Findings from SPD Scientific Work Group

 

This information is updated as scientists in the SPD Scientific Work Group inform the SPD Foundation about their new findings.

The SPD Scientific Work Group, initially founded in 2002, is a collaboration of researchers who have been conducting studies to further the understanding of SPD. Funded by the Wallace Research Foundation, these researchers have helped develop a blueprint for current and future research into SPD.

Information about the scientists is available by clicking on their name. Please visit the active member listing for biographical information and links to work group member's websites.

 

What is the prevalence of SPD?

In a study of children born between July 1995 and September 1997 in the New Haven, CT area 16% of 7 to 11 year olds had symptoms of SPD-SOR (Ben-Sasson et al., 2009). That is the same as 1 in 6 children.  An earlier study in younger children (Ahn et al., 2004) found a prevalence of 5%, which is 1 in 20 children.

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What are the risk factors for SPD?

Several groups (Ben- Sasson et al., 2009; Keuler et al., 2011; May-Benson et al., 2009; Schneider et al., 2007, 2008, 2009; Wickremasinghe et al. in press;) suggest the following are possible risk factors associated with SPD:

  • Low birth weight (less than 2200 gram  
  • Prematurity (less than 36 weeks gestation)
  • Prenatal complications
  • Maternal stress
  • Maternal illness
  • Maternal use of medications
  • Delivery complications
  • Assisted delivery methods
  • Ethnic minority
  • Living with a single parent
  • Lower socioeconomic status

Schneider’s group (Schneider et al., 2007, 2008, 2009; Moore et al., 2008) working with non-human primates provided corroborating evidence. They found that SPD-SOR was associated with maternal stress during gestation, drug and/or alcohol use by mothers during pregnancy, and postnatal lead exposure. PET scans revealed up-regulation of D2-receptor binding that correlated with increased behavioral withdrawal responses to tactile stimuli, supporting the hypothesis that neurophysiologic factors contribute to the expression of SOR behavior.

Studies also suggest a possible genetic susceptibility for tactile and auditory SOR (Goldsmith et al., 2006).

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Is SPD a unique disorder, independent of other mental disorders?

SPD, like other DSM-IV recognized disorders such as ADHD and depression, can occur together with other mental disorders, but SPD quite often occurs alone, in the absence of other disorders.

Separate research groups, in different areas of the USA, have reported that many individuals with SPD-Sensory Over-Responsive (SOR) symptoms do not have other disorders:

  • 75% of individuals with SPD-SOR evaluated in CT (Carter et al., 2011)
            
  • 58% of individuals with SPD-SOR evaluated in WI (Van Hulle et al., 2012)
           
  • 37 to 67% of preschoolers with SPD-SOR in IL (Gouze et al., 2009).
  •        
  • 80% of those with SPD-SOR in CT do not meet DSM criteria for ADHD (Ben-Sasson et al., in preparation).

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Do symptoms of SPD persist if untreated?

Studies have shown that characteristics of SPD-SOR are stable and most often continue from 1 to 8 years of age in children who are not treated.

  • Atypical sensory characteristics of SPD-SOR observed in early childhood (1 to 3 years of age) are still present at 8 years of age (Ben-Sasson et al., 2010)
           
  • 50% of twins who were over-responsive to auditory stimuli at age 2 were over-responsive at age 4-5 (Goldsmith et al., 2007)
          
  • 48% of twins who were over-responsive to tactile stimuli at age 2 were over-responsive at age 4-5 (Goldsmith et al., 2007)
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Are there symptoms/challenges that individuals with SPD face, in addition to sensory challenges?

Individuals with SPD-Sensory Over-Responsivity (SOR) have been reported to be 4 times more likely to also have internalizing problems (e.g., anxiety) and 3 times more likely to have externalizing problems (e.g., aggression; Ben-Sasson et al., 2009).

Children with SPD-SOR have been reported to have impaired participation in daily life activities (e.g., lower levels of activities, reduced frequency of activities, less enjoyment of activities) with a direct relationship between severity of sensory symptoms and degree of activity impairment (Bar-Shalita et al., 2008).

Additionally, adults with SPD demonstrate social-emotional difficulties and impairments in quality of life (e.g., increased symptoms of anxiety, decreased sense of vitality, decreased social functioning, decreased general health, and increased bodily pain; Kinnealey et al., 2011).

