Sensory processing

Sensory Over-Responsivity: Signs and What Helps

When ordinary sound, touch or light lands harder than it should, and why the reaction is not an overreaction.

• Expert Reviewed
• Evidence Based
• Patient Focused

Sensory over-responsivity, or sensory hypersensitivity (hipersensibilidad sensorial in Spanish, hipersensibilidade sensorial in Portuguese), means the nervous system reacts to ordinary sensation faster, more intensely or for longer than most people’s does. A shirt tag, a hand dryer or a haircut can feel genuinely painful, and the reaction is automatic, not chosen.⁠^1,5 It affects roughly one child in five or six in community studies, more in autism and ADHD, and in two long-term studies it came before anxiety and predicted it.⁠^3,4,6,7,8 What helps is lowering the load, adjusting the hardest routines and coaching the family.⁠^4,9

Sources

1. Miller LJ, Anzalone ME, Lane SJ, Cermak SA, Osten ET. Concept evolution in sensory integration: a proposed nosology for diagnosis. American Journal of Occupational Therapy. 2007;61(2):135–140. PMID 17436834. Checked October 10, 2026.
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   The paper proposes three patterns of sensory processing disorder, “SMD, SDD, and SBMD, with subtypes in each pattern,” and “that a diagnosis of SPD be made if, and only if, the sensory processing difficulties impair daily routines or roles.” Of the first modulation subtype: “People with SOR respond to sensation faster, with more intensity, or for a longer duration than those with typical sensory responsivity. Overresponsivity may occur in only one sensory system (e.g., tactile defensiveness) or in multiple sensory systems (e.g., sensory defensiveness)”; “Difficulties are particularly evident in new situations and during transitions”; “the atypical responses observed are not willful; they are automatic, unconscious physiologic reactions to sensation. More intense responses generally occur if the stimulation is unexpected rather than self-generated. In addition, sensory input often has a summative effect; thus, a sudden exaggerated response may occur to a seeming trivial event because of the accumulated events of the day”; “Behaviors in SOR range from active, negative, impulsive, or aggressive responses to more passive withdrawal or avoidance of sensation. Sympathetic nervous system activation is a marker of SOR”; and SOR “is often observed concomitantly with sensory discrimination disorder (SDD), dyspraxia, or both.” People with under-responsivity “disregard, or do not respond to, sensory stimuli” and may fail to respond to pain or extreme temperatures; people with sensory seeking “crave an unusual amount or type of sensory input”; “Some children with SOR will engage in SS behaviors as an attempt at self-regulation”; and avoidance of movement from postural disorder can be told from vestibular over-responsivity by whether the child “(a) is unstable or fearful in challenging positions (PD) or (b) seems to have an aversive response to the movement (SOR).”
2. Cleveland Clinic. Sensory Processing Disorder (SPD). Health Library, last updated March 20, 2025. Checked October 10, 2026.
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   “Currently, SPD isn’t an official medical diagnosis. But providers recognize the benefits of identifying SPD and using therapy to manage it”; “Researchers don’t yet know the cause of sensory processing disorder. Studies show that genetics and environmental factors likely play a role”; a pediatrician “may refer you to an occupational therapist. These professionals can assess your child for SPD by watching them interact with certain sensory experiences. They’ll also ask about your child’s symptoms, behavior and medical history”; and at school a child may need “Access to headphones to block out background noises while they work,” “Access to fidget toys” and “A designated break to do a sensory activity, like walking, spinning or swinging.”
3. Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory over-responsivity: an early risk factor for anxiety and behavioral challenges in young children. Journal of Abnormal Child Psychology. 2019;47(6):1075–1088. PMID 30569253. Checked October 10, 2026.
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   The abstract: symptoms were assessed “in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old”; “Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age.” The full text: “Twenty percent of parents reported over-responsivity at least one sensory domain in our preschool sample. The most commonly reported sensory over-responsivity was to tactile experiences (18%), followed by auditory experiences (4%). Of the children with sensory over-responsivity at preschool who were assessed again at school-age, 56% of them still had a parent-reported sensory over-responsivity at school-age. Of children for whom their parents did not endorse any sensory over-responsivity as a preschooler, 16% ... endorsed at least one sensory over-responsivity by school-age”; “only 52% of children who had at least one sensory sensitivity as preschoolers in our sample went on to meet criteria for an anxiety disorder at school-age”; and “sensory over-responsivity is not, in and of itself, a sufficient marker for risk of anxiety.” The authors give, as an example of how over-responsivity may lead to anxiety, a child for whom “going to a restaurant or using a public bathroom” brings “unpredictable and uncontrollable auditory input that they experience as unpleasant.”
4. Green SA, Hernandez L, Tottenham N, Krasileva K, Bookheimer SY, Dapretto M. Neurobiology of sensory overresponsivity in youth with autism spectrum disorders. JAMA Psychiatry. 2015;72(8):778–786. PMID 26061819. Checked October 10, 2026.
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   “More than half of youth with autism spectrum disorders (ASDs) have sensory overresponsivity (SOR), an extreme negative reaction to sensory stimuli”; in 19 autistic and 19 typically developing youths aged 9 to 17, autistic participants “displayed stronger activation in primary sensory cortices and the amygdala”; “The ASDs with SOR subgroup had decreased neural habituation to stimuli in sensory cortices and the amygdala”; the hyperresponsivity was seen “particularly to multiple modalities presented simultaneously” and is “due to failure to habituate”; “a subset of youth with ASDs can regulate their responses through prefrontal downregulation of amygdala activity”; and “Implications for intervention include minimizing exposure to multiple sensory modalities and building coping strategies for regulating emotional response to stimuli.”
