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Running head: SENSORY PROCESSING DIFFERENCES IN AUTISM

Sensory Processing Differences in Children with Autism


Shelina Hassanali
University of Calgary
EDPS 654
November 18, 2012















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Sensory Processing Differences in Children with Autism
Literature in the area of childhood disorders shows a wealth of research related to autism.
However, much of the focus of the research is on certain deficits, including social, linguistic, and
affective development. While not currently part of the diagnostic criteria, research has found that
sensory processing differences are very common in children with autism spectrum disorders and
that these have a profound effect on functioning. This paper will briefly explain the prevalence of
the disorder and its characteristics; explore the various sensory processing differences in these
children in oral, tactile, auditory, and visual realms; and investigate possible neurobiological
underpinnings of these differences. The functional impact of these differences of will also be
discussed.
Prevalence & Characteristics of the Disorder
While autism has been recognized as one of the most common developmental disabilities
of childhood, there is currently no federal program in place to monitor its prevalence in Canada
(Autism Society Canada, 2012). There is, however, information available regarding these
statistics in the United States. In a recently released report by the Centers for Disease Control
(CDC, 2012), it was estimated that one in 88 children was living with autism based on combined
data from 14 communities studied from 2000-2008. Although there is no federal tracking of
autism prevalence in Canada, the National Epidemiologic Database for the Study of Autism in
Canada (NEDSAC, 2012) suggested trends in certain regions, including Newfoundland and
Labrador, Prince Edward Island, and Southeastern Ontario. The researchers found that the
prevalence of autism increased in all age groups, and across all studied regions, during the study
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period of 2003-2010 (NEDSAC, 2012). This upward trend has been confirmed in the United
States as well (CDC, 2012), indicating the importance of continued research in this area.
Autistic spectrum disorders are characterized by impairments in social interaction (i.e.
nonverbal behaviours, lack of developmentally appropriate peer relationships, deficiency of
social and/or emotional reciprocity); impairments in communication (i.e. delay or total lack of
spoken language, inability to sustain conversation, repetitive use of language); and restricted and
repetitive patterns of behaviour, interests and activities (i.e. preoccupation with certain items,
inflexible adherence to certain routines, repetitive motor mannerisms) (American Psychiatric
Association, 2000). Sensory processing deficits are not currently listed as part of the diagnostic
criteria for autistic disorder; however, they are listed under associated features as odd responses
to sensory stimuli (APA, 2000, pg. 72). The emerging consensus that sensory processing issues
are a large part of autism spectrum disorders is seen in proposals to include them as part of the
diagnostic criteria in the DSM-V, however it remains unknown whether this proposal will be
accepted (Kwakye, Foss-Feig, Cascio, Stone & Wallace, 2011). Regardless of inclusion in
diagnostic criteria, sensory processing differences are common among children with autism, with
as many as 90% exhibiting some sort of sensory abnormalities across multiple domains (Leekam,
Nieto, Libby, Wing & Gould, 2007). We will now consider these atypical processing patterns in
detail.
Realms of Sensory Processing Difficulties
Sensory processing has been defined as the ability of the brain to register, organize, and
make sense of information received from the senses (Miller, Anzalone, Lane, Cermak, & Osten,
2007). In typically developing children, their patterns of processing sensory input arriving from
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visual, tactile, auditory, oral and other pathways are generally consistent and do not cause
distress. Children with autism however, may process and react to this input much differently,
such as abnormal reactions to common, everyday objects (Mash & Barkley, 2003). Their
responses can generally be categorized as being hyposensitive or hypersensitive, with the former
requiring/seeking heightened sensory input and the latter requiring/seeking less sensory input
(Autism Society of Newfoundland & Labrador (ASNL), n.d.). Due to the vast difference in the
type of information received by each of the senses and the varying reactions to them, it is
important to consider each individually.
Visual Processing
The ability to perceive, process and react to information which is presented from sight is
known as visual processing. According to the ASNL (n.d.), hyposensitivity in these children may
present as difficulty tracking objects as well as focusing on the parts of an object rather than the
whole, while hypersensitivity may include oversensitivity to bright lights, being easily distracted
by visual stimuli, and a marked avoidance of eye-contact. Research in this area shows that the
tendency of an individual with autism to actively avoid or seek out visual stimuli, and their
subsequent reaction to this stimuli, may be based in neurology. Dinstein et al (2012) used fMRI
technology to examine neurological differences in the way typically developing adults and adults
with autism reacted to visual, tactile, and auditory stimuli. They found that while the typically
developing participants showed the same response in their primary visual system every time they
were shown the same visual stimulus, this was not the case for those with autism. Instead, they
saw considerable variability for those with autism, with fluctuating degrees of weak and strong
neurological responses for the same stimulus (Dinstein et al, 2012). While the sample size of this
study was relatively small (14 participants in each group), the results provide insight regarding
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the perception of (and reaction to) visual stimuli in individuals with autism. If the visual areas of
the cortex are responding to the same image differently each time it is presented, this may help to
explain the differences in perception and reaction to various visual stimuli in the childs
environment. The tendency of the brain to react inconsistently may be the driving force behind a
childs avoidance of certain stimuli, with the rationale being that it is more comfortable to avoid
the stimuli entirely rather than risking the uncomfortable effects of a strong neural response.
