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Sensory Integration and Learning From this analysis the authors gener-

ated yet another description of typologies

Disabilities: Ayres' Factor Analyses for sensory integrative dysfunction de-
Reappraised rived from Ayres' work:

• Vestibular bilateral integration dys-

Robert A. Cummins function
• Dyspraxia
• Left hemisphere dysfunction
Between 1965 and 1987 Ayres published eight papers that contain among them 10 • Right hemisphere dysfunction
multivariate analyses that bear upon her conception of sensory integration. These • Generalized dysfunction
analyses purport to have identified factors that emerge from the scores of children
with learning disabilities but not from the scores of academically nondisabled The reason for this diversity of views
children. A reappraisal of these analyses in combination finds no support for this is that Ayres has not attempted to cross-
claim. As a consequence, these data provide no validity for either the diagnostic validate her factors. Each analysis has
procedures or the remedial programs for children with learning disabilities that have been performed on a new combination of
been derived from this work. variables and so has produced a different
set of factors. One consequence of this

A yres has operationalized her concept

of sensory integration by conduct-
ing multivariate studies on the percep-
wood & Rutherford, 1980)
• Postural and bilateral integration (Ot-
tenbacher & Short, 1985)
is that factor labeling becomes a critical
issue. Since none are identical in com-
position, it might be assumed that all of
tual-motor performance of children with the factors would have been given unique
learning disabilities (Cermak, 1988). Of The most comprehensive review of labels, but that is not so. Whereas some
particular relevance is a series of factor Ayres' factor analytic work was pub- factor labels have certainly been unique
analyses from which Ayres claimed to lished by Clark, Mailloux, and Parham to individual studies and have contrib-
have identified perceptual-motor factors (1985). Those authors examined the emer- uted to the diversity of views mentioned
that emerge from the scores of children gent factors and concluded as follows previously, other labels have been more
with learning disabilities but not from the (P. 379): commonly employed.
scores of normally learning children. The In the absence of cross-validated fac-
perceptual-motor content of these factors • Apraxia: "Emerged in nearly all the tors between studies, this use of common
has been used to provide both the format studies in which dysfunctional children factor labels is of special interest. It
and the rationale for diagnostic and made up the sample." implies that factors with a similar and
remedial programs (e.g., Ayres, 1968, • Deficits inform and space perception: distinctive variable composition have
1975, 1979). "Were more varied, and the configura- emerged from different studies. Indeed,
Of concern, however, is the diversity tion and patterns of the clusters sug- the previously cited reviewers of Ayres'
of opinion among reviewers of Ayres' gested that there were at least two studies appear to have made just that
studies as to the precise nature and kinds of visual perceptual problems. assumption when searching for factor
nomenclature of the factors she dis- The first seemed to be related to soma- typologies.
covered. Although there seems to be a tosensory processing, the second to It seems timely, therefore, to reexamine
majority opinion in favor of four factors functions associated with the right Ayres' data and to question these con-
(i.e., Praxis, Form and Space Perception, hemisphere." clusions, which assume a simple relation-
Tactile Defensiveness, and Bilateral In- • Deficits in postural and bilateral inte- ship between factor labels and factor
tegration), not all reviewers agree, and gration: "Emerged relatively consis- composition. This will be achieved by
several other factor names have been sug- tently and in later studies were linked identifying the groups of similarly named
gested. Some examples are to vestibular dysfunction." factors and examining each group to
• Auditory language dysfunctions: determine (a) their distinctive, common
• Tactile, kinesthetic, and visual percep- "Seemed to bifurcate in the same way content, (b) whether their common con-
tion dysfunction (Abbie, 1974) that visual spatial perception had. One tent distinguishes them from factors that
• Auditory language problems (Wilson, type seemed to be related to the left have been differently labeled, and (c)
1975) hemisphere and did not seem to be re- whether their common content distin-
• Praxis and tactile functions (Kimball, lated to sensory integrative processes. guishes between scores derived from
1977) The second type was found in associa- children with learning disabilities and
• Vestibular and bilateral integration tion with vestibular dysfunction and nondisabled children.
(Clark & Shuer, 1978) poor bilateral integration."
• Left hemisphere dysfunction and right • Tactile defensiveness: "In nearly every An Overview of Ayres' Studies
hemisphere dysfunction (Clark & study a strong association between tac-
Shuer, 1978) tile defensiveness and hyperactivity Between 1965 and 1987 Ayres pub-
• Unilateral cerebral dysfunction (Grim- was found." lished eight papers that contain among

