3.2 Pediatric Developmental & Sensory Assessments
Key Takeaways
- The PDMS-2 evaluates gross and fine motor skills from birth through 5 years 11 months using established Basal (three consecutive 2s) and Ceiling (three consecutive 0s) rules across six subtests.
- The BOT-2 assesses motor proficiency from 4 years through 21 years 11 months across four motor composites: Fine Manual Control, Manual Coordination, Body Coordination, and Strength & Agility.
- For infants born prematurely (<37 weeks gestation), chronological age must be adjusted for prematurity on developmental assessments such as the Bayley-4 until the child reaches 24 months of age.
- The Beery VMI assesses visual-motor integration via geometric copying; supplemental Visual Perception and Motor Coordination subtests isolate whether deficits stem from visual processing, motor control, or integration.
- Dunn's Sensory Profile 2 classifies sensory processing patterns into four distinct quadrants based on neurological threshold (high vs. low) and behavioral response strategy (passive vs. active): Seeking, Avoiding, Sensitivity, and Registration.
Last updated: August 2026
Pediatric Developmental & Sensory Assessments
Standardized pediatric assessments enable occupational therapists to evaluate developmental progress, quantify motor and visual-perceptual delays, analyze sensory processing differences, and determine eligibility for early intervention or school-based services under IDEA (Individuals with Disabilities Education Act).
1. Comprehensive Developmental & Motor Batteries
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| PEDIATRIC MOTOR BATTERIES COMPARISON |
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| Assessment | Age Range | Primary Focus & Composite Structure |
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| **Bayley-4** | 16 days to 42 months | Comprehensive developmental milestones: |
| | | Cognitive, Language, Motor, Social- |
| | | Emotional, Adaptive Behavior |
+-----------------------+-----------------------+-----------------------------------------+
| **PDMS-2** | Birth to 5 years | Gross & Fine Motor quotients: Reflexes, |
| | (0 to 71 months) | Stationary, Locomotion, Object |
| | | Manipulation, Grasping, Visual-Motor |
+-----------------------+-----------------------+-----------------------------------------+
| **BOT-2** | 4 years to 21 years | Motor proficiency & athletic skills: |
| | 11 months | Fine Manual Control, Manual Coord, |
| | | Body Coord, Strength & Agility |
+-----------------------+-----------------------+-----------------------------------------+
Peabody Developmental Motor Scales (PDMS-2)
The PDMS-2 is an early childhood motor assessment evaluating fine and gross motor skills from birth through 5 years 11 months (0 to 71 months).
- Subtests (6 Total):
- Reflexes (Birth to 11 months only: primitive reflexes and automatic reactions)
- Stationary (Sustained body control, balance, center of gravity equilibrium)
- Locomotion (Crawling, creeping, walking, running, jumping, hopping)
- Object Manipulation (≥ 12 months only: throwing, catching, kicking balls)
- Grasping (Fine motor grasp patterns, finger control, manual dexterity)
- Visual-Motor Integration (Eye-hand coordination, building blocks, copying designs)
- Composite Quotients: Gross Motor Quotient (GMQ), Fine Motor Quotient (FMQ), and Total Motor Quotient (TMQ) (Standardized with mean of 100, SD of 15).
- Scoring & Testing Rules:
- Each item scored 0 (child cannot or will not attempt), 1 (resemblance to item criterion/emerging skill), or 2 (mastery/criterion fully met).
- Basal Level: Established when the child scores 2 on three consecutive items before the first 1 or 0.
- Ceiling Level: Established when the child scores 0 on three consecutive items; testing is discontinued for that subtest.
Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
The BOT-2 evaluates motor proficiency, coordination, and strength in individuals aged 4 years 0 months through 21 years 11 months.
- 4 Motor Area Composites & 8 Subtests:
- Fine Manual Control: Fine Motor Precision (drawing lines, folding paper) & Fine Motor Integration (copying geometric designs).
