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Turkish Translation and Cultural Adaptation of the Adult/Adolescent Sensory History

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12 September 2026

Posted:

18 September 2026

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Abstract
Background: The Adult/Adolescent Sensory History (ASH) is a comprehensive self-report measure of sensory processing and integration in adolescents and adults. This study aimed to translate and culturally adapt the ASH into Turkish using an established cross-cultural adaptation process. Methods: A multistage process included forward translation, synthesis, linguistic review, back-translation, expert committee review, expert evaluation and pretesting. The adaptation team comprised 39 translators, linguists, multidisciplinary professionals and representatives of the target population. Qualitative feedback and descriptive statistics were used to evaluate linguistic clarity, conceptual equivalence, cultural appropriateness and comprehensibility. Results: The Turkish ASH demonstrated semantic, idiomatic, experiential and conceptual equivalence with the original. Minor linguistic modifications improved readability and fluency without altering conceptual content. Expert evaluation supported its clarity, comprehensibility, internal coherence and cultural relevance. During pretesting, participants considered the questionnaire clear, comprehensible and culturally appropriate; no items required conceptual modification. Although some participants noted that completion required considerable time and concentration, no further revisions were necessary. Conclusion: The Turkish ASH was successfully translated and culturally adapted while preserving the conceptual integrity of the original instrument. Further research should establish its psychometric properties in clinical and non-clinical populations.
Keywords: 
adult/adolescent sensory history
;  
sensory integration
;  
cross-cultural adaptation
;  
occupational therapy
Subject: 
Public Health and Healthcare  -   Public, Environmental and Occupational Health

Introduction

Sensory processing refers to the capacity of the central nervous system to receive, organize, and integrate sensory information to generate adaptive responses that support participation in daily life (Ayres and Robbins, 2005; Blanche et al., 2014; Bundy and Lane, 2020). Within occupational therapy and related disciplines, sensory processing is conceptualized as a foundational mechanism underlying engagement in meaningful occupations, emotional regulation, interpersonal functioning, and overall well-being (Bundy and Lane, 2020). Accumulating evidence demonstrates that persistent sensory processing differences are associated with functional limitations, psychological distress, and diminished quality of life across the lifespan (May-Benson et al., 2022; Van den Boogert et al., 2022).
Although early investigations primarily focused on pediatric populations, sensory processing differences have increasingly been documented in adolescents and adults (Blanche et al., 2014; DuBois et al., 2017; Goycolea Martinic et al., 2024). Longitudinal findings indicate that while symptom severity may decrease from childhood to adulthood, a substantial proportion of individuals continue to exhibit clinically meaningful sensory processing differences later in life (May-Benson et al., 2023). Moreover, adults who report ongoing sensory processing challenges demonstrate significant associations with poorer physical and psychological quality of life (May-Benson et al., 2022). These findings underscore the importance of reliable and developmentally appropriate assessment tools for adult populations.
The clinical relevance of sensory processing extends across diagnostic categories. A meta-analysis of psychiatric populations identified elevated patterns of sensory sensitivity, low registration, and sensory avoiding behaviors across multiple disorders, suggesting that sensory processing differences may represent a transdiagnostic vulnerability factor (Van den Boogert et al., 2022). Similarly, a systematic review reported consistent associations between atypical sensory processing and perceived stress in adults (Harrold et al., 2024). In neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD), sensory processing differences are closely linked to executive dysfunction and reduced participation in meaningful activities (Kamath et al., 2020; Kazemy-Pour et al., 2025). Adults with ADHD demonstrate significantly higher levels of sensory hyper- and hypo-sensitivity compared to controls, and these patterns correlate with executive functioning and occupational participation (Kazemy-Pour et al., 2025).
Sensory processing differences have also been identified in adolescents with non-suicidal self-injury (NSSI), where atypical modulation patterns may contribute to emotional dysregulation (Lanteri et al., 2019). In autism spectrum disorder (ASD), sensory reactivity is a core diagnostic feature. (DuBois et al., 2017). Furthermore, sensory processing differences have been observed in healthy adults and areassociated with demographic characteristics, indicating that contextual and cultural factors influence sensory experiences and responses (Machingura et al., 2020). Collectively, these findings highlight the broad relevance of adult sensory processing assessment across clinical and non-clinical populations. Further, sensory assessment has demonstrated clinical utility in neurological conditions such as stroke, where individualized sensory profiles may inform intervention planning (Chung and Song, 2016). However, assessment practices in adolescents and adults remain heterogeneous, with self-report measures constituting the most frequently utilized tools (DuBois et al., 2017).
Standardized self-report instruments are commonly employed to evaluate sensory processing in adolescents and adults. The Adolescent/Adult Sensory Profile (AASP) is among the most widely used measures internationally (Blanche et al., 2014; DuBois et al., 2017), and its convergent validity with the Sensory Processing Measure 2–Adult Form (SPM-2-Adult) has been supported (Skocic et al., 2024). In Turkey, adapted versions of the AASPare already available, providing clinicians with access to quadrant-based sensory processing assessment. However, several limitations of existing quadrant-based tools have been noted in the literature, including restricted sensitivity to specific sensory systems and limited coverage of certain functional domains (Blanche et al., 2014; DuBois et al., 2017).
In response to the need for broader and more comprehensive adult assessment, alternative measures have been developed. The Adult Sensory Processing Scale (ASPS), for example, was designed to evaluate responsiveness across specific sensory systems such as auditory, visual, tactile, vestibular, and proprioceptive domains (Blanche et al., 2014). Similarly, the Adult/Adolescent Sensory History (ASH) was developed to provide a comprehensive self-report instrument specifically tailored to older adolescents and adults (May-Benson, 2015). The ASH uniquely emerged from extensive clinical practice, research, and normative data collection efforts; and reflects a function-based perspective grounded in Ayres Sensory IntegrationTM theory that recognizes that sensory integration and processing challenges may influence adult functioning and participation across occupational, social, and health-related domains (May-Benson, 2015; May-Benson et al., 2023).
Importantly, the ASH differs conceptually from quadrant-based profiles in that it was designed within a sensory integration framework emphasizing the historical and functional impact of sensory processing patterns. In particular, the ASH offers information on postural control and praxis/motor related functioning not addressed in other adult measures. Further, longitudinal research utilizing the ASH has demonstrated its utility in examining the long-term trajectory of childhood sensory integration challenges into adulthood (May-Benson et al., 2023). Furthermore, ASH findings have been linked to adult quality-of-life outcomes, particularly in physical and psychological health domains (May-Benson et al., 2022). These characteristics suggest that the ASH may offer complementary clinical information beyond that provided by existing adult sensory processing measures.
Given that a Turkish version of the AASPe is already available, the rationale for adapting the ASH is not redundancy but conceptual expansion. The ASH provides a function-oriented, sensory-integration-based assessment perspective that allows clinicians and researchers to examine the historical continuity, functional impact, and qualitative aspects of sensory processing patterns in adolescence and adulthood. The ASH also provides extensive scoring information which allows detailed and comprehensive analysis of the individual’s sensory processing and motor strengths and challenges. This is particularly relevant for longitudinal research, for adults with childhood sensory integration histories, and for clinical contexts in which a broader developmental and functional understanding of sensory processing is required (May-Benson, 2015; May-Benson et al., 2023). Moreover, cultural context significantly influences daily routines, environmental expectations, and interpretations of sensory experiences. Therefore, systematic translation and cultural adaptation are essential to ensure semantic, conceptual, and measurement equivalence of the ASH within Turkish-speaking populations. Without rigorous adaptation, the clinical and research utility of the instrument may be compromised.
Considering the growing evidence linking sensory processing differences to stress, psychopathology, executive function, participation, and quality of life in adulthood (Harrold et al., 2024; Kazemy-Pour et al., 2025; May-Benson et al., 2022; Van den Boogert et al., 2022), the availability of diverse and theoretically grounded assessment tools is critical. Translating and culturally adapting the Adult/Adolescent Sensory History into Turkish will provide clinicians and researchers with an additional, lifespan-oriented instrument that complements existing quadrant-based measures and supports comprehensive evaluation of sensory processing in Turkish populations.
Accordingly, the present study aims to conduct a systematic translation and cultural adaptation of the ASH for use in Turkish-speaking adolescents and adults, thereby strengthening clinical assessment capacity and contributing to cross-cultural research in sensory integration and processing.

