The Adult Sensory Profile: measuring patterns of sensory processing

Prevalence Models to Support Participation: Sensory Patterns as a Feature of All Children’s Humanity

Purpose

Research about children tends to consider differences from expected patterns problematic, and associates differences with disabilities [e.g., Autism, attention deficit hyperactivity disorder (ADHD)]. When we focus on disabilities and consider differences automatically problematic, we miss the natural variability in the general population. The International Classification of Functioning, Disability and Health (ICF 11) acknowledges that the experience of disability results from interactions between “environmental” and “personal” factors which determine the person’s capacity to participate. The purpose of this study was to examine sensory patterns across a national sample of children in the general population and samples of children with disabilities to investigate the extent to which differences in sensory processing are representative of natural variability rather than automatically problematic or part of a disability.

Materials and Methods

We employed descriptive statistics and chi-square tests to examine sensory processing patterns in children in the general population and autistic children and children with ADHD. We used standardization and validity data from the Sensory Profile 2 to conduct analyses.

Results

Consistent sensory patterns exist across all groups. Children in all groups had different rates of certain patterns.

Conclusion

Since children in all groups have certain sensory patterns, we cannot associate differences with problematic behaviors. Children participating successfully with all sensory patterns might provide insights for universal design that supports participation of all children.

The Need for Sensory-Friendly "Zones": Learning From Youth on the Autism Spectrum, Their Families, and Autistic Mentors Using a Participatory Approach

Introduction

Differences in sensory processing were linked to a diagnosis of autism spectrum disorder (ASD) before its inclusion as a core characteristic in the revised DSM-V. Yet, research focused on sensory processing and meaningful participation of children and youth with ASD remains relatively scarce. Although refinement of the International Classification of Functioning and Disability (ICF) relies on first-person accounts, longitudinal studies that foreground sensory experiences and its impact on involvement in a life situation from first-person perspectives are largely missing from this body of research.

Objectives

In this sub-study, we drew from a longitudinal participatory research project consisting of two separately funded studies with children and youth with ASD and their families between 2014 and 2021. The participatory project used photovoice (PV) methods to identify the primary concerns related to socio-spatial exclusion (PV-1) and the action steps needed to redress them (PV-2). The objective of this sub-study was to understand what really mattered to children with autism, their parents, autistic youth and an adult mentor to consider how their experiential knowledge could deepen understanding of meaningful participation.

Materials and Methods

We used an overarching narrative phenomenological and aesthetic theoretical framework to focus data analysis on the bodily sensing experiences related to significant moments or events, followed by an inductive thematic analysis of what mattered about those moments.

Results

The topical areas of concern that emerged from analyses were: (1) the relationship between sensory experiences and mental health (motion madness); (2) the indivisibility or layering of sensory and social experiences (squishing and squeezing); (3) the impact when "tricks" to stay involved are categorically misunderstood (When you don't respond in the correct way), and (4) how care and consideration of others can lead to innovative solutions for inclusion (I can't be the only one). Listening to the bodily-sensing experiences of children with ASD, autistic youth and adults, and their families in their own terms has implications for remapping the ICF and envisioning sensory curb-cuts to access, initiate and sustain occupational participation for all.

Investigating autonomic biomarkers of sensory processing patterns in young adults

Introduction

Autonomic nervous system functioning is theorised to underpin individual differences in sensory processing, with a small amount of supporting evidence. Despite recognition of the need to measure the balance between sympathetic and parasympathetic activity, most studies have measured only one of these systems. This study investigated whether sensory processing patterns are related to autonomic balance for young adults at rest and in response to a sensory-based stressor.

Method

In this cross-sectional laboratory study, 100 young adults completed the adolescent/adult sensory profile. Heart rate variability and pre-ejection period were recorded before, during and after a coldpressor task.

Results

Relationships between sensory processing patterns and autonomic balance varied by gender. In males, low sensory thresholds were generally related to a state of reciprocal sympathetic activation. In females, low thresholds were associated with greater autonomic reactivity in response to the coldpressor.

Conclusion

This study showed, for the first time in young adults, that sensory processing patterns may be linked to patterns of autonomic balance. Therapists should be aware that young men with low sensory thresholds may be more likely than others to exhibit a resting state of sympathetic hyperarousal and further research should investigate whether this impacts their daily functioning and wellbeing.

Increased context adjustment is associated with auditory sensitivities but not with autistic traits

Bayesian models of autism suggest that alterations in context-sensitive prediction error weighting may underpin sensory perceptual alterations, such as hypersensitivities. We used an auditory oddball paradigm with pure tones arising from high or low uncertainty contexts to determine whether autistic individuals display differences in context adjustment relative to neurotypicals. We did not find group differences in early prediction error responses indexed by mismatch negativity. A dimensional approach revealed a positive correlation between context-dependent prediction errors and subjective reports of auditory sensitivities, but not with autistic traits. These findings suggest that autism studies may benefit from accounting for sensory sensitivities in group comparisons. LAY SUMMARY: We aimed to understand if autistic and non-autistic groups showed differences in their electrical brain activity measured by electroencephalography (EEG) when listening to surprising tones infrequently embedded in a statistical pattern. We found no differences between the autistic and the non-autistic group in their EEG response to the surprising sound even if the pattern switched, indicating their ability to learn a pattern. We did find that, as subjective sensory sensitivities (but not autistic traits) increased, there were increasingly large differences between the EEG responses to surprising tones that were embedded in the different statistical patterns of tones. These findings show that perceptual alterations may be a function of sensory sensitivities, but not necessarily autistic traits. We suggest that future EEG studies in autism may benefit from accounting for sensory sensitivities.

Relationship between Sensitivity Tendency and Psychological Stress Reactivity in Healthy Students

This study examined the relationship between sensory processing sensitivity and psychological stress reactivity in 69 healthy Japanese university students. The Japanese version of the Highly Sensitive Person Scale and the Japanese version of the Adolescent/Adult Sensory Profile were used for subjective assessment. The Galvanic skin response was measured as an objective measure of stress responses while the participants were completing the Stroop task. The Wilcoxon signed-rank test, the Spearman rank correlation coefficient, and the Mann−Whitney U test were conducted for data analysis. The results demonstrated that there was no significant correlation between the Japanese version of the Highly Sensitive Person Scale and Galvanic skin response. However, there was a marginal trend toward significance between low registration in the Japanese version of the Adolescent/Adult Sensory Profile and Galvanic skin response (rs = 0.231, p < 0.10; rs = 0.219, p < 0.10), suggesting that self-rated sensitivity was not necessarily associated with objective measures. These results indicate that sensory processing sensitivity analyses require the consideration of the traits and characteristics of the participants and multifaceted evaluations using a sensitivity assessment scale other than the Japanese version of the Highly Sensitive Person Scale.

Effectiveness of sensory modulation for people with schizophrenia: A multisite quantitative prospective cohort study

INTRODUCTION

Current research evidence suggests that people with schizophrenia have sensory processing difficulties. Sensory modulation has growing evidence for use in this population. This study aimed to evaluate the extent to which health, social, cognitive, and occupational functioning outcomes were impacted by sensory modulation interventions for people with schizophrenia.

