Journal of Autism and Developmental Disorders

, Volume 38, Issue 3, pp 516–529

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

Original Paper


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 over-responsivity was the most common and pervasive form of this condition.


Sensory processing Sensitivity Modulation Sensory integration Defensiveness 


  1. Andreassi, J. L. (1989). Psychophysiology: Human behavior and physiological response (2nd ed.). Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc.Google Scholar
  2. Ayres, A. J. (1964). Tactile functions: The relation to hyperactive and perceptual motor behavior. Perceptual and Motor Skills, 20, 288–292.Google Scholar
  3. Ayres, A. J. (1965). Patterns of perceptual-motor dysfunction in children: A factor analytic study. Perceptual and Motor Skills, 20(2), 335–368.PubMedGoogle Scholar
  4. Ayres, A. J. (1969). Deficits in sensory integration in educationally handicapped children. Journal of Learning Disabilities, 2(3), 44–52.CrossRefGoogle Scholar
  5. Ayres, A. J. (1972a). Improving academic scores through sensory integration. Journal of Learning Disabilities, 5, 338–343.Google Scholar
  6. Ayres, A. J. (1972b). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.Google Scholar
  7. Ayres, A. J. (1972c). Southern California sensory integration tests. Los Angeles: Western Psychological Services.Google Scholar
  8. Ayres, A. J. (1989). Sensory integration and Praxis tests. Los Angeles: Western Psychological Services.Google Scholar
  9. Baranek, G. T., Chin, Y. H., Greiss-Hess, L. M., Yankee, J. G., Hatton, D. D., & Hooper, S. R. (2002). Sensory processing correlates of occupational performance in children with fragile X syndrome: Preliminary findings. The American Journal of Occupational Therapy, 56(5), 538–546.PubMedCrossRefGoogle Scholar
  10. Baranek, G. T., David, F. J., Poe, M. D., Stone, W. L., & Watson, L. R. (2006). Sensory experiences questionnaire: Discriminating sensory features in young children with autism, developmental delays, and typical development. Journal of Child Psychology and Psychiatry, 47(6), 591–601.PubMedCrossRefGoogle Scholar
  11. Baranek, G. T., Foster, L. G., & Berkson, G. (1997). Sensory defensiveness in persons with developmental disabilities. Occupational Therapy Journal of Research, 17(3), 173–185.Google Scholar
  12. Blair, R. J. R. (1999). Psychophysiological responsiveness to the distress of others in children with autism. Personality and Individual Differences, 26(3), 477–485.CrossRefGoogle Scholar
  13. Blakemore, S. J., Tavassoli, T., Calo, S., Thomas, R. M., Catmur, C., Frith, U., & Haggard, P. (2006). Tactile sensitivity in asperger syndrome. Brain and Cognition, 61, 5–13.PubMedCrossRefGoogle Scholar
  14. Brown, C., Cromwell, R. L., Filion, D., Dunn, W., & Tollefson, N. (2002). Sensory processing in schizophrenia: Missing and avoiding information. Schizophrenia Research, 55(1–2), 187–195.PubMedCrossRefGoogle Scholar
  15. Brown, C. E., & Dunn, W. (2002). Adolescent/adult sensory profile. San Antonio, TX: Harcourt Assessment Company.Google Scholar
  16. Cadenhead, K. S., Geyer, M. A., & Braff, D. L. (1993). Impaired startle prepulse inhibition and habituation in patients with schizptypal personality disorder. American Journal of Psychiatry, 150(12), 1862–1867.PubMedGoogle Scholar
  17. Cadenhead, K. S., Light, G. A., Geyer, M. A., & Braff, D. L. (2000). Sensory gating deficits assessed by the P50 event-related potential in subjects with schizotypal personality disorder. American Journal of Psychiatry, 157, 55–59.PubMedCrossRefGoogle Scholar
