Sensory Discrimination Difficulties: Signs and Support

What is sensory discrimination disorder?

Sensory discrimination is how the brain and nervous system recognize and interpret sensory experiences, such as telling the sound of one phone from another; the STAR Institute describes it as perceiving the specific qualities of a stimulus and giving them meaning.⁠^1,3 In sensory discrimination disorder, that interpretation is unreliable. In the words of the classification that named it, people with the disorder can perceive that stimuli are present and can regulate their response to them, but cannot tell precisely what or where the stimulus is, and they may need extra time to process what matters in what they sense.⁠²

Sensory discrimination disorder is one of three patterns of sensory processing disorder that Miller and colleagues proposed in 2007, alongside sensory modulation disorder and sensory-based motor disorder, each with subtypes; the guide to the types of sensory processing disorder compares all three.⁠² The same paper proposed that the diagnosis be made only when sensory difficulties impair daily routines or roles.⁠² Cleveland Clinic lists it among the types of sensory processing disorder and describes it as difficulty interpreting subtle qualities of sensory information, with subtypes such as auditory discrimination disorder.⁠⁵

Where does the term sensory discrimination come from?

From occupational therapy research going back 60 years. A. Jean Ayres first used the term sensory integration dysfunction in 1963, and her Sensory Integration and Praxis Tests (SIPT) became the main empirical basis for the diagnostic patterns.⁠^2,12 Analyses of SIPT scores keep finding a discrimination pattern: in 273 children aged 4 to 9, factor analysis identified tactile and visual discrimination as one of four patterns, and a 1998 analysis of 10,475 children found a somatosensory deficit factor.⁠^12,19 What Miller and colleagues added in 2007 was a focus on the body senses (touch, body position and balance) alongside the traditional focus on vision, hearing and touch.⁠²

What are the signs of sensory discrimination disorder?

The signs depend on which senses are affected, but they share a theme: the child is working from less precise information, so actions come out less precise.⁠^1,2

• Clumsiness in gross and fine motor tasks, because discrimination in touch, body position and balance underlies smooth, graded movement.⁠^1,2
• Slowness, because picking out what matters in what is seen, heard or felt takes extra time.⁠^1,2
• The wrong amount of force, pressing too hard or too lightly. The STAR Institute’s checklist includes a child who uses too much force with friends and an adult who uses an inappropriate amount of force when handling objects.⁠⁴
• Avoiding fine motor work such as crayons, fasteners and handwriting.⁠⁴
• Confusing similar-sounding words and misinterpreting questions or requests.⁠⁴
• Watching the hands. Children with coordination difficulties do not always get the feel of a movement and must rely on vision, which makes snaps on jeans or pulling on a sweater awkward.⁠²⁰
• Knock-on effects: low self-confidence, attention-seeking behavior and temper tantrums may follow.⁠²

None of these signs proves a discrimination problem on its own. In one small study, children whose only difficulty was handwriting had the same hand sensation as proficient writers.⁠²¹

What does sensory discrimination look like in each sense?

Discrimination is not a single skill. It runs through every sensory system, and a person may have a discrimination difficulty in one sense, such as vision or hearing, and good discrimination in all the others.⁠² That unevenness is part of why the pattern is missed.

Sensory discrimination vs modulation: how are they different?

Over- and under-responsivity are problems of sensory modulation: how strongly the nervous system reacts. Discrimination is about accuracy: what the input is and where it came from. A child with a discrimination difficulty can perceive that a stimulus is present and regulate the response, but cannot tell precisely what or where it is.⁠²

They can co-occur. Discrimination disorder frequently comes with under-responsivity, and under-responsivity in touch and body position usually leads to poor tactile discrimination and a poor body scheme. It can also come with over-responsivity, which is thought to override discriminative information from the body.⁠² Miller and colleagues argued that naming the specific pattern makes treatment more specific.⁠²

Why the difference is practical. Children who are over-responsive tend to avoid or minimize sensations.⁠¹ Discrimination difficulty is a problem of accuracy rather than intensity, so guidance for children with coordination difficulties points instead to practicing the task itself and adapting it to the child.⁠^7,29

Is it a discrimination problem or a hearing or vision problem?

Check the sense organs first. A hearing screening tells whether a child might have hearing loss; a child who does not pass needs a full hearing test, and children at risk of later hearing loss should have at least one test by 2 to 2 1/2 years of age.⁠⁹ For vision, pediatricians screen at checkups and refer to an eye doctor when they find signs of a problem, and visual acuity screening is recommended at ages 4 and 5 and in cooperative 3-year-olds.⁠^25,30 Squinting, rubbing the eyes or headaches after schoolwork are reasons to have vision checked.⁠²⁵

Passing those checks does not settle the question, because they test whether the signal arrives, not how it is interpreted. ASHA defines central auditory processing disorder as deficits in processing sound in the central nervous system, shown in skills that include auditory discrimination, and states that it is not due to peripheral hearing loss.⁠¹⁰

How does auditory discrimination affect listening and speech?

