Sensory Correlations in Autism

 

Sensory correlations in autism  J A N E T K . K E R N

autism © 2007 SAGE Publications and The National Autistic Society Vol 11(2) 123–134; 075702 1362-3613(200703)11:2

University of Texas, Texas, Southwestern Medical Center,

Dallas,USA 

MADHUKAR H. TRIVEDI

Universityy of Texas, Universit

Southwestern Medical Center Center,, Dallas, Dallas,USA  USA 

B R U C E D. G R A N N E M A N N

Universityy of Texas, Universit

Southwestern Medical Center Center,, Dallas, Dallas,USA  USA 

C A R O L Y N R . G A RV E R

 Autism Treatment Center, Center,Dallas, Dallas,USA  USA 

DANNY G. JOHNSON

University of Texas, Texas,Southwestern Southwestern

Medical Center Center,, Dallas, Dallas,USA  USA 

ALONZO A. ANDREWS

 Autism Treatment Center, Center,

San Antonio, Antonio,USA  USA 

 J A Y S H R E E S . S A V L A

University of Texas, Texas,Southwestern Southwestern

Medical Center Center,, Dallas, Dallas,USA  USA 

 J Y U T I K A A . M E H T A

University of Texas Texas at Dallas, Dallas, Dallas,USA  USA 

 J E N N I F E R L . S C H R O E D E R

Universityy of T Universit Texas, exas,

Southwestern Medical Center Center,, Dallas, Dallas,USA  USA 

This study examined the relationship between auditory, visual, touch, and oral sensory sensory dysfunction dysfunction in autism and and their relationrelationship to multisensory dysfunction dysfunction and severity severity of autism. The Sensory Profile was completed on 104 persons with a diagnosis diagnosis of autism, 3 to 56 years of age. Analysis showed a significant correlation between the different processing modalities using total scores. Analysis also showed a significant correlation between processing modalities for both high and low thresholds, with the exception that auditory high threshold processing did not correlate with oral low threshold or touch low threshold processing. Examination of the different age groups suggests that sensory disturbance correlates with severity severity of autism in children, but not in adolescents and adults. Evidence from this study suggests that: all the main modalities and multisensory processing appear to be affected; sensory processing dysfunction in autism is global in nature; and sensory processing problems need to be considered part of the disorder. ABSTRACT

KEYWORDS

autism; sensory  processing; Sensory Profile

Correspondence should be addressed to:  J A N E T K . K E R N , Universi University ty of  Texas Southwestern Medical Center at Dallas, 6363 Forest Forest Park Park Road, Suite 13.354, Dallas,T Dallas, Texas 75390–9119, 75390–9119, USA. e-mail: janet.kern@ UTSouthwestern.edu ADDRESS

