An Overview of the
T
Sensory Integration
and Praxis Tests
Zoe Mailloux
Key Words: pediatrics test construction
tests, by title, Sensory Integration and
Praxis Tests
This paper reviews the Sensory Integration and
Praxis Tests (SIPT) (Ayres, 1989b), including its his-
tory and development, standardization, reliability,
validity, and intelpretation. Based on decades of
theory development and earlier standardized tests,
the SIPT represents a sound assessment tool for the
evaluation of sensory integration and praxis in chil-
dren. The SIPT's implications for thefield of occupa-
tional therapy are important and widespread. This
article serves as an introduction to other papers in
this issue that have used the SIPT as a research tool.
Zoe Mailloux, MA, OTR, is Director of Administration and
Practice at the Ayres Clinic, 1514 Cahrillo Avenue, Tor-
rance, California 90')01. She is also AdjunCl Instructor in
the Occupational Thel-apy Department, University of-
Southern California, Los Angeles
This article was accepted for puiJlication FebrllGl]' 20, 7990.
Tbe AmeriCallJournal of Occupational TberapJ'
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he Sensory Integration and Praxis Tests (SIPT)
(Ayres, 1989b) represents a culmination of A.
Jean Ayres's lifework. Based on theoretical
concepts and research hypotheses that evolved over
three decades, the SIPT is one of the most sophisti-
cated and psychometrically sound assessment tools to
have emerged not only from within the field of occu-
pational therapy but from any field that assesses chil-
dren's development. As such, the SIPT signals an im-
portant turning point, not only in relation to the
theory of sensory integration, but also for the entire
occupational therapy profession. According to Ayres,
"a science is marked by the quality and degree to
which it measures the parameters of its field. Measur-
ing instruments are critical tools for acquiring knowl-
edge and it is difficult to acqUire knowledge without
them. The more precisely behavior is measured the
better it is unclerstood" (1989a, p. xi)
The purpose of this paper is to prOVide an over-
view of the SIPT, including a discussion of its devel-
opment, standardization, validity, reliability, and in-
terpretation. This paper is also meant to serve as an
introduction to the other papers in this issue that dis-
cuss the use of the SIPT as a research tool.
History and Development of the SIPT
The SIPT, which evolved from an earlier group of
tests designed to measure sensory integrative func-
tion, was first presented as indiVidual tests during the
1960s (Ayres, 1962, 1964, 1966a, 1966b, 1968) and
later published as the Southern California Sensory In-
tegration Tests (SCSIT) (Ayres, 1972, 1980) and the
Southern California Postrotary Nystagmus Test
(SCPNT) (Ayres, 1975) Altbough these tests were
criticized for their small, local normative sample sizes
and some questionable reliability factors, they were
used Widely within the fields of occupational therapy
and physical therapy and were described as clinically
useful by therapists wbo used them to assess children.
In 1978, Ayres began developing new methods of
measuring praxis, an area of great clinical and re-
search interest to her. In the early 1980s, Rush Univer-
Sity of Chicago offered Ayres assistance in collecting a
national normative sample for the SCSIT, and Sensory
Integration International in Torrance. California, ex-
pressed interest in helping her to coordinate reliabil-
ity and validity studies. These proposals, in addition
to a commitmeOl by Western Psychological Services
in Los Angeles to undertake the standardization and
publication process, lecl Ayres to develop and stan-
dardize a new set of tests, which came to be called the
SIPT. This name was chosen to reflect a continued
focus on basic sensory processing and integration as
well as a heightening interest in the process and
function of praxis.
589
 The parameters assessed by the SCSIT and its
precursors were based on Ayres's early interest in
brain function as it related to learning and behavior.
Her postdoctoral studies at the Brain Research Insti-
tute and Division of Child Development at the Univer-
sity of California, Los Angeles, led her to develop the
early concepts of sensory integration theory. These
ideas had their roots in early neuropsychological and
neurobiological premises proposed by such re-
searchers as Head (1920), Schilder (1950), Bender
(1956), Denny-Brown (1958), and Nielson (1946).