Auditory discrimination is the part of this pattern most likely to be mistaken for not listening, because a hearing test can come back clear.⁠¹⁰ In a classroom, a child has to pick the teacher’s voice out of background noise and echo, and ASHA notes that poor classroom acoustics can affect how students understand speech, read, spell, behave and pay attention, especially students with auditory processing disorder.⁠³¹

Speech sound disorders are defined by difficulty with the perception, motor production or phonological representation of speech sounds.⁠³² A 2019 meta-analysis found that 60 of 73 studies reported speech perception difficulties in some or all children with speech sound disorders, and a 2026 meta-analysis found their perception scores lower than typical peers’ (Hedges’s g = 0.84).⁠^15,33 Among 54 children aged 6 to 16 with persistent speech sound disorders, those with childhood apraxia of speech had lower auditory discrimination scores than those with speech motor delay.⁠³⁴ Where speech and listening difficulties appear together, it is worth asking about both rather than assuming one explains the other.

RelatedChildhood apraxia of speech

Is it sensory discrimination, dyspraxia or DCD?

Families often arrive here having read about dyspraxia or developmental coordination disorder, and the honest answer is that these overlap rather than compete. Discrimination is about how accurate the incoming information is; praxis is the ability to conceive of, plan, sequence and carry out new actions. Miller and colleagues note that dyspraxia most commonly occurs with under-responsivity or discrimination difficulty in touch, body position or balance, and that the combination of discrimination disorder and under-responsivity results in a poor body scheme and dyspraxia.⁠²

The link goes back to Ayres, who noted between 1963 and 1971 an association between praxis and touch, an early milestone of sensory integration theory.⁠¹² Later SIPT analyses identified a pattern called somatodyspraxia, and current neuroscience supports the idea that touch and body-position input feed the prediction of movement.⁠⁸ Developmental coordination disorder is defined by motor skills well below what age and opportunity predict, but a meta-analysis of 129 studies found that children with DCD also differ from peers in aspects of sensory and perceptual function.⁠^7,37

The overlap shows in research. In children with DCD, localization of touch on the hand was poorer than in peers and was linked to handwriting legibility and the speed of everyday hand tasks.⁠³⁸ In 225 university students, those with probable DCD differed from peers on every sensory system measured except taste and smell, even after attention was accounted for.⁠²⁷

RelatedDyspraxiaPostural difficultiesCrossing the midline

What is stereognosis?

Stereognosis is recognizing the form of an object by touch alone. In one study, children identified ten common objects, such as a coin, a comb and a pencil, while wearing a sleeping mask; the SIPT version of the test is called Manual Form Perception, and stereognosis tests showed excellent test-retest reliability in children with cerebral palsy.⁠^11,22 Healthy children manage it easily: all 25 children aged 7 to 11 in one study recognized every object with both hands.⁠³⁹ Results in other groups vary. Autistic children showed no difference in stereognosis despite reduced proprioception, and children whose only difficulty was handwriting scored like proficient writers on stereognosis and graphesthesia, the recognition of figures drawn on the skin.⁠^12,21,22

How is sensory discrimination disorder assessed?

By an occupational therapist, mostly by watching a child do things. Cleveland Clinic describes therapists assessing children by watching them interact with sensory experiences and asking about symptoms, behavior and medical history.⁠⁵ AOTA’s Practice Smart recommendations ask therapists not to begin sensory-based interventions without documented assessment results.⁠⁴⁰ Expect questions about dressing, mealtimes, handwriting and play, observation of the tasks that are hard and, for this pattern, performance tests of touch, body position and balance, after hearing and vision have been checked. The guide to testing for sensory processing disorder walks through the wider evaluation.

What is the SIPT?

The Sensory Integration and Praxis Tests are Ayres’ standardized battery and the empirical basis of her diagnostic patterns.⁠² They include touch tests such as graphesthesia and Manual Form Perception, with excellent inter-rater reliability reported, and were used in the 273-child study that identified tactile and visual discrimination as a pattern.⁠^11,19 Many children who receive occupational therapy with a sensory integration approach cannot be tested with the SIPT, one reason newer tools were developed.⁠²

What is the EASI?

The Evaluation in Ayres Sensory Integration is a newer set of performance tests, built to be psychometrically strong, internationally appropriate and easily accessible, and the tests are freely available.⁠^12,41 Its four tactile perception tests showed construct validity and moderate to strong reliability in 327 children aged 3 to 12, with typically developing children scoring higher on all four, and its vestibular and proprioceptive tests showed strong validity and reliability.⁠^6,42 In 120 children aged 6 to 12, those with sensory integration difficulties scored below their peers on every EASI subtest.⁠⁴³

What does the SPM-2 measure?

The Sensory Processing Measure, Second Edition, is a rating scale completed by parents, teachers or the person themselves, normed on 3,850 people aged 4 months to 87 years. Its scales cover vision, hearing, touch, taste and smell, body awareness, balance and motion, planning and ideas, and social participation, and its items describe under- and over-reactivity, sensory seeking and difficulties with perception.⁠¹³ As a questionnaire it records what people notice day to day, while the EASI tests performance directly.⁠^13,43

Research tools can measure body position and force more finely still: tests of reproducing a joint angle or a level of effort without looking were adapted for children and proved highly reliable in 28 children aged 10 to 15 with DCD.⁠⁴⁴ They are research protocols rather than something every clinic runs, but they show that “how hard to press” is a real, measurable thing.

RelatedFind an occupational therapist

What helps with sensory discrimination disorder?