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What physiologic evidence differentiates individuals with SPD from other conditions?

Several studies have shown that children with SPD- Sensory Over-Responsivity (SOR) have different physiological (i.e., electrodermal) responses to sensory stimuli compared to typically developing control children (McIntosh et al., 1999; Miller et al., 2012; Schoen et al., 2009) as well as children with autism spectrum disorders (Schoen et al., 2009) and ADHD (Miller et al., 2001). In particular, children with SPD-SOR were reported to have an increased number of and larger electrodermal responses to sensory stimuli as well as slower rates of habituation compared to typically developing control children (McIntosh et al., 1999). Additionally, children with SPD-SOR had greater levels of baseline arousal and higher reactivity in response to sensory stimuli than children with autism spectrum disorders (Schoen et al., 2009).

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What is the physiological basis of SPD?

Studies suggest that children with SPD-SOR have different neurophysiological (i.e., brain) responses to sensory stimuli than controls (Brett-Green et al., 2010; Davies & Gavin, 2007; Davies et al., 2009, 2010; Gavin et al., 2011).

  • Initial studies demonstrated that multisensory integration (i.e., information from different sensory modalities combining in the nervous system) can be reliably measured in typically developing children and children with SPD (Brett-Green et al., 2008, 2010). Additional findings suggest that the spatio-temporal pattern of both unisensory and multisensory nervous system processing of sensory stimuli is different in children with SPD-SOR than typically developing children (Brett-Green et al., 2010).
  • Studies suggest that children with SPD demonstrate less sensory gating and more within-group variability than typically developing control children (Davies, Chang, & Gavin, 2009; Davies & Gavin, 2007). Moreover, while sensory gating improves with age in typically developing children, the developmental trajectory in children with SPD-SOR is significantly different from the typically developing controls (Davies and Gavin, 2007; Davies et al., 2009, 2010). Children with SPD-SOR were also found to have decreased ability to regulate sensitivity to changes in frequency and volume of auditory tones compared to typically developing control children (Davies et al., 2009, 2010). A unique combination of the brain activity measured during in the intensity and gating paradigms correctly classified children with SPD-SOR versus typically developing children with 77-90% accuracy (Davies & Gavin, 2007; Davies et al., 2010; Gavin et al., 2011).
  • Studies suggest that boys with SPD have decreased white matter connectivity, particularly in the parietal regions of the brain that distinguish them from typical boys (Owen J & Marco E, submitted).
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 What are treatments for SPD?

Occupational therapy researchers and clinicians have developed effective behavioral treatments for SPD (Miller et al., 2007a, b, c). The most promising intervention that we know of is the STAR model.  This model includes the following elements;

  • Intensive model (3 to 5 times a week) for a set, relatively short time e.g., 20 to 40 sessions)
  • Priority on parent education (~ 1 of every 5 or 6 sessions is parents only)
  • Multi-disciplinary approach with pediatrician, psychologist, speech/language therapist and occupational therapist
  • Intervention model focuses on arousal regulation first, relationships and engagement second, and sensory integration third.  The overall goal of treatment is joie du vivre, (joy in life), not repairing sensory or motor functioning.  Sensory and motor activities are a means to an end; the end is 1) social participation 2) self-regulation, and 3) self-esteem & self-confidence.

    For more information see SPDstar.org and SPDuniversity.org

 

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How does SPD affect the family?

SPD symptoms have been shown to affect individual relationships as well as family engagement in personal and social routines. Differences between families with a child who has SPD and those who have typically developing children include the following for families with SPD:

  • Decreased frequency of taking a child with SPD to visit friends or family, to eat in a restaurant, to attend a community gathering
            
  • Parent exhaustion and parenting stress
           
  • Rates of family impairment are greater for families that have children with symptoms of SPD- Sensory Over-Responsivity (SOR) contributed to family life impairment above and beyond concurrent DSM-IV mental health diagnoses, and socioeconomic risk (Carter et al., 2011).

  • Reduced feelings of competance in their parenting role (Cohen et al. 2011)

 

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What are the characteristics of disorders that have comorbid SPD?

