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REVIEW PAPER

Psychological Correlates of Sensory Processing Patternsin Individuals with Autism Spectrum Disorder:A Systematic Review

Magdalena Glod1& Deborah M. Riby2 & Emma Honey3 & Jacqui Rodgers4

Received: 28 November 2014 /Accepted: 24 March 2015 /Published online: 15 April 2015# Springer Science+Business Media New York 2015

Abstract Existing evidence suggests that there is a relation-ship between sensory processing difficulties and the clinicaland non-clinical features of autism spectrum disorder (ASD).The current review aimed to evaluate evidence of the psycho-logical correlates of sensory processing patterns in individualswith ASD. Primary studies investigating sensory processingpatterns in children and adolescents with ASD were identifiedthrough systematic searches of electronic databases and eval-uated for methodological rigor and reporting quality. In 21studies, associations between sensory processing patternsand psychological correlates were found. Sensory hypore-sponsiveness was correlated with core features of ASD.Social awareness difficulties and affective disorders were as-sociated with hyperresponsiveness. Mixed results were foundfor repetitive behaviours. Further research is needed to con-firm, clarify and extend these findings.

Keywords Autism spectrum disorder . Sensory processingpatterns . Psychological correlates . Children . Adolescents .

Systematic review

Sensory Atypicalities in ASD

Effective reception, integration and processing of sensory in-put, as visual, auditory or proprioceptive information, enablesus to respond to environmental signals in an adaptive manner(John and Mervis 2010), which is essential to everyday func-tioning and learning. In autism spectrum disorder (ASD), ithas been reported that sensory processing atypicalities arepresent in over 90 % of children (Leekam et al. 2007) andadults (Crane et al. 2009). Sensory processing difficulties arenow included in the most recent diagnostic criteria for ASD(Diagnostic and Statistical Manual of Mental Disorders—5thedition, DSM-V, APA 2013) with ‘hyper- or hyporeactivity tosensory input or unusual interests in sensory aspects of theenvironment (e.g. apparent indifference to pain/temperature,adverse response to specific sounds or textures, excessivesmelling or touching of objects, visual fascination with lightsor movement)’ (APA 2013 p.50) as one of the diagnosticfeatures.

Sensory Processing Patterns in ASD

There are several theoretical approaches to the classificationof sensory processing difficulties in ASD. The DSM-V (APA2013) highlights two sensory processing patterns, hyper- andhyporesponsiveness, understood as exaggerated behaviouralreaction and lack of, or insufficient behavioural reaction to,sensory stimuli (Boyd et al. 2009). It has been claimed, forexample, that features associated with the hyporesponsivenesspattern can discriminate between children with autism, devel-opmental delay and those of typical development (Baraneket al. 2006). In addition, sensory atypicalities associated withdifferent patterns of sensory processing may be present withinthe same individual with ASD (Baranek 2002; Baranek et al.

* Jacqui [email protected]

1 Institute of Neuroscience, Sir James Spence Institute, 3rd Floor,Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK

2 Department of Psychology, Science Laboratories, DurhamUniversity, South Road, Durham DH1 3LE, UK

3 School of Psychology, Newcastle University, 4th Floor, RidleyBuilding 1, Newcastle upon Tyne NE1 7RU, UK

4 Institute of Neuroscience, Newcastle University, 4th Floor, RidleyBuilding 1, Newcastle upon Tyne NE1 7RU, UK

Rev J Autism Dev Disord (2015) 2:199–221DOI 10.1007/s40489-015-0047-8

2006; Ben-Sasson et al. 2009). Another approach taken ininvestigating sensory atypicalities focuses on sensory mod-ulation disorder (SMD). SMD is characterised by difficul-ties in regulating and organising appropriate behaviouralresponses to sensory input (Miller et al. 2007). The disor-der has distinct three subtypes—overresponsivity,underresponsivity and sensory seeking associated with thecraving of sensory experience (Miller et al. 2007). Thisclassification system has been acknowledged by theDiagnostic Classification of Mental Health andDevelopmental Disorders of Infancy and Early Childhood,Revised (known as the DC: 0–3R) (Zero to Three 2005),the Diagnostic Manual for Infancy and Early Childhood ofthe Interdisciplinary Council on Developmental andLearning Disorders (ICDL 2005), and the PsychodynamicDiagnostic Manual (PDM Task Force 2006). Other re-searchers examine sensory difficulties in ASD by applyingDunn’s model of sensory processing (Dunn 1997). In thatapproach, hyper- and hyporesponsiveness are further divid-ed depending on whether passive and active self-responding strategies are used to respond to sensory stim-ulation. As a result, four patterns of sensory processing aredistinguished: Low Registration, Sensation Seeking,Sensory Sensitivity and Sensation Avoiding. All four sen-sory processing patterns have been reported as present inindividuals with ASD (Kern et al. 2007). These multipletheoretical stands present in investigating sensory processingatypicalities in ASD are reflected in the current literature.

Symptom Comorbidity

Research suggests that there is a relationship between sen-sory processing difficulties and the clinical features ofASD. Some studies reported significant associations be-tween sensory processing atypicalities, communication andsocial impairments (Watson et al. 2011) as well as repeti-tive behaviours (Boyd et al. 2009), the presence of mal-adaptive behaviours, antisocial behaviours, self-absorptionand parent-reported child anxiety (Baker et al. 2008) orperseveration and overfocusing attention (Liss et al.2006). There is also evidence of significant associationsbetween sensory processing atypicalities and other non-clinical psychological constructs such as temperament(Brock et al. 2012), emotion dysregulation (Samson et al.2013) or eating difficulties (Nadon et al. 2011). However,there is variability in the methodological approaches usedin those studies, including the selection of measures, diag-nostic subgroups and specified inclusion criteria. Due to avast number of psychological constructs that have beeninvestigated, and a wide range of methods of investigationemployed, both interpretation and comparison of findingshas been hampered.

Previous Reviews

Four literature reviews of sensory atypicalities in individualswith ASD have been published to date (Ben-Sasson et al.2009; Iarocci and McDonald 2006; O’Neill and Jones 1997;Rogers and Ozonoff 2005). However, these evaluations fo-cused on differently defined sensory difficulties: Ben-Sassonet al. (2009) reviewed sensory modulation symptoms in indi-viduals with autism, Iarocci and McDonald (2006) investigat-ed multisensory integration, O’Neill and Jones (1997) studiedunusual sensory responses, while Rogers and Ozonoff (2005)concentrated on sensory dysfunction. Secondly, the previousreviews employed different methodological approaches, rang-ing from experimental laboratory findings combined with the-oretical and conceptual papers (Iarocci and McDonald 2006;Rogers and Ozonoff 2005), through reviewing clinical andexperimental studies (O’Neill and Jones 1997) to the inclusionof only clinical findings (Ben-Sasson et al. 2009). Thirdly, theprevious reviews focused more on the discriminant validity ofsensory atypicalities between ASD and typical groups. Thereis also growing number of studies investigating physiologicalreactivity to different types of sensory stimuli (for review seeLydon et al. 2014). However, none of the published reviewshave described evidence of associations between sensory pro-cessing patterns in individuals with ASD and other psycho-logical constructs. Therefore, this current approach to the re-view is important because, while there is growing interest andresearch in sensory processing in individuals with ASD andsensory processing patterns are included in the diagnosticcriteria for ASD (APA 2013), a systematic summary of therecent findings is lacking.

Aim of the Review

The current review therefore aims to systematically summa-rise and evaluate available evidence, recognise and discussany shortcomings, and identify goals for future research inorder to address the following question: What are the psycho-logical correlates of sensory processing patterns in individualswith ASD?

Method

Inclusion/ Exclusion Criteria

Inclusion and exclusion criteria were defined prior toconducting the literature search. Studies were eligible for in-clusion if they investigated sensory processing patterns in in-dividuals with ASD and explicitly reported associations withpsychological correlates such as cognition, emotions, behav-iour or interpersonal relationships. Studies were searched from

200 Rev J Autism Dev Disord (2015) 2:199–221

1997 onwards. Non-primary studies were excluded from thesearch (e.g. reviews, book chapters). Also, single case studiesand case series designs were excluded. This decision wasbased upon the consideration that results from single casestudies would not provide quantitative statistical data whichis important from the point of this review and do not allowfurther generalisation of the findings. The search was neitherrestricted to any particular age group nor particular diagnosticsubgroup.

Search Strategy

A systematic literature search aimed to identify studiesreporting sensory processing patterns of individuals withASD conducted up to February 2014. The search used fiveelectronic databases: Scopus, Web of Knowledge, PsychInfo,Embase and Medline. For both Scopus and Web ofKnowledge, which allow authors to search for a number ofkeywords, the search terms were based on the keywords usedin the Ben-Sasson et al. (2009) meta-analysis. After identify-ing relevant papers, additional keywords that were used incategorising those papers were added into the search terms.The combinations of the following search terms were used: adiagnostic term (autis* or Bpervasive developmentaldisorder*^ or Asperger), a sensory term (sensory or reactivityor responsivity or sensation*) and a descriptor term (process-ing or integration or modulation or regulation or stimul* orinput or event* or dysfunction or respons* or profile* orsymptom* or unusual or difficulties or interest* or feature*or experience* or hypo* or hyper* or pattern* or sensitiv* orseeking or avoid* or registration or threshold* or defensive-ness). In PsychInfo, Embase and Medline databases, searchesare based on controlled vocabularies. However, because dif-ferent types of headings are used for each database (e.g. med-ical subjects headings for Medline, but APA thesaurus forPsychInfo), the vocabulary used in the databases varied. ForPsychInfo, autism or pervasive developmental disorders orAsperger syndrome were used as diagnostic terms, combinedwith sensory integration or intersensory processes or percep-tual motor processes or sensorimotor measures or sensoryadaptation or adaptation or thresholds or self stimulation. Inthe Embase database, Asperger syndrome or infantile autismor autism terms were used, combined with sensory dysfunc-tion or abnormal sensation or sensory defensiveness or senso-ry stimulation or sensation or abnormal sensation or sensationseeking or self stimulation or perceptive threshold or sensori-motor function or sensorimotor integration. When searchingin Medline, a combination of terms child development disor-ders, pervasive or autistic disorder or Asperger syndrome, andsensory thresholds or sensation disorders or self stimulation oroccupational therapy were used.

A flowchart of the search strategy and numbers of articlesidentified and excluded at each stage is outlined in Fig. 1. All

databases were searched between 1997 and the 2nd ofFebruary 2014.