Support targets the specific tasks affected, such as handwriting, dressing and tool use, with practice, adaptations and strategies for the activity itself. That is where the evidence points. Guidelines for developmental coordination disorder give their strongest recommendation to activity- and participation-oriented approaches, such as task-specific training and the CO-OP approach, and rate the evidence for sensory integration therapy and kinesthetic sensitivity training in DCD as inconclusive.⁠⁷ CanChild describes the aim of most intervention as building specific skills for everyday participation rather than changing underlying motor ability, and reports that CO-OP has shown some transfer between skills.⁠²⁸

Does sensory integration therapy help?

For goals families choose, the evidence is encouraging. A 2026 systematic review of 12 higher-level studies of occupational therapy using Ayres Sensory Integration with children and young people found strong evidence for individual goal attainment and occupational performance, and moderate evidence for daily living and self-care skills and for social, communication and play skills.⁠¹⁴ A 2019 review judged Ayres Sensory Integration an evidence-based practice for autistic children aged 4 to 12.⁠⁴⁵ Those reviews measured goals and daily function rather than discrimination itself, so they support therapy built around what the child needs to do. Sensory integration therapy sessions can be paired with a sensory diet that carries strategies into the day.

Which everyday adjustments help at home and school?

CanChild’s M.A.T.C.H. framework for children with coordination difficulties sums up the approach: modify the task, alter your expectations, teach strategies, change the environment and help by understanding.⁠²⁹ DCD guidelines add that compensatory techniques such as equipment and environmental adjustments may enhance the effects of treatment.⁠⁷

Where handwriting is the main struggle, see how it overlaps with dysgraphia. Handwriting difficulties do not resolve without intervention, and studies of handwriting remediation suggest it is effective.⁠²⁶

How does sensory discrimination relate to autism and ADHD?

The diagnostic criteria for autism describe reactivity rather than discrimination: the DSM-5 lists hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment, and ICD-11 lists persistent hypersensitivity or hyposensitivity to sensory stimuli.⁠^17,18 Discrimination has been studied less. In 27 autistic children compared with 30 peers, touch and pain sensitivity were higher and proprioception and fine motor performance lower, but stereognosis did not differ, and SIPT studies of autistic children have found tactile and kinesthetic patterns, part of the wider picture of sensory processing and autism.⁠^12,22

In ADHD, motor difficulties are common, and fine motor impairments can lead to academic underachievement, low self-esteem and frustration; fine motor training programs helped in the studies a 2021 scoping review found.⁠⁴⁷ Auditory processing difficulties can co-occur with ADHD and need to be told apart from it, just as ADHD and sensory processing disorder do.⁠¹⁰

Can adults have sensory discrimination problems?

Yes. Sensory processing disorder in adults can include discrimination difficulties: the STAR Institute’s adult checklist includes using an inappropriate amount of force when handling objects, bumping into things and misinterpreting questions and requests, and the SPM-2 has adult forms up to age 87.⁠^4,13 Among university students, those with probable DCD reported sensory differences in every system measured except taste and smell.⁠²⁷

When to seek an assessment for sensory discrimination problems

Consider an occupational therapy assessment if the pattern interferes with daily life (school, friendships, self-care or family routines) or if you are unsure what you are seeing; the classification’s authors propose diagnosing sensory processing disorder only when difficulties impair daily routines or roles.⁠² You do not need to be certain something is wrong to ask; that is what the assessment is for. If a child loses skills they previously had, contact their doctor promptly: the CDC advises acting early when a child has lost skills they once had.⁠⁴⁸

