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Exploring the Sensory Profiles of Children on the Autism Spectrum Using the Short Sensory Profile-2 (SSP-2)

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Title: Exploring the Sensory Profiles of Children on the Autism Spectrum Using the Short Sensory Profile-2 (SSP-2)
Language: English
Authors: Simpson, Kate (ORCID 0000-0003-0743-7304), Adams, Dawn, Alston-Knox, Clair, Heussler, Helen S., Keen, Deb
Source: Journal of Autism and Developmental Disorders. May 2019 49(5):2069-2079.
Availability: Springer. Available from: Springer Nature. 233 Spring Street, New York, NY 10013. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-348-4505; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 11
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Descriptors: Autism, Pervasive Developmental Disorders, Sensory Integration, Children, Measures (Individuals), Young Children, Parent Attitudes, Caregiver Attitudes, Responses, Scores, Age Differences, Interpersonal Communication, Interpersonal Competence, Profiles
DOI: 10.1007/s10803-019-03889-2
ISSN: 0162-3257
Abstract: The aim of this study was to identify sensory subtypes in children on the autism spectrum using the Short Sensory Profile-2 (SSP-2). Caregivers of children on the autism spectrum aged 4-11 years (n = 271) completed the SSP-2. Analysis using Dirichlet process mixture model identified a two-cluster model which provided the best solution to subtype sensory responses. Two distinct subtypes were identified: Uniformly elevated (67%) with high scores across all quadrants and Raised avoiding and sensitivity (33%) with raised scores in the avoiding and sensitivity quadrants. There were no differences between subtypes based on chronological age and autism characteristics measured using the social communication questionnaire (total score). Based on the SSP-2, children were reported to experience differences in responses to sensory input, in particular in the area of sensitivity and avoiding.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1213607
Database: ERIC
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  Value: <anid>AN0136098432;aut01may.19;2019Apr27.05:27;v2.2.500</anid> <title id="AN0136098432-1">Exploring the Sensory Profiles of Children on the Autism Spectrum Using the Short Sensory Profile-2 (SSP-2) </title> <p>The aim of this study was to identify sensory subtypes in children on the autism spectrum using the Short Sensory Profile-2 (SSP-2). Caregivers of children on the autism spectrum aged 4–11 years (n = 271) completed the SSP-2. Analysis using Dirichlet process mixture model identified a two-cluster model which provided the best solution to subtype sensory responses. Two distinct subtypes were identified: Uniformly elevated (67%) with high scores across all quadrants and Raised avoiding and sensitivity (33%) with raised scores in the avoiding and sensitivity quadrants. There were no differences between subtypes based on chronological age and autism characteristics measured using the social communication questionnaire (total score). Based on the SSP-2, children were reported to experience differences in responses to sensory input, in particular in the area of sensitivity and avoiding.</p> <p>Keywords: Children; Autism; Sensory; Subtypes</p> <hd id="AN0136098432-2">Introduction</hd> <p>Many children on the autism spectrum display sensory differences and have difficulties processing sensory information (Ben-Sasson et al. [<reflink idref="bib8" id="ref1">8</reflink>]). Hyper- and hypo-reactivity to sensory input is now included as a core characteristic of autism in the fifth edition of the <emph>Diagnostic and Statistical Manual of Mental Disorders</emph> (DSM-5; American Psychiatric Association [<reflink idref="bib3" id="ref2">3</reflink>]). Differences in sensory profiles appear early in young children on the autism spectrum and impact on individuals across their lifespan (see review by Dunn et al. [<reflink idref="bib13" id="ref3">13</reflink>]). Children on the autism spectrum may display hypo-responsiveness (under responsiveness) and/or hyper-responsiveness (over responsiveness) to sensory input, with differing profiles occurring across and within sensory modalities (Baranek et al. [<reflink idref="bib7" id="ref4">7</reflink>]). These sensory responses can have a profound effect on daily life and have been associated with decreased activity, school and social participation, increased anxiety, challenging behaviours, and poorer cognitive outcomes (see review by Dunn et al. [<reflink idref="bib13" id="ref5">13</reflink>]). More specifically, sensory response types have been associated with differing behaviours. Hypo-responsivity has been associated with lower developmental outcomes in young children (Tomchek et al. [<reflink idref="bib32" id="ref6">32</reflink>]), while hyper-responsivity has been associated with poorer activity and social competence (Reynolds et al. [<reflink idref="bib29" id="ref7">29</reflink>]).</p> <p>One of the challenges in tailoring support for individuals on the autism spectrum is the extensive heterogeneity among children on the spectrum in relation to sensory differences. One possible approach that may better describe and characterise this heterogeneity is sensory subtyping. Subtyping uses statistical analysis to test the validity of subgroups within a broader group or category and has been explored in autism since the 1970s (Lotter [<reflink idref="bib25" id="ref8">25</reflink>]).