Electronic Search

Results from five electronic databases were exported toEndnote® referencing software resulting in 3336 records intotal. Most duplicates of the papers were identified byEndnote’s duplicate identification function and removed fromthe records’ list. Further duplicates not recognised by the soft-ware were removed manually, and 1964 records were carriedforward to the screening stage.

Screening of Electronic Search Results

Screening of the search results consisted of four main phases.In phase 1, the non-primary sources were electronically iden-tified and removed (a total of 99 records). In phase 2, theremaining titles of the records were screened considering theirrelevance to the search question and 1441 studies were re-moved. In phase 3, remaining article abstracts were screened.Only 90 met inclusion criteria and those were carried forwardto the final phase in which articles were screened by full textand the final selection was made.

Final Selection

Sixty nine papers were excluded after screening the full text.Five papers were excluded due to unpublished status (threetheses, two conference papers). Four were excluded due tobeing published in languages other than English (Japanese,Italian, Portuguese and Chinese). Four papers focused on sen-sory modalities (such as auditory or tactile modality) ratherthan sensory patterns, which were a main interest of this re-view. In another 27 papers, sensory atypicalities in generalwere investigated (mainly reporting the Short SensoryProfile total score). Four studies used physiological measuresof sensory processing. Nine papers were not found appropriatedue to the lack of correlational analysis (four were descriptivein nature, reporting, for example, cross-group comparisonsand another five presented onlymeans for different constructs,without reporting relations between the constructs or present-ing sensory clusters). Seven papers did not include any psy-chological constructs, but examined relationships betweensensory processing and for example oral care difficulties, lei-sure activities, or family life impairment and maternal parent-ing stress. Two papers were validity studies (investigatingpsychometric properties of tools). In seven papers, a clearASD sample was not recruited, either studies included partic-ipants from the general population, with or without someASD-traits, or the results were presented for a combinedASD sample with another group (e.g. developmental delay).The remaining 21 papers were included in the systematic

Rev J Autism Dev Disord (2015) 2:199–221 201

Medline (Ovid)

n=156

Embase (Ovid)

n=505

PsychInfo (Ovid)

n=311

Exported to Endnote®

n=3336

Phase 1. Non-primary sourced electronically iden�fied

n=1964

Phase 2. Ar�cles screened by �tle

n=1865

Phase 3. Ar�cles screened by abstract

n=424

Phase 4. Ar�cles screened by full text

n=90

Final selec�on of ar�cles included in review n=21

Excluded:

unpublished status n=5

published not in English n=4

sensory pa�erns not included n=31

physiological measures of sensory processing n=4

analysis not appropriate n=9

constructs out of interest n=7

validity studies n=2

sample not relevant n=7

Excluded:

not relevant n=334

Excluded:

not relevant n=1431

design (e.g.case studies/case series) n=10

total n=1441

Excluded:

editorial n=7

commentary/reply n=13

reviews n=53

book sec�ons n=26

total n=99

Duplicates removed:

electronically n=1173

manually n=199

total n=1372

Web of Science

n=1232

Scopus

n=1132

Fig. 1 Flowchart of search


review. The summary of the descriptive characteristics of the-se studies can be found in Table 1.

Critical Evaluation

Each of the retained papers was evaluated against a reviewquality evaluation grid developed for the purpose of this re-view. The available checklists for the quality assessment ofstudies (e.g. PRISMA,Moher et al. 2009; QUADAS,Whitinget al. 2003) or well-known guidelines for conducting system-atic reviews in health care (e.g. the Cochrane Collaboration)focus on diagnostic accuracy, evaluation of randomised trialsand intervention studies. The newly developed grid aimed tosystematically evaluate the overall quality of the studies, theirstrengths and limitations or potential sources of bias. The gridwas divided into four main sections, following the IMRaDstructure: introduction, methods, results and discussion(Sollaci and Pereira 2004). The methods section was of par-ticular importance including items evaluating a studies qualityin participants and method selection. To adequately evaluatethe methodology used in the studies, the grid contained itemsconcentrating on appropriate sample characteristics and con-firmation of ASD diagnosis. The methods section of the eval-uation grid also highlighted the importance of sound psycho-metric properties of the tools used in the studies as suggestedby the COnsensus-based Standards for the selection of healthMeasurement INstruments (COSMIN) guideline (Mokkinket al. 2010). The total number of criteria that the studies werescored against was kept within the recommended limit to keepclear focus of the review (SIGN 2008).

Subjective judgement is a part of the evaluation process(Deeks et al. 2003; SIGN 2008); to minimise the reviewer’ssubjectivity, the following steps were undertaken. First, allscoring criteria were explained in detail. Second, three levelsof quality ratings were used, the equivalent of the levels ofratings proposed by SIGN (high, acceptable and low quality).Finally, a proportion of the studies included in the review(19 %) were evaluated by an independent rater. The inter-rater reliability between the author’s and independent rater’sscorings calculated as percentage agreement on individualcriteria was 87.5 %.

Results

Of the 1964 unique references identified via the electronicsearches, 21 papers met the inclusion criteria and wereretained for review.

Evaluation Grid—Papers’ Quality

Originally, the papers included in the review were scoredagainst 26 criteria. Ten criteria were emphasised during the

evaluation. Two criteria were selected from the participants’section (‘Was ASD diagnosis confirmed for the study?’ and‘Is the sample adequately described?’). They allowed us toassess whether the sample of interest was included in the studyand whether the authors reported participants’ characteristicsin a high-quality manner. Items from the ‘Sensory measures’and ‘Psychological correlate measure’ sections were also con-sidered as the criteria of the key importance. They allowed usto evaluate the appropriateness, reliability and validity of thetools used in the studies. The chosen criteria are fundamentalto evaluate the quality of the studies in the light of the researchquestion asked in this review. For the summary of the infor-mation included in the evaluation grid and ten selectedcriteria, see Table 2.

Participants’ Section

The two items describing participants’ characteristics are es-sential to establish whether the particular clinical group ofinterest was selected according to widely accepted researchstandards. In addition, it was important to confirm whetheror not the characteristics were described well enough to allowother researchers to replicate the study and identify some pos-sible important covariates that might influence the study find-ings. All the studies provided a confirmation of diagnosis ofparticipants. In 14 papers, the assessment of children was car-ried out prior to inclusion in the study by using ‘gold-stan-dard’ diagnostic tools such as the Autism DiagnosticObservation Schedule (ADOS) or the Autism DiagnosticInterview-Revised (ADI-R). In the remaining seven papers(Ashburner et al. 2008; Gal et al. 2010; Hilton et al. 2007;Lane et al. 2012; Liss et al. 2006; Nadon et al. 2011; Tsenget al. 2011), documents stating children’s and young people’sdiagnosis were gathered or non-‘gold-standard’ tools wereused to confirm diagnosis, e.g. medical chart review.However, sample characteristics were not always well de-scribed. Three studies (Lane et al. 2012; Liss et al. 2006;Tseng et al. 2011) reported only gender and age of their par-ticipants. Only Nadon et al. (2011) provided all thedemographics selected in the evaluation grid characteristics(e.g. age, gender, ASD subtype, comorbidities and demo-graphic variables). The remaining studies reported three orfour of these features.

Sensory Measures Section

Nine different tools were used to assess sensory processingpattern or patterns in the selected studies (additionally theSensory Profile was used in two language versions—Englishand Chinese). Three authors (Boyd et al. 2010; Brock et al.2012; Watson et al. 2011) used more than one sensory mea-sure and selected items from each measure to inform a factoranalytic model of sensory processing patterns. These models


Tab

le1

Summaryof

included

studies

Reference

Sam

ple

Sensory

processing

pattern(s)

(Sensory

measures)

Analysistype

Psychological

correlates

measures

Mainfinding(s)

NAge

Diagnosis

Ashburner

etal.(2008)

28Range:6

–10yearsold

ASD

Underresponsive/seeks

sensation(SSP)

Correlatio

nal

CTRS-R:L

ASE

BA:TRF

GADS

GARS


sensationwas

significantly

negativ

elyassociated

with

academ

icperformance

andattentionto

cognitive

tasks

andwith

autism

quotient

Baker

etal.(2008)

22M=64.86months

(SD=20.70)

Range:3

3–101

monthsold

AD


sensation(SSP)

Correlatio

nal

VABS

DBC-P

Poor

sensoryprocessing

ability

was

associated

with

higher

levelsof

behaviouraland/or

emotionalp

roblem

s

Baranek

etal.(2013)

63Range:2

0–83

monthsold

AD

Hyporesponsiveness(SPA

)Inferential(series

ofregression

models)

JAA

MSE

LPL

S-4

Sensoryhyporesponsiveness

was

significantly

negativ

elyassociated

with

jointattention

andlanguage

skills

Boydetal.(2010)

67M=51.69months

(SD=17.07)

AD

Hyporesponsiveness,

hyperresponsiveness,

sensoryseeking

(SEQ,S

P,SPA

,TDDT-R)

Inferential(series

ofregression

models)

RBS-R

Higherhyperresponsivescores

wererelatedto

avarietyof

repetitivebehaviours.T

hesignificantassociatio

nwas

foundbetween

sensoryseekingandritualistic/sam

eness

behaviours

Brock

etal.(2012)

54M=56.17months

(SD=3.67)

Range:3

6–84

monthsold

ASD

Hyporesponsiveness,


sensoryseeking(SEQ,

SP,SPA

,TDDT-R)

Inferential(series

ofregression

models)

BSQ

Hyporesponsivenesswas

mostassociated

with

distractibility,slowness

toadapt

andthethresholdsubscale.H

ighlevels

ofsensoryfeatures

wereassociated

with

increasedwith

draw

alandmorenegativ

emood

Chenetal.(2009)

29Range:8

–16yearsold

Aspergersyndromeor

ASD


sensation(SSP)

Correlatio

naland

multip

leregression

CRI

EFT

Nosignificantrelationshipwas

found

betweenthepresence

ofsensoryabnorm

alities

(underresponsiveness)andrestricted

and

repetitivebehavioursanddetail-focused

cognitive

style

Galetal.(2010)

56M=9.71

years(SD=1.86)

Autism


sensation(SSP)

Correlatio

nal

SSIMI

Atypicalsensory

processing

was

strongly

relatedto

stereotypedmovem

ents

(underresponsiveness

was

thebestpredictor

ofstereotypedmovem

ents)

Green

etal.(2012)

149

M=28.3

months(SD=5.5)

ASD

orPDD-N

OS

Sensoryoverresponsivity

(ITSEA)

Correlatio

nal

ITSE

ASensoryoverresponsivity

was

positiv

ely

associated

with

anxiety(and

positiv

ely

predictedincreasesin

anxiety)