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them 10 multivariate analyses. All are
concerned with the relationships between Subject Characteristics in Ayres' Multivariate Analyses
sensory and motor skills, with academic
skill variables sometimes being included Studies 1965 1965 1966a 1966c 1969 1971 1972b 1977 1987
as well. The broad characteristics of these Age range 5-10 5-8 4-0 4-0 6-1 5-10 7-6 6-0 4-0
studies are outlined in Table 1. There are 8-0 7-11 8-0 8-0 9-10 10-0 10-0 10-0 9-11
only nine columns because two different IQ 71- ? ? ? X 70- 70- ? ?
analyses were conducted on the scores of 139 93 132 132
the same children in 1972 (Ayres, 1972b). Academic
All children were aged between 4-0 and Disabled (N) 100 - 7 - 36 148 148 128 172
Nondisabled (N) - 50 93 64 - - - - -
10-0 years, were of normal intelligence Cerebral
(where this was reported), and comprised Palsy (N) - - 3 - - - - - -
a mixture of males and females (where Males (%) 69 70 ? ? 81 74 74 80 65
reported). Females (%) 31 30 ? ? 19 26 26 20 35
Variables (N) 36 36 19 19 64 48 46 19 19
Of the 10 studies, 9 were factor analy- Loading cutoff
ses and 1 a multiple regression. The latter for factor None None None
study (1971) will be considered separate- definition 0.3 0.3 used used 0.4 - 0.2 0.3 used
ly, as will the most recent factor analysis
Note. ? = not reported.
(Ayres, Mailloux, & Wendler, 1987). The
other eight analyses will be considered as
a group, with a view to comparing their 2. Raw scores/Ipsative scores. While this report contained one analysis that in-
factor structures. six of the factor analyses have used the volved children with "suspected dysfunc-
The factor analyses differed from one conventional raw scores derived from tion" and another analysis on nondis-
another on a number of dimensions as each test, the 1969 analysis and one of abled children. From the former group,
follows: the 1972b analyses used ipsative scores. Ayres located five factors that "were in-
1. Nondisabled/Learning disabled. This process led to the emergence of terpretable as hypothesized behavioral
Three of the studies (1965, 1966a, 1966c) quite different factor structures, as will correlates of patterns of neurological
involved nondisabled children. The 1965 be seen from the 1972b study, which per- dysfunction" (p. 345). From the nondis-
sample was "chosen from public and formed both raw score and ipsative score abled children, on the other hand, she
private schools and child care centers on analyses on the same set of data. For found that the emergent factors "on the
the basis of parental occupation so as to future reference, the studies involving whole were not comparable to the major
represent proportionately the working raw scores will be designated as (R), factors emerging from the dysfunction
population of the United States" (p. 339). while those using ipsative scores will be group." This apparent difference be-
In 1966c, all were adopted children liv- designated (I). tween factor structures from the two
ing in middle socioeconomic class fami- 3. Loading cut-off. As shown in Table groups led Ayres to hypothesize that in
lies. The 1966a children, however, were 1, the studies differed somewhat in the the case of the dysfunctional group
a bit different. Of the 92 subjects, Ayres minimum size of the variable loading "these factors were not due to normal
reported that "approximately 10 per cent that was used to define the content of developmental processes but to underly-
could be considered to have possible cen- factors. For comparative purposes, all ing deficits in specific mechanisms of
tral nervous system dysfunction" (p. 68). studies will be standardized such that a integration, resulting in symptom com-
No further information on these chil- minimum loading of 0.30 is required for plexes" (p. 465).
dren's specific problems was given, but any variable to be considered part of a Over the next 12 years Ayres con-
it seems likely that their disorders were factor. ducted six more analyses that sought to
minimal. In addition, three children had 4. Variables. Of the 113 different vari- validate the emergence of such "symptom
mild cerebral palsy. Since such a mixture ables used in these studies, only 8 were complexes" from the scores of children
of children would not be uncommon common to all analyses, while 50 were with learning disabilities. The labels or
within any unselected group of regular used on just one occasion each. A de- descriptions that Ayres gave to the fac-
school children, for the purposes of scription of the variable names and their tors from all of these analyses are shown
future comparisons the children from test protocols can be found in Ayres in Table 2. Where a simple label has been
1966a will also be considered nondis- (1965, 1966a, 1969). attached to a factor, such as "Praxis,"
abled. The remaining five studies all in- this label has been used. Where a factor
volved children with academic disabilities has not been named, but only described,
who had been classified as such using a EXAMINATION OF THE the major variables involved in the de-
variety of criteria. For future reference, FACTOR LABELS scription have been used as the title.
the studies involving children who are What is immediately clear from this
nondisabled will be designated (N) and Ayres' first two factor analyses (1965) listing is that relatively few factor titles
those involving children who are aca- set the conceptual stage for all of the or descriptors have emerged on more
demically disabled will be designated (D). analyses to follow. As shown in Table 1, than one occasion. To summarize:

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TABLE 2 It is interesting to relate these labels to
Factor Labels or Descriptions those actually used to describe the emer-
gent factors (see Table 2). With the possi-
Labels/ 1965 1965 1966a 1966c 1969 1972b 1972b 1977
Descriptions DR NR NR NR Dl DR Dl DR
ble exception of "Praxis," it seems rather
extravagant to claim their general emer-
Praxis (or apraxia) X X X X X gence. "Auditory language problems" was
Form and space perception X X X used as a label on only two occasions,
Tactile defensiveness X X X
whereas on no occasion had any factor
Bilateral integration X
Figure-ground been designated as a disorder of postural,
discrimination X X ocular, and bilateral integration.
General perceptual-motor
and cognitive ability X
Visual perception X INDIVIDUAL FACTORS
Visual motor X
Interaction of sides of body Using Table 2 as a guide, each similar-
with tactile perception X ly labeled group of factors will now be
Auditory, language, examined to determine the nature of their
and sequencing X
Postural and bilateral
common content.
integration X
Left-side coordination, Praxis
posture, and bilateral
integration X
According to Meulders (1983), the
Academic achievement
and sensory perception X
concept of praxia derives from apraxia,
Auditory/visual association the latter term being defined by Liep-
and horizontal perception X mann (1908) as the impossibility of per-
Auditory, language, and forming intentionally certain movements,
intelligence X or sequences of movements, in spite of
Postural and ocular
the integrity of the primary motor path-
Reading, spelling, ways and the conservation of most of the
and intelligence X X elementary or automatic motor functions.
Eye-hand dominance and In the context of sensory integration
left-eye dominance X
theory, the term praxia is used to de-
Left-hand vs. right-
hand coordination X
scribe the ability to plan motor acts. The
Auditory-language deficit is usually referred to as develop-
problems X X mental dyspraxia, which Ayres et al.
Kinesthesia X (1987) describe as being caused by dis-
Somatosensory X ordered sensory integration resulting in
Use of one hand in
contralateral space
poor development of the ability to motor
Auditory-perception X
plan or to sense what sequence of move-
Uninterpreted factor X X ments will be needed in order to accom-
plish a motor task. According to Vezie
Note. D = Learning disabled; N = Normal; R = Raw scores; I == Ipsative scores.
(1975) it also implies that while specific
motor skills may be learned through
repetition, the growth of generalized
• One factor label ("Praxis") has emerged parameters to be considered functionally ability to motor plan is lacking.
five times. related aspects of human behavior. It is Ayres has claimed that this factor
• Three factors have emerged three times. hypothesized that they reflect neural sys- tends to emerge more readily from the
• Three factors have emerged on two tems in which disorder has been found in data of children with LD than from non-
occasions. children with learning problems" (p. 94). disabled children—an important finding,
• The remaining 19 factor labels have The terms Ayres (1972a) used to des- if true. Unfortunately, evaluating this
been used by Ayres on only one occa- ignate the five factors were: claim on the basis of Ayres' data is not
sion each. easy, for reasons that can be seen in
1. Disorder in postural, ocular, and bi- Table 3. There, under "A," are listed the
Despite this lack of consistency, in 1972a lateral integration compositions of all five factors Ayres has
Ayres summarized her findings as fol- 2. Apraxia labeled as "Praxis." (Note that a key im-
lows: "From the author's statistical anal- 3. Disorder in form and space perception mediately follows this table.) It can be
yses . . . five factors emerged with suffi- 4. Auditory-language problems seen that of the 32 variables included at
cient frequency and similarity of operative 5. Tactile defensiveness one time or another, only 5 have been

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included on three or more occasions, 17
have been included on two or more oc- The Variable Composition off Praxis
casions, and the remaining 15 have ap-
peared only once. A B C

1965 1966a 1972b 1972b> 1977 1965 1966c 1969

Definition of the Praxis Factor Variables DR NR DR Dl DR Deffn NR NR Dl

Wire grommet
Even a casual glance at the five fac- manipulation 1 7.5 X X X . X X
tors under "A" will indicate their very S.Calif.Mot.Acc. Test 2 3 X X X . 7 X
heterogeneous composition. Ayres has Posture duplication 3.5 1 2.5 1 1 .. 2 12
proposed a content definition for these Finger identification 3.5 7.5 3.5 •• 7
praxis factors, which will be discussed Graphesthesia 5 5 . 1
Single stimulus
later. First, the factors will be examined localization 6 4 3.5 .. 8.5 11
for their similarity of content. Stereognosis 7 X 3.5 . 6 1
Table 3 permits the formulation of an Eye-motor coordination 8.5 X X X 6 X X
operational definition based on common Two-point discrimination 8.5 X X X X X X

elements: Praxis may be defined in terms Face-hand test 10 6 9 3.5 •• 3

Time and rhythm 11 X X X X X X
of those variables that have loaded 0.30 String winding 12 X X X X X X
or higher, on more than one occasion, Visual figure-ground 13 13.5 • 4 4
within a factor named by Ayres as Superimposed figures 14 X X X X X X
"Praxis." In terms of the data in Table Eye pursuit 15 X X X