- Manual Coordination: Manual Dexterity (sorting cards, stringing beads) & Upper-Limb Coordination (catching, throwing, dribbling tennis ball).
- Body Coordination: Bilateral Coordination (jumping jacks, tapping feet/hands) & Balance (standing on balance beam, heel-to-toe walking).
- Strength & Agility: Running Speed & Agility (shuttle run, stepping over hurdles) & Strength (push-ups, sit-ups, standing broad jump).
- Scoring Output: Yields scale scores (mean 15, SD 5), composite standard scores (mean 50, SD 10), percentile ranks, and age equivalents. Available as Complete Form (comprehensive diagnostic evaluation) and Short Form (screening).
Bayley Scales of Infant and Toddler Development (Bayley-4)
The Bayley-4 is an individually administered developmental battery for infants and toddlers aged 16 days to 42 months.
- 5 Core Domains:
- Directly Administered: Cognitive Domain, Language Domain (Receptive & Expressive Communication), Motor Domain (Fine & Gross Motor).
- Caregiver Questionnaires: Social-Emotional Domain, Adaptive Behavior Domain.
- Prematurity Correction Formula: For infants born before 37 weeks gestation, testing must utilize the adjusted age (corrected age) rather than chronological age until the child reaches 24 months of age:
2. Visual-Perceptual & Visual-Motor Assessments
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| BEERY VMI THREE-TEST DIAGNOSTIC MODEL |
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| BEERY VMI (Full Form) |
| (Integrates Visual Perception + Motor Output) |
| | |
| +--------------------------+--------------------------+ |
| | | |
| ▼ ▼ |
| VISUAL PERCEPTION SUPPLEMENT MOTOR COORDINATION SUPPLEMENT |
| (Point/Match Shapes - Motor-Free) (Draw Lines in Paths - Motor Output Only)|
| | | |
| • Low Score = Visual Processing Deficit • Low Score = Fine Motor Control Deficit |
| • Normal Score = Visual Perception Intact • Normal Score = Motor Control Intact |
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Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI, 6th Ed)
- Target Age: 2 years 0 months through 99 years 11 months (Full Form: 30 items); Short Form (21 items) for ages 2 to 7 years.
- Primary Function: Assesses the extent to which individuals can integrate visual and motor abilities by copying a developmental sequence of geometric forms (e.g., vertical line, horizontal line, circle, cross, square, diagonal lines, triangle).
- Standardized Supplemental Subtests:
- Visual Perception Subtest: Identifies matching geometric shapes without requiring drawing/motor skills.
- Motor Coordination Subtest: Draws lines within restricted geometric boundaries/mazes.
- Clinical Diagnostic Value: If a child scores poorly on the main VMI, the supplemental subtests isolate whether the root impairment is purely visual-perceptual, purely fine motor coordination, or an integration deficit between the two systems.
Test of Visual-Perceptual Skills (TVPS-4)
- Target Age: 5 years 0 months through 21 years 11 months.
- Administration Format: Completely motor-free (multiple-choice pointing/verbal).
- 7 Subtests Evaluated: Visual Discrimination, Visual Memory, Spatial Relationships, Form Constancy, Sequential Memory, Visual Figure-Ground, and Visual Closure.
3. Sensory Processing Frameworks & Assessments
Sensory processing assessments identify how sensory modulation, registration, and discrimination affect functional participation across home, classroom, and community environments.