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Frequently Asked Questions

Sources

1. STAR Institute for Sensory Processing. Patterns or Subtypes of Differences in Sensory Integration & Processing. Sensoryhealth.org, undated. Checked October 10, 2026.
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   “Sensory discrimination refers to the process whereby specific qualities of sensory stimuli are perceived and meaning attributed to them. Discriminate means understanding accurately what is seen, heard, felt, tasted, or smelled. Individuals with sensory discrimination difficulties have problems determining the characteristics of sensory stimuli ... (Do I see a ‘P’ or a ‘Q’? Do I hear ‘cat’ or ‘cap’? Do I feel a quarter or a dime in my pocket? Am I falling to the side or backwards?). Individuals with poor sensory discrimination may appear awkward in both gross and fine motor abilities and/or inattentive to people and objects in their environment. They may take extra time to process the important aspects of sensory stimuli.” The table lists discrimination differences by sense: auditory, visual, tactile (“felt via the skin and/or interpreting higher level visual/spatial characteristics of touch”), vestibular (“movement of the body through space or against gravity”), proprioceptive (“experienced through use of the muscles and joints”), gustatory, olfactory and interoception (“interpreting stimulation from internal organs (stomach, heart, gut, lungs etc.)”). Over-responsivity is a “predisposition to respond more intensely, quicker, and/or longer to sensory stimuli”; people who are over-responsive “often have a ‘fight or flight’ response to sensation” and “may try to avoid or minimize sensations, e.g. withdraw from being touched or cover their ears to avoid loud sounds.” People who are under-responsive “require more intensity and repetition of sensation than others”; their under-responsivity “may lead to poor body awareness, clumsiness or movements that are not graded appropriately”; and they “may not perceive objects that are too hot or cold or they may not notice pain in response to bumps, falls, cuts, or scrapes.”
2. Miller LJ, Anzalone ME, Lane SJ, Cermak SA, Osten ET. Concept evolution in sensory integration: a proposed nosology for diagnosis. American Journal of Occupational Therapy. 2007;61(2):135–140. PMID 17436834. Checked October 10, 2026.
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   “The proposed new nosology differentiates three classic patterns: SMD, SDD, and SBMD, with subtypes in each pattern”; “We propose that a diagnosis of SPD be made if, and only if, the sensory processing difficulties impair daily routines or roles.” Of pattern 2: “People with SDD have difficulty interpreting qualities of sensory stimuli and are unable to perceive similarities and differences among stimuli. They can perceive that stimuli are present and can regulate their response to stimuli but cannot tell precisely what or where the stimulus is. SDD can be observed in any sensory modality. A person with SDD may have different capacities in each modality (e.g., a visual or auditory discrimination disorder but good discrimination in all other modalities). Traditional models of sensory discrimination focus on visual, auditory, and tactile perceptions. Unique to the model proposed here is the focus on somatic senses. Discrimination in the tactile, proprioceptive, and vestibular systems leads to smooth, graded, coordinated movement. SDD in these three systems results in awkward motor abilities. SDD in the visual and auditory systems can lead to a learning or language disability. A person with SDD may require extra time to process the salient aspects of sensory stimuli, leading to ‘slow’ performance. Low self-confidence, attention-seeking behavior, and temper tantrums may result”; “SDD frequently cooccurs with SUR, resulting in poor body scheme and dyspraxia. However, people with SDD also may have SOR; in this situation, overresponsivity is seen to override the discriminative perceptions from the body.” “People with SOR respond to sensation faster, with more intensity, or for a longer duration than those with typical sensory responsivity.” Figure 1 lists the SDD subtypes as visual, auditory, tactile, vestibular, proprioception and taste/smell. Under-responsivity “occurring in tactile and proprioceptive systems usually leads to poor tactile discrimination and a poor body scheme with clumsiness”; dyspraxia, “an impaired ability to conceive of, plan, sequence, or execute novel actions,” “most commonly occurs in the presence of SUR or SDD in the tactile, proprioceptive, or vestibular domains.” The term sensory integration dysfunction “was first used by Ayres in 1963”; the SIPT “formed the primary empirical basis for the diagnostic categories,” and occupational therapy with a sensory integration approach “is used with many people who cannot be tested using the SIPT”; “Use of specific diagnoses also will increase treatment specificity for clinical practice.”
3. STAR Institute for Sensory Processing. Understanding the Sensory Integration Process. Sensoryhealth.org, undated. Checked October 10, 2026.
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   “Sensory discrimination refers to how our brains and nervous systems recognize and interpret different sensory experiences, such as distinguishing between the sound of our mobile phone and our landline ... This ability is crucial for creating a clear picture of our environment and understanding our place within it”; “Effective praxis depends on the integration of our tactile, vestibular, and proprioceptive systems”; and “Sensory processing isn’t static; it can fluctuate based on factors like stress, fatigue, or environmental changes. A person might find a certain fabric tolerable one day and unbearable the next.”
4. STAR Institute for Sensory Processing. Symptoms Checklist. Sensoryhealth.org, undated. Checked October 10, 2026.
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   The preschool list includes “My child has difficulty learning and/or avoids performing fine motor tasks such as using crayons and fasteners on clothing” and “My child has difficulty making friends (touches too much or uses too much force or is passive/ withdrawn)”; the school-age list, “My child is slow to perform tasks,” “My child has difficulty performing or avoids fine motor tasks such as handwriting” and “My child confuses similar sounding words, misinterprets questions or requests”; the adolescent and adult list, “I use an inappropriate amount of force when handling objects,” “I often bump into things or develop bruises that I cannot recall” and “I misinterpret questions and requests, requiring more clarification than usual.” “While this checklist cannot diagnose Sensory Processing Disorder, it can be a helpful guide to see if additional testing should be done.”
