Validating the diagnosis of sensory processing disorders using EEG technology

Inter-hemispheric somatosensory coherence and parental stress in hypersensitivity at 8 months old: An electroencephalography study

OBJECTIVE

Infant hypersensitivity affects daily challenges and parental stress. Although the crucial role of tactile sensation in infants' brain function has been highlighted, hypersensitive infants and their families lack support. Electroencephalography may be useful for understanding hypersensitivity traits. We investigated the relationship between infant perceptual hypersensitivity and parental stress, somatosensory-evoked potential (SEP), and magnitude-squared coherence (MSC) in the general population.

METHODS

Infants aged 8 months (n = 63) were evaluated for hypersensitivity and parental stress using a questionnaire and for cortical activity using electroencephalography. Vibration stimuli were applied to the infant's left foot. SEP components that peaked around 150 ms (N2) and at 200 ms (P2) after stimulus onset were evaluated by amplitude and latency at the midline electrode (Cz) and MSC between the midline electrodes (C3-C4).

RESULTS

Parental stress was associated with infant hypersensitivity. The latency of Cz was delayed, and C3-C4 delta MSC was high in infants with hypersensitivity.

CONCLUSIONS

Increasing inter-hemispheric MSC synchrony in the stimulated condition in infants with hypersensitivity suggested atypical somatosensory cortical function.

SIGNIFICANCE

These findings contribute to identifying, understanding the mechanisms of, and developing effective coping strategies for early-stage hypersensitivity.

Sensory reactivity assessment in children: A systematic review

AIM

To identify sensory reactivity assessments published in the literature for children aged 3 to 12 years and evaluate their psychometric properties to select the most appropriate one for adaptation to South Africa, with implications for other low- and middle-income countries.

METHOD

We addressed the following two review questions. What tests have been published in the literature in the past 30 years to evaluate sensory reactivity with children aged 3 to 12 years? What is the validity and reliability of the tests reported in the studies? The COnsensus-based standards for the Selection of health Measurement INstruments (COSMIN) methodology was used. We searched eight databases. Two reviewers independently screened and selected the studies.

RESULTS

The reviewers identified 41 studies, representing 19 assessments. The most common type of assessment was the proxy-reported caregiver questionnaire. Sensory systems most often assessed were visual, tactile, auditory, and vestibular. Study populations included those with autism spectrum disorder, attention-deficit/hyperactivity disorder, and children born preterm. Ratings for measurement properties of most assessments were moderate to low.

INTERPRETATION

Limited psychometric information was reported, with low ratings for many properties. The Sensory Processing 3-Dimensions Scale was selected on the basis of its psychometric properties and alignment with best-practice recommendation to use a caregiver questionnaire and a performance test to assess sensory reactivity.

Diffusion tensor imaging of the brain in children with sensory processing disorder: A review

Sensory processing disorder (SPD) is a clinical condition characterized by difficulties in the neurological processes of registering, discriminating, organizing, and responding to various sensory sensations. This study aimed to review the association between impaired white matter (WM) tract structure and neurofunctional deficits in children with SPD using diffusion tensor imaging (DTI). A comprehensive literature search was conducted using the online databases Google Scholar and PubMed (from 2010 to July 2023), resulting in the selection of nine relevant studies. Findings revealed that the splenium of the corpus callosum (SCC), superior longitudinal fasciculus (SLF), posterior corona radiata (PCR), and posterior thalamic radiation (PTR) exhibited reduced microstructural integrity, strongly associated with SPD. Specifically, auditory over-responsivity, a subtype of SPD, was linked to impaired integrity of the PCR, PTR, anterior corona radiata, and SLF. Tactile over-responsivity (TOR) was correlated with markers of decreased integrity in the SCC, superior corona radiata, and left PTR. Among the DTI parameters, decreased fractional anisotropy (FA) emerged as the most reliable factor for identifying SPD, followed by increased radial diffusivity (RD) and mean diffusivity (MD). Notably, significant correlations were observed between with auditory over-responsivity and TOR with the DTI parameters (positive for FA and negative for RD and MD). Overall, this review confirms the impaired integrity of specific WM tracts in children with SPD and establishes correlations between DTI parameters and neurobehavioral deficits associated with the disorder. The insights gained from this review contribute to a better understanding of SPD and hold clinical implications for its diagnosis and treatment.

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

Sensory Processing and Autistic Traits: Mediation Effect of Frontal Alpha Asymmetry

A sensory processing approach can be used to intervene with behaviours in individuals with autistic symptoms. However, neural mechanisms linking sensory processing patterns and autistic features are less understood. The purpose of this study was to investigate whether frontal alpha asymmetry could mediate the relationship between atypical sensory processing and autistic traits. Seventy-three neurotypical young adults were included in this study. Resting-state brain activity was recorded using electroencephalography. After the recording, participants completed the Adolescent/Adult Sensory Profile and the Autism-Spectrum Quotient. Frontal alpha asymmetry was calculated by subtracting left frontal alpha power from right frontal alpha power. Correlation analysis was performed to find which sensory processing patterns were related to frontal alpha asymmetry and autistic traits. Mediation analysis was then conducted with sensory avoiding patterns as an independent variable, autistic traits as a dependent variable, and frontal alpha asymmetry as a mediator. Interrelations between higher sensation avoiding patterns, greater right-sided cortical activity, and increased autistic traits were found. The sensation avoiding patterns affected autistic traits directly and indirectly through right-sided cortical activity. Findings of the current study demonstrate a mediating role of frontal alpha asymmetry in the relationship between sensation avoiding patterns and autistic traits in neurotypical adults. This study suggests that sensation avoiding patterns and withdrawal-related emotions, which are associated with right-sided cortical activity, need to be considered to improve autism symptoms.

Sensory Over-responsivity: A Feature of Childhood Psychiatric Illness Associated With Altered Functional Connectivity of Sensory Networks

BACKGROUND

Sensory over-responsivity (SOR) is recognized as a common feature of autism spectrum disorder. However, SOR is also common among typically developing children, in whom it is associated with elevated levels of psychiatric symptoms. The clinical significance and neurocognitive bases of SOR in these children remain poorly understood and actively debated.

METHODS

This study used linear mixed-effects models to identify psychiatric symptoms and network-level functional connectivity (FC) differences associated with parent-reported SOR in the Adolescent Brain Cognitive Development (ABCD) Study, a large community sample (9 to 12 years of age) (N = 11,210).