Hilton

etal.(2007)

36Range:6

–10yearsold

HFA

SD

Low

registratio

n,sensation

seeking,sensory

sensitivity,sensatio

navoiding

(SP)

Correlatio

nal

SRS

The

SRSscores

show

edmoderateto

strong

relatio

nships

with

SensoryProfile

quadrant

scores


Tab

le1

(contin

ued)

Reference

Sam

ple

Sensory

processing

pattern(s)

(Sensory

measures)

Analysistype

Psychological

correlates

measures

Mainfinding(s)

NAge

Diagnosis

Jasm

inetal.(2009)

35Range:3

–4yearsold

ASD

(ADand

PDD-N

OS)

Low

registratio

n,sensation

seeking,sensory


navoiding

(SP)

Correlatio

nal

PDMS-2

WeeFIM

VABS-2

Somesensoryresponseswereassociated

with

motor

skills,andthereweremany

correlations

betweensensorim

otor

performancesanddaily

livingskills

Laneetal.(2010)

54M=79.02months

(SD=19.22)

Range:3

3–115months

AD


sensation(SP)

Correlatio

naland

multip

leregression

VABS

Aclearpredictiv

eassociationwas

evident

betweensensoryprocessing

patterns,

communicationperformance

and

generalm

aladaptiv

ebehaviour

Laneetal.(2012)

23Range:6

–10yearsold

ASD


(SPor

SensO

RInventory)

Correlatio

nal

RCMAS


was

strongly

linkedwith

anxiety

Lidstoneetal.(2014)

49M=10.7

years(SD=3.10)

Range:3

–17;9yearsold

ASD

Low

registratio

n,sensation

seeking,sensory


navoiding

(SP)

Correlatio

nal

andmediatio

nRBQ-2

SCAS-P

orPA

SDifferent

sensoryfeatures

contributedin

differentw

aysto

theassociationbetween

anxietyandrestricted

andrepetitivebehaviours

Lissetal.(2006)

144

M=102.4monthsold

(SD=50.1)

ASD

Overreactivity,underreactiv

ity,

sensoryseeking(SQ)

Correlatio

nal

DSM

-IVchecklist

KOS

VABS

The

strongestp

ositive

correlationwas

found

betweenoverreactiv

ityandoverfocusing

Mazurek

etal.(2013)

2973

M=6.0years(SD=3.5)

Range:2

–17yearsold

ASD


(SSP

)Correlatio

nal

CBCL

GISIQ

Anxiety,sensory

overresponsivity

and

GIproblemswerepossibly

interrelated

phenom

enon

forchild

renwith

ASD

.There

was

astrong

associationbetween

anxietyandsensoryoverresponsivity

Nadon

etal.(2011)

95M=7.3years(SD=2.5)

Range:3

–10yearsold

Autism

(61%),

PDD-N

OS(29%)or

Aspergersyndrome

(10%)


sensation(SSP)

Linearregression

EatingProfile


sensationwas

not

significantly

associated

with

thenumber

ofeatin

gproblems

Pfeifferetal.(2005)

50M=9.8years

Range:6

–16yearsold

Asperger’sdisorder

Hypersensitivity,

hyposensitivity

(SPor

AASP

)

Correlatio

nal

RCMAS

CDI

ABAS

There

weresignificantly

strong

positiv

ecorrelations

betweensensory

defensivenessandanxiety

Reynoldsetal.(2012)

27Range:6

–12yearsold

ASD

Low

registratio

n,sensation

seeking,sensory


navoiding

(SP)

Correlatio

nal

CBCL

There

was

asignificantcorrelatio

nbetween

sleepproblemsandalowsensory

threshold/high

arousal

Sam

sonetal.(2013)

56Range:6

–16yearsold

ASD


sensation(SSP)

Correlatio

nal

EDI

Sensory

abnorm

alities

weresignificantly

relatedto

emotiondysregulation

Tsengetal.(2011)

67M=64.21months

(SD=9.01)

Autism

Low

registratio

n,sensation

seeking,sensory

Correlatio

nal

CBCL-C

Correlatio

nsbetweeninternalisingand

externalisingproblemsandthefour


Tab

le1

(contin

ued)

Reference

Sam

ple

Sensory

processing

pattern(s)

(Sensory

measures)

Analysistype

Psychological

correlates

measures

Mainfinding(s)

NAge

Diagnosis


navoiding

(SP-C)

quadrantsscores

oftheSP-Cwere

significant,butlow

Watsonetal.(2011)

72M=52.3

months

(SD=16.5)

AD

Hyporesponsiveness,


sensoryseeking

(SEQ,S

P,SPA

,TDDT-R)

Factor

analyticmodel

ADOS

MSELor

PLS-4

VABS

Hyporesponsivenesshadasignificant

positiv

eassociationwith

social-com

municativesymptom

severity

andwas

negativ

elyassociated

with

language

scores

aswellassocial

adaptiv

escores.A

lso,sensoryseeking

was

negativ

elycorrelated

with

language

scores

AASP

Adolescent/A

dultSensory

Profile,ABASAdaptiveBehaviorAssessm

entSystem,ADOSAutism

Diagnostic

Observatio

nSchedule,

ASE

BA:TRFAchenbach

System

ofEmpirically

Based

Assessm

ent:Teacher

ReportForm,BSQ

BehavioralStyle

Questionnaire,CBCLC

Child

BehaviorChecklistforages

4–18

Chinese

version,

CBCLChild

BehaviorChecklist,CDIChildren’s

DepressionInventory,CRIChildhood

Routin

esInventory,CTRS-R:L

Conner’sTeacherRatingScale–Revised

LongVersion,DBCPDevelopmentalBehaviour

Checklist—

Parent,DSM

IVchecklist

Diagnostic

andStatisticalManualof

MentalDisorders4thedition

checklist,EDIEmotionDysregulatio

nIndex,

EFTEmbedded

Figures

Test,G

ADSGilliam

Asperger’sDisorderScale,G

ARSGilliam

Autism

RatingScale,G

ISIQGastrointestin

alProblemsSym

ptom

InventoryQuestionnaire,ITS

EAInfant

ToddlerSo

cialandEmotionalA

ssessm

ent,JA

AJointA

ttentionAssessm

ent,KOSKinsbourne

OverfocusingScale,M

SELMullenScales

ofEarlyLearning,PA

SPreschoolAnxietyScale,PDMS2PeabodyDevelopmentalM

otor

Scales—2ndedition,P

LS4PreschoolL

anguageScaleFourthEditio

n,RBQ-2

Repetitive

BehaviorQuestionnaire

2,RCMASRevised

Children’sManifestAnxiety

ScaleAdapted

Parent’s

Version,S

CASPSpenceChildren’sAnxiety

ScaleParent

Version,S

ensO

RSensory

OverresponsivenessInventory,SPASensoryProcessing

Assessm

ent,SP

CSensoryProfileChinese

version,SP

SensoryProfile,SEQSensoryExperiences

Questionnaire,SQSensoryQuestionnaire,SRS

SocialR

esponsivenessScale,SSIMIStereotypedandSelf-Injurious

Movem

entInterview

,SSP

ShortS

ensory

Profile,T

DDTRTactile

Defensiveness

andDiscrim

inationTest,V

ABS2VinelandAdaptive

BehaviorScales—Second

Editio

n,VA

BSVinelandAdaptiveBehaviour

Scales,WeeFIM

Functio

nalIndependenceMeasure


Tab

le2

Evaluationgrid

Dom

ain

Criterion

Classification

Scoring

criteria

Introductio

n

Item

1Are

theconstructsof

interestadequately

described?

Yes

The

constructsof

interestareadequately

definedor

described

Partially

The

constructsof

interestaresomew

hatu

nclear

oronly

someconstructsareclearlydefined

No/NR

Lackof

definitio

nsanddescriptions

oftheconstructsof

interest

Item

2Istheresearch

questio

nclearlyform

ulated?

Yes

The

research

questio

nof

thestudyisclearlyform

ulated

Partially

The

research

questio

nisstated

butsom

ewhatu

nclear

No/NR

The

research

questio

nof

thestudyisunclearor

notstated

Item

3Are

thehypotheses

clearlystated

andoperationalised?

Yes

The

hypotheses

ofthestudyareclearlystated

andoperationalised

Partially

The

hypotheses

areclearlystated,but

noto

peratio

nalised

oroperationalisationof

hypotheses

issomew

hatu

nclear

orhypotheses

arevague,butthe

operationalisationisclear

No/NR

The

hypotheses

ofthestudyareunclearandarenoto

peratio

nalised

ornotstated

Methods

Participants

Item

4Isthesampleused

inthestudyrepresentativ

e?Yes

Apopulatio

n-basedsamplewas

targeted

Partially

Aconveniencesamplewas

used

with

anattempt

tousemultip

lerecruitm

entsources

No/NR

Ahighly

selectiverecruitm

entm

ethodwas

used

(e.g.selectiv

elyreferred

patients

alreadytaking

partin

anotherstudy)

orrecruitm

entsources

arenotreported

Item

5Isthesampleused

inthestudyhomogenousand

recruitedatthesametim

epoint?

Yes

The

sampleisrecruitedforthestudyatthesametim

epoint.

Partially

The

sampleisrecruitedforthestudy,butthe

participantsareassessed

atdifferenttim

epoints

No/NR

The

sampleconsistsof

pooled

samples

from

differentstudies

andthedata

iscollected

atdifferenttim

epoints

Item

6*Was

ASD

diagnosisconfirmed

forthestudy?

Yes

Diagnoses

have

been

confirmed

forthisstudyby

useof

a‘gold-standard’diagnostictool

(i.e.A

DOSor

ADI-R)

Partially

Diagnoses

have

been

confirmed

forthisstudy,butn

otby

useof

agold-standardtool

No/NR

ASD

diagnoseshave

notb

eenconfirmed

forthisstudyor

diagnoseswereconfirmed

for

thestudybutp

aper

does

notp

rovide

detailhow

Item

7Are

inclusionandexclusioncriteriadescribed?

Yes

Inclusionandexclusioncriteriaareexplicitlyreported

Partially

Onlyinclusionbutn

otexclusioncriteriaareexplicitlyreported

No/NR

Inclusionandexclusioncriteriaarenotexplicitlyreported

Item

8Was

levelo

fcognitive

functio

ning

ofparticipantsassessed?

