Sensory Pattern Contributions to DevelopmentalPerformance in Children With AutismSpectrum Disorder

Scott D. Tomchek, Lauren M. Little, Winnie Dunn

MeSH TERMS

� adaptation, psychological

� child development

� child development disorders, pervasive

� sensation

� sensation disorders

Scott D. Tomchek, PhD, OTR/L, FAOTA, is Associate

Professor of Pediatrics, Weisskopf Center, School of

Medicine, University of Louisville, Louisville, KY, and

Adjunct Associate Research Professor, Department of

Occupational Therapy Education, School of Health

Professions, University of Kansas Medical Center, Kansas

City; scott.tomchek@louisville.edu

Lauren M. Little, PhD, OTR, is Assistant Professor,

Department of Occupational Therapy Education, School of

Health Professions, University of Kansas Medical Center,

Kansas City.

Winnie Dunn, PhD, OTR, FAOTA, is Professor and

Chair, Department of Occupational Therapy Education,

School of Health Professions, University of Kansas

Medical Center, Kansas City.

Sensory processing differences in preschool-age children with autism spectrum disorder (ASD) affect their

engagement in everyday activities, thereby influencing opportunities to practice and develop skills such as

social communication and adaptive behavior. The purpose of this study was to investigate the extent to which

specific sensory processing patterns relate to aspects of development (i.e., adaptive behavior, expressive and

receptive language, fine and gross motor skills, social behavior) in a sample of preschool-age children with

ASD (N 5 400). A retrospective chart review was used to gather clinical data. Results suggest that sensory

processing patterns differentially affect children’s developmental skills and adaptive behavior. Certain sensory

processing patterns predicted children’s development of language, motor, and adaptive skills. These findings

have clear implications for occupational therapy practice with young children with ASD. Practitioners should

consider how sensory processing in ASD both supports and limits children’s ability to engage in social

communication and learning opportunities.

Tomchek, S. D., Little, L. M., & Dunn, W. (2015). Sensory pattern contributions to developmental performance in children

with autism spectrum disorder. American Journal of Occupational Therapy, 69, 6905185040. http://dx.doi.org/

10.5014/ajot.2015.018044

Research suggests that children with autism spectrum disorder (ASD) respond

to sensory experiences differently from peers with or without disabilities.

These differences in sensory responding are well documented in clinical literature

by direct observation (Adrien et al., 1992, 1993; Adrien, Ornitz, Barthelemy,

Sauvage, & Lelord, 1987), parent report (Baranek, David, Poe, Stone, &

Watson, 2006; Ben-Sasson et al., 2009; Ermer & Dunn, 1998; Kern et al., 2006;

Kientz & Dunn, 1997; Leekam, Nieto, Libby, Wing, & Gould, 2007;

O’Donnell, Deitz, Kartin, Nalty, & Dawson, 2012; Watling, Deitz, & White,

2001; Tomchek & Dunn, 2007), and first-person accounts of living with autism

(Cesaroni & Garber, 1991; Grandin, 1995; Minshew & Hobson, 2008). The

initial appearance of these sensory processing differences often predates diagnosis

(Adrien et al., 1993; Baranek, 1999; Dahlgren & Gillberg, 1989; Lord, 1995)

and has been associated with later behavioral presentations of adaptive behavior

(e.g., Lane, Young, Baker, & Angley, 2010) and other developmental domains

such as social communication (e.g., Watson et al., 2011). Although sensory

processing differences are highly prevalent and early indicators of an eventual

diagnosis of ASD, studies on the associations between specific sensory processing

characteristics and developmental functioning in early childhood present variable

findings. Therefore, this study focused on the extent to which specific sensory

processing patterns contribute to aspects of developmental function (i.e., social

communication, adaptive functioning) that influence diagnostic consideration

and participation in preschool-age children with ASD. If we can uncover how

early behavioral presentations of sensory differences are associated with particular

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aspects of development, intervention approaches may be

tailored to meet the needs of preschool children with ASD.

Investigations have explored differences in patterns of

sensory responding using established Sensory Profile (SP;

Dunn, 1999, 2006, 2014) factor summary scoring that is

based on performance of typically developing children.

