Developing a novel methodology to evaluate the content validity of two sensory reactivity assessments adapted for South Africa.

The power imbalance between the occupational therapist testers and participants, compounded by language differences, may have influenced how freely caregivers and children reported difficulties. The caregiver questionnaire was in English only. Many caregivers' home language was not English, and this likely drove the comprehensibility failure. A translated version was not available. Caregivers' reading ability was not formally tested; the study relied on self-reported education level (grade 5 or higher) as a proxy. Only the sensory reactivity component was evaluated. The other aspects of Ayres Sensory Integration (sensory discrimination, modulation, and sensory-based motor skills) were not addressed. The EASI used was a research version without established ceiling or floor levels or discontinuation criteria, making it lengthy and some children struggled to stay focused. The sample was 30 children from one province, which limits generalisability to the rest of South Africa.

No conflicts of interest declared. Funding was received from the South African Institute for Sensory Integration, the South African Occupational Therapy Association, and the Harry Crossley Foundation.

Do not read this as the assessment being ready for clinical use in South Africa. It is only a content validity check, which is the first of several measurement properties to establish. The caregiver questionnaire also failed on language clarity for non-English speakers, and three of six sensory subscales fell below the study's own 80% threshold.