RESULTS

Children with SOR constituted 18% of the overall sample but comprised more than half of the children with internalizing or externalizing scores in the clinical range. Controlling for autistic traits, both mild and severe SOR were associated with greater concurrent symptoms of depression, anxiety, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. Controlling for psychiatric symptoms and autistic traits, SOR predicted increased anxiety, attention-deficit/hyperactivity disorder, and prodromal psychosis symptoms 1 year later and was associated with FC differences in brain networks supporting sensory and salience processing in datasets collected 2 years apart. Differences included reduced FC within and between sensorimotor networks, enhanced sensorimotor-salience FC, and altered FC between sensory networks and bilateral hippocampi.

CONCLUSIONS

SOR is a common, clinically relevant feature of childhood psychiatric illness that provides unique predictive information about risk. It is associated with differences in brain networks that subserve tactile processing, implicating a neural basis for sensory differences in affected children.

Modeling electrophysiological measures of decision-making and performance monitoring in neurotypical children engaging in a speeded flanker task

This study aims to use structural equation modeling (SEM) to investigate the role of error processing in behavioral adaptation in children by testing relationships between error-related and stimulus-related event-related potentials (ERPs) obtained from two sessions of a speeded Eriksen flanker task. First, path models of averaged ERP components and mean response times (N1 → P2 → N2 → P3 → RTs) while controlling for trait effects, age, and sex, on each was examined separately for correct and incorrect trials from each session. While the model demonstrated acceptable fit statistics, the four models yielded diverse results. Next, path models for correct and incorrect trials were tested using latent variables defined by factoring together respective measures of ERP component amplitudes from each session. Comparison of correct and incorrect models revealed significant differences in the relationships between the successive measures of neural processing after controlling for trait effects. Moreover, latent variable models controlling for both trait and session-specific state variables yielded excellent model fit while models without session-specific state variables did not. In the final model, the error-related neural activity (i.e., the ERN and Pe) from incorrect trials was found to significantly relate to the stream of neural processes contributing to trials with the correct behavior. Importantly, the relationship between RT and error detection in the final model signifies a brain-and-behavior feedback loop. These findings provided empirical evidence that supports the adaptive orienting theory of error processing by demonstrating how the neural signals of error processing influence behavioral adaptations that facilitate correct behavioral performance.

Could virtual reality applications pose real risks to children and adolescents? A systematic review of ethical issues and concerns

Virtual reality technologies (VRTs) are high-tech human-computer interfaces used to develop digital content and can be applied to multiple different areas, often offering innovative solutions to existing problems. A wide range of digital games is being also developed with VRTs and together with their components, the games' structural elements are appealing to children and engaging them more in virtual worlds. Our research interest is directed towards children's development and the effects of VRTs within gaming environments. Contemporary psychology studies perceive human development as a holistic and lifelong process with important interrelationships between physical, mental, social and emotional aspects. For the objectives and scope of this work, we examine children development across three domains: physical, cognitive and psychosocial. In this context, the authors review the literature on the impact of VRTs on children, in terms of software and hardware. Since research requires an wide-ranging approach, we study the evidence reported on the brain and neural structure, knowledge, behaviour, pedagogy, academic performance, and wellness. Our main concern is to outline the emerging ethical issues and worries of parents, educators, ophthalmologists, neurologists, psychologists, paediatricians and all relevant scientists, as well as the industry's views and actions. The systematic review was performed on the databases Scopus, IEEE Xplore, PubMed, and Google Scholar from 2010 to 2020 and 85 studies were selected. The review concluded that findings remain contradictory especially for the psychosocial domain. Official recommendations from organizations and well-documented researches by academics on child well-being are reassuring if health and safety specifications and particularly the time limit are met. Research is still ongoing, constantly updated and consist of a priority for the scientific community given that technology evolves.

REM Sleep EEG Activity and Clinical Correlates in Adults With Autism

We tested the hypothesis of an atypical scalp distribution of electroencephalography (EEG) activity during Rapid Eye Movement (REM) sleep in young autistic adults. EEG spectral activity and ratios along the anteroposterior axis and across hemispheres were compared in 16 neurotypical (NT) young adults and 17 individuals with autism spectrum disorder (ASD). EEG spectral power was lower in the ASD group over the bilateral central and right parietal (beta activity) as well as bilateral occipital (beta, theta, and total activity) recording sites. The NT group displayed a significant posterior polarity of intra-hemispheric EEG activity while EEG activity was more evenly or anteriorly distributed in ASD participants. No significant inter-hemispheric EEG lateralization was found. Correlations between EEG distribution and ASD symptoms using the Autism Diagnostic Interview-Revised (ADI-R) showed that a higher posterior ratio was associated with a better ADI-R score on communication skills, whereas a higher anterior ratio was related to more restricted interests and repetitive behaviors. EEG activity thus appears to be atypically distributed over the scalp surface in young adults with autism during REM sleep within cerebral hemispheres, and this correlates with some ASD symptoms. These suggests the existence in autism of a common substrate between some of the symptoms of ASD and an atypical organization and/or functioning of the thalamo-cortical loop during REM sleep.

Characteristics of Idiopathic Sensory Processing Disorder in Young Children

This study described the developmental and behavioral characteristics of children identified with idiopathic sensory processing disorder (SPD) as well as the relations among specific types of SPD as proposed by the nosology presented by Miller et al. (2007), adaptive behavior profiles, and behaviors associated with mental functioning. A retrospective, non-experimental design applying descriptive and correlational analyses was used. Data were obtained from clinic medical records of 78 children ages 2 to 7 years who were identified with sensory processing problems affecting daily life, but who did not meet criteria for any other neurodevelopmental or mental disorders following a comprehensive diagnostic evaluation. Results revealed that all SPD types as described by current typologies were well represented with the most common being the over-responsivity sensory modulation subtype. Within the sample, 53% of the children displayed more than one SPD type. Atypical externalizing and internalizing behavior scores associated with various mental disorders as measured by the child behavior checklist (CBCL) fell in the borderline dysfunctional range. Adaptive behavior for all developmental domains was below average, and the severity of SPD symptoms moderately and positively correlated with behaviors associated with mental disorders, and with lower adaptive behavior performance. It was concluded that symptoms characteristic of the various types of idiopathic SPD overlap substantially suggesting that current typologies may include more types/subtypes than are necessary or clinically useful. Children with SPD share similar, but often less severe pathological behaviors associated with other mental or related neurodevelopmental disorders. Psychometrically sound measures of SPD are needed, and further study of the neural mechanisms involved in sensory processing deficits is vital for validating idiopathic SPD as its own diagnostic entity.

Expanding our understanding of sensory gating in children with autism spectrum disorders

OBJECTIVE

This study examined sensory gating in children with autism spectrum disorders (ASD). Gating is usually examined at the P50 component and rarely at mid- and late-latency components.

METHODS

Electroencephalography data were recorded during a paired-click paradigm, from 18 children with ASD (5-12 years), and 18 typically-developing (TD) children. Gating was assessed at the P50, N1, P2, and N2 event-related potential components. Parents of all participants completed the Short Sensory Profile (SSP).

