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We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. The editor and reviewers' affiliations are the latest provided on their Loop research profiles and may not reflect their situation at time of review. Sensory processing disorders (SPDs) affect up to 16% of school-aged children, and contribute to cognitive and behavioral deficits impacting affected individuals and their families. As our previous imaging findings were limited to a small cohort of affected boys, we seek to investigate these results in a larger mixed-gender cohort sample.
Children ages 8–12 years were enrolled under an institutional review board approved protocol. All TDC and SPD subjects were assessed with the Sensory Profile (Dunn and Westman, 1997), a parent report questionnaire which measures atypical sensory related behaviors. The Acoustic Index of the Differential Screening Test for Processing (DSTP) was used to assess auditory processing (Richard and Ferre, 2006) for all subjects. MR imaging was performed on a 3T Tim Trio scanner (Siemens, Erlangen, Germany) using a 12 channel head coil. Tract-Based Spatial Statistics (TBSS) in FSL (Smith et al., 2006) was used to skeletonize and register the diffusion maps for each subject in order to perform voxel-wise comparisons along the white matter skeleton. For each subject, mean FA values were obtained within the significant voxels of each of the four white matter regions implicated in the group difference analyses – the left and right posterior thalamic radiations (PTR), splenium of the corpus callosum (SCC), and retrolenticular limb of the right internal capsule (RLIC), as defined by the JHU white matter atlas. In order to limit the number of statistical comparisons, FA alone was examined for correlations with our sensory variables. As a post hoc analysis to determine contributions of group, age, and gender to the correlational results, for each sensory metric, FA was averaged across the voxels of significant clusters separately for each subject, and separately for several JHU white matter regions. To further investigate the contributions of different types of auditory processing to the correlational results found with DSTP, an additional post hoc analysis of correlations between the three subscores of the DSTP acoustic subtest and FA was conducted using the same approach described above. Significantly lower FA, and higher MD and RD values, were found in the SPD cohort relative to TDC (Figure 1). This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. While sensory processing differences are now widely recognized in children with autism, children with sensory-based dysfunction who do not meet autism criteria based on social communication deficits remain virtually unstudied. Such sensory dysfunction can hinder a child’s ability to accomplish practical, daily activities and age-appropriate learning tasks, thus resulting in long-term impairment of intellectual and social abilities. Recently, our group has published two studies using diffusion tensor imaging (DTI) to better define the neural correlates of these sensory processing deficits.
We hypothesize that boys and girls with SPD will show impaired white matter microstructural integrity, with a posterior predominance, relative to typically developing children (TDC). SPD subjects were recruited from the UCSF Sensory Neurodevelopment and Autism Program (SNAP) and from local online parent board listings. This test was administered by the lead study coordinator in accordance with manualized instructions and with training and supervision by a cognitive and behavioral neurologist. No significant differences were found in any of the demographic or sensory variables between boys and girls, for either TDC or SPD kids.


FA was tested for correlations with the Sensory Profile auditory score and DSTP separately to assess the relationship between white matter microstructure and auditory processing.
Then, GLMs were constructed with the cognitive metric as the response variable, and FA, group (TDC vs. Visual reference with the JHU white matter atlas reveals that the differences in FA are primarily localized to the bilateral PTRs, the SCC, and the right RLIC. In a previous pilot diffusion tensor imaging (DTI) study, we demonstrated that boys with SPD have altered white matter microstructure primarily affecting the posterior cerebral tracts, which subserve sensory processing and integration. Sensory processing disorder (SPD) is reported to be highly co-incident with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASDs).
Our first study took a whole-brain, data-driven approach to demonstrate decreased fractional anisotropy (FA) and increased mean diffusivity (MD) and radial diffusivity (RD), reflecting reduced microstructural integrity, in the posterior white matter tracts of 16 boys with SPD compared to 24 neurotypically developing boys (Owen et al., 2013). We further hypothesize that this microstructural integrity will correlate with parent report as well as with direct measurements of sensory processing, but that the direct measurements will show stronger correlation with the underlying microstructure. TDC were recruited from online parent group listings as well as referrals from affiliated sensory neurodevelopment and autism research groups. All four boys scored less than 3 for the social and communication total score with a score greater than 7 meeting concern for ASD and a score greater than 10 meeting concern for a full autism disorder diagnosis based on DSM IV-TR criteria. There was one child without an auditory processing score, one without tactile, one without multisensory, two without visual scores, and five without sensory profile total scores given incomplete data from the parent survey. To evaluate subject movement, we calculated a scalar parameter quantifying the transformation of each diffusion volume to the reference.
FA was tested for correlations with the Sensory Profile tactile score and Graphesthesia separately to assess the relationship between white matter microstructure and tactile processing.
This disrupted microstructural integrity, measured as reduced white matter fractional anisotropy (FA), correlated with parent report measures of atypical sensory behavior. However, it is also clear that children can have sensory processing dysfunction without the degree of attention, language, or social challenges that would meet criteria for ADHD or ASD. In addition, we found that FA in affected brain regions correlated with atypical auditory, multisensory, and attention-related behaviors as reported by parents on the Sensory Profile. Informed consent was obtained from the parents or legal guardians, with the assent of all participants.
A child was included in the SPD cohort if they carried an outside diagnosis of SPD from a community occupational therapist and they had a score in the definite difference range on at least one of the Sensory Profile subscores listed above. Next, each subject’s FA data was projected onto this mean skeleton to obtain skeletonized FA maps per subject. The correlation analyses were performed on a voxel-wise basis along the white matter skeleton. Consistent with the FA results, MD and RD are elevated only in the posterior corpus callosum. In this present study, we investigate white matter microstructure as it relates to tactile and auditory function in depth with a larger, mixed-gender cohort of children 8–12 years of age.
In a subsequent report, we established that children with SPD and those with ASD both demonstrate decreased FA in parietal-occipital tracts whereas only children with ASD show differences in temporal tracts subserving social-emotional processing (Chang et al., 2014). Marco, a pediatric cognitive and behavioral child neurologist was also non-consistent with a clinical ASD diagnosis.