Methods

Study Design

This study employed a systematic, multistage approach to translate and culturally adapt the ASH into Turkish, following the International Test Commission (ITC) Guidelines for Translating and Adapting Tests (Second Edition) (International Test Commission [ITC], 2017) and established methodological recommendations for cross-cultural adaptation (Beaton et al., 2000; Cruchinho et al., 2024; Schuster et al., 2010). The methodological framework was further informed by published recommendations for the implementation of the ITC guidelines (Hernández et al., 2020; Nguyen et al., 2024) and was consistent with the procedures adopted in our previous cross-cultural adaptation study (Sagliyan et al., 2026). Prior to initiating the adaptation process, permission to translate and culturally adapt the ASH into Turkish was obtained from the copyright holder. The adaptation process was designed to achieve semantic, conceptual, idiomatic, experiential, and cultural equivalence between the original English and Turkish versions through a multistage procedure involving translation, expert review, evaluation of linguistic and cultural equivalence, and pre-testing with the target population. Ethical approval was obtained from the Fenerbahçe University Academic Research and Publication Ethics Committee (Protocol No. 2020-015; Approval Date: September 28, 2020), and written informed consent was obtained from all experts and participants prior to their involvement in the study.

Participants

A total of 39 individuals participated in the translation and cross-cultural adaptation process of the ASH. The participants represented multiple professional disciplines to ensure linguistic, clinical, and conceptual rigor throughout the adaptation procedure. The study included two forward translators, four synthesis committee members, two linguistic reviewers, two backward translators, eight expert reviewers, and twenty adolescents and adults who participated in cognitive debriefing and field testing. All professionals had at least five years of relevant clinical or academic experience in their respective fields. Adolescents and adults who participated in cognitive debriefing were recruited from community and university settings and were able to independently complete self-report questionnaires. Detailed information regarding participant groups, characteristics, and assigned tasks is presented in Table 1.