  18. Caetano, S. C., Olvera, R. L., Glahn, D., Fonseca, M., Pliszka, S., & Soares, J. C. (2005). Fronto-limbic brain abnormalities in juvenile onset bipolar disorder. Biological Psychiatry, 58, 525–531.PubMedCrossRefGoogle Scholar
  19. Castellanos, F. X., Fine, E. J., Kaysen, D., Marsh, W. L., Rapoport, J. L., & Hallett, M. (1996). Sensorimotor gating in boys with tourettte’s syndrome and ADHD: Preliminary results. Biological Psychiatry, 39, 33–41.PubMedCrossRefGoogle Scholar
  20. Chen, L., & Toth, M. (2001). Fragile X mice develop sensory hyperreactivity to auditory stimuli. Neuroscience, 103(4), 1043–1050.PubMedCrossRefGoogle Scholar
  21. Cheng, M., & Boggett-Carsjens, J. (2005). Consider sensory processing disorders in the explosive child: Case report and review. The Canadian Child and Adolescent Psychiatry Review, 14(2), 44–48.PubMedGoogle Scholar
  22. Crowell, S. E., Beauchaine, T. P., Gatzke-Kopp, L., Sylvers, P., Mead, H., & Chipman-Chacon, J. (2006). Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Journal of Abnormal Psychology, 115(1), 174–178.PubMedCrossRefGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. Dunn, W. (1999). The sensory profile: Users manual. San Antonio, TX: The Psychological Corporation.Google Scholar
  25. Dunn, W. (2002). Infant/toddler sensory profile: User’s manual. San Antonio, TX: Harcourt Assessment company.Google Scholar
  26. Dunn, W., & Bennett, D. (2002). Patterns of sensory processing in children with attention deficit hyperactivity disorder (ADHD). Occupational Therapy Journal of Research, 22(1), 4–15.Google Scholar
  27. Dunn, W., & Brown, C. (1997). Factor analysis on the sensory profile from a national sample of children without disabilities. American Journal of Occupational Therapy, 51(7), 490–495.PubMedGoogle Scholar
  28. Dunn, W., Smith-Myles, B., & Orr, S. (2002). Sensory processing issues associated with asperger syndrome: A preliminary investigation. The American Journal of Occupational Therapy, 56(1), 97–102.PubMedCrossRefGoogle Scholar
  29. Frankland, W., Wang, Y., Rosner, B., Shimizu, T., Balleine, B. W., Dykens, E. M., Ornitz, E. M., & Silva, A. J. (2004). Sensorimotor gating abnormalities in young males with fragile X syndrome and Fmr1-knockout mice. Molecular Psychiatry, 9, 417–425.PubMedCrossRefGoogle Scholar
  30. Gadow, K. D., & Sprafkin, J. (2002). Child symptom inventory 4 screening and norms manual. Stony Brook, NY: Checkmate Plus, LTD.Google Scholar
  31. Goldsmith, H. H., Van Hulle, C. A., Arneson, C. L., Schreiber, J. E., & Gernsbacher, M. A. (2006). A population-based twin study of parentally reported tactile and auditory defensiveness in young children. Journal of Abnormal Child Psychology, 34(3), 393–407.PubMedCrossRefGoogle Scholar
  32. Hagerman, R. J., Miller, L. J., McGrath-Clarke, J., Riley, K., Goldson, E., Harris, S. W., et al. (2002). Influence of stimulants on electrodermal studies in Fragile X syndrome. Microscopic Research and Technique, 57(3), 168–173.CrossRefGoogle Scholar
  33. Hong, L. E., Summerfelt. A., Wonodi, I., Adami, H., Buchanan, R. W., & Thaker, G. K. (2007). Independent domains of inhibitory gating in schizophrenia and the effect of stimulus interval. American Journal of Psychiatry, 164(1), 61–65.PubMedCrossRefGoogle Scholar
  34. Interdisciplinary Council on Developmental, Learning Disorders (2005). Diagnostic manual for infancy and early childhood. Bethesda: ICDL.Google Scholar
  35. Jones, R. S., Quigney, C., & Huws, J. C. (2003). First-hand accounts of sensory perceptual experiences in autism: A qualitative analysis. Journal of Intellectual & Developmental Disability, 28(2), 112–121.CrossRefGoogle Scholar