Yes

Levelof

cognitive

functio

ning

isreported

andbasedon

assessmentu

sing

astandardised

instrumentand

was

assessed

either

forthestudyor

with

inthepreceding3months

Partially

Levelof

cognitive

functio

ning

isreported

butisbasedon

previous

(non-recent)assessment

oron

methodotherthan

standardised

instrument(e.g.positio

nin

school

system

)or

cognitive

functio

nwas

assessed

butv

erybroadlyreported

(e.g.‘allp

articipantshad

FSIQ

sover

75as

assessed

by….’or

‘MAless

than

6months’)

No/NR

Levelof

cognitive

functio

ning

isnotreported


Tab

le2

(contin

ued)

Dom

ain

Criterion

Classification

Scoring

criteria

Are

samplecharacteristicsdescribed?

Age

Yes

Age

rangeandmeanarereported

Partially

Eith

eragerangeor

meanisreported

No/NR

Age

rangeandmeanarenotreported

Gender

Yes

Genderof

participantsisreported

Partially

Genderof

participantsissomehow

reported

(proportionald

atareported)

No/NR

Genderof

participantsisnotreported

ASD

subtype

Yes

ASD

subtypes

included

arereported

No

ASD

subtypes

included

arenotreported

Com

orbidities

Yes

Presence

anddetailof

relevant

comorbiditiesisreported

No

Presence

anddetailof

relevant

comorbiditiesisnotreported

Other

demographicvariables

Yes

Other

demographicvariablesarereported

(e.g.location,ethnicity,race)

No

Other

demographicvariablesarenotreported

Item

9*Based

ontheabove,isthesampleadequately

described?

Yes

Alltheabovedetails

aregiven

Partially

Mosto

ftheabovedetails

aregiven

No/NR

Fewor

none

oftheabovedetails

aregiven

Measures

Sensory

measures

Item

10*

Item

11*

Are

sensoryprocessing

patternsmeasuredusing

standardised

measuresof

sensoryprocessing?

Yes

Standardised

measuresareused

inthisstudy

Are

sensoryprocessing

patternsmeasuredusingvalid

measuresof

sensoryprocessing?

Partially

Non-standardisedmeasuresareused,but

referenceto

currentstandardisatio

nworkisprovided

No/NR

Non-standardisedmeasuresareused

Yes

Evidenceof

good

valid

ityof

themeasuresisprovided

inthisstudy(e.g.50%

ofthe

variance

explainedby

factors,correlations

with

‘gold’

standard

measures≥0

.70)

Partially

Evidenceof

valid

itynotp

rovidedin

thisstudy,butreference

tocitedstudiesproviding

evidence

ofacceptablevalid

ityof

themeasuresor

evidence

provided

forthewhole

measure,but

only

someitems/subscalesareused

inthestudy

No/NR

Non-validated

measuresareused

orno

reported

evidence

ofvalid

ityisprovided

Item

12*

Are

sensoryprocessing

patternsmeasuredusing

reliablemeasuresof

sensoryprocessing?

Yes

Evidenceof

good

reliabilityof


inthisstudy

(e.g.C

ronbach’salpha(s),ICC≥0

.7)

Partially

Evidenceof

reliabilitynotp

rovidedin



evidence

ofacceptablereliabilityof

themeasuresor

evidence

provided

forthewhole

measure,but

only


inthestudy

No/NR

Non-reliablemeasuresareused

orno

reported

evidence

ofreliabilityisprovided

Item

13*

Are

themeasuresused

appropriateforusewith

anASD

populatio

n?Yes

Evidenceprovided

thattoolsused

have

been

standardised

andvalid

ated

foruse

with

ASD

populatio

nor

areASD

-specific


Tab

le2

(contin

ued)

Dom

ain

Criterion

Classification

Scoring

criteria

Partially

Tool

hasnotb

eenstandardised

forASD

populatio

nbutith

asbeen

valid

ated

oris

widelyused

inASD

research

orevidence

ofusewith

comparabledevelopm

ental

groups

isprovided

inthisstudy

No/NR

Noevidence

thattool

isappropriateforASD

populatio

n

Psychologicalcorrelatemeasure

Item

14*

Isthepsychologicalcorrelatemeasuredusing

standardised

measuresof

theconstruct?

Yes

Standardised

measuresareused

inthisstudy

Partially

Non-standardisedmeasuresused,but

referenceto

currentstandardisatio

nworkisprovided

No/NR

Non-standardisedmeasuresareused

Item

15*


valid

measuresof

theconstruct?

Yes

Evidenceof

good

valid

ityof


inthisstudy(e.g.50%

ofthe

variance

explainedby

factors,correlations

with

‘gold’

standard

measures≥0

.70)

Partially

Evidenceof

valid

itynotp

rovidedin



evidence

ofacceptablevalid

ityof

themeasuresor

evidence

provided

forthe

wholemeasure,but

only


inthestudy

No/NR

Non-validated

measuresareused

orno

reported

evidence

ofvalid

ityisprovided

Item

16*


reliablemeasuresof

theconstruct?

Yes

Evidenceof

good

reliabilityof


inthisstudy

(e.g.C

ronbach’salpha(s),ICC≥0

.7)

Partially

Evidenceof

reliabilitynotp

rovidedin



evidence

ofacceptablereliabilityof

themeasuresor

evidence

provided

forthe

wholemeasure,but

only


inthestudy

No/NR

Non-reliablemeasuresareused

orno

reported

evidence

ofreliabilityisprovided

Item

17*

Are

themeasuresused

appropriateforuse

with

anASD

populatio

n?Yes

Evidenceprovided

thattool

used

hasbeen

standardised

andvalid

ated

forusewith

ASD

populatio

nor

isASD

-specific

Partially

Tool

hasnotb

eenstandardised

forASD

populatio

n,butith

asbeen

valid

ated

oriswidelyused

inASD

research

orevidence

ofusewith

comparable

developm

entalg

roupsisprovided

inthisstudy

No/NR

Noevidence

thattool

isappropriateforASD

populatio

n

Results

Item

18Are

thedescriptivestatisticsappropriatelyreported?

Yes

The

descriptivestatisticsareappropriatelyreported

(e.g.M

,SD,range)

Partially

Onlysomeof

thedescriptivestatisticsarereported

orthedescriptivestatistics

arereported

forselected

constructs

No/NR

The

descriptivestatisticsarenotappropriately

reported

ornotreportedatall

Item

19Are

theresults

presentedclearly?

Yes

The

results

arepresentedclearly(e.g.tablesandfiguresareeasy

toread,clearly

labelled,thedescriptionof

theresults

iseasy

tofollo

w)

Partially

The

results

arepresentedsomehow

unclear

No/NR

The

presentatio

nof

theresults

isdifficulttofollo

w

Item

20Are

thepsychometricpropertiesreported

inthecurrentsam

ple?

Yes

Validity

andreliabilityarereported

inthecurrentsam

ple

Partially

Eith

ervalid

ityor

reliabilityisreported

inthecurrentsam

pleor

both

reported

only

forselected

constructs


Tab

le2

(contin

ued)

Dom

ain

Criterion

Classification

Scoring

criteria

No/NR

Validity

andreliabilityarenotreportedin

thecurrentsam

ple

Item

21Are

themissing

values

reported

and

howthey

werehandled?

Yes

Percentage

ofmissing

itemsandhowmissing

itemswerehandledaredescribed

inthestudyor

one-to-one

assessmentsareconducted

Partially

Percentage

ofmissing

itemsisdescribed,butsom

ehow

notclear

howmissing

itemswerehandled

No/NR

Percentage

ofmissing

itemsnotd

escribed

andnotreportedhowmissing

itemswerehandled

Analysis

Item

22Isthestatisticalanalysisappropriateto

thedesign?

Yes

The

analyticstrategy

isappropriateto

thedesign

Partially

The

analyticstrategy

isappropriatebuth

assomelim

itatio

ns(e.g.other

analyticalstrategy

would

have

been

morepowerfulo

rsomeassumptions

have

been

violated)

No/NR

Inappropriatestatisticaltestswereused

orinsufficient

inform

ationisprovided

tojudgethe

appropriatenessof

theanalysis

Item

23Isthesamplesize

sufficient?

Yes

Samplesize

isbasedon

appropriatepower

calculations,w

hich

areexplicitlyreported

Partially

Power

calculations

arenotreportedbutsam

plesize

appearssufficiently

large

No/NR

Nojustificationisgivenforsamplesize

andsamplesize

appearssm

all

Item

24Are

theeffectsizescalculated

andreported

inthestudy?

Yes

The

effectsizesarecalculated

forthedataandreported

inthestudy

Partially

The

effectsizesarecalculated

forthedata,but

notreportedin

thestudy

No/NR

Lackof

calculationof

theeffectsizesforthedata

Discussion

Item

25Dotheconclusionsfollo

wadequately

from

results?

Yes

Mainfindings

areclearlydescribedandfollo

wappropriatelyfrom

theresults

andanalyses

Partially

Somelim

itatio

nsin

theclarity

ofdescriptionof

mainfindings

andtheirrelatio

nto

results

No/NR

Lackof

appropriatedescriptionof

findings

and/or

findings

areover/understated

anddo

notfollow

clearlyfrom

results

Item

26Are

limitatio

nsacknow

ledged?

Yes

Clear

acknow

ledgem

ento

fmainlim

itatio

nsof

thestudyandconsiderationgivento

theim

pact

oftheseon

interpretatio

n

Partially

Somelim

itatio

nsareacknow

ledged

butn

otall,or

noconsiderationgivento

theim

pactof

limitatio

nson

interpretatio

n

No/NR

Noacknow

ledgem

ento

flim

itatio

ns

NRnotreported,*indicatesitemsincluded

intenselected

criteriaof

evaluatio

n


were informed with both observational data and parent re-ports, and in both studies further confirmatory factor analysiswas performed to ensure appropriate model fit to the data (inTable 3, information on each measure separately rather thanthe final models can be found). Pfeiffer et al. (2005) used twomeasures depending on the age of their participants and Laneet al. (2012) used two tools, reporting their outcomes as equiv-alent to each other. Hence, overall there were ten differentsensory measures used across the 21 selected papers (with38 tool’s references in total), with the Sensory Profile andShort Sensory Profile being used most frequently.

