Sensory processing
SPD Test: How Sensory Processing Disorder Is Diagnosed in Children
Everything about testing a child for sensory processing disorder: the screening tools and tests, who can diagnose SPD, what an evaluation involves, and how to arrange one.
- Expert Reviewed
- Plain Language
- Patient Focused
There is no single test for sensory processing disorder. An occupational therapist combines standardized questionnaires such as the Sensory Profile 2 or the Sensory Processing Measure with observation, performance tests and your child’s history.1,2,3 SPD is not a DSM-5-TR or ICD-11 diagnosis, so a good evaluation also checks hearing and vision and considers autism, ADHD and anxiety.4,5,6
There is no single test for sensory processing disorder (SPD). An occupational therapist assesses it by combining standardized parent and teacher questionnaires such as the Sensory Profile 2 or the Sensory Processing Measure with observation, performance tests where needed, and your child’s history.1,2,3 SPD is not a diagnosis in the DSM-5-TR or ICD-11, and the American Academy of Pediatrics advises that it generally should not be diagnosed, so a good evaluation also checks hearing and vision and considers autism, ADHD and anxiety.4,5,6 What you come away with is a profile of how your child responds to sensation, and a plan built on it.3
Key takeaways
- There is no single test for SPD: an occupational therapist combines questionnaires, observation, performance tests and your child’s history.1,3
- SPD is not a diagnosis in the DSM-5-TR or ICD-11, and the American Academy of Pediatrics advises that it generally should not be diagnosed.4,5
- Sensory differences are part of the autism criteria and common in ADHD, so an evaluation always considers other conditions.5,7,8,9
- The Sensory Profile 2 and the SPM-2 are the questionnaires most used, with forms from birth to adulthood.1,10,11
- Online quizzes give no standard scores: a worrying result is a reason to ask for an evaluation, not a diagnosis.1
- Under age 3, early intervention evaluates at no cost and needs no diagnosis; from age 3, a parent can ask the school district to evaluate.12,13,14
- Ayres Sensory Integration helps autistic children reach individual goals but has not been shown to change behavior, and for other children the evidence is thinner.15,16
On the word “diagnosis.” Sensory processing disorder is not a standalone diagnosis in the DSM-5-TR or ICD-11, and the American Academy of Pediatrics advises that it generally should not be diagnosed, because there is no universally accepted framework for diagnosing it.4,5 What an occupational therapist can do is assess your child’s sensory patterns, describe them and build a plan around them, which is what this page means by an evaluation.1,3
What is sensory processing disorder (SPD)?
Sensory processing disorder (SPD) is the name used for difficulty detecting, modulating, interpreting or responding to sensory experiences, to the point that it gets in the way of daily life.17,18 In child development and therapy, SPD stands for sensory processing disorder; it is the current name for what A. Jean Ayres, the occupational therapist who founded the field, called sensory integration dysfunction.19,20
It can involve any sense: the familiar five, balance and movement (vestibular), body position (proprioception) and signals from inside the body (interoception).18,20 Clinicians also speak of sensory integration or sensory processing challenges, interconnected terms for how the nervous system organizes input from the body and the world.1
| Question | Answer |
|---|---|
| What it is | Difficulty detecting, modulating, interpreting or responding to sensation, enough to interfere with daily life17,18 |
| Is it a formal diagnosis? | Not in the DSM-5-TR or ICD-11; for young children the DC:0–5 classification recognizes it4,18 |
| How common it is | About 5% to 16% of children in the general population, and far more often alongside autism or ADHD17,18 |
| Who assesses it | An occupational therapist, often as part of a team18,21 |
| How it is assessed | Questionnaires, observation, performance tests and history, with hearing and vision checked2,3,6 |
| Main treatment | Occupational therapy, often using Ayres Sensory Integration1,15 |
How common it is depends on the definition: about 5% to 16% of children in the general population, and 60% to 90% of children with conditions such as autism.18 In one US district, parents’ screening answers placed a cautiously estimated 5.3% of incoming kindergartners in the SPD range; in a sample of 925 children aged 7 to 11, 16% of parents said at least four touch or sound sensations bothered their child.22,23
What are the types of sensory processing disorder?
The most widely used framework, proposed by Miller and colleagues in 2007, sorts SPD into three groups and six subtypes.19,24 The field is not fully agreed on the subtypes, and a child can have more than one.19
| Subtype | Group | What it looks like |
|---|---|---|
| Sensory over-responsivity | Sensory modulation disorder | Responds too much, for too long, or to weak sensations, and often avoids or withdraws18,19 |
| Sensory under-responsivity | Sensory modulation disorder | Responds too little, or needs very strong input to notice it; can seem unaware or slow to react18,19 |
| Sensory seeking or craving | Sensory modulation disorder | Searches for more or stronger input, sometimes in disruptive or risky ways18,19 |
| Postural disorder | Sensory-based motor disorder | Problems with balance, core stability and holding the body steady18,19 |
| Dyspraxia | Sensory-based motor disorder | Difficulty planning, sequencing and learning new movements18,19 |
| Sensory discrimination disorder | Its own group | Difficulty telling apart the qualities of a sensation, such as its intensity, duration or location19 |
Real children rarely fit one box. In a clinic sample of 78 children aged 2 to 7 with sensory problems and no other diagnosis, over-responsivity was the most common type (60%), followed by under-responsivity (51%), craving (42%), sensory-based motor problems (40%) and discrimination problems (29%), and 53% showed more than one type.18 Each group has its own page: sensory modulation, sensory-based motor difficulties and sensory discrimination, with the whole topic on our sensory processing hub.
Is there a test for sensory processing disorder?
Not a single one, and not one that returns a diagnosis. Sensory processing is assessed by combining several sources: standardized questionnaires completed by parents and teachers, the clinician’s observation, performance tests where the picture calls for them, and the child’s history.2,3,17 Three quite different things get called an SPD test, and it helps to know which one someone means:1
- Online quizzes and checklists
Free checklists from clinics, and quizzes like our SPD quiz for kids, give a first picture of possible difficulties but no standard scores or scoring rules. They are a place to begin.1
- Standardized questionnaires
The Sensory Profile 2 and the Sensory Processing Measure, completed by parents and teachers and scored against norms by a therapist. These are the tools most often used in practice, and they describe a pattern rather than diagnose.1,2
- Performance tests
The Sensory Integration and Praxis Tests (SIPT) and the newer Evaluation in Ayres Sensory Integration (EASI), given one to one when motor planning, perception or discrimination is in question.3,18
None of these is a laboratory test. Researchers are still looking for objective measures, such as patterns of brain activity, that could separate SPD from other childhood conditions; an imaging study of 16 boys with SPD found differences in white matter compared with other children.19,25 In practice, questionnaires and clinical observation remain the methods used.17
So the practical route is a quiz for a first read if you want one, then a full evaluation through your pediatrician or an occupational therapist, which is the step that produces a plan.1,20
Is sensory processing disorder a real diagnosis?
The difficulties are real; the diagnosis is contested. SPD does not appear in the DSM-5-TR or ICD-11, the two main diagnostic manuals.4 In 2012 the American Academy of Pediatrics said it is unclear whether children with sensory-based problems have an actual disorder of the sensory pathways of the brain, or whether these are features of other developmental and behavioral conditions. Its recommendation, in its own words:5
“Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed.” The same statement says other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed.5
Others see it differently. The DC:0–5, a classification for infants and young children, recognizes sensory processing disorder; its sensory over-responsivity disorder requires intense reactions to ordinary sensations across settings, not better explained by autism or ADHD.18,26 Researchers have found physiological and brain differences in children with SPD, and some children have sensory problems that affect daily life without meeting the criteria for any other disorder.18,19,25
| System | Does it list SPD? | What it says about sensory differences |
|---|---|---|
| DSM-5-TR (American Psychiatric Association) | No4 | Sensory reactivity is one of the autism criteria, criterion B44,7 |
| ICD-11 (World Health Organization) | No4 | Persistent hypersensitivity or hyposensitivity to sensory stimuli is now part of autism spectrum disorder, code 6A028 |
| DC:0–5 (infancy and early childhood) | Yes18 | Includes sensory over-responsivity disorder, given only when autism or ADHD does not better explain it26 |
| American Academy of Pediatrics, 2012 | Advises against diagnosing it5 | Sensory difficulties occur in autism, ADHD, developmental coordination disorder and anxiety5 |
| IDEA, the US special education law | Not a disability category27 | Lists unusual responses to sensory experiences among the characteristics often associated with autism27 |
Is SPD in the DSM-5?
No. The DSM-5, published in 2013, and its text revision, the DSM-5-TR, do not include sensory processing disorder.4,7 What the DSM-5 added was a sensory item in the autism criteria: “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment” is one of the restricted, repetitive behavior criteria, of which at least two must be met. The DSM-IV had not addressed sensory symptoms at all.7 In the DSM-5-TR this is criterion B4; there are no DSM criteria for SPD itself.4
What does ICD-11 say about sensory processing?
