Journal of Child Psychology and Psychiatry 47:6 (2006), pp 591601

doi:10.1111/j.1469-7610.2005.01546.x

Sensory Experiences Questionnaire:

discriminating sensory features in young
children with autism, developmental delays,
and typical development
Grace T. Baranek,1 Fabian J. David,1 Michele D. Poe,1 Wendy L. Stone,2
and Linda R. Watson1
1

University of North Carolina at Chapel Hill, USA; 2Vanderbilt University, USA

Background: This study describes a new caregiver-report assessment, the Sensory Experiences Questionnaire (SEQ), and explicates the nature of sensory patterns of hyper- and hyporesponsiveness, their
prevalence, and developmental correlates in autism relative to comparison groups. Method: Caregivers
of 258 children in five diagnostic groups (Autism, PDD, DD/MR, Other DD, Typical) ages 580 months
completed the SEQ. Results: The SEQs internal consistency was a .80. Prevalence of overall sensory
symptoms for the Autism group was 69%. Sensory symptoms were inversely related to mental age. The
Autism group had significantly higher symptoms than either the Typical or DD groups and presented with
a unique pattern of response to sensory stimuli hyporesponsiveness in both social and nonsocial
contexts. A pattern of hyperresponsiveness was similar in the Autism and DD groups, but significantly
greater in both clinical groups than in the Typical group. Conclusion: The SEQ was able to characterize
sensory features in young children with autism, and differentiate their sensory patterns from comparison
groups. These unique sensory patterns have etiological implications, as well as relevance for assessment
and intervention practices. Keywords: Sensory modulation/processing, hyper/hyporesponsiveness,
autism, developmental disabilities.

There is a dearth of research on the nature of sensory features in autism despite decades of phenomenological reports documenting the presence of
these intriguing behaviors. As early as 1943, Kanner
described sensory fascinations that provided endless joy, such as staring at light reflecting from
mirrors, as well as heightened sensitivities that
caused distress, for example covering ears to certain
sounds, in some children with autism. Recently,
qualitative descriptions posted on websites of
persons with autism have emerged in the literature,
adding to our understanding of these unusual features (Jones, Quigney, & Huws, 2003). The two
most common sensory patterns reported among
myriad terms are hyper- and hyporesponsiveness
(Baranek, 2002; ONeill & Jones, 1997). Hyporesponsiveness refers to lack of response, or insufficient intensity of response to sensory stimuli
(e.g., diminished response to pain, lack of orienting
to novel sounds). Hyperresponsiveness is an exaggerated behavioral response to sensory stimuli
(e.g., aversive reaction to lights, covering ears to
sounds, avoidance of touch). These two behaviorally
observed patterns have also been confirmed by a few
psychophysiological studies in autism and related
populations (Hirstein, Iversen, & Ramachandran,
2001; McAlonan et al., 2002; Miller, Reisman,
McIntosh, & Simon, 2001). Preliminary evidence
suggests that sensory patterns of hyper- and hyporesponsiveness may co-exist in autism (Greenspan

& Wieder, 1997; Hirstein et al., 2001; Williams,

1994), adding a layer of complexity underlying
explanations of such features.
Although unusual sensory experiences are
thought not to be universal in autism (Baranek,
2002; Dawson & Watling, 2000), large-scale epidemiological studies are lacking. In smaller-scale
studies prevalence rates vary dependent upon
methodologies used and behaviors sampled. For
example, Greenspan and Wieder (1997) reviewed
clinical charts of children with autism and reported
that 100% had auditory processing problems.
Volkmar, Cohen, and Paul (1986) used parent report
methods to determine that 53% of their sample were
disturbed by noises; whereas teacher-report methods used by Baranek, Foster, and Berkson (1997)
found a lower rate of 30% for auditory hyperresponsiveness. Likewise, rates may depend upon
participant characteristics (e.g., age, diagnosis) that
vary in these studies. Although unusual sensory
features have been reported across all sensory
modalities, auditory symptoms are more commonly
endorsed, or perhaps, more commonly studied in
autism due to a hypothesized relationship with language deficits. Recent neuroscience theories
emphasize the multimodal nature of sensory processes for adaptive behavior, suggesting that a unimodal sensory stimulus will trigger a variety of
cross-modal functions and result in a holistic perceptual experience (Schroeder & Foxe, 2004).