From the work of these and other researchers, Ayres
focused her interest on such concepts as body
schema, the relationship between sensory perception
and movement, and praxis. This interest led her to
develop the SCSIT and, later, the SIPT.
Two early studies (Ayres 1965, 1969a) that exam-
ined relationships between a number of perceptual-
motor, postural, auditory-language, and behavioral
measures resulted in analyses that led to the selection
of tests that later became the subtests of the SCSIT.
Some parameters believed to be clinically useful,
such as assessment of tactile defensiveness and gravi-
tational insecurity, were not included due to difficulty
in the reliable measurement of these functions. The
SCSIT was used in a number of factor analyses con-
ducted during the I960s and 19705. These studies
formed one of the bases of validity for the subtests of
the SCSIT, because they revealed similar patterns of
dysfunction across studies.
The subtests from the SCSIT that had demon-
strated poor reliability, had been less helpful in form-
ing conclusions, or were difficult to administer were
excluded from the SIPT. The subtests from the SCSIT
that were to be included in the SIPT were changed to
facilitate administration and improve reliability. The
SCPNT was included with the SIPT to form the Post
rotary Nystagmus subtest and four new praxis tests.
The rationale for including Postrotary Nystagmus as
part of the SIPT was based on the consistency with
which inefficient processing of vestibular sensory
input by the central nervous system was seen in asso-
ciation with learning and other neurological dis-
orders. The praxis tests were developed in part from
research on adult-onset apraxia. Aspects of praxis that
were thought to contribute most to developmental
dyspraXia, such as imitation of positions, translation of
verbal directions into action, sequencing of move-
ments, and two- and three-dimensional construction,
were used to design the new praxis tests (Ayres,
1989b).
Extensive field and pilot tests were conducted in
the early 1980s, mostly in Southern California and
Chicago. Initial versions of the tests were lengthy and
often reqUired 30 min to 1 hr each to administer.
Three criteria were used in the se lection of the final
590
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tests and the individual test items: (a) the capacity of
items to distinguish between children without dys-
function and those identified as exhibiting dysfunc-
tion; (b) evidence of a logical association between
items and functions under assessment, as determined
by a factor analysis; and (c) the reliability of the test
and test items (Ayres, 1989b). The final version of the
SIPT comprises 17 tests designed to assess sensory
perception and the processing of the vestibular, pro-
prioceptive, tactile, and visual systems as well as sev-
eral aspects of praxis (see Table 1). The primary pur-
pose of the SIPT is to proVide diagnostic and descrip-
tive information related to sensory integrative and
praxis functions in children.
The SIPT requires approximately 2 hr to admin-
ister and an additional 30 to 45 min to score. Com-
pleted computer score sheets are sent to Western Psy-
chological Services (WPS) for computer weighting of
scores and determination of standard scores based on
relevant norms. The examiner then receives a full-
color plotted profile of the child's scores, called the
WPS ChromaGraph, and a computer-generated test
report that can be used to compile a professional
evaluative report. Formal training in the administra-
tion and interpretation of the SIPT is highly recom-
mended for the appropriate use of the tests. Such
training is currently available through Sensory Inte-
gration International and through the occupational
therapy programs at several universities.
Test Standardization
The selection of normative data collectors involved
the solicitation of applicants from all over the United
States and Canada, the rating of applicants on speci-
fied criteria, and the selection of qualified examiners
who would have access to defined communities. The
selected examiners and alternates were trained on the
administration and scoring of the SIPT and were then
tested on their skills in workshops held in six loca-
tions around the country. A final group of 100 occupa-
tional therapists and physical therapists were selected
as the normative data collectors for the SIPT.
The 1980 U.S. Census was used to determine the
criteria that would ensure appropriate representation
of the U.S. population in the normative sample. The
variables considered were age, sex, ethnicity, type of
community (i.e., urban versus rural), and geographic
location. The final normative sample comprised 1,997
children, aged 4 years 0 months to 8 years 11 months,
with an almost equal number of boys and girls. The
children in the sample were selected from nine geo-
graphic divisions speCified by the U.S. Census; 73%
were from urban areas, and 27% were from rural areas.