ICD-11, the World Health Organization’s classification, has been in effect since 2022 and does not list SPD either.4,28 Like the DSM, it moved sensory features into autism: lifelong, strong and persistent hypersensitivity or hyposensitivity to sensory stimuli is now part of the diagnostic requirements for autism spectrum disorder (6A02), where in ICD-10 unusual sensory processing was not a core feature.8 An autism assessment against the current criteria therefore asks about sensory responses, which older assessments may not have done.8
What does the diagnosis debate mean for your family?
- No diagnosis code of its own
A report describes sensory processing difficulties rather than giving an SPD diagnosis.3,4
- Insurance can be harder
Some insurers cover occupational therapy using Ayres Sensory Integration as a neurodevelopmental concern; ask how the provider bills.1
- Clinicians disagree
Some treat SPD as a condition in its own right; others, following the AAP, look first for autism, ADHD or anxiety.5,18
Who can diagnose sensory processing disorder?
An occupational therapist is the professional who assesses sensory processing. Occupational therapists are widely recognized as leaders in evaluating and treating these challenges, and the professionals who first see children mostly recommend referral to one.1,21 Because SPD is not a formal diagnosis, the occupational therapist’s report describes your child’s sensory profile, and a doctor’s job is to look for other explanations and refer.1,4,5 If you are asking what type of doctor to see, start with your pediatrician; a developmental-behavioral pediatrician is the specialist for developmental, learning and behavioral problems.20,29
| Professional | Their role | What they can diagnose |
|---|---|---|
| Occupational therapist | Evaluates sensory processing, motor skills and daily activities with questionnaires, observation and tests, and writes the plan1,30 | Describes sensory processing difficulties; SPD itself has no DSM-5-TR or ICD-11 diagnosis4 |
| Pediatrician | Usually the first stop: screens development, checks hearing and vision, and refers1,31,32 | Autism and ADHD, among other conditions33,34 |
| Developmental-behavioral pediatrician | A pediatric subspecialist for developmental, learning and behavioral problems, including feeding and sleep problems29 | Autism, ADHD, learning disorders and developmental disabilities29 |
| Child psychologist | Behavioral testing for autism, usually as part of a team29,33 | Autism and other developmental and mental health conditions33 |
| Audiologist | Tests hearing and how the brain processes sound35 | Hearing loss and central auditory processing disorder35 |
| Speech-language pathologist | Evaluates language, including how spoken language is understood35 | Language disorders35 |
A sensory evaluation is often part of a team assessment, with a developmental pediatrician, an occupational therapist and a speech-language pathologist.18 When you choose an occupational therapist, ask about training in Ayres Sensory Integration, which researchers in the field call essential.1 You can find a pediatric occupational therapist near you in our directory, and our occupational therapy guide explains what the profession does.
What are the early signs of sensory processing disorder in toddlers?
Many sensory quirks are a normal part of growing up. Sensory differences do not always affect daily life; they become a concern when they get in the way of eating, sleeping, dressing, play or learning, which is also the DC:0–5’s threshold.18,21
Patterns often mix. A child can be over-responsive to some input and under-responsive or seeking with other input; more than half of the children in one clinic sample showed more than one type, and touch and movement were the senses most often affected.18 Reading across a row for the same sense tells you more than reading either column on its own.19
| Sense | Over-responsive (hypersensitive) can look like | Under-responsive or seeking can look like |
|---|---|---|
| Touch | Bothered by clothing or certain textures; avoids messy play or going barefoot in grass and sand; tactile defensiveness1,17 | Does not notice food or dirt on the face and hands; or constantly touches things and crashes into them17,24 |
| Sound | Upset by everyday noise; withdraws from noisy group play1,3 | Seems unaware of loud sounds or of being called, which needs a hearing check first3,6 |
| Sight | Covers the eyes or squints to shield them from light17 | May not notice when someone comes into the room24 |
| Taste and smell | Very picky about tastes or food textures; avoids ordinary food smells; may react against whole food groups1,17 | Mouths objects, or explores things that are not food with the mouth17,20 |
| Movement and balance | Anxious about or avoids movement, which therapists call gravitational insecurity17,24 | Rocks, moves constantly or crashes into things, and may seem clumsy and unaware of danger17,20,24 |
| Body and motor skills | Strong reactions that disrupt self-care routines such as tooth brushing24,30 | Low endurance, poor balance, clumsiness, or trouble learning new motor tasks such as dressing or using a spoon1,17,30 |
Each pattern has its own page in more depth: sensory over-responsivity and sensory under-responsivity, with the two compared side by side the shortest route if your child seems to show some of each. Sensory seeking is a third pattern again.18
These signs are not specific to any one condition. A study of 239 children on the Sensory Profile 2 found that children with autism and children with ADHD did not differ from each other in sensory processing patterns, and both were elevated compared with typically developing children.9 That is one reason an assessment considers the whole picture rather than the sensory pattern alone; see our comparison with ADHD.5
Which sensory tests exist for babies, toddlers and preschoolers?
There are standardized tools for the youngest children. The Infant Sensory Profile 2 covers birth to 6 months and the Toddler Sensory Profile 2 covers 7 to 35 months, both completed by a caregiver, and the preschool form of the SPM-2 covers ages 2 to 5, with home and school versions; a 3-year-old can also be assessed with the Child Sensory Profile 2.2,3,10,36
For a child under 3, early intervention is the free route. Anyone, including a parent, can refer a child to the state’s early intervention program, the child does not need a diagnosis, and the evaluation and assessment must be provided at no cost to the family.12,13,37 The evaluation, the assessments and the first planning meeting must be completed within 45 days of the referral, and at age 3 the plan moves the child on to school services.13,38 See occupational therapy for babies and toddlers.
What can you observe at home before an assessment?
You cannot test for or diagnose sensory processing differences at home, but you can watch and write down what you notice. A caregiver’s long-term observation can be more reliable than a single clinic visit, although parent reports can also miss things, which is why an evaluation uses both.17 Think of yourself as gathering information, not reaching a conclusion.1
How do you keep a simple sensory-observation chart?
An evaluation draws on what caregivers report about the child at home, at school and in the community, so a short written record is worth bringing, one line per incident:1
- When and whereDate, time and setting
- SenseTouch, sound, sight, taste, smell or movement
- What happenedThe activity or trigger
- ReactionWhat your child did, and for how long
- What helpedAnything that calmed or settled it
Bring a week or two of notes to the evaluation; patterns across settings are the point.
What should you watch for across everyday routines?
Rather than setting up special tests, pay attention during moments that already happen each day. These questions come from a review for primary care providers and from the self-care tasks an occupational therapist looks at:1,30
Questions to ask yourself
- Is your child picky about certain tastes or textures when eating?1
- Does your child have difficulty getting dressed or finding comfortable clothing?1
- Has your child been sensitive to sounds, or do they withdraw from noisy group play?1
- Are self-care tasks such as dressing, using a spoon or brushing teeth unusually hard?30
- Is your child clumsy, unsteady, or slow to learn new motor skills?1
- Do these sensory experiences get in the way of play, friendships or schoolwork?1
When do your observations point toward booking an assessment?
Talk with your pediatrician, or contact an occupational therapist, when sensory reactions consistently get in the way of ordinary life.1,20 Watch especially for difficulties that:18
- disrupt daily routines such as eating, sleeping or dressing;1,18
- interfere with play, friendships or learning at school;18
- cause significant or lasting stress for your child or your family;1
- appear alongside delays in motor skills, speech, language or learning.1,29
These are reasons to seek a professional opinion, not a diagnosis in themselves. If something feels wrong, trust your instincts and ask: your pediatrician’s role is to listen and act on your concerns, and you can get a second opinion if you are not heard.32,33
Which SPD screening tools and online quizzes exist?
Screening answers one question: is a closer look worth it? A review for primary care providers found few true screening tools for sensory integration; most tools in use are assessments, not screeners.1
What can an online SPD quiz tell you, and what can it not?
Many clinics publish free checklists. They give an initial picture, but they are not standardized and provide no standard scores or scoring guidelines.1 Our free quizzes work the same way: the SPD quiz for kids, the seeking-versus-avoiding quiz and the ADHD-or-SPD quiz, all on our quizzes page, give a pattern and a sense of whether to look further, not a diagnosis.1
| Option | Completed by | What you get | Its limits |
|---|---|---|---|
| Online quiz or clinic checklist | A parent | A first picture of possible difficulties1 | No standard scores or scoring guidelines1 |
| Standardized questionnaire, such as the Sensory Profile 2 or SPM-2 | Parents, teachers, or teens and adults themselves1,11 | Standard scores that place your child against others of the same age1 | Rests on the rater’s perceptions, and the norms mainly reflect North American children3,17 |
| Occupational therapy evaluation | An occupational therapist, with you and your child | A profile of sensory, motor and daily function, and a plan3,30 | No SPD diagnosis code, and it may need to be combined with other evaluations4,5 |
What is the Sensory Profile 2, and which forms cover which ages?
