A newly published South African study invites us to look more carefully at what we mean when we say that a child has “sensory difficulties”.
Perhaps more importantly, it reminds us why a questionnaire alone is not a sensory integration assessment.
Published in the South African Journal of Occupational Therapy, Nicola van Ravenswaay, Gina Rencken and Pragashnie Govender examined sensory integration patterns in 35 children with confirmed learning differences attending a short-term remedial school in KwaZulu-Natal.
The researchers brought together information from the Evaluation in Ayres Sensory Integration® (EASI), the Sensory Processing Measure (SPM) and the Family Life Impact Questionnaire (FLIQ).
That combination matters because it allowed them to look beyond how children appeared to respond to sensory experiences. They considered sensory perception, praxis, postural control and bilateral integration alongside sensory reactivity and the impact of these differences on everyday family life.
What did they find?
Within this small group, 71.4% of children showed difficulties with bilateral integration and sequencing, 42.9% showed a pattern described as somatodyspraxia and 42.9% had difficulties involving tactile and vestibular perception. Auditory, tactile and visual sensitivities were also reported, alongside difficulties with praxis and postural control that could be relevant to classroom participation.
At home, sensory experiences were linked to planning, responses to auditory and olfactory input, daily living, social participation, and community engagement.
These percentages are interesting. But I do not think they are the most important part of the paper.
The more interesting question is what we mean by “sensory integration” in the first place.
Sensory integration is much more than modulation
Sensory processing can easily become shorthand for whether someone appears overresponsive, underresponsive, or sensory-seeking.
Those experiences matter, but sensory integration is much more than modulation.
Our nervous systems continually need to register sensory information, discriminate and perceive what that information means, integrate information across sensory systems and use it to support posture, movement, timing, bilateral coordination, body awareness and praxis.
Praxis becomes important when we have an idea, work out what our body needs to do and organise a new or unfamiliar action. Sensory discrimination helps us gain accurate information about our body and the world around us. Postural and bilateral functions support apparently ordinary activities such as sitting at a desk, stabilising a page, using both hands together, dressing, writing, cutting, climbing, moving around the playground or joining a game.
Sensory responsiveness matters too. But responsivity, perception, discrimination, postural control and praxis are related processes, not interchangeable explanations.
This is one reason a sensory questionnaire can provide valuable information about someone’s sensory experiences without, on its own, being able to tell us which underlying sensory integrative processes may be contributing to participation.
The authors themselves highlight the value of a comprehensive assessment that considers sensory perception, praxis, and sensory reactivity, alongside the impact on family life.
Notice before we interpret
There is an important caution here.
This was a retrospective study of only 35 children attending one particular remedial school. There was no comparison group.
We therefore cannot conclude that differences in sensory integration caused these children’s learning differences. Nor should the percentages be read as prevalence figures for children with learning differences more generally.
Importantly, the study does not show that every child demonstrating one of these patterns requires Ayres Sensory Integration® intervention.
Assessment should help us ask better questions, not simply give us another label.
Imagine a child struggling to copy information from the board. Visual perceptual demands might be contributing. Another child might find maintaining postural stability effortful. Another might have difficulty sequencing an unfamiliar motor action. Someone else might be trying to work while managing competing sensory information around them.
But there are other possibilities too.
A child may understand perfectly but need more processing time. They may be exhausted, hungry or anxious. They may not understand what is expected. The activity might feel meaningless. They may be worried about getting it wrong. The classroom may simply be asking too much of them at that particular moment.
And, of course, several of these things may be happening together.
This is why observation and interpretation need to remain separate for long enough for us to stay curious.
Behaviour is the observation.
It is not yet the explanation.
Connecting sensory findings with participation
This is where the South African paper becomes particularly relevant to occupational therapy.
The researchers did not stop with sensory test performance. They also considered family impact and described consequences within daily living, social participation and community participation. Collaboration with caregivers and educators, environmental modification and everyday occupation remain part of the wider clinical picture.
That changes the conversation.
Rather than beginning with “What sensory dysfunction does this child have?”, we can begin with the person and their participation.