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592

Grace T. Baranek et al.

Higher overall rates of sensory symptoms are

consistently reported in children with autism compared to typically developing children (Kientz &
Dunn, 1997; Ornitz, 1987; Talay-Ongan & Wood,
2000; Watling, Deitz, & White, 2001). Among the
most intriguing of questions is whether or not sensory features are unique to autism an answer to
such a question may inform etiological explanations
and interventions. This issue of specificity has been
a source of skepticism in the literature, as sensory
symptoms are also evidenced in other populations.
Children with ADHD (Ermer & Dunn, 1998), Fragile
X, and other developmental delays (Rogers, Hepburn, & Wehner, 2003) have higher rates of sensory
symptoms as compared to typical norms. Studies
utilizing appropriate developmental controls are required to sort out sensory features uniquely associated with autism, independent of cognitive delay
that often co-occurs in autism. Two such studies
utilizing parent-report methods (Lord, 1995; Rogers
et al., 2003) found that preschoolers with autism
had greater sensory symptoms than children with
nonspecific developmental delays; whereas another
study (Stone & Hogan, 1993) did not find such differences. Thus, the question of specificity of sensory
features requires further investigation.
Unusual sensory symptoms cannot be attributed
to deficits in visual or hearing acuity (Rosenhall,
Nordin, Sandstroem, Ahlsen, & Gillberg, 1999;
Scharre & Creedon, 1992). Etiological speculations
based on behavioral or physiological studies of sensory features in autism have included dysmodulation of sensory input (Ornitz, 1989), impaired
sensory discrimination (Tecchio et al., 2003), generalized hyperarousal (Hirstein et al., 2001), overselective attention (Kinsbourne, 1987), deficient
sensorimotor gating (McAlonan et al., 2002), imbalance of excitation/inhibition in key neural systems
(Rubenstein & Merzenich, 2003), and canalesthesia
(Waterhouse, Fein, & Modahl, 1996). Although
neuropsychological theories (e.g., social cognition)
account for core social features of autism, they do
not sufficiently explain the cause of hyper- and
hyporesponsiveness to sensory stimuli. Likewise,
attributing sensory hyperarousal as an etiological
explanation for social deficits in autism is equally
inadequate (Corona, Dissanayake, Arbelle, Wellington, & Sigman, 1998). More research is needed to
determine whether sensory abnormalities and core
social features of autism interact, or whether these
two domains, and perhaps their underlying
mechanisms, are largely independent.
Developmental perspectives addressing how and
when sensory features manifest and change during
early childhood are lacking in the literature. Existing
studies engender controversy about age of onset of
sensory features in autism (Baranek, 1999a; Stone &
Hogan, 1993), and whether these symptoms increase (Talay-Ongan & Wood, 2000), decrease (Baranek et al., 1997), or do not change (Rogers et al.,

2003) with maturation. A contributing factor to the

dearth of knowledge about the nature and development of sensory features is the lack of sensitive, reliable, and valid tools with a strong conceptual base
for characterizing specific sensory patterns in young
children with autism.
Caregiver report instruments are ecologically valid
for obtaining information about childrens behavior.
Two such sensory assessments that are not specific
to autism but often used in the United States are the
Sensory Profile (Dunn, 1999) and the Evaluation of
Sensory Processing (Johnson-Ecker & Parham,
2000). Another parent-report instrument, the Sensory Sensitivity Questionnaire-Revised (Talay-Ongan
& Wood, 2000) developed in Australia, was specifically designed for autism. However, none of these
tools specifically separates patterns of hyper- from
hyporesponsiveness across social and nonsocial
contexts, and none has established validity in discriminating sensory features between young children with autism and those with developmental
delays (DD).
Psychometric studies are needed to validate tools
that can accurately characterize the sensory phenotype of young children with autism. The purpose of
this study was to assess specific psychometric
properties of the Sensory Experiences Questionnaire
(SEQ), and explicate the nature of sensory patterns,
their prevalence, uniqueness, and developmental
correlates in a sample of young children with autism
and related disorders using the SEQ. Our questions
were:
1. What is the SEQs internal consistency (reliability)?
2. What is the prevalence of sensory features in
children with autism in our sample?
3. Do maturational variables correlate with level of
sensory symptoms?
4. Do overall sensory features in children with autism
differ from those of typically developing children
and children with other DD? If so, a) what sensory
patterns (levels of hyper/hyporesponsiveness)
best distinguish the groups, and b) does the social
versus non-social context of sensory experiences
affect patterns differentially among groups?

