Predictive Factors for Sensory Processing Disorders

  

    
Sensory factor 
    
Pregnancy 
    
p-value 
  
  

    
Typical 
    
Rest 
    
High-risk 
    
Stressful-traumatic 
  
  

    
Hearing processing
    
19.72 (7.81) 
    
20.00 (7.36) 
    
14.25 (9.74) 
    
27.33 (3.06) 
    
0.19 
  
  

    
Visual processing
    
13.33 (5.28)a,b
    
13.36 (5.28)a 
    
6.25 (4.27)a,b 
    
20.67 (6.66)b 
    
0.007 
  
  

    
Tactile processing
    
20.89 (8.20)
    
19.18 (7.22) 
    
17.50 (14.15) 
    
29.00 (5.57) 
    
0.282 
  
  

    
Movement    processing 
    
16.67 (7.71)
    
15.45 (5.91) 
    
10.50 (7.19) 
    
23.67 (3.79) 
    
0.133 
  
  

    
Body position 
    
11.5 (8-17.15)
    
12 (8-17.5) 
    
8 (6-8.50) 
    
8 (8-17.75) 
    
0.129 
  
  

    
Oral processing 
    
19.39 (8.77)
    
21.18 (9.15) 
    
16.00 (17.05) 
    
24.67 (12.86) 
    
0.636 
  
  

    
Behaviour 
    
20.50 (9.64)
    
20.55 (6.71) 
    
13.50 (9.26) 
    
24.33 (5.51) 
    
0.42 
  
  

    
Socio-emotional 
    
36.46 (14.25)b
    
36.45 (8.66)a,b 
    
15.75 (18.95)b 
    
31.67 (12.66)a,b 
    
0,042 
  
  

    
Attention 
    
26.57 (9.72)
    
27.00 (10.89) 
    
19.75 (14.17) 
    
24.33 (8.39) 
    
0.609 
  
  

    
Low registration 
    
44.07 (16.22)
    
42.64 (14.75) 
    
25.00 (18.06) 
    
44.00 (6.56) 
    
0.158 
  
  

    
Sensory seeking 
    
41.65 (16.61)
    
40.09 (13.09) 
    
32.30 (25.01) 
    
52.33 (10.12) 
    
0.467 
  
  

    
Sensory    sensitivity 
    
42.83 (12.82)
    
41.27 (15.06) 
    
28.50 (19.67) 
    
51.33 (8.08) 
    
0.143 
  
  

    
Sensory avoiding 
    
48.26 (16.04)
    
50.00 (10.13) 
    
27.50 (26.66) 
    
51.67 (9.71) 
    
0.082 
  
  

    
Note: p-value of ANOVA or Kruskal-Wallis test. 
  

Table 3: Results according to pregnancy. Different letters indicate significant differences.

This study aims to identify differences in sensory processing in children with sensory reactivity difficulties (both with and without prenatal and perinatal problems).

The results obtained in this research indicate that there are statistically significant differences in sensory processing in children who have suffered problems in pregnancy or who have been premature. Specifically, statistically significant differences have been identified in visual sensory processing, in body position and in emotional difficulties in children who have undergone a stressful pregnancy, premature children and children who have had high-risk pregnancy, respectively.

Studying sensory reactivity within the field of Occupational Therapy (OT) is essential, as problems with self-regulation have been associated with difficulties in social skills and academic competence and behavioural problems [17,18]. Authors have even linked sensory reactivity problems to mental health problems in adulthood [19].

Various research studies have found that prenatal distress and stress can interfere with self-regulation [20] and negatively affect a baby’s neurological development [18,21]. Following this vein, the present study has found that children who have experienced prenatal distress show statistically significant differences in visual processing versus children with sensory processing difficulties who have not. The findings of Jafari et al. [12] indicate that prenatal stress produces a fourfold increase in basal corticosterone and reduced amplitude of all cortical sensory responses evoked, including visual and auditory responses.

Other results obtained in this study were statistically significant differences between the pregnancy variable (specifically, high-risk pregnancy) and emotional problems derived from inadequate sensory processing. These findings support the results of O’Connor, Heron, Golding, Glover & AL Spac Study Team [22] who has obtained that regulatory problems have been linked to problems in social-emotional development and behavioural problems. With this, it can be expected that the sensory regulation problems obtained using the SP-2 sensory questionnaire [15] will yield statistically significant scores in factors such as the emotional state of children with sensory processing problems. Bush et al. [23] have showed than mothers who felt more stressed during pregnancy and postpartum indicated that their babies had a difficult temperament and less ability to self-regulate. Stress during pregnancy, especially in early pregnancy, results in delayed fetal maturation, altered emotional regulation and impaired cognitive performance during childhood [21].

