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Tal I, Cervin M, Liberman N, Dar R. Obsessive-Compulsive Symptoms in Children Are Related to Sensory Sensitivity and to Seeking Proxies for Internal States. Brain Sci 2023; 13:1463. [PMID: 37891831 PMCID: PMC10605487 DOI: 10.3390/brainsci13101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Symptoms of obsessive-compulsive disorder are related to atypical sensory processing, particularly sensory over-responsivity, in both children and adults. In adults, obsessive-compulsive symptoms are also associated with the attenuation of access to the internal state and compensatory reliance on proxies for these states, including fixed rules and rituals. We aimed to examine the associations between sensory over-responsivity, the tendency to seek proxies for internal states, and obsessive-compulsive symptoms in children. Parents of 404 children between 5 and 10 years of age completed online measures of obsessive-compulsive symptoms, seeking proxies for internal states, sensory over-responsivity, and anxiety. Linear regression, dominance analysis, and network analysis were used to explore the unique associations between these variables. The tendency to seek proxies for internal states was more strongly associated with obsessive-compulsive symptoms than with anxiety symptoms and uniquely associated with all major obsessive-compulsive symptom dimensions except obsessing. Both the tendency to seek proxies for internal states and sensory over-responsivity were significantly associated with obsessive-compulsive symptoms, but the association was significantly stronger for the tendency to seek proxies for internal states. While limited by the sole reliance on the parent-report, the present study shows that the tendency to seek proxies for internal states could help clarify the developmental processes involved in the onset of obsessive-compulsive symptoms during childhood and that sensory sensitivity may be important to consider in this process.
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Affiliation(s)
- Ilil Tal
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel; (I.T.); (N.L.)
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden;
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel; (I.T.); (N.L.)
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel; (I.T.); (N.L.)
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Wang C, Wang Z. The effects of model age and familiarity on children's reproduction of ritual behaviour. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2023; 41:259-275. [PMID: 37019847 DOI: 10.1111/bjdp.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Rituals are fundamental social acts that structure relationships and enable the filtering of important cognitive attributes (e.g. working memory and inhibitory control) that make humans what they are today. This study investigated the influence of model age and familiarity on the reproduction of ritual behaviour in five-year-old children. Through an exploration of these factors, this study sheds light on the cognitive mechanisms children use to comprehend and replicate rituals. Ninety-eight five-year-old children were divided into two groups: an experimental group, which observed an adult or child model, either familiar or unfamiliar to them, demonstrating eight ritual acts; and a control group, which received no video demonstration. The results revealed that children who observed an adult reproduced more ritual acts than those who observed a child, and children who observed unfamiliar models reproduced ritual acts more frequently than those who observed familiar ones. Additionally, when exposed to unfamiliar models, children's reproductive fidelity was higher. These findings suggest that children have the ability to address new adaptation challenges by participating in rituals at an early age and that they generate suitable solutions depending on the model's characteristics. This provides evidence for the adaptive bias in children's cultural learning from a ritual perspective.
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Affiliation(s)
- Chang Wang
- School of Education Science, Jiangsu Normal University, Xuzhou, China
| | - Zhidan Wang
- School of Education Science, Jiangsu Normal University, Xuzhou, China
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Ben-Sasson A, Podoly TY, Lebowitz ER. The Role of Pediatric Sensory Over-responsivity and Anxiety Symptoms in the Development of Family Accommodations. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01547-4. [PMID: 37219643 DOI: 10.1007/s10578-023-01547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
Sensory over-responsivity (SOR) is linked with elevated anxiety and reduced family wellbeing. Family accommodation of anxiety relates with greater symptom severity and reduced intervention outcome. This study examined the contribution of child SOR and co-occurring anxiety symptoms to family accommodation and its consequences. Ninety families of typically developing children (ages 4-13 years), completed an online survey including the Sensory Profile 2, Screen for Child Anxiety Related Emotional Disorders (SCARED), and Family Accommodation Sensory Scale (FASENS). FASENS scores include frequency of accommodation, child impact, and family impact.Children with elevated anxiety symptoms had significantly higher sensory and FASENS scores. Stepwise linear regression indicated that only SOR symptoms significantly predicted the frequency of sensory family accommodation, while both SOR and anxiety symptoms predicted the impact of family accommodation upon child and family well-being.Both SOR and anxiety symptoms in children predict the impact of sensory family accommodations on child and family well-being.