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| WINNIE DUNN'S SENSORY PROCESSING FRAMEWORK |
+-----------------------+-----------------------------------+---------------------------------------+
| NEUROLOGICAL | BEHAVIORAL RESPONSE STRATEGY: | BEHAVIORAL RESPONSE STRATEGY: |
| THRESHOLD | PASSIVE (Acts in accordance) | ACTIVE (Counteracts threshold) |
+-----------------------+-----------------------------------+---------------------------------------+
| **HIGH THRESHOLD** | **LOW REGISTRATION / BYSTANDER** | **SENSORY SEEKING / SEEKER** |
| (Needs lots of input | • Misses cues, oblivious | • Constantly moving, fidgeting |
| to trigger firing) | • Lethargic, slow to respond | • Touches everything, makes noises |
| | • Unaware of messy face/hands | • Craves intense sensory input |
+-----------------------+-----------------------------------+---------------------------------------+
| **LOW THRESHOLD** | **SENSORY SENSITIVITY / SENSOR** | **SENSORY AVOIDING / AVOIDER** |
| (Fires with minimal | • Easily overwhelmed & distracted | • Withdraws, leaves noisy rooms |
| sensory input) | • Complains of tags, textures | • Establishes rigid rituals |
| | • Hyper-reactive to stimuli | • Refuses messy play, covers ears |
+-----------------------+-----------------------------------+---------------------------------------+
Sensory Profile 2 (Winnie Dunn)
- Standardized Caregiver & Teacher Questionnaires: Infant (Birth to 6 mos), Toddler (7 to 35 mos), Child (3 to 14 years 11 mos), Short Form, and School Companion (Teacher form for ages 3 to 14 years).
- Quadrant Profiling: Classifies scores into Much Less Than Others, Less Than Others, Similar to Others, More Than Others, or Much More Than Others across Seeking, Avoiding, Sensitivity, and Registration.
Sensory Processing Measure (SPM & SPM-2)
- Contextual Triad: Home Form (completed by parent), Classroom Form (completed by primary educator), and School Environments Form (evaluates Art, Music, PE, Cafeteria, Recess, and Bus).
- Key Diagnostic Feature: Highlights environmental/contextual discrepancies. For instance, a child with low registration or sensory defensiveness may function well in a calm, structured home environment but demonstrate severe dysregulation in a high-stimulus cafeteria or gymnasium.
4. Functional Pediatric & School-Based Assessments
| Assessment | Target Population | Core Domains Evaluated | Clinical Application |
|---|---|---|---|
| Pediatric Evaluation of Disability Inventory (PEDI / PEDI-CAT) | • PEDI: 6 mos to 7.5 years<br>• PEDI-CAT: Birth through 20 years | 1. Daily Activities<br>2. Mobility<br>3. Social / Cognitive<br>4. Responsibility (PEDI-CAT) | Measures functional capabilities, caregiver assistance, and environmental modifications. Computer-adaptive testing (PEDI-CAT) rapidly generates normative scores for children with cerebral palsy, autism, or developmental delays. |
| School Function Assessment (SFA) | Kindergarten through Grade 6 (Elementary school) | • Part I: Participation in 6 settings<br>• Part II: Task Supports<br>• Part III: Activity Performance | Criterion-referenced judgment questionnaire completed by the school-based team. Evaluates non-academic functional participation across 6 school settings: Classroom, Playground/Recess, Cafeteria, Hallway/Transitions, Bathroom, and Bus/Transportation. Directly guides IEP goals. |
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Test Your Knowledge
A 5-year-old child with autism spectrum disorder is evaluated using Dunn's Sensory Profile 2. The assessment reveals that the child demonstrates a low neurological threshold and employs an active self-regulation strategy, frequently covering their ears, fleeing the noisy cafeteria, and resisting transitions into the gymnasium. In which sensory processing quadrant does this child fall, and what is the primary intervention strategy?
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Test Your Knowledge
An occupational therapist is evaluating a 14-month-old infant who was born prematurely at 28 weeks gestation (12 weeks premature). Which age must the therapist use when scoring the Bayley Scales of Infant and Toddler Development (Bayley-4)?
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Test Your Knowledge
A school-based occupational therapist evaluates a 7-year-old second-grader referred for illegible handwriting. Administration of the Beery VMI reveals a standard score of 72 (below average). However, on the Beery Supplemental Visual Perception subtest, the child scores a standard score of 105 (average), and on the Motor Coordination subtest, the child scores a standard score of 74 (below average). How should the therapist clinically interpret these findings?
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