Instruments

The Adult/Adolescent Sensory History

The Adult/Adolescent Sensory History (May-Benson, 2015) is a standardized self-report assessment developed to identify sensory processing and integration difficulties in individuals aged 13–95 years. The ASH consists of a primary self-report form, a near identical caregiver report form, a simplified supplement form, and a medical history form. The primary form and the caregiver report forms each consist of 163 items rated on a 5-point Likert scale (1 = almost never to 5 = almost always), with higher scores indicating greater dysfunction. The measure generates a Total Score and multiple standardized section scores reflecting Visual-Spatial Processing (29 items), Auditory & Language Processing (12 items), Vestibular/Movement Processing (28 items), Tactile Processing (33 items), Proprioceptive Processing (10 items), Taste & Smell (11 items), Sensory Modulation (58 items), Sensory Discrimination (67 items), Postural Control (11 items), Motor Coordination/Praxis (12 items), and Social-Emotional Functioning (17 items). Raw scores are converted to standardized z-scores or scaled scores via a computerized scoring program and interpreted across three performance levels (Typical Performance: > −1.0 SD; Mild Difficulties: −1.0 to −2.0 SD; Definite Difficulties: ≤ −2.0 SD). An abridged simplified supplement form to the caregiver form for individuals with lower reading, language, or cognitive levels consists of 63 items across the same sensory-motor areas as the self-report form which is scored as no, a little, and a lot. There is no formal scoring for this form. It is designed to provide additional information on items where research demonstrated discrepancies between caregiver and self-report. All forms were translated and evaluated simultaneously so use of the term ASH in this study refers to all of the forms associated with this assessment.
The ASH was developed over a 15-year research process by a doctoral level occupational therapist that included clinical use, tryout studies, pilot studies, exploratory factor analysis, Rasch modeling, and large-scale standardization (May-Benson, 2015). Internal consistency coefficients for the research version demonstrated strong reliability, with Cronbach’s alpha values exceeding .80 for the Total Score and major sensory sections. Test–retest reliability coefficients for the Total and Section Scores ranged from moderate to high (r values generally reported above .70), indicating temporal stability. Inter-rater reliability analyses, including child–parent and mother–father comparisons, demonstrated moderate to strong agreement (correlation coefficients reported in the .60–.80 range). Concurrent validity was established through statistically significant correlations with the Adolescent/Adult Sensory Profile, with Pearson correlation coefficients reported as moderate in magnitude, supporting construct convergence. Discriminative validity analyses demonstrated significant mean differences between individuals with Autism Spectrum Disorder, Sensory Processing Disorder, and typically developing peers, confirming the instrument’s ability to distinguish clinical and non-clinical populations. Rasch analysis supported item functioning and scale structure across developmental stages, and normative data were derived from a geographically and demographically diverse standardization sample (May-Benson, 2015).

Expert Evaluation Form

A structured expert evaluation form was developed exclusively for this study to systematically evaluate the pre-final Turkish version of the ASH during the expert review stage. This form had 10 items assessing important features of the translated instrument such as linguistic clarity, comprehensibility, suitability of terminology, cultural appropriateness, linguistic consistency, and overall usability. Each item was scored on a five-point Likert scale from 1 (not appropriate) to 5 (totally appropriate). The form also included open-ended areas for qualitative input and recommendations from language and cultural experts on language, cultural adaptation, and potential adjustments to individual items, in addition to the quantitative ratings.

Pretest Participant Evaluation Form

A structured participant evaluation form was designed to systematically evaluate the comprehensibility, acceptability, and usability of the pre-final Turkish version of the ASH in the pretesting phase. The form contained eleven items to assess the clarity of the instructions, the readability and understandability of the questionnaire items, the appropriateness of the language, the cultural appropriateness, the ease of using the response options, the ability to complete the questionnaire independently, the appropriateness of the time required to complete the questionnaire and the overall usefulness of the instrument. Items were graded on a five point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Furthermore, the form had open-ended questions for qualitative comments about the phrasing of the questions, culturally inappropriate terms, difficulty in completing the questionnaire and suggestions for improving the translated version.

Translation and Cross-Cultural Adaptation Procedure

A seven-step translation and cross-cultural adaptation protocol was implemented in accordance with established methodological recommendations (Beaton et al., 2000; Cruchinho et al., 2024; ITC, 2017; 2019; Schuster et al., 2010; Sagliyan et al., 2026).
Step 1: Forward Translation
Two independent bilingual translators whose native language was Turkish produced separate forward translations of each of the ASH Questionnaires. Both translators had professional expertise in rehabilitation-related translation and were involved exclusively in this phase of the study.
Step 2: Synthesis
An expert synthesis committee consisting of four specialists in physical and occupational therapy reviewed both forward translations and reconciled discrepancies through consensus to produce a single Turkish version of each form. The committee ensured that the translated items preserved the conceptual intent of the original instrument, used appropriate terminology, and were linguistically and culturally appropriate for the Turkish population. Where necessary, wording was refined to improve conceptual equivalence and cultural relevance without altering the original meaning.
Step 3: Linguistic and Cultural Review
The synthesized Turkish version of each form was reviewed by a linguist and an educational sciences specialist with expertise in language, education, and assessment. They evaluated grammatical accuracy, linguistic clarity, readability, comprehensibility, and cultural appropriateness, and provided recommendations for modifications where necessary while preserving the conceptual meaning of the original instrument. These experts participated exclusively in this phase.
Step 4: Backward Translation
Two independent bilingual professionals, blinded to the original instrument, back-translated the reconciled Turkish draft into English. Both had advanced expertise in rehabilitation and academic contexts. This step enabled evaluation of semantic and conceptual consistency with the source version. These translators were involved exclusively in this phase.
Step 5: Expert Committee Review
An expert committee comprising members of the synthesis committee and the original developer of the ASH compared the back-translated versions with the original English instrument to evaluate semantic, idiomatic, experiential, and conceptual equivalence in accordance with cross-cultural adaptation standards. Any discrepancies identified during the comparison were discussed, and revisions were implemented by consensus where necessary to preserve the conceptual meaning and scoring intent of the original instrument. The original developer participated exclusively in this phase.
Step 6: Expert Interviews
An interdisciplinary panel of experts from occupational therapy, physical therapy, psychiatry, and psychology evaluated the pre-final Turkish version using a structured evaluation form. The form assessed linguistic clarity, comprehensibility, cultural appropriateness, consistency, and overall usability using a five-point Likert scale (1 = not appropriate to 5 = completely appropriate), together with open-ended recommendations for item modification. Based on the experts’ quantitative ratings and qualitative feedback, revisions were made by consensus where necessary.
Step 7: Field Testing and Pretesting
The pre-final Turkish version of each of the ASH forms was administered to typically functioning individuals from the target adult population who were able to complete the self-report measures independently. The pretesting phase focused on adults to provide an initial evaluation of the comprehensibility, clarity, and cultural appropriateness of the translated forms within a relatively homogeneous non-clinical sample. Accordingly, adolescents and individuals with disabilities were not included in this phase; evaluation of the adapted forms in these populations was reserved for subsequent studies. After completing the questionnaires, participants completed a structured evaluation form assessing their clarity, comprehensibility, readability, cultural appropriateness, and ease of completion using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree) and provided qualitative feedback. The caregiver form was also reviewed with consideration of items for which caregivers may not have sufficient opportunity to observe or rate the target individual’s sensory experiences, which is an expected feature of caregiver reporting. The simplified supplement was additionally reviewed for readability, comprehensibility, and suitability for its intended use. The supplement is written at approximately a fourth-grade reading level, uses simplified response options, and does not generate standardized scores. It is designed to provide the target individual’s perspective on selected items for which discrepancies may occur between caregiver and self-report responses, thereby supplementing information obtained from the caregiver form when needed. Based on participant feedback across the forms, minor linguistic refinements were made by consensus to improve readability and comprehensibility without altering the conceptual meaning of the original instrument.