Tactile Processing
The experience of various types of sensations on the body including pain, touch,
temperature, and pressure, are all examples of tactile processing. While there is variability in
typically developing children as to their thresholds for these inputs, children with autism may
have extreme reactions to them. Hyposensitive children may seek out heightened pressure,
engage in rough play, continuously touch objects or have a very high pain threshold while
hypersensitive children may resist touch, dislike the feeling of labels and seams on their clothing
and may resist showers or baths (ASNL, n.d.). Research in the area of tactile processing indicates
that there may be a neurological basis for these touch-related preferences and reactions. Coskun
et al (2009) investigated whether somatic cortical maps differed in autistic brains versus typically
developing brains. Mechanical taps were delivered to the participants right thumb, index finger,
and lip and the results indicated that the cortical representations of all of these areas were
significantly more distant than those of typically developing individuals who underwent the same
procedure. The authors of the study suggest that these findings are the first of their kind and
reveal abnormalities in the somatosensory cortex as well as cortical circuitry in individuals with
autism (Coskun et al, 2009). A neurological basis of altered tactile processing has also been
demonstrated by Dinstein et al (2012) who, in the somatosensory portion of their experiment,
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delivered air puffs through a hose to the left hand of participants. Similar to their findings for
visual stimuli, their fMRI data indicated that the typically developing participants had reliable
cortical responses to the somatosensory stimuli while the cortical responses of participants with
autism were unreliable, with stronger or weaker reactions each time the same stimulus was
presented (Dinstein, 2012). The above studies suggest that individuals with autism process touch
and other tactile sensations differently and therefore may have unique tactile perceptions,
experiences, and reactions.
Auditory Processing
Auditory processing refers to the perception, processing, and reaction to stimuli received
from the ears. A child with autism who is hyposensitive to sound may not hear and/or respond to
various sounds including their own name, may engage in behaviours like tapping to create noise,
or keeping the television loud, while a hypersensitive child will be bothered by such noise and
may actually experience it as pain (ASNL, n.d.). Just as in the realms of visual and tactile
processing, researchers have examined the role of the brain in causing some of these auditory
processing issues. Kwakye et al (2011) presented auditory stimuli consisting of alternate clicks in
each ear via headphones to their sample, which consisted of 27 typically developing children and
35 children with autism spectrum disorder (ASD). The participants were asked to determine
which ear the first click was heard in. Results of this study revealed that the ability to
discriminate timing information between sequential stimuli is also impaired in ASD (pg. 8) and
the authors also suggest an altered ability of neurons in the primary auditory cortex of these
children (Kwakye et al, 2011). Neurophysiological underpinnings of altered auditory processing
have also been found in related research (Dinstein et al, 2012; Marco, Leighton & Hinkley,
2011). Upon recent review of the literature in this area, it has been summarized that, In general,
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the neurophysiologic study of auditory processing in autism does suggest atypical neural activity
as early in the processing stream as the primary auditory cortex (Marco, Hinkley, Hill &
Nagarajan, 2011, pg. 49R).
Oral Processing
The experience of sensory input in the mouth is known as oral processing. Children with
autism who are hyposensitive to oral stimuli may put inedible objects in their mouths, gravitate
towards foods with intense flavour or seek oral stimuli in other ways, while those who are
hypersensitive may be very picky eaters, be sensitive to the textures of food, have difficulty with
chewing and swallowing, and dislike having objects like toothbrushes in their mouths (ASNL,
n.d.). There is significantly less research available on a neurological basis for oral processing
differences in individuals with autism. One reason for this discrepancy may be that while the
senses of sight, sound, and touch are localized in the brain (i.e. visual cortex, auditory cortex, and
sensorimotor cortex), the degree of localization is not the same for oral input. Another reason for
the lack of available research in this area may be that oral activities such as eating involve so
many of the other senses (sight, smell, texture, etc.), that it is difficult to separate oral processing
from other processing difficulties. For example, a child may refuse to eat chicken for many
different sensory reasons, including the colour, the smell, the taste, or the texture. Therefore,
researchers in the area of neurological bases of oral processing issues would be required to
somehow control for all of the other sensory input and isolate the oral input, a task which would
be quite difficult.
