ORIGINAL RESEARCH

published: 23 June 2022

doi: 10.3389/fpsyg.2022.875972

Prevalence Models to Support

Participation: Sensory Patterns as a
Feature of All Children’s Humanity
Evan E. Dean 1* † , Lauren Little 2† , Scott Tomchek 3† , Anna Wallisch 4† and Winnie Dunn 5†
1
Kansas University Center on Developmental Disabilities, University of Kansas, Lawrence, KS, United States, 2 Department
of Occupational Therapy Education, Rush University, Chicago, IL, United States, 3 Department of Pediatrics, University
of Louisville, Louisville, KY, United States, 4 Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS,
United States, 5 Department of Occupational Therapy Education, University of Missouri, Columbia, MO, United States

Purpose: Research about children tends to consider differences from expected

patterns problematic, and associates differences with disabilities [e.g., Autism, attention
deficit hyperactivity disorder (ADHD)]. When we focus on disabilities and consider
differences automatically problematic, we miss the natural variability in the general
population. The International Classification of Functioning, Disability and Health (ICF
11) acknowledges that the experience of disability results from interactions between
“environmental” and “personal” factors which determine the person’s capacity to
Edited by:
Pamela Bryden, participate. The purpose of this study was to examine sensory patterns across a national
Wilfrid Laurier University, Canada sample of children in the general population and samples of children with disabilities to
Reviewed by: investigate the extent to which differences in sensory processing are representative of
Rosa Angela Fabio,
University of Messina, Italy natural variability rather than automatically problematic or part of a disability.
Carrie Ballantyne,
University of the West of Scotland,
Materials and Methods: We employed descriptive statistics and chi-square tests to
United Kingdom examine sensory processing patterns in children in the general population and autistic
*Correspondence: children and children with ADHD. We used standardization and validity data from the
Evan E. Dean
Sensory Profile 2 to conduct analyses.
edean2@ku.edu
† These authors have contributed Results: Consistent sensory patterns exist across all groups. Children in all groups had
equally to this work different rates of certain patterns.
Specialty section: Conclusion: Since children in all groups have certain sensory patterns, we cannot
This article was submitted to
associate differences with problematic behaviors. Children participating successfully
Perception Science,
a section of the journal with all sensory patterns might provide insights for universal design that supports
Frontiers in Psychology participation of all children.
Received: 14 February 2022
Accepted: 30 May 2022 Keywords: sensory processing, ASD, ADHD, general population, children, sensory profile, participation,
environment
Published: 23 June 2022
Citation:
Dean EE, Little L, Tomchek S,
Wallisch A and Dunn W (2022)
INTRODUCTION
Prevalence Models to Support
Participation: Sensory Patterns as
Research describing children frequently focuses on maladaptive behaviors, associating these
a Feature of All Children’s Humanity. behaviors with meeting diagnostic criteria. The International Classification of Function model (ICF
Front. Psychol. 13:875972. 11) (World Health Organization, 2013) invites us to think differently. The ICF makes it clear that
doi: 10.3389/fpsyg.2022.875972 “activities” and “participation” are critical features of health. In addition, the ICF acknowledges

Frontiers in Psychology | www.frontiersin.org 1 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

that disabilities result from an interaction between the identified from a national sample of children (Dunn, 1999) and
“environmental” and “personal” factors which determine have been validated in other studies examining people across the
the person’s capacity to participate. Consistent with the ICF life span (e.g., Daniels and Dunn, 2000; Brown et al., 2001; Dunn
view, Willis et al. (2017) conducted a scoping review to et al., 2002; Pohl et al., 2003; Dunn, 2006, 2014).
identify the elements of meaningful participation for children
with disabilities and identified “person-based elements” and Sensory Patterns in Disability Groups
“environment-focused elements” as substantial factors. Egilson Research about children’s sensory patterns has investigated the
et al. (2017) added to this alignment when they report that ways in which children with various disabilities show higher
autistic children participate less in community activities, and rates of sensory responses when compared to their peers without
parents report that social and physical environmental features conditions (Dunn et al., 2016). For example, studies show
create barriers. that autistic children show higher rates of sensory responses
Sensory processing is a factor that bridges personal compared to typically developing peers (Baranek et al., 2006;
and environmental factors. Pfeiffer et al. (2018) consider Tomchek and Dunn, 2007). Studies have shown variability in
autistic people and describe the lack of fit between personal findings with Registration (failing to detect sensory information)
characteristics such as sensory processing and environmental (Ben-Sasson et al., 2007) and Seeking (Miller et al., 2007) reported
characteristics (e.g., sensory stimuli) as critical factors in limited as pronounced sensory patterns in autistic children; however,
or satisfying participation. Other authors have also described lack other research suggests that Avoidance and Sensitivity are highly
of fit between individuals’ sensory processing patterns and the characteristic of autistic children (Baranek et al., 2007). Sensory
sensory environment as instrumental to performance of activities processing patterns can also define distinct profiles of autistic
of daily life (Hochhauser and Engel-Yeger, 2010; Reynolds et al., children (Lane et al., 2010, 2011, 2014; Ausderau et al., 2014;
2011). Chien et al. (2016) found that children with differences in Tomchek et al., 2018). These studies have consistently identified
sensory processing, when compared to national norms, had lower four subtypes characterized by the overall intensity of sensory
participation overall and enjoyed themselves less than children patterns within multisensory systems.
with expected patterns of sensory processing even though both Children with ADHD also show sensory sensitivities and
groups participated the same amount. DaLomba et al. (2017) avoidance to sensory input (Reynolds and Lane, 2008). Using the
demonstrated a relationship between toddler behavior patterns Short Sensory Profile (SSP; McIntosh et al., 1999), Mangeot et al.
(using parental perceptions) and patterns of sensory processing. (2001) found that children with ADHD demonstrated higher
Additionally, Booth et al. (2015) linked high sensitivity to lower variability in sensory responses compared to typical peers on
satisfaction with life. Therefore, sensory processing, in particular all scales of the SSP. Sensory sensitivity and avoidance have
the interaction between the person and the sensory environment, been a consistent finding (Mangeot et al., 2001; Lane et al.,
may be an area to inform a more adapted and integrated view 2010; Reynolds et al., 2010). Dunn and Bennett (2002), using the
about children’s behavior and our approach to supporting Sensory Profile (Dunn, 1999), found that children with ADHD
their participation. differed from typically developing peers on sensory seeking,
In this introduction we review the evidence-based concepts emotional reactivity, and inattention-distractibility. In partial
of sensory processing and examine how sensory processing support of these findings, Yochman et al. (2004) found that
has emerged as a critical factor in understanding the preschool aged children with ADHD differed from those with
person/environment interaction. We propose there is a need to typical development on Seeking; however, the ADHD group did
examine our use of sensory processing patterns in light of the not significantly differ on Registration. Additionally, Pfeiffer et al.
ICF’s conception of health and disability so we can support all (2015) using the Sensory Processing Measure (Parham and Ecker,
children to participate successfully in their everyday lives. 2007), found that children with ADHD demonstrated increased
overall sensory processing scores as compared to those without
Sensory Processing ADHD. These findings are consistent with reports that children
Sensory processing refers to how an individual detects and with ADHD have reduced processing and scanning linked
responds to environmental and body stimuli. An individual’s to cognitive functions (Capri et al., 2020; Mohammadhasani
sensory preferences and aversions can both support and inhibit et al., 2020); low threshold sensory patterns (i.e., sensitivity and
activity participation (Dunn, 2001, 2014; Little et al., 2015). In this avoiding) are also associated with high detection paired with low
way, particular behaviors may reflect adaptive responses based capacity to process sensory input.
on individuals’ sensory needs even when those behaviors are
challenging in a particular context. Group vs. Individual Patterns
Based on Dunn’s Sensory Processing Framework (DSPF; In group comparisons such as those described above, we may lose
Dunn, 2014), children may exhibit clusters of behaviors that sight of the extent to which individual children have differences
reflect underlying sensory detection thresholds (how quickly one in sensory processing that affect their everyday routines and
detects) and self-regulation strategies (how one manages input). activities. Do just some of the children contribute to the
Sensory patterns include Sensitivity (low threshold, passive self- statistically significant differences, or are the group findings
regulation); Avoidance (low threshold, active self-regulation); characteristic of the entire sample? Additionally, because the
Seeking (high threshold, active self-regulation); and Registration focus of the above-mentioned studies was to identify patterns
(high threshold, passive self-regulation). These patterns were that are prevalent in children with specific disabilities such as