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Affiliation(s)
- Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Hushi, Haifa, 3498838, Israel.
| | - Tamar Y Podoly
- Oti, Israeli Association for ASD, Reserach Center, Givat Shmuel, Israel
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
| | - Eli R Lebowitz
- Child Study Center, Yale University School of Medicine, New Haven, USA
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Podoly TY, Derby DS, Ben-Sasson A. Sensory over-responsivity and obsessive-compulsive disorder: Measuring habituation and sensitivity through self-report, physiological and behavioral indices. J Psychiatr Res 2022; 149:266-273. [PMID: 35305380 DOI: 10.1016/j.jpsychires.2022.02.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022]
Abstract
Individuals with obsessive-compulsive disorder (OCD) may report Sensory Over Responsivity (SOR), but evidence for specific shared mechanism is limited. This study investigated a habituation-sensitivity mechanism in individuals with OCD (n = 30). Sensory habituation and sensitivity were compared with a neurotypical sample, divided to high (n = 30) and low (n = 30) obsessive-compulsive symptoms (HOCS and LOCS). Participants completed self-report sensory questionnaires and a physiological protocol measuring Electro Dermal Activity (EDA) while presenting aversive and neutral sounds in two conditions: Aversive stimuli followed by neutral stimuli (AVfirst), or neutral stimuli followed by aversive stimuli (NEfirst). In addition, participants could shorten the stimulus duration by pressing a key. LOCS differed from HOCS and OCD in most sensory self-report scores, with no significant difference between OCD and HOCS. HOCS had no significant differences in habituation patterns across conditions, while OCD had no differences in habituation patterns in AVfirst (p = .08) but significantly slower habituation patterns to the NEfirst neutral stimuli (p < .001). Condition order determined sensitivity for LOCS (AVfirst p = .017; NEfirst p = .045) but not for OCD and HOCS. HOCS and OCD shortened aversive stimuli by key pressing more than LOCS, with no significant difference between OCD and HOCS. The habituation process of individuals with OCD and HOCS was more influenced by stimulus type than by condition order, which might be due to a cognitive bias of prediction. Individuals with elevated OCS have difficulty relying upon sensory input to respond adaptively to the environment. This process can explain the avoidant behavior and complains of individuals with OCD not being able to ignore and to habituate to the sensory environment. These evidence warrants design of psychoeducation and intervention methods for relying on prior sensory information to improve functioning in individuals with OCD and SOR.
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Affiliation(s)
- Tamar Y Podoly
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences University of Haifa, Mount Carmel, Haifa, Israel; Cognetica: the Israeli Center for Cognitive Behavioral Therapy, Tel-Aviv, Israel.
| | - Danny S Derby
- Cognetica: the Israeli Center for Cognitive Behavioral Therapy, Tel-Aviv, Israel
| | - Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences University of Haifa, Mount Carmel, Haifa, Israel
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Assayag N, Berger I, Parush S, Mell H, Bar-Shalita T. Attention-Deficit/Hyperactivity Disorder Symptoms, Sensation-Seeking, and Sensory Modulation Dysfunction in Substance Use Disorder: A Cross Sectional Two-Group Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052541. [PMID: 35270233 PMCID: PMC8909105 DOI: 10.3390/ijerph19052541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 12/23/2022]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) and sensation-seeking, a trait characterized by risk-related behaviors, have been recognized as risk factors in substance use disorder (SUD). Though ADHD co-occurs with sensory modulation dysfunction (SMD), SMD has scarcely been explored in SUD. Thus, this study aimed to characterize ADHD symptomology, sensation-seeking, and SMD, as well as to explore their contribution to SUD likelihood. Methods: A cross sectional two-group comparative study including therapeutic community residents with SUD (n = 58; study group) and healthy individuals (n = 62; comparison group) applying the MOXO continuous performance test (MOXO-CPT) evaluating ADHD-related symptoms. In addition, participants completed the ADHD Self-Report Scale—Version 1.1 for ADHD screening; the Brief Sensation Seeking Scale quantifying risk-taking behaviors; and the Sensory Responsiveness Questionnaire-Intensity Scale for identifying SMD. Results: The study group demonstrated higher SMD incidence (53.57% vs. 14.52%) and lower performance in three MOXO-CPT indexes: Attention, Impulsivity, and Hyperactivity, but not in Timing, compared to the comparison group. Sensory over-responsiveness had the strongest relationship with SUD, indicating 27-times increased odds for SUD (95% CI = 5.965, 121.216; p ≤ 0.0001). A probability risk index is proposed. Conclusion: We found SMD with the strongest relation to SUD exceeding that of ADHD, thus contributing a new perspective for developing future therapeutic modalities. Our findings highlight the need to address SMD above and beyond ADHD symptomology throughout the SUD rehabilitation.
