Attention and Sensory Characteristics in Children With High-Functioning Autism and Sensory Processing Disorder

PURPOSE: This study evaluated differences in attention and sensory processing between three groups of children: typically developing (TD), sensory processing disorder (SPD), and high-functioning autism (HFA). We examined whether differences in these abilities can accurately classify SPD, HFA, and TD children into their respective groups. We also examined associations between attention and neural sensory gating, measured by electroencephalography (EEG).

RATIONALE: Attention is critical for everyday occupations. Studies have shown that attentional deficits are related to sensory processing issues (Schaaf & Miller, 2005; Zhang et al., 2011). However, there is need for research examining specific attention and sensory profiles and the association between attention and neural sensory processing in these groups.

DESIGN AND METHOD: A cross-sectional, quasi-experimental quantitative design with convenience sampling was used. Participants included 21 children ages 6–12 yr with SPD, 30 children with HFA, and 30 TD children. Data from a subgroup of children with HFA (n = 22) and matched TD peers were used to examine the association between attention and sensory gating.

Attention was measured by The Test of Everyday Attention for Children (TEACh), a standardized test that contains nine subtests that are categorized into three subtypes of attention: sustained, selective, and control/shift. Sensory processing was assessed by the Short Sensory Profile (SSP). To assess sensory gating, EEG data were recorded while children were presented with pairs of click stimuli. In the resulting event-related potential (ERP), the P50 represents a positive deflection that occurs around 50 ms after each click. Neurological sensory gating was measured by the reduction in the P50 amplitude to the second/Test click compared to the first/Conditioning click (T/C ratio).

Mann–Whitney U was used to examine the group differences on the TEACh and SSP. Discriminant analysis was used to assess whether attention and sensory processing abilities can accurately classify children according to their diagnostic category. Pearson’s correlations were used to examine the association between the attention subtypes and the T/C ratio.

RESULTS: The SPD group had lower scores on the TEACh compared to TD peers on all subtests of sustained attention (p < .04) and one subtest of shift/control attention (p = .002). The HFA group had poorer performance than TD peers on all three subtypes of attention (p < .05). The SSP revealed that the TD group differed from both the SPD (p < .03) and HFA (p < .02) groups on all sensory subscales except movement sensitivity for the HFA group. The SPD group had more difficulties in tactile processing than the HFA group (p = .013). However, the group mean scores indicated that the SPD group had more severe sensory processing deficits than the HFA group on all subscales. Discriminant analysis significantly classified the three groups based on TEACh and SSP scores with 83.1% accuracy (λ = .27, p < .001). TEACh subtypes were significantly related to the P50 T/C ratio for children with HFA and TD peers.

CONCLUSION: The SPD and HFA groups had different attention and sensory characteristics compared with the TD group. Specifically, the HFA group had more difficulties in attention, whereas the SPD group had more difficulties in sensory processing. Individual differences in both sensory processing and attention measures were required to successfully discriminate among all three groups. Also, better attention skills were related to better neural sensory gating.

IMPACT STATEMENT: Results can help occupational therapists identify specific treatment strategies while working on attention and sensory processing in children with SPD and HFA. Treatment could focus more on sustained attention skills for children with SPD and global attention skills for children with HFA.

References

Schaaf, R. C., & Miller, L. J. (2005). Occupational therapy using a sensory integrative approach for children with developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 11, 143–148. https://doi.org/10.1002/mrdd.20067

Zhang, Y., Meyers, E. M., Bichot, N. P., Serre, T., Poggio, T. A., & Desimone, R. (2011). Object decoding with attention in inferior temporal cortex. Proceedings of the National Academy of Sciences, 108, 8850–8855. https://doi.org/10.1073/pnas.1100999108