• Enhanced somatovestibular functioning
• Better bilateral integration and sequencing
• Individual improvement visible on ChromaGraphs for 17 of 19 participants

These findings suggested that, unlike earlier assessment tools, the SIPT could effectively measure progress—an important consideration for justifying treatment and demonstrating outcomes.

Limitations and Considerations

While the SIPT remains a valuable tool, clinicians should be aware of certain limitations:

Age of Normative Data

The normative sample dates to the late 1980s, now more than 35 years old. Critics argue that:

• Children's sensory experiences have changed dramatically with technology
• Contemporary lifestyles, educational models, and environmental factors differ significantly
• Updated norms may be needed for accurate interpretation

Limited Scope

The SIPT has acknowledged gaps in coverage:

• Relatively few items address vestibular function comprehensively
• Limited assessment of proprioceptive processing
• No measures of sensory modulation (over- or under-responsiveness)
• Absence of ideational praxis (generating ideas for what to do) assessment
• No evaluation of auditory discrimination

Practical Challenges

Several practical considerations affect SIPT use:

Time Intensity: The 2+ hour assessment time is substantial, particularly for:

• School-based therapists with large caseloads
• Children with attention difficulties
• Settings with tight scheduling constraints

Cost Factors: The assessment requires:

• Expensive test kit purchase
• Computer scoring software and credits
• Specialized training programs
• Ongoing equipment maintenance

Population Limitations: The SIPT may not be appropriate for:

• Children unable to follow verbal directions
• Those with severe attention deficits
• Children with significant cognitive impairments
• Very young children (under 4 years)

Test-Retest Considerations

When using the SIPT to monitor progress, clinicians must carefully maintain standardization and be mindful of practice effects—children may perform better on retesting simply from familiarity with tasks rather than actual skill improvement.

Beyond the SIPT: Contemporary Assessment Options

As sensory integration assessment continues evolving, new tools complement or provide alternatives to the SIPT:

Evaluation in Ayres Sensory Integration (EASI)

A newer, internationally recognized assessment that addresses many SIPT limitations while maintaining theoretical consistency with Ayres' work.

Sensory Processing Measure (SPM-2)

A family of questionnaires (parent, teacher, self-report) providing standardized tools to evaluate sensory processing patterns in home, school, and community contexts.

Sensory Profile

Developed by Dr. Winnie Dunn, this parent questionnaire measures sensory processing from a different theoretical framework, categorizing sensory patterns based on neurological thresholds and behavioral responses.

SP3D (In Development)

The Sensory Processing 3-Dimensions Assessment, currently being developed by Lucy Miller, Sarah Schoen, and Shelly Mulligan, promises a norm-referenced performance tool measuring sensory modulation, discrimination, and sensory-based motor abilities across ages 3 to adult.

Integrating the SIPT into Comprehensive Assessment

Best practice dictates that the SIPT should never stand alone. Comprehensive sensory integration assessment typically includes:

1. Parent/caregiver interviews: Gathering developmental history and daily life observations
2. Questionnaires: SPM, Sensory Profile, or Adolescent/Adult Sensory History
3. Clinical observations: Structured observation of posture, movement patterns, and behavioral responses
4. SIPT administration: Formal standardized testing when appropriate
5. Functional assessments: Tools like the Canadian Occupational Performance Measure (COPM) to identify meaningful goals
6. Contextual observation: Watching the child in natural environments (home, school, playground)

This multi-method approach ensures clinicians develop a complete picture of how sensory processing affects the child's participation in meaningful activities.

From Assessment to Intervention: The Clinical Pathway

Once the SIPT is administered and scored, skilled therapists use the results to:

Develop Hypotheses

The SIPT report doesn't provide a simple diagnosis. Instead, it offers data that therapists interpret within the broader clinical context to form hypotheses about:

• The nature of underlying sensory difficulties
• How these difficulties affect functional performance
• Which intervention approaches might be most beneficial

Create Individualized Goals

Working collaboratively with families, therapists use SIPT findings to establish:

• Meaningful, participation-focused goals
• Specific intervention targets
• Measurable outcomes for tracking progress

Design Ayres Sensory Integration® (ASI®) Intervention

For children whose SIPT results suggest they would benefit, therapists trained in ASI® use the "just-right challenge" principle to provide:

