Classifying sensory profiles of children in the general population

Sensory Family Accommodation for Autistic and Sensory Overresponsive Children: The Mediating Role of Parenting Distress Tolerance

IMPORTANCE

Family accommodation of anxiety disorders is associated with poorer outcomes; therefore, they are important to detect. A child's sensory problems often cause anxiety and disrupt family routines, which can increase family accommodation.

OBJECTIVE

To compare family sensory accommodation among children with autism spectrum disorder (ASD), children with sensory overresponsiveness (SOR), and typically developing children (TD). To examine the role of parenting distress tolerance in explaining the relation between SOR and family accommodation.

DESIGN

Cross-sectional case control design involving nonrandomized sampling and a survey methodology.

SETTING

Internet.

PARTICIPANTS

Parents of 57 ASD children, 54 SOR children, and 48 TD children. Groups were matched on child age and ethnicity.

OUTCOMES AND MEASURES

The Short Sensory Profile 2, Adapted SensOR Inventory (total SOR), Family Accommodations Scale for Sensory Over-Responsivity (FASENS), and the Parenting Distress Tolerance Scale (P-DTS).

RESULTS

The groups with ASD or SOR (clinical groups) had a higher frequency of family sensory accommodation, and these accommodations showed greater interference with child and family well-being than among the TD group. The clinical groups had significantly more bothersome sensations and lower P-DTS scores than the TD group. In the clinical groups, the P-DTS mediated the relation between total SOR and FASENS scores, controlling for mother's years of education.

CONCLUSIONS AND RELEVANCE

Family sensory accommodation was more frequent among families of children with ASD or SOR and interfered more with child and family well-being. For clinical groups, being bothered by more sensations reduced parenting distress tolerance, which increased family accommodation. Plain-Language Summary: When children have strong reactions to sensory experiences, families often change their routines to prevent discomfort. This is called family sensory accommodation-when family members adjust their behaviors to avoid or minimize their child's sensory challenges and the associated distress. Although this may reduce stress in the short term, it can also reinforce anxiety and limit a child's ability to cope. We found that parents of children with autism spectrum disorder or sensory overresponsiveness were more likely to make these accommodations compared with parents of typically developing children. These accommodations were linked to greater disruptions in both child and family well-being. We also found that parents who had more difficulty managing their own stress were more likely to engage in family sensory accommodation. These findings highlight the need for occupational therapists to support families in reducing restrictive accommodations while helping children build independence and coping skills.

Use of sensory processing information in the diagnosis of autism spectrum disorder and attention deficit hyperactivity disorder in children at an Australian community hospital

INTRODUCTION

The provision of sensory processing information is one aspect of occupational therapy involvement in diagnostic assessment for autism spectrum disorder and attention deficit hyperactivity disorder. The aim of this study was to retrospectively compare SHORT Sensory Profile 2 results of children with suspected diagnoses and assess the discriminatory ability of modified scales of SHORT Sensory Profile 2 to identify diagnostic criteria.

METHOD

This study involved a retrospective chart audit of SHORT Sensory Profile 2 results and paediatrician letter of diagnosis (N = 92) for children aged 6-13 years who had multidisciplinary diagnostic assessment through outpatient paediatric service.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers participated in the study design or analysis. Study involved retrospective analysis of de-identified results from caregiver assessments.

RESULTS

Forty nine per cent of children in study sample had confirmed diagnosis of attention deficit hyperactivity disorder, and 26% had diagnosis of autism spectrum disorder. Average percentage scores for both behavioural and sensory components of the SHORT Sensory Profile 2 were highest amongst children with a diagnosis of autism spectrum disorder, as well as higher classification for avoiding and seeking quadrants. In relation to modified scales, Cronbach's alpha indicated high internal consistency for inattention (0.84) and social communication and interaction (0.86). Based on the ROC analyses, the discriminatory ability when all the modified scales are used in combination ranged from poor (original four quadrants to distinguish ADHD vs no diagnosis: AUC = 0.59) to good (ASD vs ADHD; AUC = 0.82; ASD vs no diagnosis (AUC = 0.81).

CONCLUSION

Results of this study highlight the need for more rigorous investigation for validation of modified scales and consensus within occupational therapy and multidisciplinary team in relation to reporting of sensory processing information and contribution to diagnostic criteria.

PLAIN LANGUAGE SUMMARY

Many children with attentional difficulties or autism require information from occupational therapists about their sensory issues to help inform and identify behaviours of concern. This study looked at how a sensory processing screening tool can identify traits related to attentional difficulties and autism in children. Seventy-eight medical charts of children from a community hospital were reviewed. This study showed that information from the sensory processing screening tool related to attention and social communication traits. Clinicians can consider using information from a sensory processing screening tool in combination with other assessments to contribute to the identification of attention difficulties and autism in children.

Cytomegalovirus-Reactive IgG Correlates with Increased IL-6 and IL-1β Levels, Affecting Eating Behaviours and Tactile Sensitivity in Children with Autism

BACKGROUND/OBJECTIVES

Elevated cytokine levels, including IL-6 and IL-1β, can contribute to persistent brain inflammation in children with autism and cytomegalovirus (CMV) infection, exacerbating autism-related behaviours and symptoms. This study evaluates the impact of CMV-induced cytokine increases on the eating behaviours and sensory profiles of children with autism.

METHODS

A cross-sectional design was employed, involving children aged two to five years (CMV-reactive IgG), with ASD (n= 98) and TD (n = 96). Serological tests using ELISA were conducted to measure IgG CMV, IL-6, and IL-1β biomarkers. Eating behaviours were evaluated using the BAMBI (Brief Autism Mealtime Behaviour Inventory), and sensory profiles were assessed using the SSP (Short Sensory Profile). Statistical analyses were performed using Spearman's rank and chi-square tests.

RESULTS

The results show that autism significantly affects children's eating behaviours and sensory profiles (p < 0.001), with notable differences found between the groups. Correlation analysis revealed a significant association between IgG CMV and IL-6 (p = 0.026) and IL-1β (p = 0.014) in the ASD group. Additionally, eating behaviours (food refusal and limited variety) in ASD correlated with IL-6 and IL-1β. Sensory characteristics, such as tactile sensitivity, were found to correlate with IL-6 (p = 0.027) and IL-1β (p = 0.002) in the ASD group.

CONCLUSIONS

These findings suggest that CMV-infected children with autism are at increased risk of IL-6 and IL-1β dysregulation, contributing to sensory processing issues and eating behaviours. Further research is needed to enhance CMV testing protocols and better understand the virus's role in the development of sensory and behavioural issues in children with autism.

Perinatal factors associated with sensory processing difficulties in infancy: Findings from the Etude Longitudinale Francaise depuis l'Enfance (ELFE) French national birth cohort

BACKGROUND

Sensory processing involves the nervous system receiving, modulating, and responding to sensory stimuli. Clinical samples have elevated rates of sensory processing difficulties, less is known about sensory processing at population-level. We aimed to investigate patterns of sensory processing in infancy and their association with perinatal factors.

METHODS

Data from a French prospective birth cohort of 9861 babies were used to identify latent sensory classes of 1-year-olds. Multinomial logistic regression examined whether sex, cumulative sociodemographic risk or perinatal factors, were associated with these classes.

RESULTS

Three classes, 'typical sensory' (71.2 %), 'definite sensory difficulties' (21.3 %) and a 'possible sensory difficulties' group (7.5 %) best fit the data. The 'typical' group were easy to calm, adaptable, had low anxiety with no feeding concerns. The 'definite' group were the least easy to calm, least accepting of confined spaces, least adaptable and most anxious. They exhibited more sleeping and feeding problems. The 'possible' group were similar to the 'typical' group apart from being less adaptable with increased sleep difficulties. Dose-response relationships were observed between low 1.5 (relative risk ratio (RRR) CI 1.3-1.9), moderate 2.3 (CI 1.9-2.7) and high 3.5 (CI 2.6-4.8) sociodemographic risk and increasing number of pregnancy-specific adverse experiences:1.5 (CI 1.2-1.9), 1.9 (CI 1.5-2.5), 2.1 (CI 1.6-2.9), 2.4 (CI 1.6-3.6), 3.0 (CI 1.7-5.3) with an increasing risk of sensory difficulties.

CONCLUSIONS

Using public and patient involvement to guide sensory indicator selection for latent class analyses we found that post-natal sociodemographic risk and adverse pregnancy-specific experiences were most strongly associated with sensory difficulties in infants.

Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort

Children with autism and other neurodevelopmental concerns (NDC) frequently exhibit an array of sensory processing dysfunction phenotypes, posing a significant challenge their adaptive development. Additionally, these children often encounter difficulties with self-regulation, including emotion dysregulation, anxiety, and symptoms associated with attention and hyperactivity. However, further research is required to comprehend how patterns of sensory processing differences across neurodevelopmental conditions may contribute to regulatory control problems. Adopting a transdiagnostic perspective within the Research Domain Criteria (RDoC) framework, this study examined the relationship between clusters of sensory processing phenotypes and differential patterns of self-regulation behaviors. We recruited a sample of 117 participants (8-12 years) with a diverse range of neurodevelopmental concerns including autism, ADHD, anxiety, and sensory processing differences. This study aimed to (1) establish the prevalence of self-regulation problems in a community-recruited cohort of children with diverse NDCs; (2) construct data-driven sensory processing latent subtypes; (3) investigate group differences in emotion dysregulation, anxiety, and ADHD symptoms. Results showed that 39% of NDC children met clinically concerning thresholds for emotion dysregulation, 19% for anxiety, and 62% for ADHD. Second, latent profile analysis identified five sensory processing subtypes categorized by modality: Typical Processing, Intermediate/Mixed, Sensory Over-Responsive, Sensory Seeking, and Sensory Under-Responsive. Notably, the Sensory Over-Responsive group exhibited distinctively elevated anxiety scores, while the Sensory Seeking and Sensory Under-Responsive groups showed heightened ADHD scores. Intriguingly, the Sensory Over-Responsive, Sensory Under-Responsive, and Sensory Seeking subgroups all demonstrated elevated emotion dysregulation scores, suggesting a potential shared mechanism of emotion dysregulation that might elucidate the connection between sensory processing differences and increased anxiety and ADHD behaviors in children with autism and other NDCs.

Prevalence and correlates of meeting 24-hour movement behavior guidelines among 8523 youth prescribed eyeglasses/contact lenses

BACKGROUND

Contemporary 24-h movement behavior (24-HMB) guidelines provide recommendations on time spent on physical activity (PA), screen time (ST), and sleep (SL). There is evidence of physiological and psychological health benefits associated with meeting such guidelines. However, the prevalence of meeting 24-HMB guidelines among youth prescribed eyeglasses/contact lenses is less clear. The primary purpose of this cross-sectional analysis was to examine the prevalence of partially or fully meeting 24-HMB guidelines in U.S. youth prescribed eyeglasses/contact lenses, and variations in meeting the guidelines by demographic, health status, and environmental attributes.

METHODS

Data from the 2021 National Survey of Children's Health (NSCH) yielded a target subpopulation of 8523 youth aged 6-17 years (54.22 % girls) prescribed eyeglasses/contact lenses. The representative sample of US children and adolescents was used to estimate the prevalence of meeting 24-HMB guidelines, and a multinomial logistic regression analysis was conducted to examine the odds of meeting 24-HMB guidelines by demographic, health status, and environmental variables.

RESULTS

Overall, only 6.57 % met all three 24-HMB guidelines, 23.74 % did not meet any of the three 24-HMB guidelines, and 3.57 %, 10.88 %, and 29.98 % met single guidelines for physical activity, screen time, or sleep duration, respectively, while 25.27 % met any of two 24-HMB guidelines. Female participants were less likely to meet PA + SL guidelines (OR = 0.57, 95 % CI [0.38, 0.56]) but more likely to meet ST + SL guidelines (OR = 1.52, 95 % CI [1.20, 1.91]). Hispanic participants were less likely to meet PA + ST (OR = 0.28, 95 % CI [0.14, 0.52]) guidelines and all three guidelines (OR = 0.41, 95 % CI [0.23, 0.71]) while participants identified as black (OR = 0.33, 95 % CI [0.21, 0.51]) were significantly less likely to meet ST + SL guidelines. With respect to health status, overweight status, repeated/chronic physical pain, and born premature, were detrimentally associated with meeting two or more 24-HMB guidelines. Living in neighborhoods with parks or playgrounds and neighborhood safety were positively linked to meeting the guidelines while living in neighborhoods with sidewalks or walking paths was negatively linked to meeting PA + ST guidelines.

CONCLUSION

In U.S. youth prescribed eyeglasses/contact lenses the prevalence of meeting all three 24-HMB guidelines was low, especially the low prevalence observed in female participants, Hispanic and black participants, participants with overweight status, repeated/chronic pain, born premature, living in neighborhoods with sidewalks. Policy makers should take initiative to promote integrated guidelines among this special age group for health benefits.

Sensory processing in typically developing toddlers with and without sleep problems

This study investigates the sensory processing of typically developing toddlers with and without sleep problems. The research group consisted of typically developing toddlers with sleep problems (n = 110, mean age=18.35 ± 3.4 months), while the control group included typically developing toddlers without sleep problems (n = 110, mean age=18.67 ± 3.5 months) and their mothers. Toddlers were assigned to the research and control groups based on their sleep problems, as determined by the Brief Infant Sleep Questionnaire. The sensory processing of the toddlers was evaluated using the Infant/Toddler Sensory Profile 2. Sensory patterns and sensory processing sub-parameters of the research and control groups were compared. The sensory processing of the research group showed atypical behavioral responses in low registration (low awareness or indifferent attitude to sensory stimuli), sensory sensitivity (distracted or irritable attitude, intensely stimulated by sensory stimuli), and sensory avoiding (intentional avoidance of sensory stimuli or attitudes that produce out-of-norm responses) patterns compared to the control group (p < 0.05). Behavioral responses were similar in the sensory seeking (disturbing or dangerous attitude to the environment in search of sensory stimuli) pattern (p > 0.309). Statistically significant differences were observed in all sub-parameters of sensory processing compared to the control group. Our findings indicate that toddlers with sleep problems are at risk for sensory processing issues. Toddlers with sleep problems exhibit atypical sensory responses related to sensory sensitivity, low registration, and sensory avoiding. It should be considered that toddlers with sleep problems may show sensitivity to different sensory stimuli, avoidance or may not be able to recognize sensory stimuli. These findings suggest that the inclusion of sensory profile assessments in interdisciplinary care for toddlers with sleep problems may contribute to parent-infant well-being.

Affective Contact in Autism: A Phenomenological Study of the Emotional Experiences of Autistic Adults

IMPORTANCE

Since the first descriptions of autism, difficulties with affective contact (e.g., interpersonal exchanges of feelings between individuals) have been considered a common feature of autism spectrum disorder, and these difficulties frequently manifest in occupational therapy interventions.

OBJECTIVE

To (1) explore how autistic young adults describe their emotions and (2) suggest ways to improve the affective contact between autistic clients and their therapists.

DESIGN

Virtual focus group interviews.

SETTING

Online (Qualtrics) survey and Zoom focus groups.

PARTICIPANTS

Autistic adults (N = 24) who met the following inclusion criteria: self-reported diagnosis of autism spectrum disorder or Asperger syndrome, age 18-35 yr, able to understand English, and able to participate in a focus group or individual interview using verbal or written communication.

RESULTS

Two themes were noted and are presented in this article: (1) Autistic people experience complex emotions and (2) autistic people's emotions are often (mis)measured and (mis)understood.

CONCLUSIONS AND RELEVANCE

The findings indicate that autistic people experience diverse, complex, and intense emotions and that these are connected to occupation. This suggests that occupational therapists must be attuned to the emotional dimension of occupation when working with autistic clients and that autistic clients may benefit from the use of embodied language to reference their emotions. Occupational therapists can help autistic clients recognize their bodily changes when experiencing emotions and to better identify and regulate their emotions. The results also show that there were many cases nonautistic people misinterpreted the emotions of autistic people on the basis of their facial expressions or words. Plain-Language Summary: This article provides information about the emotional experiences of autistic people. The study found that autistic people experience complex emotions and that those emotions are often misinterpreted or misunderstood. The author provides information on how occupational therapists can use a neurodiversity-affirming and person-centered approach to support the emotional experiences of people in the autism community. Positionality Statement: In this article, identity-first language is used when referring to autistic adults. This deliberate choice aligns with the principles of the neurodiversity-affirming movement. Autistic self-advocates have indicated a preference for this style of language over person-first language. The author would also like to acknowledge their positionality. As both a neurodivergent researcher and a self-advocate for the disabled community, this style of language aligns with their own experiences of and beliefs about their disability.