Frontiers in Psychology | www.frontiersin.org 2 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

Autism and ADHD, we lack an understanding of children in the and without conditions (general population). They reported
general population. There has been a paucity of research on the an increasing pattern of studying the impact of sensory
extent to which children in the general population may also show processing on everyday life across a 10-year period. The studies
particular sensory patterns. If we apply the ICF broadly, we need demonstrated a clear relationship between sensory processing
to understand how sensory processing helps us understand all and activities of daily living (ADL’s) such as eating (e.g.,
children’s participation. Coulthard and Blissett, 2009; Marquenie et al., 2011; Nadon
Researchers have begun to focus on the variability of sensory et al., 2011) and sleeping (Wengel et al., 2011; Reynolds et al.,
processing in children from the general population (Meredith 2012), instrumental ADL’s (IADL’s) such as school learning
et al., 2015; Little et al., 2018). Emerging evidence suggests that (e.g., Brown and Dunn, 2010) and socialization (e.g., Cosbey
some children in the general population might also display high et al., 2010; Robertson and Simmons, 2013) as well as other
rates of sensory-related behaviors (e.g., avoidance or sensitivity aspects of cognition (e.g., Nardini et al., 2008) and temperament
patterns). For example, researchers have found that avoidance (Reynolds and Lane, 2009; DeSantis et al., 2011) that mediate
is related to anxiety (Farrow and Coulthard, 2012; Lane et al., participation outcomes. For example, autistic children who had
2012; Kotsiris et al., 2020) and associated with sleep difficulties enhanced perception (i.e., sensory hyperacuity and attention to
(Shochat et al., 2009) in typically developing children. Similarly, details) were more likely to have increased activity participation,
another study found relationships between all four sensory and children with a high Seeking pattern participated in more
patterns and sleep habits across school-aged typically developing adult/child play with family (Little et al., 2015). In ADHD,
children (Rajaei et al., 2020). Additionally, Registration relates to researchers have shown that children have reduced development
both easy going approaches and delayed responding to intense of automatic processing, which can impact school learning (Capri
situations in typically developing children (DeSantis et al., 2011). et al., 2020; Mohammadhasani et al., 2020). Additionally, in
Recognizing the variability in sensory processing patterns in the general population Avoiding and Seeking patterns seem to
the general population, this research encourages researchers negatively affect resiliency while Avoiding also negatively affects
and practitioners to think beyond identifying and ameliorating adaptability. The authors concluded that professionals may need
“individual deficits” of sensory preferences and instead focus on to provide more support for children with Avoiding patterns
environmental and activity features that support participation. In to overcome obstacles or adjust to changes in routine (Dean
the book Saving Normal: An Insider’s Look at What Caused the et al., 2018). These findings illustrate that all children participate
Epidemic of Mental Illness and How to Cure It, Frances (2013) in distinct ways that reflect their sensory patterns, pointing
succinctly sums up the dilemma between identifying individual out the need to understand how sensory processing distributes
deficits and supporting participation as: across the population.
The purpose of this study was to examine sensory patterns
We must reconcile to there not being any simple standard to across a national sample of children in the general population
decide the question of how many of us are abnormal. The normal
and samples of children with disabilities to investigate the extent
curve tells us a great deal about the distribution of everything from
quarks to koalas, but it doesn’t dictate to us where normal ends
to which differences in sensory processing are representative
and abnormal begins. Human difference was never meant to be of natural variability in all children rather than automatically
reducible to an exhaustive list of diagnoses. It takes all types to problematic or part of a disability.
make a successful tribe and a full palette of emotions to make a
fully lived life. We shouldn’t medicalize difference and attempt to Research Questions
treat it away (p. 8). This study addressed the following research questions:
Finally, most previous research has considered each sensory (1) What is the distribution of sensory pattern scores among
pattern in isolation. It is unclear how many children have 2 or children ages 7 months to 14 years 11 months in the general
more sensory patterns that are different from the expected “just population?
like others” range (i.e., −1 standard deviation to +1 standard (2) What is the distribution of sensory pattern scores among
deviation), and whether these children have disabilities (e.g., autistic children and children with ADHD when compared
Autism, ADHD) or are from the general population. If children in to the general population?
the general population who are successfully participating in their
lives have two or more sensory patterns in the difference range
(i.e., more than 1 standard deviation from the mean in either MATERIALS AND METHODS
direction), then we cannot attribute participation challenges of
children with disabilities such as Autism and ADHD solely to Sample
their sensory pattern differences. For this study, we used the standardization sample for the
Sensory Profile 2 (Dunn, 2014); specifically, we used the data
Sensory Processing and Participation from 1,065 children who were part of the standardization
Dunn et al. (2016) conducted a scoping review about the (n = 805, 76% of the sample) and children included in validity
relationship between sensory processing and participation in studies that compared children with conditions to their peers
everyday activities. They reviewed 261 articles from 122 different without conditions (n = 260, 24% of sample) for the Toddler
journals and included children with (e.g., Autism, ADHD) Sensory Profile 2 (TSP2) and the Child Sensory Profile 2 (CSP2).

