Sensory Reactivity Symptoms Are Related to Specific Anxiety Symptomology in Autistic Children

Background:

Sensory reactivity symptoms are reported in around 60-90% of autistic individuals, such as being hyperreactive (e.g. over-sensitive to sounds), hyporeactive (e.g. under-responsive to touch), or sensory seeking (e.g. fascinated by lights). Additionally, over half of autistic children experience co-morbid anxiety disorders, which can impact learning, social inclusion, and future prospects. Sensory hyperreactivity can be distressing and has previously been linked to anxiety in autistic children. However, hyporeactivity and seeking behaviours are often neglected in research. Therefore, it is unclear if different sensory reactivity constructs relate to anxiety generally, as well as specific anxiety symptomology, such as generalised anxiety disorder (GAD) or obsessive-compulsive disorder (OCD).

Objectives:

This study aimed to elucidate the relationships between sensory reactivity sub-types (i.e. sensory hyperreactivity, hyporeactivity and seeking behaviour), and specific anxiety symptomology in autistic children.

Methods:

Sensory reactivity and anxiety were assessed for 40 autistic children (age 4 – 14 years, 11 females, 29 males) using a multidisciplinary approach, combining caregiver questionnaires, direct observation and self-report.

Caregiver reported sensory reactivity was measured by the Sensory Profile 2 (SP2) and Sensory Processing Scale Inventory (SPSI). Observed and caregiver-reported sensory reactivity was measured by the Sensory Assessment for Neurodevelopmental Disorders (SAND). Composite scores were derived from these measures for sensory hyperreactivity, hyporeactivity, and seeking behaviour.

Caregiver-reported anxiety was measured by the Spence Children’s Anxiety Scale (SCAS), the Preschool Anxiety Scale (PAS), which provide a score for total anxiety symptoms, and sub-scores for symptoms of panic attack/agoraphobia, separation anxiety (SAD), physical injury fears, social phobia, OCD, and GAD. Self-reported anxiety was measured using the Dominic Interactive computer game, which provides scores indicative of GAD, SAD, and specific phobia.

The relationship between sensory reactivity sub-types and specific anxiety symptoms were analysed using a bivariate correlation analysis, and a partial correlation analysis controlling for age. Significant multicollinear relationships were then analysed using hierarchical regression to explore predictive relationships.

Results:

Bivariate correlation analysis revealed principal correlations between sensory hyperreactivity and specific anxiety symptoms; total anxiety symptoms (r = .54, p = .002), SAD (r = .48, p = .005), physical injury fears (r = .48, p = .005) and GAD (r = .42, p = .03). OCD related to sensory hyperreactivity (r = .44, p = .01), hyporeactivity (r = .58, p = .001) and seeking behaviour (r = .37, p = .04). Hierarchical regression analyses established that hyporeactivity and hyperreactivity explained 39% of the variance in OCD, F(2,32) = 6.3, p = .002.

Conclusions:

The results suggest that sensory hyperreactivity is primarily related to specific anxiety symptomology and predicts total anxiety symptoms, and that sensory hyporeactivity could be a key predictor of OCD in autistic children. Understanding the role of sensory reactivity symptoms in anxiety is important for developing early clinical interventions, aimed at improving mental health outcomes. Future directions should determine the developmental relationship of sensory reactivity symptoms and specific anxiety symptomology, and further define the role of sensory hyporeactivity and seeking behaviour in the development and maintenance of anxiety symptoms in autistic children.