Current models of occupational therapy practice advocate for consideration of the environment in relation to a person’s occupational performance (American Occupational Therapy Association [AOTA], 2014). The classroom is an important practice environment because 19.9% of occupational therapists work in the public schools (AOTA, 2015a). The increase in the prevalence of autism suggests that many children with autism spectrum disorder (ASD) are being educated in the public schools (Centers for Disease Control and Prevention [CDC], 2014). These children have high rates of sensory processing difficulties (Marco, Hinkley, Hill, & Nagarajan, 2011) and may therefore require sensory environments that meet their needs to enable them to learn effectively. Teachers must create these learning environments in their classroom but may feel ill equipped to understand the needs of children with ASD (Barnhill, Polloway, & Sumutka, 2011; Morrier, Hess, & Helfin, 2011). This article describes the development of a tool to assist therapists and teachers in systematically gathering and then discussing information about the classroom sensory environment, developed in particular for the inclusion of children with ASD.

Our national practice standards require the consideration of the impact of the environment on a client’s functioning, stating

The therapist chooses which aspect of the environment must be assessed on the basis of the needs of the client and the situation (AOTA, 2014) and “analyze[s] the environment and context to understand how these elements can best support learning and performance” (AOTA, 2015b, p. 1). However, occupational therapists have somewhat limited tools with which to gather these data for many of the environments in which their interventions occur (see Gitlow, 2014a, 2014b).

For therapists in school-based practice, the critical environment is the classroom and the school in which it resides. Classroom environments afford enormous amounts of sensory stimulation. The physical environment is frequently brightly lit, with additional visual stimulation provided by items hanging on the walls and people moving about the room. Learning activities often provide touch inputs, movement experiences, and smells. The physical environment, visual stimuli, and activities with movement can each affect a student’s learning and attention (Barrett, Zhang, Moffat, & Kobbacy, 2013; Fisher, Godwin, & Seltman, 2014; Godwin, Almeda, Petroccia, Baker, & Fisher, 2013). Classrooms are also noisy, with poor acoustics further influencing attention, concentration, and academic performance (Shield & Dockrell, 2008). Most of the research on learning impact has occurred with typically developing children in general education classrooms. However, given the sensory difficulties of children with ASD, the potential impact of the sensory environment on learning is likely amplified for these children (Kinnealey et al., 2012; Menzinger & Jackson, 2009).

Sensory processing issues are frequently evident in ASD (Marco et al., 2011) and have been added to the diagnostic criteria for ASD (American Psychiatric Association, 2013). These sensory processing difficulties may result in unique behaviors that can hinder classroom performance (Ashburner, Ziviani, & Rodger, 2008). Sensory integration theory (Ayres, 1979) would suggest that learning will be more difficult for these children. An environment that does not meet their sensory needs may magnify their difficulties. For students with ASD, the environmental stimuli of the classroom may be too much, too little, or of the wrong type. People with ASD may react to uncomfortable stimuli with a range of behaviors, from avoidance to violent physical aggression (Menzinger & Jackson, 2009). The importance of the match between student sensory preferences and classroom sensory environments cannot be overstated. Research has suggested that strategies based on knowledge of students’ unique sensory needs have the potential to support classroom engagement (Pfeiffer, Koenig, Kinnealey, Sheppard, & Henderson, 2011; Schilling & Schwartz, 2004). Modification of the sensory environment may have the same effect (Kinnealey et al., 2012). However, a thorough assessment is required before the provision of intervention.

Currently, multiple assessments of environment can be used to rate the home, the workplace, and the community, often in terms of access for those with physical disabilities (see Gitlow, 2014a, 2014b). Table 1 provides a list of some of the available classroom assessments and their characteristics. None of these tools specifically focus on the sensory aspects of the classroom environment on the basis of Ayres Sensory Integration^TM theory. For example, although the Sensory Processing Measure’s (SPM’s; Parham, Ecker, Miller-Kuhaneck, Henry, & Glennon, 2007) multiple environments were developed to aid the team in understanding the sensory needs of a specific child in different arenas and the authors specifically advocated for a collaborative process (Miller Kuhaneck, Ecker, Parham, Henry, & Glennon, 2010; Miller-Kuhaneck, Henry, Glennon, & Mu, 2007; Parham et al., 2007), the SPM does not rate aspects of the classroom environment directly. Available tools often do not suit therapists’ needs and consider classroom environment in a different and sometimes more limited way than is meant by occupational therapists using Ayres' Sensory Integration Theory.