Method
Instrument
The Sensory Experiences Questionnaire (SEQ; formerly
known as the Sensory Supplement Questionnaire) is a
brief (10-minute) caregiver report instrument designed
to evaluate behavioral responses to common everyday
sensory experiences in children ages 5 months through
6 years. Its primary purpose is to characterize sensory
features in young children with autism, and to discriminate patterns of hypo- and hyperresponsiveness
among those with autism, DD, or typical development.
The SEQ is intended to be used either for research

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2006 Association for Child and Adolescent Mental Health.

SEQ

purposes, or as a clinical supplement to traditional

developmental or diagnostic assessments that typically
do not tap sensory features. Because it is a brief evaluation, it can be used expeditiously in pediatric
screening settings to provide direction for more extensive observational assessments of sensory modulation
functions and/or intervention planning.
The SEQs items were selected by conducting a
thorough review of the literature on sensory abnormalities in children with autism spectrum disorders,
including empirical studies (Ayres & Tickle, 1980;
Baranek et al., 1997), parental report studies (Kientz &
Dunn, 1997; Lord, 1995; Ornitz, Guthrie, & Farley,
1977; Stone & Hogan, 1993), expert clinical reports
(Greenspan & Wieder, 1997), conceptual models of
sensory processing (Ayres, 1989; Dunn, 1997; Miller
et al., 2001), and consideration of neuropsychological
theories of autism describing core social features
(Mundy & Neal, 2001; Waterhouse et al., 1996). The
conceptual structure for the SEQ follows the model
depicted by Baranek, Reinhartsen, and Wannamaker
(2001), whereby two thresholds for processing sensation
a sensory orienting threshold and a sensory aversion
threshold may shift to result in varying degrees of
hyper- and/or hyporesponsiveness seen behaviorally.
Thus, the SEQ items largely reflect hyper- and hyporesponsiveness patterns. Additionally, the SEQ framework considers whether sensory experiences occur in a
predominantly social context (e.g., tolerating physical
contact with people), or a nonsocial context (e.g.,
responding to loud sounds or textured objects). Socialcognitive deficits central to autism may impact upon a
childs ability to understand other peoples intentions
(Baron-Cohen, 2000; Hobson, 1990; Sigman & Ruskin,
1999), and potentially could create more variability in
responding to particular types of sensory experiences.
The 21 items on this research version of the SEQ are
each divided into three parts: (a), (b), and (c). Questions
in part (a) ask the caregiver to rate the frequency of occurrence of a childs sensory experience, based on a 5point Likert scale: 0 almost never, 1 once in a while,
2 sometimes, 3 frequently, and 4 almost always.
Part (b) of each SEQ item asks the caregiver to choose if
he/she attempts to change (e.g., intervene with) the
childs sensory behavior, and uses a binary scale yes
or no, while part (c) requests the caregiver to describe
the specific strategies used to change the behavior (i.e.,
support, cope, intervene).
This study presents only the quantitative data (Part
(a) 21 questions) of the SEQ representing caregiver
perceptions of the childs responses to common sensory
experiences. Sum scores for all 21 items, as well as
scale scores for Hyper- (10 items) and Hypo- (11 items)
responsiveness are derived. Because we were interested
in the nature of sensory responses under both social
and nonsocial contexts for this study, the items were
further designated as primarily Social (8 items) or Nonsocial (13 items). Thus, the SEQ items were divided into
four mutually exclusive sensory subscales (hypo-social
3 items; hypo-nonsocial 8 items; hyper-social 5
items; hyper-nonsocial 5 items) for analysis. Higher
scores indicate greater symptoms. Mean scale and
mean subscale scores range from 0 to 4. Table 1 lists
the 21 SEQ Items, their conceptual groupings, and item
means across groups.