Ermer and Dunn (1998) used discriminant analysis to

differentiate children with disabilities (ASD and attention

deficit hyperactivity disorder [ADHD]) from those without

disabilities and also to differentiate the two groups with

disabilities from each other. Specifically, children with au-

tism or pervasive developmental disorder (PDD) displayed

a low incidence of seeking and a high incidence of SP Oral

Sensitivity, Inattention/Distractibility, and Fine Motor/

Perceptual factors compared with children with ADHD.

Further, Watling et al. (2001) compared sensory processing

behaviors of children aged 3–6 yr with and without ASD.

Sensory processing of children with ASD was significantly

different from that of controls on 8 of 10 SP factors

(Sensory Seeking, Emotionally Reactive, Low Endurance/

Tone, Oral Sensitivity, Inattention/Distractibility, Poor

Registration, Fine Motor/Perceptual, and Other).

Baranek and colleagues (2007), using the Sensory Ex-

periences Questionnaire (Baranek et al., 2006), found that

mental age was inversely related to sensory seeking, hyper-

responsiveness, and hyporesponsiveness across five di-

agnostic groups (i.e., ASD, PDD, developmental delay

[DD]/intellectual disability, other DD, typical) in chil-

dren ages 5–80 mo. Notably, the group with ASD yielded

a higher rate of symptoms than other groups and demon-

strated a distinct pattern of hyporesponsiveness in both social

and nonsocial contexts. A similar study (Leekam et al., 2007)

compared sensory responding of children ages 34–140 mo

across four diagnostic groups (ASD, DD, language impair-

ment, typical). The ASD group again showed a higher rate of

sensory differences across multiple domains, though the

symptoms changed with age and IQ, leading the authors to

conclude it was difficult to draw conclusions given the var-

iability in presentation. Additional analysis by Joosten and

Bundy (2010) compared children with ASD and intellectual

disability with those with intellectual disability alone and

found differences between the groups on sensitivity and

avoiding factors.

In a different approach to understanding sensory

processing patterns, others have used subtyping analysis in

an attempt to capture the variability in sensory processing

patterns as related to developmental domains in ASD. The

intent was to group participants on the basis of perfor-

mance on a set of variables. Recent cluster analysis

(Lane et al., 2010) using the Short Sensory Profile (SSP;

McIntosh, Miller, & Shyu, 1999) with 54 children with

ASD ages 2–10 yr found three subtypes: Sensory-Based

Inattentive Seeking, Sensory Modulation With Move-

ment Sensitivity, and Sensory Modulation With Taste/

Smell Sensitivity.

Follow-up replication with a separate sample of 29

children with ASD confirmed these subtypes and iden-

tified further details about the groups (Lane, Dennis, &

Geraghty, 2011). Children with a primary pattern of

sensory-based inattention were further described as sensory

seekers or nonseekers. Children with a primary pattern of

vestibular and proprioceptive dysfunction were also differ-

entiated on movement and tactile sensitivity. A recent study

(Lane, Molloy, & Bishop, 2014) replicated and further

refined their previously identified clusters by identifying

sensory adaptive, taste- and smell-sensitive, postural in-

attentive, and generalized sensory difference clusters.

Similarly, Ausderau and colleagues (2014), using the

Sensory Experiences Questionnaire (version 3.0; Baranek,

2009), found four sensory subtypes (Mild, Sensitive–

Distressed, Attenuated–Preoccupied, and Extreme–Mixed),

which differed by age and autism severity.

Patterns of sensory processing and responding have

been theorized to contribute to a person’s ability to partic-

ipate successfully in daily routines (Dunn, 2007). Recogni-

tion of a person’s sensory patterns allows environments and

experiences to be tailored to meet sensory processing needs

to facilitate opportunities for successful participation in ev-

eryday life. Likewise, adaptive living skills allow a person to

use developmental capabilities (e.g., cognitive, language,

motor, social) to function within everyday routines and

contexts. Adaptive living skills contribute strongly to the

ability of a person with ASD to function successfully and

independently in the world (Liss et al., 2001; Paul, Loomis,

& Chawarska, 2014; Saulnier & Klin, 2007).

Research on the extent to which sensory processing is

related to overall development and adaptive functioning in

ASD has been emerging. Baker, Lane, Angley, and Young

(2008) reported significant moderate positive correlations

between maladaptive and emotional and behavioral prob-

lems and the SSP factors of Underresponsive/Seeks Sensa-

tion, Auditory Filtering, and Low Energy/Weak. Significant

associations have also been found between sensory pro-

cessing difficulties and levels of problem behavior, in-

cluding irritability, lethargy, hyperactivity, inappropriate

speech, and stereotypic behavior (O’Donnell et al., 2012).