Data Analysis

Data obtained throughout the translation and cross-cultural adaptation process were analyzed descriptively. Semantic, idiomatic, experiential, and conceptual equivalence between the original and Turkish versions of the ASH forms were systematically evaluated at each stage of the adaptation process.
Qualitative feedback obtained from the forward translators, synthesis committee, linguists, expert panel, back-translation review, and pilot testing participants was reviewed to evaluate the clarity, comprehensibility, linguistic accuracy, cultural appropriateness, and conceptual equivalence of the translated questionnaire. Revisions were incorporated based on consensus among the synthesis committee while preserving the conceptual meaning of the original instruments.
Experts completed a structured evaluation form assessing the linguistic clarity, comprehensibility, cultural appropriateness, consistency, and overall usability of the Turkish versions of the ASH forms as a whole. Responses were rated on a five-point Likert scale ranging from 1 (“not appropriate”) to 5 (“completely appropriate”). Ratings of 4 (“appropriate”) and 5 (“completely appropriate”) were considered positive evaluations, whereas ratings of 1–3 were considered non-positive evaluations. The distribution of responses was summarized using frequencies and percentages for each evaluation criterion.
During the pretesting phase, participants completed a structured evaluation form assessing the clarity, comprehensibility, and ease of completing the Turkish version of the ASH forms. Each item was rated using a five-point Likert scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). Ratings of 4 (“agree”) and 5 (“strongly agree”) were considered positive evaluations, whereas ratings of 1–3 were considered non-positive evaluations. The distribution of responses for each evaluation criterion was summarized using frequencies and percentages. In addition, participants were encouraged to provide qualitative comments regarding any items they found difficult to understand, culturally inappropriate, or linguistically unclear. These comments were reviewed descriptively by the research team, and final revisions were implemented through consensus whenever necessary to improve the readability and comprehensibility of the questionnaire without altering its conceptual meaning.

