Sensory

processing
A Guide for Parents
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Contents
Part 1-Introduction 4
Part 2 - Sensory Assessments 11
Part 3 - Interventions and strategies for sensory processing difficulties 15
References24
About the authors 28

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 Part 1-Introduction
zz Experiencing too little stimulation
What is sensory processing? from incoming sensory information
Sensory processing refers to how people (hyporeactivity)
experience, interpret and use their senses to
zz Needing to seek out sensory experiences
guide their day-to-day behaviour. We receive
(sensory seeking)
sensory information from many different sources,
including our vision, hearing, touch, tastes and zz Having difficulty combining sensory inputs
smells. from different senses (often referred to as
problems with multi-sensory integration).
Other senses include proprioception, (senses
of body awareness and position), vestibular, “He really cannot stand loud noises. If
(awareness of movement, balance, and somebody is speaking loudly or with
coordination), and interoception, (our internal
sensory system that tells us what is happening
intonation in their voice, he really doesn’t
inside our body e.g. noticing when we are tired or like it.”
hungery).
Some people may have difficulty processing
Hyperreactivity can lead to avoidance of certain
information from one particular sense (e.g.
sensory inputs, in an attempt to avoid the
hearing), whereas other people may have
overwhelming experience of sensory information.
difficulty with more than one of these types of
On the other hand, a hyperreactive person may
sensory inputs.
seek out sensory stimulation to ‘drown out’
People with high levels of sensory processing another input that is overwhelming for them e.g.
difficulties can show different responses in their rocking when there is too much noise.
brains and behaviour following sensory input.
Hyporeactivity is when a person does not
They can also show different physiological
respond or register sensory input when you
responses (e.g. heart rate and sweat responses)1,2,
might usually expect someone to respond. A
suggesting that their brains are processing
hyporeactive person may seek additional sensory
incoming sensory information in a different way.
stimulation to help improve alertness.
Sensory processing difficulties are different from
It is important to note that hyperreactivity and
sensory impairments (e.g. blindness/hearing
hyporeactivity can both be linked to sensory
loss).
seeking.
This guide will outline the most common sensory
People may also be sensory seeking because
processing difficulties people can experience, but
they enjoy certain sensations or because it can
it is important to know that there may be other
make them feel calm in stressful situations. Every
difficulties that your child experiences that are not
child is different and will have a different profile
covered in this guide.
of sensory needs; an individual may seek one
Common types of sensory processing difficulties type of input but avoid another. Box1 outlines
include: what hyperreactivity, hyporeactivity and sensory
zz Experiencing too much stimulation seeking can look like in terms of observable
from incoming sensory information behaviours.
(hyperreactivity)

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 Box 1

Hyperreactivity Hyporeactivity Sensory Seeking

zz Become distressed by zz May not respond to zz Enjoying deep pressure or

bright lights or loud noises certain sensations where other types of stimulation
(e.g., hoovers, sirens) most people normally zz Often touching items
zz Cannot tolerate the feeling would (e.g., another with interesting textures,
of certain types of clothing person touching their even when socially
or labels within the clothes hand or their calling unacceptable (e.g., a
name, no differentiation strangers clothing)
zz Often distracted by when touching very hot
background noises that or very cold objects) zz Have difficulty
most people are able to understanding personal
ignore (e.g., the sound of a zz May have a high space and be overly
flickering lightbulb) tolerance for pain physically affectionate
zz May seek out and seem
to enjoy extreme sensory
experiences (e.g., climbing
high buildings or trees)

When do differences in sensory sensory processing difficulties that are so severe

and/or prevalent that they have a clear negative
processing become an issue? impact on a person’s day-to-day life. Although
It’s very common for people to occasionally feel not currently a formal disorder, a professional
over or under sensitive to different sensory inputs. may assess and treat difficulties in sensory
For example, some people can feel that lights that processing to support and improve a person’s
don’t normally bother them are too bright when everyday functioning.
they have a headache. Others may feel less It is important to note that there are certain
sensitive to things going on around them when sensory behaviours that are part of the diagnostic
they are over-tired. These feelings usually don’t criteria for autism.
last that long, and don’t have a large impact on
everyday life functioning. However, when sensory “He doesn’t like the sound of his
processing difficulties get in the way of everyday sister speaking because she is higher
life, or are present most of the time, they may
pitched. Especially if we are in smaller
have reached a level that requires clinical support
or advice.
environments like the car, the sound is
more intense for him. ”
Currently, there are no formal diagnostic labels or
criteria for sensory processing disorders, meaning
you cannot receive a formal diagnosis of Sensory
Processing Disorder (SPD) in the UK. However,
many people use this term (SPD) to describe

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 Important information for families
Many parents go online to find out about sensory processing disorders. There are a lot of internet
bloggers and other individuals online that push parents to go and get a Sensory Processing Disorder
diagnosis. This can be confusing for families because many professionals won’t give this diagnosis
because there are no formal diagnostic labels or criteria for sensory processing disorders in the UK.
It is also important to be aware that if a therapist is offering a SPD diagnosis, this should be a
warning sign because of the lack of a formal diagnostic process. A good professional should know
this.

In the general population, studies find that around discussed with your child’s doctor or health
16% of children are classified as having elevated care provider. When reading information in this
reactions to sensory input3. Other studies find guide, it is important for you to know that most
that 66% of autistic children (65-90% of autistic of the research looking at the impact of sensory
children, depending on the research study), and processing on anxiety, behavioural problems and
32% of children with special education needs sleep has been conducted with autistic people.
(who were not autistic) show definite differences Whether there are similar patterns found in
in sensory processing4. Although researchers are individuals with intellectual disability and other
still trying to agree on the exact rates of different genetic syndromes is less well tested.
types of sensory processing problems in different
Anxiety
groups of people, it is generally believed that
people with a diagnosis of autism, and people Research suggests a link between sensory
with genetic syndromes and/or intellectual hyperreactivity and anxiety problems5, 6. This
disability are more likely to experience sensory could be due to hyperreactivity to certain sensory
processing difficulties. These difficulties are inputs leading to over-arousal and problems
also present in people without developmental regulating negative emotions (like anxiety). This
disorders. Other risk factors for sensory processing in turn can lead to worry around experiencing
difficulties include prenatal complications, certain sensory inputs in the future. In addition,
complications during birth and premature birth. children with neurodevelopmental disorders,
such as autism, are often poor at predicting
How can sensory processing what is going to happen next, and this can lead
to these children worrying even more about
difficulties impact upon sensory inputs they may experience. Children
behaviour? may then try and avoid situations where they
think they may experience those sensory inputs7
There are three main areas of a young person’s
(see Box 2). Although most research suggests
life which can be affected by sensory processing
hyperreactivity may lead to anxiety, high levels
difficulties that will be covered in this guide;
of anxiety may also make people feel more
anxiety, behavioural problems and sleep.
sensitive to certain sensory information.
However, there are other areas of life that might
be impacted too. If you feel a specific area of
your child’s life is being impacted by sensory
processing difficulties (e.g. feeding, toileting,
physical health issues) then this should be

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Box 2. Links between sensory hyperreactivity and anxiety.