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Affiliation(s)
- Naama Assayag
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Itai Berger
- Pediatric Neurology, Pediatric Division, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva 8443944, Israel;
- School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Shula Parush
- School of Occupational Therapy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel; (N.A.); (S.P.)
| | - Haim Mell
- Department of Criminology, Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel;
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
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Dar R, Lazarov A, Liberman N. Seeking proxies for internal states (SPIS): Towards a novel model of obsessive-compulsive disorder. Behav Res Ther 2021; 147:103987. [PMID: 34688103 DOI: 10.1016/j.brat.2021.103987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) proposes an account of OCD symptoms in terms of two core components: attenuation of access to internal states and seeking proxies for internal states. Specifically, the SPIS model posits that OCD is associated with difficulty in accessing various internal states, including feelings, preferences, memories, and even physiological states. This difficulty drives obsessive-compulsive individuals seek and rely on compensatory proxies, or substitutes, for their internal states. These proxies are perceived by the individual with OCD to be more easily discernible or less ambiguous compared to the internal states for which they substitute, and can take the form of fixed rules, rituals, or reliance on external sources of information. In the present article we first provide a detailed explanation of the SPIS model, and then review empirical studies that examined the model in a variety of domains, including bodily states, emotions, and decision-making. Next, we elaborate on the SPIS model's novel account of compulsive rituals, obsessions and doubt and relate them to extant theoretical accounts of OCD. To conclude, we highlight open questions that can guide future research and discuss the model's clinical implications.
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Affiliation(s)
- Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Israel.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Israel
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Exploration of Sensory Processing Difficulties among Children Attending Primary School in Denmark. Occup Ther Int 2021; 2021:8893345. [PMID: 33824631 PMCID: PMC8016559 DOI: 10.1155/2021/8893345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/26/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Current research shows that children with sensory processing (SP) difficulties have limited participation and enjoyment in their daily activities at school. The aim of this study was to explore the prevalence of SP difficulties among Danish children and to explore possible associated factors. Since SP difficulties can affect children's prerequisites for participation in school activities and learning possibilities, this study focused on primary school children. Method. The study was designed as a cross-sectional survey. The sample consisted of 1723 children age 5 to 11 years, who were attending Danish public school (45.5% girls, 53.2% boys). The parents or caregivers of the child completed a Short Sensory Profile (SSP) questionnaire and a demographic questionnaire. One-way ANOVA was used to examine differences between girls and boys regarding sports, geographic area, and parental level of education. Chi-square analysis was used to explore the relationship between sex and SPP scores in the different behavioral sections. Logistic regression analysis was used to investigate possible associations between SP difficulties and sex and the included demographics. Results. A total of 21.3% of the children had SSP scores suggesting SP difficulties. Boys had a higher probability of having SP difficulties than girls (odds ratio (OR) = 1.55, confidence level (Cl): 1.22, 1.97). An association was found between participating in sports outside of school and SP difficulties (OR = 0.55, Cl: 0.47, 0.65 (p ≤ 0.001)). Additionally, a slight association between SP difficulties and parental education level (OR = 0.80) was found. No association was found regarding geographic area, i.e., where in Denmark the children attended school (OR = 1.00). Conclusion. The study results suggest that approximately 20% of the children in Danish public schools might have SP difficulties and over 20% might be at risk of having SP difficulties. The results suggest that Danish schools should focus on both identifying children with SP difficulties and implement interventions such as sensory integration through occupational therapy to help children with SP difficulties, in order to improve their ability to participate and learn from school activities.