Differentiating early sensory profiles in toddlers at elevated likelihood of autism and association with later clinical outcome and diagnosis

LAY ABSTRACT

Early sensory responsiveness may produce cascading effects on later development, but the relation between sensory profiles and autistic diagnosis remains unclear. In a longitudinal sample of toddlers at elevated likelihood for autism, we aimed to characterize sensory subgroups and their association with clinical outcomes later on. Three sensory subgroups were described and early sensory sensitivity plays a significant role in later development and diagnosis. This study supported the importance of examining different levels of sensory patterns to dissect the phenotypic heterogeneity in sensory processing. As sensory differences are associated with later developmental outcomes, these results may be critical when designing intervention needs and support for children at increased likelihood for neurodevelopmental disorders.

Inter-hemispheric somatosensory coherence and parental stress in hypersensitivity at 8 months old: An electroencephalography study

OBJECTIVE

Infant hypersensitivity affects daily challenges and parental stress. Although the crucial role of tactile sensation in infants' brain function has been highlighted, hypersensitive infants and their families lack support. Electroencephalography may be useful for understanding hypersensitivity traits. We investigated the relationship between infant perceptual hypersensitivity and parental stress, somatosensory-evoked potential (SEP), and magnitude-squared coherence (MSC) in the general population.

METHODS

Infants aged 8 months (n = 63) were evaluated for hypersensitivity and parental stress using a questionnaire and for cortical activity using electroencephalography. Vibration stimuli were applied to the infant's left foot. SEP components that peaked around 150 ms (N2) and at 200 ms (P2) after stimulus onset were evaluated by amplitude and latency at the midline electrode (Cz) and MSC between the midline electrodes (C3-C4).

RESULTS

Parental stress was associated with infant hypersensitivity. The latency of Cz was delayed, and C3-C4 delta MSC was high in infants with hypersensitivity.

CONCLUSIONS

Increasing inter-hemispheric MSC synchrony in the stimulated condition in infants with hypersensitivity suggested atypical somatosensory cortical function.

SIGNIFICANCE

These findings contribute to identifying, understanding the mechanisms of, and developing effective coping strategies for early-stage hypersensitivity.

Caregivers' Assessment of the Sensory Processing Patterns Exhibited by Children with Autism in the Gulf Region

This study explored the nature, prevalence, and developmental profiles of sensory processing disorders among children with autism spectrum disorder (ASD). The participants comprised 119 children with ASD and 30 typically developing children and their parents. The Child Sensory Profile-2 was used to assess the children's sensory processing characteristics. The children with ASD exhibited elevated sensory processing difficulties. Deficits were observed in all the sensory modalities among the children with ASD, except the visual processing modality. Age-related improvements were observed in most sensory processing domains, although non-significant differences were noted in three domains. These findings should enhance understanding of the sensory challenges faced by children with ASD and contribute to the development of individually tailored, targeted, and age-specific therapeutic interventions.

Global Sensory Features are Linked to Executive and Attentional Impairments in Autism Spectrum Disorders

Sensory features, executive and attentional impairments are frequently reported in individuals with autism spectrum disorders (ASD). However, little is known about their complex relationships. In this study, we aim to examine the executive and attentional difficulties related to distinct sensory profiles. We identified sensory profiles with a Latent Profile Analysis (LPA) based on scores on the Short Sensory Profile (SSP) questionnaire in 95 children with ASD aged 6 to 17 years. Executive and attention functions were assessed using the Behavior Rating Inventory of Executive Functions (BRIEF) questionnaire and Attention-Deficit Hyperactivity Disorder Rating Scale (ADHD-RS). A three-cluster solution based on raw SSP scores identified a "high'', a "medium" and a "low'' SSP profile. We found a significant relationship between executive functions, attentional skills and the global severity of sensory features, reinforcing findings of previous studies in the literature. A two-cluster solution based on normalized SSP (i.e. equalized for the global severity) identified distinct sensory profiles, mainly discriminated by the score of underresponsive/seeks sensation. We found no significant difference between these two clusters for the BRIEF and ADHD-RS related scores. Our study suggests that the heterogeneity of sensory features in ASD may not be explained by differences in executive and attention functions. Future studies are needed to refine the link between sensory features and executive functions in autism.

Autistic traits and ARFID-associated eating behaviors in preschoolers: Mediating effects of sensory processing patterns

OBJECTIVE

This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.

METHOD

A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4-6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.

RESULTS

The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.

DISCUSSION

Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.

Early developmental profiles of sensory features and links to school-age adaptive and maladaptive outcomes: A birth cohort investigation

Sensory-based subtypes among autistic children have been well documented, but little is known about longitudinal sensory subtypes beyond autistic populations. This prospective study aimed to identify subtypes based on trajectories of parent-reported sensory features measured at 6-19 months, 3-4, and 6-7 years of age among a community-based birth cohort (N = 1,517), and to examine their associations with school-age clinical and adaptive/maladaptive outcomes on a subset sample (N = 389). Latent class growth analysis revealed five trajectory subtypes varying in intensity and change rates across three sensory domains. In contrast to an Adaptive-All Improving subtype (35%) with very low sensory features and overall better school-age outcomes, an Elevated-All Worsening subtype (3%), comprised of more boys and children of parents with less education, was associated with most elevated autistic traits and poorest adaptive/maladaptive outcomes. Three other subtypes (62% in total) were generally characterized by stable or improving patterns of sensory features at mild to moderate levels, and challenges in certain outcome domains. Our findings indicate that characterizing children based on early sensory trajectories may contribute to earlier detection of subgroups of children with sensory challenges who are more likely to experience developmental challenges by school age, followed by early targeted interventions for improved long-term outcomes.

Transdiagnostic Patterns of Sensory Processing in Autism and ADHD

Sensory processing abilities are highly variable within and across people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD). This study examined the transdiagnostic nature of sensory processing abilities, and their association with features of autism and ADHD, in a large sample of autistic people (n = 495) and people with ADHD (n = 461). Five similar data-driven sensory phenotypes characterized sensory processing abilities, and showed similar patterns of association with features of autism and ADHD, across both diagnostic groups. These results demonstrate the transdiagnostic nature of sensory processing abilities, while contributing to a growing body of literature that suggests the autism and ADHD diagnostic labels have poor explanatory power.

Patterns of sensory processing in young children with autism: Differences in autism characteristics, adaptive skills, and attentional problems

LAY ABSTRACT

Research has found differences in responding to various sensory stimuli among autistic individuals, which are associated with social and adaptive skills. However, our understanding of sensory profiles in autism has been complicated due to the variable presentation of sensory symptoms. One way to better understand variability in sensory symptoms is to use advanced statistical approaches, such as latent profile analysis, that allow for the identification of more similar sensory classes in otherwise variable groups. We used the Short Sensory Profile to identify homogeneous classes of sensory reactivity in autistic children based on both severity and modality and examined whether sensory classes differed in terms of autism characteristics, adaptive skills, and attention-deficit/hyperactivity disorder symptoms. Based on the pattern of both severity and modality, four sensory classes emerged and were named Moderate/Mixed (35.5%; probable-to-definite differences in all modalities except in movement sensitivity and low energy/weakness), Severe/Mixed (8.5%; definite sensory differences in all modalities except in low energy/weakness), Moderate/Broad (14.6%; probable-to-definite differences in all modalities), and Low/Mixed (41.1%; typical scores in most modalities with probable differences in taste/smell sensitivity, under-responsive/seeks sensation, and auditory filtering). The Severe/Mixed class exhibited greater problems in a variety of areas such as social, adaptive, and attention-deficit/hyperactivity disorder symptoms, whereas the Low/Mixed class showed overall fewer problems. This may provide insight for clinicians and researchers aiming to understand whether autistic children who exhibit distinct sensory patterns are more or less likely to also experience social, adaptive, and/or attention/behavior-related difficulties.

Sensory Over-responsivity: A Feature of Childhood Psychiatric Illness Associated With Altered Functional Connectivity of Sensory Networks

BACKGROUND

Sensory over-responsivity (SOR) is recognized as a common feature of autism spectrum disorder. However, SOR is also common among typically developing children, in whom it is associated with elevated levels of psychiatric symptoms. The clinical significance and neurocognitive bases of SOR in these children remain poorly understood and actively debated.

METHODS

This study used linear mixed-effects models to identify psychiatric symptoms and network-level functional connectivity (FC) differences associated with parent-reported SOR in the Adolescent Brain Cognitive Development (ABCD) Study, a large community sample (9 to 12 years of age) (N = 11,210).