Frontiers in Psychology | www.frontiersin.org 3 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

TABLE 1 | Summary of the study sample. Data Analysis

Child groups N % We used descriptive statistics, chi-square tests, and visual
displays of the data to characterize sensory processing
General population 805 76% patterns of the groups.
Children with conditions:
Developmental delay (DD), 25 2%
Intellectual disability (ID), Down
syndrome (DS)
RESULTS
Autism 70 7%
Autism + ADHD* 22 2%
Research Question 1
ADHD* 85 8% The first research question was: “What is the distribution of
Learning disability 40 4% sensory pattern scores among children ages 7 months to 14 years
Gifted 18 2% 11 months in the general population?” We graphed the findings
Total 1,065 100% for this question in Figure 1. As you can see, 53% (n = 565) of
the sample have all 4 of their sensory processing pattern scores
n, number of children in each group; %, percentage of total sample.
*Attention deficit hyperactivity disorder.
in the expected range, 31% (n = 327) have one or more sensory
processing pattern scores in the “more than others” range, and
16% (n = 166) have one or more sensory processing pattern scores
in the “less than others” range. Seven children had missing data
Table 1 provides a summary of the children’s demographic and could not be included in this analysis.
characteristics.
Research Question 2
The second research question was: “What is the distribution of
Design
sensory pattern scores among autistic children and children with
We employed a descriptive design to characterize the patterns of
ADHD when compared to the general population?” (Figure 2).
sensory processing in the children included in this study.
As you can see, 13% (n = 8) of autistic children, 32% (n = 28)
of children with ADHD and 53% (n = 565) of children in the
general population group have all 4 of their sensory processing
Data Collection Process pattern scores in the expected range. Additionally, 34% (n = 21)
The Pearson testing company used their national sites to obtain
of autistic children, 22% (n = 18) of children with ADHD and
informed consent for the data for this database. We obtained a
8% (n = 85) of children in the general population group have all
de-identified data set for analyses and documented this with our
human subject’s office.

Measures
We used the data from the TSP2 (7–36 months) and the CSP2
(3–14 years, 11 months) measures. These measures are parent
reports of the frequency their children respond to sensory events
in everyday life. The TSP2 contains 54 items and the CSP2
contains 86 items. Both measures produce scores that align
with the four sensory processing patterns described in DSPF
(i.e., Avoiding, Registration, Sensitivity, and Seeking). Parents
respond to statements about sensory experiences in everyday life
by recording how frequently the children engage in that behavior
on a 6 point Likert Scale (i.e., 5 = almost always, 4 = frequently,
3 = half the time, 2 = occasionally, 1 = almost never, 0 = does not
apply). There is strong validity and reliability for these measures
(Dunn, 2014).
The Sensory Profile measures yield category scores based on
the bell curve. Expected scores (i.e., “just like others”) include
68% of any group and fall between −1 standard deviation
(SD) and +1 SD. Scores reflecting more frequent behaviors are FIGURE 1 | Distribution of “expected,” “more than others,” and “less than
considered “more than others” scores (i.e., scores higher than +1 others” scores in the general population. Less, all children who had 1 or more
SD). Scores reflecting less frequent behaviors are considered “less sensory pattern scores in the “less than others” categories; More, all children
who had 1 or more sensory pattern scores in the “more than others”
than others” scores (i.e., scores lower than −1 SD). The “more
categories. All Expected, all children who had all 4 sensory pattern scores in
than others” and “less than others” categories each represent the “just like others” category.
approximately 15% of a sample.

Frontiers in Psychology | www.frontiersin.org 4 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

4 of their sensory processing pattern scores in the “more than “Seeking” in the “more than others” range, 24 (3% of total general
others” range. Fewer children had all 4 scores in the “less than population group) had all 4 sensory processing pattern scores in
others” range; 2% (n = 1) autistic children, 2% (n = 2) children the “more than others” range.
with ADHD and 5% (n = 52) children in the general population. For the children in the autistic group, 22 (31% of total autistic
To examine if the distribution of scores between autistic group) had all 4 sensory processing pattern scores in the “more
children, children with ADHD, and those in the general than others” range, and 11 (16% of total autistic group) had
population was significantly different, we used chi-square 3 pattern scores (i.e., Registration, Sensitivity, Avoiding) in the
analyses. Results showed significant differences in the number “more than others” range.
of sensory patterns that fell within the “expected” and “more For the children in the ADHD group, 18 (21% of total ADHD
than others” range. We did not use a chi-square to examine the group) had all 4 sensory processing pattern scores in the “more
distribution of those that showed sensory processing patterns in than others” range, and 8 (9% of total ADHD group) had 3
the “less than others” range because there were 4 children or less pattern scores (i.e., Registration, Sensitivity, Avoiding) in the
in each cell in the autistic and ADHD groups. First, the three “more than others” range. Other groups (Learning Disabilities,
groups (autistic, ADHD, general population) were significantly Gifted, Developmental Delay) had small numbers and so were
different in the number of children that had all sensory patterns excluded from the “more than others” analysis.
within the “expected” range, X2 (2, N = 1065) = 80.99, p < 0.001.
Using follow up tests with Bonferroni corrections, results showed
that children in each group significantly differed from one other DISCUSSION
(see Figure 2). Second, the number of sensory response patterns
that fell within the “more than others” range significantly differed This study is the first to examine the prevalence of sensory
by group, X2 (8, N = 1065) = 241.26, p < 0.001. Using follow up patterns in the general population. The findings illustrate that
tests with Bonferroni corrections, results showed that children children in the general population, as well as children with
in the general population were significantly different from the disabilities, exhibit differences in expected sensory patterns.
autistic and ADHD groups in showing 3 and 4 sensory processing Therefore, we cannot associate those patterns solely to disability
patterns in the “more than others” range. However, the three groups. Additionally, many children with disabilities scored
groups were not different in showing 1 or 2 sensory processing within the “expected” ranges based on the standardization sample
patterns within the “more than others” range. This means that on all four sensory processing patterns. These results demonstrate
children in the general population and those with autism and the importance of considering individual responses to sensory
ADHD show similar rates of differences in 1 or 2 sensory stimuli instead of generalizing based on particular conditions. We
processing patterns, while autistic children and children with will discuss key points here.
ADHD show higher rates of differences that fall within 3 or 4
sensory processing patterns. Implications for Supporting Participation
To examine the “more than others” groups in more detail, As detailed below, evidence from this study indicates that
we investigated which patterns were most prominent within the children with and without identified conditions have sensory
groups (see Table 2). For the children in the general population processing scores both within the expected range and ranges
group, 27 (3% of total general population group) had only outside of the expected range. This suggests that participation