METHODS

A prospective observational cohort study using a waitlist control design was used in two large hospital and health services in Queensland, Australia. The study recruited patients who used sensory modulation (n = 30) across the two hospitals and those who did not use sensory modulation interventions as a control (n = 11). Results were analysed using a series of planned comparisons including independent and paired t-tests, and mixed ANOVA was used whenever statistically indicated. The analysed measures were pre- and post-intervention scores.

RESULTS

This study found no statically significant differences between the control and intervention groups at both pre- and post-intervention. However, analysis of results from within the intervention group showed statistically significant improvements between pre- and post-test scores on distress, occupational functioning, and health and social functioning but not on sensory processing and global cognitive processing. Further analysis of results from this study, compared with those from an earlier study on the general population showed significant differences in Low Registration and Sensation Avoiding, as measured by the Adult/Adolescent Sensory Profile, between participants with schizophrenia and those without schizophrenia.

CONCLUSION

This study provides evidence to suggest that sensory modulation interventions can be complementary to standard care when utilised appropriately in clinical settings. Findings also suggest that the sensory profile of people with schizophrenia is different to that of the general population and this may have clinical implications. Further longitudinal research is needed with larger and randomised samples, using more targeted measures to better explore effectiveness of sensory modulation interventions.

Sensory Processing Difficulties in Patients with Functional Neurological Disorder: Occupational Therapy Management Strategies and Two Cases

Functional neurological disorder (FND) is a condition at the intersection of neurology and psychiatry, with some patients experiencing sensory hypersensitivities and other sensory processing difficulties. It has been postulated that poor integration and modulation of sensory information with cognitive, affective and behavioral processes may play a role in the pathophysiology of FND. In this article, we first succinctly review the role for occupational therapy (OT) in the multidisciplinary therapeutic approach to managing patients with FND. After highlighting previously published data identifying sensory processing difficulties in patients with FND, we subsequently outline the components of the sensory-based outpatient OT program for FND at the Massachusetts General Hospital. Here, we detail how occupational therapists assess and treat sensory modulation difficulties with the aid of resources like the Adolescent/Adult Sensory Profile (AASP), The Canadian Occupational Performance Measure (COPM), and the Sensory-Motor Preference Checklist. We then report on 2 clinical cases representative of the sensory modulation difficulties endorsed by some patients with FND, illustrating how developing an individualized, sensory-based treatment plan can help improve functional neurological symptoms and overall participation in activities of daily living. Prospective, controlled research is needed to further operationalize OT-based sensory modulation interventions, as well as define the tolerability and efficacy of this intervention for pediatric and adult populations with FND.

The Effects of Ayres Sensory Integration and Related Sensory Based Interventions in Children with Cerebral Palsy: A Scoping Review

The theory of Ayres Sensory Integration^® was formulated in the 1960s, and is also known as sensory integration (SI). It has been used in people with cerebral palsy (CP), though the research evidence for its effects in this population is contradictory and inconclusive. To fill in this knowledge gap, we conducted a scoping review of the body of literature on the topic, including any type of quantitative or qualitative research of SI in people with CP without any restrictions of age, language, geography, professionals involved, etc. In September 2020, we searched Scopus, ProQuest Central, MEDLINE (via PubMed), CINAHL Plus and the Academic Search Ultimate and Web of Science, as well as the grey literature sources OpenGrey and MedNar. Two reviewers independently screened the texts and the references lists of the included papers. We finally included seven relevant papers (four randomized controlled trials, two quasi-experimental studies and one case series), though not all fidelity measures required for Ayres SI were reported in the papers. The age of participants ranged from 3 months to 15 years; no studies were identified on adults. There is some evidence that SI or related sensory-based interventions (SBI) may be useful for movement development and other outcomes (attention span, therapy of sensory processing disorders, body perception and therapy of strabismus), but there is only scarce and low-quality evidence comparing interventions. We recommend to conduct well-designed randomized controlled trials (RCTs) with an optimal sample size on the effectiveness of formal Ayres SI for the motor development or other outcomes (as attention span or self-care abilities) using standardized measurement tools.

Toward a Multidimensional Understanding of Misophonia Using Cluster-Based Phenotyping

Misophonia is a condition characterized by hypersensitivity and strong emotional reactivity to specific auditory stimuli. Misophonia clinical presentations are relatively complex and reflect individualized experiences across clinical populations. Like some overlapping neurodevelopmental and neuropsychiatric disorders, misophonia is potentially syndromic where symptom patterns rather than any one symptom contribute to diagnosis. The current study conducted an exploratory k-means cluster analysis to evaluate symptom presentation in a non-clinical sample of young adult undergraduate students (N = 343). Individuals participated in a self-report spectrum characteristics survey indexing misophonia, tinnitus severity, sensory hypersensitivity, and social and psychiatric symptoms. Results supported a three-cluster solution that split participants on symptom presentation: cluster 1 presented with more severe misophonia symptoms but few overlapping formally diagnosed psychiatric co-occurring conditions; cluster 3 was characterized by a more nuanced clinical presentation of misophonia with broad-band sensory hypersensitivities, tinnitus, and increased incidence of social processing and psychiatric symptoms, and cluster 2 was relatively unaffected by misophonia or other sensitivities. Clustering results illustrate the spectrum characteristics of misophonia where symptom patterns range from more “pure” form misophonia to presentations that involve more broad-range sensory-related and psychiatric symptoms. Subgroups of individuals with misophonia may characterize differential neuropsychiatric risk patterns and stem from potentially different causative factors, highlighting the importance of exploring misophonia as a multidimensional condition of complex etiology.

A survey of autistic adults, relatives and clinical teams in the United Kingdom: And Delphi process consensus statements on optimal autism diagnostic assessment for adults

Accessing adult autism diagnostic pathways can be difficult. This study explored perspectives of UK autistic adults, relatives and clinicians regarding the characteristics of optimal adult autism assessment and diagnostic services. In stage 1, three key stakeholder groups were surveyed about experiences of adult autism diagnostic services (pre-assessment/assessment): 343 autistic adults, 45 relatives and 35 clinicians completed parallel surveys. Information from stage 1 surveys was used to devise statements for a modified Delphi process in stage 2 seeking consensus among clinicians on optimal diagnostic service characteristics. Data analyses were non-parametric and descriptive. Over half of adults were in contact with mental health services prior to autism diagnosis. Clinicians reported that multidisciplinary diagnostic teams lacked key professionals. Thirteen statements describing optimal autism diagnostic service provision were developed. There was consensus from clinicians on 11 statements relating to clear assessment pathways, updates for people while waiting, pre-assessment information gathering/provision, co-occurring condition identification and training/networking. Some autistic adults, relatives and clinicians were positive about services, all stakeholders identified improvements were needed. The findings describing optimal service provision are relevant for UK clinicians, managers and commissioners to improve diagnostic assessments for autistic adults, and have international relevance for similar health systems.