According to the U.S. Department of Education, 417,000 students with ASD were in the U.S. school system in the 2010–2011 school year (National Center for Education Statistics, 2013). Approximately 37% of children with autism spend at least a portion of their day, as much as 80% in some states, in inclusive classrooms (Kurth, 2014). Teachers struggle with including students with ASD in their classroom, and their preparation is often inadequate to serve the needs of these students (Barnhill et al., 2011; Morrier et al., 2011). Students with ASD can respond well to educational settings that include accommodations tailored to meet their needs, but teachers may not understand the potential impact of the variety of sensory experiences in a typical classroom and may need education (Miller Kuhaneck & Kelleher, 2014). The classroom is the teacher’s domain, and teachers must comprehend the influence of the environment on a student’s behavior and decide whether to make a change in their classroom (Cook & Friend, 2010). Best practice in collaborative processes suggests that to promote meaningful change in that environment, therapists’ use of informational power (i.e., sharing of knowledge to allow another to make informed decisions) may be most successful (Erchul & Martens, 2001). The Classroom Sensory Environment Assessment (CSEA) is being developed to promote therapist–teacher collaboration to provide student supports and classroom modifications. The research questions that guided the current phase of this project were as follows:

1. What are the sensory features of the typical general education classroom?

2. Do general education teachers find the CSEA acceptable, understandable, and worthwhile?

3. Does the CSEA demonstrate adequate reliability?

Because the CSEA is meant to be completed by teachers, it has been developed with significant input from teachers and authored by an occupational therapist and a special educator who specializes in children with autism. This project has progressed in multiple phases over several years. Phase 1 consisted of a focus group, classroom observations, and teacher interviews and ended with a draft of an assessment tool. Phase 2 consisted of piloting the first draft of the tool and ended with revisions and a second draft. Phase 3 consisted of piloting the second draft, another small focus group, and pilot examination of interrater reliability. The authors examined the feasibility of one method of examining interrater reliability of the tool with six pairs of teachers and either the school’s occupational therapist or an MSOT student research assistant. The current phase (Phase 4) included collection of descriptive data from a variety of elementary classrooms using the current version of the CSEA and an initial investigation of its internal consistency. Institutional review board approval has been provided throughout the process. A small university-sponsored grant provided incentive gift cards for teachers involved in Phase 1 and supported student research assistants.

The participants in this phase were 159 elementary classrooms in urban, suburban, and rural schools in a small New England state. The teachers who rated these classrooms were general educators and student teachers with a range of experience. However, the majority (more than 80%) were student teachers with limited experience who were rating the classroom of another, more experienced teacher.

Classroom data were analyzed with counts, frequencies, means, and standard deviations. Reliability was examined with internal consistency ratings using Cronbach’s α. Skew and kurtosis were examined using the Kolmogorov–Smirnov test of normality and histogram. Interrater reliability was analyzed with intraclass correlation coefficients (ICC).

The CSEA contained 161 items divided into sections by sensory type: vision (47), hearing (50), touch (20), movement (vestibular and proprioceptive; 25), smell (15), and taste (4). Items for the cafeteria, recess, and playground were included. The teachers rated items on the basis of a typical week. Teachers rated the frequency of occurrence of the sensory experience as no, never, or not applicable; rarely; occasionally; sometimes; and always. Next, if applicable, the teachers rated the intensity of the experience as weak, moderate, or strong. CSEA items are not categorized as good or bad; they just exist. For example, one item lists something a student might see as “objects hanging from or taped to the ceiling.” Another item lists something a student might hear as “blinds opening and closing.” The point is not to score a classroom as good or bad but to promote discussion between the teacher and the occupational therapist about the sensory experiences that are occurring in the classroom and their potential impact on learning.

This article reports data primarily gathered in the latter two phases of development (3 and 4). However, in the early phases (1 and 2), observations documented wide variation in sensory experiences, leading to the large number of items in the current version (161). Teachers rated the items as being understandable and clear, with all items achieving a mean score of 4 or more on a scale ranging from 1 to 5 (1 = not at all clear or understandable; 5 = completely clear/understandable).

In Phase 3, the five most frequent classroom sensory experiences included fluorescent lighting, use of primary colors, use of patterns, use of multiple storage bins, and children sitting in close proximity to peers. Cafeteria noise levels measured between 81 dBA and 98–99 dBA, and hallway noise ranged from the high 70s to the high 80s. One of the highest classroom decibel levels the authors found was the sound of plastic toys and cars scraping against the bottom of the sandbox in a kindergarten classroom. Other very loud classroom noises for those nearby included electric pencil sharpeners and electronic paper towel dispensers.

For the current analysis, 152 classrooms had usable data. Missing data were analyzed following procedures outlined by Bannon (2013) . Of the original 157 classrooms, 5 had more than 20% of the items on the form left blank, and these classrooms were dropped from all further analyses. Further examination of the remaining 152 classrooms indicated that 55% had at least one item left blank. Of these, the large majority had only 1–4 items of 161 left blank (<2%). There was no clear pattern to the missing items by rater. Movement section items and the hearing items that occurred in the cafeteria had the greatest number of missing values. It appeared on review of sample CSEA forms with missing data that the student teachers who had not had the opportunity to rate the cafeteria or recess had not circled the appropriate score (N) for no, never, or not applicable. Various methods of managing missing data were considered, but each can be problematic. For the purposes of this analysis, missing values were substituted with a score of 1, which is the score that would be given for no, never, or not applicable.