3 (A), this definition has been used to Vertical perception 16 X X X X X

provide two different definitional struc-

Design copying 17.5 X 6 • X
Kinesthetic memory 17.5 9 • 8.5
tures: a "hard" definition, consisting of Space relations 15 X X X 1 X
only those variables that have appeared Form constancy 12 X X X 5 X
on three or more occasions (marked •• Bilateral motor control X 2 5 2 •• X 5
under column B), and a "soft" definition, Standing balance-eyes
consisting of variables that have been in-
open 10 7.5 • X 5
Tactile defensiveness 11 2.5 X .
cluded at least twice (designated • in col- Position in space 13.5 3 • X
umn B). Each of these two operational Hyperactivity 16 1 X •
definitions has then been applied back to Right-left discrimination 17 X

the five praxis factors to gauge the ex- Hands crossing body
tent of their internal conformity, both in
midline X 4 4 . 2
Muscle co-contraction X X 7.5 X X
terms of the 5 "hard" and the 17 "soft" Standing b a l a n c e -
definitional variables indicated under eyes closed X 10 X
"B." Ayres space test 11
ITPA sound blending X X 5.5 X X
Unfortunately, this process is compli-
Muscle tone X X 5.5 X X
cated by the fact that each of the studies
to be compared failed to include some Note. A = those factors labeled by Ayres as "Praxis"; B = hard (••) or soft (•) definitional
of the definitional variables. For exam- variables; C = factors not labeled by Ayres as "Praxis," but being the factor in that study
with a variable structure most conforming to the definitional variables; D = data from dis-
ple, the 1965 study did not include the
abled children; N = data from nondisabled children; R = raw data; I == ipsatized data
variable "Bilateral motor control" and so The variable list comprises all variables loading 0.3 or more on the Praxis factors under
it was not available to form part of the "A." It is not a complete list of variables comprising the factors under" C." Each blank space
Praxis factor in that study. To compen- in the table indicates that the variable was used irl the study but did not load 0.30 or above
sate for such differences, the extent of on the factor. Each "x" in the table indicates that the variable was not used in the par-
ticular study, and therefore could not have formed part of the factor. Numbers in the table
definitional conformity has been judged
indicate the rank order of variable loading s within each factor. The variable numbered " 1 "
only on the basis of the definitional had the highest loading, and equally ranked loadings are indicated as the combined rank
variables available to each study. Thus, midpoint.
the extent of definitional conformity, for
both the hard and soft definitions, is ex-
pressed as a percentage calculated as: In other words, definitional conformity tween studies, ranging from 40% to
is to be judged only on the basis of the 100% for the hard definition and from
% conformity = — x ^ definitional variables available to each 27% to 100% for the soft definition. In-
study. terestingly, the only factor to contain
P = Number of definitional variables The results of these calculations are 100% conformity with both hard and
included within the named factor. shown in the upper-left-hand quadrant soft definitions was derived from the
Q = Number of definitional variables of Table 4. As can be seen, there are con- scores of nondisabled children (1966a).
included within the study. siderable differences in conformity be- These discrepancies are highlighted by