RESULTS

TD children showed gating at all components while children with ASD showed gating only at P2 and N2. Compared to TD children, the ASD group showed significantly reduced gating at P50, N1, and P2. No group differences were found at N2, suggesting typical N2 gating in the ASD group. Time-frequency analyses showed reduced orientation and neural synchronization of auditory stimuli. P50 and N1 gating significantly correlated with the SSP.

CONCLUSION

Although children with ASD have impaired early orientation and filtering of auditory stimuli, they exhibited gating at P2 and N2 components suggesting use of different gating mechanisms compared to TD children. Sensory deficits in ASD may relate to gating.

SIGNIFICANCE

The data provide novel evidence for impaired neural orientation, filtering, and synchronization in children with ASD.

An Exploratory Study Testing Autonomic Reactivity to Pain in Women with Sensory Over-Responsiveness

BACKGROUND

Difficulty modulating sensory input related to multi-sensory integration dysfunction, specifically the sensory over-responsive (SOR) type, is associated with psychological distress and hyperalgesia in children and adults. Scares reports suggest atypical autonomic nervous system (ANS) reactivity to innocuous sensory stimuli in children with SOR. Thus, the ANS may contribute to sensory stimuli responses and psychological distress. This exploratory study aimed to characterize the ANS reactivity to single and dual pain stimulation, and in relation to psychological distress in adults with SOR.

METHODS

Healthy women with SOR (n = 9) vs. without SOR (n = 9) underwent two runs of single pain stimulation and a third run comprised of dual pain stimulation. Pain was self-rated, while heart rate variability was measured and analyzed in the time and frequency domains. In addition, questionnaires assessing anxiety and somatization were utilized.

RESULTS

While controls demonstrated a vagal tone withdrawal (root mean square of successive differences in R-R-intervals; (RMSSD)) p = 0.029 from base-line to the third run, this was absent in the SOR group. However, no group differences were found in pain ratings. Furthermore, groups differed in the correlations between R-R mean and the level of both anxiety (p = 0.006) and somatization (p < 0.001); while in the SOR group, higher levels of anxiety and somatization correlated with shorter R-R intervals, the opposite was found in the control group.

CONCLUSIONS

This is the first study to demonstrate in women with SOR atypical vagal tone reactivity to challenging pain load. Vagal tone reactivity is related to both pain ratings and psychological distress.

Attentional concentration during physiotherapeutic intervention improves gait and trunk control in patients with stroke

The restoration of motor function is important in daily life in patients with brain damage. Although attentional concentration can affect motor function, most physical therapists focus only on therapeutic exercise. Therefore, we investigated changes in motor function in patients with high attentional concentration during our intervention. A total of 21 subjects diagnosed with stroke participated in the study. They were divided into the high attentional concentration group and low attentional concentration group based on the self-programmed attention index. The subjects underwent trunk strengthening and gait training for 30 min per session, twice a day, 5 days a week, for a total of 4 weeks. All patients wore electroencephalogram (EEG) devices during the treatment to enable EEG examinations. Diagnostic ultrasound was used to measure muscles of the abdomen: external oblique abdominal, internal oblique abdominal, transversus abdominis, and rectus abdominal muscles. A trunk impairment scale was used to evaluate trunk control. We used Gaitrite to measure the spatial and temporal components during gait. The group with high attentional concentration showed significant differences in abdominal muscle strength and trunk control. In gait, there was a significant difference in swing cycle, stance cycle, single cycle, double support cycle, stance time, and double support time. Therefore, attentional concentration should be considered to improve motor function as a part of therapeutic exercises for stroke patients.

Sensory Processing and Attention Profiles Among Children With Sensory Processing Disorders and Autism Spectrum Disorders

This study explores the differences in the profile of relationships between sensory processing and attention abilities among children with sensory processing disorder (SPD), autism spectrum disorder (ASD), and typically developing (TD) children. The Test of Everyday Attention for Children (TEA-Ch), a performance-based measure of attention, was administered to 69 children (TD: n = 24; SPD: n = 21; ASD: n = 24), ages 6-10 years. All participants' parents completed the Short Sensory Profile (SSP), a standardized parent-report measure of sensory-related behaviors. Discriminant analyses using the TEA-Ch and the SSP domains revealed two classification functions; the first revealed that both clinical groups significantly differed from the TD group with greater sensory processing challenges in the categories of auditory filtering, under-responsive/seeks sensation, low energy/weak, and taste/smell sensitivity subscales of the SSP. The second function discriminated between the two clinical groups, indicating that children with ASD had significantly greater control and sustained attention deficits and less sensory issues than did children with SPD. Together, the two functions correctly classified 76.8% of the participants as to their group membership. The different profiles of sensory processing and attention abilities in children with SPD and ASD may provide guidance in identifying appropriate individualized therapeutic strategies for these children.

Sensory Habituation as a Shared Mechanism for Sensory Over-Responsivity and Obsessive-Compulsive Symptoms

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.

Unisensory and Multisensory Responses in Fetal Alcohol Spectrum Disorders (FASD): Effects of Spatial Congruence

While it is generally accepted that structural and functional brain deficits underlie the behavioral deficits associated with Fetal Alcohol Spectrum Disorders (FASD), the degree to which these problems are expressed in sensory pathology is unknown. Electrophysiological measures indicate that neural processing is delayed in visual and auditory domains. Furthermore, multiple reports of white matter deficits due to prenatal alcohol exposure indicate altered cortical connectivity in individuals with FASD. Multisensory integration requires close coordination between disparate cortical areas leading us to hypothesize that individuals with FASD will have impaired multisensory integration relative to healthy control (HC) participants. Participants' neurophysiological responses were recorded using magnetoencephalography (MEG) during passive unisensory or simultaneous, spatially congruent or incongruent multisensory auditory and somatosensory stimuli. Source timecourses from evoked responses were estimated using multi-dipole spatiotemporal modeling. Auditory M100 response latency was faster for the multisensory relative to the unisensory condition but no group differences were observed. M200 auditory latency to congruent stimuli was earlier and congruent amplitude was larger in participants with FASD relative to controls. Somatosensory M100 response latency was faster in right hemisphere for multisensory relative to unisensory stimulation in both groups. FASD participants' somatosensory M200 responses were delayed by 13 ms, but only for the unisensory presentation of the somatosensory stimulus. M200 results indicate that unisensory and multisensory processing is altered in FASD; it remains to be seen if the multisensory response represents a normalization of the unisensory deficits.