RESULTS

Children with SOR constituted 18% of the overall sample but comprised more than half of the children with internalizing or externalizing scores in the clinical range. Controlling for autistic traits, both mild and severe SOR were associated with greater concurrent symptoms of depression, anxiety, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. Controlling for psychiatric symptoms and autistic traits, SOR predicted increased anxiety, attention-deficit/hyperactivity disorder, and prodromal psychosis symptoms 1 year later and was associated with FC differences in brain networks supporting sensory and salience processing in datasets collected 2 years apart. Differences included reduced FC within and between sensorimotor networks, enhanced sensorimotor-salience FC, and altered FC between sensory networks and bilateral hippocampi.

CONCLUSIONS

SOR is a common, clinically relevant feature of childhood psychiatric illness that provides unique predictive information about risk. It is associated with differences in brain networks that subserve tactile processing, implicating a neural basis for sensory differences in affected children.

Sensory Processing in Children and Adolescents with Attention Deficit Hyperactivity Disorder

OBJECTIVE

The aim is to assess the sensory processing difficulties in children and adolescents with ADHD.

METHODS

In all, 38 ADHD children of the age group 6-14 years and 34 age- and gender-matched typically developing controls were included in the study. Sensory processing was assessed on Child Sensory Profile-2. The child behavior checklist and Weiss functional impairment rating scale were applied to assess behavioral problems and functional impairments, respectively.

RESULTS

A significantly higher sensory processing difficulties were seen in children with ADHD than typically developing controls. There were positive correlations between the scores of Child sensory profile 2 with internalizing (with Sensitivity p = .036, Avoiding p = .001, and Auditory p = .029) and externalizing T scores (with Seeking p = .031, Movement p = .025, and Visual p = .018) of CBCL and also with scores of Weiss functional impairment rating scale (with Seeking p = .001, Sensitivity p = .019, and Registration p = .045).

CONCLUSIONS

Sensory problems were common in children with ADHD and add to the functional impairments.

Findings of a Multidisciplinary Assessment of Children Referred for Possible Neurodevelopmental Disorders: Insights from a Retrospective Chart Review Study

Children with ASD have a wide spectrum of functional deficits in multiple neurodevelopmental domains. A multidisciplinary team assessment (MDT) is required to assess those deficits to help construct a multimodal intervention plan. This is a retrospective chart review of the assessment for children who were referred for an assessment of potential neurodevelopmental disorders. We reviewed 221 participants' charts from January 2019 to January 2020. The mean age of the children was 7.95 ± 3.69, while the mean age of the fathers and mothers was 37.31 ± 8.57 and 31.95 ± 6.93, respectively. Consanguinity was as high as 37.9% for the referred children with developmental delay who were first-degree related, and 13.2% of the parents were second-degree relatives. Approximately 26.6% of children had a family history of mental illness in first-degree relatives. ASD was the most commonly reported diagnosis post-assessment, and ADHD was the most common reported comorbidity at 64.3% and 88.5%, respectively. The MDT findings showed that 58% of children required moderate or higher assistance with toileting, 79.2% were unable to answer yes/no questions, and 86.8% were unable to understand "wh" questions. Only 26% of the nonverbal children had average IQ testing results, and 31% of verbal children did. In conclusion, the mean age of the children when assessed was above that recommended for early screening and intervention. An increased paternal and maternal age was noticeable. Consanguinity and a family history of mental disorders in first-degree relatives were high, attesting to a possible genetic risk.

Cluster Analysis of Short Sensory Profile Data Reveals Sensory-Based Subgroups in Autism Spectrum Disorder

Autism spectrum disorder is a common, heterogeneous neurodevelopmental disorder lacking targeted treatments. Additional features include restricted, repetitive patterns of behaviors and differences in sensory processing. We hypothesized that detailed sensory features including modality specific hyper- and hypo-sensitivity could be used to identify clinically recognizable subgroups with unique underlying gene variants. Participants included 378 individuals with a clinical diagnosis of autism spectrum disorder who contributed Short Sensory Profile data assessing the frequency of sensory behaviors and whole genome sequencing results to the Autism Speaks' MSSNG database. Sensory phenotypes in this cohort were not randomly distributed with 10 patterns describing 43% (162/378) of participants. Cross comparison of two independent cluster analyses on sensory responses identified six distinct sensory-based subgroups. We then characterized subgroups by calculating the percent of patients in each subgroup who had variants with a Combined Annotation Dependent Depletion (CADD) score of 15 or greater in each of 24,896 genes. Each subgroup exhibited a unique pattern of genes with a high frequency of variants. These results support the use of sensory features to identify autism spectrum disorder subgroups with shared genetic variants.

Exploring Sensory Subgroups in Typical Development and Autism Spectrum Development Using Factor Mixture Modelling

This study uses factor mixture modelling of the Short Sensory Profile (SSP) at two time points to describe subgroups of young autistic and typically-developing children. This approach allows separate SSP subscales to influence overall SSP performance differentially across subgroups. Three subgroups were described, one including almost all typically-developing participants plus many autistic participants. SSP performance of a second, largely-autistic subgroup was predominantly shaped by a subscale indexing behaviours of low energy/weakness. Finally, the third subgroup, again largely autistic, contained participants with low (or more "atypical") SSP scores across most subscales. In this subgroup, autistic participants exhibited large P1 amplitudes to loud sounds. Autistic participants in subgroups with more atypical SSP scores had higher anxiety and more sleep disturbances.

A longitudinal exploratory study of changes in sensory processing in children with ASD from the ELENA cohort

Atypical sensory processing (SP) is a diagnostic criterion of autism spectrum disorder (ASD). However, little is known about its course during development. In this exploratory longitudinal study, we aimed to investigate the course of SP among children with ASD and identify clinical variables associated with changes. We used a subsample of 51 children with confirmed ASD, aged from 3 to 10 years, recruited from the ELENA cohort. SP was assessed using the Sensory Profile questionnaire at baseline and three years later. Our preliminary results highlight the heterogeneity of the evolution of SP during the children's development and the existence of three subgroups based on the course of SP (improvement, stable, and worsening). In addition, the children's adaptive skills and maladaptive behaviors were related to the course of SP. These results could be confirmed in future studies with a larger sample size using a longitudinal approach to capture individual variability in SP. In addition, our results highlight the importance of accounting for temporal changes in the sensory needs of individuals with ASD in clinical practice.

Prevalence Models to Support Participation: Sensory Patterns as a Feature of All Children’s Humanity

Purpose

Research about children tends to consider differences from expected patterns problematic, and associates differences with disabilities [e.g., Autism, attention deficit hyperactivity disorder (ADHD)]. When we focus on disabilities and consider differences automatically problematic, we miss the natural variability in the general population. The International Classification of Functioning, Disability and Health (ICF 11) acknowledges that the experience of disability results from interactions between “environmental” and “personal” factors which determine the person’s capacity to participate. The purpose of this study was to examine sensory patterns across a national sample of children in the general population and samples of children with disabilities to investigate the extent to which differences in sensory processing are representative of natural variability rather than automatically problematic or part of a disability.

Materials and Methods

We employed descriptive statistics and chi-square tests to examine sensory processing patterns in children in the general population and autistic children and children with ADHD. We used standardization and validity data from the Sensory Profile 2 to conduct analyses.

Results

Consistent sensory patterns exist across all groups. Children in all groups had different rates of certain patterns.

Conclusion

Since children in all groups have certain sensory patterns, we cannot associate differences with problematic behaviors. Children participating successfully with all sensory patterns might provide insights for universal design that supports participation of all children.

Exploring Effects of Sensory Garments on Participation of Children on the Autism Spectrum: A Pretest-Posttest Repeated Measure Design

Objective

Autistic children experience sensory challenges that interfere with participation and increase parent stress. Sensory-based interventions are used to address children's behaviors affected by sensory processing difficulties, but research is limited regarding use of sensory garments to support participation of autistic children. This study explored sensory garment effects on participation, parental competence, and perceived stress of autistic children and their parents.

Method

Twenty-one children were recruited and 17 males with ASD and atypical sensory processing patterns completed the 14-week study. The Canadian Occupational Performance (COPM) and Goal Attainment Scaling (GAS) were used to set and monitor participation goals. After a baseline period, children wore sensory garment(s) for 8 weeks. The COPM, GAS, Parent Stress Index-Short Form (PSI-SF), and Parent Sense of Competence Scale (PSOC) were administered four times (prebaseline, before and after the intervention, and three weeks postintervention).