Sensory Processing, Perceived Stress and Burnout Symptoms in a Working Population during the COVID-19 Crisis

Although previous research suggests an association between sensory processing and perceived stress in a broad spectrum of mental health conditions, it remains unclear whether this phenomenon occurs independently from psychopathology. The present study investigated the association between sensory processing patterns, perceived stress and occupational burnout as a stress-related condition in a working population. We focused on different aspects of sensory processing and used the momentum of a particularly stressful period: during the first months of the global COVID-19 crisis. A total of 116 workers at a mental healthcare institution in The Netherlands completed the Adolescent/Adult Sensory Profile (AASP), the Perceived Stress Scale (PSS-10) and the Burnout Assessment Tool (BAT). Our results demonstrated that higher scores on sensory sensitivity and low registration were associated with higher scores on perceived stress and core burnout symptoms. Sensory hypersensitivity was also associated with more secondary burnout symptoms. Associations were not driven by underlying sensory-related disorders (e.g., ASD or ADHD). In conclusion, sensory processing difficulties are relevant predictors of stress and occupational burnout, also in healthy employees. This phenomenon warrants further attention, as relatively simple adjustments in working environment may possess important preventive effects.

Atypical Sensory Processing Is Associated With Lower Body Mass Index and Increased Eating Disturbance in Individuals With Anorexia Nervosa

BACKGROUND

Elevated autism spectrum disorder (ASD) traits are associated with anorexia nervosa (AN). Conversely, eating disturbances, which are core characteristics of AN, are common in ASD. Among individuals with ASD, atypical sensory processing is associated with eating disturbance. Because AN and ASD appear to overlap, it would be crucial to understand whether sensory processing atypicality exist also in AN. Further, it would be essential to find if atypical sensory processing is associated with eating disturbances in individuals with AN, since treatment modifications may be needed. We therefore aimed to examine whether atypical sensory processing is associated with AN and its core characteristics.

METHODS

Participants of the current study included 42 individuals with AN and 40 healthy controls (HCs). All participants were adult women. Sensory processing, other ASD traits, and eating disorder symptoms were assessed with self-report questionnaires.

RESULTS

Individuals with AN reported lower registration, decreased sensation seeking, increased sensory sensitivity, and increased sensation avoiding compared to HCs. When analyzing groups with restrictive AN (AN-R) and binge-purge type AN (AN-BP) separately, only individuals with AN-R exhibited decreased sensation seeking, and only those with AN-BP exhibited lower registration. After controlling for body mass index as a covariate, group differences remained significant only in sensory sensitivity between individuals with AN and HCs. Increased atypical sensory processing predicted lower body mass index and increased disordered eating.

CONCLUSION

Results suggest that sensory processing appears to differ between AN and HC women, and AN subtypes may exhibit distinct sensory processing atypicality. Sensory sensitivity may be stable traits whereas other aspects of atypical sensory processing may be related to acute AN. Atypical sensory processing may contribute to the severity of AN, and thus it is crucial to recognize sensory processing differences when treating individuals with AN.

Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study

Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants' sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment.

Atypical Auditory Perception Caused by Environmental Stimuli in Autism Spectrum Disorder: A Systematic Approach to the Evaluation of Self-Reports

Recent studies have revealed that atypical sensory perception is common in individuals with autism spectrum disorder (ASD) and is considered a potential cause of social difficulties. Self-reports by individuals with ASD have provided great insights into atypical perception from the first-person point of view and indicated its dependence on the environment. This study aimed to investigate the patterns and environmental causes of atypical auditory perception in individuals with ASD. Qualitative data from subject reports are inappropriate for statistical analysis, and reporting subjective sensory experiences is not easy for every individual. To cope with such challenges, we employed audio signal processing methods to simulate the potential patterns of atypical auditory perception. The participants in our experiment were able to select and adjust the strength of the processing methods to manipulate the sounds in the videos to match their experiences. Thus, the strength of atypical perception was recorded quantitatively and then analyzed to assess its correlation with the audio-visual stimuli contained in the videos the participants observed. In total, 22 participants with ASD and 22 typically developed (TD) participants were recruited for the experiment. The results revealed several common patterns of atypical auditory perception: Louder sounds perceived in a quiet environment, noise perception induced by intense and unsteady audio-visual stimuli, and echo perception correlated with movement and variation in sound level. The ASD group reported atypical perceptions more frequently than the control group. However, similar environmental causes were shared by the ASD and TD groups. The results help us infer the potential neural and physiological mechanisms of sensory processing in ASD.

Top-down, bottom-up, and history-driven processing of multisensory attentional cues in intellectual disability: An experimental study in virtual reality

Models of attention demonstrated the existence of top-down, bottom-up, and history-driven attentional mechanisms, controlled by partially segregated networks of brain areas. However, few studies have examined the specific deficits in those attentional mechanisms in intellectual disability within the same experimental setting. The aim of the current study was to specify the attentional deficits in intellectual disability in top-down, bottom-up, and history-driven processing of multisensory stimuli, and gain insight into effective attentional cues that could be utilized in cognitive training programs for intellectual disability. The performance of adults with mild to moderate intellectual disability (n = 20) was compared with that of typically developing controls (n = 20) in a virtual reality visual search task. The type of a spatial cue that could aid search performance was manipulated to be either endogenous or exogenous in different sensory modalities (visual, auditory, tactile). The results identified that attentional deficits in intellectual disability are overall more pronounced in top-down rather than in bottom-up processing, but with different magnitudes across cue types: The auditory or tactile endogenous cues were much less effective than the visual endogenous cue in the intellectual disability group. Moreover, the history-driven processing in intellectual disability was altered, such that a reversed priming effect was observed for immediate repetitions of the same cue type. These results suggest that the impact of intellectual disability on attentional processing is specific to attentional mechanisms and cue types, which has theoretical as well as practical implications for developing effective cognitive training programs for the target population.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

The peril and promise of sensitivity in eating disorders

Differential susceptibility, a reconceptualization of the diathesis-stress model of psychopathology, describes gene-environment interactions that reflect individual differences in responsiveness to environmental influences, both detrimental and beneficial. This model has been described metaphorically by the classification of orchids, which thrive under optimal care but wither under adverse conditions, and dandelions, which weather broad environmental circumstances but are less responsive to careful cultivation. Etiological research in the field of eating disorders has largely focused on the identification of specific behavioral phenotypes, temperamental traits, genotypes and neurobiological processes that confer risk. In this article, we propose that these putative vulnerability factors represent phenotypes and endophenotypes of a genetic predisposition towards environmental sensitivity. We assert that this sensitivity not only transmits eating disorder risk but also confers resilience, depending on the circumstances. In particular, we propose that differential susceptibility can be used as a framework to organize disparate temperamental and neurobiological findings and their complex interplay with various developmental, environmental and sociocultural influences to increase eating disorder risk and treatment responsiveness. Finally, we assert that viewed through the lens of differential susceptibility, sensitivity can be leveraged to refine our interventions and develop novel treatment and prevention strategies to support favorable outcomes for individuals with eating disorders.