Multisensory Audiovisual Processing in Children With a Sensory Processing Disorder (II): Speech Integration Under Noisy Environmental Conditions

Background: There exists a cohort of children and adults who exhibit an inordinately high degree of discomfort when experiencing what would be considered moderate and manageable levels of sensory input. That is, they show over-responsivity in the face of entirely typical sound, light, touch, taste, or smell inputs, and this occurs to such an extent that it interferes with their daily functioning and reaches clinical levels of dysfunction. What marks these individuals apart is that this sensory processing disorder (SPD) is observed in the absence of other symptom clusters that would result in a diagnosis of Autism, ADHD, or other neurodevelopmental disorders more typically associated with sensory processing difficulties. One major theory forwarded to account for these SPDs posits a deficit in multisensory integration, such that the various sensory inputs are not appropriately integrated into the central nervous system, leading to an overwhelming sensory-perceptual environment, and in turn to the sensory-defensive phenotype observed in these individuals. Methods: We tested whether children (6-16 years) with an over-responsive SPD phenotype (N = 12) integrated multisensory speech differently from age-matched typically-developing controls (TD: N = 12). Participants identified monosyllabic words while background noise level and sensory modality (auditory-alone, visual-alone, audiovisual) were varied in pseudorandom order. Improved word identification when speech was both seen and heard compared to when it was simply heard served to index multisensory speech integration. Results: School-aged children with an SPD show a deficit in the ability to benefit from the combination of both seen and heard speech inputs under noisy environmental conditions, suggesting that these children do not benefit from multisensory integrative processing to the same extent as their typically developing peers. In contrast, auditory-alone performance did not differ between the groups, signifying that this multisensory deficit is not simply due to impaired processing of auditory speech. Conclusions: Children with an over-responsive SPD show a substantial reduction in their ability to benefit from complementary audiovisual speech, to enhance speech perception in a noisy environment. This has clear implications for performance in the classroom and other learning environments. Impaired multisensory integration may contribute to sensory over-reactivity that is the definitional of SPD.

The involvement of altered sensory modulation in neurological conditions and its relevance to neuro-rehabilitation: a narrative literature review

PURPOSE

Neurological conditions are frequently described and treated with emphasis on primarily body dysfunctions that appear in the diagnostic criteria. This perspective paper aims to provide knowledge about the involvement of secondary body dysfunctions - altered sensory modulation - in neurological conditions and their relevance to neuro-rehabilitation. This paper refers to children and adults, to provide a life span view. Health models and approaches are discussed to bring ideas for optimizing rehabilitation.

METHODS

Perspective based on narrative literature review.

RESULTS

Altered sensory modulation is prevalent in neurological conditions. It is related to clinical symptoms, comorbidities and severity level. Many studies focus on specific modalities and on laboratory/clinical measurements. However, information gathered from subjective measures reflects the alterations in various sensory modalities and their negative impacts on the individuals' daily activity performance, participation and quality of life (QOL).

CONCLUSIONS

Neuro-rehabilitation should consider altered sensory modulation in neurological conditions, apply health models with broad perspective, as the ICF, with multi-disciplinary team, objective and subjective measures to understand how pathogenic mechanisms in primary and secondary body dysfunctions impact the performance and participation in daily life. This approach may optimize the individuals' involvement in therapy, enhance daily function and QOL and elevate intervention success.Implications for rehabilitationSensory modulation should be evaluated in children and adults with neurologic conditions.The evaluation and intervention should refer to the involvement of altered sensory modulation in the conditions' clinical characteristics, severity and comorbidities.In case altered sensory modulation is found, the evaluation and intervention should incorporate a multi-disciplinary collaboration and health models such as the ICF model, to optimize neuro-rehabilitation efficiency.Objective measures should be applied to profile altered sensory modulation and its role in pathogenic mechanisms.Subjective measures should also be used to reflect the expressions of altered sensory modulation as experienced by the individual (and family members), in daily life scenarios.By bridging between the clinic and the individuals' real-life context, rehabilitation process and outcomes may be optimized, in terms of the individual's greater involvement in therapy, better function and quality of life.

Assessing the Impact of Music Therapy on Sensory Gating and Attention in Children With Autism: A Pilot and Feasibility Study

Children with autism spectrum disorder (ASD) frequently demonstrate atypical processing of sensory information and deficits in attentional abilities. These deficits may impact social and academic functioning. Although music therapy has been used to address sensory and attentional needs, there are no studies including physiologic indicators of sensory processing to determine the impact of music therapy. The objective of this study was to determine the feasibility of conducting study protocols, determine the adequacy of electroencephalography (EEG) and behavioral measures in identifying attentional differences in children with ASD compared with typically developing (TD) children, and to gather preliminary evidence of intervention effects on brain responses and attention outcomes. Seven children with high functioning ASD ages 5 -12 and seven age- and gender-matched TD completed procedures measuring brain responses (EEG) and behaviors (the Test of Everyday Attention for Children). Children with ASD then completed a 35-min individual music therapy attention protocol delivered by a board-certified music therapist ten times over 5 weeks. Children with ASD completed measures of brain responses and behavior post-intervention to determine pre- to post-test differences. Consent and completion rates were 100% for children who met the study criteria. Feasibility measures indicated that measures of brain responsivity could be used to determine attentional differences between children with ASD and typical children. Initial outcome data for brain responses and behavior indicated positive trends for the impact of music therapy on selective attention skills.

Sensory Modulation Disorder (SMD) and Pain: A New Perspective

Sensory modulation disorder (SMD) affects sensory processing across single or multiple sensory systems. The sensory over-responsivity (SOR) subtype of SMD is manifested clinically as a condition in which non-painful stimuli are perceived as abnormally irritating, unpleasant, or even painful. Moreover, SOR interferes with participation in daily routines and activities (Dunn, 2007; Bar-Shalita et al., 2008; Chien et al., 2016), co-occurs with daily pain hyper-sensitivity, and reduces quality of life due to bodily pain. Laboratory behavioral studies have confirmed abnormal pain perception, as demonstrated by hyperalgesia and an enhanced lingering painful sensation, in children and adults with SMD. Advanced quantitative sensory testing (QST) has revealed the mechanisms of altered pain processing in SOR whereby despite the existence of normal peripheral sensory processing, there is enhanced facilitation of pain-transmitting pathways along with preserved but delayed inhibitory pain modulation. These findings point to central nervous system (CNS) involvement as the underlying mechanism of pain hypersensitivity in SOR. Based on the mutual central processing of both non-painful and painful sensory stimuli, we suggest shared mechanisms such as cortical hyper-excitation, an excitatory-inhibitory neuronal imbalance, and sensory modulation alterations. This is supported by novel findings indicating that SOR is a risk factor and comorbidity of chronic non-neuropathic pain disorders. This is the first review to summarize current empirical knowledge investigating SMD and pain, a sensory modality not yet part of the official SMD realm. We propose a neurophysiological mechanism-based model for the interrelation between pain and SMD. Embracing the pain domain could significantly contribute to the understanding of this condition’s pathogenesis and how it manifests in daily life, as well as suggesting the basis for future potential mechanism-based therapies.