5. Cleveland Clinic. Sensory Processing Disorder (SPD). Health Library, March 20, 2025. Checked October 10, 2026.
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   “Currently, SPD isn’t an official medical diagnosis. But providers recognize the benefits of identifying SPD and using therapy to manage it”; among the types, “Sensory discrimination disorder. This type includes difficulty interpreting subtle qualities of sensory information. There are several subtypes. For example, auditory discrimination disorder makes it difficult to understand the things you hear”; occupational therapists “can assess your child for SPD by watching them interact with certain sensory experiences. They’ll also ask about your child’s symptoms, behavior and medical history.”
6. Schaaf RC, Wright KA, Mailloux Z, Grady P, Parham LD, Roley SS, Bundy A. Evaluation in Ayres Sensory Integration® (EASI) tactile perception tests: construct validity and internal reliability. American Journal of Occupational Therapy. 2023;77(1):7701205050. PMID 36779979. Checked October 10, 2026.
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   Children aged 3 to 12, typically developing (n = 174) and with sensory integration concerns (n = 153): “The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests ... Person reliability indices and strata indicated moderate to strong internal reliability”; the tests “are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr.”
7. Blank R, Barnett AL, Cairney J, Green D, Kirby A, Polatajko H, Rosenblum S, Smits-Engelsman B, Sugden D, Wilson P, Vincon S. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology. 2019;61(3):242–285. PMID 30671947. Checked October 10, 2026.
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   Recommendation 22 (level A): “If an intervention is to be provided then we recommend that activity-oriented and participation-oriented approaches be used as a means to improve general, fundamental, and specific motor skills in individuals with DCD,” including “task-specific training, NTT, and cognitive orientation to daily occupational performance approach (CO-OP)”; Statement 3: “the evidence is inconclusive for the effectiveness of sensory integration therapy as an intervention for children with DCD; (2) the evidence is inconclusive for the effectiveness of kinesthetic sensitivity training for children with DCD”; Recommendation 21: “Compensatory techniques (e.g. equipment, environmental adjustments) and social support may enhance the treatment effects.” Diagnostic criterion I: “The acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and sufficient opportunities to acquire age-appropriate motor skills.”
8. Lane SJ, Mailloux Z, Schoen S, Bundy A, May-Benson TA, Parham LD, Smith Roley S, Schaaf RC. Neural foundations of Ayres Sensory Integration®. Brain Sciences. 2019;9(7):153. PMID 31261689. Checked October 10, 2026.
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   Tactile sensations project to “the secondary somatosensory cortex (S2), a region that contributes to object manipulation and grasp as well as to tactile discrimination”; Ayres’ hypothesis that the somatosensory system plays a crucial role in praxis “was grounded in repeated studies showing clear relationships among tests of tactile perception and praxis ... Recent science supports these findings showing that somatosensation impacts feedforward processing, and prediction of movement”; with SIPT data, Ayres “found three patterns of praxis dysfunction; she labelled these somatodyspraxia, visuodyspraxia, and dyspraxia on verbal command.”
9. Centers for Disease Control and Prevention. Screening for Hearing Loss. Page dated October 8, 2024. Checked October 10, 2026.
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   “Hearing screening is a test to tell if people might have hearing loss”; “If a child does not pass a hearing screening, it is very important to get a full hearing test as soon as possible”; “Children who are at risk for acquired, progressive, or delayed-onset hearing loss should have at least one hearing test by 2 to 2 1/2 years of age.”
10. American Speech-Language-Hearing Association. Central Auditory Processing Disorder. ASHA Practice Portal, undated. Checked October 10, 2026.
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    Central auditory processing mechanisms “underlie skills such as auditory discrimination, temporal aspects of audition, and binaural processing”; ASHA uses CAPD “to refer to deficits in the neural processing of auditory information in the CANS (not due to higher order language or cognitive factors) demonstrated by poor performance in one or more of the following skills,” including auditory discrimination; “CAPD may co-occur with (and necessitate differentiation from) other disorders (e.g., attention-deficit/hyperactivity disorder, language delay or disorder, and learning disability)”; “CAPD is not due to peripheral hearing loss.”
11. Auld ML, Boyd RN, Moseley GL, Johnston LM. Tactile assessment in children with cerebral palsy: a clinimetric review. Physical & Occupational Therapy in Pediatrics. 2011;31(4):413–439. PMID 21599569. Checked October 10, 2026.
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    “graphaesthesia was reported from the Sensory Integration and Praxis Test (SIPT); and stereognosis was assessed using Manual Form Perception from the SIPT and the Klingels method ... Inter-rater reliability was excellent for SIPT (ICC = 0.99) ... Test-retest reliability was excellent for exteroception (k = 0.89) and stereognosis (ICC = 0.86; 100%).”
12. Botha M, van der Linde J, Mailloux Z. Patterns recognized in Ayres Sensory Integration®: a scoping review. Brain Sciences. 2026;16(7):700. PMID 42512475. Checked October 10, 2026.
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    Seventeen studies; the research behind the patterns “has been conducted over the past 60 years.” From 1963 to 1971 Ayres noted “an association between this pattern and tactile functions ... This observation that a link exists between somatosensory perception and motor planning represented an important early milestone in the development of ASI theory.” Mulligan’s 1998 factor analysis of SIPT scores from 10,475 children found first-order factors including a visual perceptual deficit and a somatosensory deficit; studies of autistic children identified patterns including “Somatosensory: tactile and kinaesthesia” and “Tactile perception.” The conflict of interest statement describes the EASI as “a set of tests which measure sensory and motor functions in children, which are freely available.”
13. Parham LD, Ecker CL, Kuhaneck H, Henry DA, Glennon TJ. Sensory Processing Measure, Second Edition (SPM-2). WPS, undated. Checked October 10, 2026.