The ethnic distribution of the children was as follows:
Caucasian, 78%; Black, 12%; Hispanic, 6%; Asian, 2%;
and Other, 2% (Ayres, 1989b).
.ful)' 1990, Volume 44, Numher 7
 Table 1
Functions Measured by the Sensory Integration and
Praxis Tests
_ _~__F_u_n_c_ti_on D_escriptiOn
Space Visualization Mowrfree visual space
perception; mental
manipulation of objects.
Figure-Ground Perception Motorfree visual perception
of figures on a rival
background.
Manual Form Perception Identification of block held in
hand with visual
counterpart or with block
held in other hand.
Kinesthesia Somatic perception of hand
and arm position and
movement.
Finger Identification Tactile perception of
individual fingers.
Graphesthesia Tactile perception and practic
replication of designs.
Localization of TaCtile Tactile perception of specinc
Stimuli stimulus applied to arm or
hand.
Praxis on Verbal Command Ability to motor-plan body
postures on the basis of
verbal direCtions withom
visual cues.
Design Copying Visuopractic ability to copy
simple and complex two
dimensional designs, and
the manner or approach
one uses w copy designs.
ConstruCtional Praxis Abi !ity to re late objects to
each other in three
Jimensional space.
Postural Praxis Ability to plan and execute
hody movements and
positions.
Oral Praxis Ability to plan and execute
lip, tongue, anJ jaw
movements
Sequencing Praxis Ability to repeat a series of
hand anJ tinger
movements.
Bilateral Motor Coordination Ahility to move both hands
and both feet in a Sl1lo()[h
and integrated pattern.
Standing and Walking Static and dynamic balance
Balance on one or hath feet with
eyes Opel) and closed.
Mowr Accuracy Eye-hand coordination and
control of movement.
Post[Otary Nystagmus Central nervous system
proc 'sing of vestibular
input 'lssesseJ through
0l.i;l~iva~jon of the duration
and integrity of a vestlbu:"
ocular renex.
, Based on the test manual for Sensory fntcgraliol/ ,md Praxis Tests
(Ayres, 1989b) and Sensory I ntegration I nlernationa I's (989) 5fPT
fnterpretation Course Manual.
Preliminary analyses of the normative data with a
multivariate analysis of variance revea1ed significant
age and sex differences; therefore, separate norms
were established for boys and girls in 12 age groups
(4-moruh intervals for children aged 4 years 0 months
to 5 years 11 months, and 6-month intervals for chil
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dren aged 6 years 0 months to 8 years 11 months)
Multiple discriminant analyses were used with a
matched sample of 352 children without dysfunction
and children with sensory integrative or learning dis
orders to establish appropriate weighting procedures
for time and accuracy scores. Those weights that best
discriminated between the children without dysfunc
tion and the children with dysfunction across age
grou ps were used (Ayres, 1989b) Table 2 lists the
major scores and all of the partial scores for the 17
subtests of the SIPT.
Test Reliability
The reliability of a test is a measure of its consistency
and stability over time Or in various testing situations.
Test reliability includes consideration of errOr related
to variability in human performance and test imper
fections (Deitz, 1989). The two types of reliability
reported for the SIPT are test-retest and interrater
reliability.