Food neophobia and the evaluation of novel foods in adults; the sensory, emotional, association (SEA) model of the decision to taste a novel food

Reluctance to eat new foods, known as food neophobia, is well researched in children but not adults. Two studies were carried out to understand the emotional, sensory, and cognitive factors associated with food neophobia in an adult sample, and to propose a preliminary explanation of the decision to taste a novel food named the SEA model (Sensory, Emotional, cognitive Association model). Participants were recruited through opportunity sampling of a university population in the Leicester region of the UK. Study one (n = 534) was a cross sectional study examining associations between self-report measures of food neophobia, emotional variables and sensory variables. In study two (n = 160), participants completed an online cognitive evaluation of 7 images of novel fruits and vegetables, rating perceived familiarity, categorisation as fruit or vegetable, cognitive associations based on appearance (what does the food look like), liking of any associated foods, and expected liking of the novel food. In study 1 it was found that tactile sensitivity and disgust sensitivity were the main sensory and emotional variables associated with food neophobia. In study 2, it was found that food neophobia and lower expected liking of novel foods were associated with disgust sensitivity, associating the novel foods with disliked foods, and lower perceived familiarity. The SEA model further proposes that underlying tendencies and automatic reactions to foods, combine with cognitive associations based on negative memories and negative beliefs about tasting new foods, to create expected disliking of a food and a decreased likelihood that it will be tried. Further work is needed to fully test the SEA model of the decision to taste a novel food, in particular to further examine how associations are formed.

Sensory processing and detection thresholds of burn-injured patients: A comparison to normative data

OBJECTIVE

Emerging evidence suggests that individual levels of sensory sensitivity may impact treatment outcomes for people recovering from burn injuries. For example, individuals with higher levels of sensory sensitivity were less adherent with compression garment wear, often used for scar management. The purpose of this study was to characterise sensory patterns for a sample of burn-injured patients as a cohort, using normative data as the reference. As different patterns of sensory processing can have implications clinically, understanding this at the cohort level may provide valuable insight for therapy.

METHOD

This was a secondary analysis of data collected during a cross-sectional study. Adults (N = 117) attending the Professor Stuart Pegg Adult Burns Unit outpatient clinic completed the Adolescent/Adult Sensory Profile and the following quantitative sensory tests: two-point discrimination; mechanical detection threshold; and pressure pain threshold.

RESULTS

Compared to matched normative data, burn-injured patients reported higher levels of sensory sensitive and avoiding patterns, and experienced lower detection thresholds for touch and pain.

CONCLUSIONS

Higher reports of sensory sensitivity and sensory avoiding, and lower thresholds for touch and pain, have been correlated with tactile defensiveness. Tactile defensiveness has been associated with social withdrawal and isolation, all of which could contribute to decreased engagement in therapy. The ways in which these sensory characteristics impact on burn-related treatments, such as compression garment adherence, warrant further investigation.

World model learning and inference

Understanding information processing in the brain-and creating general-purpose artificial intelligence-are long-standing aspirations of scientists and engineers worldwide. The distinctive features of human intelligence are high-level cognition and control in various interactions with the world including the self, which are not defined in advance and are vary over time. The challenge of building human-like intelligent machines, as well as progress in brain science and behavioural analyses, robotics, and their associated theoretical formalisations, speaks to the importance of the world-model learning and inference. In this article, after briefly surveying the history and challenges of internal model learning and probabilistic learning, we introduce the free energy principle, which provides a useful framework within which to consider neuronal computation and probabilistic world models. Next, we showcase examples of human behaviour and cognition explained under that principle. We then describe symbol emergence in the context of probabilistic modelling, as a topic at the frontiers of cognitive robotics. Lastly, we review recent progress in creating human-like intelligence by using novel probabilistic programming languages. The striking consensus that emerges from these studies is that probabilistic descriptions of learning and inference are powerful and effective ways to create human-like artificial intelligent machines and to understand intelligence in the context of how humans interact with their world.

Internal Consistency and Item Analysis of the Persian Version of the Child Sensory Profile 2 in Vulnerable Populations

Objective: The purpose of the present study was to establish the item analysis and internal consistency of the Persian version of the Child Sensory Profile 2 in 2 groups of typical and atypical children (autism spectrum disorder and learning disabilities) aged 3 to 14 years.

Method: The sample of this study included 120 typical and atypical children aged 3 to 14 years who referred to schools and rehabilitation centers in Tehran were selected using multistage sampling method. To collect data, the Child Sensory Profile 2 questionnaire was used, which is a set of questionnaires of the Sensory Profile 2. To analyze the data, the discrimination index was used to determine the discriminant validity of the Child Sensory Profile 2, and the Cronbach's alpha coefficient was used to determine the reliability in terms of internal consistency.

Results: Discrimination index was satisfactory for all the items of the Child Sensory Profile 2. The values of Cronbach's alpha ranged from 0.795-0.919 in typical children and 0.617-0.901 in autistic children, and 0.792-0.920 in children with learning disabilities.

Conclusion: The Persian version of the child sensory profile 2 is a valid (discrimination with vulnerable populations) and reliable (internal consistency) tool for assessing sensory processing.

Subjective sensory sensitivity and its relationship with anxiety in people with probable migraine

OBJECTIVE

To better characterize differences in interictal sensory experience in adults with migraine and more comprehensively describe the relevance of anxiety to these experiences.

BACKGROUND

Evidence suggests that sensitivity to sensory input may not be limited to migraine attacks but continues between them. However, there is a need to better understand whether this is the case across senses, and to clearly distinguish sensory experience from measured sensory threshold, which are not straightforwardly related. Previous literature also indicates a co-occurrence between sensory sensitivity, migraine, and anxiety, but this relationship remains to be fully elucidated.

METHODS

The present cross-sectional study used online questionnaires to investigate how self-reported sensory experiences relate to migraine in a large community sample including 117 individuals with probable migraine and 827 without. Mediation analyses were also used to determine whether any relationship between migraine and sensory sensitivity was mediated by anxiety.

RESULTS

Significant increases in subjective reports of sensory sensitivity (d = 0.80) and sensory avoidance (d = 0.71) were found in participants with migraine. Anxiety symptoms partially mediated the relationship between subjective sensory sensitivity and migraine. Finally, visual, movement, and auditory subscales were found to provide unique explanatory variance in analyses predicting the incidence of migraine (area under the curve = 0.73, 0.69, 0.62 respectively).

CONCLUSION

Subjective sensory sensitivities are present between attacks and across senses in individuals with migraine. Anxiety symptoms are relevant to this relationship; however, sensory sensitivities appear to exist independent of this affective influence. The implications of interictal sensitivities for the daily lives of those with migraine should, therefore, be considered in clinical management wherever appropriate.

Cross-cultural adaptation, reliability, and validity of the Turkish Adult Sensory Processing Scale

Introduction

Sensory processing is crucial to adaptive behavioural responses in occupational therapy. Nevertheless, information on sensory processing in adults is limited. The Adult Sensory Processing Scale (ASPS) measures behavioural responses indicative of sensory processing in different sensory systems. The study aimed to examine the cultural adaptation, reliability and validity of the ASPS-Turkish (ASPS-T).