</p> <p>However, subtyping of sensory profiles has received limited attention in the research literature. A systematic review of sensory-based subtypes within children on the autism spectrum identified only eight sensory subtyping studies (DeBoth and Reynolds [<reflink idref="bib9" id="ref9">9</reflink>]). Two additional subtyping studies have been published (Tomchek et al. [<reflink idref="bib32" id="ref10">32</reflink>]; Uljarević et al. [<reflink idref="bib33" id="ref11">33</reflink>]). The summary of these studies provided in Table 1 (with the exclusion of Baranek et al. ([<reflink idref="bib6" id="ref12">6</reflink>]) who focused only on hyper-responsive sensory patterns), demonstrates the lack of consensus on both the number and nature of sensory subtypes in children on the autism spectrum, with differences based on severity of responses and sensory modality. Studies reported between three and five subtypes. Across the studies, there were two commonly reported subtypes: children who were clinically not significantly different from the normative sample in their sensory responsiveness, and children with significant impairments across all or most sensory domains. However, there were qualitative differences in the features of other subtypes reported across the studies.</p> <p>Sensory subtype classifications of children on the autism spectrum</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Author/year</p></th><th align="left"><p>Population</p></th><th align="left"><p>Measure</p></th><th align="left"><p>Subtypes</p></th></tr></thead><tbody><tr><td align="left"><p>Ausderau et al. (<xref ref-type="bibr" rid="bibr4">2014a</xref>, <xref ref-type="bibr" rid="bibr5">b</xref>)</p></td><td align="left"><p><italic>N</italic> = 1294 Time 1</p><p><italic>N</italic> = 884 Time 2</p><p>2–12 years</p></td><td align="left"><p>Sensory Experiences Questionnaire</p></td><td align="left"><p>1. Mild (n = 308; 29%)*: lower than average on hypo-responsiveness (HYPO), hyper-responsiveness (HYPER), sensory interests and seeking behaviours (SIRS), enhanced perception (EP)</p><p>2. Extreme mixed (n = 291; 28%): elevated scores on HYPO, HYPER, SIRS, EP</p><p>3. Sensitive-distressed (n = 179; 17%): elevated scores on HYPER and EP</p><p>4. Attenuated-preoccupied (n = 182; 17%): elevated scores on HYPO and SIRS</p></td></tr><tr><td align="left"><p>Ben-Sasson et al. (2008)</p></td><td align="left"><p><italic>N</italic> = 170</p><p>18–33 months</p></td><td align="left"><p>Infant Toddler Sensory Profile</p></td><td align="left"><p>1. Low frequency (n = 44; 25.9%): on under- and over-responsivity and seeking scales</p><p>2. High frequency (n = 49; 28.8%): on under- and over-responsivity and seeking scales</p><p>3. Mixed (n = 77; 45.3%) high frequency of under- and over-responsivity, low frequency of seeking</p></td></tr><tr><td align="left"><p>Lane et al. (<xref ref-type="bibr" rid="bibr19">2010</xref>)</p></td><td align="left"><p><italic>N</italic> = 54</p><p>33–115 months</p></td><td align="left"><p>Short Sensory Profile</p></td><td align="left"><p>1. Sensory-based inattentive seeking (n = 24; 44.4%): typical with mild elevation in auditory filtering and under-responsive/seeks sensation</p><p>2. Sensory modulation with movement sensitivity (n = 17; 31.5%): severe differences on all domains</p><p>3. Sensory modulation with taste/smell sensitivity (n = 13; 24.1%): differences across domains with extreme differences in taste/smell but typical on movement sensitivity and low energy/weak</p></td></tr><tr><td align="left"><p>Lane et al. (<xref ref-type="bibr" rid="bibr18">2014</xref>)</p></td><td align="left"><p><italic>N</italic> = 228</p><p>2–10 years</p></td><td align="left"><p>Short Sensory Profile</p></td><td align="left"><p>1. Sensory adaptive (n = 84; 36.8%): typical with mild elevation in auditory filtering and under-responsive/seeks sensation</p><p>2. Taste/smell sensitive (n = 92; 40.4%): extreme taste/smell sensitivity and elevated auditory filtering, under-responsive/seeks sensation</p><p>3. Postural inattentive (n = 23; 10.1%): extreme low energy weak, and elevated auditory filtering, under-responsive/seeks sensation</p><p>4. Generalised sensory difference (n = 29; 12.7%): differences on all sensory domains</p></td></tr><tr><td align="left"><p>Lane et al. (<xref ref-type="bibr" rid="bibr17">2011</xref>)</p></td><td align="left"><p><italic>N</italic> = 30</p><p>41–113 months</p></td><td align="left"><p>Short Sensory Profile</p></td><td align="left"><p>1. Cluster 1 (n = 4; 13.3%): severe difference in taste/smell and low energy/weak, moderate differences in under-responsive/seeks</p><p>2. Cluster 2 (n = 6; 20.0%): low differences</p><p>3. Cluster 3 (n = 6; 20.0%): high under-responsivity and sensory seeking</p><p>4. Cluster 4 (n = 9; 30.0%): severe difference in taste/smell</p><p>5. Cluster 5 (n = 4; 13.3%): moderate to severe differences in all domains</p></td></tr><tr><td align="left"><p>Liss et al. (<xref ref-type="bibr" rid="bibr20">2006</xref>)</p></td><td align="left"><p><italic>N</italic> = 144</p><p><italic>M</italic>age(SD) = 102.4 (50.1) months</p></td><td align="left"><p>Sensory Profile (52 of the 125 items selected) plus 43 additional questions specific to sensory behaviours in autism</p></td><td align="left"><p>1. Cluster 1 (n = 17; 11.8%): sensory over responsivity</p><p>2. Cluster 2 (n = 36; 25.0%): low differences</p><p>3. Cluster 3 (n = 44; 30.6%): high under-responsivity and sensory seeking</p><p>4. Cluster 4 (n = 47; 32.6%): sensory over responsivity (not as high as Cluster 1)</p></td></tr><tr><td align="left"><p>Little et al. (2017)</p></td><td align="left"><p><italic>n</italic> = 101 (ASD, ASD + ADHD)</p><p>3–14 years</p></td><td align="left"><p>Sensory Profile 2</p></td><td align="left"><p>1. Balanced (n = 36; 35.6%): within typical range</p><p>2. Interested (n = 9; 8.9%): elevated sensory seeking</p><p>3. Intense (n = 22; 21.8%): elevated across all domains</p><p>4. Mellow until... (n = 11; 10.9%): elevated on registration and avoidance</p><p>5. Vigilant (n = 23; 22.8%): elevated on avoiding and sensitivity</p></td></tr><tr><td align="left"><p>Tomchek et al. (<xref ref-type="bibr" rid="bibr32">2018</xref>)</p></td><td align="left"><p><italic>N</italic> = 400</p><p>3–6 years</p></td><td align="left"><p>Short Sensory Profile</p></td><td align="left"><p>1. Sensorimotor (n = 204; 51.0%): increased taste/smell sensitivity, seeking, hypo-responsiveness</p><p>2. Selective-complex (n = 59; 14.8%): increased taste/smell and auditory/visual