The Sensory Profile 2 suite is one of the two questionnaire families occupational therapists use most, built on Dunn’s model of sensory processing.1,2 It sorts a child’s responses into four patterns: seeking (how much a child obtains sensory input), avoiding (how much they are bothered by it), sensitivity (how much they detect it) and registration (how much they miss it).39
| Form | Ages | Completed by | What it covers |
|---|---|---|---|
| Infant Sensory Profile 2 | Birth to 6 months10 | A caregiver10 | 25 items across general, auditory, visual, touch, movement and oral processing, giving a total score10 |
| Toddler Sensory Profile 2 | 7 to 35 months36 | A caregiver36 | 54 items in seven categories, scored in the four patterns36 |
| Child Sensory Profile 2 | 3 years to 14 years 11 months2 | A caregiver17 | 86 items on six sensory systems and on conduct, attention and social-emotional responses17 |
| Short Sensory Profile 2 | Up to 14 years 11 months39 | A parent or caregiver39 | 34 items taken from the child form39 |
| Adolescent/Adult Sensory Profile | 11 to 65 and older11 | The person themselves11 | 60 items in the same four patterns, in about 15 minutes11 |
The forms have been translated and adapted for other countries, including Brazil in Portuguese, Spain, Korea and Poland.2,10,36,39
What is the Sensory Processing Measure, Second Edition (SPM-2)?
The SPM-2 is the other common family, used from infancy to adulthood and based on Ayres Sensory Integration theory.3,11 It scores each sense separately, along with body awareness, balance and motion, planning and ideas, and social participation, and its forms include a preschool form for ages 2 to 5 with home and school versions, an adolescent self-report and an adult self-report for ages 21 to 87.3,11
Both families are designed to be used with other tools and clinical observation as part of a comprehensive evaluation, and in a Spanish study of 116 children the two agreed adequately on most sensory factors.2
Which sensory processing assessment tools do OTs use?
There is no single best test, and no checklist that settles it. A comprehensive evaluation combines several methods, because each answers a different question and each has a limit.2,3 Performance tests such as the SIPT and the EASI do not formally measure sensory modulation, so therapists add caregiver questionnaires to complete the picture.3
| Method | What it is | What it tells you | What it does not tell you |
|---|---|---|---|
| Questionnaires | Standardized forms about everyday responses at home and school, such as the Sensory Profile 2 and the SPM-21 | How your child responds across everyday situations, against same-age norms1 | What the rater does not notice: parents can underestimate difficulties17 |
| Performance tests | One-to-one tests of perception, praxis and motor skills: the SIPT, with 17 subtests, and the EASI3,17 | Where your child stands on specific skills, especially motor planning and discrimination24 | Over- or under-responsivity: neither battery formally measures sensory modulation3 |
| Clinical observation | Watching how your child moves, plays and responds, in structured tasks and free play17,24 | Direct evidence rather than report17 | How your child manages a real classroom, which a test room cannot show17 |
| Interview and history | Development, health, family history and the problems behind the referral1,24 | Context, and the daily-life goals a plan should be built around15 | Whether the pattern is sensory rather than something else; the ruling-out is for that5 |
What are the Sensory Integration and Praxis Tests (SIPT)?
The SIPT, created by A. Jean Ayres in 1989, is a norm-referenced battery of 17 brief tests that has long been treated as the gold standard for measuring sensory integration and praxis in children aged 4 to 9.17,18,24 But it was validated only in North America, has never been revised, needs an accredited examiner, is costly, and takes long to give and score, so it is not often used in everyday practice; it also gives no information on sensory modulation.3,24
What is the Evaluation in Ayres Sensory Integration (EASI)?
The EASI was developed to evaluate the constructs of Ayres Sensory Integration with psychometrically strong, internationally appropriate and easily accessible tests.40 It assesses sensory perception, praxis, motor integration and sensory reactivity using open-access, low-cost materials, with international norms from more than 2,300 children.3 Validation studies in children aged 3 to 12 support its touch-perception, balance and body-position tests, which therapists are trained to give; the tests themselves are freely available.1,41,42 Like the SIPT, it does not formally measure sensory modulation disorder.3
What an assessment produces is a profile: which senses, which direction, and how much it interferes with daily life. That profile, not a label, is what an intervention plan is built from.3,21
What should you expect during a sensory processing evaluation?
Much of an evaluation is activities and play while the therapist watches how your child moves and responds.17,24 Its length depends on what is used: a self-report questionnaire such as the Adolescent/Adult Sensory Profile takes about 15 minutes, a full battery such as the SIPT much longer to give and score. It usually covers these steps:11,24
- The interview
Your concerns, your child’s development and history, and how they manage at home, at school and in the community.1,24 Bring examples with the setting attached: a reaction only in the school cafeteria says more than a general sense that your child is sensitive to noise.
- Questionnaires
You, and often your child’s teacher, complete standardized forms such as the Sensory Profile 2 or the SPM-2, which cover home and school.1,3
- Building rapport
Time for your child to settle in while the therapist follows their lead, noting what they are drawn to and what they avoid: direct observation is evidence a questionnaire cannot give.17
- Structured activities
Tasks presented as games, such as tests of touch perception, balance and body position, showing how your child takes in and uses sensory input.3,17
- Praxis
How your child plans and carries out an unfamiliar motor task, such as copying a sequence of movements; the EASI and the SIPT both test it.3,18
- The results meeting
Scores are interpreted afterward alongside the history and observation, and the findings and the plan are discussed with you.3,24 This is the appointment to prepare questions for.
Three questions worth taking to the results meeting: which senses is this affecting, and which is it not; what would you expect to change first if the plan works; and what would tell us in three months that it is not working. The AAP advises families to agree a trial period and learn how to judge whether a therapy is working.5 Our printable questions-to-ask guide covers more.
How long does it take to get a sensory evaluation?
Public programs have legal deadlines. Early intervention, for children under 3, must complete the evaluation, the assessments and the first planning meeting within 45 days of the referral.38 A school district’s initial evaluation must be done within 60 days of receiving your consent, or within the state’s own timeframe if it sets one.14 Private clinics set their own waiting lists.
What should a sensory evaluation report include?
A good report gives you
- A sensory profile: how your child responds across the senses, and where those responses differ from typical ranges1,3
- Functional goals in daily-life terms, such as getting through a haircut or wearing school shoes, rather than better sensory integration15
- A treatment plan: therapy sessions, changes to the environment, and strategies to practice at home and at school21,30
- Recommendations for school, which can support an evaluation for an IEP or a 504 plan43,44
- What was ruled out, and any referrals for hearing, vision, language or developmental checks5,6
What a report will not give you is an SPD diagnosis code, or an explanation of the cause.4,19
How are hearing, vision and other causes ruled out?
The AAP is explicit that other developmental and behavioral disorders must always be considered, because sensory difficulty is seen in autism, ADHD, coordination disorders and anxiety.5 Some apparently sensory behavior has a simpler cause: a child who does not always respond when called may have a partial hearing loss, often mistaken for inattention or resistance.6
What a thorough evaluation checks
- Hearing, always, and promptly whenever hearing loss is suspected, at any age6
- Vision: some eye problems have no symptoms and are found only by screening, which pediatricians do at well-child visits31
- Autism, ADHD, coordination disorders and anxiety, which often occur with sensory difficulties and change the plan1,5
- Language and auditory processing, which a speech-language pathologist and an audiologist evaluate35
When should you call your pediatrician about hearing?
These signs call for a hearing check before anything is put down to sensory processing:6
- Does not startle at loud noises by 1 month, or turn toward a sound by 3 to 4 months6
- Does not say single words such as mama or dada by 12 to 15 months, or has speech that is delayed or hard to understand6
- Does not always respond when called, or seems to hear some sounds but not others6
- Hears poorly and also has trouble holding the head steady, or is slow to sit or walk unsupported6
A school evaluation has to cover this ground by law: the child must be assessed in all areas related to the suspected disability, including, where appropriate, health, vision, hearing, social and emotional status, communication and motor abilities.45
SPD vs autism, ADHD, anxiety and auditory processing disorder
Sensory difficulties overlap heavily with other conditions: atypical sensory experiences are reported in up to 90% of people with autism and in 50% to 64% of children with ADHD, and they also occur in children with no other condition.17,18
| Condition | Core features | Where sensory differences fit | Who diagnoses it |
|---|---|---|---|
| Sensory processing disorder | Trouble detecting, modulating, interpreting or responding to sensation that impairs daily life17 | They are the problem itself18 | Not a formal diagnosis; an occupational therapist assesses it4,21 |
| Autism | Persistent differences in social communication and interaction, with restricted, repetitive behavior7 | Part of the diagnostic criteria in the DSM-5 and ICD-117,8 | A pediatrician, developmental pediatrician, child psychologist or other autism specialist33 |
| ADHD | Inattention, hyperactivity or impulsivity in two or more settings, starting before age 1234 | Common; on the Sensory Profile 2, children with ADHD and with autism had similar patterns9 | A pediatrician, using AAP guidelines for ages 4 to 1834 |
| Childhood anxiety | An internalizing condition in which sensory over-responsivity has also been found26 | Sensory difficulty is one of its possible features5 | A pediatrician or developmental-behavioral pediatrician29 |
| Auditory processing disorder | Deficits in the brain’s processing of sound, not caused by hearing loss35 | Limited to auditory information35 | An audiologist35 |
Is sensory processing disorder a form of autism?