5. STAR Institute for Sensory Processing. Patterns or Subtypes of Differences in Sensory Integration & Processing. Sensoryhealth.org, undated. Checked October 10, 2026.
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   Of sensory over-responsivity: “Tends to be referred to as SOR in the research and education literature. A more neutral term might be heightened responsivity. Individuals with sensory over-responsivity are more sensitive to sensory stimulation than most people. Their bodies feel sensation more easily and/or more intensely. They might feel as if they are being constantly bombarded with information. Consequently, these people often have a ‘fight or flight’ response to sensation, e.g. being touched unexpectedly or loud noise, a condition sometimes called ‘sensory defensiveness.’ They may try to avoid or minimize sensations, e.g. withdraw from being touched or cover their ears to avoid loud sounds.” Of under-responsivity: “Individuals who are under-responsive to sensory stimuli require more intensity and repetition of sensation than others ... These children may not perceive objects that are too hot or cold or they may not notice pain in response to bumps, falls, cuts, or scrapes.”
6. Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. Journal of Abnormal Child Psychology. 2009;37(5):705–716. PMID 19153827. Checked October 10, 2026.
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   The abstract: in “a representative sample of elementary school-aged children (n = 925, 50% boys, ages 7-11 years) who were followed from infancy. Sixteen percent of parents reported that at least four tactile or auditory sensations bothered their children”; parents of children with elevated SOR “reported higher frequencies of early and co-occurring internalizing, externalizing, and dysregulation problems, and lower levels of concurrent adaptive social behaviors”; and SOR “can impact children’s participation in academic and social activities.” The full text: the sensations reported most often were “tags in clothing (39%), cutting finger or toe nails (19%), hair brushing (16%), and mud (11%),” and among sounds “alarms (12%), sirens, and concerts (both 10%)”; of the children above the cutoff, “76.4% (n=113) had only elevated tactile scores”; the background reports a much higher prevalence in clinical groups, “ASD (e.g., 56% ...), Fragile X (e.g., ~40% ...) and ADHD (e.g., 69% ...)”; “According to Dunn’s model, SOR reflects a low neurological threshold” and Dunn describes two types of SOR behaviors, avoiding and sensitivity; and SOR “can be more pronounced in certain contexts in which specific aversive sensations are present, or in those that involve unexpected and intense sensation, hence may be missed in a one-time evaluation.”
7. Van Hulle CA, Schmidt NL, Goldsmith HH. Is sensory over-responsivity distinguishable from childhood behavior problems? A phenotypic and genetic analysis. Journal of Child Psychology and Psychiatry. 2012;53(1):64–72. PMID 21797864. Checked October 10, 2026.
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   970 twins from the Wisconsin Twin Project, about 7 years old, children with autism excluded. The full text: “Of the 970 children in this sample, 201 (20.7%; 95 girls) screened positive for SOR”; “When we excluded specific phobia, the number of children who screened positive for SOR but had no DISC diagnosis number rose from 85 to 117 (58.2%)”; and “Additive genetic factors accounted for nearly all variation in the latent externalizing and SOR phenotypes.” The abstract: “modest covariation between SOR and DISC symptoms could be entirely accounted for by common underlying genetic effects” and “SOR occurs independently of recognized childhood psychiatric diagnoses but is also a relatively frequent comorbid condition with recognized diagnoses.”
8. Green SA, Ben-Sasson A, Soto TW, Carter AS. Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: bidirectional effects across time. Journal of Autism and Developmental Disorders. 2012;42(6):1112–1119. PMID 21935727. Checked October 10, 2026.
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   The title asks about effects in both directions; the finding runs one way: “Participants were 149 toddlers with ASD and their mothers, assessed at 2 annual time points. A cross-lag analysis showed that anxiety symptoms increased over time while SOR remained relatively stable. SOR positively predicted changes in anxiety over and above child age, autism symptom severity, NVDQ, and maternal anxiety, but anxiety did not predict changes in SOR. Results suggest that SOR emerges earlier than anxiety, and predicts later development of anxiety.”
9. Piller A, McHugh Conlin J, Glennon TJ, Andelin L, Auld-Wright K, Teng K, Tarver T. Systematic review of sensory-based interventions for children and youth (2015–2024). Frontiers in Pediatrics. 2025;13:1720179. PMID 41321460. Checked October 10, 2026.
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   “Twenty-one studies were included. Strong strength of evidence supported use of deep pressure tactile input and caregiver training on the use of sensory strategies. Moderate strength of evidence supported that alternative seating did not improve attention ... There is a lack of evidence on the impact of sensory environmental modifications.” The full text: “Four studies supported the use of deep pressure tactile stimulation, two of which examined weighted items and two of which examined massage”; “Two studies found sleep behavior improvements, one with use of weighted blankets during sleep and one with massage and joint compressions prior to bedtime,” while improvements with a vest “were not significant,” and “All three of these studies focused on children with ADHD or SI/SP challenges”; “Only one study (56) explored sensory environmental modifications,” in a dental office; “noise-cancelling headphones (44) were not found to impact auditory participation goals,” though earmuffs improved auditory-related goals; and “The evidence indicates that caregiver training or coaching should be considered as part of any sensory intervention.”
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Psychiatry.org, undated. “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) features the most current text updates based on scientific literature with contributions from more than 200 subject matter experts.” Checked October 10, 2026.
11. Grobelna N, Rutkowski R, Rybakowski F, Rybakowski J, Ferensztajn-Rochowiak E. The phenomenon of sensory processing: historical overview, theoretical models, and neurophysiological underpinnings. Acta Neurobiologiae Experimentalis. 2024;84(4):359–370 (published January 14, 2025). PMID 39812532. Checked October 10, 2026.