Methods

The ASPS-T was administered to 405 individuals, who were aged 18 to 64 (38.5 ± 11.4) years. The cross-cultural adaptation and translation procedures were conducted following Beaton’s guidelines. Internal consistency was examined by Cronbach’s alpha. Criterion-related validity of the ASPS was determined by the Adolescent/Adult Sensory Profile using Construct validity and was examined by confirmatory factor analysis using AMOS.

Results

The study included 405 participants (271 female and 134 male). Exploratory factor analysis with varimax rotation determined 11 factors with 55.15% total variance. In confirmatory factor analysis (CFA), model fit indices showed an acceptable fit. The reliability of the scale was 0.834, and test–retest reliability changed from 0.94 to 0.99, illustrating high internal consistency and excellent reliability of the scale.

Conclusions

The ASPS-T is reliable and valid for analysing sensory processing patterns of adults in the Turkish population.

The impact of atypical sensory processing on adaptive functioning within and beyond autism: The role of familial factors

LAY ABSTRACT

Individuals diagnosed with autism tend to process sensory information differently than individuals without autism, resulting for instance in increased sensitivity to sounds or smells. This leads to challenges in everyday life and may restrict the individual's daily functioning. How direct this link is, however, is currently unclear. We investigated this question in 289 twins of whom 60 were diagnosed with autism and further 61 were diagnosed with other neurodevelopmental disorders. We looked at the association between unusual sensory processing and adaptive skills, both across individuals and within-twin pairs, testing whether individuals with higher levels of atypical sensory processing showed reduced adaptive skills compared to their twins. Since twins share 50%-100% of their genes and part of their environment (e.g. family background), associations within-twin pairs are free from effects of these familial factors. We found that an increased sensitivity to, as well as the avoiding of, sensory input (hyper-responsiveness) was linked to reduced adaptive skills across individuals-but not within-twin pairs. We also found an association between the degree to which individuals seek for sensory input (sensation seeking) and reduced adaptive skills, but only in individuals diagnosed with autism. The results suggest that sensory hyper-responsiveness has negative effects on individuals' general ability to function, but that this link is influenced by familial factors and hence not direct. In addition, sensation seeking behaviors might have a negative impact on adaptive skills specifically in autistic individuals.

Increased resting-state activity in the cerebellum with mothers having less adaptive sensory processing and trait anxiety

Child‐rearing mothers with high levels of trait anxiety have a tendency for less adaptive sensory processing, which causes parenting stress. However, the neural mechanisms underlying this sensory processing and trait anxiety remain unclear. We aimed to determine the whole‐brain spontaneous neural activity and sensory processing characteristics in mothers with varying parenting stress levels. Using resting‐state functional magnetic resonance imaging, we assessed mothers caring for more than one preschool aged (2–5 years) child and presenting with varying levels of sensory processing, trait anxiety, and parenting stress. Spontaneous neural activities in select brain regions were evaluated by whole‐brain correlation analyses based on the fractional amplitude of low‐frequency fluctuations (fALFF). We found significant positive correlations between levels of sensory processing with trait anxiety and parenting stress. Mothers having less adaptive sensory processing had significantly increased resting‐state network activities in the left lobule VI of the cerebellum. Increased fALFF values in the left lobule VI confirmed the mediation effect on the relationship between trait anxiety and sensory processing. A tendency for less adaptive sensory processing involving increased brain activity in lobule VI could be an indicator of maternal trait anxiety and the risk of parenting stress.

In Our Own Words: The Complex Sensory Experiences of Autistic Adults

Autistic adults commonly experience sensory reactivity differences. Sensory hyperreactivity is frequently researched, whilst hyporeactivity and seeking, and experiences across domains, e.g., vision, are often neglected. Therefore, we aimed to understand more about the sensory experiences of autistic adults. We conducted a mixed-methods study, co-produced with stakeholders; recruiting 49 autistic adults who completed an online survey. Firstly, quantitative results and content analysis enhanced our understanding of sensory input/contexts associated with sensory hyperreactivity, hyporeactivity, and seeking across modalities. Secondly, thematic analysis developed themes relating to 'Outcomes', 'Control', 'Tolerance and management', and 'The role of other people', informing a theoretical model of sensory reactivity differences in autistic adults. These findings have implications for support services and improving quality of life for autistic adults.

Elucidation of the relationship between sensory processing and white matter using diffusion tensor imaging tractography in young adults

Sensory processing and behaviors are altered during the development of connectivity between the sensory cortices and multiple brain regions in an experience-dependent manner. To reveal the relationship between sensory processing and brain white matter, we investigated the association between the Adolescent/Adult Sensory Profile (AASP) and neural connectivity in the white matter tracts of 84 healthy young adults using diffusion tensor imaging (DTI). We observed a positive relationship between AASP scores (i.e., sensory sensitivity, sensation avoiding, activity level)/subscores (i.e., sensory sensitivity–activity level, sensation avoiding–touch) and DTI parameters in the cingulum–cingulate gyrus bundle (CCG) and between AASP subscores (i.e., sensory sensitivity–auditory) and a diffusion parameter in the uncinate fasciculus (UNC). The diffusion parameters that correlated with AASP scores/subscores and AASP quadrant scores (i.e., sensory avoiding and sensitivity) were axonal diffusivity (AD) and mean diffusivity (MD) in the CCG and MD in the UNC. Moreover, the increased sensory avoiding and sensitivity scores represent the sensitization of sensory processing, and the level of diffusivity parameters indicates white matter microstructure variability, such as axons and myelin from diffusivity of water molecules. Thus, the present study suggests that the CCG and UNC are critical white matter microstructures for determining the level of sensory processing in young adults.

Alexithymia and Sensory Processing Sensitivity: Areas of Overlap and Links to Sensory Processing Styles

Alexithymia is a dimensional trait characterized by difficulties identifying and describing feelings and an externally oriented thinking (EOT) style. Here, we explored interrelationships between alexithymia and measures assessing how individuals process and regulate their responses to environmental and body-based cues. Young adults (N = 201) completed self-report questionnaires assessing alexithymia, sensory processing sensitivity (SPS), interoceptive accuracy (IA), sensory processing styles, and current levels of depression, anxiety, and stress. Whereas EOT was related to low orienting sensitivity, problems with emotional appraisal (difficulties identifying feelings/difficulties describing feelings) were related to heightened sensory sensitivity. In addition, features of SPS improved the prediction of alexithymia above and beyond that accounted for by IA. We suggest that EOT is linked to problems maintaining a representation of one’s emotions in working memory and that low IA and problems with emotional appraisal are linked to atypicalities in sensory processing that may impact embodiment. A latent profile analysis revealed five classes of individuals distinguished by the relative strength of different alexithymic traits and by differences in IA and sensory processing styles. The classes identified included two lexithymic, one modal, and two alexithymic groups, showing different susceptibilities to SPS. Overall, our findings lend support to the view that alexithymia is associated with atypicalities in both bottom–up and top–down processes that impact emotion processing and regulation. They also raise the possibility that individuals with different alexithymia subtypes may differ with regard to a range of factors, including not only SPS but also early life experiences, mental health outcomes, and susceptibility to various personality disorders.