  36. Kalpogianni, D. (2002). Focus on research...Sensory characteristics of boys with attention deficit hyperactivity disorder: A comparison of their performance on the sensory profile to boys without disabilities. British Journal of Occupational Therapy, 65(10), 475.Google Scholar
  37. Kemner, C., Oranje, B., Verbaten, M. N., & van Engeland, H. (2002). Normal P50 gating in children with autism. Journal of Clinical Psychiatry, 63(3), 214–217.PubMedGoogle Scholar
  38. Kern, J. K., Trivedi, M. H., Garver, C. R., Grannemann, B. D., Andrews, A. A., Savla, J. S., Johnson, D. G., Mehta, J. A., & Schroeder, J. L. (2006). The pattern of sensory processing abnormalities in autism. Autism, 10(5), 480–494.PubMedCrossRefGoogle Scholar
  39. Kinnealey, M., & Fuiek, M. (1999). The relationship between sensory defensiveness, anxiety, depression, and perception of pain in adults. Occupational Therapy International, 6(3), 195–206.CrossRefGoogle Scholar
  40. Kinnealey, M., Oliver, B., & Wilbarger, P. (1995). A phenomenological study of sensory defensiveness in adults. The American Journal of Occupational Therapy, 49(5), 444–451.PubMedGoogle Scholar
  41. Kruger, S., Frasnelli, J., Braunig, P., & Hummel, T. (2006). Increased olfactory sensitivity in euthymic patients with bipolar disorder with even-related episodes compared with patients with bipolar disorder without such episodes. Journal of Psychiatry Neuroscience, 31(4), 263–270.PubMedGoogle Scholar
  42. Lane, S. J. (2002). Sensory modulation. In A. C. Bundy, S. J. Lane, & E. A. Murray (Eds.), Sensory integration theory and practice (2nd ed., pp. 101–122). Philadelphia, PA: F.A. Davis Company.Google Scholar
  43. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2006). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37(5), 894–910.CrossRefGoogle Scholar
  44. Liss, M., Saulnier, C., Fein, D., & Kinsbourne, M. (2006). Sensory and attention abnormalities in autistic spectrum disorders. Autism, 10(2), 155–172.PubMedCrossRefGoogle Scholar
  45. Lyoo, I. K., Sung, Y. H., Friedman, S. D., Lee, J. Y., Kim, S. J., Dunner, D. L., & Renshaw, P. F. (2006). Regional cerebral cortical thinning in bipolar disorder. Bipolar Disorders, 8, 65–74.PubMedCrossRefGoogle Scholar
  46. Maier, W., Zobel, A., & Wagner, M. (2006). Schizophrenia and bipolar disorder: Differences and overlaps. Current Opinions in Psychiatry, 19, 165–170.CrossRefGoogle Scholar
  47. Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath, J., Simon, J., Hagerman, R., & Goldson, E. (2001). Sensory modulation dysfunction in children with attention-deficit-hyperactivity disorder. Developmental Medicine and Child Neurology, 43, 399–406.PubMedCrossRefGoogle Scholar
  48. Mattison, R. E., Gadow, K. D., Sprafkin, J., Nolan, E. E., & Schneider, J. (2003). A DSM-IV-referenced teacher rating scale for use in clinical management. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 442–449.PubMedGoogle Scholar
  49. McAlonan, G. M., Daly, E., Kumari, V., Critchley, H. D., van Amelsvoort, T., Suckling, J., Simmons, A., Sigmundsson, T., Greenwood, K., Russell, A., Schmitz, N., Happe, F., Howlin, P., & Murphy, D. G. M. (2002). Brain anatomy and sensorimotor gating in asperger’s syndrome. Brain, 127, 1594–1606.CrossRefGoogle Scholar
  50. McIntosh, D. N., Miller, L. J., Shyu, V., & Hagerman, R. J. (1999). Sensory-modulation disruption, electrodermal responses, and functional behaviors. Developmental Medicine and Child Neurology, 41, 608–615.PubMedCrossRefGoogle Scholar