Long term:
Child is
Anxiety increases.
hyperreactive to
Child loses
certain sensations
confidence and does
(e.g. noise from
not have chance
handryers)
to develop coping
strategies

Child tries to avoid

these sensations Child feels
(e.g. not going overwhelmed
to certain when these
bathrooms, sensations are
often wearing experienced
earphones)

Child worries
Child becomes
about
watchful and
experiencing
hyper-vigilant of
these sensations
these sensations
again

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 Behavioural problems Sensory processing and specific
Sensory processing difficulties, specifically
movement sensitivity, have also been linked to
genetic syndrome groups
behaviour problems8. Although more research There are certain genetic conditions that can
has focused on sensory hyperreactivity, children cause developmental differences, including
who are hyporeactive may also be at risk of intellectual disabilities and/or autism.
developing emotional and behaviour problems. These are sometimes known as genetic
Adults with intellectual disability and autism, who neurodevelopmental syndromes. Some of the
are under-sensitive to sensory input experience better-known, and better-researched, syndromes
more emotional disorders, anxiety, irritability and include Down syndrome, Fragile X syndrome,
aggressive behaviour9. Angelman syndrome and Williams syndrome.
Each of these is caused by a specific type of
Sleep genetic alteration in an individual.
Others also suggest there is a link between The number of known genetic
sensory processing and sleep10,11. For example, neurodevelopmental syndromes is growing
being hyperreactive can lead to sensitivity to the year on year as the availability of detailed
feel of bedsheets or pyjamas, or sensitivity to genetic testing, and knowledge of genetics
background noise. Hyporeactivities could result increases. Many children for whom the cause of
in not feeling stimulated enough during the developmental differences might not have been
day, and therefore not feeling tired by bedtime. identified in the past are now receiving diagnoses
Interoception difficulties can cause errors in our of genetic conditions.
interpretation of bodily signals necessary for
optimal sleep e.g. when a child is not able to read Of course, having a diagnosis of a genetic
body clues that indicate they are tired12. Sensory syndrome in itself tells us relatively little about
processing may therefore be important to consider a person. There are just as many differences
when exploring factors affecting sleep quality. It’s between people with a specific diagnosed
likely that sensory processing and sleep impact genetic syndrome as there are for people without
on each other. For example, sensory processing a genetic syndrome – everyone is different.
difficulties may make sleep more difficult, but However, it can sometimes be useful to know
poorer sleep may also make sensory sensitivities which characteristics or difficulties are more likely
worse. for people with certain genetic conditions. This
may help parents and professionals to spot any
The family issues early, and provide appropriate support.
It is important to consider how sensory processing For a number of the better-researched genetic
difficulties impact the whole family. Sensory neurodevelopmental syndromes, there is evidence
processing difficulties can create significant anxiety of increased rates of sensory processing difficulties
for families and has been linked to parenting (see below). For other genetic conditions, where
stress13. Whole family working (including parental less research has been done (including rarer or
self-care) is key to ensure appropriate and more recently-discovered genetic syndromes
sustainable intervention and support. Research and genetic variants of unknown causes), it may
suggests that sensory processing difficulties are be that the direct evidence base remains limited.
likely to persist over time14, 15, so appropriate advice However, it can still often be useful to consider
(e.g., from a clinician or healthcare provider), whether sensory processing difficulties are present
should be sought if these difficulties are beginning for individuals. There are a few potential reasons
to impact on a young person’s day-to-day life for this. First, having a genetic syndrome increases
and/or the well-being of the family. the overall chance an individual will have autism,
which is diagnostically linked to difficulties with
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sensory processing. For some syndromes, a large Fragile X syndrome (FXS)
proportion of people may meet diagnostic criteria
Research suggests that men and boys with FXS
for autism (e.g., Phelan-McDermid syndrome;
have heightened risks of sensory processing
Fragile X syndrome)16. For others (like Down
difficulties, especially if they also have autism20.
syndrome), rates of autism are lower (around
Hyper- and hyporeactivity sensory processing
one fifth), but still greater than in the general
has been noted in this group. It may be that
population.
hyperreactivity becomes more obvious as people
In some syndrome groups, many individuals with FXS get older. Hyperreactivity may be
have difficulties with issues such as anxiety (e.g., in related to people with FXS not getting used to
Williams syndrome; Cornelia de Lange syndrome; sensory stimuli, so they may respond more21,22.
Fragile X syndrome), sleep difficulties (e.g., Smith- Hyporeactivity is more apparent in younger
Magenis syndrome), self-injurious behaviour people and people with more limited ability23.
(e.g., Cornelia de Lange syndrome; Smith-
Some of the differences in hyperreactivity
Magenis syndrome), or repetitive behaviours (e.g.,
in FXS may be linked with poor eye contact,
Angelman syndrome; Fragile X syndrome). These
hyperactivity, tactile defensiveness (disliking
problems might sometimes relate to sensory
being touched), avoidant behaviours, aggression,
processing difficulties 17,18,19. This means that
anxiety, verbal tics and repetitive motor
sensory processing may be investigated for that
behaviours. Children who show more avoidance
individual by clinical professionals.
of sensory inputs may also perform more poorly
in school and have lower independence in daily
It can be helpful to know the specific problems living skills24.
associated with a genetic syndrome your child Little is known about sensory processing for
has – you might want to look out for these, females with FXS (although research with
or alert clinicians to relevant problems that this group is now growing). It may be worth
might need further assessment. However, considering whether sensory processing is an
remember that just because certain difficulties issue if, for example, a female with FXS has high
are more common for people with a specific levels of anxiety and avoidance behaviours (which
syndrome than those without the syndrome, are known to be common in girls with FXS).
it does not mean everyone with the syndrome
will be affected in the same way. Williams syndrome (WS)
A high proportion of children with WS
have sensory processing difficulties, with
The genetic syndromes reviewed here are hypersensitivity to sound being the best-
included because they are associated with researched area25. Children with WS may also
elevated rates of autism16, and/or because be hypersensitive to tastes and proprioceptive
more is known about sensory processing information (body awareness and position)26.
in these syndrome groups. Just because a Some research has found that people with
syndrome isn’t mentioned here doesn’t mean Williams syndrome who have greater sensory
sensory processing difficulties aren’t present, or processing difficulties have more difficulties in
even prevalent, for people with this syndrome. other areas, such as “executive functioning”
The information here isn’t intended as a and behaviours that challenge27. (“Executive
comprehensive summary of the research for functioning” refers to the set of processes by
any given syndrome group; the evidence base which we control and monitor behaviour. These
is expanding all the time. processes include control of attention, inhibiting
behaviours which aren’t currently useful, and
holding relevant information in mind). Anxiety,
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 which is known often to be a problem for people Phelan-McDermid syndrome (PHMDS)
with WS, might also be related to sensory
A study of 24 children with PHMDS32 found
processing difficulties and repetitive behaviours26.
that children had possible sensory processing
Therefore, anxiety and repetitive behaviours
differences. Children were mainly more
may sometimes be a sign of sensory processing
hyporeactive and less hyperreactive compared
difficulties in people with WS.
to children with idiopathic autism, (autism with
Angelman syndrome (AS) unknown genetic cause).
The majority of children with AS have differences PHMDS is very strongly associated with autism,
in sensory processing. This is often in the form and one of the most common forms of autism
of hyporeactiveness to touch and vestibular caused by a single gene. Compared with children
sensation (movement, balance, coordination), with autism that have no single known genetic
alongside (perhaps leading to) sensory seeking cause, children with PHMDS may have fewer
behaviours28, 29. However, the same individual difficulties with hyperreactivity (specifically
may show signs of hyper- and hyporeactivity. not being hyperactive to taste, smell, vision,
hearing, and touch) but greater difficulties with
Down syndrome (DS) hyporeactivity and low muscle tone.
Individuals with DS may be more likely to have
sensory processing difficulties in a number of
areas. These include low energy/weakness,
hyporeactivity and sensation-seeking, and
difficulties with filtering of sounds30. Sensory
processing difficulties may relate to decreased
muscle tone in people with DS, and possibly to
lower participation in school activities and daily
living skills31.