No, though the two often go together. Sensory differences are part of the autism criteria, but autism also requires persistent differences in social communication and interaction.7,8 Sensory problems that affect daily life also occur in children who meet the criteria for no other condition, and imaging research found social-emotional pathways affected in autism but not in SPD.18 See autism or SPD, SPD without autism and sensory processing and autism.
Is it ADHD or sensory processing disorder?
It can be either, or both. Children with ADHD and children with autism did not differ in their Sensory Profile 2 patterns, and both differed from typically developing children.9 In studies comparing the groups directly, inattention was greater in ADHD, while children with sensory modulation disorder had more sensory problems, more anxiety and stronger physiological reactions to sensation.18 ADHD is diagnosed by a pediatrician from symptoms in two or more settings, and there is no single test for it either.34 See ADHD vs SPD: the key differences.
How is SPD different from auditory processing disorder?
Auditory processing disorder is narrower. It refers to deficits in the brain’s processing of sound, shown in skills such as telling sounds apart or listening against competing sounds, and it is not caused by hearing loss.35 It is diagnosed by an audiologist, although there is no reference standard for the diagnosis, and a speech-language pathologist evaluates the language side, so a child whose difficulty is only with sound may need an audiologist as well as, or instead of, a sensory evaluation.35 Our guide to auditory processing disorder explains its testing, and where sensory issues and anxiety overlap covers the anxiety side.
Sensory processing sensitivity vs sensory processing disorder
Sensory processing sensitivity, the trait behind the phrase highly sensitive person, is a different idea from sensory processing disorder. Aron and Aron described it in 1997 as a core personality variable, partly independent of introversion and emotionality, and built a 27-item Highly Sensitive Person Scale to measure it.46 It is a common, heritable trait describing differences in sensitivity to both negative and positive environments, estimated at 15% to 20% of the population.47,48
| Question | Sensory processing sensitivity | Sensory processing disorder |
|---|---|---|
| What it is | A stable temperament or personality trait48,49 | A pattern of atypical sensory modulation, or of sensory-based motor or discrimination difficulty19,48 |
| Effect on daily life | Not necessarily any clinically significant impairment48 | Often causes difficulties at home, at school or with other people48 |
| Typical features | Deeper processing of stimuli, a lower sensory threshold and strong emotional reactions49 | Over-responsivity, under-responsivity, seeking, or motor and discrimination problems18 |
| How it is measured | The Highly Sensitive Person Scale (27 items) in adults; the Highly Sensitive Child Scale (12 items) from age 846,49 | The Sensory Profile 2, the SPM-2 and an occupational therapy evaluation1 |
| Outlook | More risk of stress-related problems in hard environments, and more benefit from supportive ones47 | Occupational therapy aimed at daily-life goals15 |
The two can overlap: a low sensory threshold is shared with sensory over-responsivity, which is why researchers stress keeping them apart.48 The question is whether the sensitivity gets in the way of daily life; if it does, an evaluation can tell the two apart.18,48 Our sensory spectrum quiz for kids is a gentle first read.
Which sensory processing disorder tests exist for teens and adults?
Sensory processing differences do not end in childhood: they can persist into adult life and affect social functioning and well-being.17 Some patterns ease with age, though: on the Sensory Profile 2, older children scored lower than younger ones for seeking and for several senses, whatever their diagnosis.9
| Measure | Ages | What it involves |
|---|---|---|
| Adolescent/Adult Sensory Profile | 11 to 65 and older11 | 60 self-report items in Dunn’s four patterns, about 15 minutes; the most common tool for teens and adults11 |
| SPM-2 Adolescent Self-Report | Teenagers11 | The adolescent self-report form in the SPM-2 family11 |
| SPM-2 Adult | 21 to 8711 | 80 self-report items on vision, hearing, touch, taste and smell, body awareness, balance and motion, planning and ideas, and social participation11 |
Adult assessment is less developed: information on assessing adults is scarce, and the Adolescent/Adult Sensory Profile has not been validated in clinical groups.11 An occupational therapist uses tools like these to plan practical, person-centered changes.11 For a self-check first, try our adult sensory self-assessment, and read sensory processing differences in adults and in teenagers.
How do you get your child assessed for sensory processing disorder?
Children with sensory difficulties are likely to be seen first by their primary care provider, and the AAP’s advice to parents is to raise suspected sensory problems there. These are the routes:1,20
- Your pediatrician. Ask for a developmental screen and a referral to occupational therapy.1,32 Describe what your child cannot do rather than a label: lunch going uneaten because the cafeteria is too loud tells a doctor more than a suspicion of SPD.
- Early intervention, under age 3. Contact your state’s program yourself: anyone can refer a child, no diagnosis is needed, and the evaluation is free.12,13
- Your school district, from age 3. A parent can request an initial evaluation, which must be done within 60 days of your consent or the state’s timeframe; if the district refuses, it must explain why in writing.14,50
- A private occupational therapist. Check which standardized tests are used, whether your child will be observed directly, and what the report will contain.2,17
- Within an autism or ADHD evaluation. If one is planned, ask that sensory processing be addressed specifically, since sensory features are now part of the autism criteria.7,8
How do you request a school evaluation?
Under IDEA, either a parent or the school can start a request for an initial evaluation, which decides whether a child has a disability and what their educational needs are.14 States must identify, locate and evaluate children with disabilities who need special education, including children in private schools.51 Put your request in writing, date it and keep a copy, so there is no doubt about when you asked; our sample school evaluation letter is ready to adapt.
The district must use a variety of assessment tools, including information from you, never a single measure.45 If you disagree with the result, you can ask for an independent educational evaluation at public expense, and a private evaluation you share must be considered if it meets the district’s criteria.43 Sensory processing disorder is not one of IDEA’s disability categories: a child qualifies under a category such as autism, other health impairment or, where a state uses it, developmental delay, and only if they need special education because of it.27 Section 504 of the Rehabilitation Act has its own evaluation rule for a student who needs or is believed to need special education or related services because of a disability.44,52 Our guide to IEPs and 504 plans covers the school process.
How much does a sensory processing evaluation cost?
It depends on the route. Early intervention evaluations must be provided at public expense, with no fees to parents, and if you disagree with a school district’s evaluation you can ask for an independent one at public expense.12,43 A private evaluation is billed to insurance or paid directly, at the clinic’s own rates.
- Early intervention, under 3
Evaluation, assessment and service coordination at no cost; a family the state counts as unable to pay must get all early intervention services free.12,13
- School district, 3 and up
The district runs the evaluation; if you disagree with it, you can request an independent educational evaluation at public expense.14,43
- Private clinic
Billed to insurance or paid out of pocket. Some insurers cover occupational therapy using Ayres Sensory Integration as a neurodevelopmental concern.1
Because SPD has no diagnosis of its own in the DSM-5-TR or ICD-11, ask the provider before the evaluation how they will bill it and what they have seen insurers cover, and check your plan’s rules on referrals and visits.1,4
Our guides cover whether insurance covers therapy for kids, what pediatric occupational therapy costs, free and low-cost routes without insurance and how to get a free evaluation for your child.
What happens after a sensory processing assessment?
An assessment is not an end point. It gives a description to a pattern your child has been managing without one, and it points support at the right difficulties.3
- Occupational therapy
The usual next step is occupational therapy, often using Ayres Sensory Integration: play-based sessions with swings and other equipment, built around your child’s profile.1,20 The aim is participation in daily life, not a cure.15
- A sensory diet
Sensory diets, planned sensory activities through the day, are a different approach from Ayres Sensory Integration, and their evidence is thin: one small school study found three of four children’s behavior improved.1,21 Our page on sensory diet strategies covers what these look like.
- Home and school changes
Training caregivers to use sensory strategies has strong evidence, and earmuffs helped autistic children with sound-related goals in one trial where noise-canceling headphones did not.21 Our resources for teachers and sensory-friendly home guide are written to be handed over.
- Knowing what the evidence supports
A review that screened 11,436 abstracts found strong evidence for Qigong massage, moderate evidence for sensory changes to the dental care environment, limited evidence for weighted vests, and too little to judge slow swinging.53 Worth knowing before buying anything.
Does sensory integration therapy work?
For some goals, in some children. A 2019 review rated Ayres Sensory Integration an evidence-based practice for autistic children aged 4 to 12, on the strength of three studies, from 19 screened, that survived quality appraisal.54 A 2025 review of nine randomized trials found strong evidence that it helps autistic children meet individualized goals, moderate evidence that it does not improve behaviors such as irritability, and too little research to judge other groups of children.15 The UK SenITA trial of 138 autistic children found no clinical benefit over usual care on behavior, though carers and therapists reported better daily functioning.16
The AAP is more cautious: sensory-based occupational therapy may be acceptable as one part of a comprehensive plan, but the research is limited and inconclusive.5,20
| Approach | What the evidence says |
|---|---|
| Ayres Sensory Integration, for autistic children’s goals | Supported Strong evidence from five randomized trials for individualized goals.15 |
| Ayres Sensory Integration, for behavior | Not supported No benefit for behaviors such as irritability in three trials, or over usual care in the UK trial.15,16 |
| Ayres Sensory Integration, for other children | Too little evidence More research is needed outside autism.15 |
| Deep pressure touch | Supported Strong strength of evidence in a 2025 review, from weighted items and massage.21 |
| Training caregivers in sensory strategies | Supported Strong strength of evidence.21 |
| Weighted vests | Limited Some gains in attention, but the overall evidence is insubstantial.21,53 |
| Alternative seating such as therapy balls | Not supported Did not improve attention.21 |
| Slow linear swinging | Too little evidence Insufficient evidence to draw conclusions.53 |
| Auditory integration training and behavioral optometry | Not supported Neither has proved to be scientifically valid.20 |
Before you begin, agree what should change first, how you will know, and a trial period, as the AAP advises.5 Our pages on sensory processing treatment and sensory integration therapy go into each option.