www.sagepublications.com DOI: 10.1177/1362361307075702 10.1177/1362361307075702

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Introduction Autism is a neurological disorder that limits a person’s ability to function normally.. Beha normally Behavioral vioral aabnormalities, bnormalities, social limitations, and impair impaired ed aability bility to communicate are the main issues in this multifaceted disorder (American Psychiatric Assoc Association iation,, 1994; Coh Cohen en and Volkmar olkmar,, 1997; Frith Frith,, 1997). Another common characteristic of persons with autism is their difference in perceptual sensory processing, a disability commonly known as ‘sensory ‘senso ry dysf dysfunctio unction’ n’ or ‘senso ‘sensory ry diffe difference rence’’ (Bauman and K Kemper emper,, 1994; Kern, Ke rn, 200 2002; 2; Ke Kern rn et al., 200 2001; 1; Mol Moller ler an and d Kern Kern,, 200 2005). 5). The These se pr prob oblem lemss were we re note noted d earl earlyy in the stud studyy of autism autism.. Kanner (1 (1943), 943), for exa example mple,, in his description of 11 11 children with autistic disturbances, stated that a child might be overly sensitive to sounds and small changes in the daily routine and yet unresponsive to parents. Sensory dysfunction results from the brain’ brai n’ss inability to correctly process stimuli from the sensory inputs including vi visi sion on,, he heari aring ng,, touch touch,, tas taste te,, sm smel ell, l, ve vest stib ibul ular ar,, prop proprio riocep cepti tive ve,, and and ki kine nessthetic. Even though sensory dysfunction is mentioned in the Diagnostic and fourth h edition (DSM-IV (DSM-IV:: America American n PsychiStatistical Manual of Mental Disorders, fourt atric Associa Association, tion, 1994), senso sensory ry abnormal abnormalities ities re remain main exclud excluded ed from the indicativee profile. As with any medical condition, symptoma indicativ symptomatology tology is critical in directing areas of research. Since the nature or the frequency of abnormal sensory responses is not included in the diagnostic criteria for autism or pervasive developmental developmental disord disorder er (PDD), it has been d disregarded isregarded in some research (Tadev (Tadevosyan-Leyf osyan-Leyfer er et al., 2003). The ability of a person to t o respond to unexpected stimuli in their environment is a fundamental character characteristic istic of mammalian behavior behavior and is necessary for functional performance. Dysfunction of this ‘orienting response’ comes in many ma ny forms under many more names as symptoms for even more disorders. Howe However ver,, the numerous forms are hard to label and discuss due to the highly subjective nature of the language developed by by, and most often discussed discus sed with, typical typically ly de develo veloping ping peopl peoplee (Cesaron (Cesaronii and Garber Garber,, 1991). Per Perhaps haps,, then, bes bestt accoun accounts ts of thefrom vvarious arious man manifes ifestation tationsspeople of sens sensory ory dysfunction arethe captured in self-reports high-functioning with autism auti sm (Gran (Grandin din,, 199 1992; 2; Grand Grandin in and Scarino Scarino,, 198 1986; 6; Whi White te and Whi White te,, 1987). Howev However er,, because descriptions are given from a subgroup, they only begin to explain the perceptual aversions aversions experienced by the wider autistic population, from whom such explanation explanationss woul would d be nearl nearlyy impossible to obtain (O’Neil (O’Neil an and d Jone Jones, s, 1997). Some researchers have suggested that there is a link between the sensory processing problems that a person with autism experiences and the difficultiess in mana cultie managing ging dail dailyy life (Cook an and d Dunn, 1998; Du Dunn, nn, 1997; 19 1999; 99; 2001; Dunn Dunn et al al., ., 1994; K Kern ern et al. al.,, 2006). The sec secondary ondary ps psycholog ychological ical 124

 

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consequences associated with these perceptual differences may include anxiety related behaviors behaviors or disorders, and a detrimental impact on selfselfconceptt or social empa concep empathy thy (O’Nei (O’Neill and Jone Jones, s, 1997; Watlin atling g et al., 2001). While in the past pa st these problems may hav havee been overlooked in many autistic programs, attention to sen sensory sory dysfunction and the various treatments treatments for it is incre increasing asing (Dunn et al. al.,, 1994; Grandi Grandin, n, 1992). The purpose of this analysis was to examine the relationship between auditoryy, visu auditor visual, al, tou touch, ch, and ora orall senso sensory ry dys dysfun functio ction n in autism (inc (includ luding ing both high and low thresholds) and also to examine their relationship to multisensory dysfunction and the severity of autism. The data for the analysis in this study were were collected as part of a larger study study (Kern et al., 2006).