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    The abstract notes interest in sensory processing in adults “despite the lack of a formal diagnosis in DSM-5 and ICD classifications.” The full text: sensory processing sensitivity, introduced by Elaine and Arthur Aron in 1997, “overlaps in part with the concepts of neuroticism and introversion but is not identical to them”; “about 20% of the population is highly sensitive”; “the SPS trait is currently understood as a continuum of sensitivity in the population”; “the key feature of SPS is the depth of processing of stimuli in higher cortical centers”; “the HSPS scale primarily examines emotional responses, and the Adolescent/Adult Sensory Profile ... mainly measures behavioral responses to sensory stimuli”; and “using different concepts and terminology regarding sensory processing interchangeably can complicate the interpretation of research results and lead to wrong conclusions.”
12. ZERO TO THREE. Numerical Codes for DC:0–5. PDF, undated. “The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5) was published by ZERO TO THREE in 2016”; its list includes “20 Sensory Processing Disorders: 20.1 Sensory Over-Responsivity Disorder, 20.2 Sensory Under-Responsivity Disorder, 20.3 Other Sensory Processing Disorder.” Checked October 10, 2026.
13. Cummings KK, Jung J, Zbozinek TD, Wilhelm FH, Dapretto M, Craske MG, Bookheimer SY, Green SA. Shared and distinct biological mechanisms for anxiety and sensory over-responsivity in youth with autism versus anxiety disorders. Journal of Neuroscience Research. 2024;102(1):e25250 (published online October 16, 2023). PMID 37840458. Checked October 10, 2026.
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    “Age/IQ-matched youth aged 8-18 years (22 ANX; 30 ASD; 22 TD) experienced mildly aversive tactile and auditory stimuli”; “ASD/ANX youth showed similar, heightened brain responses to sensory stimulation compared to TD youth, but brain responses were more highly related to SOR symptoms in ASD youth and to anxiety symptoms in ANX youth. Across ASD/ANX youth, anxiety symptoms uniquely related to greater SCR whereas SOR uniquely related to greater HR responses to sensory stimulation”; and the findings “support SOR and anxiety as distinct symptoms with unique biological mechanisms.”
14. Pfeiffer B, Stein Duker L, Murphy A, Shui C. Effectiveness of noise-attenuating headphones on physiological responses for children with autism spectrum disorders. Frontiers in Integrative Neuroscience. 2019;13:65. PMID 31798424. Checked October 10, 2026.
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    A single-subject design “with six children, aged 8-16 years” with autism and auditory hypersensitivity; “regardless of intervention type, noise attenuating headphones led to a significance difference in both skin conductance levels (SCL) and frequency of non-specific conductance responses”; and “the use of noise attenuating headphones for individuals with ASD and hyperacusis may reduce sympathetic activation.”
15. American Speech-Language-Hearing Association. Tinnitus and Hyperacusis. Practice Portal, undated. Checked October 10, 2026.
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    “Hyperacusis is a heightened sensitivity to ordinary sounds in the environment that are tolerated well by those without hyperacusis”; “Audiologists play a central role in the assessment, diagnosis, and management/treatment of individuals with tinnitus and/or hyperacusis”; “Cognitive behavioral therapy (CBT) is a specific type of therapy that focuses on modifying problem emotions, thoughts, and behaviors”; “Sound therapy for hyperacusis requires the patient to listen to low-level sounds for long periods of time to encourage habituation,” with “gradual increases of the level and/or duration of the sound treatment ... along with positive reinforcement by the clinician”; and “Some individuals with hyperacusis feel that wearing hearing protection to avoid disturbing sounds is helpful. This is not generally advisable when environmental sound levels are safe. Avoiding sounds in the environment can make the auditory system become more sensitive to these sounds when protection is not used. This increased sensitivity can exacerbate hyperacusis (Formby et al., 2003). Using hearing protection when exposed to excessive noise is advisable for all individuals.”
16. Centers for Disease Control and Prevention. CDC’s Developmental Milestones. Learn the Signs. Act Early., page dated May 15, 2026. Checked October 10, 2026.
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    “Don’t wait. If your child is not meeting one or more milestones, has lost skills he or she once had, or you have other concerns, act early. Talk with your child’s doctor, share your concerns, and ask about developmental screening.”
17. Centers for Disease Control and Prevention. Clinical Testing and Diagnosis for Autism Spectrum Disorder. Page dated May 8, 2025, reproducing the DSM-5 criteria. Checked October 10, 2026.
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    “To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction ... plus at least two of four types of restricted, repetitive behaviors”; the fourth reads “Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).”
18. World Health Organization. 6A02 Autism spectrum disorder. ICD-11 for Mortality and Morbidity Statistics, release 2026-01. Checked October 10, 2026.
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    Among the restricted, repetitive features: “Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.” Boundary with avoidant-restrictive food intake disorder: autistic people “may also restrict intake of certain foods because of their sensory characteristics.” Boundary with oppositional defiant disorder: in autism, aggressive outbursts “are often associated with a specific trigger (e.g., a change in routine, aversive sensory stimulation, anxiety, or rigidity ...), rather than reflecting an intention to be defiant, provocative, or spiteful.”
19. STAR Institute for Sensory Processing. About SPD. Sensoryhealth.org, undated. “We also have a vision of a world where SPD is an accepted diagnosis, is included in diagnostic manuals such as the DSM and ICD, and where treatment is covered by insurance.” Checked October 10, 2026.
20. Zimmer M, Desch L; Section on Complementary and Integrative Medicine; Council on Children with Disabilities; American Academy of Pediatrics. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012;129(6):1186–1189. PMID 22641765. Checked October 10, 2026.