sensitivity, seeking, hypo-responsiveness</p><p>3. Perceptive-adaptive (n = 98; 24.5%): slightly increased response in seeking</p><p>4. Vigilant-Engaged (n = 39; 9.7%): increased taste/smell and auditory/visual sensitivity, and seeking</p></td></tr><tr><td align="left"><p>Uljarević et al. (<xref ref-type="bibr" rid="bibr33">2016</xref>)</p></td><td align="left"><p><italic>N</italic> = 57</p><p>11–17 years</p></td><td align="left"><p>Short Sensory Profile</p></td><td align="left"><p>1. Sensory adaptive (N = 19; 33.3%): responses within normative range</p><p>2. Sensory moderate (N = 29; 50.9%): responses 1–3 <italic>SDs</italic> below the mean</p><p>3. Sensory severe (N = 9; 15.8%): responses 6 = – 3 <italic>SDs</italic> below the mean</p><p>(Note: lower scores indicate more severity)</p></td></tr></tbody></table> </ephtml> </p> <p>A considerable proportion of the disparity between subtypes is likely to be associated with the selection of measures and age of the participants (DeBoth and Reynolds [<reflink idref="bib9" id="ref13">9</reflink>]). Current standardised measures of sensory differences predominantly rely on parent/caregiver report and vary in composition of total and subscale scores and aspects of the sensory profile assessed. For example, Lane, Molloy and Bishop ([<reflink idref="bib18" id="ref14">18</reflink>]) report a specific subtype on the Short Sensory Profile (SSP; McIntosh et al. [<reflink idref="bib26" id="ref15">26</reflink>]) characterised by taste and smell sensitivity, auditory sensitivity and seeking sensation; a profile that is only possible to describe using the SSP as other measures do not have the same or equivalent subscales. Disparity across studies may also be due to measures being adapted by specific research teams (e.g. Liss et al. ([<reflink idref="bib20" id="ref16">20</reflink>]) created their own questionnaire using items from the Sensory Profile with additional questions) or entered as part of a range of measures in the analysis (e.g., Tomchek et al. [<reflink idref="bib32" id="ref17">32</reflink>]).</p> <p>The most frequently used measures have been those within Dunn et al.'s Sensory Profile, which includes the Sensory Profile (SP; Dunn [<reflink idref="bib10" id="ref18">10</reflink>]), the Short Sensory Profile (McIntosh et al. [<reflink idref="bib26" id="ref19">26</reflink>]), and the Infant Toddler Sensory Profile (ITSP; Dunn [<reflink idref="bib11" id="ref20">11</reflink>]). These measures have been recently revised to create the Sensory Profile Second Edition (SP2; Dunn [<reflink idref="bib12" id="ref21">12</reflink>]). This version has improved consistency of questions across forms allowing for easier comparison, a change in the order of ratings to reflect a strengths-based approach, a reduction in the number of questions, and an increase in age range and behaviours described based on Dunn's Sensory Processing Framework (Dunn [<reflink idref="bib12" id="ref22">12</reflink>]). Furthermore, these changes which classify items under the broader sensory modalities including hypo-responsivity, hyper-responsivity and sensory seeking have been suggested as being more representative of sensory responses (Williams et al. [<reflink idref="bib34" id="ref23">34</reflink>], [<reflink idref="bib35" id="ref24">35</reflink>]). This measure may prove to be a useful tool for sensory subtyping however only one published study could be found that has used the SP2 as a measure to determine sensory subtypes. Little et al. ([<reflink idref="bib21" id="ref25">21</reflink>]) used the SP2 to classify subtypes across 1132 children aged 3–14 years recruited through a national study. Based on parent reports, 69.6% of participants were described as typically developing, 17.4% with a diagnosis on the autism spectrum, of ADHD or both, and the remaining 13% with other exceptionalities. Five clusters were identified (see Table 1), with 35.1% of children on the autism spectrum being classified under the balanced subtype, 24.7% vigilant, and 19.5% intense. These results suggest that the SP2 is able to discriminate between different sensory profiles for children on the spectrum. However, given the disparity of results across previous subtyping studies, further subtyping studies using this newly available measures are required.</p> <p>Developed as part of the SP2, Short Sensory Profile-2 (SSP-2; Dunn [<reflink idref="bib12" id="ref26">12</reflink>]) could provide useful information that may inform intervention efforts. The SSP-2 consists of 34 items from the SP2. The advantage of the SSP-2 is that it can easily be administered within a clinical practice and the shorter survey length is associated with increased response rates, quality of responses, and survey completeness (Haunberger [<reflink idref="bib15" id="ref27">15</reflink>]; Liu and Wronski [<reflink idref="bib22" id="ref28">22</reflink>]). The aim of this study was to investigate sensory subtypes with a large population of children on the autism spectrum using the SSP-2.</p> <hd id="AN0136098432-3">Method</hd> <p>Data used in this study were drawn from the Longitudinal study of Australian Students with Autism (LASA), a cross-sequential cohort study focusing on child participation and educational outcomes for children on the autism spectrum. The full recruitment procedure for the larger study is described in Roberts et al. ([<reflink idref="bib30" id="ref29">30</reflink>]). Briefly, primary recruitment for caregivers of children on the autism spectrum aged 4–5 and 9–10 years living in Australia was through clinics and advertisements on social media. The child's diagnosis of autism was reported by parents. All participants were asked to provide copies of their child's diagnostic reports to confirm diagnosis. The LASA study collects data for the two cohorts at six-time points approximately 1 year apart, using Qualtrics online survey software. Data for the current analysis were drawn from the first year of data collection. Ethical approval for this study was obtained from participating universities and health authorities.