Methods Participant selection and participation The participants included 104 persons persons with a dia diagnosis gnosis of autism, 3 to 56 years of age (see Table 1 for demographic information). The participants were recruited across seven age categories (3–7; 8–12; 13–17; 18–22; 23–27; 28–32; and 33+) inseven ordercategories. to ensure Each a fullcategory range ofhad ages a balance of participants in the no and fewer than 12 participants. These persons had been given a diagnosis of autism during dur ing childhood. The diagnosis was confirmed at the time of the study by one of the inv investiestigatorss (JKK gator (JKK,, CRG CRG,, AAA, or JJAM) AM) b based ased on tthe he DSM DSM-IV -IV ccriteria riteria ffor or au autism tism and clinical clinical judgme judgment. nt. Each of these in invest vestigato igators rs (JKK, CRG CRG,, AAA, or JAM JAM)) has had at least eight years of experience as a professional in the field. To determine determi ne the seve severity rity of the autistic sympto symptoms, ms, the Childho Childhood od A Autism utism Rating Scale (CARS: Schopler et al., al., 1994) was comple completed ted on all participants in the autism group (see T Table able 1 for CARS information). The only exc exclusion lusion

Table 1

Demographics

 Autism group

Age  Mean (SD)

Age range range

CARS Mean (SD)

CARS range

All n = 104

19.92 (11.42)

3–56

41.73 (8.80)

20.5–58.5

Females n = 25 Males n = 79

21.54 (10.62)

4–37

41.84 (8.91)

26.5–58.5

19.44 (11.66)

3–56

41.70 (8.82)

20.5–58

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criteria were the presence of blindness or deafness. The authors acknowledge that eight of the 104 persons in the study had a CARS score between 20 and 30. These persons were included in the stud studyy because, although they were very very high functioning, they had pre previously viously been given a diagn diagnosis osis and still displayed the features of autism. Forty (40) of the 104 participants with autism were residents of the Autism Treatment Center (ATC) in Dallas; 28 of the participants were from the ATC in San Antonio; and 36 were from the local autism societies (see Table 1 for demogra demographic phic information). FFor or the autism group group,, informed consentt and HIP consen HIPAA AA fo forms rms we were re sig signed ned b byy the par parent, ent, legal g guardia uardian, n, or caseworker.

Measures The Sensory Profile (Dunn, 1999) and the Childhood Autism Rating Scale (CARS: Schopler et al., 1994) were were completed fo forr each of the 104 participants with autism. At the ATC, the Sensory Profile was comp completed leted by a teacher,, a job coach, a facilita teacher facilitator tor,, a group hom homee manag manager er,, or a therap therapist ist who was very familiar familiar with the participant, seeing him or her 5 da days ys or more per week. For the participants with autism from the local autism societies, the Sensory Profile was completed by a family member (typically a parent). The CARS was completed by the same person that completed the Sensory Sensor y Profile with the assistance of one of the investigators: JKK (40 participants from the ATC ATC in Dallas and 31 partic participants ipants from the general population in the Dallas Metroplex, Metroplex, Fort Worth, and Collin County area of communi community); ty); AAA (28 participants partic ipants from the ATC ATC in San Antonio where he is the director); directo r); or JAM (five participants from her practice).

Sensory Profile The Sensory Profile is a 125-question caregiver caregiver-completed -completed profile that reports the frequency of the person’s response to various sensory experiences (Dunn, 1999). Careg Caregivers ivers are ask asked ed to check the box that best describe describess the frequency with which the participant engages in the listed behaviors. Choices are: never (5 points); seldom (4 points); occasionally (3 points); frequently (2 points); and always always (1 point). On the Sensory Profile, low lower er scores indicate greater symptoms. sympt oms. The level of measurement is interval. Most of the sections on the Sensory Profile (and all of the sections used in this study) include high threshold and low threshold items. High threshold items measure an individual’s lack of response or need for more intense stimuli. Low threshold items measure a person’ person’ss notice of or annoyance with sensory stimuli. The items on the Sensory Profile are grouped into three categories: (1) sensory pr processing, ocessing, (2) modulation, and (3) beha behavioral vioral and emotional responses. The Sensory Profile has 14 sections: (A) auditory 126

 