Single dose testosterone administration enhances novelty responsiveness and short-term habituation in healthy males

The role of testosterone in sensory perception suggests that testosterone likely regulates adaptive responses to sensory changes, including habituation to repeated events and responsiveness to novel events. To test this hypothesis, we investigated how testosterone modulates brain responses to rapid changes in sensory inputs. Using a double-blind, placebo-controlled, within-participant design, each participant received a single dose of either testosterone or placebo, and then completed a passive auditory oddball task in which infrequent deviant tones were embedded in a series of frequent standard tones. Analysis of novelty-evoked potentials revealed smaller Mismatch Negativity (MMN) responses, but larger P3a responses in the testosterone session than in the placebo session. This suggests testosterone attenuates MMN responses that are associated with pre-attentive novelty detection and enhances P3a responses that are associated with involuntary attentional orientation toward novelty. Along with the repetition of standard tones, P2 responses on the auditory evoked potentials became significantly attenuated in the testosterone session, but not in the placebo session. This suggests testosterone enhances short-term habituation of P2 responses to recurring sensory events, which has been associated with bottom-up attention allocation. Mediation analysis further revealed that the role of testosterone in promoting attentional orientation toward novelty could be explained by the influence it exerts on short-term habituation and pre-attentive novelty detection. Overall, testosterone facilitated involuntary attention switching-withdrawal of attention from repeated sensory events and orientation toward novel sensory events-at the cost of attenuated pre-attentive novelty detection. This finding provides insight into the interplay between endocrinology and involuntary attentional processes.

How Processing of Sensory Information From the Internal and External Worlds Shape the Perception and Engagement With the World in the Aftermath of Trauma: Implications for PTSD

Post-traumatic stress disorder (PTSD) is triggered by an individual experiencing or witnessing a traumatic event, often precipitating persistent flashbacks and severe anxiety that are associated with a fearful and hypervigilant presentation. Approximately 14–30% of traumatized individuals present with the dissociative subtype of PTSD, which is often associated with repeated or childhood trauma. This presentation includes symptoms of depersonalization and derealization, where individuals may feel as if the world or self is “dream-like” and not real and/or describe “out-of-body” experiences. Here, we review putative neural alterations that may underlie how sensations are experienced among traumatized individuals with PTSD and its dissociative subtype, including those from the outside world (e.g., touch, auditory, and visual sensations) and the internal world of the body (e.g., visceral sensations, physical sensations associated with feeling states). We postulate that alterations in the neural pathways important for the processing of sensations originating in the outer and inner worlds may have cascading effects on the performance of higher-order cognitive functions, including emotion regulation, social cognition, and goal-oriented action, thereby shaping the perception of and engagement with the world. Finally, we introduce a theoretical neurobiological framework to account for altered sensory processing among traumatized individuals with and without the dissociative subtype of PTSD.

Convergent Validity of Behavioural and Subjective Sensitivity in Relation to Autistic Traits

Sensory issues are highly prevalent in autism and previous findings support a relationship between questionnaires of sensitivity and autistic symptoms and traits, whereas studies that examine this relationship through behavioural assessments of sensitivity are less consistent. The current study explores these differences and suggests that behavioural thresholds for sensitivity and subjective sensitivity are distinct constructs. One hundred and eighteen adults completed a visual and auditory detection task and questionnaires on sensory processing and autistic traits. Visual thresholds and subjective visual sensitivity were not correlated, but both were related to autistic traits. Auditory thresholds and subjective auditory sensitivity were also unrelated. Overall, sensitivity is highly associated with autistic traits, however, behavioural and questionnaire assessments lack convergent validity and therefore, likely assess distinct constructs.

Substances and your senses: The sensory patterns of young people within an alcohol and drug treatment service

Background: Substance use disorders (SUD) and trauma histories in adults have been linked with sensory processing patterns that are significantly different from the general population. Nevertheless, no studies have investigated sensory patterns, or the variables with which they are related, in youth with SUD. This study aimed to compare sensory patterns of this sample with normative data and consider associations between sensory patterns and: substance use, trauma, quality-of-life, mental and physical health. Methods: A cross-sectional quantitative research design was employed with a sample of 87 young people (mean age = 20.8 years) with SUD voluntarily attending a specialist youth outpatient alcohol and other drug (AOD) service. For participants, the Adolescent Adult Sensory Profile was added to measures routinely collected at the service. Results: Participants' sensory processing patterns for low registration, sensory sensitivity, and sensation avoiding were significantly higher than the normative population, while sensation seeking was both lower and higher. Ninety-one percent reported atypical scores on one or more sensory patterns. High rates of probable Post-Traumatic-Stress-Disorder (PTSD), psychological distress, and low quality-of-life were also reported, which were meaningfully related with sensory patterns. Conclusion: Young people reported complex combinations of sensory processing patterns, with comorbid probable PTSD, psychological distress, and low quality-of-life. Findings reflect studies with adult AOD, trauma, and other clinical conditions, and highlight the potential value of screening for sensory patterns and applying transdiagnostic approaches which simultaneously address substance use, mental health, trauma and sensory needs to optimize outcomes for young people with SUD.

Sensory profile alterations in patients with insular epilepsy surgery: Preliminary findings

The insular cortex is now well-established as a potential site of epileptogenesis in patients with drug-resistant epilepsy, and its resection has been associated with good outcomes in terms of seizure control. However, given the role of the insula in sensory processing and in visceral information integration, it remains unclear whether insular cortex epilepsy and its surgery are associated with disturbances in sensory information processing and visceral sensation processes as experienced in daily life. In the present study, we examined such sensory disturbances in a group of patients (n = 17) who underwent epilepsy surgery involving a resection of the insula and compared them to a lesion-control group of patients with temporal epilepsy surgery (n = 22) and a healthy control group (n = 29) matched for age, gender, and education. Participants were assessed on the self-report "Adolescent/Adult Sensory Profile" questionnaire at least four months after surgery. Our series of one-way analyses of variance (ANOVAs) revealed that insular and temporal resections in patients with drug-refractory epilepsy were associated with a low "sensation seeking" behavior reflecting a lack of engagement with sensory inputs from the environment. Furthermore, insular resections were associated with impairments in the "active behavioral responses" for the gustatory/olfactory modalities. These preliminary findings suggest that insular resections may be associated with mild to moderate alterations in sensory processing.

Sensory Processing and Aggressive Behavior in Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) may be accompanied by aggressive behavior and is associated with sensory processing difficulties. The present study aims to investigate the direct association between sensory processing and aggressive behavior in adults with ASD. A total of 101 Dutch adult participants with ASD, treated in outpatient or inpatient facilities, completed the Adolescent/Adult Sensory Profile (AASP), the Reactive-Proactive Aggression Questionnaire (RPQ), and the Aggression Questionnaire—Short Form (AQ-SF). Results revealed that sensory processing difficulties are associated with more aggressive behavior (f2=0.25), more proactive (f2=0.19) and reactive aggression (f2=0.27), more physical (f2=0.08) and verbal aggression (f2=0.13), and more anger (f2=0.20) and hostility (f2=0.12). Evidence was found for an interaction of the neurological threshold and behavioral response on total aggression and hostility. Participants with higher scores in comparison to the norm group in sensory sensitivity had the highest risk of aggressive behavior. In conclusion, clinical practice may benefit from applying detailed diagnostics on sensory processing difficulties when treating aggressive behavior in adults with ASD.