Probably due to the small sample used in this research, this study has not yielded statistically significant differences between children who have suffered from a stressful/traumatic pregnancy and tactile and auditory sensory processing, expected results following the findings obtained by Keuler et al. [24], who drew a relationship between prenatal complications and problems of auditory and tactile hyperreactivity. These results [30] are a finding compatible with the research of Schneider et al. [11] in rhesus monkeys, thus suggesting that prenatal maternal stress increases babies’ tactile sensitivity, and the study by Heuvel, Donkers, Winkler, Otte & Van Der Bergh [25], which indicates that greater maternal anxiety could be interpreted as a reflection of weaker habituation to auditory stimuli in these babies, thus indicating less adaptive brain functioning.

This study has found that children born prematurely have greater problems in proprioceptive processing (body position) than children carried to term who have problems in sensory processing. Previous research studies have linked prenatal depression to an increased likelihood of preterm birth and, in turn, preterm birth to increased sensory processing deficiencies [26] and sensory-motor development [27]. Babies of mothers with prenatal depression or anxiety suffer from more hypotonia in the neonatal period [28]. Ryckman, Hilton, Rogers and Pineda [29] conclude that premature infants are at an increased risk of developing a sensory processing disorder, with results indicating that 50% of premature infants have sensory processing problems.

With the aim of determining whether preterm infants have atypical responses to sensory stimuli, Wickremasinghe, Rogers, Johnson, Shen, Barkovich and Marco [30] conducted a study similar to this study by administering the Sensory Profile [31] sensory questionnaire to 107 infants born at 32 weeks. The results of Wickremasinghe et al. [30] indicated that 39% of the children evaluated had at least one sensory factor or quadrant with a deviation of -2 SD, particularly auditory, tactile and vestibular factors. Along the same lines, Cabral, Pereira da Silva, Martinez & Tudella [26] show that premature infants present with differences in tactile and vestibular processing and Bart, Shayevits, Gabis & Morag [32], using the Infant/Toddler Sensory Profile [33], found that premature babies are more likely to have sensory reactivity problems, specifically in auditory and oral processing.

The results of the present study do not yield significant correlation between the other sensory factors analyzed using the SP-2 [15] and the prematurity variable. This may be due to the fact that the sample size is small and the group of children born prematurely vs. children born at term is not balanced and, therefore, there may be difficulties in detecting significant differences, despite the fact that the effect size is medium and large in several sensory factors.

However, the results obtained in this study indicate that the prevalence of prematurity in children with sensory reactivity problems with and without ASD was 10.2%. This result is similar to the prevalence found by May-Bensson et al. [5], who found that between 12.4-16.0 % of children with DIS with and without an ASD diagnosis were children born prematurely.

Regarding the birth variable, it should be noted that the results of this study indicate similar data to those found by May-Bensson et al. [5]. This study shows that 43% of the children had an instrumental delivery, which is closely in line with May-Bensson et al. [5] who found that 36.1% of the children with sensory reactivity and 43.5% of the children with sensory reactivity and ASD needed some kind of assistance during delivery.

The results of this and other similar studies are relevant since previous research studies indicate that children with sensory reactivity problems at younger ages score significantly higher at older ages and are more likely to have a clinical diagnosis [34,35]. Examples can be found in the study by DeGangi, Breinbauer, Doussard-Roosevelt, Porges and Greenspan [34] which, when analyzing children between 7 and 30 months and then at 36 months of age, still observed sensory reactivity problems, and the results of Schneider et al. [35] in rhesus monkeys, which found that neonatal sensory processing function correlates with adult tactile sensory function, indicating continuity of sensory processing function over a wide age range.

The relationship between prenatal and perinatal problems and sensory processing difficulties persisting at older ages demonstrates the need for early identification and treatment of such problems in public health services. Early identification of sensory processing problems in these children could anticipate interventions from disciplines such as occupational therapy in neonatal and early care units at public and private hospitals, thus improving children’s self-regulation, sensory-motor development and the acquisition of functional skills.

One of the limitations of this study is the small convenience sample used, accordingly, the results should be interpreted with caution. This study has assumed a margin of error greater than 5% since it is a pilot study that aims to initiate a line of research, and given the difficulty of access to the sample since, although the prevalence of sensory reactivity problems in Spain in typically developing children is between 9.5% and 13%, it is still an under-diagnosed condition [36].

However, this research sets the stage for future work that can explore these hypotheses in a larger sample.

Another limitation has been the lack of adapted, validated and standardized measures in Spain to analyze and detect prenatal distress problems. The use of standardized assessment tools in future studies could yield promising new results.

Conclusion

These results confirm that there are differences in the sensory processing of children with sensory processing disorders who have suffered perinatal and postnatal problems compared to those who have not. Prenatal and perinatal factors like a prematurity or pregnancy are predictive factors for sensory processing disorders.

Acknowledgment

Thanks to the families that have participated. Thanks to the Scientific and Technical Services consultancy unit of the Universidad de Oviedo, and particularly to Tania Iglesias, for methodological advice. Research carried out by the Unidad de Integración y Promoción de la Salud (Integra-Saúde), Universidade da Coruña.

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