FIGURE 2 | Distribution of sensory pattern scores among three groups of children. ASD, autism; GenPop, general population; ADHD, attention deficit hyperactivity
disorder. *Denotes significant differences at p < 0.05.

Frontiers in Psychology | www.frontiersin.org 5 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

TABLE 2 | Number of children who had some pattern of “more than others” scores.

More than others scores No. of patterns in “more than others” range (more than + 1 SD) Groups

Gen. pop. Autism ADHD

All 4 More than others 4 24** 21* 18*

Avoid Seek Sens More 3 7 5 3
Reg Avoid Seek More 3 10 0 2
Reg Avoid Sens More 3 14 11** 8**
Reg Seek Sens More 3 9 4 3
Avoid Seek More 2 6 0 1
Avoid Sens More 2 9 4 1
Reg Avoid More 2 8 0 3
Reg Seek More 2 11 0 1
Reg Sens More 2 7 1 3
Seek Sens More 2 6 0 1
Avoid More 1 16 2 4
Reg More 1 8 2 1
Seek More 1 27* 0 1
Sens More 1 10 2 2
Total with “more than others” scores 172 53 52
% of the group totals 21% 76% 61%

*Highest number of children in group. **Second highest number of children in group. avoid, avoiding score; seek, seeking score; sens, sensitivity score; reg, registration
score. Other groups were excluded from this analysis (DD, ID, DS, learning disability, and gifted).

may be broadly supported for all children by contextual design the most effective interventions to support their learning
interventions (e.g., adapting places and tasks to meet the and participation.
sensory preferences) and universal design that provides a way to The literature contains many reports about the sensory
participate for everyone (Dean et al., 2019). Further, this research processing differences of autistic children (Baranek et al., 2006;
adds weight to the argument that we need to normalize rather Tomchek and Dunn, 2007) and ADHD (Parham and Ecker,
than pathologize sensory preferences outside of the expended 2007; Reynolds and Lane, 2008). This study points out that even
range and focus instead on building supports for participation. though group studies report significant differences, there are
There is a need for research focused on understanding some children with these conditions whose sensory patterns are
the strategies that children use to successfully participate in in the expected range. Perhaps for children with conditions such
environments that do not match their sensory preferences, as Autism and ADHD who have sensory processing scores in the
which can inform practitioner strategies for supporting children expected range, other factors are interfering with participation,
who have not yet learned to participate successfully in those such as cognitive or psychosocial factors not related to sensory
same environments. processing. Alternatively, these children could face situations that
provide a more intense sensory experience than they are equipped
Some Children in All Groups Have All to handle even with expected patterns. Consider a situation that
“Expected” Scores would overwhelm an otherwise calm person, such as a fire drill
or a family reunion. It is important to remember that a person
Some children in all the groups (i.e., general population,
with any sensory processing pattern can reach a limit within a
autistic, ADHD) had all 4 patterns of sensory processing
particular context.
scores in the expected range (i.e., between −1 and
We also need to examine other features (e.g., demographic
+1 standard deviation from the mean). As expected,
variables such as age, cognition) for the children with disabilities
children in the general population were the most likely
that we would expect to have sensory processing differences, but
to have this pattern, although only 61% of them have
who have all expected scores on the SP2. In our sample, we
this profile. Since the standardization cut scores are based
verified there was no relationship between age and having all
on standard deviations, we would expect to see about
expected scores in the autistic or ADHD groups. This finding
68% in the expected score range for each of the 4 sensory
contrasts with other data which suggests older children are more
processing pattern scores.
adaptable (Kern et al., 2006; Ben-Sasson et al., 2009).
Researchers have reported that only about half of children
with ADHD have sensory processing as a correlate of their
learning challenges (Dove and Dunn, 2008); we see in our data Some Children in All Groups Have at
that 32% (n = 27) of children with ADHD have all expected Least One “More Than Others” Scores
scores on the sensory profile. This finding suggests that we must Even though children with disabilities are more likely to have
differentiate the underlying features for children with ADHD to differences in their sensory patterns (76% of autistic children and

Frontiers in Psychology | www.frontiersin.org 6 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

