Diagnostic Validity of Sensory Over-Responsivity: A Review of the Literature and Case Reports

Abstract

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

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