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processing; (B) visual processing; (C) vestibular processing; (D) touch processing; (E) multisensory processing; (F) oral sensory processing; (G) sensory processing related to endurance/tone; (H) modulation related to body position and movement; (I) modulation of movement affecting activity level; (J) modulation of sensory input affecting emotional response; (K) modulation of visual input affecting emotional responses and activity level; (L) emotional/social response; (M) behavioral outcomes of sensory processing; (N) items indicating thresholds for response. The Sensory Profile characterizes character izes the person’ person’ss responsiven responsiveness ess to sensory input, sensory seeking, emotional emoti onal react reactive ive,, endur endurance/t ance/tone one,, oral senso sensory ry se sensitiv nsitivity ity,, inattention inattention/ / distra dis tractib ctibili ility ty,, poo poorr reg regist istrat ration ion,, sen sensory sory sen sensit sitivi ivity ty,, sedent sedentary ary,, and fine motor perceptual. Cronbach’s alpha for the internal consistency for the various sections sections ranged from 0.47 tto o 0.91 (Dunn (Dunn,, 1999). Construct valid validity ity was rated as high when compared to the functional tasks measured by the School Function Assess Assessment ment (Coster et al., 1998). Internal vali validity dity correlations tio ns range ranged d from 0.25 to 0.7 0.76, 6, sugg suggesting esting th that at the sectio sections ns of the Sensory Profile use relatively unique constructs and support the factor structure developed. dev eloped. Construct validity was obtained by comparing the results of the Sensory Profile to electrodermal response rating (EDR) which captures the physiological response to sensation. The EDR and the Sensory Profile show showed ed a correlation ( p < 0.05) 0.05) (Dun (Dunn, n, 199 1999). 9). The scoring of the Sensory Profile was conducted in two ways. ways. First, the standard scoring was conducted. conducted. Second, the high and low thre threshold shold scores were scored separately, providing providing a separate high and low threshold score for that subsca subscale. le. FFor or the multise multisensory nsory subsca subscale, le, please not notee that there is only one item defined as a low threshold item.

Autism rating The CARS (Schopler (Schopler et al., 1994) is a 15-it 15-item em beha behavioral vioral ra rating ting scal scalee developed to identify autism as well as quantitatively describe the severity of the disorder disorder.. The CARS is a well establish established ed measure and psychometrics are available. available. The CARS has been used in previous studies to rate aautism utism in childre chil dren, n, ado adoles lescen cents, ts, and aadul dults ts (E (Elia lia eett al. al.,, 200 2000; 0; Nj Njard ardvik vik eett al. al.,, 199 1999; 9; Schopler et al., 1994). The CARS rating ratingss were compared compared to the sensory processing data only; no normative values were obtained.

Analyses In order to determine the relationships between the different sensory subscales, two sets of correlations w were ere conducted. The first set of correlations (see Table 2) included the standard sc scoring oring of the sensory items. The second set of correlations (see Table 3) included the high threshold and low 127

 

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Table 2

Correlations between Sensory Profile subscales and CARS total: Correlations correlationss significant beyond the 0.05 cutoff are in bold correlation

 Auditory  Visual  Oral  Touch  Multisensory 

Visual

Oral

Touch

Multisensor y

C ARS total  

0.46

0.40 0.47

0.49 0.53 0.46

0.63 0.50 0.47 0.58

0.01 0.15 0.07  –0.10  –0.01

Table 3

Correlations between the Sensory Profile high and low subscales and Correlations the CARS total: correla correlations tions significant beyond the 0.05 cutoff are in bold  Auditory High  Auditory Visual Oral