Test-retest reliability studies of the SIPT were
conducted by several researchers and involved a sam
ple of 41 children with some type of disability and 10
children without dysfunction The retest interval was
1 to 2 weeks. The test-retest reliability coefficients for
the major test scores on the 17 subtests of the SIPT
ranged from 48 10 .93, but only 5 of the tests had
coefficients below .70 Generally, the praxis tests had
the highest test-retest reliability, and the reliability of
the other tests was considered to be in the acceptable
range (Ayres, 1989b) Several factors may have af
fected the test-retest reliability of some of the sub
tests of the SIPT. First, the sample size was small, and
secone!, the sample was predominated by children
with dysfunction. A third factor was the nature of the
assessed functions in the SIPT Because these tests
evaluate neural functions that are likely to be some
what unstable, especially in children with learning or
sensory integrative disorders, it might be expected
that test-retest reliability would be less than optimal
in this small sample made up mostly of children with
dysfunction Nonetheless, the test-retest reliability
should be considered in the interpretation of the test
results, especially for those tests in which lower test
retest cot:fftcicnrs were obtained
lnterrater reliability studies Joc the ~lP 1 il:volved
several research projects, with a total of eight exam
iners. The total sample consisted of 63 children (19
with reading disorders, 41 with other learning disabil
ities, and 3 with spina bifida). Interrater reliabilitywas
determined with two trained examiners who scored
each child's performance on each of the subtests of
the SIPT The inrerrarer reliability coefficients for all
of the major SIPT scores were between ,94 and ,99,
thus demonstrating thar trained examiners are likely
591
 Table 2
Major and Partial Scores for the Subtests of the Sensory Integration and Praxis Tests
SUbteSl Major Score" Partial Score

Space Visualization Timeadjusted accuracy Accuracy

Time
Contralateral use
Preferred hand use
Figure-Ground Perception Accuracy Time
Manual Form Perception Total accuracy Total lime
Part I accuracy
Pan I right accuracy
Part I left accuracy
Pan I time
Part I right time
Part I left time
Part II accuracy
Part 11 right accuracy
Part II left accuracy
Part 11 time
Part II right time
Part II Jefl time
Kinesthesia Total accuracy Right hand accuracy
Left hand accuracy
Finger Identification Total accuracy Right hand accuracy
Left hand accuracy
Graphesthesia Total accuracy Right hand accuracy
Left hand accuracy
Localization of Tactile Stimuli Total accuracy Right hand accuracy
Left hand accuracy
Praxis on Verbal Command Towl accuracy Toral lime
Design Copying Total accuracy Adjusted accuracy
Part I accuracy
Part [I accu racy
Constructional Praxis Total accuracy Parr I accuracv
Part II accuracy
Postural Praxis Total accuracy
Oral Praxis Total accuracy
Sequencing Praxis Total accuracy Hand accuracy
Finger accuracy
Bilateral Motor Coordination Total accuracy Arm accuracy
Feet accuracy
Standing and Walking Balance Total score Eyes open
Eyes closed
Right fOOl
l.eft foot
Motor Accuracy Weighted total Unweighted total accuracy
accuracy Preferred hand weighted accuracy
Preferred hand unweighted accuracy
Nonpreferred hand weighled accuracy
Nonpreferred hand unweighted
accuracy
Postrotary Nystagmus Average nystagmus Average clockWise
Average counterclockwise
Time 1 clockwise
Time 1 counlerclockwise
Time 2 clockwise
Time 2 counterclockwise

, (Ayres, 1989b). "This score was used in all anaJy:;es ::ild is the lest score plotted on the child's Western Psychological Services Chroma
Graph.

to obtain similar results when administering the SI PT
(Ayres, 1989b).
Test Validity
"Validity information indicates the degree to which
the test is capable of achieving certain aims" (Issac &
Michael, 1981, p. 120) The primary aims of the SIPT
are to evaluate the sensory integrative and praxis abili
ties of children and to guide the treatment of such
disorders (Ayres, 1989b) To address the extent to
which the SIPT achieves its aims requires the consid-
eration of not only the analyses related specifically to
the SIPT but also of the larger body of work upon
which the SIPT was built.

592 July 1990, Volume 44, Number 7

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 " '
The content validity of an assessment helps to
answer the question, "How well does the content of
the test sample the kinds of things about which con-
clusions are to be drawn?" (Issac & Michael, 1981, p.
119). Content validity for the SIPT was established
through the work that led to the development of the
SCSIT, use and refinement of the SCSIT, use of cur-
rent research in related areas, and consultation with a
group of experts in the field of sensory integration in
preparation for the development of the SIPT. This
process is documented in detail in the SIPT manual
(Ayres, 1989b).