Results

Forward Translation and Synthesis

Two independent forward translations of the ASH forms were performed by two different bilingual translators and sent to the synthesis committee for review. Both translators stated that the translation procedure was straightforward and that the questionnaire items were clear and easy to translate into Turkish. During the forward translation stage, no major linguistic or conceptual challenges were experienced.
All synthesis committee members (%100) determined that the two forward translations prepared independently were in good agreement, differing primarily in minor language and sentence structure. Overall, the semantic, conceptual, idiomatic, and contextual comparability of the two versions was high, demonstrating consistency in translating the original content into Turkish. Minor adjustments were sufficient to increase linguistic naturalness, clarity, and cultural appropriateness. One of the important changes was the transformation of the items from interrogative form in the original English version (e.g., “Do you…?”) to first-person declarative statements, which better fit Turkish linguistic conventions. . Readability and comprehensibility were improved by using more natural and common Turkish expressions, increasing contextual specificity where appropriate (e.g. replacing generic terms with culturally resonant examples such as “market shelves” or “vehicle headlights”), and clarifying potentially ambiguous wording without changing the original conceptual meaning. Representative examples of these adjustments are shown in Table 2.
Following completion of the synthesis process, a single reconciled Turkish version of each ASH form was produced and submitted to two linguists for linguistic evaluation. Both linguists (100%) considered the questionnaire forms to be generally clear, comprehensible, and appropriate for Turkish-speaking respondents. Nevertheless, they proposed several minor linguistic refinements to further improve readability, grammatical accuracy, and conformity with standard Turkish language conventions without altering the conceptual meaning of the original instrument. For example, “Seslere karşı aşırı hassas görünürüm” was revised to “Seslere karşı aşırı hassasım” to improve linguistic naturalness, and “Hızlı hareket içeren aktiviteleri ararım” was modified to “Hızlı hareket içeren aktivitelerden hoşlanırım” to better reflect natural Turkish usage while preserving the original concept. In addition, several revisions were recommended for the demographic and instructional sections to enhance clarity and cultural appropriateness. For example, the marital status options were simplified by consolidating multiple categories into the more concise response options of “married”, “single”, and “other”, and the instructions were rewritten using clearer and more natural wording to facilitate respondents’ understanding. No culturally inappropriate expressions or concepts requiring modification were identified within the questionnaire items themselves. Following incorporation of these recommendations, the pre-final Turkish version of the questionnaires were established. Representative examples of additional linguistic revisions are presented in Table 3.
Following the linguistic revisions, a single pre-final Turkish version of eachASH form was established through collaboration between the synthesis committee and the linguists. This version was independently back-translated into English by two bilingual translators. The back-translated versions were subsequently evaluated by the synthesis committee and the developer of the original ASH (last author). Compared with the original English instrument, the back-translations demonstrated several expected wording differences that primarily reflected the cultural and linguistic adaptations introduced during the Turkish translation process rather than changes in conceptual meaning. The most notable differences resulted from converting the original interrogative item format (e.g., “Do you…?”) into first-person declarative statements (e.g., “I…”), consistent with Turkish linguistic conventions. Additional differences were limited to stylistic and lexical variations intended to improve the naturalness and readability of the Turkish version. Following this review, all evaluators (100%) agreed that the back-translated version was conceptually equivalent to the original instrument, and no further modifications affecting the content or underlying constructs were required. Representative examples are presented in Table 4.
During the expert interview phase, all experts (100%) rated every evaluation criterion as either 4 (appropriate) or 5 (completely appropriate), indicating that the Turkish ASH was considered linguistically clear, easily understandable, culturally appropriate, internally consistent, and suitable for the target population. Overall, the experts agreed that the questionnaires were comprehensible and ready for use. Nevertheless, several minor recommendations were provided to further enhance clarity and readability without altering the conceptual content of the forms. For example, experts recommended replacing “Ne istediğimi ifade edecek ifadeleri bulmakta zorlanırım” with “Ne istediğimi ifade edecek kelimeleri bulmakta zorlanırım” to improve linguistic precision, and revising “Çarşafımdaki rahatsız edici yükseltileri fark ederim” to “Çarşafımdaki küçük yükseltiler ya da pürüzler beni rahatsız eder” to increase comprehensibility. The synthesis committee reviewed all expert recommendations and incorporated those considered conceptually appropriate while preserving the original constructs of the ASH. Representative examples of the revisions made following expert review are presented in Table 5.
During the pretesting, the pre-final Turkish version of the ASH was completed by 20 participants, 12 of whom were parents of individuals over 18 years of age (60.0%) and 8 young adults aged 18–30 years (40.0%). Overall, feedback from the participants suggested that the translated questionnaires were quite understandable, acceptable and culturally appropriate. All participants indicated either Agree (4) or Strongly Agree (5) to all items except one, “The time required to complete the questionnaire was appropriate”. This indicates that the instructions, wording, response options, and overall format of the questionnaire were clear, easy to understand, and appropriate for independent completion. Moreover, 100% of the total participants felt that none of the items were culturally inappropriate. Feedback regarding the caregiver form and simplified supplement similarly indicated that both forms were comprehensible and suitable for their intended use. No concerns requiring linguistic or conceptual modification were identified for either form, including the simplified wording and response format of the supplement.
For the item rating the appropriateness of the completion time, 16 participants (80.0%) selected Agree (4) or Strongly Agree (5), while 4 participants (20.0%) selected the neutral answer (Neither agree nor disapprove; score = 3). No participant gave this item a bad rating.
No responses indicated unclear or ambiguous issues, culturally incorrect phrasing, or suggestions for altering the questionnaire in the open-ended questions. Four participants (20.0%) reported that the questionnaires had a pretty significant number of items and consequently needed enough time and serious attention to complete. Several participants also remarked that they did not have relevant daily-life experience for some situations detailed in the questionnaire, which made it difficult to evaluate those questions based on personal experience, rather than showing problems with comprehension. It should be noted that the ASH scoring accounts for this response in scoring on a number of items so this response was to be expected. The qualitative response in general confirmed the clarity and cultural compatibility of the Turkish version and no changes were recommended after the pretesting phase.

