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BACKGROUND: Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these supra-modal traits in the autistic population. METHODS: Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a general response pattern factor for each supra-modal construct and determine the added value of modality-specific response pattern scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs. RESULTS: All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations). LIMITATIONS: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many real-world sensory experiences. CONCLUSION: Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.

Author(s): Roseann C. Schaaf [sup.1] , Zoe Mailloux [sup.1] , Elizabeth Ridgway [sup.2] , Alaina S. Berruti [sup.3] , Rachel L. Dumont [sup.1] , Emily A. Jones [sup.4] , Benjamin [...], Sensory features are part of the diagnostic criteria for autism and include sensory hypo/hyper reactivity and unusual sensory interest; however, additional sensory differences, namely differences in sensory integration, have not been routinely explored. This study characterized sensory integration differences in a cohort of children (n = 93) with a confirmed diagnosis of autism (5-9 years) using a standardized, norm-referenced battery. Mean z scores, autism diagnostic scores, and IQ are reported. Participants showed substantial deficits in tactile perception, praxis, balance, visual perception, and visual-motor skills. Relationship with autism diagnostic test scores were weak or absent. Findings suggest additional sensory difficulties that are not typically assessed or considered when characterizing sensory features in autism. These data have implications for a greater understanding of the sensory features in the autism phenotype and the development of personalized treatments.

Challenges with processing and integrating sensory information affect children's ability to successfully engage in their occupations at school and fully participate in the educational process. Occupational therapy using Ayres Sensory Integration® (ASI) is an evidence-based intervention for autistic children that has emerging evidence for children with idiopathic sensory integration differences. This article is a call to action for the occupational therapy profession to increase the use of ASI principles in school settings because it historically has been limited in its application. In this column, we respond to two main questions. First, is ASI necessary, essential, and inherently appropriate in school settings? Second, does ASI align with education laws and mandates? We present evidence showing that interventions to address sensory integration and processing function fall within the domain of school-based occupational therapy practitioners and provide examples for ways to use the principles of ASI across all the tiers of a multitiered system of supports. We also make recommendations for next steps that focus on best practices for implementing ASI in the academic setting and address concerns related to the feasibility of ASI in school-based practice within existing systemic and logistical constraints. As a result, occupational therapy practitioners will be empowered to advocate for use of ASI and its principles in the educational setting to proactively provide the support their students deserve. This article is a call to action for the occupational therapy profession to increase the use of Ayres Sensory Integration® in school settings. [ABSTRACT FROM AUTHOR]

This article reviews current evidence for autism spectrum disorder (ASD) screening based on peer-reviewed articles published to December 2013. Screening provides a standardized process to ensure that children are systematically monitored for early signs of ASD to promote earlier diagnosis. The current review indicates that screening in children aged 18 to 24 months can assist in early detection, consistent with current American Academy of Pediatrics' recommendations. We identify ASD-specific and broadband screening tools that have been evaluated in large community samples which show particular promise in terms of accurate classification and clinical utility. We also suggest strategies to help overcome challenges to implementing ASD screening in community practice, as well as priorities for future research.

This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged

Early identification of autism spectrum disorder (ASD) is essential to ensure that children can access specialized evidence-based interventions that can help to optimize long-term outcomes. Early identification also helps shorten the stressful "diagnostic odyssey" that many families experience before diagnosis. There have been important advances in research into the early development of ASDs, incorporating prospective designs and new technologies aimed at more precisely delineating the early emergence of ASD. Thus, an updated review of the state of the science of early identification of ASD was needed to inform best practice. These issues were the focus of a multidisciplinary panel of clinical practitioners and researchers who completed a literature review and reached consensus on current evidence addressing the question "What are the earliest signs and symptoms of ASD in children aged ≤24 months that can be used for early identification?" Summary statements address current knowledge on early signs of ASD, potential contributions and limitations of prospective research with high-risk infants, and priorities for promoting the incorporation of this knowledge into clinical practice and future research.

