Date Presented 03/26/20
Attention, sensory processing, and social skills each represent targets for OT intervention in ASD, and understanding the complex interrelationships between these constructs will allow therapists to design more efficient interventions. Study results indicate that sensory processing, specifically low registration, fully mediated the relationship between attentional abilities and social responsiveness in 24 young adults with ASD and 24 age-matched neurotypical peers.
Primary Author and Speaker: Jewel Crasta
Additional Authors and Speakers: Patricia Davies
Contributing Authors: William Gavin
RATIONALE: Researchers have posited that early deficits in disengaging attention in children with autism spectrum disorders (ASD) might result in a cascade of impairments which contribute to the emergence of the ASD phenotype (Keehn, Müller, & Townsend, 2013). Sensory processing abilities are dependent on attention control and are associated with social responsiveness in children with ASD (Marco, Hinkley, Hill, & Nagarajan, 2011). However, there is limited research examining the relationship between attention, sensory processing, and social responsiveness in adults with ASD beyond simple correlations.
PURPOSE: To evaluate whether sensory processing mediates the relationship between attention and social responsiveness in adults with ASD and neurotypical peers.
DESIGN: Cross-sectional, quantitative design, with convenience sampling.
PARTICIPANTS: Participants were 24 young adults (M age=23.3 years, SD=3.8) with ASD and 24 age-matched neurotypical adults.
METHODS: Participants completed the self-report forms, Social Responsiveness Scale 2 (SRS-2), and the Adolescent/Adult Sensory Profile (AASP) and were administered the Test of Everyday Attention (TEA), a performance-based attention measure.
ANALYSIS: Mediation analysis was used to investigate the hypothesis that sensory processing mediates the relationship between the total scores of TEA (attention) and SRS-2 (social responsiveness). The mediators were AASP quadrant scores which are based on neurological thresholds (high or low) and behavioral responses (active or passive). For example, for low registration (high thresholds and passive responses), more intense sensory stimulation is required to notice stimuli. Participants from both groups were included in the mediation analysis. Independent samples t-tests were used to examine group differences in study measures.
RESULTS: Mediation analysis indicated that attention was a significant predictor of sensory processing (low registration), B=-.34, SE=.08, p=.0002, and that sensory processing was a significant predictor of social responsiveness, B=3.63, SE=.43, p<.0005. These results support the mediational hypothesis. Attention was no longer a significant predictor of social responsiveness after controlling for the mediator, sensory processing, B=-.01, SE=.28, ns, consistent with full mediation. The predictors accounted for around 69% of the variance in social responsiveness. The indirect effect was tested using a percentile bootstrap estimation approach with 10000 samples (Hayes, 2017). These results indicate that the indirect coefficient was significant, B=-1.2, SE=.26, 95% CI=-1.8, -.74. Analyses with the other 3 AASP quadrants did not result in full mediation. There were significant group differences on TEA subtests corresponding to visual selective attention/speed, auditory-verbal working memory, and attention switching, and all 4 AASP quadrants which further support the model (p’s<.0005).
CONCLUSION: Sensory processing, specifically low registration fully mediated the relationship between attention abilities and social responsiveness in young adults with ASD and neurotypical peers. Deficits in attention may lead to low registration such that individuals may miss social cues, in turn leading to difficulties in social skills. The persistence of attention and sensory processing issues into adulthood and its significant impact on social responsiveness indicate that therapy emphasizing attention and sensory processing in ASD can potentially modify social participation for transitioning youth/adults.
IMPACT: Since attention, sensory processing, and social skills each represent targets for OT intervention in ASD, understanding the complex inter-relationships between these constructs will allow therapists to design more efficient interventions.
References
Keehn, B., Müller, R.-A., & Townsend, J. (2013). Atypical attentional networks and the emergence of autism. Neuroscience & Biobehavioral Reviews, 37(2), 164–183. https://doi.org/10.1016/j.neubiorev.2012.11.014
Marco, E. J., Hinkley, L. B. N., Hill, S. S., & Nagarajan, S. S. (2011). Sensory Processing in Autism: A Review of Neurophysiologic Findings. Pediatric Research, 69(5), 48-54. https://doi.org/10.1203/PDR.0b013e3182130c54
Hayes, A. F. (2017). Introduction to Mediation, Moderation, and Conditional Process Analysis, Second Edition: A Regression-Based Approach. New York: NY: Guilford Publications.