Results

There were moderate to large significant differences in both COPM and GAS scores after the intervention and from the beginning to the end of the study indicating sensory garments may improve participation of autistic children. There were no significant differences in PSI or PSOC at any timepoint. Two children rejected the garments.

Conclusions

Parent- or child-selected sensory garments may improve participation in individually meaningful activities for children who can tolerate wearing them. Children's improvement in participation did not improve parent stress or competence, possibly due to the passive nature of the intervention. More research is needed explore the influence of heterogeneous sensory patterns on response to intervention.

Family Accommodation Scale for Sensory Over-Responsivity: A Measure Development Study

Family accommodation refers to the attempt of family members (most often parents) to prevent their child's distress related to psychopathology. Family accommodation can limit meaningful participation in personal and social routines and activities. Accommodation has been studied extensively in the context of childhood anxiety and has been linked to greater impairment, and poor intervention outcomes. Like anxiety, sensory over-responsivity (SOR) symptoms are associated with heightened distress and thus, may also be accommodated by family members. The current study describes the validation of a new pediatric family accommodation scale for SOR. Parents of 301 children ages 3-13 years completed an online survey, of which 48 had medical or developmental conditions. The survey included the Child Sensory Profile 2 and the newly developed family accommodation scale for sensory over-responsivity (FASENS). Three Sensory Profile 2 scores were analyzed: SOR, sensory under-responsivity and sensory seeking. The FASENS consists of 18 items; 12 describing the frequency of accommodation behaviors and 6 describing the impact of the accommodation on the wellbeing of the family and the child. Results indicated that the FASENS has high internal consistency (α = 0.94) as well as a significant 3-factor confirmatory model fit: (1) accommodations (i.e., avoidance and changes), (2) family impact, and (3) child impact. FASENS scores significantly correlated with SOR symptoms (r = 0.52-0.60, p < 0.001). However, they also correlated with under-responsivity and seeking (r = 0.33-0.42, p < 0.001). Parents of children with health conditions reported significantly higher FASENS scores (p < 0.002), which corresponded with their child's significantly higher sensory scores (p < 0.001). Family accommodations for SOR occur to some extent in the general population, but their prevalence and impact are significantly greater when the child has a health condition, in addition to SOR. Additional research is needed to explore whether these accommodations are adaptive and whether families and children would benefit from learning to reduce them, as with anxiety.

Construct Validity of the Sensory Profile Interoception Scale: Measuring Sensory Processing in Everyday Life

Scholars and providers are coming to realize that one’s ability to notice and respond to internal body sensations (i.e., interoception) contributes to an overall sense of wellbeing. Research has demonstrated a relationship between interoceptive awareness and anxiety, for example. Currently, however, tools for evaluating one’s interoception lack the conceptual foundation and clarity necessary to identify everyday behaviors that specifically reflect interoceptive awareness. Unlike existing interoceptive measures, the Sensory Profile Interoception (SPI) scale is participation-based and grounded in Dunn’s Sensory Processing framework. In this study we investigated concurrent validity by correlating the SPI with the Adolescent/Adult Sensory Profile (A/ASP); we investigated construct validity by correlating the SPI with the Perth Alexithymia Scale (PAS), the Body Awareness Scale (BAS), and the State-Trait Anxiety Inventory (STAI). Using the REDCAP online platform, 74 college-aged participants completed the measures. Using Spearman rank order correlations there were statistically significant relationships between the corresponding sensory pattern subscales on SPI and A/ASP (r = 0.277 to r = 0.582). The PAS was only weakly related to the registration subscale of the SPI (r = 0.260). The BAS had significant relationships with seeking and avoiding on the SPI (r = 0.496 and r = 0.385). The STAI had significant relationships with sensitivity and registrations of the SPI (r = 0.266 and r = 0.361 for state; r = 0.403 and r = 0.321 for trait). Taken together, these findings provide evidence of construct validity of the SPI to identify participation patterns associated with both high and low interoception. With the more precise information the SPI provides, professionals can design tailored interventions to support everyday life goals and researchers can study interoception within authentic activities.

Developmental trajectories of sensory patterns from infancy to school age in a community sample and associations with autistic traits

This prospective study examined the latent growth trajectories of sensory patterns among a North Carolina birth cohort (N = 1517; 49% boys, 87% White) across infancy (6-19 months), preschool (3-4 years), and school years (6-7 years). Change rates of sensory hyper- and hyporesponsiveness better differentiated children with an autism diagnosis or elevated autistic traits from those with other developmental conditions, including non-autistic children with sensory differences. More sensory hyper- and hyporesponsiveness at infancy followed by steeper increases differentially predicted more autistic traits at school age. Further, children of parents with higher education tended to show stable or improving trajectories. These findings highlight the importance of tracking sensory patterns from infancy for facilitating early identification of associated challenges and tailored support for families.

Cognitive, Behavioral, and Sensory Profile of Pallister–Killian Syndrome: A Prospective Study of 22 Individuals

Background: Developmental delay and intellectual disability are two pivotal elements of the phenotype of Pallister–Killian Syndrome (PKS). Our study aims to define the cognitive, adaptive, behavioral, and sensory profile of these patients and to evaluate possible correlations between the different aspects investigated and with the main clinical and demographic variables. Methods: Individuals of any age with genetically confirmed PKS were recruited. Those ≤ 42 months were administered the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III), and those > 42 months the Vineland Adaptive Behavior Scales—Second Edition (Vineland-II). Stereotyped behaviors (Stereotypy Severity Scale, SSS) and aggressive behaviors (Behavior Problems Inventory—Short Version, BPIs) were assessed in all subjects > 1 year; sensory profile (Child Sensory Profile 2, C-SP2) in all aged 2–18 years. Results: Twenty-two subjects were enrolled (11 F/11 M; age 9 months to 28 years). All subjects ≤ 42 months had psychomotor developmental delay. Of the subjects > 42 months, 15 had low IQ deviation, and 1 in the normal range. Stereotypies were frequent (median SSS-total score 25/68). Lower Vineland-II values corresponded to greater intensity and frequency of stereotypies (p = 0.004 and p = 0.003), and self-injurious behaviors (p = 0.002 and p = 0.002). Patients with severe low vision had greater interference of stereotypies (p = 0.027), and frequency and severity of aggressive behaviors (p = 0.026; p = 0.032). The C-SP2, while not homogeneous across subjects, showed prevalence of low registration and sensory seeking profiles and hypersensitivity to tactile and auditory stimuli. Lower Vineland-II scores correlated with higher Registration scores (p = 0.041), while stereotypies were more frequent and severe in case of high auditory sensitivity (p = 0.019; p = 0.007). Finally, greater sleep impairment correlated with stereotypies and self-injurious behaviors, and lower Vineland-II scores. Conclusions: The present study provides a further step in the investigation of the etiopathogenesis of the syndrome. Furthermore, these aspects could guide rehabilitation therapy through the identification of targeted protocols.

Exploring sensory phenotypes in autism spectrum disorder

BACKGROUND

Atypical reactions to the sensory environment are often reported in autistic individuals, with a high degree of variability across the sensory modalities. These sensory differences have been shown to promote challenging behaviours and distress in autistic individuals and are predictive of other functions including motor, social, and cognitive abilities. Preliminary research suggests that specific sensory differences may cluster together within individuals creating discrete sensory phenotypes. However, the manner in which these sensory differences cluster, and whether the resulting phenotypes are associated with specific cognitive and social challenges is unclear.

METHODS

Short sensory profile data from 599 autistic children and adults between the ages of 1 and 21 years were subjected to a K-means cluster analysis. Analysis of variances compared age, adaptive behaviour, and traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder across the resultant clusters.

RESULTS

A five-cluster model was found to minimize error variance and produce five sensory phenotypes: (1) sensory adaptive, (2) generalized sensory differences, (3) taste and smell sensitivity, (4) under-responsive and sensation seeking, and (5) movement difficulties with low energy. Age, adaptive behaviour, and traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder were found to differ significantly across the five phenotypes.

LIMITATIONS

The results were based on parent-report measures of sensory processing, adaptive behaviour, traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder, which may limit the generalizability of the findings. Further, not all measures are standardized, or psychometrically validated with an autism population. Autistic individuals with an intellectual disability were underrepresented in this sample. Further, as these data were obtained from established records from a large provincial database, not all measures were completed for all individuals.