593

The SEQ caregiver report format provides a reliable

and valid method for collecting information about
young children who cannot report for themselves. It can
be filled out by caregivers who have at least a 6th-grade
reading level. Preliminary findings indicated that out of
111 parents, 72% rated the SEQ easy to use, 25%
rated it average, and only 3% rated it as confusing or
difficult (Parsons, Tignor, Beers, & Baranek, 2001).
Testretest reliability of the SEQ on 20 caregivers conducted 23 weeks apart was ICC .81 (Guckian, Carbine, Sparkman, & Baranek, 2002). Convergent validity
between the SEQ and an observational measure the
Sensory Processing Assessment (Baranek, 1999b) was
r .36 for SEQ hyporesponsiveness with SPA orienting
to novel sensory stimuli, and r .43 for SEQ hyperresponsiveness with SPA avoidance/aversion to sensory toys (Baranek & Costello, 2003).

Participants
SEQ data from 290 children ages 580 months were
collected in this study using convenience-sampling
methods. Thirty-two participants were excluded, as
they did not meet our inclusion/exclusion criteria. Our
final sample included 258 SEQs completed by primary
caregivers of children with autism (n 56), other pervasive developmental delays (PDD) (n 24), developmental disabilities/mental retardation (DD/MR) (n
33), other developmental delays (Other DD) (n 35)
and typical development (n 110). Table 2 provides
descriptive statistics. Table 3 summarizes demographic
data.

Procedures
Because data were pooled from several projects, procedures varied with the nature of the studies, all approved by institutional review boards. In approximately
50% of our sample, SEQs were distributed to parents of
typical children in public schools, or to children with
autism or DD participating in diagnostic evaluations at
one of several developmental clinics where no additional assessments or direct contact was being requested. Out of 322 SEQs distributed, 134 (47%) were
returned. In the remaining 50% of the sample, SEQs
were pooled from two studies about early development.
Similarly, children were recruited from preschools,
early intervention centers, clinics, and parent support
groups. Parents filled out the SEQ, and children completed developmental and diagnostic assessments.
The Autism group (n 56) included children diagnosed with Autistic Disorder by a licensed psychologist or physician, confirmed by the Childhood Autism
Rating Scale (Schloper, Reichler, & Renner, 1986) or the
Autism Diagnostic Observation Schedule (Lord, Rutter,
Dilavore, & Risi, 1999), or the Autism Diagnostic Interview-Revised (Lord, Rutter, & Le Couteur, 1994). The
PDD group (n 24) included children with Asperger
Disorder or PDDNOS. One of these children additionally
had an idiocentric chromosome 15. The DD/MR (n
33) group included children with known developmental
disabilities associated with mental retardation, or
developmental delay of a nonspecific nature (i.e., IQ > 2
standard deviations below the mean), or significant

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Grace T. Baranek et al.

Table 1 Abbreviated SEQ items, conceptual groupings, and item means across groups
Mean (SD)
SEQ Item# Sensory mode Autism n 56 PDD n 24 DD Combined n 68 Typical n 110

Subscale/Item
Hypo-Social
Does not respond to name
Ignores new person
Seeks rough-housing play
Raw Score
Mean Score
Hypo-NonSocial
Stares at lights/objects
Flaps arms
Lacks attention to novel objects
Mouths objects
Ignores loud noises
Smells objects
Does not respond to pain
Craves movement
Raw Score
Mean Score
Hyper-Social
Dislikes being held
Distressed during grooming
Averse to social touch
Avoids eye contact
Dislikes tickling
Raw Score
Mean Score
Hyper-NonSocial
Sensitive to loud noises
Avoids textures
Sensitive to lights
Averse to water
Avoids food taste/texture
Raw Score
Mean Score
Overall SEQ Raw Score
Overall SEQ Mean score

4
17
21

A
V
P

3.18
2.49
3.23
8.89
2.96

(.97)
(1.12)
(1.32)
(2.24)
(.75)

2.79
2.04
2.67
7.50
2.50

(1.02)
(1.2)
(1.58)
(2.90)
(.97)

2.49
1.62
2.94
7.04
2.35

(1.00)
(1.05)
(1.38)
(2.14)
(.71)

2.15
1.22
2.41
5.78
1.93

(.94)
(.58)
(1.18)
(1.85)
(.62)

