Sensory over-Responsivity and Emotion Regulation in Children with Autism Spectrum Disorders Essay
While there has been considerable clinical and research effort in delineating the problems of social interaction, communication, and cognition in those with autism spectrum disorders (ASDs), the disturbances of sensory processing and the performance of emotion regulation remain less explored. Emotion regulation is the modification of any process in the system that generates emotion or its manifestation in behavior. The processes that modify emotions come from the same set of processes as the ones that are involved in emotion in the first place.
Levels of emotion regulation are one of the main concerns of caregivers and occupational therapists because they are essential for helping with the integration of a child into daycare and school. However, emotion regulation is not documented much in scientific literature on ASDs. Sensory processing involves the registration and modulation of sensory information, as well as the internal organization of sensory input. This allows human beings to execute successful adaptive responses to situational demands and thus engage meaningfully in daily occupations (Humphry, 2002).
Approximately 10% of the pediatric populations in the United States have severe over- or under-responsiveness to sensory stimuli that interfere with activities of daily living (ADL) (Ahn, Miller, & Milberger, 2002). Although sensory over-responsivity has been identified in children with specific diagnoses such as autism (Baranek et al. 2006; Liss et al. 2006; Miller et al. 2007; Rogers & Ozonoff 2005), occupational therapists often receive referrals for children with ASDs to mitigate sensory processing difficulties and help families cope more effectively.
Sensory over-responsivity, however, has only been minimally described separate of this diagnosis (Kinnealey and Fuiek 1999; Kinnealey et al. , 1995) and has still failed to be recognized unanimously as an independent syndrome. In sum, the impact of sensory over-responsivity on emotion regulation has not yet been investigated in children with ASDs. In order to better understand the specific needs of school-age children with ASDs and to facilitate their emotion regulation competence, it is important to document the relationship between sensory over-responsivity and emotion regulation in children with ASDs.
The purpose of this reaction paper is a literature review of the relationship between sensory over-responsivity and emotion regulation in children with ASDs in order to use the information in later research, which will investigate whether sensory over-responsivity is associated with the emotion regulation of children with ASDs. Sensory Over-Responsivity and Children with ASDs Children with ASDs struggle with social interaction problems, communication impairments, and restricted and repetitive behaviors (American Psychiatric Association, 1994).
Although sensory over-responsivity is not included in current diagnostic criteria, studies using caregiver questionnaires have consistently found children with ASDs to exhibit atypical behavioral responses to sensory input (Baranek et al, 2006; Rogers, Hepburn, & Wehner, 2003; Tomchek & Dunn, 2007). There is a growing body of literature on the disturbances of sensory processing in children with ASDs. A study conducted by Kern et al. 2001) of 39 children with a diagnosis of autism or pervasive development disorder (3 to 11 years of age) found that sensory difficulties were one of the most common of the associated clinical features observed in the children. On Dunn’s (1999) Sensory Profile, an instrument sensitive to anomalous sensori-motor behavior, 32 individuals with autism scored significantly higher than the control group on 85% of the items across all factors. Watling et al. (2001) found that 8 of 10 Sensory Profile factor scores of 40 children with autism indicated abnormality relative to matched controls.
However, none of these studies specifically related the question of general or special sensitivities in the majority of children with ASDs. Some authors suggest that children with ASDs have sensory under-responsivity impeding their social and emotional development (DesLauriers & Carlson, 1969; Rutter et al. , 1999; van Engeland, 1984). Others hypothesize that children with ASDs have sensory over-responsivity and fail to integrate new experiences efficiently (Bergman & Escalona, 1949; Dawson & Lewy, 1989).
Within the field of occupational therapy, sensory over-responsivity has been identified as the more common form of sensory modulation dysfunction, with approximately 80% based on referrals to research programs (Schaaf, Miller, Seawell, & O’Keefe, 2003). Rogers and Ozonoff (2005) utilized reports from parents that examined the sensory reactivity. Their study suggested that children with autism had significantly more sensory symptoms overall than the comparison groups. Researchers from fields outside of occupational therapy have also contributed to scientific literature regarding sensory over-responsivity and children with ASDs.