Ben-Sasson et al. (2008) used cluster analysis to group 170

toddlers with ASD ages 18–33 mo by sensory category and

social factors, yielding three clusters: low frequency, mixed

frequency, and high frequency of sensory behaviors. High

under- or overresponsivity clusters were related to more

negative emotions, anxiety, and depressive symptoms than

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were low under- or overresponsivity. Similarly, Pfeiffer,

Kinnealey, Reed, and Herzberg (2005) found a positive

relationship between sensory defensiveness and anxiety in

persons with Asperger syndrome; older study participants

displayed symptoms of depression and hyposensitivity and

younger participants had symptoms of depression and hy-

persensitivity. As sensory hyper- and hyposensitivity in-

creased, community use and social skill decreased.

Sensory avoiding has been found to negatively affect

daily living skills (Jasmin et al., 2009) and activity par-

ticipation (Little, Sideris, Ausderau, & Baranek, 2014) in

people with ASD. Moreover, Ashburner, Ziviani, and

Rodger (2008) found that sensory processing scores on

the SSP (Tactile Sensitivity, Auditory Filtering, and

Underresponsive/Seeks Sensation) were negatively as-

sociated with academic, behavioral, and emotional per-

formance. Liss, Saulnier, Fein, and Kinsbourne (2006)

also used cluster analysis to examine relationships be-

tween function and sensory processing. Sensory over-

responsivity was associated with perseverative behavior

and interests, overfocused attention, and exceptional

memory. The underresponsivity cluster was associated

with lower adaptive functioning, communication impair-

ments, and deficits in social skill. In contrast, other studies

(Rogers, Hepburn, & Wehner, 2003; Wiggins, Robins,

Bakeman, & Adamson, 2009) have not found associations

between sensory processing and social or communication

scores on the Autism Diagnostic Observation Schedule

(ADOS; Lord, Rutter, DiLavore, & Risi, 1999).

These studies have clear variability regarding mea-

surement of sensory processing and the developmental

variables of interest (e.g., adaptive behavior versus social

communication). Such variability in findings results in a lack

of understanding regarding how specific sensory processing

patterns contribute to aspects of development in preschool-

age children with ASD. Therefore, this study addressed two

research questions: (1) To what extent do sensory processing

patterns contribute to specific developmental domains (i.e.,

adaptive behavior, social interaction, receptive and expressive

language, and gross and fine motor) in young children with

ASD and (2) to what extent do children with varying

adaptive behavior scores differ on sensory processing scores?

Method

Procedures

We conducted a retrospective chart review of clinical data

on children diagnosed with ASD at a university-based

tertiary diagnostic center with a statewide catchment area.

Sixty percent of children accessing services at the center have

traditionally been from urban areas, with the remaining being

from rural areas. Children referred for evaluation received

a standard and comprehensive medical, psychological, speech

and language, and occupational therapy interdisciplinary

team evaluation, consistent with ASD diagnostic practice

standards (Filipek et al., 1999, 2000; Johnson & Myers,

2007; Volkmar, Cook, Pomeroy, Realmuto, & Tanguay,

1999). Inclusion criteria mandated that participants were

between the ages of 3 yr and 6 yr, 11 mo, and met criteria

for ASD on at least one of the following: Autism Di-

agnostic Interview–Revised (Lord, Rutter, & Le Couteur,

1994), ADOS, or Diagnostic and Statistical Manual ofMental Disorders (4th ed., text rev; DSM–IV–TR ) criteria(American Psychiatric Association [APA], 2000). We

included participants who had complete adaptive, social,

communication, motor, and sensory processing data from

specific measures derived from the evaluation process.

We originally identified 769 potential participants

using a query of scheduling and billing software. Chart

review began with children evaluated most recently and

worked back. A total of 471 charts were reviewed to secure

the 400 complete records using selected measures. Ex-

clusion most often related to use of another instrument

than those selected for inclusion or a lack of replication in

cases in which testing had previously been performed by

another provider. The first author (Tomchek) completed

reviews using IBM SPSS Statistics (Version 18; IBM

Corp., Armonk, NY). To examine the extent of rating bias

or error, a psychology doctoral student coded a subset of

25 charts to establish interrater reliability. Coefficients

ranged from .99 for adaptive and social variables to 1.0 for

both motor and language variables.