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TABLE 4 On the basis of these calculations it is
Conformity Between Actual and Definitional Factor Structures for Praxis apparent that the factor labeled by Ayres
as "Interaction of sides of body with tac-
Hard Soft Ayres' tile perception" (1966c) has, in fact, a
definition definition definition
greater claim to be called "Praxis" than
Soft any of the factors so named, since the
Study P Q % P Q % Loading % % Loading % nine Praxis variables made up 100% of
1965 DR 4 4 100 11 16 69 68 70 40
the factor loadings. It must again be con-
1966a NR 5 5 100 14 14 100 87 89 47 cluded that Ayres' factor titles and fac-
Factors Named 1972b DR 3 5 60 8 15 53 78 27 25 tor compositions are not in accord. The
"Praxis" 1972b Dl 2 5 40 4 15 27 75 18 34 major question, however, is whether the
1977 DR 4 5 80 5 13 38 - 33 - Praxis factor can be used to distinguish
Factors with 1965 NR 1 4 25 3 16 19 40 20 31 between the scores of academically dis-
Other 1966c NR 4 5 80 9 14 64 100 67 66 abled and nondisabled children. In this
Names 1969 Dl 2 5 40 4 14 29 - 33 - regard Ayres has claimed that one of the
Note. P = Number of definitional variables included within the Praxis factor; Q = Number
"clearest differences" between the factors
of definitional variables included within the study. derived from nondisabled and dysfunc-
% = P x 100 tional children is "the failure for the
Q 1 dimension of praxis . . . to appear as
Soft Loading % = Loading contribution of the soft definitional variables (A) to the total separate factors in the normal group"
loading of variables (0.30 or above) on the factor. (1966c, p. 289).
Ayres Loading % = Loading contribution of Ayres' definitional variables to the total loading
of variables (0.30 or above) on the factor.
The data presented in Table 4 show
quite clearly that this is not so. In terms
of either the number of Praxis variables
a comparison with the three studies the Praxis factor. Loading is a measure or their relative loadings onto the factors,
wherein Ayres did not name a Praxis fac- of the extent to which each variable con- it can be seen that Praxis may emerge
tor. In each of these studies the factor tributes to the factor, a high loading in- either strongly or weakly from the scores
has been selected that most closely con- dicating a major contribution. The "Soft of either group. It is interesting to see,
forms to the operational definition of Loading %" is the contribution of the indeed, that the two factors carrying the
Praxis. The names that Ayres had given soft definitional variables to the total highest Praxis loadings (1966c-NR and
these factors are as follows: variable loadings on the'factor. For ex- 1966a-NR) are both derived from the
ample, in 1965-DR, the Praxis factor was scores of nondisabled children.
1965-NR General perceptual-motor composed of 18 variables in all, and their
and cognitive ability combined numerical loading amounted Ayres' Definitions
1966c-NR Interaction of sides of body to 806. The 11 soft definition variables
with tactile perception found within this factor structure had a Ayres has provided a verbal descrip-
1969-DI Postural and bilateral inte- combined numerical loading of 552. The tion of the Praxis factor composition on
gration contrasted with Praxis proportion of the total loading contri- a number of different occasions (1963,
buted by the definitional variables is 1965, 1966a, 1967, 1971, 1972a, 1972b,
The extent to which these factor com- then: 1977). In general these descriptions re-
positions conform with the hard and soft 552 100 flect the heterogeneous factor composi-
definition criteria is set out in the lower Soft Loading % — x - r = 68% tion displayed in Table 3, with not one
oUo 1
left quadrant of Table 4. And what is description being totally consistent with
clear from these comparisons is that, In other words, the soft definitional vari- any other. The two most recent descrip-
despite Ayres' labeling procedures, two ables made up 68% of the total variable tions are as follows.
of these differently named factors cor- loadings onto this factor. Ayres (1972a) defined the "Syndrome
responded to the ideal Praxis structure Two further matters require clarifica- of developmental apraxia" primarily by
just as well as the 1972b-DI factor that tion in these calculations: (1) In the ip- a deficit in the variable Imitation of
had been labeled as Praxis. In fact, the sative data comprising 1972b-DI, the Postures. Other, related deficits were
differently named 1966c-NR factor cor- numerical loadings were summed regard- stated to be in the Motor Accuracy Test
responded to the definitional composi- less of sign. (2) Loading percentage could and Bilateral Motor Coordination, Tac-
tion better than three of the named not be calculated for either 1969-DI or tile Tests, Kinesthesia, Extraocular Mus-
Praxis factors. 1977-DR. In the former case the variable cle Control, and Behavior Problems. It
Further data relevant to these com- loadings were not given, while in the is difficult to reconcile this definition
parisons are presented in the column latter study "composite" variables were with Table 3. Of the seven variable types,
labeled "Soft Loading %" (see Table 4). used in the analysis, thereby rendering only two were included on three or more
The basis of these calculations is the the loadings noncomparable with those occasions (Posture Duplication and Bi-
numerical loading of each variable onto of previous analyses. lateral Motor Control), three had been

