Emily C. Sweiss PhD, OTR/L

Caregiver sensitivity to infant cues is well-established as a predictor of child development. Infants also actively influence their social environment, especially their caregivers, even from their earliest days. Sensory reactivity, characterized as hypo- (under) and hyper- (over) responding to environmental stimuli, is one domain of development that is likely to influence caregiver-infant interaction, due to its role in regulating emotions and responses to both physical and social stimuli. Although sensory reactivity could be an important target for improving caregiver-child interaction, the longitudinal, reciprocal relations between infant sensory reactivity and caregiver behaviors are currently unknown. In the present proof-of-concept study, we examined these associations in a community sample of mother-infant dyads (N = 252) at infant ages 6 and 12 months using a cross-lagged panel modeling approach. Preliminary findings, which will benefit from replication using a validated measure of sensory reactivity, indicated that maternal sensitivity may decrease infant hyperreactivity, and infant hyporeactivity may be associated with increases in maternal sensitivity. Maternal intrusiveness appears to exacerbate infant hyperreactivity over time and attenuate later infant hyporeactivity. The results of this study provide preliminary evidence for the mutually influential nature of infant sensory reactivity and maternal behavior and signals the importance of future investigation of these concepts.

Keywords. Maternal sensitivity, infant development, longitudinal changes, parent-infant reciprocity, sensory reactivity

Exposure to early life adversity (ELA) increases risk of poor mental health outcomes, including attention deficit/hyperactivity disorder (ADHD). In fact, ELA, especially in the form of “household ACEs” (e.g., socioeconomic disadvantage, incarceration of a caregiver), is among the most robust environmental predictors of a later ADHD diagnosis. Exposure to unpredictability is an understudied form of ELA that captures instability or inconsistency in routines, household experiences, and family relationships. The purpose of this study was to examine associations between unpredictability and ADHD symptoms in children and adolescents. Participants were drawn from two independent cohorts (Cohort 1: N = 99, M_age = 7.31 years [SD = 0.31]; Cohort 2: N = 217, M_age = 14.39 years [SD = 1.32]) participating in ongoing longitudinal studies of exposure to ELA. Unpredictability was measured by the Questionnaire of Unpredictability in Childhood, and ADHD symptoms were measured by the Child Behavior Checklist Attention Deficit/Hyperactivity Problems subscale, the Behavior Rating Inventory of Executive Function, and the Kiddie Schedules for Affective Disorders and Schizophrenia ADHD Screener. Childhood experiences of unpredictability were associated with ADHD symptoms in both cohorts and during childhood and adolescence. Further, associations were stronger in females than males. These findings show that unpredictability is a risk factor for ADHD which suggests that it should be explored as an early target for intervention to reduce the development of ADHD symptoms.

Keywords. ADHD, early life adversity, unpredictability

Infants at elevated likelihood of developing autism display differences in sensory reactivity, especially hyporeactivity, as early as 7 months of age, potentially contributing to a developmental cascade of autism symptoms. Caregiver responsiveness, which has been linked to positive social communication outcomes, has not been adequately examined with regard to infant sensory reactivity. This study examined the multiplicative impact of infant sensory hypo- and hyperreactivity on caregiver responsiveness to sensory reactivity and regulation cues in 43 infants at elevated likelihood of autism. Sensory hyperreactivity was found to moderate the association between sensory hyporeactivity and caregiver responsiveness, such that caregivers of infants with moderately high sensory hypo- and hyperreactivity demonstrated higher responsiveness.

Keywords. Early risk signs; Sensory reactivity; Caregiver responsiveness; Community sample

Telehealth is effective for service delivery in pediatric occupational therapy across ages and diagnoses. Remote parent coaching provides unique benefits for both parents and infants. As a result of COVID-19, practitioners and researchers pivoted to remote assessment and intervention without much preparation or training. It is critical that we evaluate the quality of these telehealth services. One important component of remote evaluations is assessment fidelity. To examine assessment fidelity of a telehealth-delivered observational autism screening tool for infants. An assessment fidelity checklist was applied as the primary outcome measure. Parents conducted assessments with 82% adherence to the fidelity checklist. Implications: A parent coaching telehealth approach may be valid for assessment in pediatric telehealth. Continually monitoring the assessment fidelity of a tool is critical for the valid administration of remote services.

Importance. Limited research has elucidated factors predicting occupational therapy–specific service utilization by children with autism. Such research is needed to inform reasons for receipt of services.

Objective. To examine factors associated with occupational therapy service utilization by children with autism. We hypothesized that elevated sensory hyperresponsiveness; greater sensory interests, repetitions, and seeking; and lower adaptive behavior would predict more service utilization.

Design. Analysis of extant data from a prospective, longitudinal survey study about autism symptom severity, adaptive behavior, sensory features, and demographic and service utilization information of children with autism ages 3 to 13 yr.

Setting. Online parent survey regarding child behaviors during daily activities and contexts.

Participants. 892 parents of children with autism from 50 U.S. states.

Outcomes and Measures. We used scores on the Vineland Adaptive Behavior Scale–Second Edition, the Social Responsiveness Scale, and the Sensory Experiences Questionnaire Version 3.0 and responses to a demographic questionnaire. We formulated hypotheses after data collection but before analysis.

Results. Predictors of higher occupational therapy service utilization were lower enhanced perception; lower adaptive behavior; elevated sensory interests, repetitions, and seeking behaviors; younger child age; and higher household income.

Conclusion and Relevance. Results partially support our hypotheses. Sensory interests, repetitions, and seeking behavior predicted occupational therapy service utilization, whereas other sensory response patterns did not, suggesting a possible referral bias for certain sensory response patterns. Occupational therapy practitioners can educate parents and teachers about the scope of practice, which includes addressing sensory features beyond sensory interests, repetitions, and seeking behaviors.

Keywords. autistic disorder, child, adaptive behavior

Background. Autistic individuals exhibit core and co-occurring features that can be disabling to daily functioning and impede quality of life. The combined expression of three closely related features: sensory hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety, may be a sign to practitioners that experiences in the environment are particularly challenging. These are investigated through many approaches, including animal modelling, neurological or physiological measures, behavioral observation, and first-hand accounts. However, little work has been done to review evidence across approaches to better understand their expression.

Method. This study was an integrated systematic review to identify factors that contribute to the collective expression of three constructs of interests (COIs; hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety). Twenty-two articles were analyzed for both structural and thematic patterns. This review is unique in its inclusion of articles from a variety of disciplines and grouping of studies based on similarities over methodological techniques (i.e. quantitative, qualitative, or mixed methods).

Results. Three overall structural approaches relating the constructs of interest were identified (parallel, relational, and contingent). Three overarching themes also emerged: 1) the broader social context, 2) predictability of environmental factors, and 3) overlap with cognitive and behavioral coping strategies.

Conclusions. Results highlight clinically relevant information about the combined expression of the three COIs and demonstrate possibilities for increased collaboration across disciplines through common themes and study structures to further understand the experiences of autistic people.

Sensory-processing challenges are measured by caregiver report and clinician observation and affect many people with autism spectrum disorder and their caregivers. It is unclear how caregiver stress influences the correlation between scores on caregiver reports and observational measures. The present analysis explored correlations between two formats of tools to assess sensory processing and indicated that caregiver stress moderates the association between sensory-seeking scores on the measures.