In eight studies, there was information about a sensory mea-sure being standardised (Gal et al. 2010; Jasmin et al. 2009;Lane et al. 2010, 2012; Nadon et al. 2011; Pfeiffer et al. 2005;Reynolds et al. 2012;Watson et al. 2011) with Liss et al. (2006)providing a reference to a current standardisation work.Remaining studies did not report on the measures’standardisation. Reliability was more often reported than valid-ity of the measures, with three studies providing calculations ofreliability—test-retest reliability (Baranek et al. 2013) and in-ternal consistency (Green et al. 2012; Pfeiffer et al. 2005, butonly for the Adolescent/Adult Sensory Profile, AASP). OnlyPfeiffer et al. (2005) provided discriminative and convergentvalidity calculations (for the AASP). Across the papers includ-ed in the review, there was no information regarding reliabilityof nine of the referenced tools used compared to 14 measuresmissing information on validity. Across the studies, four mea-sures were referenced as being appropriate for use with ASDpopulation or being ASD specific (Sensory ProcessingAssessment, SPA; Tactile Defensiveness and DiscriminationTest, TDDT-R; Sensory Experiences Questionnaire, SEQ; andSensory Questionnaire, SQ). Sensory Profile and Short SensoryProfile, in four and three studies, respectively, were reported aswidely used within the ASD research.

Psychological Correlate Measure Section

Thirty one different measures of psychological correlates wereused in the reviewed papers. Some of the tools were used inseveral publications, Child Behavior Checklist (CBCL) wasused in two language versions—English and Chinese, andVineland Adaptive Behaviour Scales were used in their orig-inal version and newest revision (VABS and VABS-2),resulting in 37 references to psychological correlate measuresacross selected papers. Only in six papers (Hilton et al. 2007;Lane et al. 2010; Lidstone et al. 2014; Mazurek et al. 2013;Pfeiffer et al. 2005; Watson et al. 2011) some measures werereported as standardised (SRS, VABS, SCAS-P, PAS, CBCL,ABAS, MSEL and PLS-4). The remaining papers did notindicate standardisation status of the tools used. In Liss et al.(2006), a tool measuring exceptional memory was used; how-ever, no information on tool development, measurement prop-erties or scoring criteria was given. Reliability calculations

were performed for four tools: inter-rater reliability for theJAA (Baranek et al. 2013), RBQ-2 (Lidstone et al. 2014),EDI (Samson et al. 2013) and test-retest for Eating Profile(Nadon et al. 2011). Structural validity was only calculatedfor the RBQ-2 in Lidstone et al. (2014) and face validity forEating Profile in Nadon et al. (2011). Across the reviewedstudies, there was no information about the reliability of the13 referenced measures and about the validity of 14 selectedtools. Across the studies, seven measures were referenced asbeing appropriate for use with ASD population or being ASDspecific (GARS, GADS, GI SIQ, Eating Profile, ADOS,RBS-R and SRS), and further five were reported as widelyused in ASD research or developmental disorders (JAA, EFT,VABS, KOS, CBCL).

Results—Associations

The authors selected different sensory patterns for their inves-tigation. Hyporesponsiveness was examined in Baranek et al.(2013); hyperresponsiveness in Green et al. (2012), Lane et al.(2012) andMazurek et al. (2013); hypo-, hyperresponsivenessand sensation seeking in Boyd et al. (2010), Brock et al.(2012) and Watson et al. (2011); a pattern combiningunderresponsiveness and sensation seeking in Ashburneret al. (2008), Baker et al.(2008), Chen et al. (2009), Galet al. (2010), Lane et al. (2010), Nadon et al. (2011) andSamson et al. (2013); and sensory processing patterns fromDunn’s model in Hilton et al. (2007), Jasmin et al. (2009),Lidstone et al. (2014), Reynolds et al. (2012) and Tsenget al. (2011). Liss et al. (2006) used terms sensory seekingand over- and under-reactivity, which were treated as syno-nyms of hyper- and hyporesponsiveness. Pfeiffer et al. (2005)examined hypo- and hypersensitivity which were treated sameas hypo- and hyperresponsiveness. Some authors preferredusing responsiveness, some responsivity—both were alsotreated as synonyms in this review.

In 12 papers (Baranek et al. 2013; Boyd et al. 2010; Brocket al. 2012; Gal et al. 2010; Green et al. 2012; Hilton et al.2007; Lane et al. 2010, 2012; Liss et al. 2006; Nadon et al.2011; Reynolds et al. 2012; Samson et al. 2013), investigationof associations between sensory processing patterns and a sin-gle psychological construct was carried out. Three of thesepapers have multiple hypotheses on the sub-constructs of thephenomenon under investigation that were tested. Baraneket al. (2013) looked at joint attention and reported the resultsfor both initiation of and response to joint attention. Brock et al.(2012) were interested in sensory patterns’ association withseveral dimensions of temperament such as withdrawal, dis-tractibility, persistence or slowness to adapt, and in Liss et al.(2006) the concept of overarousal was characterised byoverfocused behaviour, perseverative preoccupation and ex-ceptional memory for self-selected material. In the remainingstudies, the relationship between sensory processing


Tab

le3

Scoringagainstselectedcriteria

Reference

Participants

Sensory

measures


Item

6Item

9Measure

Item

10Item

11Item

12Item

13Measure

Item

14Item

15Item

16Item

17

Ashburner

etal.2008

Partially

Partially

SSP

NR

NR

Partially

No

CTRS-R:L

NR

Partially

Partially

No

ASEBA:TRF

NR

Partially

Partially

No

GARS

NR

Partially

Partially

Yes

GADS

NR

Partially

Partially

Yes

Baker

etal.2008

Yes

Partially

SSP

NR

Partially

Partially

No

VABS

NR

NR

NR

No

DBC-P

NR

NR

NR

No

Baranek

etal.2013

Yes

Partially

SPA

NR

NR

Yes

Yes

MSEL

Yes

Partially

Partially

No

PLS-4

Yes

Partially

Partially

No

JAA

NR

Partially

Yes

Partially

Boydetal.2010

Yes

Partially

SP

NR

NR

NR

No

RBS-R

NR

Partially

Partially

Yes

SEQ

NR

NR

NR

No

TDDT-R

NR

NR

NR

No

SPA

NR

NR

NR

Yes

Brock

etal.2012

Yes

Partially

SP

NR

NR

Partially

Partially

BSQ

NR

Partially

Partially

No

SEQ

NR

Partially

Partially

Yes

TDDT-R

NR

Partially

Partially

Partially

SPA

NR

NR

Partially

Yes

Chenetal.2009

Yes

Partially

SSP

NR

NR

Partially

Partially

CRI

NR

Partially

Partially

No

EFT

NR

Partially

NR

Partially

Galetal.2010

Partially

Partially

SSP

Yes

Partially

Partially

Partially

SSIM

INR

NR

Partially

No

Green

etal.2012

Yes

Partially

ITSEA

NR

NR

Yes

No

ITSEA

NR

NR

Partially

No

Hilton

etal.2007

Partially

Partially

SP

NR

Partially

Partially

Partially

SRS

Yes

Partially

Partially

Yes

Jasm

inetal.2009

Yes

Partially

SP

Yes

Partially

Partially

No

PDMS-2

NR

NR

Partially

No

WeeFIM

NR

Partially

Partially

No

VABS-2

NR

NR

Partially

No

Laneetal.2010

Yes

Partially

SSP

Yes

Partially

Partially

No

VABS

Yes

Partially

Partially

Partially

Laneetal.2012

Partially

No

SP

Yes

Partially

Partially

No

RCMAS

NR

Partially

Partially

No

SensO

RNR

Partially

Partially

No

Lidstoneetal.2014

Yes

Partially

SP

NR

Partially

Partially

No

RBQ-2

NR

Partially

Yes

No

SCAS-P

Yes

Partially

Partially

No

PAS

Yes

Partially

NR

No

Lissetal.2006

Partially

No

SQ

Partially

Partially

NR

Yes

DSM-IVchecklist

NR

NR

NR

No

KOS

NR

Partially

NR

Partially

VABS

Yes

NR

NR

No


Tab

le3

(contin

ued)

Reference

Participants

Sensory

measures


Item

6Item

9Measure

Item

10Item

11Item

12Item

13Measure

Item

14Item

15Item

16Item

17

Mazurek

etal.2013

Yes

Partially

SSP

NR

Partially

Partially

Partially

CBCL

Yes

Partially

Partially

Partially

GISIQ

NR

NR

NR

Yes

Nadon

etal.2011

No

Yes

SSP

Yes

Partially

Partially

No

EatingProfile

NR

Yes

Yes

Yes

Pfeifferetal.2005

Yes

Partially

SP

NR

Partially

Partially

No

ABAS

Yes

Partially

Partially

No

AASP

Yes

Yes

Yes

No

RCMAS

NR

Partially

Partially

No

CDI

NR

Partially

Partially

No

Reynoldsetal.2012

Yes

Partially

SP

Yes

NR

NR

No

CBCL

NR

Partially

NR

No

Sam

sonetal.2013

Yes

Partially

SSP

NR

NR

NR

No

EDI

NR

Partially

Yes

No

Tsengetal.2011

Partially

No

SP-C

NR

Partially

Partially

Partially

CBCL-C

NR

NR

Partially

No

Watsonetal.2011

Yes

Partially

SEQ

NR

Partially

Partially

Yes

ADOS

NR

NR

NR

Yes

SP

Yes

NR

NR

Partially

MSEL

Yes

NR

NR

No

SPA

NR

NR

Partially

Yes

PLS-4

Yes

NR

NR

No

TDDT-R

NR

Partially

NR

Yes

VABS

Yes

NR

NR

No

AASP

Adolescent/A

dultSensory

Profile,ABASAdaptiveBehaviorAssessm

entSystem,ADOSAutism

Diagnostic

Observatio

nSchedule,

ASE

BA:TRFAchenbach

System

ofEmpirically

Based

Assessm

ent:Teacher

ReportForm,BSQ

BehavioralStyle

Questionnaire,CBCL-C

Child

BehaviorChecklistforages

4–18

Chinese

version,

CBCLChild

BehaviorChecklist,CDIChildren’s

DepressionInventory,CRIChildhood

Routin

esInventory,CTRS-R:L

Conner’sTeacherRatingScale–R

evised

LongVersion,DBC-P

DevelopmentalBehaviour

Checklist—

Parent,DSM

-IVchecklist

Diagnostic

andStatisticalManualof

MentalDisorders4thedition

checklist,EDIEmotionDysregulatio

nIndex,

EFTEmbedded

FiguresTest,G

ADSGilliam

Asperger’sDisorderScale,G

ARSGilliam

Autism

RatingScale,G

ISIQGastrointestin

alProblemsSy

mptom

InventoryQuestionnaire,ITS

EAInfant

ToddlerSo

cialandEmotionalA

ssessm

ent,JA

AJointA

ttentionAssessm

ent,KOSKinsbourne

OverfocusingScale,M

SELMullenScales

ofEarlyLearning,PA

SPreschoolA

nxietyScale,P

DMS-2PeabodyDevelopmentalM

otorScales—2ndedition,P

LS-4PreschoolL

anguageScaleFourthEditio

n,RBQ-2

Repetitive

BehaviorQuestionnaire

2,RCMASRevised

Children’sManifestAnxiety

ScaleAdapted

Parent’sVersion,S

CAS-PSp

ence

Children’sAnxiety

ScaleParent

Version,S

ensO

RSensory

OverresponsivenessInventory,SPASensory

Processing

Assessm

ent,SP

-CSensoryProfile—Chineseversion,SP

SensoryProfile,SEQSensoryExperiencesQuestionnaire,SQSensoryQuestionnaire,SRS

SocialResponsivenessScale,SSIMIStereotypedandSelf-Injurious

Movem

entInterview

,SSP

ShortSensory

Profile,T

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atypicalities and two (Baker et al. 2008; Chen et al. 2009;Jasmin et al. 2009; Lidstone et al. 2014; Mazurek et al. 2013;Tseng et al. 2011;Watson et al. 2011) or more (Ashburner et al.2008; Pfeiffer et al. 2005) constructs were explored. Data ex-traction was carried out for each construct separately and forthis reason those papers investigating multiple constructs wereincluded in the review results’ sections more than once.