Participants

Participant age and developmental performance scores are

summarized in Table 1 (n 5 400). DSM–IV–TR (APA,

2000) criteria were used for diagnosis; consequently, the

majority of children were diagnosed with autistic disorder

(n 5 322, 80.5%), and a smaller number with PDD–not

otherwise specified (PDD–NOS; n 5 67, 16.8%) and As-

perger disorder (n5 11, 2.8%). Developmental performance

varied for each variable, consistent with diagnostic criteria;

that is, the Asperger disorder group achieved at a higher level

than either the PDD–NOS or the autism groups.

Measures

The SSP, a 38-item caregiver-report instrument, was used

to measure sensory processing. Items are scored on a Likert

scale ranging from 1 (always) to 5 (never). The seven do-

mains of the SSP were based on factor analysis with the

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normative sample of typically developing children (Dunn,

1999). However, a recent factor analysis of the SSP using

the current sample of children with ASD demonstrated

a slightly different factor structure than that of typically

developing children and was used in the current analysis.

These factors include Low Energy/Weak, Tactile/Movement

Sensitivity, Taste/Smell Sensitivity, Auditory/Visual Sensitiv-

ity, Sensory Seeking/Distractibility, and Hyporesponsivity

(Tomchek, Huebner, & Dunn, 2014). As noted in Figure 1,

the Tactile/Movement Sensitivity items of the SSP were

merged to form a single factor. Auditory Filtering from

the SSP was spread across three factors describing audi-

tory and visual sensitivity, distractibility, and sensory

hyporesponsivity. Underresponsive/Seeks Sensation items

from the SSP were separated into two factors (Sensory

Seeking/Distractibility and Hyporesponsivity).

Because the current study used a retrospective chart

review approach, we used scores from various measures of

adaptive behavior, social behavior, receptive and expressive

language, and gross and finemotor skills that were used in the

evaluation process (Supplemental Table 1, available online at

http://otjournal.net; navigate to this article, and click on

“Supplemental”). When possible, we used standard scores.

Given the inherent difficulties with utilizing standard-

ized instruments with children with ASD, we occasionally

selected criterion-referenced instruments to capture devel-

opmental ages and converted them to a developmental

quotient. This practice is common in the autism litera-

ture (see Bibby, Eikeseth, Martin, Mudford, & Reeves,

2001; Lord & Schopler, 1989; Rogers et al., 2003; Stone,

Ousley, Yoder, Hogan, & Hepburn, 1997).

Data Analysis

Data were analyzed using IBM SPSS Statistics (Version 18).

To address our first research question, we used multivariate

regression to determine the contribution of sensory pro-

cessing scores on specific aspects of development. Specifically,

we tested a model with sensory processing scores (Low

Energy/Weak, Tactile/Movement Sensitivity, Taste/Smell

Sensitivity, Auditory/Visual Sensitivity, Sensory Seeking/

Distractibility, and Hyporesponsivity) as independent var-

iables and developmental domain scores (adaptive behavior,

social behavior, receptive and expressive language, gross and

fine motor skills) as dependent variables.

Because the adaptive functioning instruments used in

the current study account for and scores are confounded

by motor and language skills, we tested the impact of sensory

processing scores on adaptive functioning in a separate

model. Therefore, to address our second question, we used

multivariate analyses of variance (MANOVAs) to determine

whether differences in sensory processing varied by adaptive

functioning level. To investigate differences by functioning

level, we classified participants into three groups of func-

tioning: high (adaptive quotient >80), moderate (adaptive

quotient 60–79), or low (adaptive quotient <60). We used

Tukey’s follow-up comparisons to determine the extent to

which each adaptive functioning group (i.e., low, moderate,

or high) differed on sensory processing scores.

Results

Sensory Processing and Developmental Domains

Results of the multivariate regression analysis showed

that sensory processing scores differentially predicted

developmental domains (see Table 2). Notably, Low

Energy/Weak, Tactile/Movement Sensitivity, Taste/Smell

Sensitivity, Auditory/Visual Sensitivity, and Hypo-

responsivity scores significantly contributed to receptive

and expressive language scores (all ps < .05). Similarly, these

scores contributed to receptive language with the addition of

Sensory Seeking/Distractibility (p < .05). The only significant

contribution to social behavior and gross and fine motor

skills scores was Sensory Seeking/Distractibility (p < .05).

