The Relationship Between Sensory Challenges and Executive Function Differs By Patterns of Sensory Responses in Preschoolers with Autism

Background: Sensory challenges, including sensory hyperresponsivity (i.e. over-reactivity to sensory input) and sensory hyporesponsivity (i.e. under-reactivity to sensory input), occur in over half of children with autism. Despite the role of executive functions, such as the ability to shift attention and inhibit behavioral responses, in the regulation of behavioral reactions to sensory stimuli, a previous study of high-functioning children with autism did not find a link between overall sensory challenges and executive dysfunction. One potential explanation for this lack of a link is that different patterns of sensory challenges are correlated with distinct executive dysfunctions.

Objectives: To identify the extent to which specific domains of executive functions, namely the abilities to shift attention and to inhibit responses, are correlated with distinct patterns of sensory challenges.

Methods: 29 children (22 Males, 7 Females) with autism between 3 and 6 years old were recruited for a study on sensory over-responsivity and anxiety in autism. Autism diagnoses were confirmed with the Autism Diagnostic Observation Schedule (ADOS-2) and the Autism Diagnostic Interview (ADI-R). Sensory challenges were characterized through parent report with the Sensory Experiences Questionnaire 3.0 (SEQ) and through behavioral observation of the child with the Sensory Processing Assessment (SPA) and the Tactile Defensiveness and Discrimination Test-Revised (TDDT-R). Executive functioning was measured through parent report using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P). We focused on the three main scales of the BRIEF-P: Shifting, Inhibition, and Emotional Control. The Shifting scale assesses a child’s ability to flexibly switch behaviors in response to external demands, including making transitions, problem-solving, and switching attention. The Inhibition scale assesses a child’s ability to resist impulses and to inhibit their behavior appropriately. Finally, the Emotional Control scale measures the impact of executive dysfunction on a child’s ability to modulate their emotional responses.

Results: Both parent reported and observational measures of sensory hyperresponsivity were associated with worse scores on the Shifting scale of the BRIEF-P. Parent reported sensory hyporesponsivity was also associated with greater dysfunction in the Shifting scale, however this relationship did not remain significant when controlling for age and IQ. Parent reported sensory hyporesponsivity was correlated with higher scores on the Inhibition scale of the BRIEF-P. Finally, emotional control was associated with parent reported hyper- and hyporesponsivity. ADOS severity was not associated with degree of sensory challenges or executive dysfunction.

Conclusions: Results suggest that different patterns of sensory challenges are correlated with distinct executive dysfunctions in young children with ASD. Specifically, after controlling for age and IQ, difficulties with flexibly switching behaviors are associated with increased sensory hyperresponsivity, but not sensory hyporesponsivity. On the other hand, difficulties with behavioral inhibition is associated with increased sensory hyporesponsivity, but not sensory hyperresponsivity. Understanding how specific neurocognitive mechanisms may influence children’s ability to regulate sensory challenges may provide more specific targets for early intervention aimed at decreasing the negative impact of sensory challenges, such as decreased adaptive behavior and increased parental stress, in individuals with ASD.