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    “Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. Other developmental and behavioral disorders must always be considered, and a thorough evaluation should be completed. Difficulty tolerating or processing sensory information is a characteristic that may be seen in many developmental behavioral disorders, including autism spectrum disorders, attention-deficit/hyperactivity disorder, developmental coordination disorders, and childhood anxiety disorders. Occupational therapy with the use of sensory-based therapies may be acceptable as one of the components of a comprehensive treatment plan. However, parents should be informed that the amount of research regarding the effectiveness of sensory integration therapy is limited and inconclusive”; clinicians may talk with families “about a trial period of sensory integration therapy” and teach them “how to evaluate the effectiveness of a therapy.”
21. ZERO TO THREE. DC:0–5 Crosswalk to DSM and ICD-10. DC:0–5 training handout, 2018. Sensory Over-Responsivity Disorder, Sensory Under-Responsivity Disorder and Other Sensory Processing Disorder each map to “Other Specified Neurodevelopmental Disorder” in the DSM-5 and to “Other Disorders of Psychological Development”, F88, in the ICD-10. Checked October 10, 2026.
22. Carter AS, Ben-Sasson A, Briggs-Gowan MJ. Sensory over-responsivity, psychopathology, and family impairment in school-aged children. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(12):1210–1219. PMID 22115142. Checked October 10, 2026.
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    In “338 children aged 7 to 10 years” from a birth cohort, “Approximately one-fifth (21.2%) of children had elevated SOR symptoms. One-fourth (24.3%) of those with an elevated SOR score met criteria for a DSM-IV diagnosis, and 25.4% of children with a DSM-IV diagnosis had an elevated SOR score. Parents of children with elevated SOR alone reported a similar number of restrictions in family life as parents of those with an internalizing and/or externalizing diagnosis. SOR predicted concurrent family impairment above and beyond DSM diagnostic status and socio-demographic risk”; and “Elevated SOR occurs in the absence of other psychiatric conditions and is associated with impairment in family life.”
23. STAR Institute for Sensory Processing. Understanding the Sensory Integration Process. Sensoryhealth.org, undated. Checked October 10, 2026.
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    “Heightened Sensitivity: Some neurodivergent individuals experience heightened sensitivity to sensory input. This can make sounds, sights, smells, being moved or moving, and even internal sensations feel overwhelmingly ‘big,’ ‘loud,’ or ‘intense.’” “Of course, you can have heightened sensitivity to some sensory systems and reduced in others”; and “Sensory processing isn’t static; it can fluctuate based on factors like stress, fatigue, or environmental changes. A person might find a certain fabric tolerable one day and unbearable the next.”
24. STAR Institute for Sensory Processing. Symptoms Checklist. Sensoryhealth.org, undated. Checked October 10, 2026.
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    The infant and toddler list includes “My infant/toddler is extremely irritable when I dress him/her; seems to be uncomfortable in clothes,” “My infant/toddler resists cuddling, arches back away from the person holding him” and “My infant/toddler is easily startled”; the adolescent and adult list, “I am extremely sensitive to environmental stimulation: I do not like being touched” and “I avoid visually stimulating environments and/or I am sensitive to sounds”; and “While this checklist cannot diagnose Sensory Processing Disorder, it can be a helpful guide to see if additional testing should be done.”
25. American Speech-Language-Hearing Association. Pediatric Feeding and Swallowing. Practice Portal, undated. Checked October 10, 2026.
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    “SLPs play a central role in the assessment, diagnosis, and treatment of infants and children with swallowing and feeding disorders”; “A team approach is necessary for appropriately diagnosing and managing pediatric feeding and swallowing disorders,” with referrals that can include “an occupational therapist (OT)”; and in avoidant/restrictive food intake disorder, “Selective eating ... is due to disinterest in eating or food in general, sensory sensitivity, and/or a fear of consequences.”
26. Dunn W. Supporting children to participate successfully in everyday life by using sensory processing knowledge. Infants & Young Children. 2007;20(2):84–101. Checked October 10, 2026.
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    The four patterns are “(a) sensation seeking, which represents high thresholds and an active self-regulation strategy; (b) sensation avoiding, which includes low thresholds and an active self-regulation strategy; (c) sensory sensitivity, which includes low thresholds and a passive self-regulation strategy; and (d) low registration, which represents a high threshold and a passive self-regulation strategy”; “no one has only one pattern of sensory processing ... a person might have sensitivity for touch but have low registration for sounds”; “children with sensitivity to movement may be hard to carry because they react to every bump in the road”; “Remember that withdrawing is an adaptive strategy the child uses to handle too much input”; and therapists consult with families and teachers to “adjust the routines so that the children can get their sensory processing needs met while continuing to participate in their life activities.”
27. Cermak SA, Stein Duker LI, Williams ME, Dawson ME, Lane CJ, Polido JC. Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: a randomized controlled pilot study. Journal of Autism and Developmental Disorders. 2015;45(9):2876–2888. PMID 25931290. Checked October 10, 2026.
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    “Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE”; “Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE.” The full text: dental office stimuli include “bright fluorescent lights, touch in and around the mouth, as well as the taste and smell of oral care products”; in a survey it cites, “60% of parents of children with ASD reported moderate to extreme difficulty having the dentist or hygienist clean their child’s teeth, in comparison to 13% of parents of TD children”; and in the adapted room the overhead fluorescent lighting and dental lamp were turned off, the dentist wore “a head-mounted lamp directed into the child’s mouth,” “rhythmic music was projected through portable speakers,” slow visual effects played on the ceiling, and a butterfly wrap weighted with a dental X-ray vest gave “deep ‘hugging’ pressure.”
