Translation and cultural adaptation of the Sensory Profile 2 to the Persian language

Abstract

Introduction

The purpose of this study was to translate and cross-culturally adapt the original Sensory Profile 2 questionnaires to Persian and access the psychometric properties of the adapted questionnaires.

Method

The translation and cultural adaptation of the original questionnaires were carried out under the published guidelines. Furthermore, we employed the multiple methods to establish the validity and reliability of the Sensory Profile 2 questionnaires. We calculated the content validity, internal consistency, and test–retest, along with the standard error of measurement. The study included 1272 children, between 0 and 14 years old, without any disabilities. They were selected from child developmental centers and elementary and middle schools of Tehran, the capital of the Islamic Republic of Iran.

Results

The item-level content validity index and the scale-level were satisfactory for all the items, quadrant, section, and factor of the Sensory Profile 2. The values of alpha for all questionnaires were ranged from 0.67 to 0.91. Furthermore, the test–retest reliability values for all questionnaires ranged from 0.72 to 0.95.

Conclusions

The Sensory Profile 2-Persian version can considered as a valid and reliable tool for utilization in Persian-speaking children between 0 and 14 years old.

Keywords

Cross-cultural Persian reliability Sensory Profile 2 translation validity

Introduction

Sensory processing represents the interface between an individual’s neurological function and the environment (Brown, 2002; Hilton et al., 2007). Person–environment interactions are at the center of the modern conceptualization of health and can affect individual’s participation (Dean et al., 2018).

Multiple models are employed to describe the sensory processing, which typically agree on the patterns of hyper- or hypo-responding to sensory and of seeking to sensory input. Dunn’s sensory processing framework (DSPF) creates these patterns in individual’s participation and addresses their neurological thresholds, self-regulation strategies, and relationship between neurological thresholds and self-regulation strategies. Furthermore, this framework facilitates better understanding of the sensory processing in terms of authentic contexts at home, school, and community (Ismael et al., 2018). According to Dunn’s (Dunn, 2014), sensory processing framework, which theorizes the sensory processing as two response continua to environmental stimuli, people differently react to sensory information based on their detection (threshold) and their manage (self-regulation) sensory stimuli. The thresholds are ranged from high (slow to detect) to low (quick to detect), and self-regulation is from passive (react to stimuli) to active (plans reaction to stimuli). These two continua interact to create four sensory processing quadrants as follows:

Registration demonstrates a high threshold and a passive self-regulation strategy. Children with sensory registration quadrant cannot notice sensory events which others quickly do.

Seeking illustrates a high threshold and an active self-regulation strategy. Children with the seeking pattern enjoy and extend their sensory experiences.

Sensitivity indicates a low threshold and a passive self-regulation strategy. Children with sensory sensitivity pattern notice more sensory events than others ordinarily do.

Avoiding represents a low threshold and an active self-regulation strategy. Children with a pattern of the sensation avoiding discover ways to limit sensory events and prefer to create their daily rituals.

A sensory processing approach (as reflected in DSPF) primarily focuses on individuals’ activity demands and contextual dimensions rather than emphasizing on performance skills and client factors outlined in the Occupational Therapy Practice Framework: Domain and Process (Roley et al., 2008). There is a strong consideration of social expectation, space, and timing demands of authentic tasks, body and objects within authentic tasks, and context features which may affect individual’s participation while using a sensory processing approach. We can apply knowledge about a person’s sensory processing to consider how aspects of activity demands and contexts might support or interfere with individual’s participation in everyday occupations. Then, interventions focus on making adjustments to environments and activities to increase participation (Cosbey et al., 2010; Dunn et al., 2012; Hochhauser and Engel-Yeger, 2010).

Many tools are developed to measure sensory processing, varying in target ages, conceptual frameworks, and purposes. Some assessment methods yield useful diagnostic information, but those provide no clear links to performance. Other assessment methods enable professionals to verify performance complications but provide no mechanism for linking this information to the reference frame in order to make the theory-based decision (Jorquera-Cabrera et al., 2017). The Sensory Profile 2 (Dunn, 2014) provides necessary links between the assessment information and the reference frame (including sensory processing, neuroscience strengths, and ecological frame of reference) to facilitate interprofessional decision-making. The Sensory Profile 2 (Dunn, 2014) also gives a set of standardized tools to evaluate a child’s sensory processing quadrants in everyday life. This information presents a unique way to define how sensory processing may be contributing to or interfering with person’s participation. When combined with other information (e.g., interviews, skilled observation across the setting, activity configurations, reports, other formal tests, and referral concerns), professionals can plan effective interventions to support children, families, and educators interact to each other throughout the day.

Given the importance of the concept of sensory processing to occupational therapists, the cultural and linguistic differences among countries, and the lack of a complete set of reliable Persian sensory processing instruments to measure a child’s sensory processing quadrants in the context of everyday life, the Sensory Profile 2 seems to be an appropriate choice. So, the present study was designed to translate Sensory Profile 2 questionnaires for Persian speakers as well as to test the psychometric properties of Persian version of the Sensory Profile 2.