As previously reported, research indicates that the prevalence of sensory processing
issues in children with autism is very high. While descriptions of how these processing
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differences may present themselves and explanations of potential neurological bases are
important, it is also important to consider the impact of these sensory processing differences on
the functioning of the child in different environments. It is to this topic which we now turn our
attention.
Functional Impact of Sensory Processing Issues
Sensory processing is integral to virtually every aspect of our functioning because all of
the informational input we receive is carried by one or more sensory modalities. Therefore,
issues with sensory processing can cause an extensive impact on functioning. In the case of
children with autism, the problem is further compounded by other characteristics of the disorder,
including communication and language deficits.
A recent study was conducted in which researchers interviewed parents of children with
autism regarding the impact of sensory processing issues on their families (Schaff, Toth-Cohen,
Johnson, Outten & Benevides, 2011). The six main themes which emerged from the study
include: the constant need for flexibility, difficulty in unfamiliar spaces, struggles with family
activities, impact on siblings, a need for constant monitoring, and the importance of developing
strategies to improve participation for the family. Participants indicated that certain activities
which the child was sensitive to were completed only in the childs absence (i.e. vacuuming),
that family activities often changed based on the sensory needs of the child, that socialization
activities with other families were sometimes limited due to the unpredictability of the childs
sensory reactions in the new environment, and that typically developing siblings often received
less attention (Schaff et al, 2011). These findings are significant and highlight the fact that
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sensory processing difficulties affect not only the child, but also the functioning of the entire
family.
Research has also considered the impact of sensory issues on well-being. Stein, Polido &
Cermac (2012) studied the impact on oral care and found that significantly more parents of
children with autism reported difficulties with tooth-brushing and dental visits for their child.
Many parents reported that their child had sensitivities to the loud sounds, bright lights, smells,
and oral sensations at the dentists office and that the texture of toothpaste and brushes also made
oral care difficult (Stein et al, 2012). While these issues undoubtedly cause distress for the parent
and child in terms of completing the task itself, they also raise potential concerns regarding oral
health.
As previously discussed, difficulty with oral processing also impacts eating habits.
Cermak, Curtin & Bandini (2010) reported that parents often describe these children as picky
eaters with diets that are sometimes restricted to as few as five foods. This has implications for
functioning in terms of food preparation, family meals, and attending get-togethers. It also has
potential repercussions for the well-being and nutrition of the child, as consuming limited types
of food and/or avoidance of important food items could be detrimental to health and physical
development.
The developmental and functional impact of processing difficulties involving more than
one sensory modality has also been studied. Deficits in auditory and visual processing may
contribute to awkward and difficult social interactions, due to difficulty integrating subtle
changes in tone of voice and body language (Kwakye et al, 2011). It has also been found that the
combination of auditory filtering and tactile sensation seeking can contribute to academic
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underachievement (Ashburner, Ziviani & Rodger, 2008). While processing difficulty in any one
modality is enough to cause a significant impact on functioning, the combination of multiple
sensory issues is particularly impactful.
Finally, sensory processing deficits in children with autism may also lead to functional
impairments stemming from poor mental health. It is quite possible that classmates and peers are
very aware of the difficulties faced by these children, and awkward social interactions combined
with abnormal responses to everyday stimuli in the school environment may lead to isolation and
decreased self-esteem. Individuals with higher functioning could also experience depression and
anxiety as they are more aware of others perceptions of them. These mental health concerns
could affect functioning in many different ways, including withdrawal from social interaction,
decreased self-confidence, and physical/medical manifestations of underlying mental health
concerns.
Conclusion & Future Directions
Research continues to show an upward trend in the prevalence of autism in both Canada
and the United States. Although not currently included in the diagnostic criteria, the incidence of
sensory processing issues in children with autism is extremely high, and is an important factor to
consider. These processing issues span over many different sensory modalities and have unique
presentations. Recent research has focused on the neurophysiological bases of sensory
processing in autism, and much of the data indicates that there is, in fact, evidence to support
brain-based causes of sensory processing difficulties. The impact of these difficulties is vast and
seems to consume virtually all aspects of functioning not only for the child, but also for family
and friends and across different settings, including at home, in the community and at school.
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Due to length constraints, an in-depth discussion of the presentation, neurological basis,
and functional impact of vestibular, proprioception, and olfactory differences in children with
autism was not possible in this paper; however, research in these areas is also equally important.
Future studies in the area of neurophysiological research may include determining whether a
relationship exists between neural circuitry and altered oral processing, as well as the nature of
this relationship. Also, it may be beneficial to study aspects related to neural plasticity in autism.
The relationship between sensory processing differences and their impact on mental health
would also be an interesting area of study. Finally, research examining the possibility of re-
wiring the autistic brain and/or training the brain to appropriately respond to sensory stimuli
would be extremely beneficial to reduce the impact of sensory processing issues in children with
autism spectrum disorders.


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