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included on two occasions, and Extra- definition than factors labeled otherwise. (Position in Space, Ayres* Space Test,
ocular Muscle Control (i.e., eye pursuit) But most importantly, the application of Figure-ground Perception, and Design
had been included only once. In addi- Ayres' definition to these data failed to Copying), with the soft definition in-
tion, the three other hard definitional discriminate the scores derived from chil- cluding three more (Kinesthetic Memory,
variables had been excluded. dren with learning disabilities and non- Stereognosis, and ITPA-Visual closure).
On the most recent occasion (1977), disabled children. It must be concluded Table 5 shows the degree of conformity
Ayres labeled a factor as Praxis and com- from these data that there is no evidence between the actual number (%) or vari-
mented: "Most apraxic children show the that a factor of Praxis emerges more able loading (soft loading %) of defini-
symptoms complex that appears as Fac- readily from the data of children with tional variables within the factors.
tor D in Table 2. These children usually learning disabilities as compared to those In terms of the hard definition, six of
have low scores on IP and tactile tests of of nondisabled children. eight studies contained a factor that in-
the SCSIT [Southern California Sensory cluded 100% of the available variables.
Integration Test]. The more severe cases Ayres, Mailloux, and Wendler However, it should be noted that two of
usually score poorly on Kinesthesia and (1987) these came from the scores of nondis-
SVCU" (p. 366). That statement trans- After an interval of 10 years, Ayres abled children, and the 1977-DR factor
lates into the following list of variables: reported another factor analysis, which had been labeled by Ayres as "Auditory
(1) Figure Ground, (2) Position in Space, confirms that a simple Praxis factor does language functions." Using the soft def-
(3) Ayres Space Test, (4) Right-Left Dis- not reliably emerge from the scores of inition, one certainly finds a more ap-
crimination, (5) Illinois Test of Psycho- children with learning disabilities. This propriate separation. However, the two
linguistic Ability (ITPA) Visual Sequen- study was not included in the previous distributions did overlap and the factor
tial Memory, (6) Posture Duplication, (7) group analysis because a quite different Ayres labeled "Visual Perception" (1966a-
Stereognosis, (8) Graphesthesia, (9) Sin- set of test scores were used. They in- NR) from nondisabled children exceeded
gle Stimulus Localization, (10) Face- cluded six different measures of praxis the "Form and Space Perception" factor
Hand Test, (11) Kinesthetic Memory, and a number of scores derived from from 1972b-DI.
and (12) Space Visualization Contra- combinations of the individual tests listed When the factor loadings are compared
lateral Use (SVCU). in Table 3. (soft loading %), it can again be seen
The following points are relevant to Three factors emerged from the data. that, though they tend to favor the
this list: One was labeled "Kinesthesia," a title named factors from groups with learn-
Ayres has used once before, in the 1972b- ing disabilities, the five top scores are
• Two variables (5 and 12) have never DI study (see Table 2). Another was separated by only 15 percentage points,
formed a significant part of a Praxis labeled "Auditory memory," which Ayres and two of these five come from non-
factor. has not used before. But the major fac- disabled children.
• Two variables (3 and 4) have formed tor, which included in its composition the In conclusion, these data do not pre-
part of the Praxis factor on only one praxis measures and a mixture of other sent convincing evidence that a Form and
occasion each. Hence they did not scores, was labeled "Visuosomatopraxis Space Perception factor could be used to
even rate inclusion in the soft defini- function with elements linked by concept reliably separate the scores of children
tion formulated earlier. formation" (abstract). Although the with learning disabilities and nondisabled
• Two other variables (Finger Identifica- precise meaning of this factor may be children.
tion and Bilateral Motor Control) have obscure, the conclusion that may be
been omitted, even though they were drawn is not. As the authors conclude, Ayres' Definition
included in three out of five of the fac- this study failed to support the emergence
tors labeled by Ayres as Praxis. of a unitary Praxis factor from the scores Ayres provided a verbal description of
Despite these shortcomings, the same of children with learning disabilities. this factor on six occasions (1963, 1965,
calculations have been performed using 1967, 1971, 1972a, 1972b). While these
these 12 definitional variables as were are fairly heterogeneous, she makes it
FORM AND SPACE clear that a central component comprises
reported using the hard and soft defini- PERCEPTION
tions. Once again, "%" refers to the pro- variables measuring form and space per-
portion of 12 variables available to the The analyses of this and subsequent ception across the three modalities of
study that were included in each Praxis factor compositions will omit the tables visual, tactile, and kinesthetic perception.
factor. "Loading %" refers to the loading that show the variable composition for In 1972a, Ayres defined the factor as
contribution of the available definitional each; these may be obtained from the consisting of the variables "visual form
variables to each factor. The results of author on request. and space perception, kinesthetic memo-
the calculations are presented on the right The investigation of this factor pro- ry, stereognosis, visual figure ground
side of Table 4. ceeded in the same manner described for perception and perception in other sen-
As can be seen, the pattern of results Praxis. A "Form and Perception" factor sory modalities that involve some kind
is quite similar to that of the operational has been named by Ayres on three occa- of form perception" (p. 191). This is con-
definition. Again, the factors labeled as sions (1965, 1972b-DR, 1972b-DI). The sistent with the soft definition that has
Praxis show no greater conformity to the hard definition involved four variables been investigated.