</p> <hd id="AN0136098432-4">Participants</hd> <p>There were 272 participants recruited in the first year of the LASA study. Participants were included in this study if they had a community diagnostic report and/or a score of ≥ 15 on the Social Communication Questionnaire (see "Measures"). Participants were excluded if their SSP-2 was incomplete and could not be scored (see "Measures"). The final sample for this study consisted of data on 248 children on the autism spectrum, with 118 aged between 4 years and 6 years 2 months (<emph>M age</emph> = 60.3 months, <emph>SD</emph> = 6.7 months), and 130 aged between 8 years 7 months and 11 years 5 months (<emph>M age</emph> = 118.9 months, <emph>SD</emph> = 7.3 months). The demographic information on the sample is shown in Table 2.</p> <p>Child and caregiver characteristics (total sample = 248)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Demographic variables</p></th><th align="left"><p><italic>N</italic> (%)</p></th></tr></thead><tbody><tr><td align="left"><p>Child gender</p></td><td align="left" /></tr><tr><td align="left"><p> Male</p></td><td align="left"><p>204 (82.3)</p></td></tr><tr><td align="left"><p>English language spoken at home</p></td><td align="left"><p>248 (100)</p></td></tr><tr><td align="left"><p>Co-occurring conditions</p></td><td align="left"><p>119 (40.1)</p></td></tr><tr><td align="left"><p>Caregiver's relationship to the child</p></td><td align="left" /></tr><tr><td align="left"><p> Mother</p></td><td align="left"><p>217 (87.5)</p></td></tr><tr><td align="left"><p> Father</p></td><td align="left"><p>25 (10.1)</p></td></tr><tr><td align="left"><p> Other</p></td><td align="left"><p>6 (2.4)</p></td></tr><tr><td align="left"><p>Caregiver's age (or mean)</p></td><td align="left" /></tr><tr><td align="left"><p> < 30 years</p></td><td align="left"><p>14 (5.6)</p></td></tr><tr><td align="left"><p> 31–40 years</p></td><td align="left"><p>127 (51.2)</p></td></tr><tr><td align="left"><p> > 41 years</p></td><td align="left"><p>107 (43.2)</p></td></tr><tr><td align="left"><p>Caregiver's highest level of education</p></td><td align="left" /></tr><tr><td align="left"><p> No formal/primary school</p></td><td align="left"><p>2 (0.8)</p></td></tr><tr><td align="left"><p> Secondary school</p></td><td align="left"><p>54 (21.8)</p></td></tr><tr><td align="left"><p> Tertiary education</p></td><td align="left"><p>191 (77.0)</p></td></tr><tr><td align="left"><p> Missing</p></td><td align="left"><p>1 (0.4)</p></td></tr></tbody></table> </ephtml> </p> <p>The child ratio of males to females was 4.6:1, which reflects a higher proportion of males than that expected given recently published rates of approximately 3.3:1 (Loomes et al. [<reflink idref="bib24" id="ref30">24</reflink>]). Over 40% of the children were identified as having co-occurring conditions including ADHD (14.8%), anxiety (5.1%), and epilepsy (2%). The majority of caregiver informants were mothers, aged 31–50 years, with a tertiary education.</p> <hd id="AN0136098432-5">Measures</hd> <p></p> <hd id="AN0136098432-6">Autism characteristics</hd> <p>Social Communication Questionnaire Lifetime Version (SCQ; Rutter et al. [<reflink idref="bib31" id="ref31">31</reflink>]) is a parent-completed questionnaire that is used as a screening tool for autism (Eaves et al. [<reflink idref="bib14" id="ref32">14</reflink>]). A cut-off score of ≥ 15 supports characteristics of autism.</p> <hd id="AN0136098432-7">Sensory</hd> <p>The Short Sensory Profile 2 (SSP-2; Dunn [<reflink idref="bib12" id="ref33">12</reflink>]) is a 34-item parent questionnaire designed to measure behaviours associated with abnormal responses to sensory stimuli in children aged 3.0–14.11 years. The SSP-2 provides scores in the four quadrants of Dunn's Sensory Processing Framework based on the child's neurological threshold to sensory input and their method of self-regulation. The four quadrants are Seeking (e.g., "rocks in chair, on floor, or while standing"), Avoiding (e.g., "resists eye contact from me or others"), Sensitivity (e.g., "is distracted when there is a lot of noise around"), and Registration (e.g., "bumps into things, failing to notice objects or people in the way"). Cronbach's alphas were calculated for this sample for each of the four quadrants. Seeking consisted of 7 items (α = 0.69), Avoiding consisted of 9 items (α = 0.83), Sensitivity consisted of 10 items (α = 0.75), and Registration consisted of 8 items (α = 0.75). The frequency the child displays each item behaviour is scored on a Likert scale ranging from 1 (<emph>almost never</emph> = 10% or less) to 5 (<emph>almost always</emph> = 90% or more). Raw score totals can be calculated for each quadrant. Dunn ([<reflink idref="bib12" id="ref34">12</reflink>]) has provided a Normal Curve and Sensory Profile 2 Classification System, based on responses from a normative sample of children without disabilities (<emph>n</emph> = 697). Based on a bell curve normed distribution, the raw score total for each quadrant can be classified as "much less than others" (lower 2%), "less than others" (between 1 <emph>SD</emph> and 2 <emph>SD</emph> below the mean, accounting for 14% of the normative sample), "just like the majority of others" (± 1 <emph>SD</emph> from the mean and accounting for 68% of the normative sample), "more than others" (between 1 <emph>SD</emph> and 2 <emph>SD</emph> above the mean), and "much more than others" (upper 2%).