61% of children with ADHD, see Table 2), 21% of children in children with ADHD show heighted responses to sensory stimuli,
the general population group have at least 1 “more than others” those with ADHD demonstrate significantly increased rates of
score as well. These data make it hard to suggest that “more than visual processing as compared to autistic children and typical
others” scores are indicators of a problem. In fact, 3% of the development (Little et al., 2017).
general population children have all 4 sensory processing patterns If we consider the sensory processing patterns of Registration,
in the “more than others” range. Recent research studying Avoiding, and Sensitivity all being in the “more than others”
children in the general population have found children with range in more depth, questions can certainly arise about how
Avoiding and Seeking patterns also have protective factors, such Registration (a high threshold pattern) fits in with Sensitivity and
as resilience and adaptability (Dean et al., 2018). It would be Avoiding (low threshold patterns). One might expect to see a co-
useful to observe and interview children who have “more than occurrence of Sensitivity and Avoiding as they both reflect a high
others” scores and who are doing well in school and at home noticing/responding behavioral profile, and the literature has
to identify the strategies they use to manage their detection reported many hyper-responsive behavior patterns for autistic
and responsiveness to sensory events. Perhaps their methods for children and ADHD (Baranek et al., 2007; Reynolds and Lane,
adaptation would also be helpful to children who have not figured 2008). But how does Registration fit in?
out how to manage their daily lives as successfully. We gained some insights from the TSP2 standardization
data and from the adult literature on sensory processing. On
Twice as Many Children Exhibit “More the Registration score on the TSP2 there are 3 items that one
Than Others” Behaviors Than “Less might consider inappropriate based on our knowledge about
Registration during the first edition of the Sensory Profile (Dunn,
Than Others” Behaviors 1999). However, when examining the data from these items, they
Another interesting observation is that in the overall sample, clearly loaded with Registration most strongly and did not load
twice as many children have “more than others” scores (n = 327) with other sensory patterns (Dunn, 2014). When looking at the
than have “less than others” scores (n = 166). There seem to be adult literature, there is a repeating pattern of Sensitivity and
2 hypotheses for this finding. First, it might be that the items on Avoiding having moderate relationships with features such as
the Sensory Profile 2 are worded in such a way that they foster anxiety, post-traumatic stress and pain catastrophizing (Engel-
a bias toward the “more than others” responses. Studies about Yeger and Dunn, 2011a,b,c; Engel-Yeger et al., 2013). In these
sensory processing have reflected a larger theme of behaviors studies, Registration also has a low but significant correlation
that are more noticeable; since the SP2 asks about frequency of with anxiety, post-traumatic stress and pain catastrophizing, with
behaviors, it might be that parents and professionals pay more Seeking being unrelated. What could this mean? One hypothesis
attention to these noticeable behaviors. Secondly, it might also be is that people who tend to miss cues (the behavior profile for
true that the groups of children with disabilities that researchers people with a “more than others” score on Registration) will
study the most (e.g., Autism, ADHD) are children who exhibit eventually notice a potentially challenging stimulus, but by the
more frequent sensory responding behaviors, and so the scores time they notice, the situation requires immediate action due
reflect our attention to those groups rather than all possibilities. to the delay in noticing/responding. People with low thresholds
notice quickly and take action quickly. When an individual
Some Patterns of Sensory Processing experiences a delay in noticing sensory stimuli, their actions
Are More Likely to Occur could look similar to noticing early and acting in a big way
It is not surprising based on the literature that children with because of low thresholds. In a latent profile analysis, researchers
disabilities are most likely to have a predominance of “more called this pattern “Mellow. . .until” to reflect the delay in
than others” scores (76% for autistic children, 61% for children noticing (mellow part) along with the eventual big response
with ADHD). Consistent with previous literature, 47% of (. . .until part) (Little et al., 2018).
autistic children and 30% of children with ADHD have 3 (with Children in the general population group were most likely
Registration, Avoiding and Sensitivity as primary pattern) or to have only the Seeking score “more than others” (3% of total
4 sensory processing pattern scores in the “more than others” group) with the other 3 scores in the expected range. Seeking
range (Kern et al., 2006; Reynolds and Lane, 2008; Ben-Sasson behaviors provide a means for children to gather information
et al., 2009). Many contexts and activities contain sensory features and subsequently learn how their bodies (i.e., person factors)
that are likely to be overwhelming for most autistic children or work within their contexts (i.e., environmental factors). It would
children with ADHD, leading to behaviors related to attention, be interesting to study this group of children to see if they are
persistence, withdrawal and/or distractibility. There may be a more adaptable, have more insights, are more creative or design
relationship between sensory patterns and display of automatic solutions differently from their peers with all expected scores.
responses such as eye movement patterns and attentional
processing in ADHD (Capri et al., 2020; Mohammadhasani et al., Limitations and Future Directions
2020); specifically, if one’s tendency is to detect more sensory We did not incorporate additional demographic data into our
input because of low thresholds, this tendency might result in analyses that might provide a more detailed profile about children
what appears to be random eye movements and unexpected with particular sensory patterns. We also focused on the “more
attentional shifts to “notice” all the input without filtering. than others” categories since these were more prominent in
Previous research has shown that while autistic children and the data; another analysis might investigate the characteristics

Frontiers in Psychology | www.frontiersin.org 7 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

of children in the “less than others” groupings in more detail. these insights expand opportunities for learning, development,
Finally, sensory processing in this study was measured using a participation and health.
standardized parent report measure. While this measure is widely
used in research and practice, research using other experimental
methods could add new insights into the sensory experiences of DATA AVAILABILITY STATEMENT
the groups of children who participated in this study.
The findings from this study suggest that understanding The data analyzed in this study is subject to the following
how children in the general population with differences in licenses/restrictions: The dataset is owned by the publisher of
sensory processing determine the strategies they use to manage the sensory profile: Pearson Publishing. Requests to access these
themselves in everyday life is a critical area for research. Insights datasets should be directed to https://www.pearsonassessments.
from these children could provide a way to understand the com/store/usassessments/en/Store/Professional-Assessments/
person/environment interaction for creating universally designed Motor-Sensory/Sensory-Profile-2/p/100000822.html.
contexts to support all children’s participation. Additionally,
these strategies might highlight the importance of considering the
impact of the context on expression of sensory patterns. ETHICS STATEMENT
The studies involving human participants were reviewed and
CONCLUSION approved by the Institutional Review Board, University of Kansas
Medical Center. Written informed consent to participate in this
Sensory processing provides a bridge between person and study was provided by the participants’ legal guardian/next of kin.
environmental factors. This study illustrated that individualized
sensory patterns occur in all children. Our findings call
into question the practice of saying that sensory processing AUTHOR CONTRIBUTIONS
differences (i.e., “more than others,” “less than others”)
alone indicate a problem, deficit or disability. Children with All authors listed have made a substantial, direct, and intellectual
conditions such as autism and ADHD do seem to exhibit contribution to the work, and approved it for publication.
certain patterns more frequently than their general population
peers. We propose that children in the general population
with differences in sensory patterns can be a source of ACKNOWLEDGMENTS
insights about effective methods for managing everyday life
successfully. Our findings suggest that adaptation (of activities We acknowledge Pearson Publishing, San Antonio, TX,
and environments) based on a child’s sensory patterns may United States, Department of Occupational Therapy Education
be a powerful vehicle to successful participation, creating a at the University of Missouri, and Department of Occupational
more inclusive context for children with disabilities. When Therapy Education at KUMC for providing support for this
children, their families and professionals understand sensory project. We also acknowledge the families who contributed their
patterns as a critical feature of person/environment interaction, data to the project.