Methods

Stage 1: Translation and cross-cultural adaptation

License

The National Check Professional Pearson works with the established publishers to translate its test. Since there is no representative in Iran, the principal investigator (first author), following correspondence by email, obtained the permission for translation and cultural adaptation of the Sensory Profile 2 from English to the Persian language from Winnie Dunn (Fri, May 18, 2018), the author of the questionnaires.

Procedure

The process of translation and linguistic adaptation of the Sensory Profile 2 was conducted via the American Educational Research Association (AERA) (American Psychological Association, 1999) and the International Test Commission (ITC) (Hernandez et al., 2020). This methodology is accepted internationally in the cultural adaptation of assessment tools because it ensures maximum conceptual and semantic equivalence with the original version. Figure 1 shows a methodology outline proposed by the authors for translating and adapting the Sensory Profile 2 into Persian culture.

Figure 1.

Procedure for translating and adapting the Sensory Profile 2 into Persian culture.

Forward translation

The original version of the Sensory Profile 2 was forward translated from English to Persian independently by three bilingual native Persian speakers. We created a team of three translators, consisting of a translator with dual citizenship (Iran and the United States of America), an English philologist, and an occupational therapist. All of them had experiences in translating technical texts. The translator with dual citizenship considered the cultural aspects of both countries to ensure the reliability in cultural adaptation, and the occupational therapist certified the adaptation with the original material (Gándara-Gafo et al., 2019). Each translator independently worked and sent his or her translation of the instruction for utilization, items, and response options to the principal investigator, who wrote the first draft of the questionnaires with coordination of the investigation team. Then, the draft was sent to the forward translation team, who evaluated the equivalence with the original (Román-Oyola and Reynolds, 2010; World Health Organization, 2009), indicating one of the following three options including (1) translation is equivalent, (2) translation is moderately equivalent with some linguistic but not semantic differences, and (3) translation is not comparable. For the items identified with 2 or 3, an alternative translation had been requested until the agreement was concluded.

Back translation

The Persian questionnaire was back-translated by two new translators, per international recommendations (American Psychological Association, 1999; Hernandez et al., 2020): a bilingual translator who was occupant in the United States of America and a bilingual occupational therapist who was resident in Australia. When both translations were finished, the investigation team examined the original version and back translations to analyze the linguistic and semantic concordance and detect any changes during the translation process. Ultimately, two back translations were merged, and the final version of the questionnaires was sent to Winnie Dunn to clarify some aspects of similarity between the original and back-translated versions.

Pretest

Once the translation process was completed, an individual’s semi-structured interview was carried out to evaluate the text comprehension and determine whether or not the vocabulary was adequate and culturally applicable (Gándara-Gafo et al., 2019). The Persian version of all questionnaires of the Sensory Profile 2 was separately tested in the child developmental centers and elementary and middle schools among five caregivers or teachers of children. They completed an appropriate questionnaire based on the child’s age and context. The sample size was obtained from the recommended procedure by Willis (2005). Subjects met the following inclusion criteria including a child between the ages of 0 and 14 years old, Iranian nationality, and informed consent form signed. When this procedure based on a similar investigation was employed (Román-Oyola and Reynolds, 2010), subjects were asked to probe the questionnaires after one of the sections of the questionnaire administrated. For each item, he or she was asked to answer: how do you interpret what the item is asking? What are some examples of your child’s behavior that made you choose that answer? Moreover, what modifications, if any, would you make to the item improve its comprehension?

Stage 2: Psychometric testing

Participants

The psychometric testing of the Persian version of the Sensory Profile 2 took place from December 2018 to July 2019 in Tehran, the capital of the Islamic Republic of Iran. It included the evaluation of 1272 children without any disabilities (children reported as receiving special education services and with severe medical or psychiatric conditions and sensory or motor impairments were excluded from the sample). We used a multistage cluster sampling technique (see Figure 2). The study sample consisted of 160 infants for the Infant Sensory Profile 2, 272 toddlers for the Toddler Sensory Profile 2, 432 children for the Child Sensory Profile 2, 180 children for the Short Sensory Profile 2, and 228 students for School Companion Sensory Profile 2 who had been in child developmental centers and elementary and middle schools. Table 1 indicates a full range of demographic characteristics of the samples for the psychometric testing.

Figure 2.

Sampling steps to evaluate the psychometric properties of the Persian version of the Sensory Profile 2.

Table 1.

Demographic characteristics for psychometric property studies for the Sensory Profile 2.