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Part 2 - Sensory Assessments
The following section on assessment has his/her full potential. Understanding of your
been written focusing on children with autism. child’s sensory experiences and needs could also
However, much of the information below is lead to a better family life36.
relevant for children with learning disabilities who Sensory assessments are, however, not regularly
do not have a diagnosis of autism. included in the autism diagnostic process and
Many autistic children perceive the world in vary greatly depending on the individual service
a different way compared to their peers. The and commissioning. Ideally a comprehensive
most recent diagnostic criteria (Diagnostic and sensory assessment should consist of gathering
Statistical Manual of Mental Disorders; DSM-5) information from several sources; a combination
included sensory reactivity symptoms, such as of both a caregiver report or interview and a direct
hyperreactivity (stronger response to sensory observation and assessment of the child37,38.
stimuli such as lights), hyporeactivity (slower or The evaluation might, for example, include a
less of a response) and sensory seeking (unusual talk with the caregiver first without the child
sensory interests), as a recognised symptom present, followed by an observation of your child,
of autism33. However, few advances have been sometimes standardised tests and questionnaires
made in the diagnostic process since the DSM-5 will also be used. These assessments should
has started to be used. be conducted by trained experts such as
Individual services vary regarding assessments for Occupational Therapists. Standardised sensory
autism; best-practice, gold-standard evaluations assessments, such as the parent reports and
generally consist of a combination of direct observations listed below, are recommended39.
diagnostic assessments such as the Autism
Diagnostic Observation Schedule, Second Edition
Caregiver/parent reports
(ADOS-2)34 and an interview with the caregiver Many different parent report measures are used
such as the Autism Diagnostic Interview-Revised for assessing sensory symptoms40, 41. In general,
(ADI-R)35. While the ADOS-2 and ADI-R provide parent reports and/or interviews will ask about
important information on social communication sensory experiences your child might have, such
difficulties and repetitive or restricted behaviors as being overwhelmed by sounds, or seeking out
and interests, these assessments do not focus bright and coloured objects. The Sensory Profile
much on sensory processing. For example, the and Sensory Processing Measure seem to be the
ADOS only includes one sensory item, ‘unusual most widely used clinical caregiver reports. New
sensory interests,’ which captures sensory seeking tools are under development and will become
behaviour. available, and it is important for healthcare
professionals to be aware of those42.
Sensory assessments/ One of the most widely used parent reports is the
evaluation The Sensory Profile that assesses an individual’s
responses towards sensory stimuli encountered
Early sensory assessments can be beneficial
in everyday life43, 44, 45. The Sensory Profile-2
as they can lead to early interventions which
has several versions depending on the age of
have been shown to be most efficient, however
your child. An example item for hyperreactivity
assessments and learning about your child’s
to sensory stimuli, such as sounds is: ‘My child
sensory needs at any stage are useful36. You
becomes upset or tries to escape from noisy
can then start making adjustments at home or
settings’. An example item for hyporeactivity is:
educational settings to allow your child to reach
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 ‘My child only pays attention if I speak loudly’. An Other assessments you may come across are the
example for seeking out sensory stimuli could be: Sensory Processing Scale Assessment (SPS)48,
‘My child looks carefully or intensely at people’. the Tactile Defensiveness and Discrimination
The Sensory Profile shows differences in 60- Test—Revised (TDDT-R)49, the Test of
90% of autistic children and adults44, 45. While the Sensory Functions in Infants (TSFI)50, 51 or the
Sensory Profile is widely used to measure sensory Sensory Assessment for Neurodevelopmental
symptoms in autistic individuals, not all questions Disorders (SAND)52. All performance-based
are applicable to minimally verbal children. tests and standardised observations include a
Another commonly used parent report for direct interaction of your child with a clinician
measuring sensory symptoms is the Sensory or healthcare professional. The healthcare
Processing Measure (SPM), which is a parent professional should be trained in these direct
or teacher rating scale that measures sensory assessments and have an adequate level
functioning in preschool and school-aged of qualification to be able to conduct these
children46. The SPM will look at different assessments.
modalities, such as vision, hearing and touch and
also includes body awareness, balance, planning
Multidisciplinary team
and awareness and social participation. The First and foremost, you as the caregiver are
Sensory Profile, Sensory Processing Measure’s a crucial member of the team, you will learn
and other parent reports have made significant how to become a ‘sensory detective‘. Given that
contributions to the clinical understanding a sensory evaluation only covers a snapshot
of sensory symptoms and are critical for a of time, it can be useful to prepare for the
“trait-based” assessment. Caregiver reports assessment in advance, e.g. use a diary to note
are important and have made important down any sensory symptoms (e.g. putting hands
contributions to understanding of sensory over ears when blender is used), or even taking
processing. However, they can be influenced a video when symptoms occur36. Your input in
by parent’s views and feelings. This is why the the assessment is important and will provide
assessment of sensory processing should include healthcare providers with the information they
a combination of parent report questionnaires need to evaluate your child’s sensory needs.
and direct assessments with the child.

Performance-based sensory
assessments and standardised
observations
Several standardised sensory observation
tools exist, including the Sensory Integration
and Praxis Tests (SIPT)47. The SIPT offers
several tasks assessing vision, touch and motor
perception in children between the ages of 4
and 847. The whole assessment takes around
two hours to complete, however, individual tests
can be administered (10 minutes per test).
During the SIPT your child might show sensory
hyperreactivity, e.g. strong response to touch.

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 BOX 3. Julie, David & Alice’s story
Alice is a young person with Kleefstra syndrome; Alice is very sensory seeking. Alice and
her parents, Julie and David, have had two experiences with sensory assessments. Their
first experience was through a self-referral to an Occupational Therapist, who was part of a
special needs parent group and was keen to get parents to take part in assessments. After the
assessment, Alice and her family received a report detailing Alice’s sensory profile. David and
Julie did not feel the report was an accurate reflection of Alice and her sensory needs, and that
some symptoms and information reported were inaccurate. Whilst the report itself was not
so helpful for Julie and David they were able to get more ideas for equipment and avenues to
pursue to help engage Alice such as brushing and sensory-rich toys.
The second assessment came from Alice’s school, who referred Alice to an Occupational
Therapist for odd posture and chewing. Not all parents would be able to access support in this
way as in some places in the country, services are not commissioned to work with sensory
issues. This referral was school specific and as can sometimes happen with school-based
assessments, David and Julie were not invited to be involved. However, Julie pushed to be
included in the process and was eventually. Whilst the process of assessment in the case of Alice,
Julie and David may appear negative, it allowed Julie to be able to understand Alice’s needs and
behaviours better and gave her the starting point to start doing her own research into helping
Alice.