</p> <hd id="AN0136098432-8">Analysis</hd> <p>Prior to the cluster analysis, the distribution spread of results for this sample was plotted against the expected distribution of results based upon the normative data in Dunn ([<reflink idref="bib12" id="ref35">12</reflink>]). A mixture model analysis was chosen for the study as this soft clustering technique allows for the identification of cluster profiles that best explain similarities between the four domains on the SSP-2 (Seeking, Avoiding, Sensitivity, Registration), whilst avoiding hard classifications of individuals who may have features of several subtypes. This analysis was used to determine if different subtype classifications explain the observed results. Initial analysis was conducted on the Sensory Profile 2 Classification System using Normal mixture models to obtain subtypes of responses. Although there was a relatively large number of individuals in the study (N = 248), the discrete nature of the test scores resulted in standardised scores with a limited range of unique values. The number of unique standardised scores ranged from 29 to 34 over the four domains. This coarseness in the data, known commonly as binning, results in a solution where a Multivariate Normal Mixture is likely to have too few components to represent the true underlying density (Alston and Mengersen [<reflink idref="bib2" id="ref36">2</reflink>]).</p> <p>Normed scales of the quadrant scores were calculated based on the Normal Curve and Sensory 2 Profile Classification System. Multivariate clusters of the normed scale scores were detected using Dirichlet process mixture models (DPMM). The DPMM was used in this analysis because the outcome variables were a mix of continuous (severity) and ordinal categorical data (Molitor et al. [<reflink idref="bib27" id="ref37">27</reflink>]). Modelling was performed using the PreMiUM library (Liverani et al. [<reflink idref="bib23" id="ref38">23</reflink>]) with R software (R Core Team [<reflink idref="bib28" id="ref39">28</reflink>]).</p> <p>The DPMM incorporates estimating the number of components within the modelling framework, rather than approaching the model selection via fitting a series of models and comparing a measure of fit, such as the Bayesian Information Criteria (BIC). Essentially, the DPMM has an infinite number of components, and the algorithm implemented with Monte Carlo Markov Chain (MCMC) techniques adapts the number of "active" components based on the previous component memberships (Liverani et al. [<reflink idref="bib23" id="ref40">23</reflink>]).</p> <hd id="AN0136098432-9">Results</hd> <p>The distribution spread of participant results for each domain was compared to the Normal Curve and Sensory Profile-2 Classification System, and is displayed in Fig. 1. Based on the normative data, 2% of the population were expected to achieve scores in the "much more than others" range. However, on each of the four domains, more than 2% achieved a score within this range; Seeking (37.1%), Avoiding (62.1%), Sensitivity (65.7%), and Registration (56.5%).</p> <p>Graph: Fig. 1Distribution of participant quadrant scores compared with the Normal Curve and Sensory Profile 2 Classification System</p> <hd id="AN0136098432-10">Cluster Profile</hd> <p>Posterior probability of k clusters suggests the two-cluster model is the most probable model (28%), followed by three cluster (26%), four cluster (16%), five cluster (11%), and six cluster (7%). The cluster proportion of score distribution in the two-cluster model is displayed in Fig. 2. The first profile, labelled as "Uniformly elevated", includes participants (<emph>n</emph> = 182) who have elevated differences across all domains. It has the highest number of people with scores on scale 5 (definite difference) across all domains, and additionally, with a high level of scale 4 (probable difference) scores in seeking. The second profile, labelled "Raised avoiding and sensitivity", includes participants (<emph>n</emph> = 66) who receive scores within the typical range on seeking and registration domains, as is indicated by the largest component weight (proportion of cluster) being seen with scale 3 (within typical range). This profile has elevated scores on sensitivity and avoiding, as is evidenced by the increased proportion of children allocated to this component who have scores on scale 4 (probable difference).</p> <p>Graph: Fig. 2Posterior summary of proportion of sample contained in each cluster. Posterior mean identified by open/closed circles and indicated spread denotes 80% credible interval</p> <p>As with any latent variable mixture model, there are many possible combinations of the mixture that can result in a satisfactory estimate of the overall density. In this analysis, the number of iterations when the three-cluster model was favoured was almost as high as the two-cluster model (26% vs 28%). However, postprocessing of the MCMC estimates indicate that there were at least two different three-cluster models explored.</p> <p>Histograms of the number of individuals allocated to each profile during the 12,839 iterations which visited the three-cluster model are displayed in Fig. 3. It can be noted that the intense cluster has a relatively stable number of individuals assigned to it (mean = 180). For around 10,300 of the iterations, the Extra 1 profile consists of a small number of individuals, 10 or fewer, where one or more of their measures did not necessarily fit the consistent pattern of either the Uniformly elevated or Raised avoiding and sensitivity profile. Because so few individuals belong to this "new" profile, it is inconclusive as to whether this would be applicable to a larger sample. For around 2500 iterations, there is a third profile which is more substantial, comprising of an average of 28.5 individuals. This Extra 2 profile aligns with individuals who were identified as having slightly different scores on seeking. While this profile contains a much larger number of individuals, overall, it was preferred in very few of the total model iterations and, as such, does not have a large support for this model. The individuals are generally those who would have been allocated to the Raised avoiding and sensitivity profile under the other models. This phenomenon can be seen in the extended left tail of the histogram for the Raised avoiding and sensitivity profile.