REFERENCES Booth, C., Standage, H., and Fox, E. (2015). Sensory-processing sensitivity
moderates the association between childhood experiences and adult life
Ausderau, K. K., Furlong, M., Sideris, J., Bulluck, J., Little, L. M., Watson, L. R., satisfaction. Personal. Indiv. Diff. 87, 24–29. doi: 10.1016/j.paid.2015.
et al. (2014). Sensory subtypes in children with autism spectrum disorder: latent 07.020
profile transition analysis using a national survey of sensory features. J. Child Brown, C., Tollefson, N., Dunn, W., Cromwell, R., and Filion, D. (2001). The adult
Psychol. Psychiatry 55, 935–944. doi: 10.1111/jcpp.12219 sensory profile: measuring patterns of sensory processing. Am. J. Occup. Ther.
Baranek, G. T., Boyd, B. A., Poe, M. D., David, F. J., and Watson, L. R. 55, 75–82.
(2007). Hyperresponsive sensory patterns in young children with autism, Brown, N. B., and Dunn, W. (2010). Relationship between context and sensory
developmental delay, and typical development. J. Inform. 112:4. doi: 10.1352/ processing in children with autism. Am. J. Occup. Ther. 64, 474–483. doi:
0895-8017 10.5014/ajot.2010.09077
Baranek, G. T., David, F. J., Poe, M. D., Stone, W. L., and Watson, L. R. (2006). Capri, T., Santoddi, E., and Fabio, R. A. (2020). Multi-Source Interference Task
Sensory Experiences Questionnaire: discriminating sensory features in young paradigm to enhance automatic and controlled processes in ADHD. Res. Dev.
children with autism, developmental delays, and typical development. J. Child Disab. 97:103542. doi: 10.1016/j.ridd.2019.103542
Psychol. Psychiat. 47, 591–601. doi: 10.1111/j.1469-7610.2005.01546.x Chien, C.-W., Rodger, S., Copley, J., Branjerdporn, G., and Taggart, C. (2016).
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Carter, A. S., Sensory Processing and Its Relationship with Children’s Daily Life Participation.
Kadlec, M. B., et al. (2007). Extreme sensory modulation behaviors in toddlers Phys. Occupat. Ther. Ped. 36, 73–87. doi: 10.3109/01942638.2015.1040573
with autism spectrum disorders. Am. J. Occupat. Therapy 61:584. doi: 10.5014/ Cosbey, J., Johnston, S. S., and Dunn, M. L. (2010). Sensory processing disorders
ajot.61.5.584 and social participation. Am. J. Occup. Ther. 64, 462–473. doi: 10.5014/ajot.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., and Gal, E. 2010.09076
(2009). A meta-analysis of sensory modulation symptoms in individuals with Coulthard, H., and Blissett, J. (2009). Fruit and vegetable consumption in children
autism spectrum disorders. J. Aut. Dev. Dis. 39, 1–11. doi: 10.1007/s10803-008- and their mothers. Moderating effects of child sensory sensitivity. Appetite 52,
0593-3 410–415. doi: 10.1016/j.appet.2008.11.015

Frontiers in Psychology | www.frontiersin.org 8 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