• Play-based, child-directed sensory-motor activities
• Carefully graded challenges that are achievable yet demanding
• Opportunities for adaptive responses that promote neural organization
• Rich sensory experiences particularly targeting vestibular, proprioceptive, and tactile systems

Monitor Progress

Serial SIPT administration (typically after 6-12 months of intervention) can document:

• Changes in specific sensory processing abilities
• Improved praxis and motor planning skills
• Enhanced bilateral integration and coordination

The Evidence Base: What Research Shows

The effectiveness of sensory integration therapy—including interventions informed by SIPT assessment—has been extensively studied with mixed historical results. However, recent research provides stronger support when interventions adhere strictly to Ayres' principles (now trademarked as ASI®):

A systematic review by Watling and Hauer (2015) found Level I evidence supporting ASI® based on three randomized controlled trials demonstrating positive and meaningful effects on individualized goals. Importantly, the review distinguished true ASI® (following Ayres' specific principles) from other "sensory-based" interventions.

Most significantly, the National Clearinghouse on Autism Evidence and Practice now categorizes ASI® as an evidence-based practice for autism treatment based on rigorous randomized controlled trials—a major shift from earlier classifications.

The Future: Evolving Assessment and Theory

As neuroscience advances with functional MRI, EEG, and other technologies unavailable to Ayres, researchers continue validating and refining sensory integration theory. Contemporary neuroscience research confirms many of Ayres' propositions about:

• Registration and detection of sensory information
• Modulation and regulation of sensory responses
• Motivation and the reward systems driving sensory-seeking or avoiding behaviors

The field is also expanding to recognize sensory integration's role across the lifespan, not just in childhood. The plateauing of SIPT scores above age 8 years 11 months indicates developmental maturity of sensory integration in typically developing children. Therefore, deviations from these mature scores in adolescents and adults may indicate specific organic problems processing sensory information—making the SIPT potentially valuable for adult assessment with appropriate clinical reasoning.

Practical Recommendations for Practitioners

For occupational therapists considering SIPT use:

1. Pursue Proper Training: Invest in comprehensive sensory integration education from recognized programs before administering the SIPT.
2. Use Selectively: Reserve the full SIPT battery for children where comprehensive assessment will meaningfully inform intervention. Consider administering selected subtests when specific questions arise.
3. Combine with Functional Assessment: Always integrate SIPT results with observation of the child's actual performance in daily activities.
4. Involve Families: Engage caregivers throughout the assessment process, gathering their observations and priorities for goal-setting.
5. Stay Current: Follow developments in sensory integration research and newer assessment tools while recognizing the SIPT's continued value.
6. Document Carefully: Maintain detailed records of administration procedures and environmental factors that may have affected performance.
7. Interpret Cautiously: Remember that test scores represent one point in time and should be interpreted within the full clinical context.

Conclusion: The Enduring Legacy of the SIPT

More than three decades after its publication, the Sensory Integration and Praxis Tests remain a cornerstone of pediatric occupational therapy assessment. While the test has limitations—aging norms, time intensity, limited scope—it continues offering unparalleled depth in evaluating specific sensory processing and praxis abilities.

The SIPT represents not just an assessment tool but the culmination of Jean Ayres' groundbreaking vision: understanding the profound impact of sensory experiences on human development, learning, and behavior. Her recognition of "hidden disabilities" gave voice to children whose struggles couldn't be seen in obvious physical or cognitive impairments but were nonetheless real and impactful.

Today's therapists benefit from Ayres' decades of meticulous research and factor analysis, which identified distinct patterns of sensory integrative dysfunction. The SIPT provides a common language for discussing these patterns, comparing results across children, and measuring change over time.

As we look forward, the field continues evolving with new assessment tools, refined theoretical frameworks, and growing neuroscience support for sensory integration principles. Yet the SIPT's legacy endures—not just in its continued clinical use, but in how it established rigorous, evidence-based assessment as fundamental to occupational therapy practice.

For children struggling to make sense of the sensory world around them, the SIPT remains an invaluable tool for uncovering hidden challenges and guiding interventions that can truly transform their ability to learn, play, and participate fully in life.

Note: SIPT administration requires specialized training and certification. Information in this article is for educational purposes and should not replace formal training programs or clinical supervision.

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