  • Examining children with ADHD based on their response to sensory challenge, Lane and Reynolds (Reynolds, Lane & Gennings, 2009) found that cortisol responses to a sensory change differ. Children with ADHD and SOR respond in a manner commensurate with the response of typical children, whereas children with ADHD-only showed a blunted response. This blunted cortisol response had been identified by other investigators for children with ADHD as a whole. This finding suggests that the larger group of children with ADHD might be better understood by also examining sensory responsivity; sensory responsivity influenced the cortisol or stress response (HPA activity) to sensory challenge in this population of children.
  • Children with both ADHD and SOR more often exhibit anxiety than do children with ADHD, but not SOR, and their level of anxiety was more likely to reach clinically significant levels, as determined by total scores on the Revised Children’s Manifest Anxiety Scale (Reynolds & Lane, 2009).
  • Links between SOR and anxiety are apparent in children without another diagnosis. Electrodermal (sympathetic nervous system) recovery from sensory challenge may be more difficult for typical children and children with ADHD if SOR is also apparent (Lane, Reynolds, & Thacker, 2010).
  • Examining participation in children with ASD, children demonstrating more frequent Sensory Sensitivity and Sensory Avoiding (Sensory Profile) had significantly lower overall level of competence in activities, social, and school performance (Child Behavior Checklist). (Reynolds, Bendixen, Lawrence, & Lane, 2011).
  • In examining the relationship between sleep and SOR in children with ASD and typical children, it was confirmed that children with ASD have a higher prevalence of atypical sensory behaviors and sleep disturbances than typical children. Overall, looking at all children in this study, behavioral and physiological measures were able to predict good sleepers versus poor sleepers with 85.7% accuracy, suggesting that atypical sensory behaviors are important to consider in relation to sleep deficits in children (Reynolds, Lane, & Thacker, 2011).
  • The relationship between sensory overresponsivity (SOR) and anxiety was examined in children with ASD, ADHD, and typical development. Path analysis indicated that the magnitude of sensory responsivity mediates the relationship between baseline arousal and attention on one hand, and anxiety and physiologic recovery from sensory challenge on the other. Further, behavioral tools used to measure SOR were not reflective of physiological responsiveness, a mismatch that warrants further investigation (Lane, Reynolds, & Dumenci, 2012).

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SPD Scientific Work Group research in progress

  • Ben-Sasson, Carter, & Briggs-Gowan: Subgroups of children with elevated SPD-SOR and ADHD scores versus elevation in one domain are being studied to understand the distinct nature of SOR versus ADHD. They have found that girls who show both elevated SOR and ADHD have greater severity of SOR in the tactile domain relative to boys in that cluster and compared to girls with only ADHD or only SOR.
            
  • Dr. Shelly Lane and Dr. Stacey Reynolds long term goal is to test the effectiveness of sensory-based arousal regulation activities, grounded in the theory of sensory integration, in improving attention and functional performance in children with neurodevelopmental disorders. Currently we are working to test the short-term effects of select sensory-based tasks on measures of attention and performance in children ages 6-10 with typical development, ADHD and ASD.
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References

Ahn, R., Miller, L. J., Milberger, S., &McIntosh, D. N. (2004). Prevalence of parents’ perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy, 58(3), 287-302.

Bar-Shalita, T., Vatine, J.J., & Parush, S. (2008). Sensory modulation disorder: a risk factor for participation in daily life activities. Developmental Medicine & Child Neurology, 50, 932-937.

Ben-Sasson, A., Carter, A.S., & Briggs Gowan, M.J. (2009). Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37,705-716.

Ben-Sasson, A., Carter, A.S., & Briggs-Gowan, M.J. (2010). The development of sensory over-responsivity from infancy to elementary school. Journal of Abnormal Child Psychology, 38(8), 1193-1202.

Ben-Sasson, A., Soto, T.W., Carter, A.S., & Briggs-Gowan, M.J. (in prep). Clusters of children with sensory over-responsivity and ADHD.

Carter, A.S., Ben-Sasson, A., & Briggs-Gowan, M.J. (2011). Sensory over-responsivity, psychopathology, and  family impairment in school-aged children. Journal of the American Academy of Child & Adolescent Psychiatry, 50(12), 1210-1219.

Cohn, E., May-Benson, T.A., Teasdale, A. (2011). The relationship between behaviors associated with sensory processing and parental sense of competence. OTJR: Occupation, Participation and Health 31(4):172-181.

Davies, P.L., Chang, W-P., & Gavin, W.J. (2009).  Maturation of Sensory Gating Performance in Children with and without Sensory Processing Disorders.  International Journal of Psychophysiology, 72,187-197.