Tables 2 and 3 list the 20 most frequently reported sensory experiences and the 20 least frequently reported sensory experiences in the current analysis of 152 classrooms. For each item, a score could range from 1 (never) to 5 (always). Therefore, higher mean scores indicate greater frequency. Of the 20 most frequent items, 16 are vision items, 2 are touch items, and 1 each are hearing and movement items. Of the 20 least frequent items, 8 are hearing items, 7 are touch items, 4 are movement items, and 1 is a vision item. Walking was the most frequent way children moved in the schools, followed by running, climbing stairs, transitioning between activities, and engaging in physical education class. Other than walking, these items were all rated as rarely to occasionally occurring. Similarly, all of the smell and taste items were rated as rarely to occasionally occurring as well. The most frequent smell was snack foods, followed by lunch foods and soap. The mean total score was 392 (range = 267–543) of a total possible score of 805. The total score demonstrated normal distribution because the Kolmogorov–Smirnov test was not significant (p = .200).

Scores for each sensory section were totaled, and internal consistency was examined for each sensory experience scale. The internal consistency values were all acceptable (Table 4). Interrater reliability values did not reach acceptable levels in the pilot using the teacher–therapist rating pairs and total score. The ICC was −.197.

Classrooms are highly stimulating environments with a large variety of potential sensory experiences. One of the most frequent experiences in the classroom is visual. Sixteen of the 20 items rated as occurring most frequently by teachers were visual in nature. Specific visual stimuli in the classroom, such as a student’s artwork or a themed bulletin board, are often highly regarded by teachers as enticing, inviting, and an encouragement to learning. However, visual stimuli have also been documented to be distracting (Fisher et al., 2014). For children with ASD, visual stimuli may be overwhelming (Ashburner, Bennett, Rodger, & Ziviani, 2013). Fluorescent lighting, a common sensory experience reported in this sample of classrooms, may affect the behavior and performance of at least some children with developmental disabilities (Fenton & Penney, 1985; Shapiro, Roth, & Marcus, 2001). Some of the visual items rated as occurring frequently could be theoretically distracting to children (e.g., having visual stimuli behind the teacher while he or she is giving instruction), and others might be helpful (e.g., having work spaces or seating arrangements well organized as opposed to cluttered or random). This categorization of items as positive or negative experiences will be explored through interviews with students with ASD.

Similar to previous research (Shield & Dockrell, 2008), initial results from the observations documented high levels of noise in the classroom, cafeteria, and hallways of public schools. Cafeteria and hallway noise levels can often be compared in decibel level to noises such as a hand saw, an electric shaver, heavy traffic, or an electric drill. The World Health Organization has provided guidelines for maximum noise levels in the schools that suggest a limit of 35 db for indoor classroom spaces and 55 db for outdoor playground areas (Berglund, Lindvall, & Schwela, 1999). The American National Standards Institute similarly recommends a noise level in the classroom of 35 db (Acoustical Society of America, 2009).

Excessive noise can harm hearing (Rabinowitz, 2012), and noise may have an impact on learning (Choi & McPherson, 2005; Crandell & Smaldino, 2000; Russo, Zecker, Trommer, Chen, & Kraus, 2009; Shield & Dockrell, 2008). Children with ASD are often overly sensitive to loud sounds (Khalfa et al., 2004; Marco et al., 2011), so these findings are concerning and may require some advocacy on the part of school personnel. Therapists can document the noise levels in their school buildings using free or inexpensive sound-level meters now available as apps on most smartphones. If high levels of noise are found, a variety of options for noise dampening are available online. One study has suggested that providing these types of modifications may have a positive impact (Kinnealey et al., 2012).

Less well documented is the amount of other types of sensory experiences in a typical classroom environment. Although teachers are encouraged to allow more movement in the classroom (Jensen, 2001), and research has suggested that movement may improve academic performance (CDC, 2010; Donnelly & Lambourne, 2011), little is currently known about how much time children actually spend moving in a classroom during the day. Studies of physical activity in schools related to decreasing childhood obesity have provided some information in this area (Pate, Pfeiffer, Trost, Ziegler, & Dowda, 2004). One experimental study of a teacher-implemented movement program in New York City documented that control group classrooms, with untrained teachers, spent an average of approximately 2.4 min on physical activity per day, not including recess and physical education classes (Dunn, Venturanza, Walsh, & Nonas, 2012). Little information is available about smell (Kielb et al., 2014), taste, or touch experiences in the classroom. The findings with the CSEA suggest that, other than walking, movement is not frequent during the school day and that exposure to smells is also infrequent. However, future analysis will examine intensity ratings of the items. Items with low frequency may still be problematic if they are of high intensity when they do occur (e.g., fire drills or car alarms).