Table 1. Participant Age and Developmental Performance Scores by Diagnosis

M (SD)

Variable Autistic Disorder (n 5 322) PDD–NOS (n 5 67) Asperger disorder (n 5 11) Total (N 5 400)

Age, mo 49.35 (10.60) 49.61 (10.14) 56.09 (10.27) 49.58 (10.54)

Developmental performancea

Adaptive behavior 53.63 (15.85) 68.48 (18.52) 80.46 (24.00) 56.85 (17.88)

Social behavior 44.93 (16.24) 62.18 (13.67) 73.42 (12.25) 48.60 (17.48)

Receptive language 35.98 (19.87) 57.17 (18.58) 96.36 (8.94) 41.19 (22.93)

Expressive language 35.07 (18.18) 57.16 (19.06) 96.55 (10.52) 40.46 (22.04)

Gross motor skills 68.51 (9.47) 71.82 (7.53) 78.64 (7.15) 69.34 (9.31)

Fine motor skills 67.76 (9.11) 70.25 (8.07) 81.00 (10.55) 68.54 (9.25)

Note. M 5 mean; PDD–NOS 5 pervasive developmental disorder–not otherwise specified; SD 5 standard deviation.aValues reflect standard score or developmental quotient with a mean of 100. Developmental quotients were calculated using the equation developmentalage/chronological age · 100.

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Differences by Level of Adaptive Functioning

To investigate differences in the sensory processing pattern

scores by adaptive functioning level, we grouped participants

as follows: high adaptive behavior (adaptive quotient >80;n 5 47), moderate adaptive behavior (adaptive quotient

60–79; n 5 115), or low adaptive behavior (adaptive

quotient <60; n 5 238). The homogeneity of variance

assumption was met on the basis of Box’s test of equality of

covariance matrices that yielded a value of 50.28, F (42,62,393) 5 1.16, p 5 .226. A significant multivariate effect

was found, Hotelling’s trace5 0.109, F (12, 782)5 4.09,

p < .001 (Table 3). Tukey’s post hoc comparisons

showed that the low versus high groups differed on

Tactile/Movement Sensitivity and Hyporesponsivity

(p < .05), whereas all three groups differed on Taste/Smell

Sensitivity and Sensory Seeking/Distractibility (p < .001).

Discussion

To date, studies investigating the variable developmental

presentation in people with ASD by subtyping have fo-

cused on cognitive and language variables and comorbid

medical and genetic conditions (see Ousley & Cermak,

2014, for a review). In these studies, the impact of di-

minished cognitive capacity on function and information

processing has been a hallmark. Studies of the con-

tributions of sensory processing to developmental domains

in ASD represent a newer line of investigation. These

studies have previously used the SSP factor structure based

on typically developing children to explore associations

with specific developmental variables.

The primary goal of this study was to supplement

previous work in a more comprehensive way to establish the

extent to which sensory processing factors, as derived from

a sample with ASD, predicted aspects of developmental

performance and adaptive behavior in preschool-age children

with ASD.Novel findings from this study suggest that sensory

processing factors differentially contribute to developmental

domains, with the greatest contribution to receptive and

expressive language. Moreover, specific sensory processing

patterns differed among the adaptive behavior groups.

Our findings suggest that sensory processing patterns are

strongly related to preschool-age children’s receptive and

expressive language abilities. Specifically, we found that

children with high scores (i.e., fewer differences) in Low

Energy/Weak and Auditory/Visual Sensitivity showed in-

creased receptive and expressive language skills. Children

who are less sedentary and less sensitive to the auditory and

visual elements of their contexts may be more likely to focus

during experiences that provide them with opportunities to

practice language. Conversely, children who showed more

differences in Hyporesponsivity and Taste/Smell Sensitivity

demonstrated decreased language skills. These children may

be missing opportunities for language. Interestingly, Sensory

Seeking/Distractibility significantly contributed to receptive,

not expressive, language skills. Children who are engaged in

sensory seeking, such as increased movement activities or

a focus on specific sensory elements in their environments,

may be missing language input from caregivers and peers.

The current study’s findings are supported by those

of Watson and colleagues (2011), which showed that

Figure 1. Factor structure of Short Sensory Profile items forchildren with autism spectrum disorder.Note. Adapted from “Patterns of Sensory Processing in Children With an AutismSpectrum Disorder,” by S. D. Tomchek, R. A. Huebner, & W. Dunn, 2014, Re-search in Autism Spectrum Disorders, 8, p. 1218. http://dx.doi.org/10.1016/j.rasd.2014.06.006. Copyright © 2014 by Elsevier. Used with permission.