  51. Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61(2), 135–140.PubMedGoogle Scholar
  52. Miller, L. J., McIntosh, D. N., McGrath, J., Shyu, V., Lampe, M., Taylor, A. K., Tassone, F., Neitzel, K., Stackhouse, T., & Hagerman, R. J. (1999). Electrodermal responses to sensory stimuli in individuals with fragile X syndrome: A preliminary report. American Journal of Medical Genetics, 83, 268–279.PubMedCrossRefGoogle Scholar
  53. Miller, L. J., Reisman, J. E., McIntosh, D. N., & Simon, J. (2001). An ecological model of sensory modulation. In S. Smith Roley, E. Blanche, & R. C. Schaaf (Eds.), Understanding the nature of sensory integration with diverse populations (pp. 57–82). San Antonio, TX: Therapy Skill Builders.Google Scholar
  54. Olincy, A., & Martin, L. (2005). Diminished suppression of the P50 auditory evoked potential in bipolar disorder subjects with a history of psychosis. American Journal of Psychiatry, 162(1), 43–49.PubMedCrossRefGoogle Scholar
  55. Oranje, R., Geyer, M. A., & Bocker, K. B. E. (2006). Prepulse inhibition and P50 suppression: Commonalities and dissociations. Psychiatry Research, 143(2–3), 147–158.PubMedCrossRefGoogle Scholar
  56. O’Riordan, M., & Passetti, F. (2006). Discrimination in autism within different sensory modalities. Journal of Autism and Developmental Disorders, 36, 665–675.PubMedCrossRefGoogle Scholar
  57. Parham, L. D., Ecker, C., Kuhaneck, H. M., Henry, D. A., & Glennon, T. J. (2006). Sensory processing measure. Los Angeles, CA: Western Psychological Services.Google Scholar
  58. Parham, L. D., & Mailloux, Z. (2005). Sensory integration. In J. Case-Smith (Ed.), Occupational therapy for children (5th ed., pp. 356–409). St. Louis, MO: Elsevier Mosby (Original work published 1985).Google Scholar
  59. Parush, S., Sohmer, H., Steinberg, A., & Kaitz, M. (2007). Somatosensory function in boys with ADHD and tactile defensiveness. Physiology & Behavior, 90(4), 553–558.CrossRefGoogle Scholar
  60. Perry, A., Condillac, R. A., Freeman, N. L., Dunn-Geier, J., & Belair, J. (2005). Multi-site study of the childhood autism rating scale (CARS) in five clinical groups of young children. Journal of Autism and Developmental Disorders, 35(5), 625–634.PubMedCrossRefGoogle Scholar
  61. Perry, W., Minassian, A., Feifel, D., & Braff, D. L. (2001). Sensorimotor gating deficits in bipolar disorder patients with acute psychotic mania. Biological Psychiatry, 50, 418–424.PubMedCrossRefGoogle Scholar
  62. Perry, W., Minassian, A., Lopez, B., Maron, L., & Lincoln, A. (2007). Sensorimotor gating deficits in adults with autism. Biological Psychiatry, 61(4), 482–486.PubMedCrossRefGoogle Scholar
  63. Pfeiffer, B., Kinnealey, M., Reed, C., & Herzberg, G. (2005). Sensory modulation and affective disorders in children and adolescents with asperger’s disorder. The American Journal of Occupational Therapy, 59(3), 335–345.PubMedGoogle Scholar
  64. Pinel, J. P. J. (Ed.). (2006). The sensorimotor system. In Biopsychology (6th ed., pp. 185–210). Boston: Pearson (Original work published 1990).Google Scholar
  65. Porges, S. W. (1992). Vagal tone: A physiologic marker of stress vulnerability. Pediatrics, 90(3), 498–504.PubMedGoogle Scholar
  66. Porges, S. W. (1995). Cardiac vagal tone: A physiological index of stress. Neuroscience and Biobehavioral reviews, 19, 225–233.PubMedCrossRefGoogle Scholar
  67. PsychCorp (1999). Wechsler abbreviated scale of intelligence manual. San Antonio, TX: Harcourt Assessment, Inc.Google Scholar
