Katy Unwin

Sensory differences are well documented in autistic individuals. However, early sensory experiences have not been fully explored, particularly from the perspective of autistic people. We sought to understand early sensory experiences in autism from the perspective of autistic adults (some of whom also had autistic children) and caregivers of autistic children (some of whom also had a personal autism diagnosis). Using a qualitative descriptive design, aligned with a constructivist paradigm, focus groups were conducted with 3 autistic adults and 12 caregivers of autistic children. Data were analysed with reflexive thematic analysis. Five themes were generated accounting for early sensory experiences in autism: (1) Acknowledging the uniqueness of sensory preferences, (2) Negative impacts of different sensory experiences, (3) Feeling different and the pursuit of belonging, (4) Controlling sensory experiences to support daily function, and finally (5) Overcoming the challenges of the sensory world. The findings highlight the specific sensory needs of autistic children in early childhood and the adaptability of caregivers. This information can help young autistic people and caregivers advocate the importance of recognising the uniqueness of each autistic child’s sensory preferences when seeking support. Lay Sensory behaviours in early childhood can impact how autistic children experience and engage in the world. There is a lot of research about sensory differences in autistic children; however, there is very little known about experiences in early childhood. We asked 3 autistic adults and 12 caregivers of autistic children about their/their child’s experiences of sensory behaviours in early childhood. In our sample, autistic adults and caregivers of autistic children shared similar experiences about the challenges they/their children face related to sensory experiences in early childhood and how they overcame these. The findings can influence how researchers and service providers view sensory preferences in early childhood by understanding that everyone’s preferences are unique, and the importance of advocating for what works for each autistic person.

Importance: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. However, research on best practice is varied, presenting difficulty for practitioners to assess the appropriateness of each support. Objective: To provide evidence-informed recommendations regarding best practices in school-based supports for students with sensory processing challenges via a Rapid Evidence Assessment of current literature. Data Sources: Searches were run in CINAHL Complete, Education Research Complete, ERIC, MEDLINE, PsycINFO, and Scopus (for articles published 2010 to 2023). Informed by a 2010 review, articles citing publications identified in the prior review were also included. Study Selection and Data Collection: A reviewer screened the title and abstract of each article for inclusion, and another screened the full texts, with 10% of each reviewer’s articles assessed by the other. Interrater reliability was excellent. Findings: The review included 61 articles, with only 15% constituting good evidence (38% provided adequate evidence, 31% provided poor evidence, and 16% were reviews). No support could be wholly recommended without caveats, but there was some evidence that sound amplification systems, alternate seating, and multisensory environments may be beneficial in certain conditions or with certain populations. The use of weighted vests is not recommended. Conclusions and Relevance: Most research had small sample sizes and inconsistent protocols, highlighting the importance of ongoing research. Evidence-informed practitioners should review research findings carefully and integrate evidence from comprehensive clinical assessment and understanding of the child, school, and family contexts when assessing the appropriateness of a support for each student. Plain-Language Summary: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. Occupational therapists provide school-based supports for children with sensory processing challenges with the goal of enabling access, participation, and achievement. It is difficult, however, for practitioners to assess the appropriateness of each support because research on best practice varies. This review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges to inform decision-making and the selection of appropriate supports for their clients. When assessing the appropriateness of a support for a student, practitioners should carefully review current research findings and integrate evidence from comprehensive clinical assessments along with an understanding of the student, school, and family contexts.

Sensory differences in autism can impact many areas of life, including engagement in church. Fewer autistic people attend church than non-autistic people, with qualitative studies finding that the sensory experience is one reason for this. To date, no quantitative studies have investigated the impact of sensory aspects of the church service on autistic people. In this study, 299 participants from a range of denominations (autistic = 82; self-diagnosed autistic = 61; non-autistic = 156; aged 18–82 years) completed an online questionnaire about their sensory experience within the church. A principal components analysis (PCA) was conducted on the questionnaire data, establishing four statistically derived components, which were then compared between diagnostic groups. We found that autistic people experienced significantly more sensory barriers in church services (“Barriers” Component 1), received/required more accommodations (“Accommodations” Component 3), and felt more connected to God when they felt in control of the sensory and social aspects of the service (“Control” Component 4) than non-autistic people. All participants experienced similar enjoyment of some sensory aspects of the service (“Facilitators” Component 2). We also found evidence that the sensory environment can make attending church difficult, or even limit attendance, in our autistic sample. Recommendations for supporting autistic attendance at, and engagement in, church are made.

Engaging in meaningful activities (e.g., leisure, spiritual, fitness) significantly affects caregivers' quality of life (QoL), yet the determinants of participation in caregivers of Autistic children remain largely unknown. The current study examined child and caregiver correlates of primary caregiver participation in meaningful activities. One hundred and six primary caregivers of Autistic children (7–12 years) were recruited from three unique cohorts of Autistic children in this cross‐sectional study. Primary caregivers completed online questionnaires measuring occupational gaps (i.e., desired activities caregivers are not participating in), QoL, parenting stress, perceived family outcomes, and social support. In addition to undertaking direct assessments of children's cognition and language, primary caregivers also reported on their child's adaptive behavior, social–emotional skills, and participation. Caregivers reporting fewer occupational gaps (i.e., ≤2 desired activities) were more likely to have Autistic children with no co‐occurring conditions, who were older, and with better adaptive behaviors, social–emotional skills, and more frequent home and school participation, compared to caregivers reporting many gaps (i.e., ≥3 desired activities). Caregivers with fewer occupational gaps also reported improved QoL, parenting stress, social support, perceived community inclusiveness, and family outcomes. Logistic regression analysis identified child age, child adaptive behavior, social–emotional skills, home participation, and the caregivers' perceived family outcomes and QoL as important predictors of their occupational gaps. The findings demonstrate that caregiver participation in desired activities was associated with increased functional ability and independence of the child, as well as their perceived capacity to meet their child's needs. Supporting parents' sense of efficacy in meeting their children's needs and building their skills and knowledge will serve to improve both caregiver and child outcomes.