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hyporesponsivity was associated with language limitations in

children with ASD and that sensory sensitivities contributed,

albeit not significantly, to better language skills. Differences

in language performance are a core feature of ASD (DSM–5;APA, 2013), and sustained attention is required to partici-

pate in activities, learn, and engage in reciprocal interaction

socially and with language. Children’s sensory processing

patterns affect a child’s ability to sustain active engagement in

activities that provide social communication opportunities.

Therefore, the current findings present strong implications

for sensory processing interventions to be an integral com-

ponent of interventions that promote engagement activities

that develop communication skills in children with ASD.

In this sample of preschool-age children with ASD, the

sole sensory processing contributor to social behavior

and fine and gross motor skills was Sensory Seeking/

Distractibility. Children who are engaged in movement

activities or intensely interested in sensory aspects of their

environment may be missing social opportunities. More-

over, distractibility in children may prevent them from

engagement in fine and gross motor activities. Because

many occupational therapy interventions that focus on fine

motor skills include sensory considerations, a particular

focus on sensory seeking and distractibility for children with

ASDmay be necessary in implementing such interventions.

Significant differences in sensory processing patterns were

found between adaptive behavior groups. These differences are

often highlighted when children are participating in daily

routines. In particular, the low adaptive behavior group showed

more tactile and movement sensitivity and sensory-seeking

behaviors than the high adaptive behavior group.Moreover,

each adaptive group differed on taste and smell sensitivity

and sensory seeking, with increased sensory behaviors

contributing to decreased adaptive skill across groups.

Our findings are partially supported by previous re-

search on the associations between sensory processing and

adaptive behavior in ASD. Rogers and colleagues (2003)

analyzed the predictive value of sensory responsivity on

adaptive skill. In their study, the developmental level of the

participants accounted for the most variability in adaptive

behavior, with the sensory responsivity accounting for only

4% of the variance in adaptive functioning. Specific to ac-

ademic performance investigated in another study, the SSP

Under responsive/Seeks Sensation and Auditory Filtering

scores explained 47% of the variance in teacher report of

school functioning, whereas estimated intelligence was not

a significant predictor of academic performance (Ashburner

et al., 2008). Lane and colleagues (2010) found that in-

creased sensory behaviors were associated with maladaptive

behaviors in ASD, although sensory processing did not

significantly contribute to specific adaptive behaviors. The

current study’s finding regarding taste and smell sensitivity

and adaptive behavior is supported by previous research

focused on feeding differences affecting mealtime routines

Table 3. Sensory Processing Pattern Differences by Adaptive Behavior Group

Mean (SD)

Sensory Processing Pattern Low Adaptive Behavior Moderate Adaptive Behavior High Adaptive Behavior Tukey’s Post Hoc Comparison, F(2, 238)

Low Energy/Weak 25.75 (4.90) 25.46 (5.00) 27.19 (4.19) 2.210

Tactile/Movement Sensitivity 37.37 (6.77) 38.33 (6.83) 40.21 (6.84) 3.652a

Taste/Smell Sensitivity 10.91 (5.21) 12.61 (5.66) 14.77 (5.43) 11.703b

Auditory/Visual Sensitivity 27.30 (6.24) 26.78 (5.93) 28.23 (7.37) 0.898

Sensory Seeking/Distractibility 13.84 (4.32) 14.30 (4.20) 16.47 (4.90) 7.155b

Hyporesponsivity 11.73 (2.99) 11.92 (2.60) 12.96 (3.13) 3.535a

Note. Lower sensory scores indicate more frequently occurring behaviors. SD 5 standard deviation.aTukey’s post hoc comparison showed that the low versus high groups differed on Tactile/Movement Sensitivity and Hyporesponsivity (p < .05). bTukey’s post hoccomparison showed differences between all three groups on Taste/Smell Sensitivity and Sensory Seeking/Distractibility (p < .001).