28. Ben-Sasson A, Carter AS, Briggs-Gowan MJ. The development of sensory over-responsivity from infancy to elementary school. Journal of Abnormal Child Psychology. 2010;38(8):1193–1202. PMID 20623174. Checked October 10, 2026.
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    “This study followed a representative sample of children (n = 521, 47% boys) at four time points from infancy (mean ages in months Year 1 = 18.23, Year 2 = 30.39, Year 3 = 39.40) to elementary school-age (mean age = 7.97 years)”; “Both early sensory sensitivities and change in early sensitivities were associated with SOR status at school-age.”
29. Kinnealey M, Oliver B, Wilbarger P. A phenomenological study of sensory defensiveness in adults. American Journal of Occupational Therapy. 1995;49(5):444–451. PMID 7598160. Checked October 10, 2026.
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    The article “describes the experiences of five adults who are defensive toward sensations of touch, movement, vision, smell, sound, and taste that most people consider harmless” and their coping strategies: “avoidance, predictability, mental preparation, talking through, counteraction, and confrontation.”
30. Pfeiffer B, Kinnealey M. Treatment of sensory defensiveness in adults. Occupational Therapy International. 2003;10(3):175–184. PMID 12900790. Checked October 10, 2026.
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    In “Fifteen adult subjects identified as having sensory defensiveness,” “Results indicated a significant correlation between anxiety and sensory defensiveness (r = 0.62, p = 0.027)”; after a one-month self-treatment protocol, the changes “supported the use of a sensory treatment protocol to decrease sensory defensiveness and secondary anxiety,” and “There is a need for further research using experimental methodology with a control group.”
31. Isaacs D, Key AP, Cascio CJ, Conley AC, Riordan H, Walker HC, Wallace MT, Claassen DO. Cross-disorder comparison of sensory over-responsivity in chronic tic disorders and obsessive-compulsive disorder. Comprehensive Psychiatry. 2022;113:152291. PMID 34952304. Checked October 10, 2026.
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    In 207 adults, “SOR is prevalent in adults with CTD and in adults with OCD but does not significantly differ in magnitude between these disorders”; and “SOR is independently associated with both obsessive-compulsive and ADHD symptoms, suggesting a transdiagnostic relationship.”
32. Pearson Assessments. Adolescent/Adult Sensory Profile. Product page for the questionnaire by Catana Brown and Winnie Dunn, published 2002. “An individual answers questions regarding how he or she generally responds to sensations”; “Age range: 11 years and older.” Checked October 10, 2026.
33. Aron EN, Aron A. Sensory-processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology. 1997;73(2):345–368. PMID 9248053. Checked October 10, 2026.
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    “Over a series of 7 studies that used diverse samples and measures, this research identified a unidimensional core variable of high sensory-processing sensitivity and demonstrated its partial independence from social introversion and emotionality”; it also “demonstrated adequate reliability and content, convergent, and discriminant validity for a 27-item Highly Sensitive Person Scale.”
34. Green SA, Ben-Sasson A. Anxiety disorders and sensory over-responsivity in children with autism spectrum disorders: is there a causal relationship? Journal of Autism and Developmental Disorders. 2010;40(12):1495–1504. PMID 20383658. Checked October 10, 2026.
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    The full text: the two conditions “can be difficult to distinguish, as they both involve misperception of threat ... and overlap in their physiological (e.g., increased heart rate and skin conductance response) and behavioral (e.g., fight-or-flight response, emotional dysregulation, avoidance) symptoms”; quoting Grillon, fear is “a response to an impending identifiable danger” while anxiety is “a state of chronic apprehension about future harm ... elicited by unpredictability and by the perception of potential, unseen, or symbolic threats”; “SOR is, almost by definition, a fearful response, but fear alone does not imply an anxiety disorder”; through context conditioning “the child might refuse to go to a birthday party or into a bedroom because they anticipate there might be aversive sounds”; conditionability rises with “the intensity of the unconditional response and uncontrollability of the conditioned stimuli”; in a study they describe, given a case written to represent SOR “all occupational therapists diagnosed SOR while 26% of psychologists diagnosed an anxiety disorder,” and given one representing general anxiety “50% of occupational therapists diagnosed SOR and 92% of psychologists diagnosed an anxiety disorder”; “SOR should be generalizable to multiple stimuli that elicit the unpleasant sensory response ... while specific phobia would be to one specific stimulus or situation” and a child with general anxiety disorder “should be generally anxious, not only to specific sensory stimuli”; anxious children without SOR “should show over-responsivity to a variety of startling stimuli, regardless of the modality”; on treatment, “there is little evidence that it [sensory integration] specifically reduces SOR,” for the sensory diet “there are no studies of its sensory or emotional outcome for children with ASD,” auditory integration training “has not been shown to be consistently efficacious in reducing auditory sensitivity,” and in the CBT trials reviewed “children in the intervention groups had a significant reduction in anxiety”; “To our knowledge no one has yet investigated the effect of anxiety interventions such as CBT or exposure therapy on SOR,” and “pairing sensory-based interventions with CBT or exposure therapy might markedly increase a child’s tolerance for previously aversive sensory stimuli.”
35. Conelea CA, Carter AC, Freeman JB. Sensory over-responsivity in a sample of children seeking treatment for anxiety. Journal of Developmental and Behavioral Pediatrics. 2014;35(8):510–521. PMID 25186122. Checked October 10, 2026.
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    In 88 children at an anxiety specialty clinic, “93.2% were bothered by at least 1 tactile or auditory sensation”; “SensOR scores did not differ by psychiatric disorder diagnosis, but SensOR scores significantly correlated with measures of OCD and depression. Higher SensOR scores were associated with greater global impairment.”