CONCLUSIONS

These findings suggest that sensory difficulties in autistic individuals can be clustered into sensory phenotypes, and that these phenotypes are associated with behavioural differences. Given the large degree of heterogeneity in sensory difficulties seen in the autistic population, these sensory phenotypes represent an effective way to parse that heterogeneity and create phenotypes that may aid in the development of effective treatments and interventions for sensory difficulties.

Examining the Relation between Self-reported ASD Symptoms and Sensory Sensitivities from a Community-based Sample of Adults

Atypical responses to sensory stimuli, termed sensory sensitivities, are a commonly reported symptom for individuals diagnosed with Autism Spectrum Disorder (ASD). In this community-based study of 604 adults, the correlation between sensory sensitivities and ASD symptoms was r = 0.23, p < .001, representing a smaller relation than estimates previously reported in the peer-reviewed research. Additionally, when examining only participants who met or exceeded the ASD screening cutoff score, the relation between sensory sensitivities and ASD symptoms was only slightly larger at r = 0.25, p < .001. Forty-four percentage who met the screening cutoff score for ASD also reported the lowest degree of sensory sensitivities. Finally, just over one-third who met the screening cutoff score for ASD had the highest sensory sensitivities. Sensory sensitivities did not appear to be a consistent feature across adults meeting the ASD screening cutoff score, but a proportion meeting the ASD screening cutoff score also exhibited the most extreme sensory sensitivities.

Sensory Processing in Williams Syndrome: Individual differences and changes over time

This study examined individual differences as well as the development of sensory processing difficulties in children with Williams syndrome (WS) using a cross-sectional (Experiment 1) and longitudinal design (Experiment 2). In Experiment 1, a clustering approach of sensory processing scores suggested two groups. Experiment 2 showed that the clusters identified in Experiment 1 were not stable across development, especially for those with high sensory impairments at either time point. Yet, most children experienced high impairments in sensory registration at both time points, suggesting impaired registration is a core phenotype of sensory processing in children with WS across development. Possible mechanisms, limitations and implications are discussed.

Sex differences in sensory processing in children with autism spectrum disorder

Despite the high prevalence of sensory processing difficulties in children with autism spectrum disorder (ASD), little research has focused on the sex differences in sensory processing. Furthermore, there is a lack of knowledge on the female‐specific symptoms of ASD, contributing to later referral, diagnosis and intervention. In this study, we examined the sex differences in sensory processing symptoms in large cohorts of ASD children (N = 168; 26 females, 142 males) and typically developing (TD) children (N = 439; 209 females, 230 males). For this, we translated the sensory processing measure (SPM) and SPM – Preschool (SPM‐P) Home Forms to French. The SPM/SPM‐P are parent/caregiver questionnaires that assess typical behavioral responses to sensory stimuli. Overall, our results showed that the magnitude of the differences in sensory processing between males and females is larger in ASD children relative to TD children, with females showing more severe symptoms in Hearing, as well as Balance and Motion subscales. Additionally, linear discriminant analysis showed that the SPM/SPM‐P are good at discriminating TD children from ASD, children with higher accuracy rates for females than for males. These findings are discussed in light of the heterogeneity of sensory processing difficulties present in ASD. Overall, our results suggest that there seem to be female‐specific profiles in sensory processing difficulties in ASD. Implications of findings concerning sex differences in sensory processing and their potential for improving identification and diagnosis of ASD females are discussed.

It's crunch time: Exploring the sensibility of food textural acoustics for individuals with dysphagia

BACKGROUND

Various fields of study have alluded to food textural, and its associated acoustic, properties (i.e. food textural acoustics). However, because of the challenging nature of the inclusion of acoustic properties in diet textural modifications in dysphagia (swallowing disorders), this construct has not been sufficiently considered in the field.

OBJECTIVE

To investigate the sensibility of food textural acoustics as a construct to understand eating for individuals with dysphagia.

METHOD

The study design was based on qualitative evidence synthesis methodologies. This involved revised scoping review methods (peer-reviewed published articles from 1980 to 2020 over seven databases), with an adapted consultation phase through online focus group discussions with six world experts. The data was analysed using frequency and thematic analysis, and ideology critique.

RESULTS

A total of 11 articles were included in the revised scoping review analysis (seven research studies and four review articles). The analysis of these articles revealed a lack of diversity in geography, discipline and perspective exploring the construct of food textural acoustics. A total of three themes with three associated core arguments emerged from the revised scoping review and the consultation phase. These arguments highlighted (1) the need to study food textural acoustics because of its salience and pleasure responses, (2) possible methodological dilemmas in studying food textural acoustics due to the complexity of eating, and (3) considerations with regard to the approach and positioning adopted when studying the construct.

CONCLUSION

Food textural acoustics may be a sensible construct to understand eating for individuals with dysphagia. As eating is a complex process, there is a need to challenge the methods we use when studying this construct of food textural acoustics. We hope that this article inspires researchers and practitioners to think differently by using textural, and its associated acoustic, properties as a way to reimagine dysphagia practice, especially for those from low- to middle-income contexts such as South Africa and Brazil.

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence

BACKGROUND

Challenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood.

METHOD

Adolescents with typical cognitive development (TD, n=84), intellectual disability (ID, n=30), or ASD (n=45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors.

RESULTS

All domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS.

CONCLUSIONS

DLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.

Shedding light on excessive crying in babies

BACKGROUND

Excessive and inconsolable crying behavior in otherwise healthy infants (a condition called infant colic (IC)) is very distressing to parents, may lead to maternal depression, and in extreme cases, may result in shaken baby syndrome. Despite the high prevalence of this condition (20% of healthy infants), the underlying neural mechanisms of IC are still unknown.

METHODS

By employing the latest magnetic resonance imaging (MRI) techniques in newborns, we prospectively investigated whether newborns' early brain responses to a sensory stimulus (smell) is associated with a subsequent crying behavior.

RESULTS

In our sample population of 21 healthy breastfed newborns, those who developed IC at 6 weeks exhibited brain activation and functional connectivity in primary and secondary olfactory brain areas that were distinct from those in babies that did not develop IC. Different activation in brain regions known to be involved in sensory integration was also observed in colicky babies. These responses measured shortly after birth were highly correlated with the mean crying time at 6 weeks of age.

CONCLUSIONS

Our results offer novel insights into IC pathophysiology by demonstrating that, shortly after birth, the central nervous system of babies developing IC has already greater reactivity to sensory stimuli than that of their noncolicky peers.

IMPACT

Shortly after birth, the central nervous system of colicky infants has a greater sensitivity to olfactory stimuli than that of their noncolicky peers. This early sensitivity explains as much as 48% of their subsequent crying behavior at 6 weeks of life. Brain activation patterns to olfactory stimuli in colicky infants include not only primary olfactory areas but also brain regions involved in pain processing, emotional valence attribution, and self-regulation. This study links earlier findings in fields as diverse as gastroenterology and behavioral psychology and has the potential of helping healthcare professionals to define strategies to advise families.

Psychometric Properties of the Sensory Processing and Self-Regulation Checklist: English Version

Background

Sensory processing supports children's development and abilities to participate in activities across contexts. Self-regulation skills may influence how children process various sensory experiences in daily life activities. The Sensory Processing and Self-Regulation Checklist (SPSRC) is a 130-item caregiver-reported checklist, covering children's essential sensory processing and self-regulation performance in daily activities.

Objectives

This study examines the psychometric properties of the SPSRC (English version) in measuring the sensory processing and self-regulation abilities of children.

Methods

A preliminary field testing of the SPSRC-English was conducted in a sample of n = 194 children (164 without disability and 30 with a disability) to evaluate its reliability and validity properties.

Results

The SPSRC-English was shown to have high internal consistency and test-retest reliability; and good discriminant, structural, and criterion validity in the sensory processing and self-regulation abilities of children with and without disability ages 4-12 years.

Conclusion

The current study provides initial evidence on the reliability and validity of SPSRC-English in measuring the sensory processing and self-regulation abilities in children with and without a disability. The SPSRC-English may provide salient information supporting the understanding of sensory processing difficulties among children.

Development, reliability, and validity of the Sensory Adventure Measure

INTRODUCTION

Sensory modulation refers to a condition in which an individual's behavioural responses to sensory stimuli do not correspond to the nature or intensity of the stimuli. Sensory modulation affects children's participation in everyday activities and their well-being. The most common assessments used are caregiver questionnaires. Our aim is twofold; first to develop a clinical evaluative measure, the Sensory Adventure Measure (SAM), for directly assessing sensory modulation in children via therapists and children's self-report, second, we aim to establish its reliability and validity.