As described in Box 3, David and Julie’s story, classified as occupations. Ideally, the sensory
snapshot assessments may not accurately reflect assessment should be conducted with an OT
what you think your child’s sensory needs are. or other healthcare professional who has extra
Despite this, some aspects of the assessment training related to sensory processing. After
may still be helpful. A multidisciplinary the assessment a report should be sent to you.
professional team is recommended for Again, the report may vary depending on the
the sensory assessment37. Different health service that will provide it. The report should
professionals will be able to evaluate different include a description of symptoms, as well as
aspects of your child’s development. A GP, strengths and weaknesses, and what intervention
pediatrician or family doctor for example can is recommended36. The NHS, for example will
evaluate your child’s general health to see if there recommend evidence-based practice. The
is an underlying medical condition. A psychologist report takes information gathered and interprets
or psychiatrist could check your child’s mental these in light of how sensory symptoms might
health and see if they have other conditions. affect daily living, participation in social and
There are other health care professions which family activities39. A report will often include
might be useful to consult with. For example, a more comprehensive picture of your child’s
a developmental optometrist can check your development, including motor function as well as
child’s visual perception of the world. Whereas sensory processing.
a pediatric ophthalmologist can test the health
of children’s eyes. An Occupational Therapist Accessing NHS services
can provide expertise on sensory processing As mentioned above, the type of assessment
and is best suited to test for sensory symptoms. varies depending on the individual service. The
Occupational Therapy is a healthcare profession availability of sensory assessments through the
that helps with everyday activities, such as NHS also varies dependent on where you live
eating, learning, playing, self-care, that are in the UK. Some Learning Disability Child and
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 Adolescent Mental Health Services (CAMHS- When discussing getting an assessment with
LD), Learning Disability Teams in primary care your child’s health team, it is important to say
settings, Child Centre’s and specialist autism how sensory reactivity symptoms are impacting
services have Occupational Therapists who work your child’s well-being and family life, particularly
within these services who could offer sensory when sensory sensitivities appear to be linked
assessments. Schools, especially special needs to anxiety. Some services may be only open
schools, may also offer Occupational Therapy to children with specific characteristics, such
services as well as some private Occupational as children who may be experiencing mental
Therapist’s. Private Occupational Therapists health problems or those who have a diagnosis
may vary in quality, so make sure to check that of autism. If your child has a genetic syndrome
necessary qualifications (e.g. registered with associated with autism but does not have an
HCPC) and training are in place. If you feel your official diagnosis of autism, you may need to
child would benefit from a sensory assessment, it make your child’s health team fully aware of how
is important to thoroughly investigate what NHS autism characteristics are associated with the
services are available to you in your local area and syndrome and be prepared to advocate for input.
to get your child’s name on a waiting list. GPs are
usually the professionals who are able to refer you
to your local learning disability or autism services,
although they may not always know about the
specific assessments that will be available to you
from these services.

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Part 3 - Interventions and strategies for sensory
processing difficulties
In addition, some children’s activity centres
Should interventions always and cinemas provide sessions specifically for
be based on a thorough children with autism where adaptations are
made to the environment to make it more
assessment? suitable to the needs of these children. Some
While sensory assessments can be difficult to examples of environmental adaptations are
access, the current recommendation is that all shown in Box 4 (pages 16-18)for hyper-and
sensory interventions should be informed by a hyporeactive children, although this is not an
thorough assessment. Interventions that are not exhaustive list. Kate and Laura’s story in Box
based on a thorough assessment are less likely to 5 ( page 18 ) describes some strategies they
be effective because they may not be matched have implemented to support Laura’s sensory
to your child’s sensory needs53, 54. In addition, processing difficulties.
there is very little research on the adverse effects
of an intervention that is not well-matched to a
child’s profile of needs. Well-planned interventions “The use of sensory activities keep him
are delivered at a time that is right for your child calm and alert and then we don’t see
and your family and, while all interventions can those swings. We think it works really
place some stress on families, it is important that well, the chewy tube and supporting
the timing of the intervention does not put more Annabel with the environment. ”
stress than necessary on your child or you. If this
is a busy period for your family, it may be worth
postponing the intervention for a short time to
ensure you have the maximum emotional and “He’s started using ear defenders. I think
physical resources before making changes. more of a comfort thing rather than the
actual like loud noises but I can’t say for
Can parents do anything to help sure because he can’t tell me. I’ve had
improve their child’s sensory them for a few years but then he was
processing or well-being anxious over the summer holidays I was
trying lots of different ways to help him
related to sensory processing and calm him down and this actually
difficulties? worked and now he’s asking for them. ”
Despite a thorough assessment being an
important component of any intervention, many
families choose to adapt the environment around
their child or implement their own strategies to
support and manage the sensory inputs that
their child experiences.

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 Box 4. Strategies that may be helpful for children with sensory sensitivities
Hyper-reactivity Ideas
Auditory zz Headphones or listening to music may be calming
zz Reducing noise in a busy environment e.g. turn off the TV
zz Install carpets to avoid the clatter of footfalls and to stop
sound travelling
zz Some children may find constant background noise, such
as white noise calming
Visual zz It may be helpful to wear a baseball cap or sunglasses
zz Use a dimmer switch
zz Fluorescent lighting may be particularly unpleasant to
some children with autism, therefore, where possible try to
ensure children are in naturally lit rooms or are not seated
directly under these lights

Tactile zz Avoid unexpected touch. Tell your child or show them a

picture card or cue to let them know that you are about to
touch them
zz If you have to queue in a line your child may feel more
comfortable being first or last
Olfactory (smell) zz Make the environment as fragrance free as possible, for
example, use un-perfumed toiletries
zz Keep rooms well ventilated
zz Teach your child appropriate coping strategies e.g.
covering nose with tissue, informing others that a smell is
unpleasant, either verbally or using a picture card or cue

Gustatory (taste) zz Involve your child in food shopping and food preparation.
This introduces your child to the texture and smell of food
items without having to eat them
zz Allow preferred food items at mealtimes and ensure that
your child is eating in a calm environment

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Hypo-responsivity Ideas
Auditory zz Gain the person’s attention before speaking to them
zz Remove other distracting background noise
zz Break down instructions into several smaller steps
Visual zz Provide visual structure e.g. colour code books and timetables/
schedules
zz Allow access to preferred types of visual stimulation for certain
periods in the day
Tactile zz Gain the person’s attention before touching them
zz Consult with an Occupational Therapist regarding activities to
increase tactile awareness e.g. messy play activities
Olfactory (smell) zz Provide activities that stimulate the olfactory senses e.g. using
scented play dough, cooking with strong smells
zz Provide appropriate scented items such as hand cream or
aromatherapy oils and direct your child to them when he/she
attempts to smell people or potentially harmful materials
Gustatory (taste) zz Allow your child to add strong flavours to meals or to choose
strongly flavoured food e.g. chilli flakes, black pepper, citrus
fruits, strong cheese
zz If your child tries to eat non-food items, teach your child to
discriminate between edible and non-edible items e.g. using a
green box for edible items and a red box for non-edible items
zz You could also try to select items which are similar in taste/
texture to the non-food item that your child seems to be
seeking e.g. chewy tubes, chewy sweets, dried fruit, raw
vegetables
zz Encourage your child to engage in oral activities e.g. blowing
bubbles, blowing up a balloon, playing a wind instrument

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 Sensory seeking Ideas
Auditory seeking zz Listening to music through headphones may be helpful
Visual seeking zz Ensure your child has access to lots of visually stimulating
toys or objects
Tactile seeking zz There is evidence that massage and pressure may be
helpful to some children
zz Make sure you have lots of different materials around the
house e.g. tactile bath mats
Olfactory (smell) zz Your child could carry a tissue or piece of material with a
preferred scent and they could be prompted to smell this
instead of smelling people or potentially harmful materials
Gustatory (taste) seeking zz Allow your child to consume meals with strong flavours

BOX 5. Kate and Laura’s story

Laura is a young person with Cornelia de Lange syndrome and has a broad profile of sensory
processing difficulties. She did not get a sensory assessment until she was in her 20s, although
her mum Kate would encourage parents to get one as early as possible even if it means
going private (if possible). Laura has particular difficulties with proprioception (problems with
understanding where her body is and positioning). This means that she likes to pace to help
fulfil her sensory needs. At times this may be viewed as inappropriate or disruptive (e.g. in the
middle of class). However, accommodating Laura’s needs by accompanying her for a 5 minute
walk means she can get her required sensory feedback and that her behaviours and anxiety do
not escalate.
Laura likes deep impact pressure to help regulate her sensory processing, so she carries around
a weighted doll whilst she paces to help. Other strategies used to help Laura with her sensory
processing include a sensory bed cover, which really improved her sleep and sensory beads that
her doll wears so that Laura can chew them when she needs.

