On a recent trip, I noticed the below billboard from Autism Speaks presented in the airport and on several billboards on the interstate into Chicagoland. The poster draws awareness to the general public about the sensory differences that many individuals with Autism Spectrum Disorder experience. In 2013, the criteria for Autism was expanded to include sensory sensitivities as a criterion for diagnosis under the Restricted and Repetitive Activities section. As such, it is becoming more standard for medical providers and families coming in for diagnostic evaluations to note sensory sensitivities in the interview process or when identifying red flags for their child. Importantly though, there is great heterogeneity in the presence of sensory sensitivities within the Autism population (and within the wider human spectrum) and it is not necessary for sensory differences to be present in order to have a diagnosis of Autism. Similarly, sensory sensitivities are also present in other developmental and behavioral disorders and are not only present in the Autism phenotype.
(Autism Speaks, 2019)
(Picture: Autism Speaks billboard of a cartoon young boy who is kneeled down, with his eyes shut, and hands over his eyes surrounded by dark lighting and a number of indistinguishable objects. In white letters it reads “Sensory Sensitivity is a sign of Autism”)
Broadly, sensory processing refers to how our bodily systems manage sensory input from our environment. Most people are aware of hyper- or hypo-sensitive differences in the five senses (touch, taste, smell, sound, and visual); however, sensory sensitivities may also be in relation to temperature, pain level, proprioceptive (i.e., body awareness), and vestibular (i.e., balance, movement) input. When we refer to sensory differences in ASD, clinicians are often looking at dysfunction in sensory modulation. Sensory modulation refers to one’s ability “regulate and organize the degree, intensity, and nature of responses to sensory input in a graded and adaptive manner, so that an optimal range of performance and adaptation to challenges can be maintained” (Lane, Miller, & Hanft, 2000). Dysfunction in sensory regulation occurs when an individual is either sensory-seeking or sensory avoiding, and are posited to be broken down into the following categories:
•Over-Responsiveness:
•Distracted
•High-Arousal
•Impulsive and responds too much
•Aggressive
•Hard time disengaging from source of input
•Sensory Avoidant:
•Hypervigilant to environment
•Scanning for threats
•Fearful
•Anxious
•Sensory Under-Responsive:
•Reduced arousal
•Lack of awareness for stimuli
•Inattentive or delayed response to stimuli
•Sensory Seeking:
•Heightened arousal and over excitable with stimuli
•Driven to seek stimuli
•Impulsive
•Stimulation may cause disorganization and not satisfy child’s sensory needs
Outside of Autism Spectrum Disorder, children who have ADHD were also demonstrated to have more sensory processing difficulties and increased reactivity to sensory input than children without developmental disorders (Mangeot, Miller, McIntosh, McGrath-Clarke, Simon, Hagerman, & Goldson, 2001; Yochman, Parush, & Ornoy, 2004). Differences in sensory processing and integration have also been related to anxiety disorders, other developmental disorders, and behavioral disorders.
There is a currently controversy over sensory processing and whether symptoms are sufficient to be considered a distinct disorder (i.e., Sensory Processing Disorder). A summary of current state of positions held by both psychiatrics/pediatricians and other allied professions can be found here: https://childmind.org/article/the-debate-over-sensory-processing/. Despite the camp of professionals that support Sensory Processing Disorder as a unique condition, the American Academy of Pediatrics recommends that an independent diagnosis of Sensory Processing Disorder not be given, as it has not been empirically-supported that this is a separate “disorder” and not recognized by any diagnostic manuals. Rather sensory differences are more likely to be a component of an underlying behavioral or developmental disorder, such as ASD and ADHD. Find their full position statements here: https://pediatrics.aappublications.org/content/129/6/1186
Regardless of the etiology of sensory differences or affiliated developmental disorders, the experience of sensory dysregulation can be impairing to a child’s day-to-day functioning and lead to more disruptive/negative behaviors. The following are three videos, which can simulate and better understand the experience of individuals with sensitivity to environmental stimuli:
https://www.youtube.com/watch?v=5Zo8lzPlUbg
https://youtu.be/ycCN3qTYVyo
https://www.autismspeaks.org/sensory-issues References:
Lane SJ, Miller LJ, Hanft BE. (2000) Toward a consensus in terminology in sensory integration theory and practice. II: Sensory integration patterns of function and dysfunction. Sensory Integration Special Interest Section Quarterly, 23, 1–3.
Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath-Clarke, J., Simon, J., Hgerman, R., J., & Goldson, E. (2001). Developmental Medicine & Child Neurology, 43. 399-406.
Yochman, A., Parush, S., & Ornoy, A. (2004). Responses of preschool children with and without ADHD to sensory events in daily life. American Journal of Occupational Therapy, 58, 294–302.
