Sensory over-Responsivity Is Associated with Anxiety Disorders in Preschoolers with Autism and Typical Development

Background: Around 50% of individuals with autism spectrum disorder (ASD) have a comorbid anxiety disorder. Despite the fact that anxiety disorders are common and impairing in individuals with ASD, we know little about the early risk factors for anxiety in ASD, especially in the preschool period. One such risk factor is sensory over-responsivity - a set of symptoms characterized by heightened and unusual reactivity to sensory stimuli.

Objectives: We conducted an in-depth study of the relationship between sensory over-responsivity and anxiety symptoms in preschool age children with ASD as compared to typically developing (TD) children.

Methods: Ninety-six 3-6 year old children (65 ASD, 31 TD) participated in this study. ASD was diagnosed using the ADOS and ADI-R by research reliable examiners. Sensory challenges were assessed via parent report using the Sensory Experiences Questionnaire v3.0 (SEQ). Anxiety disorders, including generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social anxiety disorder, and specific phobia, were assessed with the Preschool Age Psychiatric Assessment (PAPA). The relationship between sensory over-responsivity and anxiety was tested with Pearson correlations. The relative odds of meeting criteria for anxiety disorders given mean sensory over-responsivity score was tested with logistic regression. In the TD group, exact logistic regression was used to account for limited sample size.

Results: Forty-six children (71%) with ASD and 11 TD children (35%) met both symptom and impairment criteria for at least one anxiety disorder. Further, 39 children (60%) with ASD and 4 TD children (13%) fell 2SDs above typically developing norms for sensory over-responsivity. Overall, there was a significant correlation between mean sensory over-responsivity score and number of anxiety symptoms in all children (r²=0.68, p<0.0001), as well as in both groups separately (ASD: r²=0.60, p<0.0001; TD: r²=0.44, p=0.01). This relationship translated into a 5-fold increased chance of anxiety in children with high levels of sensory over-responsivity in the ASD group (OR 5.5, 95% CI: 1.72, 17.56, p<0.01) and a 7-fold increase in the TD group, though it was not statistically significant in the TD group (OR 7.1, 95% CI: 0.64, 79.24, p=0.1). In the ASD group, sensory over responsivity significantly increased the odds of GAD by a factor of 6 (OR 6.6, 95% CI: 1.69, 25.55, p<0.01) and SAD by a factor of 3 (OR 3.6, 95% CI: 1.26, 10.32, p=0.02). In the TD group, sensory over responsivity increased the odds of SAD by a factor of 15 (OR 14.96, 95% CI: 0.952, 942.9 p=0.056), but was not associated with other types of anxiety.

Conclusions: Results suggest sensory over-responsivity is strongly associated with anxiety disorders in preschoolers with ASD, as well as TD preschoolers. In preschoolers with ASD, sensory over-responsivity is associated with both GAD and SAD. In TD preschoolers, preliminary results suggest it is associated with SAD only. Identifying early child characteristics, such as sensory over-responsivity, that confer risk for anxiety may set the stage for the development of targeted treatment strategies that can reduce or prevent anxiety before it emerges in young children.