Which questions should you ask at a sensory processing evaluation?
The last one matters most: a careful evaluator says when the picture points somewhere else, to hearing, autism or anxiety, because other conditions must always be considered.5 Our printable guide has more for the day itself.
Questions to ask the assessor
- Which standardized questionnaires and tests will you use, and are their norms right for my child?2,3
- Will you observe my child directly, or will this rely on questionnaires?17
- Are you trained in Ayres Sensory Integration?1
- What are you ruling out, and does my child need a hearing or vision check first?5,6
- Will the report include functional goals and recommendations for school?15,43
- How do you bill, and what have you seen insurers cover?1
- If sensory processing is not the main issue, will you tell me?5
Myths and facts about testing for sensory processing disorder
- Myth: an online quiz can diagnose SPD
Checklists give a first picture but no standard scores or scoring guidelines.1
- Myth: SPD is in the DSM-5
It is not in the DSM-5-TR or ICD-11; sensory features appear there only within the autism criteria.4
- Myth: sensory issues always mean autism
Sensory problems also occur with ADHD, anxiety and coordination disorders, and in children with no other diagnosis.5,18
- Myth: a high questionnaire score proves it
A score describes a pattern as one rater sees it, and a diagnosis based only on a parent’s report may be incomplete.17
- Myth: a scan or blood test can confirm it
There is no laboratory test; objective measures are still a research goal.17,19
- Myth: children always grow out of it
Some patterns ease with age, but sensory processing difficulties can persist into adulthood.9,17
- Myth: sensory integration therapy is proven for everything
The strongest evidence is for autistic children’s individual goals, and it is not recommended for behaviors such as irritability.15
- Myth: you need a diagnosis to get help
Early intervention needs no diagnosis, and a parent can ask the school district for an evaluation.13,14
Popular next reads
Frequently asked questions
What does SPD stand for in medical terms?
In child development and occupational therapy, SPD stands for sensory processing disorder: difficulty detecting, modulating, interpreting or responding to sensory experiences.17 It is not a formal diagnosis in the DSM-5-TR or ICD-11.4
Is sensory integration disorder the same as sensory processing disorder?
Essentially, yes. Ayres called the condition sensory integration dysfunction, and sensory processing disorder is the current term for it.19 Sensory integration and sensory processing are interconnected terms, and occupational therapists use both.1
Can I test my child for sensory processing disorder at home?
Not in a way that gives a diagnosis. You can note what you see in everyday routines and try a free online quiz or checklist, which gives a first picture but no standard scores.1 Take your notes to your pediatrician or an occupational therapist, who can use standardized questionnaires and observation.2
What is the most accurate test for sensory processing disorder?
No single test is enough on its own. Questionnaires such as the Sensory Profile 2 and SPM-2 give standard scores but rest on a rater’s perceptions, and performance tests such as the SIPT and EASI do not measure sensory modulation.1,3,17 The most reliable picture combines them with observation and history.2
Can a pediatrician diagnose sensory processing disorder?
Not as a formal diagnosis, since the AAP advises that SPD generally should not be diagnosed.5 Your pediatrician can screen development, check hearing and vision, consider autism and ADHD, and refer you to an occupational therapist.1,31
Can a blood test or brain scan show sensory processing disorder?
No. There is no laboratory test for SPD, and researchers are still working toward objective measures that could separate it from other conditions.19 Imaging studies have found white matter differences in groups of children with SPD, but in practice assessment relies on questionnaires and clinical observation.17,25
Do I need a diagnosis to start occupational therapy for sensory issues?
Not for early intervention: a child under 3 does not need a diagnosis to be referred and evaluated.13 For private therapy, what matters is an occupational therapy evaluation and your insurer’s rules; some insurers cover Ayres Sensory Integration as a neurodevelopmental concern.1
Can a school evaluation replace a private sensory assessment?
They answer different questions. A school evaluation decides whether your child has a disability under IDEA and what their educational needs are, while an occupational therapy assessment describes the sensory profile and what would help day to day.3,14 A private evaluation you share with the school must be considered if it meets the district’s criteria.43
Should sensory processing be part of an autism evaluation?
Yes. Sensory reactivity is one of the autism criteria in the DSM-5-TR, and ICD-11 added hypersensitivity and hyposensitivity to sensory stimuli to its autism requirements.4,8 It is reasonable to ask the team to address it specifically, since older frameworks did not.7,8
Can my child get school support for sensory issues without an SPD diagnosis?
Yes. SPD is not an IDEA disability category, but a child can qualify under a category such as autism, other health impairment or developmental delay if they need special education because of it.27 Section 504 has its own evaluation for a student who needs or is believed to need special education or related services because of a disability.44,52
Can children grow out of sensory processing disorder?
Some patterns ease: older children scored lower than younger ones on the Sensory Profile 2 for seeking and several senses.9 But difficulties can persist into adulthood, so those that interfere with daily life are worth acting on rather than waiting out.17
At what age can a child be tested for sensory processing disorder?
From birth: the Infant Sensory Profile 2 covers the first 6 months, the toddler form 7 to 35 months, and the child form runs to 14 years 11 months.2,10,36 Performance tests start later; the EASI has been validated in children aged 3 to 12 and the SIPT covers ages 4 to 9.18,41
Related guides on sensory processing
Sources
- Lane SJ, Schoen SA, Schaaf R, Bundy A, Mailloux Z, Roley SS, et al. Supporting clinical identification of children with sensory integration challenges: a decision guide for primary care providers. Brain Sciences. 2025;15(11):1184. doi:10.3390/brainsci15111184 (PMID 41300190).
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A narrative review by occupational therapy researchers, among them developers of the EASI and the SPM-2 and instructors in Ayres Sensory Integration. Children with these challenges “are likely to present first to their primary care provider”; prevalence 50% to 90% in children with other diagnoses and 5% to 20% without; “Few screening tools were addressed in the literature”; the Sensory Profile-2 suite and the SPM-2 “include multiple forms, spanning the age range and contexts of home, school, and community” and are “best included as part of a comprehensive occupational therapy evaluation”; web checklists from clinics “do not provide standard scores or scoring guidelines” and are “a place to begin”; caregiver questions such as “Is the child picky about certain tastes or textures when eating?”, “Does the child have difficulty getting dressed or finding comfortable clothing?”, “Has the child been sensitive to sounds?” and “Does the child withdraw when there is noisy group play?”; signs include “motor clumsiness, challenges with balance, and difficulty with age-appropriate motor skill attainment”; parenting stress is high and families limit routines; “Most authors agreed that occupational therapists have the greatest expertise in sensory integration”; choose “a therapist with appropriate training in Ayres Sensory Integration”; sensory diets are distinguished from ASI; “some insurance carriers cover occupational therapy using ASI as a neurodevelopmental concern.” - Gándara-Gafo B, Beaudry-Bellefeuille I. Convergent validity of two sensory questionnaires in Spain: Sensory Profile-2 and Sensory Processing Measure. Children (Basel). 2023;10(9):1516. doi:10.3390/children10091516 (PMID 37761476).
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Both questionnaires “are designed to be used together with other evaluation tools, personal narratives as well as clinical observations, as part of a comprehensive evaluation”; the SP-2, derived from Dunn’s model, is “Aimed at children aged from 3 to 14 years and 11 months”; in 116 children aged 5 to 12, “There is adequate convergent validity between the SPM and the SP-2 for the Spanish population in most sensory factors”; the SP-2 has norms for Spain. - Kosasih A, Dirgantara P, Khoirunisah Z, Gidion H, Luthfi M, Arsyi RN, et al. Indonesian translation and cross-cultural adaptation of the Sensory Processing Measure-2 (SPM-2) for preschool children: a study protocol. Occupational Therapy International. 2025;2025:5513870. doi:10.1155/oti/5513870 (PMID 41190080).
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SPD “is not formally recognized as a standalone diagnosis in major classification systems such as the DSM-5 or ICD-10”; symptoms “may include food selectivity, sensitivity to textures, intolerance to noise, unawareness of loud environmental sound”; standardized assessment gives “the data about the pattern of the sensory processing difficulties of each child” that guides intervention planning; the SIPT is “expensive and may be excessive for certain situations”; the EASI assesses sensory perception, praxis, motor integration and sensory reactivity with “open-access and low-cost materials” and normative data “from over 2300 children across multiple continents”; “both EASI and SIPT do not offer a formal measurement of sensory modulation disorder”, so caregiver questionnaires complete the assessment; their norms “primarily reflect North American children”; the SPM-2 is used “from infancy to adulthood”, and its preschool form, for ages 2 to 5, has home and school forms. - Valencia M, D’Ocon A, Plata R, Simó S, Cantero MJ. Internalizing/externalizing problems and sensory processing alteration in children referred to child mental health centers. Children (Basel). 2025;12(6):664. doi:10.3390/children12060664 (PMID 40564622).