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TACTILE DEFENSIVENESS alertness of distractibility, the flight-like does not support the use of tactile defen-
One apparently unique feature of behavior of hyperactivity, and a tendency siveness as a diagnostic device.
Ayres' theory is the idea that children toward negative affect (flight)" (1972a,
with learning disabilities suffer from Tac- p. 255). It should be noted, however, that BILATERAL INTEGRATION
tile Defensiveness. This is described as Head's dichotomy has not been experi-
physical or emotional discomfort when mentally validated (Miller, 1978, pp. Whereas Ayres described factors by
touched by an examiner during tests of 318-324). the simple terms "Bilateral integration"
tactile perception (see Ayres, 1965, for The investigation of this factor pro- (1965-DR) and "Postural and bilateral in-
a description of the testing procedure). ceeded as before, with two minor modi- tegration" (1969-DI) on one occasion
Ayres has described this condition in fications: first, that no factor has been each, on two other occasions she used
considerable detail (1964, 1966b, 1972a) included from 1977-DR, because the key terms that seem to implicate Bilateral In-
and uses the work of Head (1920) as her variables of Tactile Defensiveness and tegration as a central component. These
theoretical basis. Head proposed a duality Hyperactivity were not included in the are:
in the cutaneous systems: The "Proto- study. Second, due to the small number 1966c-NR "An interaction of function
pathic system," so named because of its of shared variables between the three fac- of the two sides of the body
supposedly primitive characteristics, tors Ayres labeled as "Tactile Defensive- with emphasis on tactile
serves to protect and warn the organism ness," only the soft form of the opera- perception" (p. 288).
against potential harm. The "Epicritic tional definition has been produced. 1969-DI(2) "Poorer coordination on
system" is concerned with higher, dis- The calculations shown in Table 6 the left than on the right
criminatory functions. have been performed as before. Once side of the body along with
Ayres used this presumed dichotomy again, it is clear that the definitional deficiencies in postural and
to reason that the tactile defensive reac- variables are unable to reliably differen- bilateral integration" (p.
tions in children with learning disabilities tiate either between factors carrying the 166).
are caused by the dominance of the pro- title of "Tactile defensiveness" or between
topathic system. Hence, tactile stimuli the scores of children who are academi- It should be noted that two of these fac-
imposed upon these children warn them cally disabled and children who are non- tors are drawn from the 1969 study and
of "danger" and this leads to the "over- disabled. This lack of discrimination will be referred to as (1) and (2), re-
It can be seen from Table 7 that once
again the operational definition fails to
TABLE 5 discriminate between the scores of non-
Conformity Between Actual and Definitional Factor Structure for Form and Space Perception disabled children and children with learn-
Hard Soft ing disabilities. It can also be seen that
definition definition Soft Ayres' labeling of factors as "Bilateral In-
Loading tegration" seems to bear little relationship
Study P Q % P Q % to their variable content.
Factors Named 1965 DR 4 4 100 6 6 100 51
"Form and 1972b DR 4 4 100 7 7 100 62 FIGURE-GROUND
Space Perception 1972b Dl 4 4 100 5 7 71 64
1965 NR 1 4 25 1 6 17 13
Factors with 1966a NR 3 3 100 3 4 75 49 Ayres has asserted on a number of oc-
Other Names 1966c NR 3 3 100 3 5 60 58 casions (1963, 1975) that Figure-Ground
1969 Dl 2 3 67 2 6 33 — Discrimination is a factor that discrimi-
1977 DR 4 4 100 4 7 57 - nates between children with learning dis-
abilities and nondisabled children. It is
curious to note, therefore, that a factor
Conformity Between Actual and Definitional Factor Structures for Tactile Defensiveness
has only been given this simple designa-
tion on two occasions (1965), when it was
Definition found to emerge once each from the
scores of nondisabled children and chil-
Study %
dren with learning disabilities.
Factors Named 1965 DR 100 75
"Tactile 1966c NR 60 81
Defensiveness" 1972b Dl 80 43
1965 NR 20 49 REACTIONS
Factors with 1966a NR 100 29
Other Names 1969 Dl 40 According to Ayres, "postural mecha-
1972b DR 60 32
nisms are among the more important

166 Journal of Learning Disabilities

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Moreover, the interpretation in terms
Conformity Between Actual and Definitional Factor Structures for Bilateral Integration of degrees of dysfunction is highly
equivocal, as no pathology has been
Definition shown to be linked to the levels of
Study P Q % % functioning on these variables.

Factors Named 1965 DR 2 6 33 61

These deficiencies render the multiple
"Bilateral 1966c NR 6 6 100 67
Integration" 1969 Dl(1) 2 7 29 - regression analysis uninterpretable, pri-
1969 Dl(2) 4 7 57 — marily because the composition of the
independent variables (factors and levels
1965 NR 2 6 33 76
of dysfunction) cannot be determined
Factors with 1966a NR 5 5 100 31
Other Names 1972b DR 2 7 29 19 from the available data. As a conse-
1972b Dl 2 7 29 35 quence, this study will not be given fur-
1977 DR 1 7 14 - ther consideration.