Davies P.L., Chang, W.P., & Gavin, W.J. (2010). Middle and late latency ERP components discriminate between adults, typical children, and children with sensory processing disorders. Frontiers in Integrative Neuroscience, May 28; 4:16.

Davies, P.L. & Gavin, W.J. (2007). Validating the diagnosis of Sensory Processing Disorders using EEG technology.  American Journal of Occupational Therapy, 61(2), 176-189.

Gavin, W. J., Dotseth, A., Roush, K. K., Smith, C. A., Spain, H. D., & Davies, P. L. (2011). Electroencephalography in children with and without sensory processing disorders during auditory perception. American Journal of Occupational Therapy, 65, 370–377

Goldsmith, H.H., Van Hulle, C.A., Arneson, C.L., Schreiber, J.E., & Gernsbacher, M.A. (2006). A population-based twin study of parentally reported tactile and auditory defensiveness in young   children. Journal of Abnormal Child Psychology, 34(3), 393-407.

Goldsmith, H. H., Lemery-Chalfant, K., Schmidt, N. L., Arnerson, C.L., & Schmidt, C. K. (2007). Longitudinal analyses of affect, temperament, and childhood psychopathology. Twin Research and Human Genetics, 10(1), 118–126.

Gouze KR, Hopkins J, Lebailly SA, Lavigne JV (2009). Re-examining the epidemiology of sensory regulation dysfunction andcomorbid psychopathology. J of Abnorm Child Psychol 37:1077-1087.

Heath CJ, & Picciotto MR (2009). Nicotine-induced plasticity during development: modulation of the cholinergic system and long-term consequences for circuits involved in attention and sensory processing. Neuropharmacology 56 Suppl 1:254-262.

Keuler, M.M., Schmidt, N.L., Van Hulle, C.A., Lemery-Chalfant, K., & Goldsmith, H.H. (2011). Sensory  overresponsivity: prenatal risk factors and temperamental contributions. Journal of  Development & Behavioral Pediatrics, 32(7), 533-541.

Kinnealey, M., Koenig, K.P., & Sinclair, S. (2011). Relationships between sensory modulation and social supports and health-related quality of life. American Journal of Occupational Therapy, 65(3), 320-327.

Lane, S. J., Reynolds, S., & Dumenci, L. (2012). Sensory overresponsivity and anxiety in typically developing children and children with autism and attention deficit hyperactivity disorder: Cause or coexistence? American Journal of Occupational Therapy, 66, 1–9. http://dx.doi.org/10.5014/ajot.2012.004523

Lane, S.J., Reynolds, S., & Thacker, L. (2010). Sensory over-responsivity and ADHD: differentiating using electrodermal responses, cortisol, and anxiety. Frontiers in Integrative Neuroscience, 4(8),1-14. doi:10.3389/fnint.2010.00008

Larrauri JA & Levin ED (2010). PPI deficit induced by amphetamine is attenuated by the histamine H1 antagonist pyrilamine, but is exacerbated by the serotonin 5HT2 antagonist ketanserin. Psychopharmacology, 212:551-558.

Larrauri JA & Levin ED (2012). The α2-adrenergic antagonist idazoxan reverses prepulse inhibition deficits caused by amphetamine or dizocilpine in rats. Psychopharmacology,

Levin ED, Caldwell, DP, Perraut, C (2007). Clozapine treatment reverses dizocilpine-induced deficits of pre-pulse inhibition of tactile startle response. Pharmacology, Biochemistry and Behavior, 86:597-605.

May-Benson, T.A., Koomar, J.A., & Teasdale, A. (2009). Incidence of pre-, peri, and post-natal birth and developmental problems of children with sensory processing disorder and children with autism spectrum disorder. Frontiers in Integrative Neuroscience, 3, 31.

McIntosh DN, Miller LJ, Shyu V, Hagerman. (1999). Sensory-modulation disruption, electrodermal responses, and functional behaviors. Dev Med Child Neurol. 41:608-615.

Miller LJ, Anzalone ME, Lane, SJ, Cermak, SA, Osten, ET (2007a). Concept evolution in sensory integration: a proposed nosology for diagnosis. American Journal of Occupational Therapy 61(2):135-140.