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Strategies for sensory able to make sense of why, leading them to learn
that all unfamiliar environments are potentially
hyperreactive children dangerous. It is not possible to control and predict
Does your child have a self-regulation all elements of the environment (unpredictable
things will always happen). However, for children
strategy? who can understand phrases, it’s often helpful
Some children may be able to learn self- to let a child know what to expect when they
regulation strategies so that they can use these to are going into unfamiliar situations. Importantly,
help manage the environment around them by you can also let them know strategies they can
themselves. An example of this is a hyperreactive use to manage when an unpleasant sensory
child learning to put on their headphones and experience occurs. As children with intellectual
listen to music when the environment becomes disability often have difficulty with problem
over-whelming. Another is a child learning to solving, knowing that there is a plan to manage
point to a picture card to request a five-minute a situation can reduce anxiety. This can often be
break before returning to the activity they were achieved by using a story format (see Daniel’s
doing. At first a child may need to be prompted Story, Box 6 on page 20).
to do this with a verbal prompt and a gentle
physical prompt if necessary; these prompts can Avoid avoidance
be reduced as a child learns what to do in a given Keeping your child away from, or avoiding,
situation. For example, a parent who noticed their sensory experiences can sometimes be an
child was showing signs of discomfort because effective short-term strategy to avoid distress
the lights are too bright might put words to their caused by hyperreactive to stimuli. For example,
experience and then provide the tool to help if a child gets over-whelmed by being in a loud
e.g. ‘the lights are very bright. Let’s put on your and busy shopping centre, choosing to shop at
glasses’. less busy times may mean that your child can
still participate in the activity without experiencing
“He is a sensory seeker and has high discomfort or distress. However, avoidance is
levels of sensory needs. He has chewers a double-edged sword. There is evidence to
suggest that the more people avoid sensory
and a ball and trampoline which he
input, the more they can become sensitive to
bounces on. If he doesn’t have enough that stimulus, meaning they are more likely to
opportunity to explore his sensory notice it55. In addition, if children avoid situations
interests, he can become very anxious. ” or experiences because they make them feel
anxious, the anxiety can deepen overtime. More
information on anxiety can be found in the
Cerebra Anxiety Guide (see Box 8 on page 23).
Is your child prepared in advance? For example, a child who is given ear muffs to
Children often experience fear and anxiety in block out noise without real cause may become
unfamiliar situations where they are not sure more sensitive to sound overtime as well as very
what is going to happen next. If children have anxious about being in situations where they
sensory sensitivities they may be anticipating cannot wear the defenders. Therefore, while
that unpleasant sensory experiences could occur avoidance of sensory stimuli may be useful for
at any point. This fear or anxiety may be made specific situations, strategies that encourage
worse if unpleasant sensory experiences have avoidance should be applied only when
occurred in the past in an unpredictable way. This absolutely needed.
can be compounded when a person was not

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 BOX 6. Daniel’s story
Daniel is an eleven-year-old autistic boy who has started to go to the football with his mother,
which he loves to do. He communicates with his mother using short restricted phrases, although
he understands more words than he can speak. Daniel can sometimes be hyper-sensitive to
sounds, particularly when they are sudden and unpredictable. The first time Daniel goes to the
football and a goal is scored, Daniel is overwhelmed when the crowd stand up suddenly and
there is a lot of noise. He becomes very distressed and starts to cry, shout and lash out, and his
mother wonders whether it was the right thing to continue to take Daniel to the games. Despite
this, she persists on taking Daniel and the second time she prepares him for what is likely to
happen. She uses an illustrated story that she created on her computer to prepare Daniel for
what happens at the football match to explain to Daniel why the crowd stands up and cheers.
She also gives Daniel a strategy by telling that he can cover his ears with his thick woolly hat
when this happens to help block out the sound. She practices this with him at home when they
watch the football on the TV. The next time Daniel goes to the football and the crowd cheers,
Daniel starts to show signs of distress although he is a little less distressed than last time. His
mother prompts him to use his strategy of pulling down his hat to cover his ears, and once he
is showing signs that he is calmer, she reminds him of why the crowd cheers to help him make
sense of what has just happened. Over several matches, he starts to cover his ears without his
mother prompting him and starts to show signs he is enjoying the goals. Daniel becomes more
confident and his distress reduces, despite not always getting his hat down in time over his ears.
The fact that he now understands why the crowd cheers and that he feels more in control of
the situation has had a significant impact on his level of distress. He has also learnt to tolerate a
greater level of noise than before and has learnt a strategy he can generalise to other situations
(e.g. fireworks night). Not every child would cope with this situation as well as Daniel, however,
preparing a child for what will happen, giving them a strategy to reduce stimulation, and helping
a child make sense of a situation can all be helpful.
For a description of what a social story is and how to create one, follow the link below.
https://www.autism.org.uk/about/strategies/social-stories-comic-strips.aspx

Develop a plan to help your child build resilience to sensory stimuli

While avoidance is sometimes used as a short-term strategy for children who are hyperreactive to
stimuli, research has indicated that interventions that are child-led but pose gentle challenges to a
child’s sensory processing abilities may lead to improved outcomes for children53. Parents may be
able to support their child feel more comfortable with sensory stimuli overtime. By no means does
this mean that parents should take their child into situations that cause them clear discomfort or
distress. It means trying to gradually support your child to explore more varied environments where
they encounter new sensory stimuli. For example, if a child has difficulty being in loud busy places,
it may be that visiting a quiet shopping centre is necessary at first; it is important not to stay at this
level for too long and to try and very gradually build your child’s tolerance to busier shopping centres
again. You could combine a very short trip to a slightly louder environment while practising some of
the self-regulation strategies above (e.g. listening to white noise through headphones if the noises of
the shopping centre get too much). Importantly, there will likely be limits to this approach and not all
children will be able to learn to tolerate all environments, nor should they. The important thing is to
try to strike a balance between avoidance of experiences and providing opportunities for your child to
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experience gentle sensory challenges that build noises, sounds, lights or smells should be reduced
their confidence over time. Flexibility is key. when you are communicating with your child to
give your child the best chance of responding to
Can you reduce the impact of sensory
you.
sensitivities on your child’s sleep?
Individuals who are over-responsive to sensory Strategies for sensory seekers
input are likely to be especially sensitive to Children who are sensory seekers often benefit
the effects of stimuli in the sleep environment from more opportunities to interact with their
such as lights, noise, temperature and tactile surroundings. This allows them to obtain the
input56. Therefore, adapting the individual’s type of stimulation that they find enjoyable or
sleep environment may help the individual to soothing. For these children, providing lots of toys
fall asleep and stay asleep57. For example, the that provide sensory input may be beneficial.
use of white noise machines can help mask Occasionally, sensory-seeking behaviours may
sounds in the environment that may disturb the become concerning to parents because they
sleep of an individual36. Another example is to may pose a danger to their child e.g. a child
choose calming and neutral colours within the who turns on the hot taps to watch the water
individual’s bedroom, as some colours can be flow. In these situations, parents should work
over-stimulating for children36. There is a very with an Occupational Therapist to try to find an
limited evidence-base for sensory interventions activity that gives their child the same type of
specifically designed to improve sleep in sensory experience but in a safe way (e.g. water
individuals with neurodevelopmental disorders play or watching sand move in a sand timer).
and/or autism. Most of the interventions This means the child is no longer motivated to
suggested are based on clinical experience and engage in the dangerous behaviour to obtain
a trial and error approach, especially given that this stimulation. It is always important to rule
sensory processing problems can vary hugely out other reasons why dangerous behaviour
across individuals. For more information on how might be occurring too. For example, sometimes
to adapt the sleep environment and improve children may engage in dangerous behaviour
sleep hygiene, see the Cerebra Sleep Guide (See because it produces a strong reaction from their
Box 8 on page 23). parents and leads to another consequence that
they may find rewarding (i.e. attention from
Strategies for sensory parents, removal from a situation they would
hyporeactive children rather not be in, or delivery of a preferred item
such as an iPad). Over time, children can learn
Children who are hyporeactive, may often not
that a specific behaviour (e.g. turning on a hot
respond to stimulation around them. For these
tap) reliably leads to this reward. Therefore, when
children, it is important to ensure that you get
introducing an activity to replace a behaviour
their attention before you start communicating
presumed to be due to sensory seeking, make
fully with them. This could be done by pairing
sure that you consider whether the behaviour
their name with a gentle touch to the hand,
could be a ‘learnt’ behaviour for another
or by supplementing speech with visual
reason. You can find more information about
communication aids to give a clear prompt or
how behaviour is learnt overtime by visiting
cue that you have started to communicate with
the Challenging Behaviour Foundation or by
them. As with many children with intellectual
watching the Cerebra video about behaviours
disability and communication difficulties, it is
that challenge (see Box 8 on page 23).
important to use short phrases and to break
down instructions into small steps. Distracting

