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Sensory Over-Responsivity (SOR) in Patients with Autism Spectrum Disorder

By: Laura Gould, CCLS, MS

What is Autism Spectrum Disorder?

April is Autism Awareness Month. Autism spectrum disorder is a pervasive neuropsychiatric disorder impacting social interaction and communication as well as restrictive, repetitive patterns of behavior and interest (Yuan et al, 2022). As with all diagnoses, assumptions should not be made about an individual’s ability based solely on having autism as it is a spectrum and does not necessarily involve cognitive delays (Scarpinato, 2010).

Sensory Over-Responsivity (SOR)

A defining characteristic of autism spectrum disorder is atypical sensory processing which occurs in up to 97% of children on the autism spectrum (Griffin et al., 2022). This results in increased sensitivity to sounds, smells, and touch and can lead to challenges in everyday life (Neufeld et al., 2021). This can be especially challenging in health care settings. Sensory over-responsivity (SOR) is characterized by an overwhelmingly negative reaction to or avoidance of sensory stimulation (Yuan et al., 2022). Cognitive therapy and sensory integration therapies have been found to reduce sensory over-responsivity to reduce maladaptive behaviors (Yuan et al., 2022). Above any other maladaptive behavior, sensory over-responsivity was seen to show the strongest relationship with caregiver strain in a study of 75 children, ages 7-12 years of age with autism spectrum disorder and their caregivers, making it difficult for families to cope in unpredictable environments (Griffin et al., 2022).


Sensory over-responsivity is closely linked with anxiety, depression, sleeping difficulties, and impaired family coping (Yuan, 2022). Individuals with autism spectrum disorder display heightened physiological arousal to mildly aversive sensory stimulation with heart rate responses associating with brain and behavioral measures of sensory over-responsivity (Jung et al., 2021). Some conditions can be associated with autism spectrum disorder including seizures, sleep disturbances, gastrointestinal disorders, and psychiatric disorders and these can result in hospitalizations that can be stressful for children with autism spectrum disorder and their caregivers (Scarpinato et al., 2010).

Hospital Interventions

Tailoring the plan of care to each child can reduce patient and family anxiety to meet treatment goals and reduce stress (Scarpinanto et al., 2010). Working closely with parents is advised to identify and understand what strategies they employ to aid their child when experiencing stressors. Screening questions prior to arrival or on the initial assessment can help identify challenges and ways treatment interventions may be perceived different by a child with autism spectrum disorder. At times the physical environment may need to be modified for safety. Understanding how the individual communications both in receptive and expressive language as well as potential repetitive patterns of behavior is helpful (Scarpinato et al., 2010).

In the article “Caring for the child with an autism spectrum disorder in the acute care setting,” the authors list questions to help with assessment when working with a patient and caregiver of a child with autism spectrum disorder:

Impaired social skills
• How does this child tolerate new faces?
• How does this child react to other children their age? To adults?
• Is this child sensitive to touch? Sensitive to noise?
• What is this child's comfort with personal space?
• What is the best way to approach this child (e.g., touch or stand back)?

Impairment in communication
• How does this child communicate? Verbally? Nonverbally?
• Do they require the use of picture cards, writing, or drawing?
• Are they uncomfortable with eye contact and prefer to communicate with you via alternative means? For example, an adolescent patient may feel more comfortable communicating via text message than spoken word.
• Are they able to understand emotional cues?
• How does this child report or show pain?

Restricted interests/stereotyped behaviors
• Are there any items of fixation for this child? If yes, how does the family manage these?
• What are some things that potentially agitate this child? Especially think of the current hospital environment.
• What early warning signs may indicate that this child is becoming agitated?
• When this child becomes agitated or overstimulated, what are the interventions that work best?

Inflexibility/adherence to routine
• What is this child's schedule at home? How much can the hospital's routine mirror the child's home schedule?
• How can I best prepare this child for any upcoming transitions (e.g., a room change or preparation for a test)?
• What has the family or school done that helps with transition?

(Scarpinato et al., 2010)

Ineffective coping is often triggered when children with autism spectrum disorder are not prepared for procedures or changes in routine. Social stories can be helpful in preparing some patients. It is also important to allow staff to have adequate time for preparation in developmentally appropriate ways which may include opportunities to see, touch, and feel items that may will be utilized during an upcoming procedure. It is also important to consider will this be a procedure that involves pain and if so, how the child responds to pain and the potential utilization of pain management methods. Positive reinforcement that focuses and builds on strengths can help and should be focused on in lieu of criticism or terminology focused more on fixing a behavior as that leads to defensiveness and furthering avoidance. Reducing voices and staff members in the room at once can also be helpful but it is important to ask parents as sometimes it may be necessary to have more people in the room to create a safe environment (Scarpinato et al., 2010).

Intervention Tips: Sensory Over-Responsivity (SOR) in Patients with Autism Spectrum Disorder

Intervention Tips SOR 3 



Griffin, Z. A. M., Boulton, K. A., Thapa, R., DeMayo, M. M., Ambarchi, Z., Thomas, E., Pokorski, I., Hickie, I. B., & Guastella, A. J. (2022). Atypical sensory processing features in children with autism, and their relationships with maladaptive behaviors and caregiver strain. Autism research : official journal of the International Society for Autism Research15(6), 1120–1129.

Jung, J., Zbozinek, T. D., Cummings, K. K., Wilhelm, F. H., Dapretto, M., Craske, M. G., Bookheimer, S. Y., & Green, S. A. (2021). Associations between physiological and neural measures of sensory reactivity in youth with autism. Journal of child psychology and psychiatry, and allied disciplines62(10), 1183–1194.

Scarpinato, N., Bradley, J., Kurbjun, K., Bateman, X., Holtzer, B., & Ely, B. (2010). Caring for the child with an autism spectrum disorder in the acute care setting. Journal for specialists in pediatric nursing : JSPN15(3), 244–254.

Yuan, H. L., Lai, C. Y. Y., Wong, M. N. K., Kwong, T. C., Choy, Y. S., Mung, S. W. Y., & Chan, C. C. H. (2022). Interventions for Sensory Over-Responsivity in Individuals with Autism Spectrum Disorder: A Narrative Review. Children (Basel, Switzerland)9(10), 1584.

Child Life Profession