Visual triggers of skin picking episodes: An experimental study in self-reported skin picking disorder and atopic dermatitis

Background

Skin Picking Disorder (SPD) is a new diagnosis with limited information available about triggers of picking episodes. Itch can be induced via audio-visual stimuli and the effect of contagious itch is stronger for those affected by atopic dermatitis. We examined if picking-related visual stimuli can trigger the urge to pick skin in self-reported SPD. We compared itch and the urge to pick in a sample of AD and/or SPD-affected to controls without either.

Method

Urge to pick skin and/or scratch when viewing 24 itch-related, picking-related or neutral online pictures was assessed in adult females, who self-report skin-picking (SPD-only, n = 147) and/or atopic dermatitis (AD-only, n = 47; AD+SPD, n = 46) as well as in skin healthy controls (HC, n = 361).

Results

All participants reported a stronger urge to pick for picking-related pictures compared to neutral content (F[1, 597] = 533.96, p < .001, ηp2 = .472) and more itch for itch-related pictures compared to neutral stimuli (F[1, 597] = 518.73, p < .001, ηp2 = .465). SPD-all (SPD-only & AD+SPD) reported stronger urges to pick for picking-related vs. other stimuli compared to the AD-only and HC group (p < .001, ηp2 = .047). Likewise, AD-all (AD-only & AD+SPD) reported significantly stronger itching for itch-related vs. other stimuli compared to SPD-only and HC (p = .001, ηp2 = .019).

Conclusions

Analog to visual provocation of itch, the urge to pick can be triggered by visual stimuli. Treatments for SPD and AD may profit from addressing visual stimuli.

Evaluating sensory profiles in nociplastic chronic low back pain: a cross-sectional validation study

BACKGROUND

Sensory profiles (SPs) may be useful in classifying patients based on sensory sensitivity and behavioral responses to stimuli to develop personalized treatments for nonspecific chronic low back pain (CLBP). The Adolescent/Adult Sensory Profile (AASP) identifies four sensitivity and behavioral response-related quadrants: Sensory Sensitive, Sensation Avoiding, Low Registration, and Sensation Seeking. It is an appropriate questionnaire for evaluating SPs; however, it has not been validated in CLBP.

OBJECTIVES

To assess the internal consistency, test-retest reliability, agreement, and construct validity of the AASP in a CLBP population with nociplastic pain in primary care physiotherapy.

DESIGN

Two evaluations were performed at a 2-week interval in this non-experimental cross-sectional study.

PARTICIPANTS

Patients with CLBP.

METHODS

Questionnaires were used to compare outcomes with the AASP. Reliability was evaluated by assessing internal consistency and test-retest reliability. Construct validity was evaluated in response to the a priori hypothesis.

RESULTS

Ninety patients with CLBP were included. Internal consistency was excellent for all SPs (Cronbach's alpha, 0.91-0.92). Test-retest reliability Intraclass Correlation Coefficient (ICC (3,2)) 0.82-0.87, for the SPs (95% CI 0.74-0.91, p< .001). Construct validity correlated positively with Low Registration, Sensory Sensitive, and Sensation Avoiding and negatively with Sensation Seeking.

CONCLUSION

The AASP is suitable for evaluating SPs in primary care CLBP patients.

Sensory hypersensitivity in Tourette syndrome: A review

Tourette syndrome (TS) is a neurodevelopmental disorder defined by tics, but most patients also experience bothersome sensory phenomena, in the form of premonitory urges and/or sensory hypersensitivity. Whereas premonitory urges are temporally paired with tics, sensory hypersensitivity is a constant, heightened awareness of external and/or internal stimuli. The intensity of sensory hypersensitivity does not strongly correlate with the severity of tics or premonitory urges, suggesting it is a dissociable clinical phenomenon. At least 80% of TS patients report subjectively enhanced perception of various sensory stimuli. These same patients demonstrate normal static detection thresholds. However, individuals with TS habituate abnormally to repetitive stimuli, indicating incapacity to appropriately filter redundant sensory input, i.e. impaired sensory gating. Physiologic support for this hypothesis is provided by abnormal pre-pulse inhibition (PPI) and event-related potential (ERP) investigations. Preclinical data implicates parvalbumin-positive (PV+) interneuron dysfunction in altered sensory gating in TS and other neurodevelopment disorders. Studies probing TS sensory hypersensitivity must methodically account for comorbid psychiatric conditions, namely obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), as these entities appear to involve pathophysiologic processes shared with TS. The presence of psychiatric comorbidities in TS is associated with even more profound sensory processing dysfunction. A deepened understanding of TS sensory hypersensitivity will afford novel insights into disease mechanisms, clinical phenotype, and therapeutic management.

Occupational therapy consensus recommendations for functional neurological disorder

BACKGROUND

People with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.

METHODS

The recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.

RESULTS

We recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.

CONCLUSIONS

Occupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

Neighbourhood Environment and Cognitive Vulnerability—A Survey Investigation of Variations Across the Lifespan and Urbanity Levels

Background: Understanding the impact of local communities on wellbeing is a paramount Sustainable Development Goal. In order to inform people-centred planning interventions, it is important to understand what demographic groups need supportive communities the most and where. This study explored associations between perceived neighbourhood characteristics and cognitive vulnerability, and the moderating role of age and urbanity of the place of residence. Methods: A convenience sample of 224 Irish adults completed a survey assessing cognitive vulnerability and perceptions of neighbourhood qualities, together with sociodemographic and residential information. Correlational analyses explored bivariate associations as well as moderating effects. A subsample (n = 142) provided qualitative accounts of their preferences of neighbourhood characteristics. Results: Regression analyses showed that controlling for sociodemographic factors, higher self-reported neighbourhood pleasantness was associated with lower cognitive vulnerability, particularly in older adults who lived in the most rural and urban areas (p = 0.006). Qualitative accounts suggested urban–rural variations in perceived accessibility and perceptual stressors, and age-related variations in social preferences. Conclusions: Our findings indicate a complex association between neighbourhood characteristics and cognitive wellbeing, highlighting the potential benefits of neighbourhood pleasantness for cognition particularly for older people in very rural or very urbanised places. Implications for research and environmental interventions are discussed.

Sensory profiles in adults with and without ADHD

BACKGROUND

Our previous work demonstrates that adults with ADHD produce more force at the fingertips compared to adults without ADHD. One possibility is that somatosensation is impaired in ADHD. However, ADHD is often comorbid with anxiety, and anxiety influences sensory responsivity.

AIMS

The goal of the current work was to evaluate differences in the self-report of sensory experiences in adults with and without ADHD, while controlling for internalizing behaviors.

METHODS AND PROCEDURES

Forty-five adults (23 with ADHD) completed a semi-structured interview for the diagnosis of ADHD, the Adolescent/Adult Sensory Profile (AASP), and the Achenbach Adult Self Report (ASR).