36. American Psychiatric Association. What Is Autism Spectrum Disorder? Psychiatry.org; physician review January 2024. Restricted interests and repetitive behaviors may include “Sensory hypersensitivity, e.g., aversion to loud noises.” Checked October 10, 2026.
37. Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2009;39(1):1–11. PMID 18512135. Checked October 10, 2026.
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    “Results from 14 studies indicated a significant high difference between ASD and typical groups in the presence/frequency of sensory symptoms, with the greatest difference in under-responsivity, followed by over-responsivity and sensation seeking.”
38. Williams ZJ, Suzman E, Woynaroski TG. Prevalence of decreased sound tolerance (hyperacusis) in individuals with autism spectrum disorder: a meta-analysis. Ear and Hearing. 2021;42(5):1137–1150. PMID 33577214. The meta-analysis of interview and questionnaire measures “estimated the current and lifetime prevalence of hyperacusis in ASD to be 41.42% ... and 60.58% ..., respectively.” Checked October 10, 2026.
39. Schoen SA, Miller LJ, Brett-Green BA, Nielsen DM. Physiological and behavioral differences in sensory processing: a comparison of children with autism spectrum disorder and sensory modulation disorder. Frontiers in Integrative Neuroscience. 2009;3:29. PMID 19915733. Checked October 10, 2026.
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    “Physiological arousal and sensory reactivity were lower in children with ASD whereas reactivity after each sensory stimulus was higher in SMD, particularly to the first stimulus in each sensory domain.”
40. Jurek L, Duchier A, Gauld C, et al. Sensory processing in individuals with attention-deficit/hyperactivity disorder compared with control populations: a systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry. 2025;64(10):1132–1147. PMID 40250555. Checked October 10, 2026.
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    “30 studies (reported in 32 publications) encompassing 5,374 participants were included”; “Patients with ADHD presented with significantly more severe sensory atypicities than the control group in multiple domains: sensory sensitivity ..., sensory avoiding ..., low sensory registration ..., and sensory seeking”; “Heterogeneity was high in all analyses”; and sensory processing “should be systematically explored in the evaluation of children and adults referred for ADHD.”
41. Reynolds S, Lane SJ. Sensory overresponsivity and anxiety in children with ADHD. American Journal of Occupational Therapy. 2009;63(4):433–440. PMID 19708472. In 24 children aged 6 to 10 with ADHD and 24 without, “Children in the ADHD + SOR group were significantly more anxious than both the ADHD-only and non-ADHD (control) groups.” Checked October 10, 2026.
42. Lane SJ, Reynolds S, Thacker L. Sensory over-responsivity and ADHD: differentiating using electrodermal responses, cortisol, and anxiety. Frontiers in Integrative Neuroscience. 2010;4:8. PMID 20556242. Checked October 10, 2026.
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    The study compared “6- to 12-year-old children with ADHD and SOR (ADHDs), ADHD and no SOR (ADHDt), and typicals”; “Results substantiated links between SOR and anxiety, in both TYP and ADHD children.”
43. Miller LJ, Nielsen DM, Schoen SA. Attention deficit hyperactivity disorder and sensory modulation disorder: a comparison of behavior and physiology. Research in Developmental Disabilities. 2012;33(3):804–818. PMID 22236629. Checked October 10, 2026.
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    “Inattention was greater in ADHD compared to SMD ... SMD had more sensory issues, somatic complaints, anxiety/depression, and difficulty adapting than ADHD. SMD had greater physiological/electrodermal reactivity to sensory stimuli than ADHD and typical controls”; “Evidence suggests ADHD and SMD are distinct diagnoses.”
44. Van Hulle C, Lemery-Chalfant K, Goldsmith HH. Trajectories of sensory over-responsivity from early to middle childhood: birth and temperament risk factors. PLoS One. 2015;10(6):e0129968. PMID 26107259. Checked October 10, 2026.
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    In “a population-based, typically developing sample of twins (N=978) at age two years ... and again at age seven years,” children fell into “low symptom (N=768), remitted (N=75), late-onset (N=112), and chronic (N=24)” groups; “Children in the chronic group had more severe symptoms of sensory sensitivity at age four years, including more motion sensitivity”; they “had a younger gestational age and were more likely to be low birth-weight than the low symptom group”; “Sensory over-responsivity was modestly correlated across ages (r = .22 for tactile over-responsivity and r = .11 for auditory over-responsivity), but symptoms were more stable among children born prematurely or who had more fearful and less soothable temperaments”; and “assessment over development may be necessary for a valid sensory processing disorder diagnosis.”
45. American Occupational Therapy Association. Practice Smart! Undated web page; AOTA published the recommendations from 2018 to 2021 under the Choosing Wisely campaign. Checked October 10, 2026.
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    “2. Don’t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information”; “6. Don’t initiate occupational therapy interventions without completion of the client’s occupational profile and setting collaborative goals”; and “7. Don’t provide interventions for autistic persons to reduce or eliminate ‘restricted and repetitive patterns of behavior, activities, or interests’ without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.”
46. University Hospitals Dorset NHS Foundation Trust, Children’s Therapy Services. Hair care, common sensory issues, and practical tips. Patient information leaflet, January 2024 (review date January 2027). Checked October 31, 2026.
