Journal of Autism and Developmental Disorders

, Volume 45, Issue 4, pp 943–952 | Cite as

The Interplay Between Sensory Processing Abnormalities, Intolerance of Uncertainty, Anxiety and Restricted and Repetitive Behaviours in Autism Spectrum Disorder

  • Sarah WighamEmail author
  • Jacqui Rodgers
  • Mikle South
  • Helen McConachie
  • Mark Freeston
Original Paper


Sensory processing abnormalities, anxiety and restricted and repetitive behaviours (RRBs) frequently co-occur in Autism Spectrum Disorders (ASD). Though the relationship between these phenomena is not well understood, emerging evidence indicates intolerance of uncertainty (IU) may play an important role. This study aimed to determine pathways between sensory abnormalities and RRBs, and the role anxiety and IU may have. We gathered caregiver report data for 53 children with ASD aged 8–16 years. We found sensory under responsiveness and sensory over responsiveness were significantly associated with repetitive motor and insistence on sameness behaviours, and the relationships significantly mediated by IU and anxiety. Our findings indicate different mechanisms may underpin repetitive motor and insistence on sameness RRBs, which can inform treatment interventions.


Sensory processing abnormalities Intolerance of uncertainty Anxiety Repetitive behaviours Autism spectrum disorder 


  1. Baker, A. E. Z., Lane, A., Angley, M. T., & Young, R. L. (2008). The relationship between sensory processing patterns and behavioural responsiveness in autistic disorder: a pilot study. Journal of Autism and Developmental Disorders, 38, 867–875.CrossRefPubMedGoogle Scholar
  2. Baranek, G. T. (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Developmental Disorders, 32(5), 397–422.CrossRefPubMedGoogle Scholar
  3. Baranek, G. T., Boyd, B. A., Poe, M. D., David, F. J., & Watson, L. R. (2007). Over responsive sensory patterns in young children with autism, developmental delay and typical development. American Journal of Mental Retardation, 112, 233–245.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. Ben-Sasson, A., Cermak, S. A., Orsomond, G. I., Tager-Flusberg, H., Carter, A. S., Kadlec, M. B., et al. (2007). Extreme sensory modulation behaviors in toddlers with autism spectrum disorders. The American Journal of Occupational Therapy, 61, 584–592.CrossRefPubMedGoogle Scholar
  6. Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1–11.CrossRefPubMedGoogle Scholar
  7. Boulter, C., Freeston, M., South, M., & Rodgers, J. (2013). Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-013-2001-x.Google Scholar
  8. Boyd, B. A., Baranek, G. T., Sideris, J., Poe, M. D., Watson, L. R., Patten, E., et al. (2010). Sensory features and repetitive behaviours in children with autism and developmental delays. Autism Research, 3(2), 78–87.PubMedCentralPubMedGoogle Scholar
  9. Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behaviour Research and Therapy, 40, 931–945.CrossRefPubMedGoogle Scholar
  10. Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. G. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26, 468–479.CrossRefPubMedGoogle Scholar
  11. Carleton, R. N., Norton, P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21, 105–117.CrossRefPubMedGoogle Scholar
  12. Chamberlain, P. D., Rodgers, J., Crowley, M. J., White, S. E., Freeston, M. H., & South, M. (2013). A potentiated startle study of uncertainty and contextual anxiety in adolescents diagnosed with autism spectrum disorder. Molecular Autism, 4(31).
  13. Constantino, J. N., Davis, S. A., Todd, R. D., Schindler, M. K., Gross, M. M., Brophy, S. L., et al. (2003). Validation of a brief quantitative measure of autistic traits: Comparison of the social responsiveness scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427–433.CrossRefPubMedGoogle Scholar
  14. Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale (SRS) Manual. Los Angeles: Western Psychological Services.Google Scholar
  15. Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., et al. (2003). Factor analysis of restricted and repetitive behaviours in autism using the autism diagnostic interview-R. Child Psychiatry and Human Development, 34(1), 3–17. doi: 10.1023/A:1025321707947.CrossRefPubMedGoogle Scholar
  16. Dickie, V. A., Baranek, G. T., Schultz, B., Watson, L. R., & McComish, C. S. (2009). Parent reports of sensory experiences of preschool children with and without autism: A qualitative study. American Journal of Occupational Therapy, 63, 172–181.CrossRefPubMedCentralPubMedGoogle Scholar
  17. Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: a preliminary test of a conceptual model. Behaviour Research and Therapy, 36, 215–226.CrossRefPubMedGoogle Scholar
  18. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants & Young Children, 9(4), 23–35.CrossRefGoogle Scholar
  19. Dunn, W. (1999). Development and validation of the short sensory profile. In W. Dunn (Ed.), The sensory profile examiner’s manual. San Antonio: The Psychological Corporation.Google Scholar
  20. Dunn, W., Saiter, J., & Rinner, L. (2002). Asperger syndrome and sensory processing: A conceptual model and guidance for intervention planning. Focus on Autism and Other Developmental Disabilities, 17(172), 172–185.CrossRefGoogle Scholar
  21. Freeston, M. H., Rhe´aume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802.CrossRefGoogle Scholar
  22. Gabriels, R. L., Agnew, J. A., Miller, L. J., Gralla, J., Pan, Z., Goldson, E., et al. (2008). Is there a relationship between restricted, repetitive stereotyped behaviours and interests and abnormal sensory response in children with autism spectrum disorders? Research in Autism Spectrum Disorders, 2, 660–670.CrossRefGoogle Scholar
