Sensory Responsiveness Patterns as Predictors of Severity in Children With Autism Spectrum Disorders

PURPOSE: Deficits in social interaction and communication are core diagnostic features of autism spectrum disorder (ASD; American Psychiatric Association, 2013). Unusual sensory responses to stimuli (hyper- or hyporeactivity) are also common in children with ASD (Baranek, David, Poe, Stone, & Watson, 2006; Lane, Young, Baker, & Angley, 2010; Wiggins, Robins, Bakeman, & Adamson, 2009). Dunn (1997) proposed a model of sensory processing that describes the interaction between a person’s neurological threshold for sensory input and his or her response to that information. The model describes a continuum of possibilities for interpreting a person’s behavior.

Individuals with high thresholds to sensory input need a large amount of input to evoke a response, while those with low thresholds respond to very small amounts of sensory input. An individual may either act passively in accordance with his or her threshold or respond actively to counteract his or her threshold. A person with a high threshold who responds passively is considered to have low registration. This individual might not even be aware of sensory input that easily evokes a response from others. A person with a high threshold who actively responds would be categorized as sensation seeking. He or she might seek out sensory experiences because a large amount of sensory input is enjoyable. Sensory sensitivity is used to describe individuals with a low threshold and a passive response mechanism. They perceive sensory stimuli very easily and become distracted or irritated by movements, sounds, and smells. In comparison, individuals who are sensation avoiding have low thresholds and respond actively to find ways that limit their exposures to those sensory stimuli (Dunn, 1997, 2001; Dunn, Saiter, & Rinner, 2002).

Atypical sensory responsiveness can limit participation at home and at school, specifically affecting tolerance of activities of daily living, such as eating, grooming, dressing, toothbrushing, and bathing (Reynolds & Lane, 2008), and individuals exhibit disruptive behaviors due to difficulty regulating their responses to stimuli (Miller, Anzalone, Lane, Cermak, & Osten, 2007). Children who are sensation avoidant may be labeled as withdrawn and asocial but are really attempting to avoid noxious sensory stimuli in their environments. Those who have low registration may appear lazy or apathetic when they simply need more sensory input to evoke the same level of responsiveness as others (Dunn, 1997). These issues can lead to a decrease in participation in many childhood activities that are important for the child’s optimal development. Our study addressed the following questions: Do sensory responsiveness patterns predict social responsiveness? Are certain patterns of sensory responsiveness more predictive of social responsiveness than others?

DESIGN: This cross-sectional study involved 183 participants ages 4–10 yr, 114 with a diagnosis of ASD and a control group of 69 unaffected children. Participants were recruited from two larger studies. Diagnostic categories were based on physician diagnosis per parent report and confirmed by the DSM–IV–TR criteria (American Psychiatric Association, 2000) on all participants.

METHOD: We used standardized measures of sensory responsiveness (Sensory Profile Caregiver Questionnaire) and social responsiveness (Social Responsiveness Scale, second edition; SRS–2) to compare children with and without an ASD diagnosis. Parents completed these questionnaires for each participant. Inclusion criteria included full-term birth; no history of cerebral palsy, epilepsy, or any other diagnosed major neurological condition; and no current uncorrected hearing or sight problems. Linear regression models including age, gender, diagnosis, ethnicity, twin status, and sensory responsiveness quadrant scores (low registration, sensory seeking, sensory sensitivity, sensory avoiding) were used to predict social responsiveness scores.

RESULTS: As expected, SRS–2 scores were significantly higher (more impaired) in the ASD group compared with the controls (p < .001). In the multivariable regression models, each sensory quadrant variable was negatively associated with social responsiveness scores (R ² range = .73–.74). When all four variables were included, only low registration remained statistically significant (b = –.55, SE = .23, R ² = .76).

CONCLUSION: Each sensory quadrant contributed to strong predictive models of social responsiveness, with low registration demonstrating the strongest independent effect. Occupational therapists often address both social and sensory issues in children with ASD; our findings reiterate the importance of examining and addressing sensory responsiveness when working with socially impaired children with ASD.

References

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