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    “This discomfort may be particularly present with light touch on the skin, such as from a shower spray or being tickled”; “The head is particularly sensitive to touch, which can make hair washing, brushing, or cutting an uncomfortable and sometimes distressing experience”; “they may struggle to tilt their head backwards to have their hair washed … or they may struggle to tolerate the smell of shampoo and other hair products”; “make sure your child is visually warned that someone is going to touch their heads, where on their head, and for how long”; “use firm pressure. Do not lightly touch the hair, provide firm pressure to the head when touching it”; “only attempt to wash, brush, or cut your child’s hair when they are calm and settled”; “Keeping your child’s hair short makes hair washing or rinsing much easier”; “Using dry shampoo … between hair washes, can reduce the frequency you need to wash your child’s hair”; “Some children do not like water in their ears”; “Hold a flannel or small towel over their eyes and face, or you can even try and encourage your child to hold the flannel themselves. A hair washing ‘hat’ … can also help keep water out of eyes and off the face. You can even try goggles or a snorkel mask”; “try taking the detachable hose off the hook and using it on a low pressure setting to rinse your child’s hair”; “Try using a jug or water cupped in your hands”; “Experiment with unscented shampoo”; “Wash your child’s hair over the sink or a basin, as some children can tolerate leaning forward to wet their hair better than lying down in the bath with their head back”; “Sometimes children are more tolerant of sensations when they are in control of them. Encourage your child to become independent in washing their own hair”; and “Try talking to your child about what it is they do not like about hair washing. It may be a fear of getting water in their eyes, disliking the feeling of wet hair, or the scent of the shampoo.”
47. Potegal M, May-Benson TA, Oxborough S, Hall A, McKnight S. Reduced gain and shortened time constant of vestibular velocity storage as a source of balance and movement sensitivities in gravitational insecurity. Occupational Therapy International. 2022;2022:5240907. PMID 35600904; full text PMC9106494. Checked October 31, 2026.
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    Gravitational insecurity “is classified as a sensory modulation problem due to the associated emotional reactions”; “most of what is known about GrI comes from its presentation in childhood as a reluctance to move the head out of an upright orientation (e.g., to lay back or somersault), sensitivity to motion (e.g., turning corners in cars), and fear of losing balance”; and in a normative sample of 1,392 adolescents and adults, 2% reported “avoiding head positions out of the upright when driving or hair-washing.”
48. Tazinaffo LS, Wolf BB, Sposito AMP, Hilton C. Performance of daily living activities of autistic children with sensory processing difficulties: caregivers’ perceptions. Occupational Therapy International. 2026;2026:5556699. PMID 41882948; full text PMC13140374. Checked October 31, 2026.
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    A qualitative study of 12 caregivers of autistic children aged 3 to 8 with sensory processing difficulties on the Sensory Profile 2: “Tactile hyperresponsiveness was the most frequent sensory modulation issue, identified in caregivers′ reports, interfering with self-care tasks such as bathing (rejection of sponges, water, and hair washing)” and personal hygiene (“aversion to nail/hair cutting and toothbrushing”).
49. Oxford Health NHS Foundation Trust, Children’s Community Occupational Therapy. Hair washing / cutting / brushing – Sensory. Leaflet, undated. Checked October 31, 2026.
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    “Ensure the child is aware of when you are going to touch their head”; “Use a firm stroke or pressure as you comb or wash your child’s hair”; “Have your child count as you comb, wash, cut or rinse the hair – give definite time limits to the task e.g. ‘let’s count to 10’”; “Give your child ownership and control with hair washing by allowing them to pour the water”; “Fold a flannel over the child’s eyes to reduce water getting into their eyes”; “Firm touch when massaging shampoo”; and “Use fragrant free shampoo.”
50. Ikuta N, Iwanaga R, Tokunaga A, Nakane H, Tanaka K, Tanaka G. Effectiveness of earmuffs and noise-cancelling headphones for coping with hyper-reactivity to auditory stimuli in children with autism spectrum disorder: a preliminary study. Hong Kong Journal of Occupational Therapy. 2016;28(1):24–32. PMID 30186064. Checked October 10, 2026.
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    “Twenty-one children with ASD aged 4-16 years”; “Four participants refused to wear either the earmuffs or the NC headphones. It was found that the T-score on the Goal Attainment Scaling was significantly higher during the earmuff period than that in the baseline period ... The behaviours of 5 children with ASD improved during the NC headphone period as compared with those in the baseline period; there were no differences in the T-scores on the Goal Attainment Scaling between the NC headphone period and the baseline period.”
51. Stephenson J, Carter M. The use of weighted vests with children with autism spectrum disorders and other disabilities. Journal of Autism and Developmental Disorders. 2009;39(1):105–114. PMID 18592366. Checked October 10, 2026.
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    “Seven studies examining weighted vests are reviewed. While there is only a limited body of research and a number of methodological weaknesses, on balance, indications are that weighted vests are ineffective ... weighted vests cannot be recommended for clinical application at this point.”
52. American Academy of Pediatrics, HealthyChildren.org. Baby Products to Avoid: Unsafe Registry Picks & Secondhand Gear. Last updated May 29, 2026. “Weighted blankets can make it harder for your baby to breathe. Your baby can also get trapped underneath a heavy blanket and suffocate.” Checked October 10, 2026.
53. Miller LJ, Coll JR, Schoen SA. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy. 2007;61(2):228–238. PMID 17436845. Checked October 10, 2026.
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    “Twenty-four children with SMD were randomly assigned to one of three treatment conditions; OT-SI, Activity Protocol, and No Treatment”; “The OT-SI group, compared to the other two groups, made significant gains on goal attainment scaling and on the Attention subtest and the Cognitive/Social composite of the Leiter International Performance Scale-Revised. Compared to the control groups, OT-SI improvement trends on the Short Sensory Profile, Child Behavior Checklist, and electrodermal reactivity were in the hypothesized direction.”
54. Acuna C, Gallegos-Berrios S, Barfoot J, Meredith P, Hill J. Ayres Sensory Integration with children ages 0 to 12: a systematic review of randomized controlled trials. American Journal of Occupational Therapy. 2025;79(3):7903205180. PMID 40193295. Checked October 10, 2026.
