Date Presented 03/28/20
Sensory-processing challenges are measured by caregiver report and clinician observation and affect many people with autism spectrum disorder and their caregivers. It is unclear how caregiver stress influences the correlation between scores on caregiver reports and observational measures. The present analysis explored correlations between two formats of tools to assess sensory processing and indicated that caregiver stress moderates the association between sensory-seeking scores on the measures.
Primary Author and Speaker: Emily Campi
Additional Authors and Speakers: Cristin Holland, Susan Agostine, Stephanie Bristol
Contributing Authors: John Sideris, Emily Sopkin, Yun-Ju Chen, Elizabeth Choi, Aaron Dallman, Amanda Wiles, Linda Watson, Elizabeth Crais, Grace Baranek
PURPOSE: Many individuals with autism spectrum disorder (ASD) demonstrate atypical sensory processing, which impacts participation (Ismael, Lawson, & Hartwell, 2018) and is known to be associated with caregiver stress (Kirby, White, & Baranek, 2015). Occupational therapists are often the only providers trained to assess sensory challenges; thus, this area of assessment is especially important to inform treatment planning and goal setting. Sensory processing can be assessed via caregiver report or observational measures; however, the correlation between these types of measures and moderators of this association have not been systematically investigated. Thus, this paper aims to (a) test the correlation between a caregiver report and observed measure of sensory processing, and (b) examine whether or not caregiver stress accounts for and moderates this association.
DESIGN: This cross-sectional study used extant data from an NIH-funded project exploring the development and impact of sensory processing. We had 269 total participants ages 2-12 years across three groups: ASD, other developmental disorders (DD), and typically developing (TD).
METHOD: Hyporesponsiveness (HYPO), hyperresponsiveness (HYPER), and sensory seeking construct scores were measured via the Sensory Processing Assessment (SPA), a semi-structured, standardized, play-based assessment and the Sensory Experiences Questionnaire (SEQ), a caregiver-report measure. Caregiver stress was measured only in the ASD and DD groups using the Caregiver Strain Questionnaire (CGSQ), a self-report measure of stress related to caregiving responsibilities including three subscales: subjective internalized, subjective externalized, and objective strain. Pearson correlations were computed across the three measures for the full sample, controlling for chronological age (CA) and IQ. Then a series of regression models of SEQ scores were run with SPA, CGSQ, and their interaction entered hierarchically for the subset of children with ASD and DD, covarying for CA and IQ.
RESULTS: In our full sample (N=269) correlations ranged between .24 and .28 (all p<.001) between the SPA and SEQ scores on the constructs. There were no significant correlations between CGSQ subjective externalized strain and any of the sensory constructs on the SPA or SEQ. CGSQ subjective internalized strain was significantly correlated with all three sensory constructs on the SEQ (r=.27-.28, p<.03), but not on the SPA. Finally, CGSQ objective strain was significantly correlated with HYPO and HYPER on the SEQ (r=.31-.39, p<.007). CGSQ subjective externalized strain was a significant moderator for the association between SPA and SEQ seeking scores, F(1,55)=6.00, p<.02, such that as externalized scores increased, the association between SPA and SEQ seeking increased.
CONCLUSION: For the full sample, small to moderate significant correlations were found between measures across the three sensory constructs. Caregiver strain was more associated with parent report versus observed measures of sensory processing, as expected. The moderator analysis demonstrated that as parent stress increased, the correlation between the two measures of seeking also increased, which suggests that parents who experience more stress may be more aware of some of their children’s sensory features that are also observable to examiners.
IMPACT STATEMENT: These findings suggest that best practice for assessing sensory processing should consider multiple sources of information to examine the three sensory constructs, and include other caregiver factors that may be contributing to elevated sensory scores.
References
Ismael, N., Lawson, L.M., & Hartwell, J. (2018) Relationship between sensory processing and participation in daily occupations for children with autism spectrum disorder: A systematic review of studies that used Dunn’s Sensory Processing Framework. American Journal of Occupational Therapy, 72(3), 7203205030p1-7203205030p9. doi: https://doi.org/10.5014/ajot.2018.024075
Kirby, A. V., White, T. J., & Baranek, G. T. (2015). Caregiver strain and sensory features in children with autism spectrum disorder and other developmental disabilities. American journal on intellectual and developmental disabilities, 120(1), 32-45. doi: https://doi.org/10.1352/1944-7558-120.1.32
