Research on psychosensory processing opens new perspectives for a comprehensive intervention in autism.
Joaquín Díaz Atienza
GENERAL FEATURES
For about a decade now, special attention has been paid to the psychosensory aspects present in autism. In fact, the DSM-5 includes any unusual sensory response related to the environment, reactivity, or unusual sensory interest as a set of symptoms that form part of the diagnosis.
However, despite its importance, literature reviews on this topic show that the studies carried out are not homogeneous either in terms of the subjects, nor in terms of the assessment instruments (ADOS, ADI-R, Short Sensory Profile, etc.) and, therefore, also not in the set of symptoms that define the different subtypes found.
In this post, I intend to update knowledge about the different subtypes that have been described, as well as the alterations in psychosensory processing found in autism. To do this, I rely on two recent publications. The first1It is a 2017 review, and the second is a 2018 investigation.2which, although retrospective, I have found to present a design appropriate enough to consider its results positively.
To date, research indicates that the different psychosensory subtypes described in children with autism have been constructed based on parents' responses to assessment instruments, which primarily reflect differences in sensory sensitivity. Given the inherent subjectivity of the evaluators (parents) and the assessment instruments themselves, these results are of limited generalizability, inevitably impacting therapeutic interventions and the evaluation of their outcomes.
Three or four subtypes have been proposed to describe the set of sensory sensitivity patterns in children with autism. These same studies have shown that there is a subgroup with normal sensory functioning, another subgroup that differs significantly from the rest due to their overall sensory differences, and a mixed subgroup whose pattern corresponds to a specific sensory responsiveness (hyperosponsiveness versus hyperresponsiveness versus sensory seeking).
These differences and lack of consensus hinder the proper implementation of the treatment based on the lack of agreement regarding the different subtypes of psychosensory processing described.
Investigation of Scott D. Tomchek et al (2018)
These researchers used a recent version of the Short Sensory Profile, previously factor-analyzed in a sample of children with autism, which showed a different factor structure than that found in typically developing children. This scale includes:
- low/weak energy,
- tactile and movement sensitivity,
- sensitivity to taste / sensitivity to smell, hearing and sight,
- Sensory seeking/distraction and hyporesponsiveness.
It also studies other specific variables, such as: prosocial and adaptive behavior, receptive and expressive language, and fine and gross motor skills. Table 1.
Four profiles are being studied:
- Profile 1 or sensorimotor.
- Profile 2 or selective/complex
- Profile 3 or perceptive/adaptive, and
- Profile 4 or vigilant/committed (involved)
Each of them is evaluated: Low energy, tactile sensitivity, taste and smell sensitivity, visual and auditory sensitivity, searching and hypo-responsiveness.
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Characteristics of the sensorimotor profile
This condition is characterized by hyporesponsiveness in olfactory and gustatory sensitivity, and in sensory seeking. They tend to be picky. They do not usually respond to the demands of others, although they do seek other sensory stimuli in their environment.
They tend to score lower on items related to adaptive and social behavior. They also show greater deficits in expressive and receptive language.
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Characteristics of the selective/complex profile
They exhibit sensory preferences and aversions to certain patterns related to tactile sensitivity, light, sounds, and are fussy eaters. They have a low search response. Compared to children with a sensorimotor profile, these children demonstrate significantly reduced adaptive skills, although they possess a good level of language and social development. Well-developed aspects of language typically emerge throughout their development.
In this profile, the reported symptoms change according to age. The younger the individual, the more the profile resembles the sensorimotor profile.
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Characteristics of the perceptual/adaptive profile
They tend to have the fewest sensory anomalies. They usually live without major interference. Their language development and motor scores are usually quite similar to the selective/complex profile.
They show better development in terms of adaptive and social behaviors.
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Characteristics of a vigilant/committed profile
Despite exhibiting anomalies in some sensory aspects, such as smell, taste, visual sensory search, they present good skills in all other areas.
The presence of sensory sensitivity promotes their involvement with objects and people, and their sensory exploration fosters healthy development.
CONCLUSION
Establishing the different subtypes of psychosensory processing in autism will facilitate clinical definition, as well as more specific protocols for therapeutic intervention and improve its effectiveness.
Similarly, the possibility of generating increasingly homogeneous groups will optimize research results through randomized and controlled investigations.
Meanwhile, therapeutic intervention is necessary, taking into account the current results, even if these are provisional.
REFERENCES
- Kelle K. DeBoth et al. A systematic review of sensory-based autism subtypes. Research in Autism Spectrum Disorders 36 (2017) 44–56. http://dx.doi.org/10.1016/j.rasd.2017.01.005 [↩]
- Scott D. Tomchek et al. Sensory Subtypes in Preschool Aged Children with Autism spectrum Disorder. 2018. Journal of Autism and Developmental Disorders https://doi.org/10.1007/s10803-018-3468-2 [↩]