</p> <p>Graph: Fig. 3Histograms of number of individuals assigned to each profile over 12,839 iterations of the sampler containing three components. Top panel: uniformly elevated, middle panel: raised avoiding and sensitivity, bottom panel: extra 1 and 2</p> <hd id="AN0136098432-11">Frequencies of Item Presentation</hd> <p>Descriptive analysis was conducted at the item level to identify if particular items occurred more or less frequently within this group. Four items were each rated as occurring more than half the time by over 70% of participants. Three items were from the avoiding quadrant: "Needs positive support to return to challenging situations"; "Gets frustrated easily"; "Has strong emotional outbursts when unable to complete a task"; and one item from the sensitivity quadrant, "Is distracted when there is a lot of noise around". Items rated as occurring less than half the time by most participants were "moves stiffly" (70.5%) and "loses balance unexpectedly when walking on uneven surfaces" (67%).</p> <hd id="AN0136098432-12">Age and Level of Autism Characteristics</hd> <p>Child age and level of autism characteristics based on SCQ scores (<emph>M</emph> = 22.33; <emph>SD</emph> = 6.05) were added as regressors within the model. Based on the posterior distribution of the parameters, no meaningful differences were identified in the cluster models with age or autism characteristics.</p> <hd id="AN0136098432-13">Discussion</hd> <p>Using the SSP-2, a two-cluster model provided the best solution to subtype the sensory responses of children on the autism spectrum (4–10 years) in this study. The two subtypes within this cohort demonstrated differing responses to sensory input on at least two of the four domains. The subtype profiles Uniformly elevated (high scores across all quadrants) and Raised avoiding and sensitivity (raised scores in the avoiding and sensitivity quadrants), correspond with Little et al.'s ([<reflink idref="bib21" id="ref41">21</reflink>]) profiles of the Intense and Vigilant subtypes. While some support for a three-cluster model was indicated, post-modelling analysis identified the clear presence of submodels and their associated covariate patterns reducing the likelihood of a three-cluster model being applicable to these data.</p> <p>A two-cluster solution differs from the findings of a previous study that used the SP-2 and that proposed a five-cluster model (Little et al. [<reflink idref="bib21" id="ref42">21</reflink>]). An explanation of these different findings may lie in details related to the study populations and type of analyses conducted. While the Little et al. study sample consisted of a large sample of children (<emph>N</emph> = 1132), by far the largest group were typically developing (<emph>n</emph> = 788) compared to a much smaller number of children on the autism spectrum (<emph>n</emph> = 77). The current study sample consisted only of children on the autism spectrum (<emph>n</emph> = 248) who may show an autism-specific profile that could have been overshadowed by the large number of typically developing children in the Little et al. study. In addition, the age ranges in the two studies differed, with the Little et al. study including a wider age range than the current study. Children in this study were clustered around two mean age points (5 years 3 months and 9 years 9 months) and this age range appears to coincide with highest rates of reported sensory differences in children on the autism spectrum compared with the typical population (6–9 years; meta-analysis Ben-Sasson et al. [<reflink idref="bib8" id="ref43">8</reflink>]). While further research is needed to confirm the two-cluster model, this study makes an important contribution in highlighting how sensory profiles of children on the autism spectrum may differ from those in the non-autistic population.</p> <p>In relation to data analyses, the (BIC) used by Little et al. ([<reflink idref="bib21" id="ref44">21</reflink>]) looks at the overall fit of the mixture model to the density of the whole data set, and when the addition of clusters' improved fit is outweighed by model complexity, no further clusters are added. Using a BIC strategy may miss small but important clusters, as the underlying strategy for the BIC is to represent the density of the whole data set with minimal complexity (minimising the number of parameters via component numbers). Therefore, when modelling a large data set, as was the case in the Little et al. study, and a few individuals do not fit well into the current mixture density, adding a cluster for them will not really enhance the overall model fit, and as such, this cluster addition will be rejected, and the individuals will be assigned to a current cluster. As a result, the children allocated to the largest cluster may or may not be appropriately allocated in the latent variable update, and a closer examination of the data would be required. In Little et al., the largest cluster was the Balanced profile and 35.1% of the children on the autism spectrum were allocated to this subtype. However, children on the autism spectrum, or those on the spectrum with a co-morbid diagnosis of ADHD, predominantly made up the Intense (37.9%) and Vigilant (45.1%) subtypes, suggesting this may be more representative of these children as reported in the current study.