Baranek et al. (2006) used a new caregiver-report assessment, the Sensory Experiences Questionnaire (SEQ), and explicated the nature of sensory patterns of hyper- and hypo-responsiveness that correlates in autism relative to comparison groups. The study was conducted such that the pattern of hyper-responsiveness was significantly greater in ASDs than in the typical group. Liss et al. (2006) also used an expanded version of the Sensory Profile to request 144 parents to rate items in three domains: “sensory over-reactivity,” “sensory under-reactivity,” and “sensory-seeking behaviors. Cluster analysis showed the predicted over-focused pattern of sensation and attention, comprising over-reactivity in 43% of this sample. Although these important studies document the physical and behavioral features or consequences of physiological hyper-activities, Miller et al. (2007) also indicated that children with ASDs who have sensory over-responsivity will engage in sensory-seeking behaviors as an attempt at self-regulation. They are not targeted specifically, however, for the sensory classification of the children with ASDs.
Characteristics Associated with Emotion Regulation and Children with ASDs Emotion regulation in children with ASDs has not been investigated directly. Much of the research on emotion regulation and children with ASDs has focused on the extent of defining characteristics of children with ASDs (such as cognition and restricted repetitive behaviors). For example, research has been conducted with children diagnosed with Down syndrome, autism, schizophrenia, disruptive behavior disorders [e. g. conduct disorder (CD) and oppositional defiant disorder (ODD)], and depressive disorders. Children with autism demonstrate a poorer ability to pose emotion expressions (e. g. , Kasari & Sigman, 1996; Loveland et al. , 1994) compared both to nondisordered children and children with Down syndrome. The deficits are particularly apparent in social situations, where children with autism fail to exhibit “affective sharing” or socially aimed expressions of positive affect.
This deficit suggests possible difficulties in the expression of complex emotions like pride (e. . , Kasari, Sigman, Baumgartner, & Stipek, 1993; for review, see Kasari & Sigman, 1996). Studies on hypervigilance and attention in individuals with anxiety disorders can inform our understanding of how anxiety might elicit sensory over-responsivity in children with ASDs. Evidence indicates that anxiety disorders are characterized by hyperarousal (i. e. , heightened baseline levels of autonomic arousal), which supports a state of hypervigilance (i. e. , scanning the environment for threat-relevant stimuli and preparation for a potential threat).
It is posited that, for anxious individuals, this hypervigilance is part of an overall difficulty in regulating negative affectivity, known as threat-based emotion regulation (Craske 2003). These individuals may have trouble shifting attention and activating or inhibiting behavior in such a way that decreases negative affectivity and arousal. These studies may diminish the potential for emotion regulation. Few studies have investigated age-related changes in emotion regulation, particularly through school-aged children.
Age-related changes in emotional experience may or may not lead to changes in emotion-expressive behavior, yet it is the emotion-expressive behavior that may be of greatest significance in shaping social interaction (Gross et al. , 1997). Given how important such attempts at emotion regulation are for psychological health (Gross & Mufioz, 1995), it is essential to consider whether age-related changes in emotional experience and expression are associated with parallel age-related changes in emotional control.
There are a few age-related influences in emotion regulation in infants that have been reported by several investigators. Infant-stranger interaction is an appropriate situation in which to examine infant “coping” or emotion regulation, because it has been well documented that, beginning around 6 months of age on through the second year of life, infants generally find interactions with strangers to be emotionally arousing events (e. g. , Kagan, 1983; Sroute, 1977).
These researchers do not, however, address whether the developmental changes affect the emotion regulation of school-aged children with ASDs in everyday life. In addition to the potential influence of emotion regulation in children with disabilities, sensory skills play important roles. Descriptions of attention-deficit–hyperactivity disorder (ADHD) and sensory modulation disorder (SMD) include an inability to modulate systematically physiological, sensory, and affective responses that can have an effect on emotion regulation (Greenspan & Wieder, 1993).
Both ADHD and SMD include hyperactivity and impulsive behaviors. Emotion regulation has been investigated indirectly in the literature on hyperactivity, conduct disorder, and aggression in children and in the perseverative behavior and lack of executive-function skills in delinquent children (Moffitt & Henry, 1989). Although these connections appear to be well accepted clinically, none of these studies specifically relate only the problem of sensory processing to individual differences in emotion regulation in the emotion regulation of children with ASDs.