Table 2. Sensory Processing Pattern Contributions to Developmental Measures

Developmental Measure, b (SE )

Sensory Processing Pattern Social Behavior Receptive Language Expressive Language Gross Motor Skills Fine Motor Skills

Low Energy/Weak 20.265 (0.223) 20.641 (0.239)** 20.629 (0.231)** 0.149 (0.101) 20.001 (0.101)

Tactile/Movement Sensitivity 0.160 (0.185) 0.233 (0.199) 0.171 (0.192) 20.022 (0.084) 0.013 (0.084)

Taste/Smell Sensitivity 0.331 (0.201) 0.545 (0.207)* 0.435 (0.210)* 0.075 (0.091) 0.079 (0.091)

Auditory/Visual Sensitivity 20.316 (0.193) 20.940 (0.207)** 20.819 (0.20)** 20.079 (0.087) 0.022 (0.087)

Sensory Seeking/ Distractibility 0.578 (0.262)* 0.594 (0.282)* 0.446 (0.273) 0.261 (0.119)* 0.257 (0.118)*

Hyporesponsivity 0.416 (0.394) 1.018 (0.425)* 1.180 (0.411)** 0.216 (0.179) 0.014 (0.179)

Note. SE 5 standard error.*p < .05. **p < .001.

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in families with a child with ASD (Jasmin et al., 2009;

Nadon, Feldman, Dunn, & Gisel, 2011).

Limitations and Future Directions

Study limitations relate to the unique diagnostic aspects

of ASD and provide direction for future investigation.

Developmental testing is a social communication process,

and optimal performance thus in part depends on what are

the weakest skills for people with ASD, which affects the

validity of developmental measures. As a result, criterion-

referenced instruments yielding developmental ages are often

used in lieu of standardized instruments or parent-report

measures. Both were used in this study. Although parent-

report measures and developmental quotients are commonly

used in the autism literature (see Bibby et al., 2001; Lord &

Schopler, 1989; Rogers et al., 2003; Stone et al., 1997), they

introduce an unknown amount of bias that could either

inflate or diminish true performance.

Also related to measurement with retrospective analysis

is the exclusion of incomplete charts. Inclusion of excluded

participants may have changed the final composition of

the sample. Moreover, interpretation of the study findings

was somewhat limited by the lack of a comparison group

of children with developmental difficulties. Use of a com-

parison group would have allowed for testing the effects of

coexisting developmental deficits (e.g., language delay) on

patterns of sensory processing. Replication of study

findings will require confirmatory factor analysis in an-

other group of children with ASD and with groups of

children with other disabilities to establish whether the

sensory patterns used in this study are specific to children

with ASD or whether they are consistent with samples of

children with other developmental disabilities.

Further investigation into the relationship between

these patterns and the developmental and behavioral

presentation of people with ASD is warranted. This line of

investigation will ultimately allow for a clearer understanding

of the contributions of sensory processing to the variable

presentation of people with ASD and will have implications

for early diagnosis and intervention.

Implications for OccupationalTherapy Practice

We found specific and differential associations between sensory

processing patterns and developmental domains, particularly

with regard to adaptive behavior and language. Certain sensory

behaviors positively predicted expressive and receptive language

(i.e., auditory and visual sensitivity and low energy and weak),

whereas others inversely predicted children’s language skills

(i.e., hyporesponsivity and taste and smell sensitivity). The

findings of this study have the following implications for

intervention programs involving people with ASD:

• Occupational therapy can play an important role to sup-

port engagement in social communication opportunities.

• Collaborative interprofessional practice between occu-

pational therapy practitioners and speech–language

pathologists may yield optimal treatment outcomes.

• Findings from this study demonstrate that strong re-

lationships exist between sensory patterns and measures

of developmental performance.

• Sensory processing differences affect children’s ability

to sustain engagement in occupations when participat-

ing in daily life.

• Recognizing sensory pattern contributions as a vital com-

ponent of the environment reduces the emphasis on skill

development and guides parents, teachers, and practi-

tioners to create effective context-specific supports that

can improve child participation in daily routines.

Conclusion

The primary goal of this study was to supplement previous

work by developing a more comprehensive way to establish

how sensory processing factors predicted developmental

performance and adaptive behavior in a sample of

preschool-age children with ASD. Study findings suggest

that sensory processing factors differentially contribute to

developmental domains, with the greatest contribution to

receptive and expressive language. Sensory processing

patterns also differed by level of adaptive behavior. Oc-

cupational therapy practitioners should therefore consider

how sensory processing in young children with ASD both

supports and limits children’s ability to engage in social

communication and learning opportunities. Practitioners

should create effective context-specific interventions to

improve child participation in daily routines. s

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