PET Measures of D1, D2, and DAT Binding Are Associated With Heightened Tactile Responsivity in Rhesus Macaques: Implications for Sensory Processing Disorder

Sensory processing disorder (SPD), a developmental regulatory condition characterized by marked under- or over-responsivity to non-noxious sensory stimulation, is a common but poorly understood disorder that can profoundly affect mood, cognition, social behavior and adaptive life skills. Little is known about the etiology and neural underpinnings. Clinical research indicates that children with SPD show greater prevalence of difficulties in complex cognitive behavior including working memory, behavioral flexibility, and regulation of sensory and affective functions, which are related to prefrontal cortex (PFC), striatal, and midbrain regions. Neuroimaging may provide insight into mechanisms underlying SPD, and animal experiments provide important evidence that is not available in human studies. Rhesus monkeys (N = 73) were followed over a 20-year period from birth into old age. We focused on a single sensory modality, the tactile system, measured at 5-7 years, because of its critical importance for nourishment, attachment, and social reward in development. Positron emission tomography imaging was conducted at ages 12-18 years to quantify the availability of the D1 and D2 subtypes of the DA receptor (D1R and D2R), and the DA transporter (DAT). Heightened tactile responsivity was related to (a) elevated D1R in PFC overall, including lateral, ventrolateral, medial, anterior cingulate (aCg), frontopolar, and orbitofrontal (OFC) subregions, as well as nucleus accumbens (Acb), (b) reduced D2R in aCg, OFC, and substantia nigra/ventral tegmental area, and (c) elevated DAT in putamen. These findings suggest a mechanism by which DA pathways may be altered in SPD. These pathways are associated with reward processing and pain regulation, providing top-down regulation of sensory and affective processes. The balance between top-down cognitive control in the PFC-Acb pathway and bottom-up motivational function of the VTA-Acb-PFC pathway is critical for successful adaptive function. An imbalance in these two systems might explain DA-related symptoms in children with SPD, including reduced top-down regulatory function and exaggerated responsivity to stimuli. These results provide more direct evidence that SPD may involve altered DA receptor and transporter function in PFC, striatal, and midbrain regions. More work is needed to extend these results to humans.

Neural Foundations of Ayres Sensory Integration®

Sensory integration, now trademarked as Ayres Sensory Integration^® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres’ propositions by describing functions of the vestibular, proprioceptive, and tactile sensory systems, and exploring their relationships to ocular, postural, bilateral integration, praxis, and sensory modulation. We close by proposing neuroplasticity as the mechanisms underlying change as a result of ASI intervention.

Towards a unified model of event-related potentials as phases of stimulus-to-response processing

This study demonstrates the utility of combining principles of connectionist theory with a sophisticated statistical approach, structural equation modeling (SEM), to better understand brain-behavior relationships in studies using event-related potentials (ERPs). The models show how sequential phases of neural processing measured by averaged ERP waveform components can successfully predict task behavior (response time; RT) while accounting for individual differences in maturation and sex. The models assume that all ERP measures are affected by individual differences in physical and mental state that inflate measurement error. ERP data were collected from 154 neurotypical children (7-13 years, M = 10.22, SD = 1.48; 74 males) performing a cued Go/No-Go task during two separate sessions. Using SEM, we show a latent variable path model with good fit (e.g., χ²(51) = 56.20, p = .25; RMSEA = .03; CFI = .99; SRMR = .06) yielding moderate-to-large predictive coefficients from N1 through the E-wave latent variables (N1 β = -.29 → P2 β = -.44 → N2 β = .28 → P3 β =.64→ E-wave), which in turn significantly predicted RT (β =.34, p = .02). Age significantly related to N1 and P3 latent variables as well as RT (β =.31, -.58, & -.40 respectively), and Sex significantly related to the E-wave latent variable and RT (β =.36 & 0.21 respectively). Additionally, the final model suggested that individual differences in emotional and physical state accounted for a significant proportion of variance in ERP measurements, and that individual states systematically varied across sessions (i.e., the variance was not just random noise). These findings suggest that modeling ERPs as a system of inter-related processes may be a more informative approach to examining brain-behavior relationships in neurotypical and clinical groups than traditional analysis techniques.

Dunn's Model of Sensory Processing: An Investigation of the Axes of the Four-Quadrant Model in Healthy Adults

We examined the behavioral response (BR) and threshold (T) axes of Dunn's four-quadrant model of sensory processing (1997). We assessed whether they are ordinal ranges and if variation is associated with other similarly described characteristics: Introversion/Extraversion (I/E) of Eysenck's personality model (Sato, 2005), and somatosensory event related potentials (SERP) and their gating (Davies &amp; Gavin, 2007). From healthy adults (n = 139), we obtained: Adult/Adolescent Profile (A/ASP, Brown &amp; Dunn, 2002) and Eysenck's Personality Questionnaire, Brief Version (Sato, 2005) scores and peak amplitude and gating factor of SERP P50. We found that BR scores did not differ across normative categories of the A/ASP, but T scores significantly increased along the axis. I/E scores did not vary with BR scores. There were no differences or correlations in P50 amplitudes and gating with T scores. The findings suggest that the BR axis may not reflect a construct with ordinal range, but the T axis may. Dunn's concept of BR appears to be distinct from Eysenck's concept of I/E. SERP and its gating may not be directly reflective of sensory processing thresholds in healthy adults. Conclusions are limited by having few participants with passive behavior regulation or low threshold patterns of processing.

Investigating Misophonia: A Review of the Empirical Literature, Clinical Implications, and a Research Agenda

Misophonia is a neurobehavioral syndrome phenotypically characterized by heightened autonomic nervous system arousal and negative emotional reactivity (e. g., irritation, anger, anxiety) in response to a decreased tolerance for specific sounds. The aims of this review are to (a) characterize the current state of the field of research on misophonia, (b) highlight what can be inferred from the small research literature to inform treatment of individuals with misophonia, and (c) outline an agenda for research on this topic. We extend previous reviews on this topic by critically reviewing the research investigating mechanisms of misophonia and differences between misophonia and other conditions. In addition, we integrate this small but growing literature with basic and applied research from other literatures in a cross-disciplinary manner.