Characteristic	ISP2	TSP2	CSP2	SCSP2	SSP2
Number	160	272	432	228	180
Age (months-years)
Mean	4.5^a	13.6^a	11.6	11.5	11.4
SD	1.5	3.4	2.3	2.2	2.4
Sex (%)
Male	49.4	53.3	46.6	56.6	47.8
Female	50.6	46.7	53.4	43.4	52.2
Maternal education level (%)
No high school diploma	15.6	7.0	4.2	—	5.0
High school graduate	36.2	23.9	18.8	—	23.9
Some college or technical school	6.9	9.9	4.5	—	7.2
Four-year degree or higher	41.3	59.2	72.5	—	63.9
Paternal education level (%)
No high school diploma	19.4	4.0	1.9	—	2.2
High school graduate	36.8	18.8	24.1	—	21.1
Some college or technical school	4.4	3.7	2.3	—	3.4
Four-year degree or higher	39.4	73.5	71.7	—	73.3
Child born in relation to siblings (%)
Only child	48.8	54.8	39.1	—	41.7
1^st	36.2	39.7	51.2	—	50.0
2^nd	12.3	3.7	6.2	—	5.4
Others	2.7	1.8	3.5	—	2.9
Who completed the forms? (%)
Mother	96.9	95.6	94.0	—	91.1
Father	3.1	4.4	6.0	—	8.9
Teacher	—	—	—	100	—
Frequency of contact with this student (%)
1 day/week	—	—	—	38.5	—
2 days/week	—	—	—	9.2	—
3 to 4 days/week	—	—	—	2.3	—
Daily	—	—	—	50.0	—
Years have you had contact with this student (%)
6 months or less	—	—	—	86.8	—
7 months to 1 year	—	—	—	10.1	—
1 year or higher	—	—	—	3.1	—

ISP2: Infant Sensory Profile 2; TSP2: Toddler Sensory Profile 2; CSP2: Child Sensory Profile 2; SCSP2: School Companion Sensory Profile 2; SSP: Short Sensory Profile.

The reason why some spaces in this table are empty is related to the fact that the School Companion Sensory Profile 2 is completed by the teachers, and other questionnaires of this tool are completed by the caregivers of the child.

^aAge reported in months for Infant Sensory Profile 2 and Toddler Sensory Profile 2 forms.

Data collection

Ethical approval from Shahid Beheshti University of Medical Sciences, Iran, Tehran, was obtained (IR.SBMU.RETECH.REC.1396.1393). Thirty-four professionals (occupational therapists, psychologists, school counselors, teachers, and healthcare providers) were engaged in data collection by asking families to complete the various questionnaires of the Sensory Profile 2. A paper questionnaire method was used for data collection. Participants completed the appropriate questionnaire based on the child’s age and context. They were reassured about the anonymity of their information and informed that they had the right to withdraw from the study at any time.

Instrument

The Sensory Profile 2 (Dunn, 2014) represents a revision of the original Sensory Profile family of assessments consisting of the Sensory Profile; the Infant/Toddler Sensory Profile; the Sensory Profile School Companion; and the Sensory Profile Supplement. There are five Sensory Profile 2 paper questionnaires:

The Infant Sensory Profile 2 asks caregivers to complete 25 items about their babies from birth to 6 months.

The Toddler Sensory Profile 2 asks caregivers to complete 54 items about their toddlers from age 7 months to 35 months.

The Child Sensory Profile 2 evaluates children’s ages from 3 to 14 years. Caregivers also completed this questionnaire, which consists of 86 items.

The Short Sensory Profile 2 also evaluates children’s ages from 3 to 14 years. This 34-item questionnaire was completed by the child’s caregivers.

The School Companion Sensory Profile 2 evaluates children’s ages from 3 to 14 years from the teacher’s perspectives. Teachers completed this 44-item questionnaire about students in their classes.

Generally, each questionnaire has some combination of sensory systems (i.e., general, auditory, visual, touch, movement, body position, and oral) and behavioral (behavioral, conduct, social-emotional, and attentional) and sensory processing associated with DSPF (seeking, avoiding, sensitivity, and registration). Nevertheless, school factors contain School Factor 1 (supports), School Factor 2 (awareness), School Factor 3 (tolerance), and School Factor 4 (availability) only included in the School Companion Sensory Profile 2. A significant change from the original Sensory Profile is that items on the Sensory Profile 2 are related to a Likert scale ranging from 0 (not applicable) to 5 (almost always). Therefore, low scores on the Sensory Profile 2 indicate lower frequencies of behaviors, whereas higher scores represent higher frequencies of behaviors. The Sensory Profile 2 was standardized on a large national sample (n = 1791) which demonstrated strong psychometric properties.

Estimations of psychometric properties of the Sensory Profile 2-Persian

Validity

Validity is the extent to which a test measurement accurately corresponds to the real world (Manee et al., 2015). We employed the content validity to establish the validity of the all Sensory Profile 2 assessments.