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Assayag N, Bonneh Y, Parush S, Mell H, Kaplan Neeman R, Bar-Shalita T. Perceived Sensitivity to Pain and Responsiveness to Non-noxious Sensation in Substance Use Disorder. PAIN MEDICINE 2020; 21:1902-1912. [PMID: 31782772 DOI: 10.1093/pm/pnz292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This comparative cross-sectional study aimed to characterize individuals with substance use disorder (SUD) in self-perception of pain sensitivity, experimental auditory aversiveness, and non-noxious sensory responsiveness, as well as examine the associations with SUD. METHODS Therapeutic community (TC) individuals with SUD (N = 63, male 88.9%) and healthy controls (N = 60, male 86.7%) completed the Pain Sensitivity Questionnaire (PSQ) and the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS), followed by a psychophysical auditory battery, the Battery of Averseness to Sounds (BAS)-Revised. RESULTS The SUD group scored higher on the PSQ (P < 0.0001), BAS-R aversiveness (P < 0.0001), BAS-R-unpleasantness (P < 0.0001), and on the aftersensation of auditory aversiveness (P < 0.0001) and unpleasantness (P < 0.000). Fifty-four percent of the SUD group vs 11.7% of the control group were identified as having sensory modulation dysfunction (SMD; P < 0.0001). Logistic regression modeling revealed that the SRQ-IS-Aversive score had a stronger relationship, indicating a 12.6-times odds ratio for SUD (P = 0.0002). Finally, a risk score calculated from a linear combination of the logistic regression model parameters is presented based on the PSQ and SRQ. CONCLUSIONS This is the first study to explore sensory and aversive domains using experimental and self-reporting in situ, revealing pain perception alteration that co-occurs with high prevalence of SMD, specifically of the over-responsive type. Findings may be significant in clinical practice for treating pain, and for expanding therapeutic modalities as part of broader rehabilitation in TC and beyond, to better meet personalized therapy.
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Affiliation(s)
- Naama Assayag
- Faculty of Medicine, School of Occupational Therapy, Hadassah and Hebrew University, Jerusalem, Israel
| | - Yoram Bonneh
- School of Optometry and Vision Science, Mina & Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Shula Parush
- Faculty of Medicine, School of Occupational Therapy, Hadassah and Hebrew University, Jerusalem, Israel
| | - Haim Mell
- Yezreel Valley College, Afula, Israel
| | - Ricky Kaplan Neeman
- Department of Communication Disorders, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Podoly TY, Ben-Sasson A. Sensory Habituation as a Shared Mechanism for Sensory Over-Responsivity and Obsessive-Compulsive Symptoms. Front Integr Neurosci 2020; 14:17. [PMID: 32317944 PMCID: PMC7146075 DOI: 10.3389/fnint.2020.00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Some individuals who suffer from obsessive-compulsive (OC) disorder (OCD), report disturbing sensory preoccupations. The inability to stop obsessing over stimuli resonates with a difficulty in sensory habituation. Impaired sensory habituation, to a degree that clearly dysregulates response to sensory stimuli, and impairs participation in everyday activities, can be part of a disorder known as sensory over-responsivity (SOR). Although previous studies indicated a correlation between OCD and SOR, physiological experiments show that individuals with OCD are not more sensitive to sensory stimuli than controls. In the current study, we (1) validated a sensory habituation psycho-physiological protocol and (2) tested whether a "slow to habituate" mechanism can explain the occurrence of elevated SOR and OC symptoms. Methods We designed a protocol to test auditory sensory habituation through electrodermal activity (EDA) recording. The protocol included two randomly ordered aversive and neutral sound conditions; each set of six everyday life sounds was presented as a continuous stimulus. During the presentation of sounds, EDA was measured and participants could press a button to shorten the stimuli. Participants also completed sensory and OC symptom questionnaires. Participants included 100 typically developing adults that were divided into high versus low OC symptom groups. Mixed models analysis was used throughout to meet the need for capturing the temporal nature of habituation. Results Distinct physiological indices were computed to measure sensitivity versus habituation. Habituation was slower in the aversive versus neutral condition. Sensitivity was higher for the aversive stimuli. Self-report of sensory habituation and sensitivity partially correlated with the physiological habituation indices. A comparison of the physiological pattern between those with high versus low OC symptoms revealed significant differences in the habituation and sensitivity indices, across conditions. Conclusion The interplay between SOR and OC symptoms can be explained by a "slow to habituate" mechanism. Identifying behavioral and physiological markers of sensory problems in OCD is important for assessment, intervention and the discovery of underlying mechanisms.