Discussion

The present study systematically translated and culturally adapted the ASH into Turkish following internationally accepted guidelines for cross-cultural adaptation of self-report instruments. Overall, the findings demonstrated that the Turkish version of all forms achieved semantic, idiomatic, experiential, and conceptual equivalence with the original instrument while preserving its clinical intent and underlying constructs. Throughout the adaptation process, only minor linguistic and cultural refinements were required, and no modifications affecting the conceptual content or scoring principles were necessary. Furthermore, expert evaluation confirmed the linguistic clarity, cultural relevance, and clinical appropriateness of the translated instrument, while the pretesting phase demonstrated high comprehensibility and acceptability among the target population. Participants reported no culturally inappropriate or unclear items and suggested no modifications to the questionnaire, supporting the adequacy of the cross-cultural adaptation process.
The translators’ complementary experience may account for the great degree of concordance between the two separate forward translations. Current guidelines suggest that forward translators should be multilingual and knowledgeable about the construct and vocabulary of the instrument to ensure conceptual equivalence (Benlidayı and Gupta, 2024; Cruchinho et al., 2024; ITC, 2017; 2019). In the present study, one of the translators was an occupational therapist familiar with the concept of sensory integration, while the other was experienced in translating texts linked to rehabilitation. This combination might have contributed to making the differences between the two forward translations small by allowing consistent interpretation of the original concepts (Ozdemir et al.,2025; Sagliyan et al.,2026).
Although the forward translators kept the ASH items in their original interrogative form, the synthesis committee changed them into first-person declarative statements so as to make them more consistent with Turkish language conventions. Current recommendations for cross-cultural adaptation emphasize that the goal of translation is not to copy the original text precisely but to maintain conceptual equivalence while ensuring language naturalness and cultural appropriateness (Benlidayı and Gupta, 2024; Cruchinho et al., 2024; ITC, 2017; 2019). Previous Turkish adaptation studies of sensory integration–related instruments have likewise reported rephrasing item expressions to improve the naturalness and comprehensibility of the Turkish version while maintaining conceptual equivalence (Ozdemir et al., 2025; Sagliyan et al., 2026). Hence, the synthesis committee did not find any culturally unacceptable items, concepts, examples or idioms that needed modification. Instead, only modest grammatical modifications were made to enhance clarity and readability and to allow the natural flow of the Turkish language while keeping the intended meaning of each item. These changes align with the current guidelines for cross-cultural adaptation, which allow for changes in wording and sentence structure during the synthesis phase to improve the comprehensibility of the text without affecting conceptual equivalence (Benlidayı and Gupta, 2024; Cruchinho et al., 2024). The review and adjudication stage also strives to improve phrasing, resolve translation options, and generate a version that is conceptually equivalent and easy for the target community to understand (McKown et al., 2020). Recent suggestions from ISOQOL have stressed that the translated items should reflect the intended notion rather than just the grammatical structure of the original (Arnold et al., 2025). Therefore, translating the ASH items into declarative statements was a linguistic and cultural change that increased the readability of the instrument without compromising the meaning and the latent constructions of the original instrument.
The linguistic review suggested that the translated questionnaires were usually clear, understandable, and adequate for Turkish-speaking respondents. The majority of the recommendations concerned minor grammatical alterations, improvements in word selection, and changes to enhance the readability and natural flow of Turkish, without changing the basic content of the items. Several changes were suggested to the introductory and explanatory parts of the questionnaire to improve clarity and cultural appropriateness; however, no terms or concepts used in the questionnaire items were identified as culturally inappropriate and requiring conceptual change. These findings align with existing cross-cultural adaptation standards, which recommend that the linguistic review should improve clarity, readability, and cultural relevance while maintaining conceptual equivalence. Small linguistic modifications are considered an expected and suitable element of the adaptation process rather than modifications to the construct being measured (Benlidayı and Gupta, 2024; Cruchinho et al., 2024; ITC, 2019).
Differences occurred during back-translation mainly because of the intentional rephrasing of the original interrogative items into first-person declarative statements by the synthesis committee and the inclusion of several wording refinements to improve clarity and naturalness in Turkish. Such differences were to be expected and should not be taken as an indication of poor translation quality. Recent cross-cultural adaptation guidelines highlight that back-translation should avoid literal equivalence to the original, but rather aim to demonstrate that the intended concepts have been maintained and to assist in the assessment of translation choices (Cruchinho et al., 2024; Sousa and Rojjanasrirat, 2011; ITC, 2017; 2019). Likewise, methodological research has shown that when deliberate language or cultural adjustments are made, differences between the original and back-translated versions are common and do not necessarily mean that there are problems in the translation. By contrast, the need for literal equivalency might lead to translations that are too literal and so not conceptually or culturally suitable (Behr, 2017). Therefore, the discrepancies found during back-translation in the present study were seen as a natural result of the language changes introduced throughout the synthesis step while keeping the conceptual integrity of the original ASH items.
The expert review further supported the linguistic and cultural adequacy of the Turkish ASH. All experts considered the translated questionnaires to be clear, comprehensible, culturally appropriate, internally consistent, and suitable for the target population, indicating that the adaptation successfully preserved the intended concepts of the original instrument. Consistent with current cross-cultural adaptation guidelines, the review was conducted by a multidisciplinary expert panel, enabling the translated version to be evaluated from complementary clinical, linguistic, and methodological perspectives (Benlidayı & Gupta, 2024; Cruchinho et al., 2024; Daouk-Öyry and McDowal, 2013; ITC, 2017;2019). A similar multidisciplinary approach involving experts with relevant subject-matter expertise has also been adopted in previous Turkish cross-cultural adaptation studies of rehabilitation and sensory processing instruments, yielding comparable findings regarding the linguistic and conceptual adequacy of the translated versions (Balikci et al., 2025; Ozdemir et al., 2025; Sagliyan et al., 2026). Although the overall evaluation was highly positive, the experts recommended several minor refinements involving wording, semantic precision, and sentence clarity to improve comprehensibility and the naturalness of the Turkish language without modifying the conceptual meaning of the items. These findings are consistent with current methodological recommendations, which recognize that expert review is intended to optimize wording and cultural appropriateness while preserving conceptual equivalence (Daouk-Öyry and McDowal, 2013; ITC, 2019; Mokkink et al., 2025; Terwee et al., 2018). Therefore, the recommendations made by the expert panel should be interpreted as linguistic refinements that enhanced the quality of the Turkish version rather than changes to the underlying constructs of the ASH.
The pretesting results demonstrated that the Turkish ASH forms weres predominantly comprehensible and acceptable to the intended demographic. The majority of participants indicated that the questionnaire were clear, comprehensible, and culturally suitable, implying that the linguistic modifications made throughout the translation process effectively improved understanding. The findings align with contemporary cross-cultural adaptation guidelines, which recognize pretesting as an essential procedure for assessing the target population’s comprehension of translated items and instructions (Cruchinho et al., 2024; Mokkink et al., 2025). While a few participants noted that the questionnaire required significant time and focus to complete, none proposed eliminating or altering any item. The extensive length of the ASH renders such comments unsurprising, largely indicating respondent burden rather than shortcomings in the translated form (May-Benson, 2015). Moreover, certain participants indicated challenges in answering specific items due to a lack of exposure to the pertinent events in their daily lives (e.g. shaving or flying in planes), rather than the items being ambiguous. This distinction is crucial, as contemporary methodological guidelines stress that pretesting must differentiate issues pertaining to comprehensibility from those concerning respondents’ experiences or their opportunities to observe the assessed behaviors (Cruchinho et al., 2024; ITC, 2017; 2019). The pretesting findings affirmed the clarity, cultural appropriateness, and practical usability of the Turkish ASH, showing no necessity for further revision.
This study possesses numerous strengths and limitations. A significant advantage is that the Turkish ASH was created through a rigorous, multistage translation and cross-cultural adaptation process, which included forward translation, synthesis, linguistic review, back translation, expert evaluation, and pretesting with the target demographic. The integration of specialists with complementary knowledge and the participation of the original developer facilitated the maintenance of conceptual equivalence throughout the process. Moreover, input from both specialists and intended users suggested that the Turkish version was lucid, culturally suitable, and intelligible, with no items needing conceptual alteration. This study was confined to translation and cultural adaptation; hence, the psychometric aspects of the Turkish ASH, such as reliability, construct validity, and measurement invariance, were not assessed. A further limitation is that the pretesting sample was comparatively small and encompassed a restricted variety of individuals (e.g. did not include teens or individuals with disabilities), thus failing to adequately reflect the entirety of Turkish-speaking adolescents and adults from diverse clinical and sociocultural contexts. Subsequent research should assess the psychometric characteristics of the Turkish ASH in bigger and more heterogeneous samples, encompassing both clinical and non-clinical individuals.

