S ensory integration is a long-standing and growing area of practice in occupational therapy. Debate and discussion with colleagues have led us to develop a proposed taxonomy reflecting a new classification scheme to enhance diagnostic specificity. The nosology proposed here is rooted in empirical data first published by Ayres (Ayres, 1972b, 1989) that has evolved based on empirical and theoretical information. This new nosology provides a viewpoint for discussion and research. Two sociopolitical trends contribute to the timeliness of the ideas presented. First, a call exists throughout health and developmental services for evidence-based practice (Sackett, Richardson, Rosenberg, & Haynes, 1997). Diagnostic precision is crucial for homogeneity of samples in empirical research, affecting the validity of the research findings. Second, the condition of sensory processing disorders (SPD) has recently been acknowledged outside the occupational therapy profession in three diagnostic classification references: the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (known as the DC: 0-3R) (Zero to Three, 2005), the Diagnostic Manual for Infancy and Early Childhood of the Interdisciplinary Council on Developmental and Learning Disorders (ICDL, 2005), and the Psychodynamic Diagnostic Manual (PDM Task Force, 2006). Both manuals include diagnostic taxonomies with subtypes of SPD suggested by a committee of occupational therapists, who assisted in developing guidelines for diagnostic specificity related to sensory-based disorders (Miller, Cermak, Lane, Anzalone, & Koomar, 2004).

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The autonomic nervous system (ANS) is responsible for multiple physiological responses, and dysfunction of this system is often hypothesized as contributing to cognitive, affective, and behavioral responses in children. Research suggests that examination of ANS activity may provide insight into behavioral dysregulation in children with autism spectrum disorders (ASD), however, there is wide variability in samples, methods, and measures reported. The purpose of this review is to describe frequently reported cardiac ANS measures; discuss theoretical models linking ANS measures with neurological structures; and synthesize pediatric literature using ANS measures on typical and ASD samples. Such a synthesis will provide researchers with a foundation for the use of ANS cardiac methods and measures in ASD research.

This pilot study explored activity patterns in children with and without ASD and examined the role of sensory responsiveness in determining children’s level of competence in activity performance. Twenty-six children with high functioning ASD and twenty-six typically-developing children 6–12 years old were assessed using the Sensory Profile and the Child Behavior Checklist. Results reflect differences in the types of activities and jobs/chores engaged in by children with ASD compared to children without ASD. Significant differences were seen in overall level of competence in activities, social, and school performance. Children demonstrating more frequent Sensory Sensitivity and Sensory Avoiding had significantly lower competence scores than children with fewer behaviors in these domains, suggesting that sensory responsiveness may impact the ability to participate successfully.

Atypical responses to sensory stimulation are frequently reported to co-occur with diagnoses such as autism, ADHD, and Fragile-X syndrome. It has also been suggested that children and adults may present with atypical sensory responses while failing to meet the criteria for other medical or psychological diagnoses. This may be particularly true for individuals with over-responsivity to sensation. This article reviews the literature related to sensory over-responsivity and presents three pediatric cases that present a profile of having sensory over-responsivity without a co-occurring diagnosis. Findings from these cases provide very preliminary evidence to support the suggestion that sensory over-responsivity can occur as a sole diagnosis. Within this small group, tactile overresponsivity was the most common and pervasive form of this condition.Diminished or exaggerated responses to typical sensory stimulation have been described as a feature of many prominent diagnostic conditions. The terms under-responsiveness and over-responsiveness have appeared as the most current descriptors of these behaviors (Miller et al. 2007). Attempts to understand, classify, research, and treat both under and over-responsiveness have been ongoing since they were first described by Ayres (1965). None-theless, after 40 years of work, our understanding of sensory processing patterns within and across groups, and their relationship to functional behaviors, continues to be imprecise.The umbrella term Sensory Modulation Dysfunction (SMD) is currently being used to encompass both over and under-responsivity, along with the overlapping or fluctuating responsivity. Sensory seeking has also been suggested as a subtype of SMD (Miller et al. 2007). This has been questioned, however, since seeking behaviors have been found in populations exhibiting both over and under-responsive (Liss et al. 2006). Liss and colleagues have suggested that sensory seeking is more a compensatory mechanism used to moderate high arousal levels, at least by children with Autism Spectrum Disorder.Some investigators have attempted to identify subgroups of individuals with sensory processing disorder, with the most prominent model presented by Dunn (Dunn and Brown 1997;Dunn 1999). Dunn's model suggests that individuals could be classified based on their neurological threshold and behavioral responses to incoming stimuli. According to this model high neuronal thresholds are indicative of a nervous system that requires a stronger or more intense input to elicit a behavioral response, suggestive of an under-responsive nervous system. Lower neuronal thresholds, on the other hand, are indicative of a nervous system that requires less intense or less frequent stimulation to fire, suggestive of an over-responsive nervous system. The model further highlights that individuals can respond either in accordance with their neurological threshold, or act to counteract their threshold. For example, individuals with high thresholds acting in accordance with