7
8
9
10
13
16
18
20

V
P
V
G
A
G
T
P

3.05
2.82
2.16
2.66
1.80
1.37
1.73
3.36
19.08
2.38

(1.27)
(1.56)
(1.11)
(1.5)
(1.15)
(.92)
(1.26)
(1.42)
(5.39)
(.67)

2.04
2.58
1.75
3.00
1.63
1.26
2.04
2.75
17.26
2.16

(1.37)
(1.53)
(1.19)
(1.59)
(1.17)
(.75)
(1.33)
(1.62)
(6.00)
(.75)

2.31
2.18
1.43
2.57
1.24
1.54
1.96
2.93
16.18
2.02

(1.37)
(1.4)
(.82)
(1.35)
(.74)
(1.04)
(1.19)
(1.59)
(5.43)
(.68)

2.29
1.95
1.13
2.66
1.16
1.35
1.63
2.81
15.00
1.88

(1.41)
(1.23)
(.59)
(1.47)
(.52)
(.74)
(1.00)
(1.34)
(4.48)
(.56)

1
3
11
12
19

T
T
T
V
T

1.71
3.27
2.16
2.71
1.13
10.98
2.20

(1.02)
(1.47)
(1.2)
(1.19)
(.51)
(3.61)
(.72)

1.67
3.21
1.92
2.52
1.17
10.39
2.08

(1.2)
(1.47)
(.97)
(1.2)
(.48)
(3.59)
(.72)

1.94
2.63
1.96
1.81
1.47
9.84
1.97

(1.18)
(1.42)
(1.11)
(1.18)
(.98)
(3.67)
(.73)

1.66
2.68
1.61
1.17
1.32
8.46
1.69

(.95)
(1.22)
(.87)
(.54)
(.62)
(2.50)
(.50)

2
5
6
14
15

A
T
V
T
G

2.27
2.38
1.27
1.39
3.91
11.21
2.24
50.42
2.40

(1.39)
2.38 (1.21)
(1.37)
2.5 (1.41)
(.62)
1.42 (.83)
(.93)
1.42 (1.02)
(1.23)
3.29 (1.52)
(3.16) 11.00 (4.00)
(.63)
2.20 (.80)
(10.43) 46.00 (12.01)
(.50)
2.19 (.57)

1.97
1.21
1.44
1.2
2.54
8.35
1.67
37.48
1.78

(1.09)
(.64)
(.88)
(.59)
(1.25)
(2.31)
(.46)
(7.16)
(.34)

2.60
1.91
1.53
1.53
2.60
10.18
2.04
43.42
2.07

(1.38)
(1.17)
(1.00)
(1.06)
(1.39)
(3.89)
(.78)
(11.57)
(.55)

A Auditory, V Visual, P Vestibular/Proprioceptive, G Gustatory/Olfactory, T Tactile, PDD Pervasive Developmental

Disorders, DD Developmental Delay.

Table 2 Descriptive statistics chronological age, mental age, and IQ

Chronological age (months)
Group
Autism
PDD
DD/MR
Other DD
Typical
Total

Mental age (months)

IQ (z scores)*

Mean

SD

Min

Max

Mean

SD

Min

Max

Mean

SD

Min

Max

56
24
33
35
110
258

40.47
39.14
33.72
33.40
29.30
33.76

12.76
10.81
9.17
10.86
11.55
12.21

23
26
11
16
5
5

80
73
56
64
49
80

48
14
25
24
110
221

20.41
31.32
22.55
28.06
29.57
26.73

7.89
16.06
7.09
12.18
11.83
11.62

11
16
8
12
7
7

58
68
38
64
52
68

47
14
25
22
31
139

)2.95
)1.76
)2.14
).92
.21
)1.66

.77
1.25
1.17
.98
.91
1.55

)4.49
)3.40
)3.40
)3.18
)1.40
)4.49

.47
.93
.60
.73
2.10
2.10

PDD Pervasive Developmental Disorders, DD/MR Developmental Delay, Other DD Other Developmental Delay.
*Standard scores from different scales were used and converted to z scores to compute group means.