Content validity

This concept is related to the degree to which a tool thoroughly measures or assesses all aspects of a given construct (Bolarinwa, 2015). To define the content validity, an expert committee consisting of 3–10 members (Lynn, 1986) based on clearly determined criteria should be selected. In our study, this panel included three occupational therapists including two cognitive neuroscientists, one child psychologist, and one language expert. They were asked to test the content validity of the Sensory Profile 2 by applying a 4-point grade scale in terms of “relevance to the intended construct” (the Likert scoring of the content validity index (CVI) of relevancy represents “1= not relevant”; “2 = somewhat relevant”; “3 = relevant”; and “4 = highly relevant”) (Davis, 1992).

Reliability

Reliability refers to the consistency of test scores obtained from individuals repeatedly evaluated with the same test (or highly similar tests) under comparable conditions (Heale and Twycross, 2015). We employed multiple methods to establish the reliability of the Sensory Profile 2. We also calculated the internal consistency (coefficient alpha) and the test–retest along with the standard error of measurement (SEM).

Internal consistency

Internal consistency reliability estimates information provided about the consistency of responses to all items on a scale or subscale (Henson, 2001). Internal consistency coefficients help evaluating how the homogeneity of the item answered is within a scale and provide one estimate of reliability as well (Osburn, 2000). Coefficient alpha is an index of the internal consistency ranging from 0 (no consistency) to 1 (perfect consistency) (Deniz and Alsaffar, 2013). Cronbach’s alpha was calculated to examine the internal consistency for each sensory pattern, sensory and behavioral system, and school factor score grouping on the various Sensory Profile 2 assessments.

Test–retest reliability

An indication of stability over time is provided by the test–retest correlation (Bolarinwa, 2015). Obtaining a rating of some child’s sensory processing abilities at two different times provides information on the stability of rating overtime. A parent’s or teacher’s view of a child can vary from time to time, but there must be some measurement consistency over time to consider the rating scales useful for the decision-making process. When the ability of child’s sensory processing is relatively stable across time, the test–retest reliability coefficients are the highest. The Sensory Profile 2 test–retest reliability was measured by a subsample (including 30 infants, 47 toddlers, 91 children, and 45 students) of the reporters in the psychometric testing samples. Hence, children were rerated after their initial evaluation. The mean retest interval is 23 days for the Infant Sensory Profile 2 (range = 14–60), 16 days for the Toddler Sensory Profile 2 (range = 14–30), 19 days for the Child Sensory Profile 2 (range = 7–45), and 28 days (range = 5–61) for the School Companion Sensory Profile 2. The Short Sensory Profile 2 was derived from the Child Sensory Profile 2 sample; therefore, it was not separately reported.

SEM

Reliability coefficients are beneficial to evaluate a test measurement consistency for a group of children, but those are not directly applicable to the interpretation of individual test scores (Weir, 2005). For a single score, the SEM shows the expected variability around the score obtained by the child. We might observe a variation of the SEM in a child’s scores, if repeatedly rated. The more reliable a test is, the smaller the SEM around a test score.

Data analysis

The data set was analyzed using SPSS software, version 21. A descriptive analysis was conducted for the demographic variables (Table 1). The assessment of content validity by the panel of experts was analyzed by calculating the CVI (DeVon et al., 2007). The CVI is simple to understand and can be used as a guide to correction or deletion of assessment items. The CVI could be calculated both for the item level (I-CVI) and the scale level (S-CVI) (Bolarinwa, 2015). Item level was computed as the number of experts giving a rating 3 or 4 to the relevance of each item divided by the total number of experts. Item level CVI, which expresses the proportion of agreement on the relevance of each item, should be at least 0.78 (Sangoseni et al., 2013). Scale level is defined as the proportion of items on an instrument ranging to 3 or 4 by the content experts (Beck and Gable, 2001). Scale-level CVI/average calculated using the average calculation method should be ≥0.90 (Waltz et al., 2010). Internal consistency was assessed by calculating Cronbach’s alpha coefficient. Test–retest reliability was assessed using the interclass correlation coefficient (ICC).

Results

Translation and cross-cultural adaptation

Forward translation

The results of the forward translation showed that of the 209 items in Sensory Profile 2 (25 items of the Infant Sensory Profile 2, 54 items of the Toddler Sensory Profile 2, 86 items of the Child Sensory Profile 2, and 44 items of the School Companion Sensory Profile 2), only 11 items indicated minor changes (Table 2). The research team brought together the forward translations carried out by three translators and made small cultural adjustments in vocabulary or content which seemed exotic in a Persian context. An example of an adaptation is item 40 of the School Companion Sensory Profile 2, “my student resists to a point which interferes with individual’s participation (e.g., cannot shift gears).” Because “cannot shift gear” is not a familiar phrase in Iran, it was changed to “needle gets stuck on a subject.”

Table 2.

Different stages of the translation and cross-cultural adaption of the Sensory Profile 2 from English to the Persian language.