What do they want, need, or expect to do? What sensory information is available to them while they are doing it? Can they register and discriminate the information they need? What does the activity require in terms of posture, bilateral integration, sequencing and praxis?
Then we can widen the lens further. What is happening in the environment? What does the child tell or show us about their experience? What are their family, teachers or other people who know them well noticing? What happens before, during and after the activity?
Most importantly, what is happening to participation?
These questions help us move from identifying a sensory difference towards understanding what that difference might mean in the context of an individual person’s life.
Looking through the PEAR TREE™ Lens
The South African study was not research into PEAR TREE™, and it would be inappropriate to suggest that it validates the Lens.
It does, however, illustrate why sensory assessment cannot meaningfully sit outside context.
Through the PEAR TREE™ Lens, we can hold the Person, Environment, Activity and Relational Response together while we think.
The Person brings far more than a sensory score. There is sensory perception and responsivity, movement and praxis, but also health, communication, interests, strengths, previous experiences, preferences and the person’s own understanding of what is happening.
The Environment contributes sensory information, opportunities and barriers. Some information may help the person know where they are and what to do. Other information may compete, overwhelm or make an already demanding activity harder.
The Activity matters because sensory processing occurs in service of doing something. Reading from a board, putting on a jumper, eating lunch, joining football, writing a sentence and navigating a busy corridor all make different demands on the nervous system.
And then there is the Relational Response. What are the people around the person doing? Are we creating safety, predictability, time and opportunity? Are we listening? Are we changing the environment or the activity where we can? Or are our responses unintentionally adding another layer of demand?
From there we can triage what needs further exploration, evaluate what happens in everyday life and keep agency, ethics and meaningful participation visible.
The wider South African issue makes the conversation even more interesting
Two other papers published in the same issue broaden this thinking beyond sensory processing alone.
A study from Rwanda involving 86 autistic children examined not only whether children participated in more activities following individualised intervention, but also their enjoyment, preferences, and playfulness. Participation and playfulness improved, while changes in activity preferences were less clear.
It is a subtle but important distinction.
Doing more is not necessarily the same as wanting to do more.
Participation cannot be understood through frequency alone. We also need to be curious about enjoyment, choice, engagement and meaning.
Another paper explored occupational identity and competence in autistic adults. It reminds us that sensory environments sit within much bigger questions about whether someone can work, connect with other people, pursue interests, exercise autonomy and build a life that feels like their own.
Read together, these papers gently shift the conversation.
They take us from sensory symptoms to sensory integration, from scores to formulation, and from intervention to participation. They ask us to consider not only whether someone can perform an activity, but whether there is enjoyment, choice and meaning in doing it. And they extend the sensory conversation beyond childhood towards identity and meaningful occupation across the lifespan.
So, what might this change in practice?
Perhaps the biggest message is not that we need to assess more.
It is that we need to connect the information better.
A standardised assessment can tell us something important. A questionnaire may reveal something different. Observation can help us see what happens during everyday activity. The child or adult can tell or show us what the experience feels like. Families know what happens before and afterwards. Teachers and other people alongside the person may notice patterns across different environments and activities.
None of these perspectives automatically replaces the others.
When we bring them together thoughtfully, we can move beyond saying, “They have sensory difficulties.”
Instead, we can begin to say:
“Here is what we are noticing. Here is what the person experiences. Here are the sensory integrative processes we may need to understand more fully. Here is what this particular environment and activity are asking of them. Here is what happens when other people respond in different ways. And here is how all of this may be influencing meaningful participation.”
That is a much richer place from which to begin thinking together.
Because sensory integration was never only about modulation.
And sensory support should never be reduced to making somebody look more regulated.
Ultimately, the question is not simply whether we can change the person’s sensory responses.
It is what might help this person feel safe enough, organised enough, understood enough and supported enough to participate in the things that matter to them.
Reference
van Ravenswaay, N., Rencken, G., & Govender, P. (2026). Patterns of sensory integration dysfunction in children with confirmed learning differences attending a short-term remedial school in KwaZulu-Natal. South African Journal of Occupational Therapy, 56(2), 1–12. https://doi.org/10.17159/2310-3833/2026/vol56no2a7