Low  0.26 High Low   High

Low   High Touch Low   High  MultiLow  sensory sen sory Hig High h

Visual

Oral

Touch

Multisensory

CARS Total  

Low

High

Low

High

Low

High

Low

High

0.41 0.23

0.34 0.25 0.51

0.35 0.18 0.39 0.35

0.29 0.23 0.33 0.38

0.28 0.16 0.41 0.26

0.43 0.56 0.45 0.51

0.35 0.42 0.29 0.32

0.42 0.14 0.50 –0.23 0.44 0.11 0.50 0.22

0.43

0.32 0.33

0.29 0.42 0.47

0.22 0.29 0.16 0.45

0.44 0.14 0.42 0.001 0.40  –0.08 0.59  –0.10 0.42 0.05  –0.004

threshold scores analyzed separately separately.. On the mu multisensory ltisensory subscale, note that there is only one item defined as a low threshold item. In order to determine the relationship between the sensory sensitivities and severity of  autism symptoms, the CARS total score was also included in both ssets ets of  correlations. The goal of the study was to explore the relationships between the auditory auditory,, visual visual,, touch, and oral sens sensory ory dys dysfunctio function n in autism (includ (includ-ing both high and low thresholds) and also examine their relationship to multisensory dysfunction dysfunction and sev severity erity of autism; therefore therefore,, no Bonferroni correction was made to correct for the number of tests being conducted, and these results need to be interpreted cautiously. In previous research research we ha have ve found tha that, t, as ages increased in autism, there was an apparent lessening of abnormal sensory processing (Kern et al., 2006). Because there wer weree differences in sensory sensitivities that were were related to age, age, analyses were conducted in the three ag agee groups to determine if the overall test masked differences for these age groups. Therefore Therefore,, a third correlation analysis examined the change over age in the relationship 128

 

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between the individual sensory modalities (including high and low thresh thresh-olds) and severity severity of autism (CARS scor score). e). In order to do this analysis, analysis, we divided the overall sample into three approximately even groups: 3 to 12 years of age (N = 37); 13 to 25 years of age (N = 33); and 26 and over (N = 34). This was divided such that we could ensure an adequate sample in each group. Though these are not developmentally developmentally defined samples, these samples do describe children and adults, with adolescents and young young adults in between.

Results The first correlation analysis showed that there was a significant correlation tio n betw between een th thee diff differ erent ent aud audito itory ry,, vis visual ual,, tou touch, ch, ora oral, l, and mu multi ltisen sensor soryy processing modalities (using the total scores) (see T Table able 2). These correlations ranged from 0.40 to 0.63. This result indicates that abnormal sensory processing in each of the main sensory modalities correlates with each other; if a lower score was found in one modality, modality, a lower lower score was more likely to be found in another modality. There was no significant correlation between the CARS and any of these subscale total scores. This finding suggests that, ov overall, erall, abnormal sensory pr processing ocessing is not related to sev severity erity of autism. The second correlation analysis showed that there was a significant correla corr elatio tion n betw between een th thee diff differe erent nt audi auditor toryy, vis visual ual,, tou touch, ch, ora oral, l, and mu multi lti-sensory processing modalities (both high and low thresholds) ranging from 0.22 to 0.59. 0.59. This res result ult indica indicates tes that, in genera general, l, abno abnormal rmal sensory processing in each of the main sensory modalities (both high and low thresholds) correlates with each other. There were some exceptions: auditory high threshold processing did not correlate cor relate with oral low threshold or touch low low threshold processing, and touch low threshold did not correlate with multisensory low threshold processing (see Table 3). The sensory high and low subscales did not correlate cor relate with the CARS total score, except there was a significant correlation between the CARS total score with only auditory high threshold (–0.23) and visual high threshold (0.22) processing.. This finding also suggests that overall, abnormal sensory processprocessing ing is not related to severity severity of autism, except possibly with auditory high threshold and visual high threshold. The third correlation analysis showed showed that in the cchildren hildren (3 to 12 years of age) there is a significant correlation between abnormal sensory processing and the autism severity score (CARS). In the children (3 to 12 years of  age), ag e), aud audito itory ry,, vis visual ual,, tou touch, ch, ora oral, l, and mu multi ltisen sensor soryy proc process essing ing mo modal daliti ities es (both high and low thresholds) showed showed a cor correlation relation with the CARS sc score; ore; scores in this group ranged from –0.31 to –0.70, with the exception of  129

 