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 What other types of other interventions are available, and do they
work?
Sensory Integration Therapy
There are some clinic-based interventions that have been developed for children with sensory
sensitivities. The evidence for the effectiveness of most of these interventions is limited; however, there
is now several research studies that provide some evidence that clinic-based sensory interventions,
in particular Ayres Sensory Integration Therapy (SIT), may help families achieve their individual
goals for their child. The interventions may also improve a child’s sleep and caregiver well-being54.
SIT is delivered in a clinic with a variety of equipment (e.g. trampolines, climbing walls etc). The child
is provided with activities that challenge their sensory processing to help them to integrate sensory
stimuli54. SIT focuses on improving the child’s self-regulation and motivation for engaging with stimuli.
If your child is going to receive SIT, it is important to ensure that this is delivered by a trained therapist
(see Box 7 below that covers some of the things you should ask your therapist). Importantly, parents
should be aware that if they seek out a therapist to deliver SIT, they may have to pay for the service
as it is not likely to be offered by the NHS due to the evidence base for this therapy only just starting to
emerge.

Box 7. (adapted from 36)

Questions to ask your Occupational Therapist or any other therapist who claims they can offer a
sensory intervention:
zz What formal training do you have in the assessment of and intervention for sensory
processing difficulties?
zz What experience do you have working with children who have intellectual disability or
neurodevelopmental conditions such as autism?
zz What sort of assessments do you use? (pay attention to whether the types of assessments
map on to what is described in this guide).

