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Autism, Anxiety and Sensory Challenges

  • April 08, 2021
  • Anxiety, Autism, Patients and Families

Anxiety disorders are common in children and adolescents, and sensory reactivity is also common among young children. Both conditions are more common in children with autism than children without autism. Researchers are exploring the connections and relationships between these conditions.

Sensory reactivity includes both hyperreactivity (or over-responsiveness) and hyporeactivity (or under-responsiveness). In hyperreactivity, people have extreme responses to sounds, smells, tastes, textures, or sights. This can include sensitivity to bright or fluorescent lights, aversions to certain tastes or textures of food, or discomfort with even light touch. Conversely, seeming indifference to pain or to heat or cold are examples of under-responsiveness. Sensory reactivity—over- and under-responsivity—was added to the diagnostic criteria for autism spectrum disorder in 2013.

Kimberly Carpenter, Ph.D., assistant professor at Duke University School of Medicine, recently presented on these issues as part of the Brain and Behavior Research Foundation’s Meet the Scientist webinar series. She discussed research on the prevalence and connections among autism, anxiety and sensory issues in children.

Dr. Carpenter shared some quotes from individuals with sensory over-sensitivity describing their experiences: “High sounds like whistles hurt my ears, and sudden sounds like a car horn… and booming sounds like a vacuum cleaner or lawn mower.” “Loud, high pitch noises hurt my ears before they become loud enough to bother most people at all.”

Here are a few of the research findings that show the extent of the issues and the interconnectedness between the conditions:

  • Sensory over-responsivity is common in children without autism, about 20%.
  • Anxiety disorders are more common in children with autism than children without autism.
  • 19% of typically developing children meet the criteria for anxiety.
  • 40% of children with autism meet the criteria for anxiety.
  • Among young children with sensory over-responsivity, more than 40% also meet the criteria for anxiety.
  • 60% of children with autism and anxiety have clinically significant sensory over-responsivity.
  • Most children with autism and sensory sensitivity meet the criteria for anxiety (more than 90% in one study).
  • Both anxiety and sensory over-responsivity are associated with other challenges for young children including sleep problems, picky eating, stomach issues, and irritability.

Carpenter and colleagues considered how potential consequences of over-responsivity differ between predictable and unpredictable experiences and how they may relate to anxiety. Over-responsivity to unpredictable experiences, such as sirens or doors slamming, can lead a child to be hypervigilant and constantly alert waiting for the next uncomfortable sound, and potentially contribute to generalized anxiety. Over-responsivity to predictable experiences (such as the loud hand dryers in public bathrooms) can cause a child to try to avoid situations where they might be exposed to the experience, potentially contributing to specific phobias.

To try to understand whether sensory over-responsivity contributes to anxiety or vice versa, researchers assessed young children at 2 different time periods, at 18-33 months and again one year later. They found that sensory over-responsivity precedes anxiety in children with and without autism. In children without autism, sensory over-responsivity increased the likelihood by more than twice of a child having anxiety by school-age.

Helping people with sensory sensitivity

Understanding and awareness is a place to start. Awareness about sensory sensitivity issues and making accommodations for them can help those experiencing sensitivity related discomfort, the advocacy organization Autism Speaks suggests. Examples of accommodations for over-sensitivity include dimmed lights or incandescent versus fluorescent lighting, ear plugs or headphones in noisy environments, and clothing that accommodates personal sensitivities (such as scratchy fabric or tags). Examples of accommodations for under-sensitivity include sensory-stimulating toys (such as fidgets), weighted blankets or strong tasting and/or textured foods.


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