  23. Green, S. A., Ben-Sasson, A., Soto, T. W., & Carter, A. S. (2012). Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: Bidirectional effects across time. Journal of Autism and Developmental Disorders, 42, 1112–1119.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Green, S. A., Rudie, J. D., Colich, N. L., Wood, J. J., Shirinyan, D., Hernandez, L., et al. (2013). Over reactive brain responses to sensory stimuli in youth with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 1158–1172.CrossRefPubMedGoogle Scholar
  25. Grupe D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: An integrated neurobiological and psychological perspective. Nature Reviews Neuroscience, 14, 488–501. doi: 10.1038/nrn3524.
  26. Guttman, I., & Smith, D. E. (1969). Investigation of rules for dealing with outliers in small samples from the normal distribution: I: Estimation of the mean. Technometrics, 11(3), 527–550.CrossRefGoogle Scholar
  27. Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling [White paper]. Retrieved from
  28. Hilton, C. L., Harper, J. D., Kueker, R. H., Lang, A. R., Abbacchi, A. M., Todorov, A., et al. (2010). Sensory responsiveness as a predictor of social severity in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 937–945.CrossRefPubMedGoogle Scholar
  29. Honey, E., McConachie, H., Turner, M., & Rodgers, J. (2012). Validation of the repetitive behaviour questionnaire for use with children with autism spectrum disorder. Research in Autism Spectrum Disorders, 6, 355–364.CrossRefGoogle Scholar
  30. Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty. Cogn Ther Res, 32, 619–638.CrossRefGoogle Scholar
  31. Leekam, S. R., Nieto, C., Libby, S. J., Wing, L., & Gould, J. (2007). Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders, 37, 894–910.CrossRefPubMedGoogle Scholar
  32. Lidstone, J., Uljarevic, M., Sullivan, J., Rodgers, J., McConachie, H., Freeston, M., et al. (2014). Relations among restricted and repetitive behaviours, anxiety and sensory features in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 8, 82–92.CrossRefGoogle Scholar
  33. MacNeil, B. M., Lopes, V. A., & Minnes, P. M. (2009). Anxiety in children and adolescents with autism spectrum disorder. Research on Autism Spectrum Disorders, 3(1), 1–21.CrossRefGoogle Scholar
  34. McConachie, H., Barry, R., Spencer, A., Parker, L., Le Couteur, A., & Colver, A. (2009). Daslne: The challenge of developing a regional database for autism spectrum disorder. Archives of Disease in Childhood, 94, 38–41. doi: 10.1136/adc.2007.126326.CrossRefPubMedGoogle Scholar
  35. McEvoy, P. M., & Mahoney, A. E. J. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behaviour Therapy, 43, 533–545.CrossRefGoogle Scholar
  36. McIntosh, D. N., Miller, L. J., Shyu, V., & Dunn, W. (1999). Overview of the Short Sensory Profile. In W. Dunn (Ed.), Sensory Profile User’s manual (pp. 59–73). San Antonio: Pearsons.Google Scholar
  37. Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M. T. (2002). Repetitive behaviours in autistic disorder. European Child and Adolescent Psychiatry, 11, 210–218. doi: 10.1007/s00787-002-0279-x.CrossRefPubMedGoogle Scholar
  38. Miller, L. J., Anzalone, M. E., Lane, S., Cermak, S. A., & Osten, E. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy, 61(2), 135–140.CrossRefPubMedGoogle Scholar
  39. Nauta, M. H., Scholing, A., Rapee, R. M., Abbott, M., Spence, S. H., & Waters, A. (2004). A parent report measure of children’s anxiety. Behaviour Research and Therapy, 42(7), 813–839.CrossRefPubMedGoogle Scholar
  40. Rodgers, J., Glod, M., Connolly, B., & McConachie, H. (2012). The relationship between anxiety and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders. 42, 2404–2409. doi: 10.1007/s10803-012-1531-y.
  41. 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 and Allied Disciplines, 46(12), 1255–1268.CrossRefGoogle Scholar
  42. Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39, 633–638.CrossRefPubMedGoogle Scholar
  43. Schaaf, R. C., & Miller, L. J. (2005). Occupational Therapy using a sensory integrative approach for children with developmental disabilities. Mental Retardation and Developmental Disabilities Research Reviews, 11, 143–148.CrossRefPubMedGoogle Scholar
  44. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and non-experimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422–445.CrossRefPubMedGoogle Scholar
  45. Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545–566.CrossRefPubMedGoogle Scholar
  46. Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: A comparative study using the short sensory profile. The American Journal of Occupational Therapy, 61(2), 190–200.CrossRefPubMedGoogle Scholar
  47. Turner, M. (1996). Repetitive behaviour and cognitive functioning in autism. Unpublished doctoral thesis UK: University of Cambridge.Google Scholar
  48. Turner, M. (1999). Annotation: Repetitive behaviour in autism: A review of psychological research. Journal of child psychology and psychiatry, 40(6), 839–849.CrossRefPubMedGoogle Scholar
  49. Van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302–317.CrossRefPubMedCentralPubMedGoogle Scholar
  50. Wechsler, D. (1999). Wechsler abbreviated scale of intelligence (WASI). San Antonio: Harcourt Assessment.Google Scholar
  51. White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sarah Wigham
    • 1
    Email author
  • Jacqui Rodgers
    • 2
  • Mikle South
    • 3
  • Helen McConachie
    • 1
  • Mark Freeston
    • 2
    • 4
  1. 1.Institute of Health and SocietyNewcastle UniversityNewcastleUK
  2. 2.Clinical Psychology, Ridley Building, Institute of NeuroscienceNewcastle UniversityNewcastleUK
  3. 3.Department of Psychology and Neuroscience CenterBrigham Young UniversityProvoUSA
  4. 4.Northumberland, Tyne and Wear NHS Foundation TrustGosforthUK

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