What’s the evidence base for the type of interventions you might implement at home?
Single sensory interventions are when one strategy or device is tried at a time. Examples of this may
be giving a child a massage. Some of the strategies that were listed in Box 4 (pages 16-18) are single
sensory interventions. At the current time, there are very few good quality research studies on the
effectiveness of these interventions.
The research that exists indicates that these interventions may not be very effective53. However,
there is some tentative evidence that movement related (vestibular) single sensory interventions,
such as bouncing up and down, may be effective for some children, particularly prior to settling to do
academic work58. There is also some evidence that massage may be helpful for improving sensory
responses and behaviours that challenge associated sensory issues59. One review of the scientific
literature states that the evidence base for massage was highest when it was applied three times a
week in the afternoon for 15-30 minutes60. However, it is important to remember that behaviours that
challenge can be caused by a broad range of factors, including unrecognised pain or discomfort, the
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child’s learning history and anxiety61,62. Massage ever trialled with guidance from an Occupational
should never be used without a thorough Therapist and removed if they are of no benefit
behavioural assessment. It is also important to the child. The Royal College of Occupational
that the child’s comfort levels and preferences Therapists has specific guidelines on the use
for tactile stimulation are considered before of weighted items, which are often viewed as
implementing massage to ensure that the child unsafe64.
and therapist are safe during the therapy63.
Psycho-education
For more information on the other causes of
behaviours that challenge you can access the Sensory processing difficulties can be complex
Cerebra Self-Injury Guide, Cerebra Pain Guide and confusing. Box 8 includes some resources
or Cerebra Anxiety Guide (see Box 8 below). that may be helpful for families who wish to
Finally, weighted vests and blankets have very learn more about sensory processing and how to
little evidence base and can be dangerous if not support their children.
implemented correctly, so these should only be
Box 8. Resources
Books
zz How does your engine Run – A Leaders Guide to The Alert Program for Self-Regulation,
Williams & Shellenberger (Therapy Works Inc)
zz Raising a Sensory Smart Child, Biel & Peske (Penguin Ltd)
zz Alert at Home and School, Williams & Shellenberger (Therapy Works)
zz Building Bridges through Sensory Integration, Yack, Aquilla & Sutton (Future Horizons)
zz Sensational Kids: Hope and Help for Children with Sensory Processing Disorder, Miller, Fuller,
Roetenberg (Penguin Group USA)
zz No Longer a Secret: Unique Common Sense Strategies for Children with Sensory or Motor
Challenges, Bialer & Miller (Future Horizons)
zz The Out-of-Sync Child: Coping with Sensory Integration Problems, Kranowitz (Perigee)
zz The Zones of Regulation, Kupers (Think Social Publishing)
Websites
zz The Challenging Behaviour Foundation https://www.challengingbehaviour.org.uk/
Cerebra Parent Guides and video
zz Anxiety : A Guide for Parents https://www.cerebra.org.uk/help-and-information/guides-for-
parents/cerebra-anxiety-guide-guide-parents/
zz Pain: A Guide for Parents https://www.cerebra.org.uk/help-and-information/guides-for-
parents/pain-in-children-with-severe-intellectual-disability-a-guide-for-parents/
zz Self Injurious Behaviour in Children with Intellectual Disability https://cerebra.org.uk/
download/self-injurious-behaviour-in-children-with-intellectual-disability/
zz Sleep: A Guide for Parents https://www.cerebra.org.uk/help-and-information/guides-for-
parents/sleep-a-guide-for-parents/
zz Behaviours that challenge in people with intellectual disabilities (video) https://youtu.be/
ozeAyJCMtMQ
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 References
1. Schaaf, R. C., Miller, L. J., Seawell, D., & O’Keefe, S. (2003). Children with disturbances in sensory processing:
A pilot study examining the role of the parasympathetic nervous system. American Journal of
Occupational Therapy, 57(4), 442-449.
2. Davies, P. L., & Gavin, W. J. (2007). Validating the diagnosis of sensory processing disorders using EEG
technology. The American Journal of Occupational Therapy, 61(2), 176-189.
3. Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2009). Sensory over-responsivity in elementary
school: prevalence and social-emotional correlates. Journal of Abnormal Child Psychology, 37(5), 705-
716.
4. Green, D., Chandler, S., Charman, T., Simonoff, E., & Baird, G. (2016). Brief report: DSM-5 sensory
behaviours in children with and without an autism spectrum disorder. Journal of Autism and
Developmental Disorders, 46(11), 3597-3606.
5. Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., ... & Herrington, J. (2014).
Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of
Autism and Developmental Disorders, 44(11), 2851-2861.
6. Lane, S. J., Reynolds, S., & Dumenci, L. (2012). Sensory overresponsivity and anxiety in typically
developing children and children with autism and attention deficit hyperactivity disorder: cause or
coexistence?. American Journal of Occupational Therapy, 66(5), 595-603.
7. Green, S. A., & Ben-Sasson, A. (2010). Anxiety disorders and sensory over-responsivity in children
with autism spectrum disorders: is there a causal relationship?. .Journal of Autism and Developmental
Disorders, 40(12), 1495-1504
8. Ashburner, J., Ziviani, J., & Rodger, S. (2008). Sensory processing and classroom emotional, behavioral,
and educational outcomes in children with autism spectrum disorder. American Journal of Occupational
Therapy, 62(5), 564-573.
9. Gonthier, C., Longuépée, L., & Bouvard, M. (2016). Sensory processing in low-functioning adults with
autism spectrum disorder: Distinct sensory profiles and their relationships with behavioral dysfunction.
Journal of Autism and Developmental Disorders, 46(9), 3078-3089.
10. Reynolds, S., Lane, S. J., & Thacker, L. (2012). Sensory processing, physiological stress, and sleep behaviors
in children with and without autism spectrum disorders. Occupation, Participation and Health, 32(1),
246-257.
11. Vasak, M., Williamson, J., Garden, J., & Zwicker, J. G. (2015). Sensory processing and sleep in typically
developing infants and toddlers. American Journal of Occupational Therapy, 69(4), 6904220040p1-
6904220040p8.
12. Harshaw, C. (2015). Interoceptive dysfunction: Toward an integrated framework for understanding
somatic and affective disturbance in depression. Psychological Bulletin, 141(2), 311-363.
13. Ben-Sasson, A., Soto, T. W., Martínez-Pedraza, F., & Carter, A. S. (2013). Early sensory over-responsivity in
toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress. Journal
of Child Psychology and Psychiatry, 54(8), 846-853.
14. Ben-Sasson, A., Carter, A. S., & Briggs-Gowan, M. J. (2010). The development of sensory over-responsivity
from infancy to elementary school. Journal of Abnormal Child Psychology, 38(8), 1193-1202.
15. Goldsmith, H. H., Lemery-Chalfant, K., Schmidt, N. L., Arneson, C. L., & Schmidt, C. K. (2007). Longitudinal
analyses of affect, temperament, and childhood psychopathology. Twin Research and Human Genetics,
10(1), 118-126.
24/30
16. Richards, C., Jones, C., Groves, L., Moss, J., & Oliver, C. (2015). Prevalence of autism spectrum disorder
phenomenology in genetic disorders: a systematic review and meta-analysis. The Lancet Psychiatry,
2(10), 909-916.
17. Uljarević, M., Lane, A., Kelly, A., & Leekam, S. (2016). Sensory subtypes and anxiety in older children and
adolescents with autism spectrum disorder. Autism Research, 9(10), 1073-1078.
18. Schulz, S. E., & Stevenson, R. A. (2019). Sensory hypersensitivity predicts repetitive behaviours in autistic
and typically-developing children. Autism, 23(4), 1028-1041.
19. Tzischinsky, O., Meiri, G., Manelis, L., Bar-Sinai, A., Flusser, H., Michaelovski, A., ... & Dinstein, I. (2018). Sleep
disturbances are associated with specific sensory sensitivities in children with autism. Molecular Autism,
9(1), 22.
20. Kolacz, J., Raspa, M., Heilman, K. J., & Porges, S. W. (2018). Evaluating sensory processing in fragile X
syndrome: psychometric analysis of the Brain Body Center Sensory Scales (BBCSS). Journal of Autism
and Developmental Disorders, 48(6), 2187-2202.
21. Miller, L. J., McIntosh, D. N., McGrath, J., Shyu, V., Lampe, M., Taylor, A. K., ... & Hagerman, R. J. (1999).
Electrodermal responses to sensory stimuli in individuals with fragile X syndrome: a preliminary report.
American Journal of Medical Genetics, 83(4), 268-279.
22. Rais, M., Binder, D. K., Razak, K. A., & Ethell, I. M. (2018). Sensory processing phenotypes in fragile X
syndrome. ASN neuro, 10, 1759091418801092.
23. Baranek, G. T., Roberts, J. E., David, F. J., Sideris, J., Mirrett, P. L., Hatton, D. D., & Bailey, D. B. (2008).
Developmental trajectories and correlates of sensory processing in young boys with fragile X syndrome.
Physical & Occupational Therapy in Pediatrics, 28(1), 79-98.
24. Baranek, G. T., Chin, Y. H., Hess, L. M. G., Yankee, J. G., Hatton, D. D., & Hooper, S. R. (2002). Sensory
processing correlates of occupational performance in children with fragile X syndrome: Preliminary
findings. American Journal of Occupational Therapy, 56(5), 538-546.
25. Glod, M., Riby, D. M., & Rodgers, J. (2019). Sensory Processing in Williams Syndrome: a Narrative Review.
Review Journal of Autism and Developmental Disorders, 1-14.
26. Janes, E., Riby, D. M., & Rodgers, J. (2014). Exploring the prevalence and phenomenology of repetitive
behaviours and abnormal sensory processing in children with Williams Syndrome. Journal of Intellectual
Disability Research, 58(8), 746-757.
27. John, A. E., & Mervis, C. B. (2010). Sensory modulation impairments in children with Williams syndrome.
American Journal of Medical Genetics Part C, Seminars in Medical Genetics, 154(2), 266-276.
28. Walz, N. C., & Baranek, G. T. (2006). Sensory processing patterns in persons with Angelman syndrome.
American Journal of Occupational Therapy, 60(4), 472-479.
29. Peters, S. U., Horowitz, L., Barbieri-Welge, R., Taylor, J. L., & Hundley, R. J. (2012). Longitudinal follow-up
of autism spectrum features and sensory behaviors in Angelman syndrome by deletion class. Journal of
Child Psychology and Psychiatry, 53(2), 152-159.
30. Bruni, M., Cameron, D., Dua, S., & Noy, S. (2010). Reported sensory processing of children with Down
syndrome. Physical & Occupational Therapy in Pediatrics, 30(4), 280-293.
31. Wuang, Y. P., & Su, C. Y. (2011). Correlations of sensory processing and visual organization ability with
participation in school-aged children with Down syndrome. Research in Developmental Disabilities,
32(6), 2398-2407.
32. Mieses, A. M., Tavassoli, T., Li, E., Soorya, L., Lurie, S., Wang, A. T., ... & Kolevzon, A. (2016). Brief report:
sensory reactivity in children with Phelan–McDermid Syndrome. Journal of Autism and Developmental
Disorders, 46(7), 2508-2513.
25/30
 33. American Psychiatric Association. (2013). Autism Spectrum Disorders. In Diagnostic and statistical
manual of mental disorders (5th ed.).
34. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation
schedule (2nd ed.). Torrance, CA: Western Psychological Services.
35. Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R: Autism Diagnostic Interview-Revised (ADI-R). Los
Angeles, CA: Western Psychological Services.
36. Miller, L. J. (2006). Sensational kids: hope and help for children with sensory processing disorder. New York,
NY: G.P Putnam and Sons.
37. Schaaf, R. C., & Lane, A. E. (2015). Toward a best-practice protocol for assessment of sensory features in
ASD. Journal of Autism and Developmental Disorders, 45(5), 1380-1395.
38. Tavassoli, T., Bellesheim, K., Siper, P. M., Wang, A. T., Halpern, D., Gorenstein, M., ... & Buxbaum, J. D. (2016).
Measuring sensory reactivity in autism spectrum disorder: application and simplification of a clinician-
administered sensory observation scale. Journal of Autism and Developmental Disorders, 46(1), 287-
293.
39. Schaaf, R. C., & Mailloux, Z. (2015). A clinician’s guide for implementing Ayres Sensory Integration®:
Promoting participation for children with autism. Bethesda, MD: AOTA Press.
40. Dunn, W. (2007). The Sensory Profile: User’s manual. San Antonio, TX: Psychological Corporation.
41. Baranek GT. Sensory Experiences Questionnaire (SEQ) University of North Carolina at Chapel Hill; 1999.
Unpublished manuscript
42. Schaaf, R. C. (2015). Creating evidence for practice using Data-Driven Decision Making. American Journal
of Occupational Therapy, 69, 6902360010.
43. Eeles, A. L., Anderson, P. J., Brown, N. C., Lee, K. J., Boyd, R. N., Spittle, A. J., & Doyle, L. W. (2013). Sensory
profiles of children born< 30 weeks’ gestation at 2 years of age and their environmental and biological
predictors. Early Human Development, 89(9), 727-732.
44. Lane, A. E., Dennis, S. J., & Geraghty, M. E. (2011). Brief report: further evidence of sensory subtypes in
autism. Journal of Autism and Developmental Disorders, 41(6), 826-831.
45. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: a
comparative study using the short sensory profile. American Journal of Occupational Therapy, 61(2),
190-200.
46. Parham, L. D., Ecker, C., Miller-Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). SPM Sensory Processing
Measure. Western Psychological Services.
47. Ayres, A. J. (1989). Sensory Integration and Praxis Tests. Los Angeles, CA: Western Psychological Services.
48. Schoen, S. A., Miller, L. J., & Sullivan, J. C. (2014). Measurement in sensory modulation: the sensory
processing scale assessment. American Journal of Occupational Therapy, 68(5), 522-530.
49. Baranek, G. T. (1998). Tactile Defensiveness and Discrimination Test-Revised (TDDT-R). University of
North Carolina; Chapel Hill. Unpublished manuscript
50. Degangi G, Greenspan SI (1989). Test of Sensory Functions in Infants (TSFI) Manual. Los Angeles, CA:
Western Psychological Services.
51. Eeles, A. L., Spittle, A. J., Anderson, P. J., Brown, N., Lee, K. J., Boyd, R. N., & Doyle, L. W. (2013). Assessments
of sensory processing in infants: a systematic review. Developmental Medicine & Child Neurology, 55(4),
314-326.