delays (>1.5 standard deviations below the mean) in at

least two developmental domains (i.e., Expressive Language, Receptive Language, Cognitive/Visual Reception, Fine or Gross Motor, and/or Adaptive Behavior).
This group specifically included 11 children with Down
syndrome and one with DiGeorges syndrome. The
Other DD group (n 35) included children with specific
developmental delays (e.g., Expressive or Receptive
Language Disorder, ADHD, etc.) that were milder or

more limited in scope than the DD/MR group. The

Typical group (n 110) included children without significant developmental or learning problems, or those
receiving special education/therapy services.
Exclusionary criteria for all groups included the following: co-morbid conditions of autism such as fragile X
syndrome and tuberous sclerosis, mental age (MA)
<6 months, severe physical impairment (e.g., cerebral
palsy), significant visual or hearing impairment, and

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SEQ

595

Table 3 Demographics by group

Demographic variable

Autism n 56

PDD n 24

DD/MR n 33

Other DD n 35

Typical n 110

86.8%
13.2%

82.6%
17.4%

75.8%
24.2%

76.5%
23.5%

46.8%
53.2%

67.3%
23.1%
3.8%
.0%
3.8%
1.9%

87.0%
.0%
.0%
.0%
13.0%
.0%

45.5%
27.3%
.0%
.0%
3.0%
24.2%

47.1%
23.5%
2.9%
.0%
5.9%
20.6%

32.1%
6.4%
.0%
.0%
2.8%
58.7%

73.2%
7.1%
10.7%
1.8%
7.2%

83.3%
4.2%
12.5%
.0%
.0%

81.8%
9.1%
3.0%
3.0%
3.0%

74.3%
5.7%
11.4%
.0%
8.6%

94.5%
1.8%
3.6%
.0%
.0%

.0%
15.7%
27.5%
45.1%
11.8%

.0%
22.7%
18.2%
22.7%
36.4%

6.3%
18.8%
15.6%
25.0%
34.4%

8.8%
17.6%
14.7%
35.3%
23.5%

.9%
1.9%
6.5%
53.3%
37.4%

Child gender
Male
Female
Child race
Caucasian
African-American
Hispanic
Asian
Other
Unknown
Respondent
Mother
Father
Both
Grandparent
Other primary
Respondent education
Grade 711
HS graduate
Partial college
College degree
Graduate degree

PDD Pervasive Developmental Disorders, DD/MR Developmental Delay, Other DD Other Developmental Delay.

undergoing psychopharmacological treatments that

may alter responses to sensory stimuli (e.g., phenobarbital), as indicated by parents or from medical
records.
Standardized developmental assessments varied
[e.g., Bayley II- Mental Developmental Index (Bayley,
1993); Mullen Scales of Early Learning (Mullen, 1995)]
depending upon the childs age and/or protocol of the
clinic or research study. The vast majority of available
assessment results (76%) were administered within
4 weeks of completing the SEQ. The remaining scores
were retrieved from records of the most recent clinical
assessment usually within 12 months. We were able to
calculate mental age (MA) for 221 of the 258 children.
MA was derived directly from available cognitive
assessments, or converted from standard scores. The
correlation between chronological age (CA) and MA in
our typical sample was extremely high (r .95, CA and
MA difference in means 1 month); thus, CA scores
were the best available estimate of MA for those children
in the typical group with missing scores (n 78). Missing MA data for 37 children in the clinical groups (Autism, PDD, DD/MR, Other DD) were statistically treated
as randomly missing. See Table 2 for descriptives.

Data analysis
Both descriptive and inferential analyses were used.
The MR/DD and Other DD groups were found to be
neither clinically nor statistically different from one
another, having similar means and standard deviations
across the four subscales (see Table 4). Therefore, the
groups were merged as a DD Combined group for the
remaining inferential analyses.
To correct for randomly missing values (n 37), a
variable was created indicating whether MA was available (missing 0) or not available (missing 1), for all
subjects. The MA variable was then mean centered
around 0 and missing values were replaced with a value
of 0. This method allowed participants with randomly
missing MA scores to be included in the analyses, while
adjusting the model estimates for any differences in
SEQ mean scores for those missing MA. It also corrected for the reduced variation due to assigning the mean
value to those with missing values.
The final analysis examined whether sensory patterns differed across groups and between subscales.
This analysis was performed using a repeated measures
mixed model with an unconstrained variancecovari-

Table 4 Means and standard deviations of the SEQ subscales and SEQ total mean scores by group
Autism
Subscale
Hypo-Social
Hyper-Social
Hypo-Nonsocial
Hyper-Nonsocial
Mean Total