Participants

Across the 21 studies included in the review, a total of 4149children and adolescents with ASD were included. One studyrecruited 2973 participants (Mazurek et al. 2013); the remain-ing studies involved between 22 and 149 participants.

The age of participants ranged from 20 months to 17 years(overall mean age=7.09 years). One study focussed particular-ly on toddlers (Green et al. 2012; with a mean of 28.2 months).Nine studies (Baker et al. 2008; Baranek et al. 2013; Boydet al. 2010; Brock et al. 2012; Jasmin et al. 2009; Lane et al.2010; Nadon et al. 2011; Tseng et al. 2011; Watson et al. 2011)focussed on early and middle childhood (20 to 115 months). Afurther nine studies (Ashburner et al. 2008; Chen et al. 2009;Gal et al. 2010; Hilton et al. 2007; Lane et al. 2012; Liss et al.2006; Pfeiffer et al. 2005; Reynolds et al. 2012; Samson et al.2013) included children and adolescents betweenmiddle child-hood and mid-teens (6 to 17 years). Two studies included bothchildren and adolescents; Lidstone et al. (2014) recruited 3–17-;9-year-old participants and Mazurek et al.(2013) used asample between 2 and 17 years old.

In all the studies, the gender of the participants was report-ed and 84.3 % of participants were male. This percentagemirrors the widely reported uneven sex ratio for theprevalence of ASD in males, with males being fourtimes more likely of having this condition than females(Anello et al. 2009).

A minority of studies were highly selective when recruitingparticipants with a particular diagnosis. Pfeiffer et al. (2005)included only children and adolescents who had Asperger’ssyndrome, while Hilton et al. (2007) included only childrenwith High Functioning ASD. Four studies included partici-pants across the spectrum. Chen et al. (2009) included thosewith a diagnosis of ASD or Asperger’s syndrome; Green et al.(2012) recruited toddlers with either autism or PDD-NOS;Jasmin et al. (2009) included in their study children with ADor PDD-NOS. In a couple of studies, participants werecharacterised as diagnosed with autism (Tseng et al. 2011;Gal et al. 2010) and further five (Baker et al. 2008; Baraneket al. 2013; Boyd et al. 2010; Lane et al. 2010; Watson et al.2011) included those with autistic disorder. In the remainingstudies, participants fell into the general diagnostic categoryfor ASD. Only Mazurek et al. (2013) and Nadon et al. (2011)reported an exact percentage of ASD children in each diag-nostic category (AD, Asperger’s disorder, PDD-NOS).

The method of reporting cognitive ability varied markedlyacross the reviewed studies. Ability in the form of an IQ scorewas reported by Lane et al. (2012), Reynolds et al. (2012) andSamson et al. (2013), with the following means (standarddeviations): 95.5 (18), 95.88 (17.8) and 82.75 (23.61), respec-tively. Standard score of 61.3 (26.5) was reported in Jasminet al. (2009). Green et al. (2012) stated non-verbal and verbaldevelopmental functioning (78.1 (18.06) and 58.62 (25.15))of their participants, whereas Baranek et al. (2013), Boydet al. (2010), Brock et al. (2012) and Watson et al. (2011)reported mental age (23.25 (14.04), 31.97 (20.84), 36.11(19.88) and 32.0 (20.6), respectively). Ashburner et al.(2008) included only participants with IQ above 80, whileChen et al. (2009) and Hilton et al. (2007) included indi-viduals with ASD with IQ above 70. Mazurek et al.(2013) reported that 3.9 % of their sample had an IQlower than 70, while the remaining sample had IQ above70. Remaining authors did not provide any indicators ofcognitive functioning of their participants.

Only two studies reported co-occurring medical con-ditions for their participants. Nadon et al. (2011) report-ed attention deficit disorder, hyperactivity and mentalretardation as the most common co-occurring conditions,while in Hilton et al. (2007) attention deficit/hyperactivitydisorder, learning disability, anxiety disorder, depressionand Tourette syndrome were reported as additionaldiagnoses.

Psychological Constructs

In the selected studies, the authors examined relationshipsbetween sensory processing patterns and a variety of psycho-logical constructs. In order to present our findings in a system-atic way, the papers have been grouped. In the most recentDiagnostic and Statistical Manuals of Mental Disorders, corefeatures of ASD, such as impairments in the social use of bothnon-verbal and verbal communication and presence of re-stricted, repetitive patterns of behaviour, interests or activities,are diagnostic components for the disorder (APA 2013). Inaddition to these core features that are present in individualswith ASD, a number of associated difficulties have been listedin the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR; APA 2000); these include emotional, attention-al, cognitive and behavioural problems. The psychologicalconstructs examined in the selected papers have been groupedaccordingly, either belonging to the core features of ASD,such as social functioning and repetitive behaviours, orcharacterised as associated conditions of ASD, e.g. affectiveand cognitive difficulties. As a result, six main groups of psy-chological constructs were created: symptom severity, socialfunctioning, restricted and repetitive behaviours, emotionaland behavioural functioning, affective and cognitive symp-toms, and physical skills.


In the identified groups, the following constructs were in-cluded (as indicated by the authors):

& symptom severity: social communicative symptoms(Watson et al. 2011), social competence (Hilton et al.2007), social symptoms/communication impairment(Liss et al. 2006), autism quotient and Asperger’s disorderquotient (Ashburner et al. 2008);

& social functioning: language skills (Watson et al. 2011),language abilities (Baranek et al. 2013), social and com-munication adaptive skills (Watson et al. 2011) and jointattention (Baranek et al. 2013);

& restricted and repetitive behaviours: restricted and repeti-tive behaviours (Chen et al. 2009; Boyd et al. 2010;Lidstone et al. 2014) and stereotyped movement (Galet al. 2010);

& emotional and behavioural functioning: emotional, behav-ioural and educational outcomes (Ashburner et al. 2008),emotional and behavioural problems (Tseng et al. 2011),emotion dysregulation (Samson et al. 2013), adaptive/maladaptive functioning (Baker et al. 2008; Lane et al.2010; Liss et al. 2006; Pfeiffer et al. 2005), behaviouralresponsiveness (Baker et al. 2008), gastrointestinal prob-lems (Mazurek et al. 2013), eating (Nadon et al. 2011) andsleep (Reynolds et al. 2012) problems;

& affective and cognitive symptoms:

affective: temperament (Brock et al. 2012), anxiety(Green et al. 2012; Lane et al. 2012; Lidstone et al.2014; Mazurek et al. 2013; Pfeiffer et al. 2005), depres-sion (Pfeiffer et al. 2005),cognitive: memory (Liss et al. 2006), cognitive style(Chen et al. 2009), attention (Liss et al. 2006);

& physical skills: motor skills (Jasmin et al. 2009) and dailyliving skills (Jasmin et al. 2009).

Symptom Severity

Four papers investigated associations between sensoryatypicalities and symptom severity. Ashburner et al. (2008)found a significant negative correlation between theunderresponsive/seeks sensation subscale of the ShortSensory Profile and GARS autism quotient (r=−0.53 p=0.003), but not with GADS Asperger’s disorder quotient, sug-gesting more sensory problems being associated with moreautism symptoms (low score on the SSP indicates more sensoryissues). Hilton et al. (2007) reported significant associationsbetween all sensory processing patterns as measured by theSensory Profile and SRS scores, both total score (correlationswith Sensory Sensitivity, r=−0.745, p<0.01; SensoryAvoiding, r=−0.796, p<0.01; Low Registration, r=−0.578,

p<0.01; and Sensation Seeking, r=−0.527, p<0.01) and sub-scales, with the exception of SRS social awareness for whichonly sensory sensitivity and sensation avoiding were found tobe negatively correlated. Liss et al. (2006) found significantcorrelations between overreactivity, underreactivity and sensa-tion seeking and all the subscales of DSM-IV checklist. Onlythe DSM-IV communication impairment subscale was not sig-nificantly associated with overreactivity. Watson et al. (2011)used ADOS as one of the outcome measures in their study andfound associations between social-communicative algorithmscores and both hyporesponsiveness (β=0.48, SE=0.023,p=0.040) and sensation seeking (β=0.78, SE=0.025,p=0.002).

Social Functioning/Social Skills

The relationship between sensory processing patterns and ver-bal and non-verbal communication skills in individuals withASD was investigated in two studies. Baranek et al. (2013)were interested in associations between sensory difficultiesand language abilities and joint attention. Watson et al.(2011) explored the relationships between sensory atypical-ities and language skills, social and communication adaptiveskills. All verbal and non-verbal variables were associatedwith sensory hyporesponsiveness (Receptive language ratioscores, β=−2.0, SE=0.68, p=0.004; Expressive language ra-tio scores, β=−2.1, SE=0.73, p=0.005; Receptive JointAttention, β=−0.83, SE=0.37, p=0.025; Initiating JointAttention, β=−1.63, SE=0.59, p=0.006; Aggregate languagequotient scores, β=−0.010, SE=0.004, p=0.018; Social adap-tive scores, β=−0.017, SE=0.007, p=0.011). Also in Watsonet al. (2011) language skills (aggregate language quotientscores) were correlated with sensory seeking (β=−0.011,SE=0.004, p=0.005).