</p> <p>The findings from this study differ also from those that have used the SSP (Lane et al. [<reflink idref="bib19" id="ref45">19</reflink>], [<reflink idref="bib17" id="ref46">17</reflink>], [<reflink idref="bib18" id="ref47">18</reflink>]). The use of different measures has been one of the explanations given for sensory subtypes differing across studies (DeBoth and Reynolds [<reflink idref="bib9" id="ref48">9</reflink>]), and this outcome appears to be supported in this study. That is, it is likely that differences between the SSP-2 and SSP have resulted in different sensory subtypes. A key difference between the two assessment tools is that the SSP consists of seven domains (tactile sensitivity, taste/smell sensitivity, movement sensitivity, under-responsive/seeks sensation auditory filtering, low energy/weak, visual/auditory sensitivity) while the SSP-2 consists of only four domains (seeking, avoiding, sensitivity and registration). This change occurred through a reclassification of items and development of new items that formed the new domains. Using the SSP, Lane et al. ([<reflink idref="bib19" id="ref49">19</reflink>], [<reflink idref="bib17" id="ref50">17</reflink>], [<reflink idref="bib18" id="ref51">18</reflink>]) identified a subtype characterised by extreme taste/smell sensitivity; however, these items are no longer included in the SSP-2 and therefore would not be replicated in the current study. A comparison of items between the two measures reveals that less than 30% of items are matched on item description, and the avoiding domain on the SSP-2 has no comparable match on the SSP. In order for sensory subtyping to be diagnostically and clinically useful, it will be important to have some consensus among researchers about subtyping methodology and selection of measures. As mentioned in the Introduction, the SSP-2 has advantages over earlier versions, with improved consistency of questions across forms allowing for easier comparison, a change in the order of ratings to reflect a strengths-based approach, fewer questions, and an increase in the age range and behaviours covered. Further work is needed, but based on an adequate sample size (larger than 62% of the previous sensory subtyping studies detailed in Table 1) and use of the SSP-2 in this study, there is preliminary support for a two-cluster model of sensory subtypes in children on the autism spectrum.</p> <p>In this study, autism characteristics, as measured by the SCQ, were not identified as a contributing factor to the sensory subtypes, a finding consistent with some earlier studies (Lane et al. [<reflink idref="bib18" id="ref52">18</reflink>]; Jasmin et al. [<reflink idref="bib16" id="ref53">16</reflink>]). However, previous findings in this regard have been mixed, with Ben-Sasson et al. ([<reflink idref="bib8" id="ref54">8</reflink>]) reporting some association between autism characteristics and sensory subtypes. Once again, comparison across studies is difficult with samples differing in age and with different measures of sensory responsiveness and autism characteristics. Therefore, the current findings need to be interpreted with caution.</p> <hd id="AN0136098432-14">Implications</hd> <p>The results from this study identified that children on the autism spectrum demonstrate differences in responses to sensory input, with overall differences in the Avoiding and Sensitivity quadrants. Increasing the awareness of a range of sensory subtypes in children on the spectrum is important if interventions are to be trialed and tailored to specific profiles. Given that recent research has shown that a child's sensory profile at an early age is differentially associated with the development of their later adaptive behaviours, and daily living skills (Williams et al. [<reflink idref="bib34" id="ref55">34</reflink>], [<reflink idref="bib35" id="ref56">35</reflink>]), identifying effective sensory-based interventions is critical for long-term outcomes. Having a method of classifying a child's sensory subtype could in the future inform the selection of intervention that has been shown to be effective for that specific subgroup.</p> <p>This deeper knowledge will also have implications for researchers. The further refinement of sensory subtype categorizations allows for each subtype to be explored in terms of their presentation (e.g., behavioural presentation), relationship with frequently reported co-morbid diagnoses (e.g., anxiety) and impact (e.g., academic outcomes, caregiver experiences). Exploring the profile of subtypes over time can also aid with prognosis and identification of children who may benefit the most from tailored and subtype-specific interventions. Further refining categorization of subtypes has clear implications for neurobiological studies that aim to link sensory profiles with the underlying mechanisms (Ausderau et al. [<reflink idref="bib5" id="ref57">5</reflink>]).</p> <p>Through gathering data on sensory measures to explore sensory subtypes, it is also possible to explore item-level profiles which may provide further insight into sensory experiences for individuals on the spectrum. For example, within this sample, over 80% of the group scored <emph>frequent</emph>/<emph>almost always</emph> on the item "is distracted when there is a lot of noise around". This level of information could inform the creation of "autism-considerate" environments that control some of the factors in the environment that may be challenging for children on the autism spectrum.</p> <hd id="AN0136098432-15">Limitations and Future Research</hd> <p>Sensory responses are interpreted based on the individual's behavioural response to the sensory input. Current sensory measures used in clinical practice require an interpretation of the behaviour, by the parent or therapist, and may not reflect individual experiences. The relationship or extent to which behaviour aligns with sensory or other autism-related behavioural difficulties requires further investigation through combining multi-informant reports recognising that each informant as a potential important source of information about how factors may influence the experience or presentation of a sensory response (Adams et al. [<reflink idref="bib1" id="ref58">1</reflink>]).</p> <p>Children in this study were drawn from a larger study with two age cohorts and when combined, ages ranged from 4 to 11 years. This can be viewed as an advantage, as results may be less confounded by age-related variability in sensory profiles. However, caution must also be taken in relation to generalizing these results to younger or older children not represented in the sample. Because parents were enrolled in to a larger, longitudinal study focusing upon educational outcomes, the risk of recruitment bias is limited for parents who are particularly interested in, or having difficulties with, their child's sensory profile. However, a different recruitment bias may be introduced with only parents who were interested in educational outcomes and willing and/or able to commit to a 6-year study enrolling into the study.