Sensory Over-Responsivity and Emotion Regulation There are few psychology or occupational therapy studies directly examining how sensory information processing affects emotion regulation. However, a large body of neuroscience literature illuminates how sensory stimuli are processed in the fear system. The “fear circuit,” which includes the amygdala, prefrontal cortex, and other areas, has emerged as part of a larger system that likely plays a role in regulating emotional arousal.
Structural and functional changes in this system have been associated with psychiatric and developmental disorders such as anxiety, depression, schizophrenia, borderline personality disorder, and autism. It is now established that sensory stimuli are processed similarly in these structures in rodents and humans. Drawing from the more general emotion regulation literature, one may expect increases in the self-regulation of sensory responsiveness with maturation. However, it is currently unclear whether there are developmental shifts in sensory over-responsiveness in early childhood (i. e. normative increases or decreases) or whether there is individual continuity in a child’s level of sensory over-responsiveness from infancy to elementary school. Many studies have examined sensory processing’s affect on the emotion regulation of children. Research conducted with cue-target paradigms demonstrates that attention-directing cues elicit activity in a fronto-parietal attentional control network (Giesbrecht, Woldorff, Song, & Mangun, 2003; Woldorff et al. , 2004). This activity appears to index multiple processes, including sensory processing, cue interpretation, and execution of the cued task.
By extension, it may be argued that results obtained in emotion regulation paradigms primarily reflect cue-directed attentional operations that are emotion independent. However, the specificity of these sensory symptoms has not yet been established and still needs to be identified. Sensory over-responsivity is a sensory processing disorder (SPD) characterized by over-orientation, distress, resistance, and avoidance reactions to certain types of sensations (Lane, 2002). SPD is estimated to affect 5% to 13% of children in the general population (Ahn, Miller, Milberger, & McIntosh, 2004).
It is important to assess sensory over-responsivity in development because it entails distress and may interfere with children’s emotion regulation. This atypical responsiveness has a significant impact on the quality of life for these children and their families by limiting their participation in home, school, and community activities (Cohn, Miller, & Tickle-Degnen, 2000; Dunn, 2001; Dunn & Westman, 1997). For example, significant food preferences due to hypersensitivities to taste and touch in the mouth may limit opportunities to participate in mealtimes with family and peers.
Similarly, restricted manual exploration and manipulation may interfere with participation in school and social activities (Schaaf et al. , 2003). Miller et al. (2007) found that individuals with sensory over-responsivity respond to sensation faster, with more intensity, and for a longer duration than those with typical sensory responsivity. Their responses may range from active, negative, impulsive, or aggressive responses to passive withdrawal or avoidance of sensation. Individuals with sensory over-responsivity may be rigid and controlling, and this can influence their emotion regulation.
Parham and Mailloux (2005) also suggested that individuals with over-responsivity to sensation may withdraw from certain types of touch, cover their ears in response to everyday sounds, and/or avoid movement activities that are typically enjoyable or non-noxious to others. Additionally, they may have limited diets due to sensitivity to the taste, smell, or texture of certain foods. They may also become easily overwhelmed in certain environments, demonstrate strong emotional reactions to sensory stimuli, and engage in disruptive behaviors when demands become too great.
This type of anxious hypervigilance and poor regulation of negative arousal through attentional bias could contribute to sensory over-responsivity. If children are hyperaroused and scanning the environment, looking for threats, they are more likely to notice and react to environmental sensory stimuli. A threat-based style of emotion regulation would exacerbate this reactivity, as they would be more likely to attribute a threat to these stimuli and have difficulty shifting their attention and nhibiting negative affect. A study by Liss et al. (2006) lends some support to the relevance of this model for children with ASDs. Liss and colleagues showed that parent ratings of sensory over-responsivity, excellent memory, and overfocused and overselective attention clustered together in a subgroup of children with ASDs. The authors suggested that these individuals overreact to aversive sensory stimuli because they are more likely to attend to them and have difficulty disengaging from them.
Thus, this study supports the idea that there is a subgroup of children with ASDs who are particularly prone to sensory over-responsivity, and these children show some symptoms similar to individuals with anxiety disorders, including difficulty with rapid disengagement and selective attention. Although this connection appears to be accepted clinically, few studies have documented it and specifically described the relationship between sensory over-responsivity and the emotion regulation.