Restricted and Repetitive Behaviours (RRBs)

Restricted and repetitive behaviours (RRBs) is a broad termwhich includes behaviours ranging from self-injurious behav-iour and stereotyped motor mannerisms through insistence onsameness and circumscribed interests (Bodfish et al. 2000).Turner (1999) suggested distinguishing two levels of behav-iours—‘lower level’ including motor repetitions and stereo-typed behaviours, and ‘higher level’ relating to insistence onsameness and circumscribed interests. This division of RRBsinto two separate levels is present in the studies included inour review, hence we present the results distinguishing be-tween ‘lower’ and ‘higher’ levels of RRBs.

Four papers looked at the relationship between sensory pro-cessing patterns and the presence of restricted and repetitivebehaviours. Boyd et al. (2010) reported a significant associationbetween hyperresponsiveness and stereotypy (β=3.40, SE=1.35, p=0.012). Gal et al. (2010) found a significant negative


correlation between the number of Different StereotypedMovements and the underresponsiveness/seeks sensation sub-scale of Short Sensory Profile (r=−0.43, p<0.001). Lidstoneet al. (2014) reported significant negative correlations betweenrepetitive motor behaviours and sensation avoiding and sensa-tion seeking (r=−0.42, p<0.01 for both). In the same study,significant negative correlations were found between all sensoryprocessing patterns and insistence of sameness (correlationswith Sensory Sensitivity, r=−0.43, p<0.01; Sensory Avoiding,r=−0.49, p<0.01; Low Registration, r=−0.38, p<.01; andSensation Seeking, r=−0.49, p<0.01). Chen et al. (2009),however, did not f ind any associat ions betweenunderresponsiveness/seeks sensation patterns and ‘compul-sive-like behaviours’. Compulsions were associated withhyperresponsiveness in Boyd et al. (2010) study (β=3.50,SE=1.41, p=0.013). The authors found also significant associ-ations between rituals and both hyperresponsiveness (β=4.47,SE=1.35, p=0.001) and sensory seeking (β=5.92, SE=2.97,p=0.046).

Emotional and Behavioural Functioning

Seven papers examined associations between sensorydifficulties and the emotional and behavioural functioning ofindividuals with ASD. Ashburner et al. (2008) reported sig-nificant correlations between the underresponsive/seeks sen-sation subscale of the Short Sensory Profile and three sub-scales of Conner’s Teacher Rating Scale–Revised LongVersion, cognitive problems/inattention (r=−0.48, p<0.01),social problems (r=−0.32, p<0.05) and inattentive (r=−0.42, p<0.05). They also found significant associations ofthe Short Sensory Profile underresponsiveness/seeks sensa-tion subscale and two of the subscales of the AchenbachSystem of Empirically Based Assessment: Teacher ReportForm, namely thought problems (r=−0.39, p<0.05) and aca-demic performance (r=0.62, p<0.01). Baker et al. (2008)using the Short Sensory Profile reported correlations withthe following subscales of the Developmental BehaviourChecklist subscales: self-absorbed (r=−0.523, p=0.012),Autism Screening Algorithm (r=−0.533, p=0.011) and totalscore (r=−0.491, p=0.020); and maladaptive behaviour scaleof Vineland Adaptive Behaviour Scales (r=−0.482, p=0.023). Lane et al. (2010) also found similar associations withthe maladaptive behaviour scale of the VABS. Using theVABS, Liss et al. (2006) reported correlations between thesocialisation subscale and hyperresponsiveness (r=−0.195,p<0.05), VABS daily living and adaptive behaviour compos-ites and hyporesponsiveness (r=−0.326, p<0.01 andr=−0.221, p<0.01, respectively) and sensory seeking withthe VABS communication (r=−0.263, p<0.01), daily living(r=−0.165, p<0.05) and adaptive behaviour composite(r=−0.235, p<0.01). Pfeiffer et al. (2005) investigated rela-tionships between sensory processing patterns and adaptive

behaviours. They found significant negative associations be-tween both hypo- and hypersensitivity and community use(r=−0.271, p=0.05 and r=−0.291, p=0.041, respectively)and social skills subscales of the Adaptive BehaviorAssessment System (r=−0.298, p=0.036 and r=−0.278,p=0.05, respectively). Samson et al. (2013) looked at emotiondysregulation and its relationship with sensory atypicalities,reporting higher emotion regulation difficulties in those indi-viduals with ASD who also had high scores on theunderresponsive/seeks sensation subscale of the SSP(r=−0.57, p<0.001). Tseng et al. (2011) were interested insensory processing dysfunction and children’s emotional andbehavioural problems. They used the Child BehaviorChecklist to measure both internalising and externalising dif-ficulties and found a number of significant associations ofthose dimensions with all the sensory processing patterns.Internalising was negatively associated with SensorySensitivity: r=−0.24, p=0.047, Sensory Avoiding: r=−0.43,p<0.001, Low Registration: r=−0.28, p=0.020 and SensationSeeking: r=−0.43, p<0.001, while externalising correlatedsignificantly with Sensory Sensitivity: r=−0.30, p=0.013,Sensory Avoiding: r=−0.29, p=0.016 and SensationSeeking: r=−0.29, p=0.016.

The relationship between associated behavioural problemswith ASD and sensory processing difficulties was investigatedin three studies. Mazurek et al. (2013) reported that thosechildren with ASD who had chronic GI problems such aschronic constipation, chronic abdominal pain, chronicbloating, chronic nausea and chronic diarrhoea had signifi-cantly lower sensory overresponsivity scores (greater levelsof overresponsivity) than those children with ASD who hadno additional GI problems (d=−0.36 to −0.71, p<0.0001).Nadon et al. (2011) did not find any significant associationsbetween underresponsive/ seeks sensation subscale of theShort Sensory Profile and the mean number of eatingproblems in children with ASD. Reynolds et al. (2012) report-ed significant positive correlation between sensation avoidingand sleep problems (r=0.502, p=0.11); associations with oth-er sensory processing patterns were not significant.

Affective and Cognitive Difficulties

Affective Symptoms

Six papers investigated the relationships between sensory pro-cessing patterns and affective symptoms such as dimensionsof temperament, anxiety and depression. Brock et al. (2012)looked at how sensory atypicalities relate to temperament di-mensions in children with ASD. Three out of the nine inves-tigated dimensions were associated with only one particularpattern, namely hyporesponsiveness (adaptability, β=0.38,p=0.001; distractibility, β=−0.46, p<0.0001; reactivity,


β=−0.28, p=0.04), reporting that children with ASD whoshow hyporesponsive behaviours may be more susceptibleto various distractions and their optimal level of engagementwith the environment may be narrower, elongating ad-justment to change. In all five papers in which the re-lationship between anxiety and sensory patterns was ex-amined (Green et al. 2012; Lane et al. 2012; Lidstoneet al. 2014; Mazurek et al. 2013; Pfeiffer et al. 2005),correlations between hyperresponsiveness and anxietywere found and reported by four authors although a numberof different measures were used across the studies (Green et al.2012: r=0.52, p<0.001 (time 1) and r=0.60, p<0.001 (time2); Lane et al. 2012: r=0.18, p<0.001; Mazurek et al. 2013:r=−0.45, p<0.0001; Pfeiffer et al. 2005:r=0.476, p<0.001).Lids tone et a l . (2014) looked a t dimensions ofhyperresponsiveness (both sensory sensitivity and sensationavoiding), and further moderate to strong correlations werereported (r=−0.61, p<0.01 and r=−0.71, p<0.01, respective-ly). Only Lidstone et al. (2014) stated a relationship betweenanxiety and low registration (r=−0.40, p<0.01). Depressionwas associated with hyperresponsiveness (r=0.394, p=0.005for the total sample, and for the younger children r=0.449,p=0.013, but not for the teenage group) as reported by Pfeifferet al. (2005), but also with hyporesponsiveness (r=0.214,p=0.05 for the total sample, non-significant associations forthe younger children and significant for the teenagers,r=0.492, p=0.027) and hyporesponsiveness dimensions(low registration was significantly associated with depressiononly in the teenage group r=0.483, p=0.031, and sensationseeking correlated with depression when the total sample wasused r=0.299, p=0.035).

Cognitive Symptoms

The relationship between cognitive functioning and sensoryabnormalities in children with ASD was examined in twostudies. Chen et al. (2009) were interested in exploring therelationship between sensory difficulties and an individual’sdetail-focused cognitive style. Only non-significant associa-tions between the under responsive/seeks sensation subscaleof the Short Sensory Profile and the Embedded Figure Testwere reported. Liss et al. (2006) looked at both ability to shiftattentional focus and exceptional memory for self-selected material in individuals with ASD. They showedthat although underreactivity and sensory seeking weresignificantly correlated with Kinsbourne OverfocusingScale (r=0.293, p<0.01 and r=0.235, p<0.01, respec-tively), the strongest positive correlation was found withoverreactivity (r=0.608, p<0.01). Overreactivity was alsonegatively correlated with the reverse log of the exceptionalmemory score (r=−0.196, p<0.05), showing an associationbetween greater exceptional memory and individual’soverreactivity to sensory stimuli.

Physical Skills

Only one study investigated the relationship between sensoryprocessing patterns and motor skills with daily living skills (asself-care skills) in children with ASD. Jasmin et al. (2009)reported significant correlations between only one sensorypattern, namely sensation avoiding and self-care domain ofthe WeeFIM (r=0.388, p<0.025), personal (r=0.457,p<0.011) and daily living skills (r=0.372, p<0.033) domainson the VABS-2. Also, sensation seeking was positively corre-lated with gross motor skills as measured by PDMS-2(r=0.39, p<0.03). The authors also looked at the associationseparately for AD and PDD-NOS groups. For the AD group,significant correlations were reported between the sensationavoiding and self-care (r=0.44, p<0.04), personal (r=0.56,p<0.01) and daily living skills (r=0.48, p<0.02) domains,and between low registration and personal skills (r=0.44,p<0.05). For the PDD-NOS group, however, the only signif-icant correlation was found between sensation seeking and theself-care domain (r=0.71, p<0.03).

Discussion

This systematic review focused on 21 studies that examinedrelationships between sensory processing patterns and psy-chological constructs in individuals with ASD.

Evaluation Grid—Papers’ Quality

The evaluation grid was designed for the purpose of this re-view, although it could be used in other reviews evaluatingstudies using correlational analysis methods in ASD research.The grid could be also easily adapted to be used in a widercontext of developmental disorders research or even typicaldevelopment. However, as it was used first time in the review,its validity is not established.