Infant Sensory Profile 2 (ISP2)		Toddler Sensory Profile 2 (TSP2)		Child Sensory Profile 2 (CSP2)		School Companion Sensory Profile 2 (SCSP2)
Forward translation		Forward translation		Forward translation		Forward translation
Item		Item		Item		Item
1	Because “active setting” is not a familiar phrase for Iranian people, it has been changed to “an environment full of auditory and visual sensory stimuli.”	6	Because “unpredictable” is not a familiar word for Iranian people, it has been changed to “irregular.”	22	Because “need” is not a familiar word for Iranian people, it has been changed to “desire.”	17	Because “touch” is not a familiar word for Iranian people, it has been changed to “twiddle.”
				35	Because “moves stiffly” is not a familiar phrase for Iranian people, it has been changed to “his/her body has little flexibility.”	28	Because “on the go” is not a familiar phrase for Iranian people, it has been changed to “dynamic.”
				38	Because “support” is not a familiar word for Iranian people, it has been changed to “protection.”
				66	Because “failure” is not a familiar word for Iranian people, it has been changed to “incapable.”	29	Because “endless reasons” is not a familiar phrase for Iranian people, it has been changed to “under various pretexts.”
				85	Because “junk drawer” is not a familiar phrase for Iranian people, it has been changed to “cluttered drawer.”	40	Because “cant shift gears” is not a familiar phrase for Iranian people, it has been changed to “ needle gets stuck on a subject.”

Back translation		Back translation		Back translation		Back translation
Item		Item		Item		Item
4	“Distract” not precisely the meaning more accurate to say “interferes, hinders, and interrupts.”	1	Similar to item number 4 of Child Sensory Profile 2	18	“Prevent” not precisely the meaning more accurate to say “avoid.”	-
11	Since the stem is “my infant,” you have to start with the verb telling what the infant does.	49	In this item, a temper by itself is quick to become angry or having little patience. Furthermore, a temper tantrum is a set of behaviors that happen all together that can mean frustration. So the word “temper” was changed to “temper tantrum.”	59	Similar to item number 49 of Child Sensory Profile 2
18	“Blanket wrapped,” not precisely the meaning more accurate to say “swaddled or blanket wrapped.”	49

Pretest (examples of behaviors)		Pretest (examples of behaviors)		Pretest (examples of behaviors)		Pretest (examples of behaviors)
Item		Item		Item		Item
4	“Meals and afternoon rest time” have been added in parentheses to better describe “family schedules.”	38	“Your toddler jumps up from a table or chair, or hangs himself from them,” has been added in parentheses to better describe “climbing risks.”	8	“My child makes repetitive sound with her or his mouth” has been added in parentheses to better describe “strange noises.”	-
11	“Telephone bell, siren, and microwave alert” have been added in parentheses to better describe “sudden everyday sounds.”
15	“The passionate atmosphere of family parties or celebrations, restaurant, and park” have been added in parentheses to describe “noisy setting.”	45	“Milk and juice” have been added to the item to better describe “drinking.”	63	“Fast or unfamiliar activities that need to be done in a short time” has been added in parentheses to better describe “challenging situations.”
22	“When being handed over to another person” has been added in parentheses to better describe “everyday movements.”

Pretest (difficulties understanding and suggestions to improve understanding of the items)		Pretest (difficulties understanding and suggestions to improve understanding of the items)		Pretest (difficulties understanding and suggestions to improve understanding of the items)		Pretest (difficulties understanding and suggestions to improve understanding of the items)
Item		Item		Item		Item
1	“An environment full of auditory and visual sensory stimuli, such as in the morning when everyone is eating breakfast and getting ready for school and work,” has been added in parentheses to better describe “active setting.”	5	“Meet new people, going to kindergarten or doctor’s office, and playground” have been added in parentheses to better describe “situations.”	35	“My child cannot smoothly move, run, and spin,” has been added in parentheses to better describe “moves stiffly.”	19	“Play dough, liquid glue, gouache, and water color” have been added in parentheses to better describe “messy tasks.”
5	“Darkroom, head rocking, and leg banging” have been added in parentheses to better describe “requires help to get to sleep.”	40	“Your toddler, because of dropping devices and frequent falls, difficulty going up and downstairs is ridiculed by other children,” has been added in parentheses to better describe “accident-prone or clumsy.”
6	“Crying and uproar” have been added to the item to better describe “irritable.”	48	“Soup containing pieces of meat, beans, and vegetables” has been added in parentheses to better describe “chunky foods.”
10	“My baby does not have eye contact or smile,” has been added in parentheses to better describe the original statement “my child ignores me when I am talking.”	49	“Wave arms, scream and kick feet” have been added in parentheses to better describe “temper tantrums.”

Unreported items mean that they have not changed during the translation and cultural adaptation process.

The Short Sensory Profile 2 derived from the Child Sensory Profile 2, therefore not reported separately.