26/30
52. Siper, P. M., Kolevzon, A., Wang, A. T., Buxbaum, J. D., & Tavassoli, T. (2017). A clinician-administered
observation and corresponding caregiver interview capturing DSM-5 sensory reactivity symptoms in
children with ASD. Autism Research, 10(6), 1133-1140.
53. Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2015). A systematic review of sensory processing
interventions for children with autism spectrum disorders. Autism, 19(2), 133-148.
54. Watling, R., & Hauer, S. (2015). Effectiveness of Ayres Sensory Integration® and sensory-based
interventions for people with autism spectrum disorder: A systematic review. American Journal of
Occupational Therapy, 69(5), 6905180030p1-6905180030p12.
55. P.J. Jastreboff and J.W.P. Hazell, Tinnitus Retraining Therapy: Implementing the Neurophysiological Model,
Cambridge University Press, 2008
56. M.O. Mazurek, G.F. Petroski (2015). Sleep problems in children with autism spectrum disorder: Examining
the contributions of sensory over-responsivity and anxiety. Sleep Medicine, 16 (2) (2015), pp. 270-279,
10.1016/j.sleep.2014.11.006
57. Jan, JE, Owens JA, Weiss, MD., Johnson, KP, Wasdell, MB Roger D. Freeman RD, & Ipsiroglu, O. (2008)
Sleep hygiene for children with Neurodevelopmental Disabilities. Pediatrics 122 (6) 1343-1350; DOI:
10.1542/peds.2007-3308
58. Van Rie GL and Heflin LJ (2009) The effect of sensory activities on correct responding for children with
autism spectrum disorders. Research in Autism Spectrum Disorders 3: 783–796
59. Weitlauf, A. S., Sathe, N., McPheeters, M. L., & Warren, Z. E. (2017). Interventions targeting sensory
challenges in autism spectrum disorder: a systematic review. Pediatrics, 139(6), e20170347.
60. Yunus, F. W., Liu, K. P., Bissett, M., & Penkala, S. (2015). Sensory-based intervention for children with
behavioral problems: a systematic review. Journal of autism and developmental disorders, 45(11),
3565-3579.
61. Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication
training. Journal of applied behavior analysis, 18(2), 111-126.
62. Carr, E. G., & Owen-DeSchryver, J. S. (2007). Physical illness, pain, and problem behavior in minimally
verbal people with developmental disabilities. Journal of Autism and Developmental Disorders, 37(3),
413-424.
63. Bundy, A., C., Lane, S., J., & Murray, E, A. (2002). Sensory integration: Theory and practice (end ed.).
Philadelphia: F. A. Davis
64. Royal College of Occupational Therapists, https://www.rcot.co.uk/

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 About the authors
Dr Jane Waite
Jane Waite is a Lecturer in Psychology in the School of Health and Life Sciences at Aston University and
honorary research fellow at the Cerebra Centre for Neurodevelopmental Disorders. Jane completed her
PhD in the behavioural phenotype of Rubinstein-Taybi syndrome at the Cerebra Centre, University
of Birmingham, before training as a Clinical Psychologist. She now leads several research projects
examining mental health in children with rare genetic syndromes and autism.
Dr Teresa Tavassoli
Teresa Tavassoli is an Associate Professor at the University of Reading. Her main research interest is
sensory processing in autism spectrum conditions (ASC), which has progressively developed during
her studies. During her doctoral studies she conducted a systematic study of different senses in ASC.
Her research investigated sensory processing in ASC using self-report questionnaires, such as the
Sensory Profile, as well as psychophysical measures of sensory detection, across multiple sensory
modalities (vision, hearing, touch, smell and taste). She is interested in elucidating underlying
mechanisms explaining variations in sensory processing in ASC and across the whole population.
Dr Virginia Carter Leno
Virginia Carter Leno is a Postdoctoral Research Fellow at the Institute of Psychiatry, Psychology and
Neuroscience (IoPPN) at King’s College London. Her PhD, also conducted at the IoPPN, explored
different individual characteristics associated with mental health problems in youth with ASC. She is
interested in delineating risk factors for mental health problems in ASC populations, and understanding
why mental health problems are so much more prevalent in individuals with ASC as compared to
those without ASC.
Ms Tara Rossow
Tara is an Occupational Therapist specialising in children with additional and complex needs. She
trained in Australia (Bachelor of Occupational Therapy) and has worked in a variety of settings, both
in Australia and overseas. She has worked extensively with children and adults with various disabilities
and abilities, including with ASC, learning disability, sensory processing difficulties, physical challenges
and challenging behaviour. Her interests lie in child- and family-centred practice, including pre and
post diagnosis intervention and occupational performance.
Dr Jo Tarver
Joanne Tarver is a Research Fellow at Aston University. Joanne completed her PhD at the University
of Nottingham where she led a small-scale randomised controlled trial of a self-help intervention
for parents of children with Attention Deficit Hyperactivity Disorder (ADHD). Following this, Joanne
worked as a post-doctoral researcher on the development of a clinical assessment tool for concerning
behaviour in ASC and a feasibility and pilot trial of a novel parent intervention for emotional and
behavioural problems in autistic children. Currently, Joanne is working on research projects aimed at
improving the identification and treatment of mental health problems in individuals with ASC and
intellectual disability.

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Ms Georgina Edwards
Georgina Edwards is a doctoral researcher at Aston University, working with Dr Jane Waite and
Professor Chris Oliver. Her PhD focuses on identifying the correlates of anxiety in children and adults
with moderate to profound intellectual disability. Her main research interests include intellectual
disability, ASC and mental health.
Dr Effie Pearson
Dr Effie Pearson is a Postdoctoral Research Fellow currently working with Dr Jane Waite at Aston
University. She completed her PhD looking at communication in Angelman syndrome under
Prof. Chris Oliver at the Cerebra Centre for Neurodevelopmental Disorders at the University
of Birmingham. Her research interests include understanding behaviours in individuals
with an intellectual disability who speak few or no words, particularly communication,
challenging behaviour and mental health difficulties. Effie has also worked with Jane Waite
on developing online resources (Further Inform Neurogenetic Disorders (FIND); www.
findresources.co.uk) to provide accessible information for families and professionals
working with individuals with a range of rare genetic syndromes.

The findings of this report are those of the author, not necessarily
those of Cerebra.
First edition: 2020
This edition: 2020
Review date: 2023
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