OUTCOMES AND RESULTS

Adults with ADHD reported more hyper- and hypo- sensitivity compared to adults without ADHD, even when controlling for internalizing behaviors. Specifically, between group differences were found for low registration, sensation seeking, and sensory sensitivity scores, but not for sensation avoiding, and for movement, visual, touch, activity, audition, or taste/smell.

CONCLUSIONS AND IMPLICATIONS

These findings demonstrate that sensory hyper- and hypo- sensitivity may be features of ADHD in adults. Further, they demonstrate that internalizing behaviors influence the perception of sensory experiences and thus should be accounted for in studies of sensory processing, integration, and modulation in adults with ADHD.

Visually-induced dizziness is associated with sensitivity and avoidance across all senses

BACKGROUND

Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine.

OBJECTIVE

To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors.

METHODS

We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach.

RESULTS

We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine.

CONCLUSIONS

Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.

The Dutch Sensory Perception Quotient-Short in adults with and without autism

Sensory symptoms were recently added to the diagnostic criteria of autism spectrum disorder and may be a mechanism underlying the broad phenotype of autism spectrum disorder. To measure sensory symptoms based on perceptual rather than affective, regulative, or attention components, the Sensory Perception Quotient (SPQ) measuring five modalities of sensory sensitivity has been developed. In this study, the Dutch translation of the abridged SPQ-Short was investigated in a large sample of adults with (n = 657) and without autism spectrum disorder (n = 585). Its hypothesized factor structure, combining modality specific and one modality-independent factor, was assessed in a hierarchical model. Results show that modality-specific subscales are indeed present in the short version. Furthermore, its reliability is high and comparable to the original English version. The autism spectrum disorder group reported higher sensory sensitivities than the comparison group, and women with autism spectrum disorder reported higher sensitivities compared with men with autism spectrum disorder. The SPQ-Short correlates with all Autism Quotient (AQ)-Short subscales, except for the “imagination” subscale. The SPQ-Short seems suitable to further explore the relationship between basic sensory sensitivities in autism spectrum disorder and their related symptoms such as over- and under-responsivity to sensory stimulation.

Prenatal Predictors of Maternal-infant Attachment

BACKGROUND.

Increasingly, occupational therapists are working with women in the perinatal period, including supporting the developing mother-child relationship.

PURPOSE.

To examine prenatal predictors of maternal-infant attachment (maternal-fetal attachment, sensory patterns, adult attachment, perinatal loss, and mental health) that may provide possible avenues for assessment and intervention by occupational therapists.

METHOD.

Women (N = 60) were assessed during pregnancy and within one year postpartum in a cohort study. Independent t-tests, correlations, and multivariate regression models were conducted.

FINDINGS.

Low threshold maternal sensory patterns, more insecure adult attachment, and poorer quality of maternal-fetal attachment were each correlated with less optimal maternal-infant attachment. Quality of prenatal attachment was the best predictor of overall postnatal attachment in multivariate regression models.

IMPLICATIONS.

Occupational therapists working in a range of clinical settings (e.g., mental health, substance use, and perinatal care) may work with women during pregnancy to promote their relationship with their developing baby in utero and after birth.

Association between sensory processing and activity performance in children with cerebral palsy levels I-II on the gross motor function classification system

BACKGROUND

Investigating the influence of sensory processing disorders on the level of function of children with cerebral palsy (CP) may help therapists identify specific impairments that impact activity and participation in these children. This may provide direction on selection of interventions to improve function and quality of life.

OBJECTIVES

To investigate if sensory processing disorders in children with CP levels I and II on the Gross Motor Function Classification System (GMFCS) are associated with activity performance.

METHODS

Sensory processing and activity performance of 28 children with CP between 5 and 15 years (mean ± standard deviation; 9.9 ± 3.2 years) were evaluated using the Sensory Profile (SP) and Pediatric Evaluation of Disability Inventory (PEDI), respectively. Associations between the components of the SP and PEDI were assessed with Spearman correlation coefficients. Multiple linear regression analysis using backward stepwise method was used to determine the variables of sensory processing that are associated with activity performance on the PEDI.

RESULTS

The category of Behavioral Outcomes of Sensory Processing was the only variable associated with Functional Abilities in self-care and social function (r² = 0.30 and r² = 0.39, respectively) and Caregiver Assistance (r² = 0.36 and r² = 0.37, respectively), (p < 0.05).

CONCLUSION

Sensory processing in children with CP levels I-II on the GMFCS is associated with their ability to perform daily living activities and in their social interaction with the environment.

Weaker neural suppression in autism

Abnormal sensory processing has been observed in autism, including superior visual motion discrimination, but the neural basis for these sensory changes remains unknown. Leveraging well-characterized suppressive neural circuits in the visual system, we used behavioral and fMRI tasks to demonstrate a significant reduction in neural suppression in young adults with autism spectrum disorder (ASD) compared to neurotypical controls. MR spectroscopy measurements revealed no group differences in neurotransmitter signals. We show how a computational model that incorporates divisive normalization, as well as narrower top-down gain (that could result, for example, from a narrower window of attention), can explain our observations and divergent previous findings. Thus, weaker neural suppression is reflected in visual task performance and fMRI measures in ASD, and may be attributable to differences in top-down processing.

Sensory hypersensitivity is common in autism spectrum disorders. Using functional MRI, psychophysics, and computational modeling, Schallmo et al. show that differences in visual motion perception in ASD are accompanied by weaker neural suppression in visual cortex.

GABA Concentration in the Left Ventral Premotor Cortex Associates With Sensory Hyper-Responsiveness in Autism Spectrum Disorders Without Intellectual Disability

Individuals with autism spectrum disorder (ASD) often exhibit abnormal processing of sensory inputs from multiple modalities and higher-order cognitive/behavioral response to those inputs. Several lines of evidence suggest that altered γ-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain, is a central characteristic of the neurophysiology of ASD. The relationship between GABA in particular brain regions and atypical sensory processing in ASD is poorly understood. We therefore employed ¹H magnetic resonance spectroscopy (¹H-MRS) to examine whether GABA levels in brain regions critical to higher-order motor and/or multiple sensory functions were associated with abnormal sensory responses in ASD. We evaluated atypical sensory processing with a clinically-validated assessment tool. Furthermore, we measured GABA levels in four regions: one each in the primary visual cortex, the left sensorimotor cortex, the left supplementary motor area (SMA), and the left ventral premotor cortex (vPMC). The latter two regions are thought to be involved in executing and coordinating cognitive and behavioral functions in response to multisensory inputs. We found severer sensory hyper-responsiveness in ASD relative to control participants. We also found reduced GABA concentrations in the left SMA but no differences in other regions of interest between ASD and control participants. A correlation analysis revealed a negative association between left vPMC GABA and the severity of sensory hyper-responsiveness across all participants, and the independent ASD group. These findings suggest that reduced inhibitory neurotransmission (reduced GABA) in a higher-order motor area, which modulates motor commands and integrates multiple sensory modalities, may underlie sensory hyper-responsiveness in ASD.