areas of assessment of children with (Ayres 1965, 1969) for identification of pat- SUMMARY
learning disorders" (1972a, p. 98). In- terns of syndromes of perceptual-motor dys-
function, each child was assigned a system or Between 1965 and 1977 Ayres published
deed, a very substantial component of her
syndrome score indicative of the degree of the results of eight factor analyses. The
remedial program is directed to this area.
dysfunction in five hypothesized neural sys- data from these studies had been derived
Specific therapeutic targets are the inhibi-
tems. (p. 329, emphasis added) from a variety of perceptual-motor and
tion of primitive reflexes, increased
other tests applied to either children with
functioning of antagonistic muscle con-
The five "hypothesized neural systems" learning disabilities or nondisabled chil-
traction, development of muscle tone,
that were defined by the children's "syn- dren. The factors that emerged were
improved extraocular muscle control,
drome scores" were as follows: claimed to discriminate between the two
and vestibular system functioning.
groups of children and have subsequently
While Ayres has labeled factors as
1. Postural and bilateral integration formed the basis of an elaborate diagnos-
"Postural and Ocular Reactions" on three
2. Praxis tic and remedial training protocol for
occasions, this factor is unfortunately not
3. Functions of the left side of the body children with learning disabilities.
amenable to analysis. The variables com-
4. Form and space perception This claim, that the data from children
mon to the named factors are not suffi-
5. Auditory-language functions with learning disabilities gives rise to
ciently represented within the other
characteristic factor structures, has not
studies for comparisons to be made.
In relation to Ayres' claim that the results been adequately tested. The claim is
from the 1965 and 1969 studies could be made solely on the basis that certain fac-
EVIDENCE FROM MULTIPLE used to divine "previously factorially tor labels, such as Praxis, have been dif-
REGRESSION determined criteria," the following points ferentially applied to data derived from
If one desires to validate the hypoth- can be made: such children. Factor labels, however,
eses arising from a factor analysis, then are fairly arbitrary devices that do not
a useful approach is to employ another 1. Neither study cited yielded all five fac- necessarily reflect true factor content.
multivariate technique, called multiple tors, and each yielded factors other The present paper explored the relation-
regression. This statistic seeks to "ex- than the ones listed. ship between factor labels and factor
plain" a single known, observed, and 2. The 1969 report contained two analy- content in Ayres' studies.
measured dependent variable in terms of ses, one using raw data and one us- The investigation of these data pro-
groups of independent variables. In other ing ipsative data. The factors derived ceeded in a multistep process. Initially the
words, the factors discovered by factor from each form of analysis differed eight analyses were scanned for common
analysis can be tested for explanatory not only between the two analyses but factor labels. Seven labels were found to
power against some other performance also differed from the 1965 analysis. have been used on more than one occa-
variable. 3. Ayres separated the syndrome scores sion each. Each group of similarly labeled
Ayres has used multiple regression for within each factor into three classes, factors was then examined to determine
this purpose on one occasion (1972b). depending on the "frequency and whether their content could be used to
Unfortunately, the result from that study severity of the disorder" indicated by reliably distinguish them from other fac-
is rendered uninterpretable due to the the score. Thus, each factor was sub- tors. The core of common content within
uncertain composition of the independent divided in terms of the "degree of each group was identified as those vari-
variables that were generated according dysfunction" into definite, mild, or ables that loaded 0.30 or more onto each
to the following procedure: none. Unfortunately, this separation factor. These core clusters were then
further confuses the picture, because compared against the content of other
By perusing the scores of each child and us- no criteria are provided for the alloca- factors using two approaches. The first
ing previously factorially determined criteria tion of scores into each category. involved a simple numerical comparison

Volume 24, Number 3, March 1991 167

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of the number of core variables also ABOUT THE AUTHOR Ayres, A.J. (1971). Characteristics of types of sen-
found in other factors. The second com- sory integrative dysfunction. American Journal
pared the accumulated factor loadings of Robert A. Cummins, PhD, is senior lecturer in psy- of Occupational Therapy, 25, 329-334.
chology at Victoria College-Toorak. In addition he Ayres, A.J. (1972a). Sensory integration and learn-
the core variables with the same variable ing disorders. Los Angeles: Western Psychological
is principal investigator with the Disability Program
loadings found in other factors. In each Evaluation Unit, which has major responsibility for Services.
case, no evidence was found for any evaluating government services to people with in- Ayres, A.J. (1972b). Types of sensory integrative
variable cluster that could reliably dis- tellectual disabilities in Victoria. His research and dysfunction among disabled learners. American
tinguish the similarly labeled factors writing activities focus on debunking remedial Journal of Occupational Therapy, 26, 13-18.
education myths, the effects of deinstitutionaliza- Ayres, A.J. (1975). Sensorimotor foundations of
from other factors that had been dif- tion, and quality of life measurement. Address: academic ability. In W.M. Cruickshank & D.P.
ferently named. Robert A. Cummins, Victoria College-Toorak, PO Hallahan (Eds.), Perceptual and learning dis-
A different approach to this discrimi- Box 224, Malvern, Victoria 3144, Australia. abilities in children (Vol. 2, pp. 301-358). New
nation problem used Ayres' definitions York: Syracuse University Press.
to determine the optimal variable content Ayres, A.J. (1977). Cluster analysis of measures of
sensory integration. American Journal of Occupa-
of the similarly named factors. Compari- tional Therapy, 31, 362-366.
sons using these different sets of defin- Ayres, A.J. (1979). Sensory integration and the
ing variables yielded no better result. AUTHOR'S NOTE child. Los Angeles: Western Psychological Services.
Again, these variable clusters could not Ayres, A. J, Mailloux, Z.K., & Wendler, C.L. W.
reliably distinguish the similarly named An extended version of this paper is available from (1987). Developmental dyspraxia: Is it a unitary
the author on request. function? Occupational Therapy Journal of Re-
factors from some other factors that car-
search, 7, 93-110.
ried different names. Cermak, S.A. (1988). Sensible integration. Ameri-
It was concluded that there is a lack can Journal on Mental Retardation, 92, 413-414.
of consistency between Ayres' factor Clark, F.A., Mailloux, Z., & Parham, D. (1985).
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