</p> <p>Finally, the survey is cross-sectional. There has been little research investigating the stability of the sensory profile over time. One large study (Ausderau et al. [<reflink idref="bib4" id="ref59">4</reflink>]) suggests that 91% of children remained stable in their subgroup over 1 year. However, this was based on a different measure and a larger number of subtypes. It may be that with a smaller number of subtypes, profiles remain more stable, although this is as yet unknown and needs to be explored longitudinally.</p> <hd id="AN0136098432-16">Conclusion</hd> <p>This is the first study to identify sensory subtypes in children on the autism spectrum using the SSP-2 and adds to the literature describing the categorisation of sensory subtypes in children on the autism spectrum. The results suggest that the children (4–11 years) on the autism spectrum experience differences in responses to sensory input, in particular in the area of sensitivity and avoiding, with overall differences in the avoiding and sensitivity sensory behaviours ranging from elevated differences on items classified in the sensitivity and avoiding quadrants through to marked differences across all sensory quadrants.</p> <hd id="AN0136098432-17">Acknowledgments</hd> <p>The authors acknowledge the work of the LASA team members: Susan Bruck, Trevor Clark, Sandra Devaraj, Robyn Garland, Antoinette Hodge, Patricia Howlin, Jessica Paynter, Natalie Silove, David Trembath, Madonna Tucker, Marleen Westerveld, Katrina Williams. The authors acknowledge the financial support of the Cooperative Research Centre for Living with Autism (Autism CRC), established and supported under the Australian Government's Cooperative Research Centres Program.</p> <hd id="AN0136098432-18">Author contributions</hd> <p>KS conceived of the study, participated in its design and coordination, interpretation of the data, and drafted the manuscript; DA participated in the design and interpretation of the data and helped to draft the manuscript; CA participated in the design, performed the statistical analysis and participated in the interpretation of the data; HH participated in its design and coordination and helped to draft the manuscript. DK participated in the conception of the study, the design and coordination of the study and helped to draft the manuscript. 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  Data: <searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Integration%22">Sensory Integration</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Measures+%28Individuals%29%22">Measures (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Attitudes%22">Parent Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Caregiver+Attitudes%22">Caregiver Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Responses%22">Responses</searchLink><br /><searchLink fieldCode="DE" term="%22Scores%22">Scores</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Profiles%22">Profiles</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-019-03889-2
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The aim of this study was to identify sensory subtypes in children on the autism spectrum using the Short Sensory Profile-2 (SSP-2). Caregivers of children on the autism spectrum aged 4-11 years (n = 271) completed the SSP-2. Analysis using Dirichlet process mixture model identified a two-cluster model which provided the best solution to subtype sensory responses. Two distinct subtypes were identified: Uniformly elevated (67%) with high scores across all quadrants and Raised avoiding and sensitivity (33%) with raised scores in the avoiding and sensitivity quadrants. There were no differences between subtypes based on chronological age and autism characteristics measured using the social communication questionnaire (total score). Based on the SSP-2, children were reported to experience differences in responses to sensory input, in particular in the area of sensitivity and avoiding.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2019
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1213607
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1213607
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1007/s10803-019-03889-2
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 2069
    Subjects:
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Sensory Integration
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Measures (Individuals)
        Type: general
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Parent Attitudes
        Type: general
      – SubjectFull: Caregiver Attitudes
        Type: general
      – SubjectFull: Responses
        Type: general
      – SubjectFull: Scores
        Type: general
      – SubjectFull: Age Differences
        Type: general
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Interpersonal Competence
        Type: general
      – SubjectFull: Profiles
        Type: general
    Titles:
      – TitleFull: Exploring the Sensory Profiles of Children on the Autism Spectrum Using the Short Sensory Profile-2 (SSP-2)
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Simpson, Kate
      – PersonEntity:
          Name:
            NameFull: Adams, Dawn
      – PersonEntity:
          Name:
            NameFull: Alston-Knox, Clair
      – PersonEntity:
          Name:
            NameFull: Heussler, Helen S.
      – PersonEntity:
          Name:
            NameFull: Keen, Deb
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 05
              Type: published
              Y: 2019
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
          Numbering:
            – Type: volume
              Value: 49
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of Autism and Developmental Disorders
              Type: main
ResultId 1