Parents of Autistic children often modify their participation in leisure, social, and employment activities to meet the caregiving needs of their child. However, few studies have examined the impact this has on caregiver quality of life (QoL). The aim in the current study was to examine the role of participation in a range of activities on QoL amongst primary and secondary caregivers of school‐aged Autistic children. Eighty‐eight primary (93% mothers) and 63 secondary (91% fathers) caregivers of Autistic children (aged 7‐ to 12‐years) participated in this cross‐sectional study, with time pressure, participation, social support, parenting stress, and QoL measured via an online questionnaire. Compared to secondary caregivers, primary caregivers reported fewer employment hours, increased time pressure, less participation in desired activities, and higher perceived responsibility of domestic and child‐rearing tasks. Similar levels of leisure frequency, parenting stress, and QoL were identified by both caregivers. Hierarchical regression revealed caregiver participation as important for QoL in both primary and secondary caregivers. However, when measures of caregiver well‐being were added to the model, the unique contribution of participation to QoL was reduced, particularly for secondary caregivers. Overall, the findings demonstrate that despite differences in caregiver roles and responsibilities, participation in meaningful activities was important for QoL in all caregivers.

Multi-sensory environments are widely used with autistic children. However, there are no data on how autistic children choose to spend time in the room and how this relates to their sensory, behavioural and intellectual profiles. We observed the frequency and duration of visits to multi-sensory environment equipment of 41 autistic children during 5 min of free play. At a group level, the bubble tube and touch, sound and light board were both highly popular, with the fibre optics and tactile board receiving less attention. Sensory seeking behaviours were more commonly observed in the multi-sensory environment than sensory-defensive behaviours. We found that observed sensory seeking behaviours, along with parent-reported sensory behaviours and non-verbal intelligence quotient, were associated with specific patterns of multi-sensory environment equipment use, but broader autistic behaviours were not. These data suggest that the multi-sensory environment equipment preferences of autistic children are related to individual differences in sensory behaviour and non-verbal intelligence quotient. This information has the potential to inform the development of best-practice multi-sensory environment guidelines that focus on individual needs. Lay Multi-sensory environments, often called sensory rooms, are widely used with autistic children. However, we know very little about how autistic children choose to spend their time in multi-sensory environments. We also do not know how their equipment preferences relate to their individual characteristics such as their sensory differences, level of ability or general autistic behaviours. We measured the frequency and duration of visits to multi-sensory environment equipment of 41 autistic children during 5 min of free play. The bubble tube and touch, sound and light board were both highly popular, with the fibre optics and tactile board receiving less attention. The children displayed significantly more sensory seeking behaviours in the multi-sensory environment than sensory-defensive behaviours. These sensory seeking behaviours, as well as the sensory behaviours that their parents reported they showed in daily life, were associated with specific patterns of multi-sensory environment equipment use. Non-verbal ability was also associated with multi-sensory environment equipment use, but broader autistic behaviours were not. Our findings show that the multi-sensory environment equipment preferences of autistic children are related to individual differences in sensory behaviours and non-verbal ability. This information could be useful for teachers and other practitioners who want to know how best to use multi-sensory environments with autistic children.

Purpose: In prioritising the needs of their autistic children, parents often modify their own participation across leisure, social, and workforce activities. Few studies have examined the impact these modifications have on caregiver quality of life (QoL). The aim in the current study was to examine how parenting their autistic child/ren impacts parent’s participation and QoL. Methods: Twenty primary caregivers (29–48 years, all female) of autistic children (7–11 years) were interviewed online about their participation in leisure, community, and employment activities including the impact of COVID-19. Results: Five themes with underlying subthemes were identified using reflexive thematic analysis. The themes were: (1) Reflecting on the important things in life, (2) Getting access to everything needed, (3) Barriers to participation in meaningful activities, (4) Facilitators of participation in meaningful activities, and (5) Participation through the COVID-19 pandemic. Conclusion: The findings highlight the importance of regular participation in meaningful activities for parents of autistic children and the support needed by them, particularly single parents, to achieve balance between meeting caring responsibilities and their own participation needs.

Autistic people experience the sensory world differently, impacting behavior. First‐hand accounts and group‐based research have found that sensory differences impact a range of things including family life, anxiety, participation, and daily living. Early sensory differences are widely reported to be associated with a cascade of developmental difference, suggesting that early autism diagnosis and sensory mapping could enable the provision of supports to facilitate flourishing. However, appropriate measurement tools are not available as all rely on proxy report or are observation measures which include limited modalities or domains and require the administration of stimuli. Therefore, following the gold‐standard recommendations for measurement development outlined by the PROMIS® framework, we created the Sensory Observation Autism Rating scale (SOAR). We identified sensory behaviors across all primary domains and modalities through an extensive autism‐sensory literature review and from focus groups with autism stakeholders. The initial item bank was then refined by an expert panel and through video coding five‐minutes of free play from Autism Diagnostic Observation Schedule assessments of 105 age‐ and gender‐matched autistic and developmentally delayed children (aged 13–36 months; 38 female). An additional 25% of the sample were double coded to investigate interrater reliability. Observational data and expert review supported the reduction of the item bank to 37 items. We propose that the refined SOAR has excellent face and ecological validity, along with interrater reliability (Intraclass correlation = 0.87–0.99). Following further data collection and refinement, SOAR has promise to fully characterize sensory behaviors in autistic children and indicate useful supports.