Atypical sensory processing is often present in persons with autism spectrum disorder. Symptoms related to atypical sensory processing are listed for the first time in DSM-5 as an optional diagnostic criterion for the disorder. Note: Sensory Processing Disorder is a frequently used term but is not the name of a formal diagnosis.
This is how this set of symptoms is summarized in the DSM-5 diagnostic criteria for autism spectrum disorder:
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Important! This atypical sensory processing often underlies many other symptoms and various types of functional impairments in children, adolescents, and adults with autism spectrum disorder.
Those who see children and adolescents should, of course, be thoroughly familiar with these symptoms so that they don’t miss them during the evaluation and don’t fail to manage them because they frequently cause significant distress to the patient and to the people around them.
But, in my experience, those who see adults frequently fail to identify in their patients a lifelong history of atypical sensory processing. I know that I was not taught anything at all about this during my training. And, for many years after graduation, I did not ask patients about or identify atypical sensory processing. Nor did I understand how problems with sensory processing might be affecting my patients’ behavior.
By the way, for many years I have been trying to raise awareness about ADHD in adults. Now, I am also working on raising awareness about autism spectrum disorder in adults, which is going largely undiagnosed and almost entirely untreated. This discussion of atypical sensory processing is part of that effort, even though such symptoms are also found in other disorders and can be present in those with no mental disorder.
How common are such problems?
One review found atypical sensory processing to be present in between 80% and nearly 100% of children with autism spectrum disorder (Dellapiazza et al., 2018).
Not only in autism spectrum disorder
Such atypical sensory processing is not unique to autism spectrum disorder, though. It may be present in other disorders including ADHD, Tourette’s disorder, etc. I have personally seen many adults with ADHD who had a history of atypical sensory processing.
Sometimes, atypical sensory processing may not indicate any disorder at all. It can also be found in neurotypical adults (Mayer, 2017).
Symptoms of atypical sensory processing
The atypical sensory processing (also called sensory dysregulation) in these patients can be present in any of the sensory modalities, including internal bodily sensations (interoception), and also in “multisensory integration” (Thye et al., 2017).
By “multisensory integration” we mean the process by which we combine different sensory experiences into a perceptual whole. For example, in interacting with others, we need to integrate the other person’s voice, face, lip movements, and gestures into a meaningful perception of that person (Thye et al., 2017).
The presentation of atypical sensory processing is heterogeneous and can include many different types of symptoms. These symptoms can be grouped into different categories (e.g., Miller et al., 2017):
– Sensory OVERsensitivity
– Sensory UNDER-responsivity
– Unusual fascination with particular types of sensory stimuli. This is sometimes also called sensory craving.
Next, let’s look at examples of how these categories may present in the patients we see.
Sensory oversensitivity or over-responsivity
Symptoms of sensory oversensitivity can occur in every sensory modality. Such oversensitivity can lead to sensory overload. Here are some examples:
Vision
– Unusual intolerance to bright lights. For example, an item in a questionnaire about sensory processing is, “I close curtains to avoid bright lights.” One of my patients would make me switch off the fluorescent ceiling lights whenever he came into my office.
– Unusual sensitivity to bright colors. For example, items in a questionnaire about sensory processing include, “I can only look at bright colors for a brief period of time” and “I choose to wear muted colors.”
Hearing
– Awareness of the slightest sounds. For example, items in a questionnaire about sensory processing include, “I would be able to hear a leaf move if blown by the wind on a quiet street” and “I would be the first to hear if there was a fly in the room.”
Touch
– Finding certain clothes to be rough and uncomfortable on their skin. Finding the labels or seams on clothes to be uncomfortable and unacceptable. So, these patients may avoid wool, cut out the labels inside their clothes before wearing them, or buy only seamless socks.
– Some of these patients particularly dislike sand at the beach. For example, an item in a questionnaire about sensory processing is, “The thought of having to walk through the sand to get to the ocean or a lake can ruin the fun of a swim.”
Smell
– Exaggerated responses to certain smells. For example, some of these persons become sickened by perfumes or scented candles.
Other
– When these persons avoid certain foods, it is typically not due to taste but because they find the texture (or appearance) of certain foods to be uncomfortable. For example, an item in a questionnaire about sensory processing is, “I avoid some foods because of the texture. I would rather go hungry than eat a mushy banana.”
Food selectivity is often found in children with autism spectrum disorders (Marí-Bauset et al., 2014), but is also found in other neurodevelopmental disorders. In one study, sensitivity to taste and smell was the main determinant of this food fussiness in children with autism spectrum disorder, ADHD, and Tourette syndrome, and also in those with typical development (Smith et al., 2020).