Conclusions

This study effectively translated and culturally adapted the ASH into Turkish utilizing a stringent, internationally endorsed cross-cultural adaptation methodology. The results indicated that the Turkish version attained semantic, idiomatic, experiential, and conceptual equivalence with the original instrument, preserving its intended meaning and clinical objective. The expert review and pretesting validated that the translated questionnaires were linguistically clear, culturally suitable, and easily understandable for Turkish-speaking teenagers and adults, necessitating only minor linguistic adjustments during the adaptation phase. The Turkish version of the ASH offers clinicians and researchers a thorough, function-focused sensory integration evaluation that enhances current adult sensory processing assessments and may aid both clinical practice and cross-cultural research. Subsequent research should ascertain the psychometric characteristics of the Turkish ASH, encompassing its reliability, validity, responsiveness, and measurement invariance across clinical and non-clinical cohorts.
Key findings
  • The Adult/Adolescent Sensory History (ASH) was successfully translated and culturally adapted into Turkish while preserving semantic, idiomatic, experiential, and conceptual equivalence with the original instrument.
  • Expert evaluation supported the linguistic clarity, comprehensibility, cultural relevance, and conceptual appropriateness of the Turkish ASH, with only minor linguistic refinements required.
  • Pretesting confirmed that the Turkish ASH was clear, comprehensible, and culturally appropriate, supporting its readiness for subsequent psychometric evaluation.
What the study has added
This study provides a culturally adapted Turkish ASH that preserves the original instrument’s conceptual integrity and is ready for subsequent psychometric evaluation.