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    “Nine RCTs (N = 344 participants), six with autistic children and three with other child populations, were included”; “Strong evidence from five RCTs (four Level 1b) indicates that ASI supports autistic children in meeting their individualized goals. Moderate evidence from three RCTs (two Level 1b) indicates no benefits of ASI for behaviors of concern, such as noncompliance or irritability.”
55. Ben-Sasson A, Podoly TY, Lebowitz ER. The role of pediatric sensory over-responsivity and anxiety symptoms in the development of family accommodations. Child Psychiatry & Human Development. 2025;56(1):134–141 (published online May 23, 2023). PMID 37219643. Checked October 10, 2026.
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    “Sensory over-responsivity (SOR) is linked with elevated anxiety and reduced family wellbeing. Family accommodation of anxiety relates with greater symptom severity and reduced intervention outcome”; “Ninety families of typically developing children (ages 4-13 years) completed an online survey”; and “only SOR symptoms significantly predicted the frequency of sensory family accommodation, while both SOR and anxiety symptoms predicted the impact of family accommodation upon child and family well-being.”
56. Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over-responsivity, and oral health behaviors and outcomes: a conceptual model. International Journal of Environmental Research and Public Health. 2022;19(4):2380. PMID 35206566. Checked October 10, 2026.
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    “Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes”; “A total of 188 articles were included”; “SOR was associated with general anxiety/fear and DBMP [dental behavior management problems]”; the full text lists triggers as “sights (e.g., needles and drills), sounds (e.g., drilling), sensations (e.g., vibrations), and smells (e.g., clinical odors),” and says a sensory adapted dental environment “is now included in the American Academy of Pediatric Dentistry’s list of best practices as a potential basic behavior guidance technique for use with dental patients with anxiety or special healthcare needs.”
57. Bodison SC, Parham LD. Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: a systematic review. American Journal of Occupational Therapy. 2018;72(1):7201190040. PMID 29280714. Checked October 10, 2026.
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    “Eight studies met inclusion criteria”; “One study of sensory environmental modifications examined adaptations to a dental clinic for children with ASD. Strong evidence supported Qigong massage, moderate evidence supported sensory modifications to the dental care environment, and limited evidence supported weighted vests.”
58. American Speech-Language-Hearing Association. Classroom Acoustics. Undated. Checked October 10, 2026.
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    “Two things cause poor classroom acoustics: too much background noise and/or too much reverberation”; and “Place rugs or carpet in the room. Hang curtains or blinds in the windows. Hang soft materials such as felt or corkboard on the walls. Turn off noisy equipment when it is not in use. Replace noisy light fixtures. Show students how hard it can be to hear when many children talk at the same time. Place soft tips on the bottom of chairs and tables.”
59. U.S. Department of Education. 34 CFR 300.8, Child with a disability. Electronic Code of Federal Regulations, up to date as of October 8, 2026. Checked October 10, 2026.
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    The categories are “intellectual disability, a hearing impairment (including deafness), a speech or language impairment, a visual impairment (including blindness), a serious emotional disturbance ..., an orthopedic impairment, autism, traumatic brain injury, an other health impairment, a specific learning disability, deaf-blindness, or multiple disabilities”; autism’s definition adds that “Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences”; and “Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that (i) Is due to chronic or acute health problems ... and (ii) Adversely affects a child’s educational performance.”
60. U.S. Department of Education, Office for Civil Rights. Frequently Asked Questions: Section 504 Free Appropriate Public Education (FAPE). Page last reviewed June 30, 2025. Checked October 10, 2026.
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    “The determination of whether a student has a physical or mental impairment that substantially limits a major life activity must be made on the basis of an individual inquiry”; “A medical diagnosis of an illness does not automatically mean a student can receive services under Section 504. The illness must cause a substantial limitation on the student’s ability to learn or another major life activity”; and an eligible student “may receive adjustments in the regular classroom.”
61. Pearson Assessments. Sensory Profile 2. Product page for the questionnaires by Winnie Dunn, published 2014. Checked October 10, 2026.
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    “The Sensory Profile™ 2 family of assessments provides standardized tools to help evaluate a child’s sensory processing patterns in the context of home, school, and community-based activities”; “Age range: Birth–14:11”; and “caregivers and teachers report on the child’s response to sensory events throughout the day.”
62. WPS. Sensory Processing Measure, Second Edition (SPM-2). Product page for the rating scales by L. Diane Parham and colleagues, published 2021. “Ages: 4 months to 87 years”; “The SPM-2 items provide descriptive clinical information on processing vulnerabilities within each sensory system, including under- and over-reactivity, sensory-seeking behavior, and difficulties with perception.” Checked October 10, 2026.
63. Schoen SA, Miller LJ, Green KE. Pilot study of the Sensory Over-Responsivity Scales: assessment and inventory. American Journal of Occupational Therapy. 2008;62(4):393–406. PMID 18712002. “The SensOR Scales include the SensOR Assessment, an examiner-administered performance evaluation, and the SensOR Inventory, a caregiver self-rating scale. Both scales measure sensory overresponsivity in 7 sensory domains.” Checked October 10, 2026.
64. Cermak SA, Curtin C, Bandini LG. Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association. 2010;110(2):238–246. PMID 20102851. Checked October 10, 2026.
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    “Children with autism spectrum disorders are often described as picky or selective eaters”; the review discusses “The possible contributions of sensory factors, such as sensory sensitivity, to food selectivity” and the “need for an interdisciplinary approach to managing atypical eating patterns.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. Sensory and motor concerns are best assessed by an occupational or physical therapist who can evaluate your individual child.