PDD

DD/MR

Other DD

Typical

Mean

SD

Mean

SD

Mean

SD

Mean

SD

Mean

SD

3.0
2.2
2.4
2.2
2.4

.75
.72
.67
.63
.51

2.5
2.1
2.2
2.2
2.2

.97
.72
.75
.80
.56

2.3
2.0
2.1
2.0
2.1

.79
.73
.64
.74
.52

2.4
1.9
2.0
2.0
2.0

.63
.74
.72
.82
.58

1.9
1.7
1.9
1.7
1.8

.62
.50
.56
.46
.34

PDD Pervasive Developmental Disorders, DD/MR Developmental Delay, Other DD Other Developmental Delay.

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Grace T. Baranek et al.

ance structure for the within-person measures

(Gueorguieva & Krystal, 2004). Each child could have
up to four measures, one for each SEQ subscale. Two
dichotomous variables indicating if the measure was
social ( 1) or non-social ( 0) in context, and hypo( 1) or hyper- ( 0) in responsiveness, were created to
define each subscale. For example, the hypo-social
subscale would be indicated by a 1 for the hypo/hyper
responsiveness variable and a 1 for the social/nonsocial context variable. The final model included group
membership, social/non-social context, hypo/hyperresponsiveness, MA, the MA missing indicator, and all
possible interaction terms. Variations in effects across
subscales and between groups were evaluated by
examining the group*context*responsiveness interaction term.

Results
The first question examined the internal consistency
of the full 21-item SEQ; Cronbachs a was .80. In
addition, alphas were calculated by diagnostic group
splitting subjects into younger and older groups
based on a median split of 33 months. See Table 5.
The second question investigated the prevalence of
sensory features in the autism group (see Figure 1a),
and found that 69% of the children in the Autism
group had a SEQ total mean score greater than 1
standard deviation (SD) above the mean of the typical controls. Specifically, 30% were between 1 and 2
SDs and 39% were greater than 2 SDs above the
typical mean. Figure 1a also indicates proportions of
hyporesponsiveness, hyperresponsivness, and both
hyper-and hyporesponsiveness in the Autism group
relative to typical means. As a contrast, Figure 1b
provides the prevalence of sensory features in the DD
group.

Table 5 Co-efficient alpha for the SEQ by age, group, and

scale

Entire sample
Young
Old
Autism
Young
Old
DD combined
Young
Old
Typical
Young
Old
Social Scale
Non-Social Scale
Hypo Scale
Hyper Scale

NE

Alpha

# of items

249
129
120
53
17
36
66
36
30
107
67
40
253
251
250
255

.80
.77
.82
.78
.78
.75
.81
.80
.82
.63
.66
.56
.68
.68
.72
.71

21
21
21
21
21
21
21
21
21
21
21
21
8
13
11
10

33 months CA is the median age of the entire sample (n 258).

Young 33 months CA; Old >33 months CA.
E
Missing cases were deleted during computation of Coefficient
alpha.