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Table 1. Participants (groups), respective steps, group size, participant characteristics, and assigned tasks.
Table 1. Participants (groups), respective steps, group size, participant characteristics, and assigned tasks.
Group Step n Participants and Their Characteristics Assigned Tasks
1 1 2 1) An independent bilingual translator whose native language was Turkish and who is a professional translator with over 10 years of experience in the field of rehabilitation.
2) Professional translator holding a bachelor’s degree in Occupational Therapy and a degree in English Language and Literature, with over five years of professional translation experience, specializing in sensory integration and occupational therapy.
 Independent forward translation of the ASH Questionnaires. The aforementioned experts were involved exclusively in this phase of the study.
2 2 4 1) Physical therapist (PhD) with over 15 years of academic and clinical experience in pediatrics, recognized expertise in sensory integration, research experience in the field, and a master’s degree in occupational therapy.
2) Physical therapist (PhD) with over 10 years of combined clinical and academic experience working with adults.
3) Doctoral candidate in occupational therapy with over five years of academic experience in the field.
4) Physical therapist with over 25 years of clinical experience working with both pediatric and adult populations, holding an advanced master’s degree in occupational therapy.		 Review and synthesis of the forward translations to produce a consensus Turkish version of each questionnaire that preserves the conceptual meaning of the original instrument, uses appropriate terminology, and is culturally appropriate.
3 3 2 1) Turkish linguist with >20 years of experience in language and literature.
2) Educational sciences specialist (PhD) with over 15 years of professional experience in the field of education, serving as both an academic and an educator, with demonstrated expertise in educational research and assessment.		 Evaluation of grammatical accuracy, linguistic clarity, readability, comprehensibility, and cultural appropriateness, with recommendations for linguistic and cultural modifications where necessary. The aforementioned experts were involved exclusively in this phase of the study.
4 4 2 Two independent bilingual translators whose native language was Turkish and who are professional translators with over 10 years of experience in the field of rehabilitation.
 Independent backward translation of the reconciled Turkish versions into English. The aforementioned experts were involved exclusively in this phase of the study.
5 5 5 1) Members of the synthesis committee.
2) The original ASH developer, an occupational therapist (PhD) with over 40 years of clinical experience.		 Review of semantic, idiomatic, experiential, and conceptual equivalence between original and back-translated versions.
The original developer of the ASH, was involved exclusively in this phase of the study.
6 6 8 1) Occupational therapist (PhD) serving as a faculty member, working with adults, with over 15 years of clinical experience.
2) Adult psychiatrist with more than 15 years of clinical experience.
3) Child and adolescent psychiatrist with over 10 years of clinical experience.
4) Clinician occupational therapist holding an advanced master’s degree, with more than five years of clinical experience.
5) Doctoral candidate in occupational therapy with over five years of clinical experience.
6) Physical therapist with over 15 years of clinical experience and a master’s degree in occupational therapy.
7) Occupational therapist with more than five years of clinical experience and a master’s degree in occupational therapy.
8) Occupational therapist pursuing a PhD in psychology, with over five years of clinical experience.		 Expert interviews of cultural relevance, clinical clarity, conceptual equivalence, and recommendations for item modification where necessary.
7 7 20 Adolescents and adults (aged 18–50 years; both genders) recruited from community and university settings; no intellectual disability; able to complete self-report measures independently. Completion of the pre-final Turkish ASH questionnaires and participation in structured cognitive debriefing interviews to evaluate comprehensibility and interpretability of items.
Note. ASH = Adult/Adolescent Sensory History; PhD = Doctor of Philosophy.
Table 2. Representative modifications made during the synthesis stage across the ASH domains.
Table 2. Representative modifications made during the synthesis stage across the ASH domains.
Section Original English item Forward translation Final synthesized Turkish version
Visual and Spatial Processing (Item 10) Do you see people in two dimensions? İnsanları iki boyutlu görür müsünüz? İnsanları iki boyutlu gibi algılarım.
Auditory and Language Processing (Item 7) Do you attend to intruding noises like mowers, planes going overhead or sirens more than most people? Çim biçme makinesi, uçak veya siren gibi beklenmedik seslere çoğu kişiden daha fazla dikkat eder misiniz? Çevresel seslere (Çim biçme makinesi, uçak veya siren gibi ) çoğu kişiden daha fazla dikkat ederim.
Movement (Vestibular Processing) (Item 7) Do you seek fast movement activities (e.g., biking, skiing, carnival rides)? Bisiklete binme, kayak yapma veya lunapark araçları gibi hızlı hareket içeren aktiviteleri arar mısınız? Hızlı hareket içeren aktiviteleri (Bisiklete binme, kayak yapma veya lunapark gibi.) özellikle tercih ederim.
Taste and Smell (Item 5) Do you have more difficulty eating textured than smooth foods? Pütürlü yiyecekleri pürüzsüz yiyeceklere göre daha zor yer misiniz? Pütürlü yiyecekleri pürüzsüz yiyeceklere göre daha zor yerim.
Touch (Tactile Processing) (Item 10) Do you prefer tight exercise-type clothing? Dar, egzersiz tipi kıyafetleri tercih eder misiniz? Dar, egzersiz tipi kıyafetler giymeyi tercih ederim.
Table 3. Representative linguistic revisions suggested by the linguists.
Table 3. Representative linguistic revisions suggested by the linguists.
Section Synthesized Turkish version Linguists’ recommendation
Visual and Spatial Processing – Item 15 Bir odaya baktığımda aynı anda sadece bazı bölümlerini görürüm. Bir odaya baktığımda aynı anda odanın sadece bazı bölümlerini görürüm.
Visual and Spatial Processing – Item 20 Market rafında aradığım ürünü bulmakta zorlanırım. Market rafında aradığım bir ürünü bulmakta zorlanırım.
Touch (Tactile Processing) – Item 16 İnsanlar bana çok yakın oturduğunda veya ayakta çok yakınımda durduğunda rahatsız olurum. İnsanlar bana çok yakın oturduğunda veya ayakta çok yakınımda durduklarında rahatsız olurum.
Touch (Tactile Processing) – Item 31 Tıraş köpüğünü yüzümün veya bacaklarımın tamamına iyice sürmekte zorlanırım. Tıraş köpüğünü yüzümün veya bacaklarımın tamamına düzgünce sürmekte zorlanırım.
Postural Control – Item 5 Fiziksel aktivite ile kolayca yorulurum. Fiziksel aktivite ile kolaylıkla yorulurum.
Table 4. Representative examples of differences identified during back translation.
Table 4. Representative examples of differences identified during back translation.
Original English item Final Turkish version Back-translated English version Interpretation
Do you become easily distracted by visual stimulation? Dikkatim görsel uyaranlarla kolayca dağılır. I am easily distracted by visual stimuli. Difference reflects conversion from interrogative to first-person declarative format; conceptual meaning preserved.
Do you seek fast movement activities (e.g., biking, skiing, carnival rides)? Hızlı hareket içeren aktiviteler ararım (Örneğin bisiklet sürme, kayak, lunapark araçları). I seek out activities that involve fast movement (e.g., cycling, skiing, amusement park rides). Minor lexical differences (carnival rides → amusement park rides) without conceptual change.
Do you have more difficulty eating textured than smooth foods? Pütürlü yiyecekleri pürüzsüz yiyeceklere göre daha zor yerim. I have more difficulty eating foods with a rough texture than smooth ones. Back translation preserved the intended comparison despite lexical variation.
Do you experience things moving when they are not moving? Hareket etmeyen şeyleri hareket ediyormuş gibi algılarım. I perceive things that are not moving as if they are moving. The verb perceive accurately reflects the intended perceptual construct.
Do you get disoriented in space easily? Bir alanda (mekanda) yönümü kolayca şaşırırım. I easily lose my sense of direction in a place. Minor wording differences with full conceptual equivalence.
Table 5. Representative revisions made following expert interview.
Table 5. Representative revisions made following expert interview.
Section (Item) Version before expert review Final version after expert review Reason for revision
Visual and Spatial Processing (Item 12) Işıklara doğru veya yaklaşmakta olan araçların farlarına bakmaktan hoşlanırım. Işıklara veya yaklaşmakta olan araçların farlarına bakmaktan hoşlanırım. Improved sentence fluency and natural Turkish word order.
Movement (Vestibular Processing) (Item 11) Kafamı sallarım. Tekrarlayıcı şekilde başımı sallama eğilimindeyim. Clarified the intended repetitive behavior and reduced ambiguity.
Taste and Smell (Item 2) Yiyeceklerin tadına olumsuz tepki veririm. Bazı yiyeceklerin tadına olumsuz tepki veririm. Increased conceptual clarity by avoiding overgeneralization.
Taste and Smell (Item 3) Yiyeceklerin dokusuna olumsuz tepki veririm. Bazı yiyeceklerin dokusuna (örn. pütürlü, sert vb.) olumsuz tepki veririm. Added representative examples to improve comprehensibility while maintaining conceptual equivalence.
Social/Emotional (Item 10) Aktif ve saldırgan olma eğilimindeyim. Atak ve saldırgan davranma eğilimindeyim. Improved semantic precision and reduced potential ambiguity in the interpretation of active.
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