This study evaluated a manualized intervention for sensory difficulties for children with autism, ages 4-8 years, using a randomized trial design. Diagnosis of autism was confirmed using gold standard measures. Results show that the children in the treatment group (n = 17) who received 30 sessions of the occupational therapy intervention scored significantly higher (p = 0.003, d = 1.2) on Goal Attainment Scales (primary outcome), and also scored significantly better on measures of caregiver assistance in self-care (p = 0.008 d = 0.9) and socialization (p = 0.04, d = 0.7) than the Usual Care control group (n = 15). The study shows high rigor in its measurement of treatment fidelity and use of a manualized protocol, and provides support for the use of this intervention for children with autism. Findings are discussed in terms of their implications for practice and future research.

Importance: Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. Objective: To evaluate evidence of construct validity and internal reliability of data gathered with four newly developed praxis tests. Design: Comparative descriptive design. Setting: Homes, schools, and therapy practices across the United States. Participants: A control group consisting of 163 children without any concerns or diagnoses and a case group of 145 children with sensory integration difficulties, ages 3 to 12 yr. Outcomes and Measures: Rasch analyses to evaluate construct validity, and Student's t tests to evaluate group differences. Results: Total test scores and most item scores conformed to Rasch model expectations. Group differences were significant; the control group scored higher. Internal reliability was strong. Conclusions and Relevance: Findings support the validity and internal reliability of the four praxis tests. What This Article Adds: This study adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® tests. This brief report adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® Praxis tests. Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. [ABSTRACT FROM AUTHOR]

Importance: Assessment of tactile perception is foundational for addressing aspects of occupational performance. Objective: To evaluate the construct validity and internal reliability of four new tactile perception tests. Design: Causal comparative groups design. Settings: Homes, schools, and therapy practices across the United States. Participants: Children ages 3 to 12 yr: typically developing (n = 174) and those with sensory integration concerns (n = 153). Outcomes and Measures: Rasch analyses to evaluate construct validity; analysis of covariance to evaluate group differences. Results: The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests (η2p =.040–.105, p <.001). Person reliability indices and strata indicated moderate to strong internal reliability (Rasch person reliability indices =.69–.87; strata = 2.33–3.82). Conclusions and Relevance: The Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr. Findings suggest that these tests are likely to be clinically useful and appropriate for children in this age range and may provide critical information regarding underlying sensory functions necessary for optimal occupational performance. What This Article Adds: This article provides data supporting the reliability and validity of the EASI Tactile Perception Tests in a U.S. sample. These assessments can be used by therapists trained in their administration to assess tactile functions that may affect participation in activities, tasks, and occupations. The Evaluation in Ayres Sensory Integration (EASI) Tactile Perception Tests are reliable and valid measures and can be used by therapists trained in their administration to assess tactile functions in children that may affect participation in activities, tasks, and occupations. [ABSTRACT FROM AUTHOR]

Importance: Occupational therapy using Ayres Sensory Integration® (ASI) is an evidence-based intervention that includes parent education and participation to support outcomes. However, guidelines for this parent component have not been published. Objective: To obtain input from stakeholders on a revised guidebook for parent education during ASI intervention. Design: Cross-sectional survey design. Setting: Online surveys. Participants: Experts in ASI, occupational therapy practitioners who use this approach, and parents of children with autism who received occupational therapy using this intervention. Outcomes and Measures: Surveys designed and vetted to obtain input on content and usability. Results: Experts rated the guidebook as consistent with ASI principles, practitioners rated it as clinically useful, and parents rated it as useful and clear. Conclusions and Relevance: The parent guidebook for ASI is ready for further testing and use. What This Article Adds: This report adds knowledge translation and best practice strategies in parent education to the parent guidebook for ASI and provides evidence that it is acceptable by experts, parents, and clinicians. This report adds knowledge translation and best practice strategies in parent education to the parent guidebook for using Ayres Sensory Integration® (ASI) and provides evidence that the guidebook is acceptable by experts, parents, and clinicians. [ABSTRACT FROM AUTHOR]