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    A behavior rating scale “based on 3,850 typically developing participants, ranging in age from 4 months to 87 years”; its main forms carry scales for vision, hearing, touch, taste and smell, body awareness, balance and motion, planning and ideas and social participation; “The SPM-2 items provide descriptive clinical information on processing vulnerabilities within each sensory system, including under- and over-reactivity, sensory-seeking behavior, and difficulties with perception.”
14. Piller A, Glennon TJ, Andelin L, Auld-Wright K, McHugh Conlin J, Teng K, Tarver T. Occupational therapy interventions using Ayres Sensory Integration® for children and youth (2015–2024): a systematic review. American Journal of Occupational Therapy. 2026;80(1):8001185030. PMID 41324442. Checked October 10, 2026.
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    Studies published between May 2015 and January 2024, participants aged 0 to 21 with sensory processing challenges, evidence levels I and II, occupation- or participation-based outcomes: “Twelve studies (four randomized controlled trials, four nonrandomized group designs, and four single-subject designs) met the inclusion criteria. Strong strength of evidence supports ASI for individual goal attainment and occupational performance. Moderate strength of evidence supports ASI in improving daily living and self-care skills and social, communication, and play skills.”
15. Hearnshaw S, Baker E, Munro N. Speech perception skills of children with speech sound disorders: a systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research. 2019;62(10):3771–3789. PMID 31525302. Checked October 10, 2026.
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    “Across 60 of 73 studies, some or all children with SSDs were reported to have difficulties with speech perception ... children with SSDs have difficulties with speech perception. This appears to be the case for some but not all children with SSDs.”
16. STAR Institute for Sensory Processing. About SPD. Sensoryhealth.org, undated. “We also have a vision of a world where SPD is an accepted diagnosis, is included in diagnostic manuals such as the DSM and ICD, and where treatment is covered by insurance.” Checked October 10, 2026.
17. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. Page dated May 8, 2025. Checked October 10, 2026.
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    The DSM-5 criteria require “at least two of four types of restricted, repetitive behaviors,” one of which is “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).”
18. World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 6A02 Autism spectrum disorder. Release 2026-01. Checked October 10, 2026.
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    Among the features of restricted, repetitive and inflexible behavior: “Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.”
19. Mailloux Z, Mulligan S, Roley SS, Blanche E, Cermak S, Coleman GG, Bodison S, Lane CJ. Verification and clarification of patterns of sensory integrative dysfunction. American Journal of Occupational Therapy. 2011;65(2):143–151. PMID 21476361. Checked October 10, 2026.
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    In 273 children aged 4 to 9 with Sensory Integration and Praxis Tests results, “Exploratory factor analysis identified patterns similar to those found in early studies by Ayres ... namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention.”
20. Pollock N, Missiuna C, McKechnie A, Embrey T. Developmental coordination disorder: dressing. CanChild Centre for Childhood Disability Research, McMaster University, 2012. Checked October 10, 2026.
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    “Children with DCD will often have difficulties with dressing, particularly with fasteners (buttons, snaps, etc.)”; “Relying on vision: Children with DCD do not always get the ‘feel’ of the movement required in a motor task and must rely on vision to help them. This is awkward for some dressing tasks such as doing up snaps on jeans or putting on a sweater or jacket.”
21. Brink AO, Jacobs AB. Kinesthetic sensitivity and related measures of hand sensitivity in children with nonproficient handwriting. Pediatric Physical Therapy. 2011;23(1):88–94. PMID 21304346. Checked October 10, 2026.
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    Sixteen children aged 10 to 12 were tested for kinesthetic sensitivity, discriminate tactile awareness, diadochokinesia, stereognosis and graphesthesia: “No significant difference was found on tests of kinesthetic sensitivity or other measures of sensation ... Children presenting with handwriting difficulty as the only complaint have similar sensitivity in hands and digits as those with proficient handwriting. Failure to detect differences may result from a small sample size.”
22. Riquelme I, Hatem SM, Montoya P. Abnormal pressure pain, touch sensitivity, proprioception, and manual dexterity in children with autism spectrum disorders. Neural Plasticity. 2016;2016:1723401. PMID 26881091. Checked October 10, 2026.
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    Stereognosis, “the ability to perceive and recognize the form of objects by only using tactile information,” was tested with ten common objects while children wore a sleeping mask. In 27 children with ASD and 30 typically developing peers, “Children with ASD showed increased pain sensitivity, increased touch sensitivity in C-tactile afferents innervated areas, and diminished fine motor performance and proprioception compared to healthy children. No group differences were observed for stereognosis.”
23. STAR Institute for Sensory Processing. Your 8 Senses. Sensoryhealth.org, undated. Checked October 10, 2026.
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    “The tactile system is responsible for processing touch information from the body”; the somatosensory cortex “integrates touch, pressure, temperature, and pain.” “The proprioceptive system ... senses the position, location, orientation, and movement of the body muscles and joints. Proprioception provides us with the sense of the relative position of neighboring parts of the body and effort used to move body parts.”
24. Pollock N, Missiuna C, McKechnie A, Embrey T. Developmental coordination disorder: eating. CanChild Centre for Childhood Disability Research, McMaster University, 2012. Checked October 10, 2026.
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    “Judging force and distance: It can be difficult to know how much pressure to use when cutting food and this may result in food flying off of the plate. Not judging the distance of a movement accurately might cause a child with DCD to reach too far for a drink and knock it over”; “Tasks requiring both sides working together, such as cutting with a fork and knife are very hard for a child with DCD.”
25. Centers for Disease Control and Prevention. Keep an Eye on Your Child’s Vision. Page dated May 15, 2024. Checked October 10, 2026.