  68. Rellini, E., Tortolani, D., Trillo, S., Carbone, S., & Montecchi, F. (2004). Childhood autism rating scale (CARS) and autism behavior checklist (ABC) correspondence and conflicts with DSM-IV critieria in diagnosis of autism. Journal of Autism and Developmental Disorders, 34(6), 703–708.PubMedCrossRefGoogle Scholar
  69. Reynolds, S. (2006). Stress and anxiety in ADHD: Links to sensory modulation dysfunction. Annual Conference of the American Occupational Therapy Association, Charlottesville, NC.Google Scholar
  70. Rich, B. A., Vinton, D., Grillon, C., Bhangoo, R. K., & Leibenluft, E. (2005). An investigation of prepulse inhibition in pediatric bipolar disorder. Bipolar Disorders, 7, 198–203.PubMedCrossRefGoogle Scholar
  71. Roberts, J. E., Boccia, M. L., Hatton, D. D., Skinner, M. L., & Sideris, J. (2006). Temperament and vagal tone in boys with fragile X syndrome. Developmental and Behavioral Pediatrics, 27(3), 193–201.CrossRefGoogle Scholar
  72. Rogers, S. J., Hepburn, S., & Wehner, E. (2003). Parent reports of sensory symptoms in toddlers with autism and those with other developmental disorders. Journal of Autism and Developmental Disorders, 33(6), 631–642.PubMedCrossRefGoogle Scholar
  73. Rogers, S. J., & Ozonoff, S. (2005). Annotation: What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry, 46(12), 1255–1268.PubMedCrossRefGoogle Scholar
  74. Schaaf, R. C. (2001). Parasympathetic nervous system functions in children with sensory modulation dysfunction: A preliminary study. Bell & Howell Information and Learning, 1–70. ProQuest UMI.Google Scholar
  75. 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. The American Journal of Occupational Therapy, 57(4), 442–449.PubMedCrossRefGoogle Scholar
  76. Schoen, S., Miller, L. J., & Green, K. E. (2005). The sensory over-responsivity assessment and inventory: Reliability and validity. Unpublished manuscript, University of Colorado Health Science Center.Google Scholar
  77. Schopler, E., Reichler, R. J., & Renner, B. R. (1988). The childhood autism rating scale (CARS). Los Angeles, CA: Western Psychological Services (Original work published 1986).Google Scholar
  78. Talay-Ongan, A., & Wood, K. (2000). Unusual sensory-sensitivities in autism: A possible crossroads. International Journal of Disability, Development, and Education, 47(2), 201–212.CrossRefGoogle Scholar
  79. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparitive study using the short sensory profile. The American Journal of Occupational Therapy, 61(2), 190–200.PubMedGoogle Scholar
  80. Venables, P. H. (1977). The electrodermal psychophysiology of schizophrenics and children at risk for schizophrenia: Controversies and developments. Schizophrenia Bulletin, 3(1), 28–48.PubMedGoogle Scholar
  81. Waltermire, D., Candy, T., Risser, K. B., & Stramara, A. (2007). Sensory processing disorders and schophrenia/schizoaffective disorders. American Occupational Therapy Association National Conference, St. Louis, MO.Google Scholar
  82. Watling, R. L., Deitz, J., & White, O. (2000). Comparison of sensory profile scores of young children with and without autism spectrum disorders. The American Journal of Occupational Therapy, 55(4), 416–423.CrossRefGoogle Scholar
  83. Yochman, A., Parush, S., & Ornoy, A. (2004). Responses of preschool children with and without ADHD to sensory events in daily life. American Journal of Occupational Therapy, 58(3), 294–302.PubMedCrossRefGoogle Scholar
  84. Zero to Three (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood: Revised edition.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Occupational TherapyVirginia Commonwealth UniversityRichmondUSA
  2. 2.RichmondUSA

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