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The Role of Sensory Dysfunction in Social Anxiety in Individuals with Autism Spectrum Disorder



Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects social communication, as well as emotional and behavioral disorders like anxiety and depression (Hickey et al. 2020). Nevertheless, individuals with ASD experience more psychological distress than non-ASD individuals (Lever & Geurts 2016). For example, suicide levels amongst those on the spectrum are 26 fold higher than the neurotypical population. Moreover, ASD is a spectrum disorder, meaning that any type of symptoms can appear at any severity for each individual. Along with the emotional disorders, atypical sensory problems occur in as many as 90% of autistic individuals (Robertson & Baron-Cohen 2017). As children with ASD may easily be distracted by the fan or AC noises or find white papers too bright to work on, the current academic system in the U.S. is not geared towards an inclusive environment. Classes that study abstract ideas, such as algebra, commonly become a blockade for those with ASD (Gradin). Temple Gradin, who is on the autism spectrum and is a professor at Colorado State University and received an honorary degree from Emory University, advocates that ASD is a gift to many people. With specialized thinking, children with ASD are capable of achieving high levels of academic success given the right resources are given. It is, in fact, important to choose a school that teaches art, theater, cooking, and sewing, which teaches children social and career skills from early on. These occupational jobs tend to be perfect for those on the spectrum. As ASD occurs more frequently now than ever before, it is important to understand secondary effects of ASD to guide each individual for a better life.

There have been numerous studies regarding the social communicative behaviors, but less research has been done on the effect of sensory processing dysfunction on social anxiety. Although it has been recognized that individuals with ASD show sensory deficits on the newest Diagnostic and Statistical Manual of Mental Disorder (DSM-5) (Baum et al. 2015), more studies are necessary to understand how sensory processing is linked to social communication and emotional disorders. This paper will investigate the role of sensory processing on the development of social anxiety and the effectiveness of interventions.

Sensory Processing and the Brain

To register sensory information, the interpretation and encoding of immediate environmental information rely on multisensory integration (MSI) (Stickel et al. 2019). In ASD, the sensory processing is disturbed, leading to hyper or hyposensitivity to sensory input; this is why we see some manifestations of autism to be over-reacting or ignoring stimuli. This sensory dysfunction, resulting from the brain’s inability to interpret the sensory inputs, leads children to be highly sensitive to changes in daily routines (Kern et al. 2007). More easily put, the brain’s top-down processing, the prediction, combined with bottom-up sensory signals resolve the discrepancy between the prediction and the actual sensory information to minimize the future prediction errors (Coll et al. 2020). In individuals with ASD, the precision of top-down and bottom-up processing is altered, causing perceptual abnormalities, which in turn, shows the typical ASD characteristics such as sensitivity to sensory illusion or decreased sensory adaptation. Due to this susceptibility on sensory input, individuals with ASD insist on sameness and show repetitive movements (Coll et al. 2020). Even little changes become amplified and perceived as a tremendous change. The alteration in sensory integration can be due to the abnormalities in white matter often found in individuals with ASD.

As a neurodevelopmental disorder, numerous ASD studies found that white matter in the brain is linked to social cognition. White matter is the connective tissue found on axons which transmits information. In order for humans to have such sophisticated social connections, larger brains, thus more neurons (building block cells of the brain), are required. To connect large areas of the brain, axon containing white matter becomes significantly important for neural communication. Although brain regions that are responsible for each sensory input and interpretation are crucial for recognition of each signal, white matter, responsible for trans-brain communication, might be more critical to social cognitive functions. Due to its widespread connection, small alteration or injuries to white matter can lead to social deficits. (Wang & Olson 2018). Studies have shown that abnormalities in white matter structure occur in individuals with ASD. Because of its role as a communication device for neurons, it affects sensory processing, anxiety, emotional distress, and potentially most of the brain function; manifestations of these issues can be seen in the behavioral symptoms of ASD.

Sensory Processing that Leads to Social Anxiety

The impediment of sensory processing early on in developing children hinders the social communication skills. Children with ASD who have problems with integrating sensory information may also find social cues and rules confusing, thus struggle to build meaningful social connections (Robertson & Baron-Cohen 2017). Moreover, one of the distinguishing features of ASD, repetitive movements or behaviors, may appear odd and be subjected to rejection and bullying. Ineffective sensory integration contributes to social isolation and withdrawal, and the negative self-thought can lead to belief in inferiority or being the odd one out (Spain et al. 2018). Not only visual and auditory cues, clothing texture or touch comes as overwhelming, making individuals extremely distracted and anxious (Tomchek & Dunn 2007). Further, sensory overload, such as bright lights, is described to cause physical symptoms like headaches and anxiety as if the body has been attacked (Pellicano & Burr 2012). Altogether, these factors promote social anxiety in individuals with ASD, and by avoiding any interaction, social anxiety can prevent individuals from learning social communication skills (Spain et al. 2018). The best way to soothe anxiety would be to avoid social interactions. Moreover, as adaptive social behaviors and communications require rapid usage of multiple social skills, there is a huge pressure on the brain to quickly and efficiently process environmental information and react appropriately (Wang & Olson 2018). Due to the widespread abnormality of white matter structure, social cognition deficit can be easily predicted in individuals with ASD.