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Affiliation(s)
- Tamar Y. Podoly
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- Cognetica: The Israeli Center for Cognitive Behavioral Therapy, Tel Aviv, Israel
| | - Ayelet Ben-Sasson
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Sinclair C, Meredith P, Strong J. Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life. Am J Occup Ther 2020; 74:7402205040p1-7402205040p11. [PMID: 32204782 DOI: 10.5014/ajot.2020.033308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. OBJECTIVE To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. DESIGN Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. SETTING Tertiary pain management clinic. PARTICIPANTS Children (ages 8-12 yr) and adolescents (ages 13-18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. MEASURES Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. RESULTS Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. CONCLUSION AND RELEVANCE Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. WHAT THIS ARTICLE ADDS Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.
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Affiliation(s)
- Cate Sinclair
- Cate Sinclair, B. App Sci. O.T., M. Art Therapy, PhD, is Director, Allied Services, Pain Specialists Australia, Richmond, Victoria, Australia, and Honorary Member, Murdoch Children's Research Institute, Parkville, Victoria, Australia;
| | - Pamela Meredith
- Pamela Meredith, PhD, is Head of Occupational Therapy, School of Health, Medical and Applied Sciences, University of Central Queensland, Rockhampton, Queensland, Australia
| | - Jenny Strong
- Jenny Strong, PhD, is Emeritus Professor, School of Health and Rehabilitation, University of Queensland, Brisbane, Queensland, Australia
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Review: Exteroceptive Sensory Abnormalities in Childhood and Adolescent Anxiety and Obsessive-Compulsive Disorder: A Critical Review. J Am Acad Child Adolesc Psychiatry 2020; 59:78-87. [PMID: 31265873 DOI: 10.1016/j.jaac.2019.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/20/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Childhood anxiety and obsessive-compulsive disorder (OCD) are defined by fear, worry, and uncertainty, but there is also evidence that affected children possess exteroceptive sensory abnormalities. These sensory features may often instigate symptoms and cause significant distress and functional impairment. In addition, a purported class of conditions known as "sensory processing disorders" may significantly overlap with childhood anxiety and OCD, which provides further support for a connection between abnormal sensation and fear-based psychopathology. METHOD The current review was conducted to synthesize and to critically evaluate the existing research on exteroceptive sensory abnormalities in childhood anxiety and OCD. Because of the paucity of research in this area, studies with adult populations were also briefly reviewed. RESULTS The review found significant support for the notion that sensory abnormalities are common in children with anxiety disorders and OCD, but there are significant limitations to research in this area that prevent firm conclusions. CONCLUSION Potential avenues for future research on sensory features of pediatric anxiety and OCD are discussed.
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12
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Attenuation of access to internal states in high obsessive-compulsive individuals might increase susceptibility to false feedback: Evidence from a visuo-motor hand-reaching task. J Behav Ther Exp Psychiatry 2019; 65:101445. [PMID: 31085384 DOI: 10.1016/j.jbtep.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Hence, they seek and rely on proxies, or discernible substitutes for these internal states. In previous studies, participants with high OC tendencies and OCD patients, compared to controls, showed increased reliance on external proxies and were more influenced by false feedback when judging their internal states. This study is the first to examine the effects of false feedback on performance of hand movements in participants with high and low OC tendencies. METHOD Thirty-four participants with high OC tendencies and 34 participants with low OC tendencies were asked to perform accurate hand reaches without visual feedback in two separate sessions of a computerized hand-reaching task: once after valid feedback training of their hand location and once with false-rotated feedback. We assessed the accuracy and directional adaptation of participants' reaches. RESULTS As predicted, high OC participants evidenced a larger decrease in their hand positioning accuracy after training with false feedback compared to low OC participants. LIMITATIONS The generalization of our findings to OCD requires replication with a clinical sample. CONCLUSIONS These results suggest that in addition to self-perceptions, motor performance of OC individuals is prone to be overly influenced by false feedback, possibly due to attenuated access to proprioceptive cues. These findings may be particularly relevant to understanding the distorted sense of agency in OCD.