The conceptual equivalence analysis of the 209 items of the Sensory Profile 2 indicated that 75% (156 items) were considered by the forward translation team to be equivalent (1), 22% (47 items) were moderately equivalent, with some linguistic but not semantic differences identified by at least one of the translators (2), and 3% (6 items) were not equivalent according to one of the translators’ comments (3). These comments considered to aid in the text understanding for a better cultural adaptation to Persian were included in the cultural adaptation of the text.

Back translation

The results of the back translation showed that of the 209 items of the Sensory Profile 2, only seven items demonstrated minor semantic differences (Table 2). Also, Winnie Dunn’s comments provided better text comprehension for the cultural adaptation. An example of an adaptation is item 49 of the Toddler Sensory Profile 2, “my child has temper tantrums.” In this item, a temper by itself is quick to get angry or have little patience (e.g., a child with a temper might bite you). Furthermore, a temper tantrum is a set of behaviors that happen all together and can mean frustration (e.g., a child with a temper tantrum is more likely to throw himself down, kick feet, scream, wave arms, and cry). So, the word “temper” was changed to “temper tantrum.”

Pretest interviews

Information collected during the interviews was classified into three main categories: (1) examples of behaviors commonly recalled by the participants when answering the items, (2) specific difficulties for understanding the items, and (3) suggestions to improve understanding of the items. The first category was especially beneficial in developing a brief guide that could be given to the participants to answer the Sensory Profile 2. The guide draft was obtained by the first author for eight items as follows: (Table 2, Pretest [examples of behaviors]). An example is item 11 of the Infant Sensory Profile 2, “my baby gets upset by everyday, suddenly sounds.” Four participants for this item proposed some examples: “telephone bell, siren, and microwave alert.” The next two categories were exclusively related to each other, and difficulties for understanding the items were accompanied by the suggestions to improve understanding. Overall, 10 items were confusing for the three or more of the caregivers or teachers who gave some specific suggestions in order to improve their understanding of the items (Table 2, Pretest [difficulties understanding and suggestions to improve understanding of the items]). An example is item 5 of the Infant Sensory Profile 2, “my baby requires help to get to sleep.” Three of the participants recommended the inclusion of examples to facilitate understanding. Examples represented his or her needs to family members (i.e., darkroom) and provide himself/herself with calming input (i.e., head rocking and leg banging).

Psychometric properties of the Sensory Profile 2-Persian

Validity

Content validity

The values of I-CVI for all items of the various questionnaires of the Sensory Profile 2 were higher than 0.78, which indicated that each item was appropriate for relevance based on the expert’s panel viewpoint. The values of S-CVI for the various questionnaires are presented in Table 3.

Table 3.

Calculation of S-CVI for Sensory Profile 2 questionnaires, by quadrant, section, and school factor.

	ISP2	TSP2	CSP2	SCSP2	SSP2
Quadrants
Seeking		0.91	0.92	0.90	0.93
Avoiding		0.90	0.95	0.93	0.94
Sensitivity		0.92	0.94	0.92	0.94
Registration		0.91	0.91	0.94
Sensory sections
Total score	0.91
General		0.95
Auditory		0.93	0.94	0.91
Visual		0.92	0.97	0.93
Touch		0.90	0.92	0.95
Movement		0.94	0.93	0.96
Body position			0.95
Oral		0.96	0.91
Sensory					0.97
Behavioral sections
Behavioral		0.93		0.90	0.95
Conduct			0.96
Social-emotional			0.97
Attentional			0.94
School factors
School Factor 1				0.93
School Factor 2				0.95
School Factor 3				0.91
School Factor 4				0.92

I-CVI: Item-level content validity index; S-CVI: scale-level content validity index; ISP2: Infant Sensory Profile 2; TSP2: Toddler Sensory Profile 2; CSP2: Child Sensory Profile 2; SCSP2: School Companion Sensory Profile 2; SSP2: Short Sensory Profile 2.

Reliability

Internal consistency

The internal consistency reliability was calculated using the internal consistency coefficient Cronbach’s alpha for Sensory Profile 2 questionnaires, by quadrant, section, and school factors. The values of alpha for all caregiver questionnaires (Infant Sensory Profile 2, Toddler Sensory Profile 2, Child Sensory Profile 2, and Short Sensory Profile 2) were ranged from 0.67 to 0.91 and from 0.70 to 0.82 for the teacher questionnaire (School Companion Sensory Profile 2). The values of alpha for the various questionnaires are provided in Table 4.

Table 4.

Internal consistency coefficient alphas, test–retest correlation coefficients, and standard error of measurement for Sensory Profile 2 questionnaires, by quadrant, section, and school factor.