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visual low threshold processing and oral low threshold processing (see Table 4). The adolescent and young adult group (13 to 25 years of age) did not show a significant correlation cor relation between abnormal sensory processing and the autism severity severity score, except there was a significant correlation between between the CARS and visual high threshold processing (0.35) (see T Table able 4). Likewise, the adult group (26 years of age and older) did not show a significant correlation between abnormal sensory processing and the autism severity score, except score, except,, similar to the 13- to 2 25-ye 5-year ar-old -old g group roup,, there was a si signifignificant correlation between the CARS and visual high threshold processing (0.42). This correlation analysis suggests that sensory dysfunction in autism may relate relate to the se severity verity of autistic symptoms in the children, but not in adolescents and adults. Table 5 shows the mean and standard deviation (SD) of the variables in the three age categories. Table 4

Correlations of the CARS score with sensory modalities (high and low Correlations thresholds) across three age groups: groups: correla correlations tions significant beyond the 0.05 cutoff are in bold C ARS

Age 3–12 Age 13–25 Age 26+

Table 5

Auditor y

Visual

Low

Low

High

Oral High

Low

Touch High

Low

Multisensor y   High

Low

High

 –0.31 –0.49  –0.18  –0.46  –0.02  –0.42 –0.45 –0.70 –0.46 –0.58 0.11 –0.32 0.16 0.35  –0.01 0.02 0.05 0.05 0.11 0.02 0.22 –0.25 0.12 0.42 0.15 0.08 –0.06 –0.09 0.21 0.02

Mean and SD of the variables in the three age categories

Variable

Age 3–12

Age 13–25

Age 26 and over  

 Mean (SD)

Mean (SD)

Mean (SD)

Auditor y low

17.09 (4.74)

19.21 (4.28)

21.59 (4.17)

A Viusd uiatlolroywhigh Visual high Oral low Oral high Touch low Touch high Multisensor y low Multisensor y high

9..4 08 3 ((4 2..5 30 6)) 27 6.51 (1.57) 17.70 (5.43) 25.66 (5.67) 42.91 (7.38) 24.00 (5.70) 2.51 (1.02) 14.30 (2.82)

9..1 70 27 2 ((3 5..0 71 8)) 6.91 (1.89) 19.96 (5.82) 27.72 (6.60) 41.20 (9.21) 24.06 (5.41) 2.64 (1.11) 16.66 (2.93)

1 2..6 89 6)) 30 0..4 01 4 ((4 7.56 (1.99) 21.44 (4.73) 28.99 (6.55) 45.63 (5.87) 28.79 (4.80) 3.03 (1.27) 16.91 (2.96)

CARS total

37.23 (7.81)

42.43 (8.92)

45.39 (8.47)