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Lane SJ, Reynolds S. Sensory Over-Responsivity as an Added Dimension in ADHD. Front Integr Neurosci 2019; 13:40. [PMID: 31555103 PMCID: PMC6742721 DOI: 10.3389/fnint.2019.00040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/02/2019] [Indexed: 01/07/2023] Open
Abstract
Years of research have added to our understanding of Attention Deficit Hyperactivity Disorder (ADHD). None-the-less there is still much that is poorly understood. There is a need for, and ongoing interest in, developing a deeper understanding of this disorder to optimally identify risk and better inform treatment. Here, we present a compilation of findings examining ADHD both behaviorally and using neurophysiologic markers. Drawing on early work of McIntosh and co-investigators, we examined response to sensory challenge in children with ADHD, measuring HPA activity and electrodermal response (EDR) secondary to sensory stressors. In addition, we have examined the relationship between these physiologic measures, and reports of behavioral sensory over-responsivity and anxiety. Findings suggest that sensory responsivity differentiates among children with ADHD and warrants consideration. We link these findings with research conducted both prior to and after our own work and emphasize that there a growing knowledge supporting a relationship between ADHD and sensory over-responsivity, but more research is needed. Given the call from the National Institute of Health to move toward a more dimensional diagnostic process for mental health concerns, and away from the more routine categorical diagnostic process, we suggest sensory over-responsivity as a dimension in the diagnostic process for children with ADHD.
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Affiliation(s)
- Shelly J. Lane
- Department of Occupational Therapy, College of Health and Human Science, Colorado State University, Fort Collins, CO, United States
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Stacey Reynolds
- Department of Occupational Therapy, Kathryn Lawrence Dragas Sensory Processing and Stress Evaluation Laboratory, Virginia Commonwealth University, Richmond, VA, United States
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Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1075-1088. [PMID: 30569253 PMCID: PMC6508996 DOI: 10.1007/s10802-018-0502-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA.
| | - Grace T Baranek
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7120, Chapel Hill, NC, 27599-7120, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA, 90089-9003, USA
| | - William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Helen L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
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Granovsky Y, Shor M, Shifrin A, Sprecher E, Yarnitsky D, Bar-Shalita T. Assessment of Responsiveness to Everyday Non-Noxious Stimuli in Pain-Free Migraineurs With Versus Without Aura. THE JOURNAL OF PAIN 2018; 19:943-951. [PMID: 29597079 DOI: 10.1016/j.jpain.2018.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/11/2018] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
Migraineurs with aura (MWA) express higher interictal response to non-noxious and noxious experimental sensory stimuli compared with migraineurs without aura (MWoA), but whether these differences also prevail in response to everyday non-noxious stimuli is not yet explored. This is a cross-sectional study testing 53 female migraineurs (30 MWA; 23 MWoA) who underwent a wide battery of noxious psychophysical testing at a pain-free phase, and completed a Sensory Responsiveness Questionnaire and pain-related psychological questionnaires. The MWA group showed higher questionnaire-based sensory over-responsiveness (P = .030), higher magnitude of pain temporal summation (P = .031) as well as higher monthly attack frequency (P = .027) compared with the MWoA group. Overall, 45% of migraineurs described abnormal sensory (hyper- or hypo-) responsiveness; its incidence was higher among MWA (19 of 30, 63%) versus MWoA (6 of 23, 27%, P = .012), with an odds ratio of 3.58 for MWA. Sensory responsiveness scores were positively correlated with attack frequency (r = .361, P = .008) and temporal summation magnitude (r = .390, P = .004), both regardless of migraine type. MWA express higher everyday sensory responsiveness than MWoA, in line with higher response to experimental noxious stimuli. Abnormal scores of sensory responsiveness characterize people with sensory modulation dysfunction, suggesting possible underlying mechanisms overlap, and possibly high incidence of both clinical entities. PERSPECTIVE This article presents findings distinguishing MWA, showing enhanced pain amplification, monthly attack frequency, and over-responsiveness to everyday sensations, compared with MWoA. Further, migraine is characterized by a high incidence of abnormal responsiveness to everyday sensation, specifically sensory over-responsiveness, that was also found related to pain.
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Affiliation(s)
- Yelena Granovsky
- Department of Neurology, Rambam Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Merav Shor
- Department of Neurology, Rambam Medical Center, Haifa, Israel
| | - Alla Shifrin
- Department of Neurology, Rambam Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Medical Center, Haifa, Israel
| | - David Yarnitsky
- Department of Neurology, Rambam Medical Center, Haifa, Israel; The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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