	ISP2			TSP2			CSP2			SCSP2			SSP2
	Α	ICC	SEM	α	ICC	SEM	α	ICC	SEM	α	ICC	SEM	α	ICC	SEM
Quadrants
Seeking	—	—	—	0.70	0.81	1.98	0.91	0.95	3.83	0.70	0.77	2.12	0.87	0.93	1.34
Avoiding	—	—	—	0.74	0.90	3.34	0.91	0.92	3.00	0.78	0.89	3.20	0.74	0.95	1.47
Sensitivity	—	—	—	0.71	0.93	3.82	0.88	0.91	2.96	0.73	0.72	2.87	0.72	0.92	1.52
Registration	—	—	—	0.70	0.87	2.57	0.87	0.90	2.48	0.79	0.88	3.48	0.71	0.88	1.08
Sensory sections
Total score	0.77	0.88	3.45	—	—	—	—	—	—	—	—	—	—	—	—
General	—	—	—	0.72	0.85	3.00	—	—	—	—	—	—	—	—	—
Auditory	—	—	—	0.71	0.87	2.13	0.83	0.89	1.15	0.82	0.74	2.78	—	—	—
Visual	—	—	—	0.70	0.92	2.35	0.67	0.76	0.83	0.77	0.86	2.23	—	—	—
Touch	—	—	—	0.70	0.84	2.18	0.85	0.88	1.79	0.76	0.77	1.95	—	—	—
Movement	—	—	—	0.70	0.85	1.49	0.87	0.89	1.56	0.74	0.81	2.08	—	—	—
Body position	—	—	—	—	—	—	0.86	0.90	2.12	—	—	—	—	—	—
Oral	—	—	—	0.69	0.83	2.56	0.87	0.84	2.11	—	—	—	—	—	—
Sensory	—	—	—							—	—	—	0.78	0.95	2.96
Behavioral sections
Behavioral	—	—	—	0.71	0.84	2.36				0.79	0.91	3.41	0.84	0.95	3.27
Conduct	—	—	—	—	—	—	0.88	0.91	1.81	—	—	—	—	—	—
Social-emotional	—	—	—	—	—	—	0.89	0.92	2.27	—	—	—	—	—	—
Attentional	—	—	—	—	—	—	0.80	0.91	1.70	—	—	—	—	—	—
School factors
School Factor 1	—	—	—	—	—	—	—	—	—	0.82	0.84	3.30	—	—	—
School Factor 2	—	—	—	—	—	—	—	—	—	0.71	0.72	2.52	—	—	—
School Factor 3	—	—	—	—	—	—	—	—	—	0.78	0.86	3.51	—	—	—
School Factor 4	—	—	—	—	—	—	—	—	—	0.70	0.89	2.44	—	—	—

ISP2: Infant Sensory Profile 2; TSP2: Toddler Sensory Profile 2; CSP2: Child Sensory Profile 2; SCSP2: School Companion Sensory Profile 2; SSP2: Short Sensory Profile 2; α: Cronbach’s alpha; ICC: intra-class correlation coefficient; SEM: standard error of measurement. Empty spaces mean that quadrant, section, and school factor do not exist in that form.

Test–retest reliability

Test–retest reliability was calculated using the ICC from the first and second administrations. The correlation coefficients by sensory and behavioral section, quadrant, and school factor are presented in Table 4. The reliability coefficients for all questionnaires (caregiver’s questionnaires and teacher questionnaire) were ranged from 0.72 to 0.95, indicating good to excellent stability in all questionnaires of Sensory Profile 2 over time.

The SEM

The Sensory Profile 2 provided SEM values for each of the quadrant, section, and school factors were separately calculated (see Table 4).

Discussion

The present study described the translation and cross-cultural adaptation of the Sensory Profile 2 to the Sensory Profile 2-Persian. The study evaluated the content validity, internal consistency, and test–retest reliability of the Sensory Profile 2-Persian.

Language equivalence follows the guidelines of ITC (Hernandez et al., 2020) and AERA (American Psychological Association, 1999). Furthermore, the study evaluated the internal consistency and test–retest reliability of the Persian version of the Sensory Profile 2. The detailed forward and backward translation procedures by the bilingual professionals in close contact with American and Persian culture resulted in a translation reflection common language used in Iran.

To ensure the adapted version retained its equivalence when used by the target group, we conducted the interviews with participants (caregivers and teachers who have regular contact with the child). This type of procedure is used to adapt the Sensory Profile for various ages like Spain (Gándara-Gafo et al., 2019; Román-Oyola and Reynolds, 2010). These semi-structured interviews were applied in the cultural adaptation of questionnaires to identify and correct comprehension problems of items which might be confusing.

Only 18 items were identified as difficult by two or more participants and consequently revised based on participants’ feedback to ensure correct comprehension of the text. The comprehension difficulties were caused by use of words or phrases unfamiliar to the participants (“active setting,” “family schedules,” “help to get to sleep,” “irritable,” “ignores me when I am talking,” “sudden everyday sounds,” “noisy settings,” “everyday movement,” “situations,” “climbing risks,” “accident-prone or clumsy,” “uses drinking to calm self,” “chunky foods,” “temper tantrums,” “strange noises,” “moves stiffly,” “challenging situations,” and “messy tasks”). Therefore, for these phrases, the inclusion of examples was recommended to improve comprehension.

