Early Sensory Over-Responsivity and Affective Symptoms of Children with ASD and Later Family Impairment

Background: Sensory over-responsivity (SOR) greatly influences family members by requiring them to adapt their routines, social activities, and home environment to meet their child’s sensory needs (Werner-DeGrace, 2004). In addition, children with ASD often show internalizing and externalizing symptoms that impact parental emotional well-being as well (Davis & Carter, 2008; Hastings et al., 2005; Lecavalier, et al., 2006). Affective symptoms are often challenging to differentiate from SOR (Ben-Sasson et al., 2007). Identifying child factors that are associated with greater parental stress and family life restrictions is important for service planning and in justifying early intervention to address such factors.

Objectives: Using family life as a measure of impairment, this study sought to examine the unique contribution of early SOR symptoms in children with ASD to later family life impairment above and beyond internalizing (i.e., anxiety and separation distress) and externalizing symptoms.

Methods: Findings are based on a longitudinal sample of young children with ASD (78% boys) with a mean age of 28 months at baseline, 40 months at 12-month follow-up (n = 156), and 53 months at 24-month follow-up (n = 88). Among other measures mothers completed the Infant Toddler Social Emotional Assessment (ITSEA; Carter & Briggs-Gowan, 2003), Infant Toddler Sensory Profile (ITSP; Dunn, 2002), Parenting Stress Index (PSI; Abidin, 1995), and the Family Life Impairment Scale (FLIS; Briggs-Gowan, 1997).

Results:

1. Children with (n=52) versus without (n=32) elevated SOR at baseline (more than 1SD above norms) showed higher family life impairment and parenting stress scores at both 12- and 24-month follow ups, which were not significantly influenced by child internalizing and externalizing symptoms at baseline.
2. In a model in which child social-communication symptom severity (step 1), and externalizing symptoms and internalizing symptoms (step 2) were entered, SOR at time 1 uniquely explained an additional 9% of the variance in family impairment at time 2 and 4% of the variance at time 3. Externalizing symptoms also significantly predicted family impairment at time 3.  
3. SOR at time 1 also accounted for an additional 12% and 5% of the variance in parenting stress at times 2 and 3, respectively, after controlling for baseline scores on social-communication symptom severity (step 1), and child externalizing and internalizing symptoms (step 2). Affective symptoms did not predict parenting stress. 

Conclusions: Findings support the independent impairing nature of SOR in the lives of children with ASD and their families over time above affective symptoms. This study suggests the need for early identification of SOR as a potential risk factor for family distress and for informing interventions that aim to minimize impairment in families of young children with ASD and SOR.