A confirmation of the diagnosis of ASD is provided in allthe papers included in the review. Some authors selected par-ticipants with a particular ASD subtype, with most of the au-thors reporting their participants as children and/or young peo-ple with ASD. In the new DSM-V (APA 2013), all the ASDsubtypes that were present in the previous version of theManual (APA 1994), namely, autistic disorder, Asperger’s dis-order and PDD-NOS (pervasive developmental disorder nototherwise specified), were merged together under the umbrellaof one term—autism spectrum disorder. This is important tobear in mind because findings from those studies, in whichparticipants with only one ASD subtype were included, mightbe less generalisable to future studies, in which participantsfrom across the spectrum will be included. Interestingly, inthe study in which the results were presented for a total sample,and for two subtypes separately—AD and PDD-NOS groups


(Jasmin et al. 2009), the findings differed for each subtype andfor the total sample. ASD is a very heterogeneous disorder, witha diverse presentation across individuals. It seems thereforeimportant to report both basic participants’ characteristics suchas gender and age, as well as features such as cognitive abilityin order to make some comparisons and generalisations be-tween and within such a varied population.

A wide variety of measures were used to assess sensoryprocessing difficulties in individuals with ASD in the selectedreview papers. Some authors, however, did not report whetherthe selected tools were appropriate to use with this clinicalpopulation. Only a few were reported as widely used withinthe ASD population or were ASD specific. Also, reliabilityand particularly validity of the tools were poorly reported.There is a lack of reliable and valid measures of sensory pro-cessing designed for use with ASD individuals. By usingmeasures developed with and for typically developing indi-viduals in ASD research without at least reporting their psy-chometric properties in this population, we have little evi-dence that the tools selected are appropriate. Therefore, re-searchers should consistently report psychometric propertiesof the tools used in the sample selected. Moreover, there are agreat number of questionnaires and observational measures ofsensory atypicalities available for use for researchers. Thedecision regarding which tools should be used to examine aresearch question might be based on a number of reasons, e.g.the measures selected in the previous studies, common use oftools by particular research group. There is no consensus be-tween researchers about which measures of sensory process-ing should be used in future studies. This lack of consensus on‘best-measures’ makes the comparison and interpretation ofthe results, obtained by employing different measures, prob-lematic. Time spent identifying and developing ‘gold-stan-dard’ sensory processing measures would help in understand-ing and interpreting the findings. Some authors (Boyd et al.2010; Brock et al. 2012; Watson et al. 2011), rather than usinga single measure, developed a sensory processing modelbased on information obtained from a range of measures andinformants. Through this approach, the authors tried to over-come some limitations associated with using single, mainlyparent-report-based measures and they yielded stronger sen-sory constructs scores. Building the factor analytic models isan interesting suggestion in sensory atypicalities measurementfield. The models not only conglomerate information fromdifferent measures but also have excellent structural validityscores. Researchers might consider implementing this form ofmeasuring sensory processing patterns in their studies.

Across the nine instruments of sensory atypicalities used inthe paper selected for this review, the Sensory Profile andShort Sensory Profile were most frequently used. It shouldbe remembered, however, that the Short Sensory Profile pro-vides very limited information in regards to sensory process-ing patterns of individuals with ASD. Researchers might

consider using tools which provide information on at leasthypo- and hyperresponsivity to follow the dimensions of sen-sory atypicalities as suggested by DSM-V (APA 2013).

Thirty two different measures were used in the reviewedpapers to assess psychological constructs in the ASD samplesstudied. Similar to the sensory processing measures, the psy-chometric properties of the selected tools were poorly reported(particularly the validity of the measures). Also, their appropri-ateness for use with this particular population was not justified.If excluding those tools which were used for both diagnosis andoutcome measurements, only eight were reported as appropri-ate for use in autism research. There is not only a lack of toolsdesigned specifically to assess a number of problems associatedwith the ASD, but also a lack of consensus regarding whichmeasures are best suited to each specific phenomenon. As aresult, researchers use different measures to investigate thesame constructs (e.g. anxiety). Interpretation of the results andtheir generalisability is therefore hampered. As alreadyhighlighted in the systematic review conducted by theMeASURe team (McConachie et al. 2015, in press), for chil-dren with ASD under 6, psychometric work still needs to bedone in order to select those tools which are reliable and validwithin autism research.

Sensory Processing Patterns and Correlates

Concentrating on two main dimensions of sensory responsive-ness—hyper- and hyporesponsiveness, as distinguished andsuggested in DSM-V (APA 2013), most of the measures ofautism symptom severity were associated with hyporespon-siveness (GARS autism quotient in Ashburner et al. 2008,DSM-IV communication impairment in Liss et al. 2006,ADOS social-communicative algorithm score in Watson et al.2011 and DBS ASA in Baker et al. 2008). What is notable,however, is that in those papers investigating the relationshipsbetween symptom severity and sensory atypicalities, associa-tions were found despite a wide range of symptom severityoutcome measures being used, different groups included(HFASD in Hilton et al. 2007; ASD in Ashburner et al. 2008and Liss et al. 2006; AD inWatson et al. 2011) and different agegroups of participating children (although they all were up to10 years old). It might indicate that those sensory atypicalitieswere so prevalent that they could be detected across ASD sub-types and with different measures. However, when the SRSwas used (Hilton et al. 2007), correlations were found with bothhypo- and hyperresponsiveness, with the social awareness sub-scale correlating only with hyperresponsiveness. Also, DMS-IV social symptoms subscale (Liss et al. 2006) was associatedsolely with hyperresponsiveness. Language and socio-communication variables (Baranek et al. 2013; Pfeiffer et al.2005; Watson et al. 2011), joint attention (Baranek et al. 2013),stereotyped movement (Gal et al. 2010), a number of cognitiveand social problems (Ashburner et al. 2008), maladaptive


behaviours (Baker et al. 2008; Lane et al. 2010), some mooddimensions (Brock et al. 2012), emotion dysregulation(Samson et al. 2013) and gross motor skills (Jasmin et al.2009) were all associated with hyporesponsiveness. On theother hand, self-care variables (Jasmin et al. 2009), anxiety(Green et al. 2012; Lane et al. 2012; Lidstone et al. 2014;Mazurek et al. 2013; Pfeiffer et al. 2005), socialisation subscaleon the VABS (Liss et al. 2006), GI problems (Mazurek et al.2013) and sleep difficulties (Reynolds et al. 2012) were corre-lated with hyperresponsiveness. Some variables were also as-sociated with both sensory patterns, repetitive motor behav-iours (Lidstone et al. 2014), insistence on sameness (Lidstoneet al. 2014), depression (Pfeiffer et al. 2005), anxiety inLidstone et al. (2014), attention (Liss et al. 2006), communityuse and social skills in Pfeiffer et al. (2005) study, andinternalising and externalising scores (Tseng et al. 2011).

This evidence suggests that sensory hyporesponsiveness ismore often associated with core features of ASD such as com-munication impairment, emotional, cognitive and behaviouralproblems while social awareness difficulties and affectivedisorders are associated with hyperresponsiveness. Similarly,Gay et al. (2008) suggested that hyporesponsiveness and sen-sory seeking may be more associated with difficulties insocio-communication domains in children with ASD. Thatsupports the findings of Baranek et al. (2006) proposing thatsensory hyporesponsiveness discriminated individuals withautism from those diagnosed with other developmental disor-ders or typically developing individuals. However, investigat-ing other sensory processing patterns in the light of the find-ings of this review seems as important. Not only are highfrequencies of hyperresponsiveness also present in individualswith ASD but also hypo- and hyperresponsiveness were re-ported to be present in the same individuals (Baranek et al.2006), and some associations between both hypo- andhyperresponsiveness and other ASD features remain unclear(e.g. repetitive behaviours). Hyperresponsiveness, neverthe-less, seems to be an under-researched sensory pattern. Forexample, in the studies investigating association between sen-sory processing patterns and anxiety, primarily the relation-ship between anxiety and overresponsivity was examined.While the link between children’s sensory overresponsivity,negative reactivity to complex sensory events and anxiety hasbeen made in the reviewed papers, other associations were notexplored. Only Lidstone et al. (2014) investigated other sen-sory processing patterns’ associations with more sensory atyp-icalities than hyperresponsivity and did find significant asso-ciations between anxiety and other sensory processing diffi-culties. Furthermore, because researchers widely use the ShortSensory Profile which includes an underresponsive/seeks sen-sation subscale only, finding and reporting associations withhyperresponsiveness is impossible.

It should also be noted that in some papers relatively smallsample sizes were used (Ashburner et al. 2008; Baker et al.

2008; Chen et al. 2009; Lane et al. 2012; Reynolds et al. 2012)and therefore type II error might have occurred and some ofthe associations might have not been detected although a re-lationship between sensory atypicalities and measured con-structs could exist in the population (Field 2009).

Study Limitations

The current review evidenced the sample selection process ishighly varied across studies. There was also a lack of consis-tency in the methods employed. First, in some reviewed areas,a small number of studies were included, which limits theconclusions that can be drawn. Secondly, studies with a wideage range of participants were often pooled together, ignoringpossible age-related differences in the presentation of bothsensory atypicalities and ASD-related difficulties. Thirdly,the wide variety of methods assessing sensory processing pat-terns and psychological constructs used in the reviewed stud-ies made the interpretation of the results very difficult.

Conclusions

In summary, the current research reports a number of associ-ations between sensory processing patterns and the clinicaland non-clinical features of ASD, highlighting that sensoryatypicalities play an important role in the disorder. However,there are several theoretical and measurement approaches tothe classification of the sensory processing patterns.Consensus on using a singular theoretical framework and setmeasures would help with clarifying results, but should bepreceded with more psychometric work. In the absence ofthe agreement on measurement tools, multiple informant mea-sures and sensory processing models based on informationobtained from a range of measures and informants might bea bridging alternative.

There are also several questions that require further investi-gation. Hyperresponsiveness remains an under-researched sen-sory processing pattern; hence, establishing its associationswith psychological constructs is an apparent research need.The current evidence provided for some constructs (e.g. repet-itive behaviours) has mixed findings. Further research examin-ing these correlations and establishing whether there are clearassociations with a particular processing pattern or whethersome psychological constructs correlate with a number of sen-sory atypicalities would benefit our understanding of the com-plexity of sensory processing difficulties in ASD.

Finally, at present, the research focuses on children andadolescents with ASD, without including adult participantsin the recruited samples. Investigating associations betweensensory processing patterns and psychological constructs inadults might shed some light into developmental changes ofASD characteristics.


Acknowledgments This research was supported by PhD funding fromthe Estate of DavidMurray Garside (awarded to authorMG). The authorswould like to thank Dr Sarah Wigham for her contribution in estimatinginter-rater reliability of the evaluation grid used in the study.

Conflict of Interest The authors declare that they have no conflict ofinterest.

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