Content validity of the Persian version of the Sensory Profile 2 was assessed, and evidence of good validity was also established as well. All quadrants, sections, and factors were highly rated by the panelists to evaluate their pertinence (I-CVI and S-CVI). These results provided a substantial support to the Persian translation of the Sensory Profile 2.

The values of Cronbach’s alpha for various groupings across forms were mostly in the adequate (0.70) to excellent (>0.90) range, with only two sensory sections below 0.70 (i.e., the oral section of the Toddler Sensory Profile 2 and the visual section of the Child Sensory Profile 2). The results of our findings are in consistent with the results of the development of the Sensory Profile 2 (Dunn, 2014) with only four sensory sections below 0.70 (the visual section of the Child Sensory Profile 2 and the touch, movement, and oral sections of the Toddler Sensory Profile 2). Dunn interpreted this finding as follows: “when looking at the details, in each case, the total score alpha is higher than any of the item-to-total correlations, suggesting the group is stronger than individual items.”

The test–retest reliability coefficients for all caregiver questionnaires (infant, toddler, and child) were ranged from 0.81 to 0.95, showing good to excellent stability in the caregiver questionnaires over time. The reliability coefficients for the teacher questionnaire (school companion) were ranged from 0.72 to 0.91. Despite a little lower than the caregiver reports, the test–retest reliability coefficients still indicated that teacher rating generally has an excellent stability over time.

The results obtained in this study indicated the experts agree that content of the test is representative of the knowledge and skills in the test domain. Also, the cultural adaptation of the Sensory Profile 2 for the Persian version could maintain an excellent repeatability and stability of answers over time for participants. Furthermore, another aspect of reliability, which provides information about the consistency of responses to all items on a scale, maintained an acceptable range to an excellent level of internal consistency of answers over the score for participants. Therefore, professionals who use this assessment tool can rely on the relevancy, stability, repeatability, and consistency of the results obtained in recording alteration in sensory reactivity in the Persian population.

Limitations

Like other studies, the present study had some limitations as follows:

Recruitment of subjects from a single urban center may limit the generalizability of the findings to the rest of the Iranian population, especially those from rural areas. Further studies are recommended among a large cohort of Iranian children with various disabilities (developmental delay, autism, attention-deficit/hyperactivity disorder, learning disability, Down syndrome, and others).

In the original standardization of the Sensory Profile 2 in the United States of America, the construct validity has been calculated among the raw summary scores on the various forms of the Sensory Profile 2 with several tests, including the original version of the Sensory Profile (Dunn, 2006; Dunn and Daniels, 2002; Rieke and Anderson, 2009); the Behavioral Assessment System for Children (BASC), second edition (Reynolds, 2010); the Social Skills Improvement System Rating Scales (SSIS) (Gresham and Elliott, 2007); the Vineland Adaptive Behavior Scales (VABS), second edition (Sparrow et al., 2005); and the School Function Assessment (SFA) (Coster et al., 1998). However, due to the lack of the Persian version of some tools, the disassociation of participation of caregivers or teachers to complete some tests because of large number of items and the lack of cooperation of some researchers to give the Persian version of some tools; therefore, it was not possible to examine the construct validity of the Sensory Profile 2 in this investigation.

Conclusion

The findings obtained in this study lead us to conclude that the Persian version of the Sensory Profile 2 could conceptually and semantically be equivalent to the original American version. It is considered as an adequate assessment to measure sensory processing in the Persian population with ages of 0–14 years old that may be beneficial for professionals (occupational therapists, psychologists, and speech-language pathologists) as both clinical and research tools. Furthermore, intra-rater reliability and other types of validity (construct and confirmatory factor analysis) of this tool would be suggested in future studies.

Footnotes

Acknowledgements

This project completed as part of Marjan Shahbazi MSc thesis in occupational therapy supported by a grant from the Shahid Beheshti University of Medical Sciences. We thank Dr. Winnie Dunn for their helpful consultations in the translation of the Sensory Profile 2. Also, the authors thank Dr. Rama Yasaei (Critical Care & Neurosurgery, Kaweah Delta Hospital) Rosi Zeinali (Occupational therapist, Novita), and Dr. Mansour Rayegani (Professor of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Research Center) for their valuable suggestions and assistance during the study. Besides, we would like to gratitude the caregivers or teachers of children and members of the translators and expert committee who took the time and trouble to participate in this research.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by Shahid Beheshti University of Medical Sciences, Tehran, Iran (grant number: IR. SBMU.RETECH.1396.1393).

ORCID iD

Marjan Shahbazi

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