DaLomba, E., Baxter, M., Fingerhut, P., and O’Donnell, A. (2017). The effects of Lane, A. E., Dennis, S. J., and Geraghty, M. E. (2011). Brief report: further evidence
sensory processing and behavior of toddlers on parent participation: a pilot of sensory subtypes in autism. J. Aut. Dev. Dis. 41, 826–831. doi: 10.1007/
study. J. Occupat. Ther. Sch. Early Interv. 10, 27–39. doi: 10.1080/19411243. s10803-010-1103-y
2016.1257968 Lane, A. E., Molloy, C. A., and Bishop, S. L. (2014). Classification of Children
Daniels, D. B., and Dunn, W. W. (2000). Development of the infant-toddler sensory With Autism Spectrum Disorder by Sensory Subtype: a Case for Sensory-Based
profile. Occupat. Ther. J. Res. 20, 86S–90S. doi: 10.1177/15394492000200S107 Phenotypes. Aut. Res. 7, 322–333. doi: 10.1002/aur.1368
Dean, E., Little, L., Wallisch, A., and Dunn, W. (2019). “Sensory processing in Lane, A. E., Young, R. L., Baker, A. E., and Angley, M. T. (2010). Sensory processing
everyday life,” in Willard and Spackman’s Occupational Therapy, Centennial subtypes in autism: association with adaptive behavior. J. Aut. Dev. Dis. 40,
Edition, eds B. Schell and G. Gillen (Netherlands: Wolters Kluwer). 112–122. doi: 10.1007/s10803-009-0840-2
Dean, E. E., Little, L., Tomchek, S., and Dunn, W. (2018). Sensory processing in Lane, S. J., Reynolds, S., and Dumenci, L. (2012). Sensory overresponsivity and
the general population: adaptability, resiliency, and challenging behavior. Am. anxiety in typically developing children and children with autism and attention
J. Occup. Ther. 72, 1–8. doi: 10.5014/ajot.2018.019919 deficit hyperactivity disorder: cause or coexistence? Am. J. Occupat. Ther. 66,
DeSantis, A., Harkins, D., Tronick, E., Kaplan, E., and Beeghly, M. (2011). 595–603. doi: 10.5014/ajot.2012.004523
Exploring an integrative model of infant behavior: What is the relationship Little, L. M., Ausderau, K., Sideris, J., and Baranek, G. T. (2015). Activity
among temperament, sensory processing, and neurobehavioral measures? participation and sensory features among children with autism spectrum
Infant Behav. Dev. 34, 280–292. doi: 10.1016/j.infbeh.2011.01.003 disorders. J. Aut. Dev. Dis. 45, 2981–2990. doi: 10.1007/s10803-015-2
Dove, S., and Dunn, W. (2008). Sensory processing in students with specific 460-3
learning disabilities: findings and implications for assessment and intervention Little, L. M., Dean, E., Tomchek, S., and Dunn, W. (2018). Sensory processing
planning. J. Occupat. Ther. Sch. Early Interv. 1, 116–127. doi: 10.1080/ patterns in autism, attention deficit hyperactivity disorder, and typical
19411240802312798 development. Phys. Occup. Ther. Ped. 38, 243–254. doi: 10.1080/01942638.2017.
Dunn, W. (1999). The Sensory Profile Manual. San Antonio, TX: Psychological 1390809
Corporation. Little, L. M., Dean, E., Tomchek, S. D., and Dunn, W. (2017). Classifying sensory
Dunn, W. (2001). The sensations of everyday life: empirical, theoretical, and profiles of children in the general population. Child: Care, Health Dev. 43,
pragmatic considerations. Am. J. Occup. Ther. 55, 608–620. doi: 10.5014/ajot. 81–88. doi: 10.1111/cch.12391
55.6.608 Mangeot, S. D., Miller, L. J., McIntosh, D. N., McGrath-Clarke, J., Simon, J.,
Dunn, W. (2006). Sensory profile school companion. San Antonio, TX: Hagerman, R. J., et al. (2001). Sensory modulation dysfunction in children with
Psychological Corporation. attention-deficit–hyperactivity disorder. Dev. Med. Child Neurol. 43, 399–406.
Dunn, W. (2014). Sensory Profile 2: Strengths Based Approach to Assessment and doi: 10.1017/S0012162201000743
Planning. San Antonio: Pearson Publishing. Marquenie, K., Rodger, S., Mangohig, K., and Cronin, A. (2011). Dinnertime and
Dunn, W., and Bennett, D. (2002). Patterns of sensory processing in children with bedtime routines and rituals in families with a young child with an autism
attention deficit hyperactivity disorder. OTJR: Occupat. Participat. Health 22, spectrum disorder. Austr. Occup. Ther. J. 58, 145–154. doi: 10.1111/j.1440-1630.
4–15. doi: 10.1177/153944920202200102 2010.00896.x
Dunn, W., Little, L., Dean, E., Robertson, S., and Evans, B. (2016). The state McIntosh, D., Miller, L., Shyu, V., and Hagerman, R. (1999). Sensory modulation
of the science on sensory factors and their impact on daily life for children: disruption, electrodermal responses and functional behaviors. Dev. Med. Child
a scoping review. OTJR: Occup. Participat. Health 2016, 1–24. doi: 10.1177/ Neurol. 41, 608–615. doi: 10.1017/S0012162299001267
1539449215617923 Meredith, P. J., Rappel, G., Strong, J., and Bailey, K. J. (2015). Sensory Sensitivity
Dunn, W., Myles, B. S., and Orr, S. (2002). Sensory processing issues associated and Strategies for Coping With Pain. Am. J. Occup. Ther. 69, 1–10. doi: 10.5014/
with Asperger syndrome: a preliminary investigation. Am. J. Occup. Ther. 56, ajot.2015.014621
97–102. doi: 10.5014/ajot.56.1.97 Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., and Osten, E. T. (2007).
Egilson, S. T., Jakobsdottir, G., Olafsson, K., and Leosdottir, T. (2017). Community Concept evolution in sensory integration: a proposed nosology for diagnosis.
participation and environment of children with and without autism spectrum Am. J. Occupat. Ther. 61:135. doi: 10.5014/ajot.61.2.135
disorder: parent perspectives. Scand. J. Occup. Ther. 24, 187–196. doi: 10.1080/ Mohammadhasani, N., Caprì, T., Nucita, A., Iannizzotto, G., and Fabio, R.
11038128.2016.1198419 (2020). Atypical Visual Scan Path Affects Remembering in ADHD. J. Internat.
Engel-Yeger, B., and Dunn, W. (2011a). Relationship between pain catastrophizing Neuropsych. Soc. 26, 557–566. doi: 10.1017/S135561771900136X
level and sensory processing patterns in typical adults. Am. J. Occup. Ther. 65, Nadon, G., Feldman, D. E., Dunn, W., and Gisel, E. (2011). Mealtime problems
e1–e10. doi: 10.5014/ajot.2011.09004 in children with autism spectrum disorder and their typically developing
Engel-Yeger, B., and Dunn, W. (2011b). Exploring the relationship between affect siblings: a comparison study. Autism 15, 98–113. doi: 10.1177/13623613093
and sensory processing patterns in adults. Br. J. Occup. Ther. 74, 456–464. 48943
doi: 10.4276/030802211x13182481841868 Nardini, M., Braddick, O., Atkinson, J., Cowie, D. A., Ahmed, T., and Reidy, H.
Engel-Yeger, B., and Dunn, W. (2011c). The relationship between sensory (2008). Uneven integration for perception and action cues in children’s working
processing difficulties and anxiety level of healthy adults. Br. J. Occupat. Ther. memory. Cogn. Neuropsychol. 25, 7–8. doi: 10.1080/02643290701866028
74, 210–216. doi: 10.4276/030802211x13046730116407 Parham, L. D., and Ecker, C. (2007). Sensory Processing Measure (SPM). Chennai:
Engel-Yeger, B., Palgy-Levin, D., and Lev-Wiesel, R. (2013). The sensory profile of Western Psychological Services.
people with post-traumatic stress symptoms. Occupat. Ther. Ment. Health 29, Pfeiffer, B., Coster, W., Tucker, C., and Piller, A. (2018). Development and content
266–278. doi: 10.1080/0164212X.2013.819466 validity of the participation and sensory environment questionnaire. Occupat.
Farrow, C. V., and Coulthard, H. (2012). Relationships between sensory sensitivity, Ther. Ment. Health 34, 105–121. doi: 10.1080/0164212X.2017.1383221
anxiety and selective eating in children. Appetite 58, 842–846. doi: 10.1016/j. Pfeiffer, B., Daly, B., Nicholls, E., and Gullo, D. (2015). Assessing Sensory
appet.2012.01.017 Processing Problems in Children With and Without Attention Deficit
Hochhauser, M., and Engel-Yeger, B. (2010). Sensory processing abilities and Hyperactivity Disorder. Phys. Occupat. Ther. Pediatr. 35, 1–12. doi: 10.3109/
their relation to participation in leisure activities among children with high- 01942638.2014.904471
functioning autism spectrum disorder (HFASD). Res. Aut. Spect. Dis. 4, 746– Pohl, P. S., Dunn, W., and Brown, C. (2003). The role of sensory processing in
754. j.rasd.2010.01.015 doi: 10.1016/ the everyday lives of older adults. OTJR: Occup. Particip. Health 23, 99–106.
Kern, J. K., Trivedi, M. H., Garver, C. R., Grannemann, B. D., Andrews, A. A., Savla, doi: 10.1177/153944920302300303
J. S., et al. (2006). The pattern of sensory processing abnormalities in autism. Rajaei, S., Kalantari, M., Azari, Z. P., Tabatabaee, S. M., and Dunn, W. (2020).
Autism 10, 480–494. doi: 10.1177/1362361306066564 Sensory processing patterns and sleep quality in primary school children. Iran.
Kotsiris, K., Westrick, J., and Little, L. (2020). [lL2] Sensory processing patterns and J. Child Neurol. 14:57.
internalizing behaviors in the pediatric and young adult general population: a Reynolds, S., Bendixen, R. M., Lawrence, T., and Lane, S. J. (2011). A pilot study
scoping review. Open J. Occupat. Ther. 8, 1–13. doi: 10.15453/2168-6408.1624 examining activity participation, sensory responsiveness, and competence in