Six of the TDC group scored in the probable difference range for one of the subscales, while the remainder scored in the normative range on all subscales. The graphesthesia subtest of The Sensory Integration Praxis Tests (Ayres, 1989) was used to assess tactile proprioception by asking participants to recreate seven designs (neither numbers nor letters) drawn on the dorsum of each hand with closed eyes.
This left a total of 81 children (40 SPD, 41 TDC) with DTI datasets meeting quality control criteria. Also consistent with the FA results, the most significant elevations of both MD and RD occur in the bilateral PTR and right RLIC. We continue to find robust alterations of posterior white matter microstructure in children with SPD relative to typically developing children (TDC), along with more spatially distributed alterations.
The Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood includes a diagnostic label for Regulation Disorders of Sensory Processing (Zero to Three, 2005), but the Diagnostic and Statistical Manual 5 (DSM-V) does not include SPDs as a standalone category.
We recently investigated whether direct assessment measures of tactile and auditory processing might also inform our understanding and evaluation of children with atypical sensory related behaviors both with and without an ASD diagnosis.
None of the TDC cohort and none of the SPD girls met screening criteria for ASD based on the SCQ.
Finally, two SPD kids and one control were born early (gestational ages 36, 35, 33 weeks, respectively). Finally, voxelwise statistics were performed on the skeletonized maps to assess for group differences with non-parametric permutation testing using the randomize function from FSL.
We find strong correlations of FA with both parent report and direct measures of tactile and auditory processing across children, with the direct assessment measures of tactile and auditory processing showing a stronger and more continuous mapping to the underlying white matter integrity than the corresponding parent report measures.
They do now, however, include hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment in their revised ASD criteria. We found that children with both ASD and SPD show impairment in tactile processing (right hand graphesthesia) whereas only the ASD group showed significant impairment in a measure of cortical auditory processing (Demopoulos et al., 2015). Based on these findings of microstructure as a neural correlate of sensory processing ability, diffusion MRI merits further investigation as a tool to find biomarkers for diagnosis, prognosis and treatment response in children with SPD. These sensory processing differences are being increasingly investigated in the field of autism research and recognized as a core and critical clinical feature—however, children with SPD who do not also have social communication deficits that meet ASD criteria can provide insight into the neural underpinnings of sensory processing in particular. However, correlations including all children (controls, SPD, and ASD) showed a significant association between a direct measure of auditory processing impairment and a parent report measure of real-world communication ability. 33 out of the 41 controls and 34 out of the 40 SPD subjects received the graphesthesia assessment.
FA, mean diffusivity (MD), and radial diffusivity (RD) were calculated using FSL’s DTIFIT at every voxel, yielding FA, MD, and RD maps for each subject.
To our knowledge, this work is the first to demonstrate associations of directly measured tactile and non-linguistic auditory function with white matter microstructural integrity – not just in children with SPD, but also in TDC. It is important to note that, in TFCE, the cluster, and not the individual voxel, is the ultimate object of statistical inference and therefore every voxel in the cluster has exactly the same level of statistical significance in the final results. The Johns Hopkins University (JHU) ICBM-DTI-81 White-Matter Labeled Atlas (Wakana et al., 2004) was used to determine the anatomic locations of white matter regions.



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