METHODS

The study sample comprised 87 children ranging in age from 4 to 6 years and 11 months old divided into two groups: study group included 63 children with mild developmental disabilities and the control group included 24 typically developed children. The SAM's internal consistency, test-retest reliability, and inter-rater reliability were examined. In addition, criterion validity was established using the total score of the Short Sensory Profile (SSP) and construct validity was established by known group differences.

RESULTS

The SAM exhibited good internal consistency (α = 0.83, 0.85) and moderate to very good test-retest reliability (r = 0.96, 0.98, 0.75). Inter-rater reliability was strong (r = 0.80-0.83). Moderate correlation was found between the SAM Therapist Rating of Magnitude total score and the total score of the SSP and significant differences were found in the SAM scores between groups thus establishing validity.

CONCLUSIONS

The SAM demonstrated good psychometric properties and can be used as a reliable and valid measure to assess sensory modulation among children aged 4 to 6 years. The SAM can be used by therapists to assess sensory modulation disorder based on observed responses to sensory stimuli and the child's self-report. The SAM contributes additional perspective to the evaluation process of sensory modulation disorder.

Identification of Longitudinal Sensory Subtypes in Typical Development and Autism Spectrum Development Using Growth Mixture Modelling

BACKGROUND

Prior longitudinal investigations of trajectories of sensory features in Autism Spectrum Development (ASD) have not explored heterogeneity. The present study explores initial levels and trajectories of sensory features in ASD as well as, for comparison, typical development.

METHOD

Growth mixture modelling was used to explore classes of autistic and typically-developing participants based on caregiver-reported total sensory behaviours on the Short Sensory Profile (SSP) at two time points, when children were aged 2-5 and 4-10 years of age, respectively.

RESULTS

Three classes are described: a mixed class of autistic and typically-developing participants with few problematic sensory behaviours ("Stable Mild"), a mostly-autistic class with more problematic sensory features ("Stable Intense"), and a small class of autistic participants whose sensory features reportedly worsened ("Increasingly Intense"). Autistic participants in the Stable Intense class exhibited high anxiety, while autistic participants in the Increasingly Intense class appeared to obtain high scores on cognitive assessments.

CONCLUSIONS

The heterogeneity of sensory features and challenges found in the present study may suggest that practitioners should conduct individualized assessments of sensory features in ASD. Furthermore, practitioners should be aware of links between sensory features and anxiety in ASD, which may imply that sensory accommodations and supports could protect against anxiety. Finally, the worsening of sensory features over time in the Increasingly Intense subgroup may indicate a need for continued monitoring of changes in sensory features, perhaps especially as sensory environments change during periods of transition.

Sensory Processing, Functional Performance and Quality of Life in Unilateral Cerebral Palsy Children: A Cross-Sectional Study

Background: The study of children with unilateral cerebral palsy (UCP) has traditionally focused on motor aspects. The extent to which sensory processing disorders can affect their functional performance and quality of life (QoL) is uncertain. This study aimed to explore the differences in sensory processing between UCP and typical development (TD) children and to analyze the relationship of sensory processing with functional performance and QoL. Methods: Fifty-three children aged from 6 to 15 years (TD = 24; UCP = 29) were recruited. The Child Sensory Profile 2, Pediatric Evaluation of Disability Inventory—Computer Adaptive Test and Kidscreen were used to evaluate sensory processing, functional performance and QoL. Results: UCP children showed sensory processing difficulties (avoidance: p = 0.02; registration: p = 0.00; body position: p = 0.00; oral: p = 0.02; social-emotional: p = 0.01), and scored lower in functional performance (daily activities: p = 0.00; mobility: p = 0.00; social/cognitive: p = 0.04) and in physical well-being (p = 0.00). The highest correlations in UCP group were found between proprioceptive processing and daily activities and mobility (r = −0.39); auditory, visual and tactile information and school environment (r = −0.63; r = −0.51; r = −0.46); behavioral and social-emotional responses and psychological well-being (r = −0.64; r = −0.49). Conclusions: UCP children have greater difficulty in sensory processing than TD children. Difficulties in proprioceptive processing contribute to poorer functional performance. Auditory, visual and tactile processing is associated with participation in the school environment and behavioral and social-emotional responses related to sensory processing are associated with the psychological well-being.

Practitioner Review: Effective management of functional difficulties associated with sensory symptoms in children and adolescents

BACKGROUND

Sensory symptoms are defined as atypical behavioral responses to daily sensory stimuli that impact on the performance of everyday routines. Sensory symptoms have been observed in young people with and without developmental concerns. There is uncertainty, however, regarding the best way to identify and manage sensory symptoms. The aim of this paper is  to provide a review of current best evidence regarding measurement of and interventions for sensory symptoms.

METHODS

A narrative review methodology is adopted to address the aims of this paper. First, sensory symptoms are defined, and then, an overview of the evidence for the relationship between sensory symptoms and childhood function is provided. Second, commonly used sensory assessment tools are summarized and evaluated. Finally, an overview and critique of the evidence for sensory and nonsensory-based interventions addressing sensory symptoms are given.

RESULTS

The terminology used to describe sensory symptoms varies by discipline, and several conceptual taxonomies including sensory subtypes have been proposed. There is ample evidence to support the association of sensory symptoms with childhood function including social engagement, repetitive behaviors, anxiety, and participation in self-care routines. Measurement of sensory symptoms is dominated by proxy-report instruments, and few single instruments assess the entire domain of sensory symptomatology. The evidence for interventions for sensory symptoms is emerging but still limited by low quantity and methodological concerns.

CONCLUSIONS

Effective management of sensory symptoms may mitigate the burden of neurodevelopmental disability and mental illness in young people. Identification of sensory symptoms should be conducted by a skilled practitioner utilizing multiple measurement methods. Intervention protocols for sensory symptoms should be informed by current best evidence which is strongest for Ayres Sensory Integration^® , Qigong massage, the Alert Program^® , and Social Stories. To make significant progress in this field, however, new intervention studies must address the question of 'what intervention works for whom?'.

Dissecting the phenotypic heterogeneity in sensory features in autism spectrum disorder: a factor mixture modelling approach

BACKGROUND

Heterogeneity in the phenotypic presentation of autism spectrum disorder (ASD) is apparent in the profile and the severity of sensory features. Here, we applied factor mixture modelling (FMM) to test a multidimensional factor model of sensory processing in ASD. We aimed to identify homogeneous sensory subgroups in ASD that differ intrinsically in their severity along continuous factor scores. We also investigated sensory subgroups in relation to clinical variables: sex, age, IQ, social-communication symptoms, restricted and repetitive behaviours, adaptive functioning and symptoms of anxiety and attention-deficit/hyperactivity disorder.

METHODS

Three hundred thirty-two children and adults with ASD between the ages of 6 and 30 years with IQs varying between 40 and 148 were included. First, three different confirmatory factor models were fit to the 38 items of the Short Sensory Profile (SSP). Then, latent class models (with two-to-six subgroups) were evaluated. The best performing factor model, the 7-factor structure, was subsequently used in two FMMs that varied in the number of subgroups: a two-subgroup, seven-factor model and a three-subgroup and seven-factor model.

RESULTS

The 'three-subgroup/seven-factor' FMM was superior to all other models based on different fit criteria. Identified subgroups differed in sensory severity from severe, moderate to low. Accounting for the potential confounding effects of age and IQ, participants in these sensory subgroups had different levels of social-communicative symptoms, restricted and repetitive behaviours, adaptive functioning skills and symptoms of inattention and anxiety.

LIMITATIONS

Results were derived using a single parent-report measure of sensory features, the SSP, which limits the generalisability of findings.

CONCLUSION

Sensory features can be best described by three homogeneous sensory subgroups that differ in sensory severity gradients along seven continuous factor scores. Identified sensory subgroups were further differentiated by the severity of core and co-occurring symptoms, and level of adaptive functioning, providing novel evidence on the associated clinical correlates of sensory subgroups. These sensory subgroups provide a platform to further interrogate the neurobiological and genetic correlates of altered sensory processing in ASD.