Frontiers in Psychology | www.frontiersin.org 9 June 2022 | Volume 13 | Article 875972

Dean et al. Sensory Patterns and Participation

children with high functioning autism spectrum disorder. J. Aut. Dev. Disab. youth with disabilities: a scoping review. Disab. Rehab. 39, 1771–1784. doi:
41, 1496–1506. doi: 10.1007/s10803-010-1173-x 10.1080/09638288.2016.1207716
Reynolds, S., and Lane, S. J. (2008). Diagnostic validity of sensory over-responsivity: World Health Organization (2013). How to use the ICF: A practical manual for
a review of the literature and case reports. J. Aut. Dev. Dis. 38, 516–529. doi: using the International Classification of Functioning, Disability and Health (ICF).
10.1007/s10803-007-0418-9 Exposure draft for comment. Geneva: WHO.
Reynolds, S., and Lane, S. J. (2009). Sensory overresponsivity and anxiety in Yochman, A., Parush, S., and Ornoy, A. (2004). Responses of preschool children
children with ADHD. Am. J. Occup. Ther. 63, 433–440. doi: 10.5014/ajot.63. with and without ADHD to sensory events in daily life. Am. J. Occupat. Ther.
4.433 58, 294–302. doi: 10.5014/ajot.58.3.294
Reynolds, S., Lane, S. J., and Gennings, C. (2010). The moderating role of sensory
overresponsivity in HPA activity: a pilot study with children diagnosed with Conflict of Interest: WD is the author of the Sensory Profile 2; she does not
ADHD. J. Attent. Dis. 13, 468–478. doi: 10.1177/1087054708329906 own the copyright for the material but does receive a royalty for the sale of
Reynolds, S., Lane, S. J., and Thacker, L. (2012). Sensory processing, physiological this assessment.
stress, and sleep behaviors in children with and without autism spectrum
disorders. OTJR: Occupat. Particip. Health 32, 246–257. doi: 10.3928/15394492- The remaining authors declare that the research was conducted in the absence of
20110513-02 any commercial or financial relationships that could be construed as a potential
Robertson, A. E., and Simmons, D. R. (2013). The relationship between sensory conflict of interest.
sensitivity and autistic traits in the general population. J. Aut. Dev. Dis. 43,
775–784. doi: 10.1007/s10803-012-1608-7 The authors declare that this study received funding from Pearson Publishing to
Shochat, T., Tzischinsky, O., and Engel-Yeger, B. (2009). Sensory hypersensitivity ED. The funder had the following involvement in the study: they provided research
as a contributing factor in the relation between sleep and behavioral assistant support for the original standardization data collection and used their
disorders in normal schoolchildren. Behav. Sleep Med. 7, 53–62. doi: 10.1080/ network to identify participants.
15402000802577777
Tomchek, S. D., and Dunn, W. (2007). Sensory processing in children with and Publisher’s Note: All claims expressed in this article are solely those of the authors
without Autism: a comparative study using the short sensory profile. Am. J. and do not necessarily represent those of their affiliated organizations, or those of
Occupat. Ther. 61, 190–200. doi: 10.5014/ajot.61.2.190 the publisher, the editors and the reviewers. Any product that may be evaluated in
Tomchek, S. D., Little, L. M., Myers, J., and Dunn, W. (2018). Sensory subtypes this article, or claim that may be made by its manufacturer, is not guaranteed or
in preschool aged children with autism spectrum disorder. J. Aut. Dev. Dis. 48, endorsed by the publisher.
2139–2147. doi: 10.1007/s10803-018-3468-2
Wengel, T., Hanlon-Dearman, A. C., and Fjeldsted, B. (2011). Sleep and Copyright © 2022 Dean, Little, Tomchek, Wallisch and Dunn. This is an open-access
sensory characteristics in young children with fetal alcohol spectrum article distributed under the terms of the Creative Commons Attribution License
disorder. J. Dev. Behav. Pediatr. 32, 384–392. doi: 10.1097/DBP.0b013e318219 (CC BY). The use, distribution or reproduction in other forums is permitted, provided
9694 the original author(s) and the copyright owner(s) are credited and that the original
Willis, C., Girdler, S., Thompson, M., Rosenberg, M., Reid, S., and Elliott, C. publication in this journal is cited, in accordance with accepted academic practice. No
(2017). Elements contributing to meaningful participation for children and use, distribution or reproduction is permitted which does not comply with these terms.

Frontiers in Psychology | www.frontiersin.org 10 June 2022 | Volume 13 | Article 875972