Preliminary data validating a qualitative assessment of core and co-morbid autism symptoms: The Sense and Self-Regulation Checklist

Background: In developmentally delayed (DD) children, abnormal sensory responses characterized by hyper and hypo-reactivity, are commonly reported. They are of varying severity/frequency, and may involve one or more senses. In autism, they are more severe than other disabilities, and are classified as co-morbid symptoms of unknown etiology. Recently two RCTs of a massage methodology based on Chinese medicine (Qigong Sensory Training, or QST) designed to improve sensory nervous system function in children with ASD under age six, demonstrated robust improvement of abnormal sensory responses following a five-month course of treatment, as well as improvement in measures of self-regulation and autism.  Chinese medicine asserts that timely achievement of self-regulatory milestones is dependent upon normal function of the senses. To further evaluate the relationship between sensory and self-regulatory impairment in young children under age 6, the Sense and Self-Regulation Checklist (SSC) was developed and validated.

Objectives: To explore the relationship between abnormal sensory responses and self-regulatory difficulties in 265 children under age six, with and without developmental delay; and to see how the scores changed for the autism group following QST treatment.

Methods: SSC data from three groups under age six are compared:  children with autism, children with other reasons for DD, and typically developing children. Children with autism received the five-month QST treatment methodology.

Results:   A strong, linear relationship between abnormal sensory responses and self-regulatory difficulties was found in all groups of children (B = .801, p < .001). The typically developing group was differentiated by mild, single-sense findings; the other DD group was differentiated by moderate multi-sensory findings; and the autism group was differentiated by severe, multi-sensory findings and a diffuse tactile abnormality with hypo and hyperesthesia (F < 122, p<.001). The mean SSC score for the group with autism was twice as high as the mean score for the typical group, and on the scatter plot, there was a sharp line of demarcation between the two groups.  Following five months of treatment for the autism group, scores moved in the direction of the typical group with mean sensory scores decreasing by 22 %, and mean self-regulatory scores improving by 18%.

Conclusions: Abnormal sensory responses occur in a spectrum of severity/frequency and uni/multi-sensority that appears directly, linearly related to difficulties achieving self-regulatory milestones.  Furthermore they are treatable, and with treatment, self-regulatory abilities improve. Given that self-regulatory abilities are foundational for social, emotional and cognitive development, this elevates the importance of early identification and treatment of abnormal sensory responses in children with developmental delay.  It appears that moderately and severely abnormal sensory responses may be as clinically relevant to the developmental trajectory as actual loss of hearing and vision.