Sensory under-responsivity
The atypical sensory processing can also consist of an unusual indifference to sensory stimuli like pain, heat, and cold (American Psychiatric Association, 2013).
Note: Sensory under-responsivity is often found along with sensory over-responsivity in the same person (Miller et al., 2017)
Unusual fascination with particular types of sensory stimuli
As noted in the diagnostic criteria, the sensory problems don’t only include intolerance and avoidance of certain sensory stimuli. they can also include the opposite; that is, being unusually fascinated with particular types of sensory stimuli (American Psychiatric Association, 2013). This group of symptoms is also sometimes called sensory craving.
Note: Sensory craving is often found along with sensory over-responsivity in the same person (Miller et al., 2017).
Here are some relatively common examples of unusual fascination with sensory stimuli:
– Excessive touching of certain objects (e.g., certain types of clothes, hair)
– Smelling certain objects that others would not typically smell
– Fascination with lights
– Fascination with spinning objects.
For example, when children with “autistic disturbances” were first described in the literature by Kanner (1943), he said about one of the patients he described: “He spun with great pleasure anything he could seize upon to spin.”
Simple and Practical Medical Education thanks Gagan Joshi, MD, for reviewing and approving this article (on May 22, 2020). Dr. Joshi is Director, Autism Spectrum Disorder Program in Pediatric Psychopharmacology, and Medical Director, The Alan & Lorraine Bressler Program for Autism Spectrum Disorder, at Massachusetts General Hospital. He is an Associate Professor of Psychiatry at Harvard Medical School, Boston, Massachusetts, USA.
Related Pages
What interventions work for atypical sensory processing symptoms?
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
Dellapiazza F, Vernhet C, Blanc N, Miot S, Schmidt R, Baghdadli A. Links between sensory processing, adaptive behaviours, and attention in children with autism spectrum disorder: A systematic review. Psychiatry Res. 2018 Dec;270:78-88. doi: 10.1016/j.psychres.2018.09.023. Epub 2018 Sep 13. PMID: 30245380.
Kanner L. Autistic disturbance of affective contact. Nerv. Child. 1943; 2:217–50. Not cited on PubMed.
Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M. Food selectivity in autism spectrum disorders: a systematic review. J Child Neurol. 2014 Nov;29(11):1554-61. doi: 10.1177/0883073813498821. Epub 2013 Oct 4. PMID: 24097852.
Mayer JL. The Relationship Between Autistic Traits and Atypical Sensory Functioning in Neurotypical and ASD Adults: A Spectrum Approach. J Autism Dev Disord. 2017 Feb;47(2):316-327. doi: 10.1007/s10803-016-2948-5. PMID: 27848052.
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National Institute for Health and Care Excellence (UK). Autism spectrum disorder in adults: diagnosis and management. London: National Institute for Health and Care Excellence (UK); 2016 Aug. PMID: 32186834.
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Thye MD, Bednarz HM, Herringshaw AJ, Sartin EB, Kana RK. The impact of atypical sensory processing on social impairments in autism spectrum disorder. Dev Cogn Neurosci. 2018 Jan;29:151-167. doi: 10.1016/j.dcn.2017.04.010. Epub 2017 May 17. PMID: 28545994; PMCID: PMC6987885.
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Does this relate to synesthesia and/or people who have been identified as having this? (naturally, not drug induced–if there is a difference in symptom presentation based on etiology)
What about sensory stimulation that is experienced as painful. It is one thing to be able to “hear a leaf blowing down the empty street.” It is another thing to experience that as painful. Is it the kind of pain that opioids will relieve? I have a middle aged man with what appears to be extreme sensitivity to sound. His family accommodates by letting him live in a specially sound insulated basement an he wears a head set that blocks sound most of the time. This doesn’t seem like a decent quality of life. Would his life improved with 15 mg of Morphine twice a day or is there another way to modify the symptoms?
I was expecting one more email in the series, addressing clinical management. Is it just education? Naming the problem in order to help the patient find solutions?
Dr. Ferro: For interventions, please see the following article on our website: https://simpleandpractical.com/atypical-sensory-processing-interventions/
I wonder how sensory over-sensitivity in migraines differs from sensory over-sensitivity in autism spectrum. I’m not on the spectrum, but have had sensory aversions even without accompanying migraine ever since my migraines started in adolescence. Blinking lights, overcast days, repetitive tapping, and ANY artificial fragrance is aversive, often makes me irritable and some of the time precipitates a migraine. If I get a migraine, all of the above sensitivities develop.
Unrelated, I can’t tolerate the creaking squashiness of squeezing a cotton ball. I have to use tweezers to take cotton out of a new bottle of Advil. Same with chalk dust on my fingers and walking through fluffy snow that creaks when you step on it. YUCK!