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Section 9
Sensory Integration in Autism Spectrum Disorder

Question 9 | Test | Table of Contents

The purpose of this article is to discuss sensory processing concepts and their application to the needs of children who have Autism Spectrum Disorder (ASD). First we will outline the basic characteristics of the sensory systems, then discuss a model for sensory processing, and, finally, present a summary of the data supporting the application of this model in work with children who have ASD. A framework is outlined for incorporating sensory processing concepts into practice and research programs that address the needs of children with ASD. Finally, we will present case studies demonstrating the application of sensory processing principles.

The Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition--Text Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000) contains the most widely used diagnostic criteria for identifying Autism Spectrum Disorder (ASD) as a category of Pervasive Developmental Disorders (PDD). This document contains three behavioral criteria--qualitative social impairment, repetitive and restrictive stereotyped patterns of behavior, and significantly decreased social function--and three exclusion criteria--language delays, cognitive delays, or other significant diagnoses, including schizophrenia or autism (APA, 2000).

It is interesting to note that these criteria do not contain any explicit reference to differences in sensory processing, even though the original work on this disorder by Hans Asperger (1944) contained descriptions about distinct sensory processing behaviors (Dunn, Myles, & Orr, 2002). Asperger studied four children and recorded the unique characteristics they exhibited (Frith, 1991; Wing, 1991), including a range of hypo-and hypersensitivities to taste, tactile, and auditory stimuli. For example, male children discussed in his case studies preferred very sour or strongly spiced foods. Similarly, they strongly disliked tactile input (e.g., textures of some fabrics, fingernail cutting) and were also very sensitive to noise in certain situations but oblivious to noise in other environments. Each of these sensory problems interfered with their daily routines.

More recently, consideration has been given to the possibility that sensory processing is an underlying feature of ASD (Attwood, 1998; Fling, 2000; Myles & Simpson, 1998; Myles & Southwick, 1999; Stagnitti, Raison, & Ryan, 1999; Willey, 1999). Practitioners and scholars have anecdotally reported about the relationships between sensory processing functions in daily life, including learning, play, work, and socialization (e.g., Adreon & Myles, 2001; Anderson & Emmons, 1996; Ayres, 1972, 1979; Cook & Dunn, 1998; Fisher, Murray, & Bundy, 1991). There is some preliminary empirical evidence suggesting that there are significant differences in the sensory processing patterns of children who have ASD (Dunn et al., 2002). Some authors view the specific criteria listed under the heading "Repetitive and Restricted Stereotyped Patterns of Behavior, Activities, and Interests" (p. 84) to be reflective of difficulty with sensory processing, including (a) a preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus; (b) inflexible adherence to specific, nonfunctional routines or rituals; (c) stereotyped and repetitive motor mannerisms; and (d) persistent preoccupation with parts of objects (Frith, 1991; Gillberg, 1992; Huebner, 2001; Zero to Three, 1994).

The purpose of this article is to discuss sensory processing concepts and their application to the needs of children who have ASD. We will outline the basic characteristics of the sensory systems, discuss a model for sensory processing, and present a summary of the data supporting the application of this model in work with children who have ASD. Then we will outline a framework for incorporating sensory processing concepts into practice and research programs that address the needs of children with ASD. Finally, we will present case studies demonstrating the application of sensory processing principles.

Basic Characteristics of the Sensory Systems
There are seven basic sensory systems within the nervous system: sound, touch, vision, taste, smell, movement, and body position. Myles, Tapscott Cook, Miller, Rinner, and Robbins (2000) provided a summary of the characteristics of these sensory systems and their function in human beings (see Table 1). The visual and auditory systems provide information about the world, the touch and body position systems provide information about the person's body, and the movement system provides information about the interaction of the body in the world. The taste and smell systems provide a mechanism for sustaining the organism by accessing information for obtaining food, and for protection.

The sensory systems provide the route for the brain to receive information. The function of the input mechanisms themselves produce sensory acuity (e.g., whether the person's eyes receive light, etc.). The brain is responsible for making meaning out of this information and for designing and implementing a response (i.e., processing). For children who have ASD, the sensory input structures are usually intact; the difficulty with sensory processing occurs as the child tries to use that sensory input (i.e., process it) to respond to task and environmental demands.

A Model for Sensory Processing
Dunn (1997) proposed a model for sensory processing that characterizes patterns of responding based on a person's neurological thresholds and self-regulation strategies. The neurological threshold continuum moves from low to high thresholds, whereas the behavioral response continuum moves from passive to active self-regulation strategies. When these continua intersect, four basic patterns of sensory processing emerge, representing the anchor points of the continua.

The neurological thresholds continuum represents the amount of input the nervous system requires before responding. When a person has high thresholds, this means that it takes a lot of input for the nervous system to take notice and then generate a response. When a person has low thresholds, this means that it takes very little input for the nervous system to take notice, and lots of responses are generated.

The self-regulation continuum represents the range of strategies a person might use in responding to task and environmental demands. A person who resorts to passive strategies has a tendency to let things happen; a person who uses active strategies reveals a tendency to generate responses to control input.

The intersection of these continua creates four basic patterns of sensory processing: low registration, sensation seeking, sensory sensitivity, and sensation avoiding. Low registration represents the combination of high neurological thresholds with a passive self-regulation strategy. Sensation seeking represents the combination of high thresholds with an active self-regulation strategy. Sensory sensitivity is the combination of low neurological thresholds with a passive self-regulation strategy, and sensation avoiding represents the combination of low neurological thresholds with an active self-regulation strategy.

Dunn, W., Saiter, J., & Rinner, L. (2002). Asperger Syndrome and Sensory Processing: A Conceptual Model and Guidance for Intervention Planning. Focus on Autism and Other Developmental Disabilities, 17(3), 172-185.
(AS is now ASD per DSM-5.)

The box directly below contains references for the above article.

Personal Reflection Exercise #2
The preceding section contained information about Autism Spectrum Disorder
and sensory processing.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Sensory Integration Training
and Social Sports Games Integrated
Intervention for the Occupational Therapy
of Children with Autism

- Wang, Z., Gui, Y., & Nie, W. (2022). Sensory Integration Training and Social Sports Games Integrated Intervention for the Occupational Therapy of Children with Autism. Occupational therapy international, 2022, 9693648.

Peer-Reviewed Journal Article References:
Brandes-Aitken, A., Anguera, J. A., Rolle, C. E., Desai, S. S., Demopoulos, C., Skinner, S. N., Gazzaley, A., & Marco, E. J. (2018). Characterizing cognitive and visuomotor control in children with sensory processing dysfunction and autism spectrum disorders. Neuropsychology, 32(2), 148–160.


Kissine, M., Bertels, J., Deconinck, N., Passeri, G., & Deliens, G. (2021). Audio-visual integration in nonverbal or minimally verbal young autistic children. Journal of Experimental Psychology: General. Advance online publication.

Proff, I., Williams, G. L., Quadt, L., & Garfinkel, S. N. (2021). Sensory processing in autism across exteroceptive and interoceptive domains. Psychology & Neuroscience. Advance online publication.

QUESTION 9
What is the difficulty with sensory processing for children who have Autism Spectrum Disorder? To select and enter your answer go to Test.


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