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“SPD is not recognized in diagnostic classification systems such as the DSM-5-TR or ICD-11”; sensory processing alteration “is only included as one of the criteria for restrictive and repetitive patterns of behavior, interests, or activities in the diagnosis of ASD”, as criterion B.4. - Section on Complementary and Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics; Zimmer M, Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186–1189. doi:10.1542/peds.2012-0876 (PMID 22641765).
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The AAP’s statement: it is unclear whether children with sensory-based problems have an actual disorder of the sensory pathways or whether these are features of other conditions; “Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed”; “Other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed”; sensory difficulty is seen in autism, ADHD, “developmental coordination disorders, and childhood anxiety disorders”; occupational therapy with sensory-based therapies “may be acceptable as one of the components of a comprehensive treatment plan”, but the research “is limited and inconclusive”; clinicians may discuss “a trial period of sensory integration therapy” and teach families “how to evaluate the effectiveness of a therapy.” - American Academy of Pediatrics, HealthyChildren.org. Hearing Loss in Children. Checked October 7, 2026.
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Contact your pediatrician if a child does not “startle at loud noises by 1 month old” or turn to a sound by 3 to 4 months, has delayed speech, or “They don’t always respond when called”: “This is usually mistaken for inattention or resistance, but could be the result of a partial hearing loss”; in some children with sensorineural hearing loss “the part of the inner ear that provides information about balance and movement of the head is also damaged”; if hearing loss is suspected at any age, “insist that a formal hearing evaluation be performed promptly.” - Hodges H, Fealko C, Soares N. Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Translational Pediatrics. 2020;9(Suppl 1):S55–S65. doi:10.21037/tp.2019.09.09 (PMID 32206584).
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The DSM-5 was published in 2013; its table of the autism criteria lists “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment” among the “Restricted, repetitive patterns of behavior, interests, or activities, manifested by at least two of the following”, alongside “Persistent deficits in social communication and social interaction across multiple contexts”; sensory symptoms were not addressed in the DSM-IV. - Greaves-Lord K, Skuse D, Mandy W. Innovations of the ICD-11 in the field of autism spectrum disorder: a psychological approach. Clinical Psychology in Europe. 2022;4(Spec Issue):e10005. doi:10.32872/cpe.10005 (PMID 36760320).
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On ICD-11 6A02 Autism spectrum disorder: “Atypical responses to sensory stimuli are included as part of the diagnostic requirements in ICD-11, in contrast to ICD-10, where unusual sensory processing was not yet considered a core (diagnostic) feature”; the addition is “the presence of lifelong strong and persistent hypersensitivity and/or hyposensitivity to sensory stimuli”, which “may include sounds, light, textures (especially clothing and food), odours and tastes.” - Little LM, Dean E, Tomchek S, Dunn W. Sensory processing patterns in autism, attention deficit hyperactivity disorder, and typical development. Physical & Occupational Therapy in Pediatrics. 2018;38(3):243–254. doi:10.1080/01942638.2017.1390809 (PMID 29240517).
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239 children aged 3 to 14 on the Sensory Profile 2: “Children with ASD and ADHD did not differ in sensory processing patterns which were elevated as compared to a TD group”; “Older children had lower scores for seeking, auditory, visual, movement, touch, and conduct than younger children, regardless of diagnosis.” - Kim S, Kim EY, Jeong Y, Kim M, Ji S. Psychometric properties of Korean Infant Sensory Profile 2. Annals of Medicine. 2023;55(1):2207037. doi:10.1080/07853890.2023.2207037 (PMID 37143337). The Infant Sensory Profile 2 “assesses sensory processing patterns in infants aged 0–6 months”; caregivers rate 25 items across general, auditory, visual, touch, movement and oral sensory processing, and it gives a total score.
- Skocic D, Brown T, Yu ML, Reed K. Convergent validity of two adult self-report sensory scales: comparing the Adolescent/Adult Sensory Profile and the Sensory Processing Measure 2–Adult Form. Australian Occupational Therapy Journal. 2024;71(6):897–909. doi:10.1111/1440-1630.12963 (PMID 38738292).
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“The A/ASP is a 60-item self-report questionnaire for individuals aged 11–65+” that takes “approximately 15 minutes to administer” and “remains the most common sensory tool for use in adolescents and adults”; “The SPM-2-Adult is an 80-item self-report questionnaire for individuals aged 21–87”, scored for vision, hearing, touch, taste and smell, body awareness, balance and motion, planning and ideas, and social participation; an SPM-2 adolescent self-report form also exists; “there is scarce information on the assessment of sensory processing in adults”, and the A/ASP “has not been validated for use in such populations” as clinical groups. - Electronic Code of Federal Regulations, Title 34, Part 303 (IDEA Part C). § 303.521 System of payments and fees. Checked October 7, 2026.
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Child find, evaluation and assessment, service coordination and the IFSP are “required functions that must be carried out at public expense, and for which no fees may be charged to parents”; a family that meets the state’s definition of inability to pay “must be provided all part C services at no cost.” - American Academy of Pediatrics, HealthyChildren.org. What is Early Intervention?. Checked October 7, 2026.
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Early intervention, run by each state under Part C of IDEA, “works with children ages 0-3”; “Anyone can refer a child to EI”, including parents; “The child does not even need a diagnosis”; “all states must provide at least some services free of charge”; the plan covers the move “to school services when the child turns three.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.301 Initial evaluations. Checked October 7, 2026.
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“either a parent of a child or a public agency may initiate a request for an initial evaluation to determine if the child is a child with a disability”; the evaluation “Must be conducted within 60 days of receiving parental consent for the evaluation”, or within the state’s own timeframe, and determines whether the child has a disability and “the educational needs of the child.” - Acuña C, Gallegos-Berrios S, Barfoot J, Meredith P, Hill J. Ayres Sensory Integration® with children ages 0 to 12: a systematic review of randomized controlled trials. American Journal of Occupational Therapy. 2025;79(3):7903205180. doi:10.5014/ajot.2025.051023 (PMID 40193295).
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Nine randomized trials, 344 children: “Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals”; “Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability”; “More research is needed to determine ASI's benefits for other child populations.” - Randell E, Wright M, Milosevic S, Gillespie D, Brookes-Howell L, Busse-Morris M, et al. Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT. Health Technology Assessment. 2022;26(29):1–140. doi:10.3310/tqge0020 (PMID 35766242).
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A UK trial randomizing 138 autistic children in mainstream primary schools to 26 weeks of manualized sensory integration therapy or usual care: “The intervention did not demonstrate clinical benefit above standard care”, though it “is likely to be effective for individualised performance goals”; “Carers and therapists reported improvement in daily functioning.” - Passarello N, Tarantino V, Chirico A, Menghini D, Costanzo F, Sorrentino P, et al. Sensory processing disorders in children and adolescents: taking stock of assessment and novel therapeutic tools. Brain Sciences. 2022;12(11):1478. doi:10.3390/brainsci12111478 (PMID 36358404).
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SPD as “difficulty detecting, modulating, interpreting, and/or responding to sensory experiences”; over-responsive children “show tactile defensiveness and gravitational insecurity; they may react negatively to certain food groups”; under-responsive children “seem uninterested, and daydream, and they often have low endurance and may mouth objects”; seeking children “constantly touch, move, crash into objects”; atypical sensory experiences in “up to 90% of individuals with ASD” and 50% to 64% of children with ADHD; the Child Sensory Profile 2 has 86 items, the Adolescent/Adult Sensory Profile 60 items for ages 11 to 65, the SIPT “17 brief tests”; short-form items such as “avoids going barefoot, especially in grass and sand” and “covers eyes or squints to protect eyes from light”; caregiver observation “might be more reliable than a single observation by a clinician”, but parents “may underestimate sensory processing difficulties” and “a diagnosis based solely on a parent/caregiver’s report may be incomplete”; observation protocols “have low ecological validity”; observation and questionnaires “remain the most used methods for assessment of SPDs”; SPD “patterns may persist into adult life.” - Mulligan S, Douglas S, Armstrong C. Characteristics of idiopathic sensory processing disorder in young children. Frontiers in Integrative Neuroscience. 2021;15:647928. doi:10.3389/fnint.2021.647928 (PMID 33994966).