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Discussion The first and second correlation analyses suggest that all of the main modalities (auditory (auditory,, visual visual,, touch, and oral) and mu multisen ltisensory sory pro processin cessing g appea appearr to be affected in autism, autism, and that abno abnormal rmal proces processing sing in the individ individual ual modalities correlates with each other. This suggests that sensory processing dysfunction in autism is global or comprehensive in nature. interpreting the correlation cor relation betw Sensory Profile and the In CARS, it is important to note analyses that the between lo lower wereen th theethe score on the Sensory Profile, the grea greater ter the abnormal sensory processing processing.. In contrast, the lo lower wer the score on the CARS, the less the sev severity erity of autism. Thus, a positive correlation means that as sensory processing is improving, autism is more sev severe, ere, or as sensory processing is worsening, autism is less severe. severe. A negative correlation means that as sensory pr processing ocessing is w worsening, orsening, autism is more se severe vere,, or as sensory processing is impro improving, ving, autism is less se severe vere.. In the first analysis analysis (using the total scores scores for the mo modalities), dalities), there was no correlation between the modalities and the severity of autism. However, in the second analysis (where high and low thresholds were looked at separately), a few correlations w were ere noted. The CARS total score did correlate negatively with auditory threshold. Thus, the negative correlation means that the more severe thehigh severe autism, the more abnormal the auditory high threshold processing. This makes sense because the items in this section of  the Sensory Profile reflect aspects commonly seen in autism, e.g e.g.. the person does not not ‘tune in in’’ to what yyou ou sa sayy, appe appears ars to ig ignore nore you. In additio addition, n, the CARS total score did correlate positively with visual high threshold processing.. This means that the more sever ing severee the autism, the less abnormal the visual high threshold processing. The items in this section ask questions that may or may may not be seen often in autism, depending on ho how w the question is interpreted, e.g e.g.. whether the person looks ccarefully arefully or intensely at objects/people. The third correlation analysis a nalysis (that looked at the three age groups) found that there was a significant correlation between abnormal sensory processing autism severity in the youngest (3 age to 12 of  age).and Thethe older groups (13 toscore 25 years of age; and 26group years of andyears older), in general, did not show a significant correlatio correlation n betwee between n abnormal sensory processing and the autism severity score. In a previous previous arti article, cle, based on th these ese data data,, comparing th thee autism gr group oup to a gender- and age-matched typically developing community control gr group oup,, we ffoun ound d tha that, t, in ge gener neral, al, as aages ges iincr ncrease eased d for tthe he gr group oup w with ith autism there was an apparent lessening of abnormal sensory processing. Thus, the finding fr from om the pre previous vious article article,, plus the finding fr from om this correlation analysis, analysis, ma mayy suggest that there is an adaptive or maturati maturation on process that occurs in sensory processing over time. There were some exceptions 131

 

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in the corre correlatio lations ns in the th third ird anal analysis ysis.. In childr children, en, visual llow ow th thresh reshold old processing and oral low threshold processing did not correlate with the CARS score. This is difficult to explain and may seem counterintuitive because, becaus e, anecdo anecdotall tallyy, so man manyy of these children ar aree reporte reported d to be orally and visually sensitive. The authors have no explanation for this finding. Also, the adolescents and adults sho showed wed a significant positiv positivee correlation between the CARS score and visual high threshold processing. This means that the more severe severe the autism, the less abnormal the visual high threshold processing. There are two items in visual high threshold processing, and one processing. item asks whether the person looks carefully or intensely at objects/people as discussed above. above. This item would ha have ve differe different nt responses according to whether the emphasis was on persons or objects, so this may may be a misleading question in autism. Synchronization of brain areas is crucial for normal multisensory processing because multiple areas a reas of the brain are involved once the sensory information reaches the cortices (Gomot et al., 2002); sensory processing involves inv olves a cascade of events that in involve volve not onl onlyy cortical regions, but also subcortical regions and the cerebellum cerebellum (Clae (Claeys ys et al., 2003). If an anyy step in the processing of sensory information is abnormal or poorly synchronized, subsequent processing would would be abnormal, and possibly mor moree so so..

Conclusion In summary, summary, evidence from our stud studyy on sensory processing suggests that all the the ma main in mo modal daliti ities es (a (audi uditory tory, vis visual ual,, tou touch, ch, and o oral ral)) ap appea pearr to be affected, affect ed, and that, at least beha behavioral viorally ly,, the abno abnormal rmal sensory pro processin cessing g in each of the modalities is not independent of the other modalities. It suggests that abnormal sensory processing dysfunction in autism is global in nature. The results also suggest that sensory dysfunction in autism may relate to the severity sev erity of autistic symptoms in the children, although this relat relationship ionship does not hold beyond childhood.

Acknowledgements This research was funded in part by a grant from the Hogg Foundation no.. 4456. The authors wish to acknowledge the help of Anna Hundley, the no Executive Director of the A Autism utism T Treatment reatment Center Center,, Dallas and San Antonio, Texas and Anne Russell-Bramlett of East Side Speech and Language Clinic in Plano, Plano, Texas. References (1994) Diagnostic and Statistical Manual of Mental Disorders,, 4th edn (DSM-IV). Disorders (DSM-IV). Washin Washington, gton, DC: APA. APA.

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