Categorisation of Mobile EEG: A Researcher's Perspective

Researchers are increasingly attempting to undertake electroencephalography (EEG) recordings in novel environments and contexts outside of the traditional static laboratory setting. The term “mobile EEG,” although commonly used to describe many of these undertakings, is ambiguous, since it attempts to encompass a wide range of EEG device mobility, participant mobility, and system specifications used across investigations. To provide quantitative parameters for “mobile EEG,” we developed a Categorisation of Mobile EEG (CoME) scheme based upon scoring of device mobility (D, from 0, off-body, to 5, head-mounted with no additional equipment), participant mobility (P, from 0, static, to 5, unconstrained running), system specification (S, from 4, lowest, to 20, highest), and number of channels (C) used. The CoME scheme was applied to twenty-nine published mobile EEG studies. Device mobility scores ranged from 0D to 4D, participant mobility scores from 0P to 4P, and system specification scores from 6S to 17S. The format of the scores for the four parameters is given, for example, as (2D, 4P, 17S, 32C) and readily enables comparisons across studies. Our CoME scheme enables researchers to quantify the degree of device mobility, participant mobility, and system specification used in their “mobile EEG” investigations in a standardised way.

Assessment of Sensory Processing Characteristics in Children between 3 and 11 Years Old: A Systematic Review

The assessment of sensory perception, discrimination, integration, modulation, praxis, and other motor skills, such as posture, balance, and bilateral motor coordination, is necessary to identify the sensory and motor factors influencing the development of personal autonomy. The aim of this work is to study the assessment tools currently available for identifying different patterns of sensory processing. There are 15 tests available that have psychometric properties, primarily for the US population. Nine of them apply to children in preschool and up to grade 12. The assessment of sensory processing is a process that includes the use of standardized tests, administration of caregiver questionnaires, and clinical observations. The review of different studies using PRISMA criteria or Osteba Critical Appraisal Cards reveals that the most commonly used tools are the Sensory Integration and Praxis Test, the Sensory Processing Measure, and the Sensory Profile.

Behavioral functioning in cardiofaciocutaneous syndrome: Risk factors and impact on parenting experience

The present study is an investigation of behavioral functioning in children with cardiofaciocutaneous syndrome (CFC). CFC is a rare single-gene disorder associated with cardiac disease, characteristic skin and facial features, intellectual disability, and neurological complications such as seizures and structural brain anomalies. Emotional and behavioral features of CFC have not been systematically investigated. We aimed to identify key variables that contribute to psychopathology during childhood and adolescence, and to examine the impact of challenging behaviors on the caregiving experience. Parents of 34 children and adolescents with CFC completed standardized broadband measures of child emotional and behavioral functioning, as well as measures of sensory modulation, functional communication, and caregiver stress. Results indicate that children with CFC syndrome are at heightened risk for psychopathology, with attention problems, social difficulties, and unusual behaviors (e.g., obsessive thoughts, strange behaviors, repetitive acts) found to be especially prevalent. Behavioral challenges in children with CFC syndrome were significantly associated with a history of obstetric complications and with problems modulating sensory information. With regard to the impact of child neurocognitive and behavioral issues on the caregiving experience, parent self-reported stress was significantly higher among parents of children who engaged in more problem behaviors, and lower among parents whose children could communicate effectively with others. Results of this study suggest avenues to help families cope with CFC-related stressors and enhance overall functioning. In particular, this study highlights the need for educational and treatment interventions aimed at addressing sensory needs, increasing functional communication, and identifying and managing challenging behaviors. © 2016 Wiley Periodicals, Inc.

Quantifying Different Tactile Sensations Evoked by Cutaneous Electrical Stimulation Using Electroencephalography Features

Psychophysical tests and standardized questionnaires are often used to analyze tactile sensation based on subjective judgment in conventional studies. In contrast with the subjective evaluation, a novel method based on electroencephalography (EEG) is proposed to explore the possibility of quantifying tactile sensation in an objective way. The proposed experiments adopt cutaneous electrical stimulation to generate two kinds of sensations (vibration and pressure) with three grades (low/medium/strong) on eight subjects. Event-related potentials (ERPs) and event-related synchronization/desynchronization (ERS/ERD) are extracted from EEG, which are used as evaluation indexes to distinguish between vibration and pressure, and also to discriminate sensation grades. Results show that five-phase P1–N1–P2–N2–P3 deflection is induced in EEG. Using amplitudes of latter ERP components (N2 and P3), vibration and pressure sensations can be discriminated on both individual and grand-averaged ERP ([Formula: see text]). The grand-average ERPs can distinguish the three sensations grades, but there is no significant difference on individuals. In addition, ERS/ERD features of mu rhythm (8–13[Formula: see text]Hz) are adopted. Vibration and pressure sensations can be discriminated on grand-average ERS/ERD ([Formula: see text]), but only some individuals show significant difference. The grand-averaged results show that most sensation grades can be differentiated, and most pairwise comparisons show significant difference on individuals ([Formula: see text]). The work suggests that ERP- and ERS/ERD-based EEG features may have potential to quantify tactile sensations for medical diagnosis or engineering applications.

State of the Science: A Roadmap for Research in Sensory Integration

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.

Sensory modulation disorders in childhood epilepsy

Background

Altered sensory sensitivity is generally linked to seizure-susceptibility in childhood epilepsy but may also be associated to the highly prevalent problems in behavioral adaptation. This association is further suggested by the frequent overlap of childhood epilepsy with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), conditions in which altered behavioral responses to sensory stimuli have been firmly established. A continuum of sensory processing defects due to imbalanced neuronal inhibition and excitation across these disorders has been hypothesizedthat may lead to common symptoms of inadequate modulation of behavioral responses to sensory stimuli. Here, we investigated the prevalence of sensory modulation disorders among children with epilepsy and their relation with symptomatology of neurodevelopmental disorders.

Methods

We used the Sensory Profile questionnaire to assess behavioral responses to sensory stimuli and categorize sensory modulation disorders in children with active epilepsy (aged 4–17 years). We related these outcomes to epilepsy characteristics and tested their association with comorbid symptoms of ASD (Social Responsiveness Scale) and ADHD (Strengths and Difficulties Questionnaire).

Results

Sensory modulation disorders were reported in 49 % of the 158 children. Children with epilepsy reported increased behavioral responses associated with sensory “sensitivity,” “sensory avoidance,” and “poor registration” but not “sensory seeking.” Comorbidity of ASD and ADHD was associated with more severe sensory modulation problems, although 27 % of typically developing children with epilepsy also reported a sensory modulation disorder.

Conclusions

Sensory modulation disorders are an under-recognized problem in children with epilepsy. The extent of the modulation difficulties indicates a substantial burden on daily functioning and may explain an important part of the behavioral distress associated with childhood epilepsy.