Miller LJ, Coll, JR, Schoen, SA (2007b). A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy 61(2):228-238.

Miller LJ, Schoen SA, James K, Schaaf RC (2007c). Lessons learned: a pilot study on occupational therapy effectiveness for children with sensory modulation disorder. American Journal of Occupational Therapy 61(2):161-169.

Miller LJ, Nielsen DM, Schoen, SA (2012). Attention deficit hyperactivity disorder and sensory modulation disorder: Acomparison of behavior and physiology. Research in Developmental Disabilities 33:804-818.

Miller, L.J., Reisman, J. E., McIntosh, D. N., & Simon, J. (2001). An ecological model of sensory modulation: Performance of children with fragile x syndrome, autistic disorder, attention-deficit/hyperactivity disorder, and sensory modulation dysfunction. In S.S. Roley, E.I. Blanche, & R.C. Schaaf (Eds.), Understanding the nature of sensory integration in diverse populations (pp. 57-82). SanAntonio, TX: Therapy Skill Builders.

Moore, C.F., Gajewski, L.L., Laughlin, N.K., Luck, M.L., Larson, J.A., Schneider, M.L. (2008). Developmental lead exposure induces tactile defensiveness in rhesus monkeys (Macaca mulatta). Environmental Health Perspectives 116(10):1322-6.

Owen J., Marco E., (submitted). White matter microstructural abnormalities in sensory processing disorders. Annals of Neurology.

Reynolds, S., Bendixen, R.M., Lawrence, T., & Lane, S.J. (2011). A Pilot Study Examining Activity Participation, Sensory Responsiveness, and Competence in Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 41, 1496-1506. DOI 10.1007/s10803-010-1173-x.

Reynolds, S. & Lane, S.J. (2007). Diagnostic validity of sensory over-responsivity: a review of the literature and case reports. Journal of Autism and Developmental Disorder, 38(3), 516-529.

Reynolds, S., Lane, S. J., & Gennings, C. (online 2009). The Moderating Role of Sensory Over-responsivity in HPA Activity: A pilot study with children diagnosed with ADHD. Journal of Attention Disorders,13, 468-478. doi:10.1177/1087054708329906

Reynolds, S., Lane, S.J., & Thacker, L. (2011). Sensory processing, physiological stress, and sleep behaviors in children with and without autism spectrum disorder. OTJR: Occupation, Participation, and Health, 31(2), 246-257.

Reynolds, S., Shepherd, J., Lane, S.J. (2008). Sensory modulation disorders in a minority Head Start population: Preliminary prevalence and characterization. Journal of Occupational Therapy, Schools & Early Intervention, 1(3), 186-198

Schneider, M.L., Moore, C.F., Gajewski, L.L., Laughlin, N.K., Larson, J.A., Gay, C.L., Roberts, Converse, A.K., & DeJesus, O.T. (2007). Sensory processing disorders in a nonhuman primate model: evidence for occupational therapy practice. The American Journal of Occupational Therapy, 61, 247-253.

Schneider, M.L., Moore, C.F., Gajewski, L.L., Larson, J.A., Roberts, A.D., Converse, A.K., & DeJesus, O.T. (2008). Sensory processing disorder in a primate model: evidence from a longitudinal study of prenatal stress effects. Child Development, 79(1), 100-113.

Schneider, M.L., Moore, C.F., Larson, J.A., Barr, C.S., DeJesus, O.T., & Roberts, A.D. (2009). Timing of moderate level of prenatal alcohol exposure influences gene expression of sensory processing behavior in rhesus monkeys. Frontiers in Integrative Neuroscience, 3, 30.

Schoen, S.A., Miller, L.J., Brett-Green, B.A., & Nielsen, D.M. (2009). Physiological and behavioral differences in sensory processing: a comparison of children with autism spectrum disorder and sensory modulation disorder. Frontiers in Integrative Neuroscience, 3, 29.

Van Hulle, C.A., Schmidt, N.L., & Goldsmith, H.H. (2012). Is sensory over-responsivity distinguishable from childhood behavior problems? A phenotypic and genetic analysis. Journal of Child Psychology and Psychiatry, 53(1), 64-72.

Wickremasinghe, A.C., Rogers, E.E., Johnson, B.C., Shen, A., Barkovich, A.J., Marco, E.J. (in press). Children born prematurely have atypical sensory profiles. Journal of Perinatology.

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