It is not surprising that the occurrence of psychiatric symptoms, such as anxiety, is higher for individuals with ASD (69%) than typically developing individuals (40%) (Lever & Geurts 2016). Due to the fact that symptoms and severity for each individual with ASD varies, what triggers anxiety varies for each individual. Many studies have found numerous different factors, such as age, gender, IQ, and severity of the symptoms, lead to anxiety, and they all vary by different types of anxiety (Magiati et al. 2016). For instance, increased anxiety levels with high functioning individuals was reported in one study. This might be because self-reporting of anxiety is affected by an individual's intellectual ability, such as reflecting on internal state with expressive language, to certain degree (Hallett et al. 2013). However, in other studies, lower IQ has been associated with both general anxiety and social anxiety (Van Steensel et al. 2011). Multiple environmental factors contribute to anxiety, and it is difficult to isolate one leading characteristic that contributes the most.

Not only does higher anxiety level affect the ASD individuals, but higher anxiety rate is also observed in families of children with ASD (Hallett et al. 2013, Elder et al. 2017). Especially in Chinese culture, mothers with ASD have found to have the highest levels of anxiety. Anxiety and other mood disorders of families are often overlooked. Because of the tremendous amount of money and time required to take care of ASD, parents inevitably feel pressured. Thus, having supportive family members, friends, and physicians lead to a better parent-child relationship, which is also indicative of a better outcome of the interventions (Elder et al. 2017). Being considerate towards individuals with ASD is important, but another crucial factor that affects social anxiety and overall life of these individuals is the relationship with parents, which can further improved by a better understanding of society surrounding them.

Intervention

Children with ASD start developing normally but lose skills they already acquired typically between 15-30 months of age (developmental regression). The role of parents is incredibly important in ASD interventions because losses of some skills, such as decline in eye-contact, social engagement, and decrease in joint attention, are more subtle and can only be noticed by parents (Pearson et al. 2018). During the early years of life, children’s brains develop rapidly, wiring and rewiring necessary brain connections, having the best learning ability for interventions. The importance of early diagnosis is stressed in numerous studies as early intervention improves long term quality of life (Elder et al. 2017). As soon as the diagnosis is made, intensive educational intervention should start. Although ASD is a heterogeneous medical condition, the intervention is mostly carried out in educational settings. The intervention should have a low student to teacher ratio and be highly structured, as children with ASD are sensitive to changes (Blenner et al. 2011). In fact, children who are attending special schools have lower degree of social phobia symptoms due to the school environment that reduces social pressure and anxiety (Magiati et al. 2016). Being placed in a special education program might decrease anxiety, but it also shelters children from being exposed to life skills like shopping, impeding them from potentially finding jobs. Further, in order for children to receive special education, there must be a label of ASD attached to them. Labels could decrease parental expectations, which is essential for positive therapeutic outcomes (Gradin, 2019). Stereotypes and labels towards the individuals with ASD stem from social norms, and it is crucial to have widespread awareness in order for children to proceed without extra barrier stereotypes in life.

Conclusion

As ASD is occurring at a higher rate than ever, the field of ASD research is blossoming. ASD is a neurodevelopmental disorder that affects social communication and sensory processing. Although separately, the effect of abnormal sensory integration and social anxiety in individuals with ASD have been researched, the connection between sensory overload and anxiety can easily be overlooked. Everyday routines, such as holding conversations, require a tremendous effort on reading and acting on social cues. The subtle changes in tones and facial expressions are harder to catch as lights, sounds, and feelings already distract children away from concentrating. Sensory overload further adds to already existing pressure on these children, leading to isolation. As everyday objects such as paper and pen colors, kinds of lights, and fan noises can be distracting or cause emotional distresses, starting an intensive educational intervention program as soon as possible helps children manage stresses better. In conclusion, abnormal sensory integration plays a key role in building social anxiety on individuals with ASD. Not only is early intervention for children with ASD recommended for an improvement of long term quality of life, but education and awareness of ASD is also required for further improvement of both children and the parents’ emotional distress.

References

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