Deficits in sensory modulation have been linked clinically with impaired attention, arousal, and impulsivity for years, but a clear understanding of the relationship between sensory modulation disorders and attention deficit hyperactivity disorder (ADHD) has proven elusive. Our preliminary work suggested that patterns of salivary cortisol and electrodermal responsivity to sensation may be linked to different groups of children with ADHD; those with and without sensory over-responsivity (SOR). Additionally, SOR has been linked to anxiety, and anxiety has been linked to ADHD. A clearer understanding of the relationship between anxiety, SOR, and ADHD may support a better understanding of ADHD diagnostic subtypes. We examined neuroendocrine, electrodermal and behavioral characteristics and sought to predict group membership among 6- to 12-year-old children with ADHD and SOR (ADHDs), ADHD and no SOR (ADHDt), and typicals (TYP). Behavioral questionnaires were completed to document SOR and anxiety. Lab testing used a Sensory Challenge Protocol (SCP) with concurrent electrodermal measurement and the collection of cortisol prior to and following the SCP. Results substantiated links between SOR and anxiety, in both TYP and ADHD children. Results suggests that ADHD should be considered in conjunction with anxiety and sensory responsivity; both may be related to bottom-up processing differences, and deficits in prefrontal cortex/hippocampal synaptic gating.

Sleep problems have been frequently identified in children with autism spectrum disorders (ASD). It has been proposed that some sleep problems are due to sensory sensitivity. The purpose of this study was to examine the relationship between physiologic responses to sensation and sleep in children with and without ASD. Fifty-five children participated in the study (ASD, n = 27; typical, n = 28). All children participated in a sensory challenge laboratory protocol. Electrodermal reactivity and salivary cortisol were used as physiological indicators of sensory responsivity. Behavioral data were collected using the Sensory Profile and the Child Behavior Checklist. Results confirmed that children with ASD have a higher prevalence of atypical sensory behaviors and sleep disturbances than typical children. Behavioral and physiological measures were able to predict good sleepers versus poor sleepers with 85.7% accuracy, suggesting that atypical sensory behaviors are important to consider in relation to sleep deficits in children.

This study of the maturation of prestimulation‐induced modulation of startle in 3 to 8 year old children and adults demonstrated significant effects of age on both startle magnitude and onset latency. Startle was evoked by 104dB(SPL) 50‐ms bursts of white noise, and the amplitude and onset latency of the blink reflex were measured after integration of the obicularis oculi EMG. Prestimulation with 75dB 1000 Hz tones resulted in severe inhibition of both amplitude and latency in adults when 20‐ms tones preceded the startling stimuli by 120 ms or 250 ms. Following sustained prestimulation for 2000 ms, the adults showed modest nonsignificant response facilitation. Eight‐year‐old children showed mature inhibitory and facilitatory startle amplitude modulation, but significantly less inhibition and more facilitation of onset latency compared to adults. Preschool children showed significantly less amplitude and latency inhibition and more facilitation than 8‐year‐olds and adults. In response to prestimulation 120 ms before startling stimuli, the preschool children actually showed latency facilitation. Modulation of startle by prestimulation is mediated by brainstem neuronal networks. These findings suggest that brainstem mechanisms which mediate startle response modulation undergo development during early childhood and do not mature until about 8 years of age.