The Effect of Development in Respiratory Sensory Gating Measured by Electrocortical Activations

The perception of respiratory sensations can be of significant importance to individuals for survival and greatly impact quality of life. Respiratory sensory gating, similar to somatosensory gating with exteroceptive stimuli, is indicative of brain cortices filtering out repetitive respiratory stimuli and has been investigated in adults with and without diseases. Respiratory gating can be tested with the respiratory-related evoked potential (RREP) method in the electroencephalogram with a paired inspiratory occlusion paradigm. Here, the RREP N1 component elicited by the second stimulus (S2) shows reduced amplitudes compared to the RREP N1 component elicited by the first stimulus (S1). However, little is known regarding the effect of development on respiratory sensory gating. The present study examined respiratory sensory gating in 22 typically developed school-aged children and 22 healthy adults. Paired inspiratory occlusions of 150-ms each with an inter-stimulus-interval of 500-ms were delivered randomly every 2–4 breaths during recording. The main results showed a significantly larger RREP N1 S2/S1 ratio in the children group than in the adult group. In addition, children compared to adults demonstrated significantly smaller N1 peak amplitudes in response to S1. Our results suggest that school-aged children, compared to adults, display reduced respiratory sensory gating.

Comparing the executive attention of adult females with ADHD to that of females with sensory modulation disorder (SMD) under aversive and non-aversive auditory conditions

Certain behavioral expressions of sensory modulation disorder (SMD) such as distractibility, hyperactivity, and impulsivity are often similar to those of attention deficit/hyperactivity disorder (ADHD) in pediatric and adult populations. There is also a high comorbidity rate between these two diagnoses and absence of research regarding the objective neuropsychological differentiation between them. In the present study we employed a factorial design which enabled us to: (a) systematically examine the effects of SMD and ADHD on executive attention in a sample of adult females using a Stroop-like task, and (b) measure the effect of aversive conditions (sounds) on executive attention. The experimental measures used were the Stroop-like Location-Direction Task (SLDT) to assess executive attention and the battery of aversiveness to sounds (BAS), a standardized measure of aversive sounds that was developed for this study and enabled individual customization of aversive auditory sounds. Results revealed, as expected, a specific core deficit in executive attention for the ADHD factor. In addition to that, the present study provides an important, pioneering finding of SMD impairment in a unique combination of a cognitively demanding task with aversive sounds, providing preliminary objective evidence differentiating SMD from ADHD.

Sensory Processing Difficulties, Behavioral Problems, and Parental Stress in a Clinical Population of Young Children

This study examined the relationship between sensory processing difficulties, parental stress, and behavioral problems in a clinical sample of young children with developmental and behavioral difficulties. We hypothesized that a high rate of sensory processing difficulties would be found, that there would be a high rate of comorbidity between sensory processing difficulties and behavioral problems, and that children's sensory processing difficulties and parental stress would be highly correlated. Parents of 59 children ages two to five who attended an out-patient clinic in a low income, urban community completed the Child Behavior Checklist, Parental Stress Inventory-Short Form and the Short Sensory Profile. Children in this clinical population showed a high prevalence (55.9%) of sensory processing difficulties, a significantly higher rate than previously reported. Sensory processing deficits were correlated with behavioral difficulties and parental stress levels-suggesting that as sensory processing difficulties increase, so do behavioral difficulties and parental stress. Parents of children with sensory processing deficits had significantly higher levels of parental stress than parents of children without sensory deficits. Parenting stress levels were also clinically elevated for the cohort of children in which sensory processing difficulties and behavioral concerns co-existed. These findings suggest that treatment outcomes might improve and parental stress could be reduced if mental health clinicians were trained to identify and address sensory problems. This could result in more children being screened and treated for sensory processing difficulties and an eventual reduction in the rates of parental stress.

The role of sensory modulation deficits and behavioral symptoms in a diagnosis for early childhood

To contribute to the validation of the sensory and behavioral criteria for Regulation Disorders of Sensory Processing (RDSP) (DC:0-3R, 2005), this study examined a sample of toddlers in a clinical setting to analyze: (1) the severity of sensory modulation deficits and the behavioral symptoms of RDSP; (2) the associations between sensory and behavioral symptoms; and (3) the specific role of sensory modulation deficits in an RDSP diagnosis. Based on clinical observations, 78 toddlers were classified into two groups: toddlers with RDSP (N = 18) and those with "other diagnoses in Axis I/II of the DC:0-3R" (OD3R; N = 60). The parents completed the Infant Toddler Sensory Profile and the Achenbach Checklist. The results revealed that the RDSP group had more severe sensory modulation deficits and specific behavioral symptoms; stronger, although not significant, associations between most sensory and behavioral symptoms; and a significant sensory modulation deficit effect. These findings support the validity of RDSP.

Sensory integration, sensory processing, and sensory modulation disorders: putative functional neuroanatomic underpinnings

This paper examines conditions that have variously been called sensory integration disorder, sensory processing disorder, and sensory modulation disorder (SID/SPD/SMD). As these conditions lack readily and consistently agreed-upon operational definitions, there has been confusion as to how these disorders are conceptualized. Rather than addressing various diagnostic controversies, we will instead focus upon explaining the symptoms that are believed to characterize these disorders. First, to clarify the overall context within which to view symptoms, we summarize a paradigm of adaptation characterized by continuous sensorimotor interaction with the environment. Next, we review a dual-tiered, integrated model of brain function in order to establish neuroanatomic underpinnings with which to conceptualize the symptom presentations. Generally accepted functions of the neocortex, basal ganglia, and cerebellum are described to illustrate how interactions between these brain regions generate both adaptive and pathological symptoms and behaviors. We then examine the symptoms of SID/SPD/SMD within this interactive model and in relation to their impact upon the development of inhibitory control, working memory, academic skill development, and behavioral automation. We present likely etiologies for these symptoms, not only as they drive neurodevelopmental pathologies but also as they can be understood as variations in the development of neural networks.

Sensory Processing and ADHD in children with Fetal Alcohol Spectrum Disorder

Background. Sensory processing problems are prevalent in children who have fetal alcohol spectrum disorder. It is unclear to what degree these problems are distinct from attention deficits as measured during the diagnostic process in these children.

Purpose. To understand sensory processing in these children, which may assist with early identification and intervention.

Method. The relationship between attention and sensory processing was studied in a retrospective sample of 26 Canadian children diagnosed with fetal alcohol spectrum disorder.

Findings. A very low correlation (r = .02) between Short Sensory Profile scores and the attention deficit hyperactivity index of the Conners' Parent Rating Scales was found for the five- to ten-year-old children. Sensory processing problems were found in 81% of the children, similar to other studies of children with fetal alcohol spectrum disorder.

Implications. These findings can guide modifications of the environments, tasks, and approaches to children with fetal alcohol spectrum disorder.

Psychophysical correlates in adults with sensory modulation disorder

PURPOSE

Individuals with sensory modulation disorder (SMD) demonstrate abnormal responses to naturally occurring stimuli in a manner that interferes with daily life activities. This study is the first study applying quantitative sensory testing to characterize the somatosensory sensitivity of adults with SMD.

