Retrospective Review of Survey Data

Linking Sensory Integration and Processing With Mental Health in Autism: A Retrospective Review of Survey Data

Authors: Virginia Spielmann, Hannah K. Burke, Sarah McCulloch, Alex Mason, Shelly J. Lane

Importance

  • Evidence-based practice (EBP) in occupational therapy can sometimes focus too much on research and neglect clinical expertise, lived experience, and context.

  • This study provides insights into sensory integration and processing (SI/P) as experienced by autistic adults, allowing occupational therapy practitioners to gain a deeper understanding.

Objective

  • Research Question: What is the relationship between SI/P differences and mental health concerns reported by autistic adults?

  • Method: Retrospective analysis of data from an international survey conducted between September 2018 and June 2019.

Design

  • Nonexperimental, retrospective analysis.

  • Data was collected via the Grand Sensory Survey (GSS).

Setting

  • The GSS was accessible internationally through the Autistic Empire and STAR Institute for Sensory Processing social media accounts and websites.

Participants

  • Total Responses: 440; after excluding participants aged ≤18 (n = 24), final sample = 416.
      - Identified as Autistic: n = 189
      - Identified as Nonautistic: n = 147
      - No Response: n = 80

Outcomes and Measures

  • The GSS included questions regarding demographics, mental health, and sensory experiences.

Results

  • Findings indicated that both SI/P disruptions and sensory sensitivity significantly predicted anxiety and depression (p < .001).

Conclusions and Relevance

  • SI/P differences significantly affect mental health among autistic adults, highlighting the complexity of these factors in understanding their influence on function and participation.

  • The survey's autistic-led design contributes meaningfully to representation in researching sensory integration issues.

Positionality Statement

  • Utilizes identity-first language as preferred by the autistic community.

  • Written from a social model of disability perspective with a neurodiversity-affirming frame of reference (three of the authors are autistic).

Definition of Sensory Integration and Processing (SI/P)

  • Definition: SI/P refers to the complex systems that support human ability to interpret sensory input, affecting participation and functioning across various occupations and environments.

  • Includes the ability to receive, process, and utilize sensory information.

  • Variability in SI/P is common across individuals and does not necessarily indicate dysfunction.

  • Rigid environments and societal attitudes can influence experiences of health and disability.

  • Perception is described as "informed guesswork" by Anil Seth, emphasizing the interpretative aspect of sensory information.

  • SI/P underlies critical functions including:
       - Safety mechanisms
       - Attachment establishment
       - Memory formation
       - Social connection
       - Planned actions
       - Emotional responses
       - Sense of self
       - Function and participation

Guest Contributors to SI/P Understanding

  • Recognized by various professionals including:
       - Pediatricians, Psychiatrists, Educators, Neuroscientists, Psychologists.

Research Insights from Literature

  • Differences in SI/P are linked to autism and significantly relate to mental health effects within the autistic population. Notable studies include:
       - Swedish twin study linking sensory responsiveness with autism (Taylor et al., 2017).
       - Correlational studies showcasing sensory processing impacts on mental health (e.g., anxiety, depression).

Methodology Overview

Survey Design

  • The GSS was collaboratively designed by autistic individuals, focusing on capturing diverse sensory experiences.

  • Launched September 2018, shared via social media to broaden reach among potential respondents.

Participants Characteristics

  • Respondent Demographics:
       - Male: 56.1% (n = 106)
       - Female: 22.2% (n = 42)
       - Nonbinary/Other: 16.9% (n = 32)
       - Age Distribution:
         - 18–24 yr: 19% (n = 36)
         - 25–34 yr: 31.2% (n = 59)
         - 35–44 yr: 27% (n = 51)
         - 45–54 yr: 16.9% (n = 32)
         - ≥55 yr: 3.7% (n = 7)
       - Geographic Distribution: Predominantly from the UK (42.3%), North America (40.2%), Australia (6.3%).

Positionality in Survey Design

  • Developed by an autistic team to represent authentic experiences in sensory processing and mental health contexts.

Grand Sensory Survey Item Categories

  • Table outlining categories for sensory processing for demographic and sensory questions.
       - Sensory perception: Basic sensory awareness.
       - Sensory registration: Detection spans of sensations.
       - Sensory sensitivity: Experiences related to discomfort from sensory cues.
       - Disrupted sensory processing: Unique phenomena associated with sensory integration complexities.

Definitions of Key Terms

  • Aphantasia: Inability to visualize images; affects memory, imagination, and sensory sensitivity.

  • Tinnitus: Perception of phantom sound without an external source, often prevalent among autistic individuals.

  • Visual Snow: Neurovisual disturbances perceived as static or snow across the field of vision, potentially linked to autism.

  • Prosopagnosia: Difficulty recognizing faces without neurological impairment, common in autism.

  • Autonomous Sensory Meridian Response (ASMR): Pleasurable sensations triggered by sensory stimuli.

Data Analysis Procedures

  • Focused on closed-ended survey items for analysis.

  • The analysis utilized techniques such as open coding and axial coding to categorize the sensory-related questions.

Results and Statistical Methods

  • Logistic regression explored the predictive relationship between sensory categories and mental health indicators like anxiety and depression using statistical significance qualities:
       - Significant predictors identified: Sensory sensitivity, differences in sensory processing.
       - Significance Threshold: Bonferroni correction accepted p-values at < 0.006 due to adjustments for multiple analyses.

Implications for Occupational Therapy Practice

  • Emphasizes the necessity for occupational therapists to incorporate sensory integration considerations in mental health assessments.

  • Advocates for continued collaboration with experts in sensory integration to improve therapeutic interventions for autistic adults.

Conclusion

  • SI/P influences overall health and function; practitioners must adapt to these findings to enhance occupational support and engagement with autistic clients.

Acknowledgments

  • No conflict of interest, with no financial support received for this research.

References

  • A detailed list of references is provided to support findings and methodology cited throughout the study, including various studies and theoretical contributions related to autism, sensory integration, and mental health.