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78 children aged 2 to 7 with sensory problems affecting daily life and no other neurodevelopmental or mental disorder, seen by a team including “a developmental pediatrician, occupational therapist, speech-language pathologist”: over-responsivity in 60%, under-responsivity 51%, craving 42%, sensory-based motor disorder 40%, discrimination 29%, and “53% of the children displayed more than one SPD type”; touch and vestibular-proprioceptive systems most often affected (76.4%); SPD “has been recognized as its own diagnostic entity” in the DC:0–5, which bases it on difficulties “to the extent that these deficits impair daily functioning and participation”; the subtypes considered cover the seven senses “as well as interoception”; over-responsivity means “intense, exaggerated responses to sensory events that most children do not perceive as negative or noxious”, under-responsivity “muted or slowed responses to sensory experiences often with an apparent lack of awareness”, craving behavior that is “inappropriate, disruptive, disorganized and/or risky”; “prevalence estimates of iSPD ranges from 5 to 16% of children in the general population”, with 60% to 90% in conditions such as autism; the SIPT “has long been the gold standard for measuring sensory integration and praxis in children 4 to 9 years of age, although it does not measure sensory modulation”; in comparisons, inattention was greater in ADHD and sensory issues, anxiety and physiological reactivity greater in sensory modulation disorder; social-emotional pathways were affected in autism “but not in the children with SPD”; daily life effects include “eating/mealtime routines and problems with sleep”; the types “overlap substantially.” - Miller LJ, Nielsen DM, Schoen SA, Brett-Green BA. Perspectives on sensory processing disorder: a call for translational research. Frontiers in Integrative Neuroscience. 2009;3:22. doi:10.3389/neuro.07.022.2009 (PMID 19826493).
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The typology Miller and colleagues proposed in 2007: “The new nosology proposes three main categories within SPD: sensory modulation disorder (SMD), sensory discrimination disorder and sensory-based motor disorder”; over-responsive “responds too much, for too long, or to stimuli of weak intensity”, under-responsive “responds too little, or needs extremely strong stimulation to become aware of the stimulus”, seeking “responds with intense searching for more or stronger stimulation”; postural disorder “reflects problems in balance and core stability” and dyspraxia “encompasses difficulties in motor planning and sequencing movements”; discrimination concerns “the intensity, the duration, the spatial, and the temporal elements of sensations”; the field “is not completely unified in how to define the subtypes” and “individuals may present with a combination of subtypes”; Ayres named “the clinical disorder sensory integration dysfunction”, and “Currently the term for the disorder is sensory processing disorder (SPD)”; physiological differences in children with sensory over-responsivity; “An improved diagnostic method is needed”, ideally with “objective laboratory measures to differentiate SPD from other childhood conditions.” - American Academy of Pediatrics, HealthyChildren.org. Sensory Integration Therapy. Last updated October 7, 2019. Checked October 7, 2026.
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“Talk with your child’s pediatrician if you suspect that your child has difficulties with sensory processing”; the therapy was “developed in the 1970s by an OT, A. Jean Ayres”; sessions “are play-oriented and may include using equipment such as swings”, trampolines and slides; besides the five senses there is a vestibular sense (balance) and a proprioceptive sense (awareness of body in space); “bright fluorescent lights that bother others may be riveting to some children with ASDs”; some children seek sensations through “rocking back and forth, head banging, and oral exploration of nonedible objects”; its effectiveness for autism “is limited and inconclusive”; of auditory integration training and behavioral optometry, “neither method has proved to be scientifically valid.” - Piller A, McHugh Conlin J, Glennon TJ, Andelin L, Auld-Wright K, Teng K, et al. Systematic review of sensory-based interventions for children and youth (2015–2024). Frontiers in Pediatrics. 2025;13:1720179. doi:10.3389/fped.2025.1720179 (PMID 41321460).
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Funded by the American Occupational Therapy Association. Twenty-one studies: “Strong strength of evidence supported use of deep pressure tactile input and caregiver training on the use of sensory strategies”; alternative seating did not improve attention; “There is a lack of evidence on the impact of sensory environmental modifications”; for weighted vests “overall evidence of their effectiveness was insubstantial”; one sensory diet study showed “three of four participants improving behavior”; earmuffs improved sound-related goals for autistic children in one trial, noise-canceling headphones did not; sensory differences “may or may not impact participation in functional activities”; they are estimated to affect 5% to 25% of US children; “Occupational therapists are widely recognized as leaders in the evaluation and treatment” of these challenges; AOTA’s 2018 practice guideline is summarized. - Ahn RR, Miller LJ, Milberger S, McIntosh DN. Prevalence of parents’ perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy. 2004;58(3):287–293. doi:10.5014/ajot.58.3.287 (PMID 15202626).
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Short Sensory Profile surveys from parents of incoming kindergartners in one suburban US district: 13.7% of 703 respondents met screening criteria, and the cautious estimate was “5.3% (96 of 1796) of the kindergarten enrollment.” - Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. Journal of Abnormal Child Psychology. 2009;37(5):705–716. doi:10.1007/s10802-008-9295-8 (PMID 19153827). A representative sample of 925 children aged 7 to 11: “Sixteen percent of parents reported that at least four tactile or auditory sensations bothered their children.”
- Jorquera-Cabrera S, Romero-Ayuso D, Rodriguez-Gil G, Triviño-Juárez JM. Assessment of sensory processing characteristics in children between 3 and 11 years old: a systematic review. Frontiers in Pediatrics. 2017;5:57. doi:10.3389/fped.2017.00057 (PMID 28424762).
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Miller’s is “the most commonly used and accepted taxonomy”; over-responsivity symptoms “include avoidance, anxiety, and hypersensitivity, e.g., tactile defensiveness or gravitational insecurity”; under-responsive children “may not notice when someone comes into a room or when they have food or dirt on their face and hands”; the SIPT is the gold standard for sensory discrimination and sensorimotor disorders but “has only been validated in a North American population”, “has never been revised since it was created in 1989”, needs accredited examiners and costly training, and takes long to give and score, “which means it is not frequently used in daily clinical practice”; it “has been criticized for not providing information on the existence of SMD”; SIPT scores need “clinical observations and case history” for interpretation. - Owen JP, Marco EJ, Desai S, Fourie E, Harris J, Hill SS, et al. Abnormal white matter microstructure in children with sensory processing disorders. NeuroImage: Clinical. 2013;2:844–853. doi:10.1016/j.nicl.2013.06.009 (PMID 24179836).
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Diffusion tensor imaging in 16 boys aged 8 to 11 with SPD and 24 matched controls: reduced white matter integrity, mainly in posterior tracts, correlated with sensory behavior; “the first study to demonstrate reduced white matter microstructural integrity in children with SPD.” - Uygun SD, Kara E, Temeltürk RD, Yürümez E, Cikili Uytun M, Öztop DB. Exploring self-regulation deficits in sensory over-responsivity disorder: a preschool comparative analysis. Global Mental Health. 2025;12:e126. doi:10.1017/gmh.2025.10076 (PMID 41292601).
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Under the DC:0–5, “children with SORD exhibit intense and aversive reactions to one or more types of ordinary sensory input across multiple environments, including home, preschool and playground settings”, and the symptoms “must not be better explained by another psychiatric disorder, such as autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD)”; “The DC:0–5 classification system is the first framework to define SORD as a disorder”; “Unlike the DC:0–5 system, the Fifth Edition of the DSM (DSM-5) does not formally recognize sensory processing disorders”; sensory over-responsivity has also been identified in “anxiety and obsessive-compulsive disorder.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.8 Child with a disability. Checked October 7, 2026.
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The thirteen categories, including autism and other health impairment, and developmental delay for ages three through nine where a state uses it, for a child “who, by reason thereof, needs special education and related services”; characteristics often associated with autism include “unusual responses to sensory experiences.” - World Health Organization. ICD-11 2022 release. Dated February 11, 2022: “ICD-11 is now officially in effect for the national and international recording and reporting of causes of illness, death - and more”; the release includes “Clinical Descriptions and Diagnostic Requirements for mental health.” Checked October 7, 2026.
- American Academy of Pediatrics, HealthyChildren.org. What is a Developmental-Behavioral Pediatrician?. Checked October 7, 2026.
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A developmental-behavioral pediatrician “has the training and expertise to evaluate and care for your child”; the problems they see include anxiety disorders, “Regulatory disorders including sleep disorders, feeding problems” and “Delayed development in speech, language, motor skills and thinking ability”; their teams may include “a psychologist, speech-language pathologist, occupational therapist.” - American Academy of Pediatrics, HealthyChildren.org. Occupational Therapy. Checked October 7, 2026.
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“An OT evaluates the child’s fine motor skills and sensory processing development and prepares strategies for learning tasks of daily living”; difficulties show up in self-care such as dressing, using a spoon and brushing teeth; interventions “may be delivered in sessions with a therapist and then practiced at home and school.” - American Academy of Pediatrics, HealthyChildren.org. Vision Screenings for Babies & Children. Checked October 7, 2026.
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“other eye problems can have no symptoms and will only be detected during screening”; pediatricians examine the eyes “at each well-check visit”; a child who fails a screening “usually are referred to an eye doctor”; visual acuity screening at ages 4 and 5 and in cooperative 3-year-olds. - American Academy of Pediatrics, HealthyChildren.org. How Pediatricians Screen for Autism. “screening for autism is not the same as diagnosing autism”; parents can “talk with your pediatrician and ask for a developmental screen”, and if they think a child needs more evaluation, “trust your instincts.” Checked October 7, 2026.
- American Academy of Pediatrics, HealthyChildren.org. How Is Autism Diagnosed?. Checked October 7, 2026.
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“It would be so much easier if autism could be diagnosed with a blood test or an x-ray”; “Primary care pediatricians can diagnose autism, or your pediatrician may refer you to a developmental pediatrician, child psychologist, or other autism specialist to complete testing”; “the pediatrician’s role in the partnership is to listen and act on your observations and concerns”, and if you are not heard, “get a second opinion.” - American Academy of Pediatrics, HealthyChildren.org. Diagnosing ADHD in Children: Guidelines & Information for Parents. Checked October 7, 2026.