Construct validity refers to the ability of a test to
assess theoretical constructs (Dunn, 1989). In rela-
tion to the SIPT, Ayres stated that "identification of
sensory integrative processes and the organization of
related behavioral parameters into a meaningful theo-
retical construct have been accomplished through
statistical analyses, from the study of clinical and basic
brain research, and from several decades of clinical
experience" 0989b, p. 197). Thus, the construct va-
lidity of the SIPT encompasses a large body of work.
Numerous factor analyses conducted during the 1960s
and 1970s laid the framework for the theoretical con-
structs that underlie the SIPT. (A summary of this re-
search can be found in the SIPT manual [Ayres, 1989b]
and in Clark, Mailloux, and Parham, 1989.) Numerous
factor analyses were performed with SIPT scores from
various configurations of samples. Three of the factor
analyses thought to be most representative of the
overall analyses are published in the SIPT manual.
These factor analyses generally demonstrate the
emergence of factors that can be seen as logically
related to past groupings of scores, with the addition
of new factors specifically reflecting the inclusion of
additional measures of praxis. Cluster analyses pro-
vided an additional means of determining whether or
not the tests successfully identified clinically impor-
tant groupings of individuals. Six cluster groups that
reflect both above-average and below-average perfor-
mance on the SIPT were identified. The fact that these
groups were shown to be significantly different from
each other, that they could be logically related to
groupings of test scores seen in the factor analyses,
and that they were felt to have clinical significance
contributes to the construct validity of the SIPT as a
whole. In addition to the factor and cluster analyses,
an important aspect of the construct validity of the
SIPT is its ability to differentiate children without
dysfunction from those with dysfunction. Preliminary
studies comparing SIPT performance in various popu-
lations (including children with language disorders,
mental retardation, traumatic brain injury, spina bi-
fida, cerebral palsy, sensory integrative dysfunction,
and autism) demonstrated some interesting patterns
of SIPT scores. Additionally, each of the subtests of
The American Journal of Occupational Therapy
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the SIPT discriminated between children without
dysfunction and those with dysfunction at a statisti-
cally significant level (p < .01) (Ayres,1989b).
Criterion-related validity considers how well a
test compares to external variables that are measures
of the function being tested (Issac & Michael, 1981).
Concurrent validity is a type of criterion-related va-
lidity that compares measures thought to be similar or
related. Numerous earlier studies compared SCSIT
performance with such tests as the Luria-Nebraska
Neuropsychological Battery (Kinnealey, 1984; Su &
Yerxa, 1984), the Bruininks-Oseretsky Test of Motor
Proficiency (Ziviani, Poulsen, & O'Brien, 1982), the
Bender-Gestalt Test (Kimball, 1977), and the Gesell
Developmental Quotients (Ayres, 1969b). Several
studies comparing the SIPT with other assessments
are included in this issue; others are in the final stages
of completion. Thus, the area of concurrent validity of
the SIPT is in the early stages of being revealed; it will
involve numerous studies.
Predictive validity is another type of criterion-
related validity that allows forecasts of future perfor-
mance based on current test scores. At least one major
study examining the predictive validity of the SIPT is
in its final stages of completion (Parham, 1989)
Interpretation
Interpretation of the SIPT requires several sources of
information. Perhaps foremost is an adequate knowl-
edge base in neurobiological and neuropsychological
theories and research, on which the SIPT is founded.
A solid understanding of statistics and test and mea-
surement theory is also needed to use and understand
the test scores and configurations. An appreciation of
each of the subtests of the SIPT, including their
strengths and weaknesses, is needed to evaluate their
meaning appropriately. Comprehension of the factor
and cluster analyses is necessary for the identification
of meaningful score patterns. Finally, when the SIPT
is used as part of an occupational therapy evaluation,
an ability to translate the test findings into implica-
tions for daily liVing is essential.
Conclusion
The SIPT comprises a set of well-developed assess-
ments aimed at the comprehensive evaluation of sen-
sory processing and praxis function in children. The
development and publication of this test clearly rep-
resents a turning pOint in the area of test development
within the field of occupational therapy. Although the
SIPT's full worth will be determined in the years to
come, its value is already evident in the standard it
sets for future test designs and the impetus it creates
for new research activity. ..
593

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