Impact of Sensory Processing on School Performance Outcomes in High Functioning Individuals with Autism Spectrum Disorder

Difficulty processing sensory information may impede progress in school for students with autism spectrum disorder (ASD). We explore the relationship between sensory processing and school performance in 26 high-functioning youths with ASD and 26 controls (age 8-14) using measures of sensory, social, cognitive, and academic functioning. In the ASD group, bivariate Pearson correlations indicated a significant positive relationship between intelligence quotient (IQ) and the School Competence Scale (SCS) of the Child Behavior Checklist (CBCL), and a significant negative relationship between Dunn's Sensory Processing Framework and SCS scores. Final hierarchical multiple linear regression model accounting for SCS scores in ASD included IQ, ADHD symptoms, and sensory features. An interaction between increased sensory sensitivity with reduced sensory avoidance behaviors explained the greatest amount of variance in SCS, meaning school performance is lowest for children with greater hypersensitivity and fewer avoidance behaviors. Results indicate a strong impact of sensory processing on school performance in ASD.

Problems in Audiovisual Filtering for Children with Special Educational Needs

There is pervasive evidence that problems in sensory processing occur across a range of developmental disorders, but their aetiology and clinical significance remain unclear. The present study investigated the relation between sensory processing and literacy skills in children with and without a background of special educational needs (SEN). Twenty-six children aged between 7 and 12 years old, from both regular classes and SEN programmes, participated. Following baseline tests of literacy, fine motor skills and naming speed, two sets of instruments were administered: the carer-assessed Child Sensory Profile-2 and a novel Audiovisual Animal Stroop (AVAS) test. The SEN group showed significantly higher ratings on three Child Sensory Profile-2 quadrants, together with body position ratings. The SEN participants also showed a specific deficit when required to ignore an accompanying incongruent auditory stimulus on the AVAS. Interestingly, AVAS performance correlated significantly with literacy scores and with the sensory profile scores. It is proposed that the children with SEN showed a specific deficit in "filtering out" irrelevant auditory input. The results highlight the importance of including analysis of sensory processes within theoretical and applied approaches to developmental differences and suggest promising new approaches to the understanding, assessment, and support of children with SEN.

Defining clusters of young autistic and typically developing children based on loudness-dependent auditory electrophysiological responses

BACKGROUND

Autistic individuals exhibit atypical patterns of sensory processing that are known to be related to quality of life, but which are also highly heterogeneous. Previous investigations of this heterogeneity have ordinarily used questionnaires and have rarely investigated sensory processing in typical development (TD) alongside autism spectrum development (ASD).

METHODS

The present study used hierarchical clustering in a large sample to identify subgroups of young autistic and typically developing children based on the normalized global field power (GFP) of their event-related potentials (ERPs) to auditory stimuli of four different loudness intensities (50, 60, 70, 80 dB SPL): that is, based on an index of the relative strengths of their neural responses across these loudness conditions.

RESULTS

Four clusters of participants were defined. Normalized GFP responses to sounds of different intensities differed strongly across clusters. There was considerable overlap in cluster assignments of autistic and typically developing participants, but autistic participants were more likely to display a pattern of relatively linear increases in response strength accompanied by a disproportionately strong response to 70 dB stimuli. Autistic participants displaying this pattern trended towards obtaining higher scores on assessments of cognitive abilities. There was also a trend for typically developing participants to disproportionately fall into a cluster characterized by disproportionately/nonlinearly strong 60 dB responses. Greater auditory distractibility was reported among autistic participants in a cluster characterized by disproportionately strong responses to the loudest (80 dB) sounds, and furthermore, relatively strong responses to loud sounds were correlated with auditory distractibility. This appears to provide evidence of coinciding behavioral and neural sensory atypicalities.

LIMITATIONS

Replication may be needed to verify exploratory results. This analysis does not address variability related to classical ERP latencies and topographies. The sensory questionnaire employed was not specifically designed for use in autism. Hearing acuity was not measured. Variability in sensory responses unrelated to loudness is not addressed, leaving room for additional research.

CONCLUSIONS

Taken together, these data demonstrate the broader benefits of using electrophysiology to explore individual differences. They illuminate different neural response patterns and suggest relationships between sensory neural responses and sensory behaviors, cognitive abilities, and autism diagnostic status.

Prevalence and patterns of sensory processing behaviors in a large clinical sample of children with prenatal alcohol exposure

BACKGROUND

Atypical behavioral responses to sensation are reported in a large proportion of children affected by prenatal alcohol exposure (PAE). Systematic examination of symptoms across the fetal alcohol spectrum in a large clinical sample is needed to inform diagnosis and intervention.

AIMS

To describe the prevalence and patterns of atypical sensory processing symptoms in a clinical sample of children with PAE.

METHODS

Retrospective analysis of diagnostic clinical data from the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network (FASDPN). Participants were ages 3 through 11 years, had a diagnosis on the fetal alcohol spectrum, and Short Sensory Profile (SSP) assessment. The proportions of children categorized with definite differences on the SSP across selected clinical and demographic features were examined with chi-square analyses.

OUTCOMES

The sample consisted of 325 children; 73.2 % had SSP total scores in the definite difference range. Atypical sensory processing symptoms were significantly more prevalent among children with higher reported levels of PAE. The prevalence of atypical symptoms was comparably high across age, levels of diagnostic severity, and other prenatal/postnatal risks.

CONCLUSIONS

Results lend support for altered sensory processing as another domain of brain function affected by the teratogenic impact of PAE, guiding clinical work and research.

Proportions of youth with visual impairments meeting 24-hr movement guidelines

BACKGROUND

Recent movement behaviour guidelines prescribe the optimal time spent in physical activity, screen time, and sleep across a 24-hr period. The proportion of youth with visual impairments meeting 0, 1, 2, or all 3 of these 24 movement guidelines is unknown. The primary purpose of this observational, cross-sectional analysis was to examine the proportions of youth with visual impairments in the United States who partially or fully meet the physical activity, screen time, and sleep duration guidelines. A secondary purpose of this analysis was to examine whether demographic variables were associated with the odds of youth with visual impairments meeting these guidelines.

METHODS

This study included 561 youth with visual impairments from the 2016 to 2017 National Survey of Children's Health (NSCH). Accounting for the NSCH sampling plan, Complex Samples was used to estimate the prevalence of meeting 24-hr movement guidelines, and a multinomial logistic regression analysis was conducted to examine the odds ratio of guidelines met across different demographic factors.

RESULTS

Of the participants in this study, 18.7%, 50.7%, and 73.2% met physical activity, sleep, and screen time guidelines, respectively. Just 5.8% of the sample met all three of the 24-hr movement guidelines, whereas 10.6% did not meet any of the three guidelines.

CONCLUSIONS

The proportion of the sample meeting of all three guidelines was low, thus depriving the majority of this population of the physiological and psychological health benefits of meeting each guideline. Moreover, the study identifies physical inactivity as a key risk factor that requires attention in this population.

A Survey of Occupational Therapists on a New Tool for Sensory Processing

Occupational therapy is the leading profession with regard to supporting children who experience difficulties with occupations as a result of sensory processing differences. However, there are mixed reports with regard to the efficacy of various sensory interventions and approaches, leaving little clear guidance for occupational therapists supporting children with these difficulties. The Sensory Form is a planning tool developed in 2017 to guide occupational therapists in their professional reasoning for assessment and intervention of sensory processing differences. To date, no research has been conducted on its use. Researchers introduced the tool to 20 occupational therapists with relevant experience and conducted an online survey of their perceptions about The Sensory Form. Findings were analysed using descriptive statistics and qualitative content analysis. Therapists reported that they found the tool acceptable for use, described key strengths and weaknesses of The Sensory Form, and outlined changes to improve the tool. The Sensory Form may have an application in guiding the practice of therapists supporting children with sensory processing differences. Further development of associated resources may be warranted.

Sensory processing and organisational abilities in children with inattentive-hyperactive behaviours

Background/Aims

Sensory processing has been theorised to contribute to object and temporal organisation. Sensory processing and organisational abilities in children with inattention-hyperactivity was assessed, and investigated if there was a relationship between the two.

Methods

A community sample of children aged 9–12 years was categorised into inattentive-hyperactive (n=20) and non-inattentive-hyperactive groups (n=56) using the Vanderbilt Attention Deficit Hyperactivity Disorder Parent and Teacher Rating Scales. The Sensory Profile, Child Organisation Scale and Child Organisation Parent Perception Scale were used to collect additional data.

Results

Sensory processing and organisational abilities differed significantly between the groups. Object organisation correlated significantly with multisensory processing; temporal organisation failed to correlate with sensory processing.

Conclusions

Results suggest there is a need to screen children with informant-reported inattention-hyperactivity for sensory processing differences and organisational deficits. Sensory processing and object organisation may be associated; further research on potential factors underlying this association is needed.