Teachers reported that the information provided by the CSEA is valuable and that they gained something from the experience of completing it (Miller Kuhaneck & Kelleher, 2014). Teachers also reported that the CSEA is understandable and clear. The tool’s internal consistency is acceptable, but the current examination of interrater reliability was problematic. The instructions for the tool state that the teacher should consider and rate a typical week of school. However, the second rater for the pilot of interrater reliability was an occupational therapist or an occupational therapy student researcher who was present in the classroom for a shorter, one-time observation period, typically 30–60 min. This method of examining interrater reliability therefore had drawbacks, and the results were not acceptable. Further investigation of interrater reliability is planned in classrooms that have coteachers who can both rate the classroom with the same level of familiarity.

The results have been primarily descriptive in nature, and all of the data thus far have come from a small New England state. The sensory experiences of classrooms may differ in substantial ways in this state, perhaps because it is considered to have one of the higher rates of inclusion of children with ASD (Kurth, 2014). How that may have influenced the results is unknown at this time, but a national sample will be gathered in the future. The level of missing data suggests that better written instructions are necessary for future data collection with the CSEA or that a separate “not observed” column should be included in addition to or instead of no, never, or not applicable. The frequency of occurrence of the movement items may have been underestimated given the method of data substitution used to manage missing data, most often noted in the movement section. Finally, the CSEA items have been grouped on the basis of theory and observation, but these groupings have not yet been validated with statistical analysis.

Further development of the tool will require additional examination of interrater reliability and gathering of national data. Interviewing adolescents with ASD about classroom experiences that help and hinder their learning may help in categorizing CSEA items differently. A better understanding of the relationship between teachers’ sensory preferences and their classroom sensory experiences may enhance therapists’ educational practices with teachers.

Although the CSEA is in early stages of development, the information gathered to date suggests that examination of the sensory environment of the classroom may be an important addition to school-based occupational therapy practice in the following ways:

• Teachers find the process of completing the CSEA beneficial and they value the information it provides.

• Commonly reported classroom sensory experiences are primarily visual in nature, but classrooms and schools are often extremely noisy environments as well. These sensory features of classrooms and school environments therefore have the potential to affect the performance of students with ASD who have difficulties with sensory processing.

• The CSEA appears to be a promising tool to promote teacher–therapist collaboration, using CSEA ratings in conjunction with assessments of a student’s sensory processing to create a better environmental match for included students.

• The limited amount of movement reported in the classroom, coupled with evidence regarding the importance of movement, suggests a possible avenue for collaboration with teachers in relation to improving learning for all students through learning activities that incorporate movement.

Classrooms are highly stimulating environments, providing a great variety of sensory experiences for students. Although in its early stages of development, the CSEA provides teachers with a depiction of the classroom sensory environment. Whether the depiction is one that is positive or negative cannot be determined until the classroom is considered in relation to a particular student. Therefore, the authors of the CSEA recommend that this tool be used in two ways. First, a teacher can rate his or her environment, and this process can be used to begin a discussion about the theories and evidence regarding the impact of sensation on learning and attention and the possible aspects of the classroom that might be generally helpful or difficult. In this way, the CSEA is used as a teaching tool to share information.

Second, the tool may be used in conjunction with an assessment of sensory functions for a specific child. SPM (Miller Kuhaneck et al., 2010; Parham et al., 2007), Sensory Profile (Dunn, 2006), or Sensory Integration and Praxis Tests (Ayres, 1989) scores can be considered in relation to a sensory map of the classroom or school environment provided by the CSEA to investigate areas of match or mismatch for a child on the basis of sensory integration theory. The teacher and therapist can then collaborate to generate potential solutions or modifications. There have been calls for research on the impact of the sensory environment for children with ASD (Shabha, 2004), and perhaps in the future the CSEA will help meet this need and foster interprofessional collaboration among educators, therapists, and people who plan and build school structures.

As is fitting for this special issue, the first author’s primary acknowledgment is to Jane Case-Smith for her spectacular mentoring throughout my career. For more than 20 years, Jane influenced my development as a researcher and, over time, became a friend. Jane encouraged my interest in tests and measures while I was her research assistant during the development of the Posture and Fine Motor Assessment of Infants. She guided me through assessment development for my master’s thesis, and the idea for the School Assessment of Sensory Integration, which eventually became the Sensory Processing Measure–Classroom, came from assisting Jane with data collection in the schools during one of her many research projects. I am forever indebted to her for any successes I have had and am eternally grateful for her friendship.

The research described in this article was carried out with the support of the Sacred Heart University Research/Creativity Grants Program.