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    “Your child’s pediatrician will likely screen your child’s vision as part of their regular checkups. If they find signs of a vision problem, they may recommend an eye doctor for a comprehensive eye exam”; refractive errors cause blurred vision; “If you notice your child squinting, rubbing their eyes, or complaining of headaches after doing schoolwork, have their vision checked.”
26. Feder KP, Majnemer A. Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology. 2007;49(4):312–317. PMID 17376144. Checked October 10, 2026.
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    “Fine motor control, bilateral and visual-motor integration, motor planning, in-hand manipulation, proprioception, visual perception, sustained attention, and sensory awareness of the fingers are some of the component skills identified”; “Studies of handwriting remediation suggest that intervention is effective. There is evidence to indicate that handwriting difficulties do not resolve without intervention and affect between 10 and 30% of school-aged children.”
27. Tal-Saban M, Yochman A, Weintraub N, Magen H. The sensory profile of students with probable developmental coordination disorder (DCD). Scientific Reports. 2025;15(1):33270. PMID 41006524. Checked October 10, 2026.
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    225 university students, 63 with probable DCD: “Significant group effects were found on all sensory systems of the AASP, except for taste/smell. Furthermore, students with pDCD showed significantly more deficits on the registration and sensitivity quadrants, even when attention was controlled.”
28. CanChild Centre for Childhood Disability Research, McMaster University. Developmental coordination disorder: management. Canchild.ca, undated. Checked October 10, 2026.
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    “Today, the overall objective of most intervention approaches is not to change the child’s motor abilities but rather to emphasize the development of specific skills in order to promote successful participation in the typical activities of childhood”; the Cognitive Orientation to Occupational Performance “has been shown to be effective in a research clinic setting and, of note, has shown some generalization and transfer of skills”; “tasks with a heavy reliance on integrating feedback from the senses will be more challenging for children with DCD.”
29. Pollock N, Missiuna C, McKechnie A, Embrey T. Developmental coordination disorder: M.A.T.C.H. CanChild Centre for Childhood Disability Research, McMaster University, 2012. Checked October 10, 2026.
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    “When a child with DCD is learning a new task or having difficulties with daily activities, M.A.T.C.H is a helpful framework ... five things that can be done to better match an activity to your child’s abilities”: modify the task, alter your expectations, teach strategies, change the environment, help by understanding.
30. Greninger DA; American Academy of Pediatrics Section on Ophthalmology. Vision Screenings for Babies & Children. HealthyChildren.org, last updated March 31, 2022. Checked October 10, 2026.
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    “Visual acuity screening is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. This involves asking your child how well they can see the details of letters or symbols from a set distance”; “If your child fails a vision screening they usually are referred to an eye doctor.”
31. American Speech-Language-Hearing Association. Classroom Acoustics. ASHA, undated. Checked October 10, 2026.
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    Poor classroom acoustics come from “too much background noise and/or too much reverberation” and can cause problems with how a student “understands speech; reads and spells; behaves in the classroom; pays attention; and/or concentrates”; a quiet room is especially important for a student with “an ear infection or fluid in the ear ... auditory processing disorder; speech and language delay; and/or attention problems.” Ways to quiet a classroom include rugs or carpet, curtains or blinds, soft materials such as felt or corkboard on the walls, turning off noisy equipment and soft tips on chair and table legs.
32. American Speech-Language-Hearing Association. Speech Sound Disorders: Articulation and Phonology. ASHA Practice Portal, undated. “Speech sound disorders (SSDs) refer to any difficulty or a combination of difficulties with perception, motor production, or phonological representation of speech sounds and speech segments.” Checked October 10, 2026.
33. Munasinghe TU, Bhat B, Terband H. Speech perception in children with speech sound disorders: a systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research. Published online August 20, 2026. PMID 42622531. Checked October 10, 2026.
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    Forty-nine papers from 2017 to 2025; seven studies using forced-choice identification were pooled: “The pooled effect size based on 277 participants (SSD: n = 140, typically developing [TD]: n = 137) was statistically significant (Hedges’s g = 0.84, p < .001), indicating that the speech perception scores of children with SSDs are lower than those of TD children.”
34. Mogren A, Rane M, Sigvant J, Carlsson E. Differences in non-word repetition, oral-motor performance and auditory discrimination in children with childhood apraxia of speech (CAS) and speech motor delay (SMD). Logopedics Phoniatrics Vocology. Published online May 18, 2026. PMID 42152575. Checked October 10, 2026.
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    54 children with persistent speech sound disorders (31 with CAS, 23 with SMD) and 39 with typical speech, aged 6 to 16: “The results revealed a difference between children with SSD and children with TSD on all variables ... Children with CAS had a lower PCC and PVC score on NWR and a lower AD score than those with SMD”; assessing auditory discrimination and oral-motor skills “is important for understanding the underlying difficulties of motor speech disorders in children.”
35. Children’s Hospital of Philadelphia. Otitis Media with Effusion (OME). Chop.edu, undated. Checked October 10, 2026.
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    “OME is usually self-limited, which means, the fluid usually resolves on its own within 4 to 6 weeks. However, in some instances the fluid may persist for a longer period of time and cause a temporary decrease in hearing”; it “is commonly underdiagnosed because of its lack of acute or obvious symptoms.”
36. Children’s Hospital of Philadelphia. Otitis Media (Middle Ear Infection). Chop.edu, undated. “Chronic otitis media with effusion (COME): With this condition, the infection clears up, but fluid either stays in the middle ear or returns again and again. As a result, your child may have hearing loss and difficulty fighting new infections.” Checked October 10, 2026.