METHOD

One hundred and fifty one adults (68 males and 83 females) were tested comparing 91 SMD to 60 SMD-free, control individuals. Group placement (SMD vs. SMD-free) was determined using the Sensory Responsiveness Questionnaire (SRQ). Sensory detection thresholds for skin warming, cooling, punctate dynamic tactile sensation, vibration and thermal pain thresholds for heat and cold stimuli were determined at several body sites. Pinprick pain and prickliness were also assessed, as well as the duration and intensity of the after-sensations of prickliness and pain evoked by the prickly stimuli.

RESULTS

Compared to control adults, individuals with SMD showed significantly higher pain intensity to prickle stimuli, marginally higher pain intensity to pinprick and hypoesthesia to punctate dynamic tactile sensation at one of two sites tested.

CONCLUSIONS

These results are in line with our previous study that investigated children with SMD using the same stimuli, and found similar results. We suggest a CNS involvement as the underlying mechanisms in SMD.

Sensory over-responsivity, psychopathology, and family impairment in school-aged children

OBJECTIVE

To establish the diagnostic validity of sensory overresponsivity (SOR), there is a need to document rates of SOR and the co-occurrence of SOR with other psychiatric disorders. Although this was not a diagnostic study of SOR, this study was designed to investigate rates of elevated SOR symptoms and associations between elevated SOR symptoms, psychiatric disorder status, and family impairment.

METHOD

From a larger birth cohort followed from infancy to school age, 338 children aged 7 to 10 years (51% boys, 49% girls) and their parents participated in an intensive assessment. Parents were interviewed with the Diagnostic Interview Schedule for Children (DISC) and completed the SensOR inventory and the Family Life Impairment Scale.

RESULTS

Approximately one-fifth (21.2%) of children had elevated SOR symptoms. One-fourth (24.3%) of those with an elevated SOR score met criteria for a DSM-IV diagnosis, and 25.4% of children with a DSM-IV diagnosis had an elevated SOR score. Parents of children with elevated SOR alone reported a similar number of restrictions in family life as parents of those with an internalizing and/or externalizing diagnosis. SOR predicted concurrent family impairment above and beyond DSM diagnostic status and socio-demographic risk.

CONCLUSIONS

Elevated SOR occurs in the absence of other psychiatric conditions and is associated with impairment in family life. Services for children with comorbid elevated SOR and an externalizing disorder are needed to address the extremely high level of family impairment reported.

Phenotypes within sensory modulation dysfunction

Sensory modulation disorder (SMD) is a severe inability to regulate responses to everyday sensory stimulation to which most people easily adapt. It is estimated to affect 5% to 16% of the general population of children. Although heterogeneity is seen in the presentation clinically, previous research has not empirically investigated whether the clinical heterogeneity of SMD can be classified into subtypes. This study explores a cohort of 98 children identified with SMD at the Department of Pediatric Rehabilitation by a member of the occupational therapy team at The Children's Hospital of Denver. Two subtypes of SMD were identified through cluster analysis based on data from 4 parent-report instruments. The first subtype is characterized by sensory seeking/craving, hyperactive, impulsive, externalizing (eg, delinquent, aggressive), unsocial, inadaptive, and impaired cognitive/social behavior. The second subtype is characterized by movement sensitivity, emotionally withdrawal, and low energy/weak behavior. Findings from this study present a step toward understanding and classifying the complexities of children with SMDs.

Electroencephalography in children with and without sensory processing disorders during auditory perception

OBJECTIVE

We sought to determine whether children with sensory processing disorder (SPD) differ from typically developing children on a neurophysiological measure, the P300 component of event-related potentials produced in response to brief auditory stimulation.

METHOD

We used electroencephalographic measures (i.e., N200 and P300 components) to examine auditory processing in 20 children with SPD and 71 typically developing children, ages 5-10 yr.

RESULTS

Children with SPD demonstrated significantly smaller P300 amplitudes and shorter N200 latencies than typically developing children. Brain activity correctly distinguished children with SPD from typically developing children with 77% accuracy. We also found a significant relationship between the neurophysiological measures and functional performance on sensory and motor tasks.

CONCLUSION

This study presents empirical evidence that children with SPD display unique brain processing mechanisms compared with typical children and, therefore, provide further evidence for the neural deviations associated with SPD.

Multisensory hypersensitivity in women with fibromyalgia: implications for well being and intervention

OBJECTIVE

To document sensory sensitivities to nonnoxious sensory stimuli in daily life for participants with fibromyalgia (FM).

DESIGN

Descriptive study of a convenience sample using a self-report survey of sensory processing.

SETTING

Participants were recruited from the general community. The procedure took place in a research room at the University of Wisconsin-Madison.

PARTICIPANTS

Women with FM (n=27) were compared with women with rheumatoid arthritis (RA) (n=28) and healthy pain-free women (controls) (n=28) (N=83).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

A self-report measure of sensory sensitivity to stimuli encountered in daily life. Items ask participants if they are sensitive to sensations that do not seem to bother other people or avoid common activities or environments because of sensory stimuli.

RESULTS

The FM group reported significantly increased sensory sensitivities to both somatic (tactile) and nonsomatic (eg, auditory and olfactory) sensory stimuli compared with the RA and control groups. The RA and control groups did not differ in reported hypersensitivities.

CONCLUSIONS

Women with fibromyalgia reported increased sensitivities to stimuli in the environment and could experience more stress related to sensory conditions in daily life.

The relationship between sensory processing difficulties and leisure activity preference of children with different types of ADHD

Sensory processing difficulties (SPD) are prevalent among children with ADHD. Yet, the question whether different SPD characterize children with different types of ADHD has not received enough attention in the literature. The current study characterized sensory processing difficulties (SPD) of children with different types of ADHD and explored the relationship between SPD and leisure activity preference. Participants were 58 boys aged 6-10 years: 29 boys with ADHD: 15 with hyperactive-impulsive type and 14 characterized as inattentive. The controls were 29 typical peers. SPD were evaluated by The Short Sensory Profile (SSP) completed by the parents. Participants answered the preference for activities of children (PAC). According the results, SPD were manifested among children with both ADHD types. Children with both ADHD types showed significantly lower preference to participate in leisure activities than the controls. Their lower preference correlated with SPD. The findings suggest that children with different ADHD types may share common SPD, which may negatively impact their activity preference. In this study it seemed that children with ADD were more vulnerable to these impacts. SPD and participation should be considered in evaluation and intervention programs for children with ADHD in order to focus on child's abilities, needs and preferences, and enhance intervention success, child's relationships with peers and child's well-being.