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The AAP guidelines “are specifically for children 4 to 18 years of age”; “There is no single test for ADHD”; symptoms “occur in 2 or more settings” and start before age 12; pediatricians refer when there are concerns including “Trouble seeing and/or hearing.” - American Speech-Language-Hearing Association. Central Auditory Processing Disorder. Practice Portal. Checked October 7, 2026.
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CAPD refers to “deficits in the neural processing of auditory information”, including auditory performance “in competing acoustic signals”; “CAPD is not due to peripheral hearing loss”; “CAPD is an auditory deficit diagnosed by an audiologist based on clinical presentation and assessment findings”, though “there is currently no reference standard for diagnosing CAPD”; speech-language pathologists evaluate “problems in the linguistic processing of the auditory signal.” - Almohalha L, Santos JLF, Pfeifer LI. Cross-cultural adaptation and reliability of the Toddler Sensory Profile 2 for Brazilian children aged 7 to 35 months. Hong Kong Journal of Occupational Therapy. 2023;36(2):92–100. doi:10.1177/15691861231183097 (PMID 38027050).
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“The TSP2 is a questionnaire for children aged 7–35 months with 54 items distributed into seven sensory categories”, classified into the seeking, avoiding, sensitivity and registration quadrants; adapted into Brazilian Portuguese with 168 caregivers. - Electronic Code of Federal Regulations, Title 34, Part 303 (IDEA Part C). § 303.303 Referral procedures. Primary referral sources include physicians and “Parents, including parents of infants and toddlers.” Checked October 7, 2026.
- Electronic Code of Federal Regulations, Title 34, Part 303 (IDEA Part C). § 303.310 Post-referral timeline (45 days). The initial evaluation, the initial assessments and the initial IFSP meeting “must be completed within 45 days from the date the lead agency or EIS provider receives the referral of the child.” Checked October 7, 2026.
- Chojnicka I, Pisula E. Adaptation and psychometric properties of the Polish version of the Short Sensory Profile 2. Medicine (Baltimore). 2019;98(44):e17689. doi:10.1097/md.0000000000017689 (PMID 31689792).
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The Short Sensory Profile 2 “was adapted from the Child Sensory Profile 2 by retaining 34 items with the greatest discrimination power” and is “suitable for older children aged up to 14 years 11 months”; Dunn’s four patterns are seeking, “the degree to which a child obtains sensory input”, avoiding, “the degree to which a child is bothered by sensory input”, sensitivity, “the degree to which a child detects sensory input”, and registration, “the degree to which a child misses sensory input.” - Mailloux Z, Parham LD, Roley SS, Ruzzano L, Schaaf RC. Introduction to the Evaluation in Ayres Sensory Integration® (EASI). American Journal of Occupational Therapy. 2018;72(1):69–76. doi:10.5014/ajot.2018.028241 (PMID 29280717). The EASI was begun “To meet the need for a set of tests that will fully evaluate the constructs of ASI with psychometrically strong, internationally appropriate, and easily accessible measurement tools.”
- Schaaf RC, Wright KA, Mailloux Z, Grady P, Parham LD, Roley SS, et al. Evaluation in Ayres Sensory Integration® (EASI) tactile perception tests: construct validity and internal reliability. American Journal of Occupational Therapy. 2023;77(1):35–41. doi:10.5014/ajot.2023.050053 (PMID 36779979).
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In 174 typically developing children and 153 with sensory integration concerns, aged 3 to 12, the tests “are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr”, for use “by therapists trained in their administration.” - Mailloux Z, Grady-Dominguez P, Petersen J, Parham LD, Roley SS, Bundy A, et al. Evaluation in Ayres Sensory Integration® (EASI) vestibular and proprioceptive tests: construct validity and internal reliability. American Journal of Occupational Therapy. 2021;75(6):1158–1169. doi:10.5014/ajot.2021.043166 (PMID 34792540).
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“The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr”; its six vestibular and proprioceptive tests “have strong construct validity and internal reliability.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.502 Independent educational evaluation. Checked October 7, 2026.
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“A parent has the right to an independent educational evaluation at public expense if the parent disagrees with an evaluation obtained by the public agency”; the agency must either file for a due process hearing or ensure one is provided; public expense means the agency pays or the evaluation is “provided at no cost to the parent”; an evaluation the parent obtains privately “Must be considered by the public agency, if it meets agency criteria.” - Electronic Code of Federal Regulations, Title 34, Part 104. § 104.35 Evaluation and placement. Checked October 7, 2026.
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A school must evaluate a student who, because of a disability, needs or is believed to need special education or related services “before taking any action with respect to the initial placement”, using tests “validated for the specific purpose for which they are used.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.304 Evaluation procedures. Checked October 7, 2026.
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The agency must “Use a variety of assessment tools and strategies”, including information provided by the parent, and “Not use any single measure or assessment as the sole criterion”; the child “is assessed in all areas related to the suspected disability, including, if appropriate, health, vision, hearing, social and emotional status”, through “communicative status, and motor abilities.” - Aron EN, Aron A. Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology. 1997;73(2):345–368. doi:10.1037//0022-3514.73.2.345 (PMID 9248053). Seven studies identified “a unidimensional core variable of high sensory-processing sensitivity”, partly independent of introversion and emotionality, and validated “a 27-item Highly Sensitive Person Scale.”
- Greven CU, Lionetti F, Booth C, Aron EN, Fox E, Schendan HE, et al. Sensory processing sensitivity in the context of environmental sensitivity: a critical review and development of research agenda. Neuroscience and Biobehavioral Reviews. 2019;98:287–305. doi:10.1016/j.neubiorev.2019.01.009 (PMID 30639671).
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“Sensory Processing Sensitivity (SPS) is a common, heritable and evolutionarily conserved trait describing inter-individual differences in sensitivity to both negative and positive environments”; it “increases risk for stress-related problems in response to negative environments, but also provides greater benefit from positive and supportive experiences.” - Shata ZN, Badr ET, Omran HA, Alkasaby M, Hamdaalah A, Soliman A, et al. The relationship between sensory processing sensitivity trait and emotional and behavioral problems among Egyptian children. BMC Pediatrics. 2026;26(1):836. doi:10.1186/s12887-026-07415-z (PMID 42706519).
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“According to Aron and Aron, the SPS trait is present in 15–20% of the population”; “it is important to distinguish the temperamental trait of SPS from the sensory sensitivities associated with sensory processing disorders (SPD)”: SPS is a stable trait “without necessarily leading to clinically significant impairment”, whereas SPD “is typically framed as a pattern of atypical sensory modulation that often results in functional difficulties in occupational, educational, or social domains”; a low sensory threshold is shared with sensory over-responsivity. - Wehrli S, Hochreuter J, Buttelmann D, Lionetti F, Pluess M, Oeri N, et al. The German version of the highly sensitive child scale: psychometric properties and identification of sensitivity groups. Current Psychology. 2026;45(7):738. doi:10.1007/s12144-026-09244-w (PMID 41884181).
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Sensory processing sensitivity “describes a genetically influenced, relatively stable personality trait that manifests in deeper cognitive processing of stimuli, a lower threshold to sensory inputs, and high emotional reactivity”; the 12-item Highly Sensitive Child Scale “measures SPS in children from the age of 8 years onwards.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.503 Prior notice by the public agency; content of notice. Checked October 7, 2026.
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Written notice must be given a reasonable time before the agency “Refuses to initiate or change the identification, evaluation, or educational placement of the child”, including “An explanation of why the agency proposes or refuses to take the action.” - Electronic Code of Federal Regulations, Title 34, Part 300 (IDEA Part B). § 300.111 Child find. States must ensure that children with disabilities, including those attending private schools, who need special education and related services “are identified, located, and evaluated.” Checked October 7, 2026.
- Electronic Code of Federal Regulations, Title 34, Part 104. § 104.1 Purpose. The part exists “to effectuate section 504 of the Rehabilitation Act of 1973.” Checked October 7, 2026.
- Bodison SC, Parham LD. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: a systematic review. American Journal of Occupational Therapy. 2018;72(1):42–53. doi:10.5014/ajot.2018.029413 (PMID 29280714).
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From 11,436 abstracts (2007 to 2015), eight studies: “Strong evidence supported Qigong massage, moderate evidence supported sensory modifications to the dental care environment, and limited evidence supported weighted vests”; “The evidence is insufficient to draw conclusions regarding slow linear swinging and incorporation of multisensory activities into preschool settings.” - Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, et al. A systematic review of Ayres Sensory Integration intervention for children with autism. Autism Research. 2019;12(1):6–19. doi:10.1002/aur.2046 (PMID 30548827).
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Council for Exceptional Children standards applied to research from 2006 to 2017: “Searches yielded 19 studies”, six met the inclusion criteria and three were rated, two randomized trials meeting 100% and 85% of the criteria; “ASI can be considered an evidence-based practice for children with autism ages 4-12 years old”; the intervention “has specific requirements for therapist qualifications.”
Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child.