37. Wilson PH, Ruddock S, Smits-Engelsman B, Polatajko H, Blank R. Understanding performance deficits in developmental coordination disorder: a meta-analysis of recent research. Developmental Medicine & Child Neurology. 2013;55(3):217–228. PMID 23106668. Checked October 10, 2026.
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    “One hundred and twenty-nine studies yielded 1785 effect sizes based on a total of 2797 children with DCD and 3407 typically developing children ... The pattern of deficits suggested several areas of pronounced difficulty, including internal (forward) modelling, rhythmic coordination, executive function, gait and postural control, catching and interceptive action, and aspects of sensoriperceptual function.”
38. Cox LE, Harris EC, Auld ML, Johnston LM. Impact of tactile function on upper limb motor function in children with developmental coordination disorder. Research in Developmental Disabilities. 2015;45–46:373–383. PMID 26299639. Checked October 10, 2026.
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    36 children aged 6 to 12 were assessed for tactile registration, tactile spatial perception, “haptic perception (Stereognosis)” and handwriting; “children with DCD demonstrated poorer localisation of touch in the non-dominant hand ... slower speed of alphabet writing ... and less legible handwriting”; “spatial tactile perception (SPL) predicted handwriting legibility (ETCH: r=0.11) and speed of functional tasks (JTTHF: r=0.33).”
39. Buitenhuis SM, Pondaag W, Wolterbeek R, Malessy MJA. Hand sensibility in healthy young children. Pediatric Neurology. 2018;86:52–56. PMID 30057144. Twenty-five healthy children aged 7 to 11: “All children had a 100% score for both hands in the stereognosis object recognition”; “Objects are recognized well.” Checked October 10, 2026.
40. American Occupational Therapy Association. Practice Smart. AOTA, undated. Recommendation 2: “Don’t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information.” Checked October 10, 2026.
41. 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):7201195030. PMID 29280717. Checked October 10, 2026.
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    “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, the development of the Evaluation in Ayres Sensory Integration® (EASI) has been initiated.”
42. Mailloux Z, Grady-Dominguez P, Petersen J, Parham LD, Roley SS, Bundy A, Schaaf RC. Evaluation in Ayres Sensory Integration® (EASI) vestibular and proprioceptive tests: construct validity and internal reliability. American Journal of Occupational Therapy. 2021;75(6):7506205070. PMID 34792540. Checked October 10, 2026.
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    Six tests in typically developing children (n = 150) and children with sensory integration concerns (n = 84): “the typically developing children group scoring significantly higher on all but one test”; “The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability.”
43. Ender Z, Asqarova S, Balikci A, Mailloux Z. The discriminative validity of the Evaluation in Ayres Sensory Integration® (EASI). Physical & Occupational Therapy in Pediatrics. 2026;46(4):911–925. PMID 41696800. Checked October 10, 2026.
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    The EASI is “a standardized, performance-based assessment of sensory integration functions that underlie children’s participation in daily life.” In 120 children aged 6 to 12, “Children in the SID group performed significantly below their TD peers across all EASI subtests”; subtests of praxis and postural control discriminated most strongly.
44. Gogola A, Wozniak P, Piscova Z, Rubika A, Lukjanenko L, Kaminska I, Gnat R. Reliability of joint position sense and force sense measurements in children with developmental coordination disorder. Journal of Functional Morphology and Kinesiology. 2026;11(1):35. PMID 41562752. Checked October 10, 2026.
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    28 children aged 10 to 15 with medically confirmed DCD completed “joint angle reproduction and differentiation, and force reproduction and differentiation”; “Reliability across all tests and movement directions ranged from good to excellent”; the adapted protocols “demonstrated high intra- and inter-rater reliability in children with DCD, supporting their use in experimental research.”
45. Schoen SA, Lane SJ, Mailloux Z, May-Benson T, Parham LD, Smith Roley S, Schaaf RC. A systematic review of Ayres Sensory Integration intervention for children with autism. Autism Research. 2019;12(1):6–19. PMID 30548827. Checked October 10, 2026.
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    Research from 2006 to 2017 rated against the Council for Exceptional Children standards: “Two randomized controlled trials respectively met 100% and 85% of the CEC criteria items ... Based on CEC criteria, ASI can be considered an evidence-based practice for children with autism ages 4–12 years old.”
46. Nemours KidsHealth. Dysgraphia Factsheet (for Schools). Medically reviewed by Amy W. Anzilotti, MD; reviewed October 2024. Checked October 10, 2026.
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    To help with writing, a student can “Use graph paper, wide-ruled paper, or paper with raised lines,” “Choose the writing utensil they’re most comfortable with (for example, a thicker pencil)” and choose “any special pen/pencil grip”; for tests and assignments a teacher can let the student “Take extra time,” “Type their assignments and test answers” and “Use assistive devices (such as talk-to-text devices).”
47. Lelong M, Zysset A, Nievergelt M, Luder R, Gotz U, Schulze C, Wieber F. How effective is fine motor training in children with ADHD? A scoping review. BMC Pediatrics. 2021;21(1):490. PMID 34736439. Checked October 10, 2026.
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    “Motor deficiencies are observed in a large number of children with ADHD. Especially fine motor impairments can lead to academic underachievement, low self-esteem and frustration”; twelve articles were included, and “All interventions including more than one session were effective in the treatment of fine motor deficiencies in children with ADHD”; “multiple approaches including specific fine motor and cognitive training components, some kind of physical activity, feedback mechanisms, or multimodal treatments can be successful.”
48. Centers for Disease Control and Prevention. Milestones by 5 Years. Page dated May 15, 2026. Checked October 10, 2026.
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    Movement milestones include “Buttons some buttons”; “If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening.”

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. Sensory and motor concerns are best assessed by an occupational or physical therapist who can evaluate your individual child.