In addition to the planned analyses, we explored

whether any participant characteristics differed
between children with high versus low sensory
abnormalities within the Autism group; we divided
the Autism group into two subgroups (+/)1 SD of the
typical mean on SEQ) and ran appropriate statistics
(i.e., t-tests or chi-squares). We found no significant
differences for CA [t(51) ).04, p .97], IQ [t(42)
.841, p .41], child gender [v21;n50 3.43, p
.06], child race [v24;n49 4.12, p .39], respondent
(mother, father etc.) [v24;n53 1.45, p .9], and
respondent education [v23;n48 .46, p .93].
In the analysis relating SEQ scores to maturational variables, SEQ mean scores were found to be
inversely related to MA (slope ).013, p < .001) in
the full cross-sectional sample. That is, as MA increased, the level of sensory symptoms decreased at
a rate of .09 standard deviations per year. The relationship between MA and the SEQ means score did
not vary across groups [F(4,247) .04, p .99]. The
possible relationship between CA and SEQ mean
score was evaluated and found to be non-significant
[F(4,247) .304, p .88]. The effects of IQ on SEQ
mean score were also evaluated and found to be nonsignificant [F(4,131) .79, p .53]. The differences in
sensory patterns between the Autism group and the
comparison groups were examined by regressing
group, MA, and MA missing, on the SEQ mean score.
The SEQ mean score was found to vary significantly
across the groups [F(4,251) 12.4, p < .001]. The
Autism group had significantly higher overall
symptoms than either the Typical or DD groups
(Table 6). Children with PDD scored lower than
children with Autism; however, this difference was
not statistically significant for overall symptoms,
although significant differences were noted on the
subscales. Gender effects were also assessed, and
while the sensory scores for boys in the DD Combined group were significantly lower than the scores
for girls [b ).53, p .003], gender was not found
to be a significant predictor for any of the other
groups, nor did it affect the relationship between
group and SEQ mean score.
Using a repeated measures regression model, the
four SEQ subscales (hypo-social, hyper-social, hypononsocial, and hyper-nonsocial) were examined to
assess the uniqueness of sensory patterns in children with Autism compared to the other groups.
Table 6 presents the MA adjusted SEQ mean scores,
subscale scores, and the two-way contrasts. When
compared to the Typical group the Autism and PDD
groups presented with increased SEQ symptoms
across all four subscales, while the DD group presented with elevated symptoms for three subscales
(i.e., hypo-social, hyper-social, and hyper-nonsocial).
Furthermore, when compared to the DD group, the
Autism group exhibited greater hyporesponsiveness
across contexts (hypo-social b .59, p < .001; hypononsocial b .33, p < .01). In summary, the Autism
group showed increased symptoms across all

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2006 Association for Child and Adolescent Mental Health.

SEQ

597

(a)
100%
21%

90%

36%

39%

80%

56%

63%

69%

70%
60%

38%

40%
17%

20%
23%

30%

50%
40%

62%

30%

44%

20%

37%

31%

10%
0%

Overall Sensory
Symptoms
Within 1SD of typical mean

Hyper responsive

Hypo responsive

Between 1 and 2SD of typical mean

Both Hyper + Hypo

responsive
Above 2SD of typical mean

(b)

1%

2%

100%
90%

22%

38%

21%

21%

40%

30%

80%
70%
60%
98%

50%
40%

80%
62%

30%

60%

20%
10%
0%

Overall Symptoms
Within 1SD of typical mean

Hyper responsive

Hypo responsive

Between 1 and 2SD of typical mean

Both Hyper + Hypo

responsive
Above 2SD of typical mean

Figure 1 Prevalence of sensory symptoms. a. Autism group. b. Developmental Delay Combined group. Note: Bars are
not mutually exclusive.

subscales, with a disproportionately larger increase

on the hypo-social responsiveness pattern compared
to all groups, including the PDD group.

Discussion
Our results suggest that the 21-item SEQ possesses
acceptable reliability (internal consistency) for children ages 5 through 80 months. In addition, the
SEQ was useful in characterizing sensory features in
young children with autism, and differentiating them
from children with either DD or typical development,
providing evidence for construct validity (i.e., knowgroups validation; DeVellis, 2003). Sensory symptoms were highest in the Autism group, followed by
the PDD group, then the Combined DD group, and
lowest in the Typical group. Furthermore, the SEQ
was able to distinguish specific sensory patterns; the
pattern best discriminating the children with autism
from all other groups (including PDD) was
hyporesponsiveness to sensory stimuli in social

contexts. Hyporesponsiveness to sensory stimuli in

nonsocial contexts also differentiated the Autism
group from both the DD and Typical groups, indicating the uniqueness of this pattern regardless of
context. These findings point to the SEQs utility in
characterizing the sensory phenotype of children
with autism for research, or clinical purposes as a
supplement to conventional developmental and
diagnostic assessments.
Our findings further elucidate the developmental
nature of sensory features in young children. Sensory symptoms were negatively related to MA, such
that less developmentally mature children evidence
the highest rates of sensory processing problems.
Despite controversy in the literature, this study
provides evidence from a larger cross-section of ages
and diagnostic groups to support its conclusions.
There are several possible explanations for our
findings. As children mature and gain life experiences, their repertoire of coping strategies expands in
number and sophistication. Likewise, executive

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598

Grace T. Baranek et al.

Table 6 Adjusted SEQ mean scores and differences between groups for the four SEQ subscales
Mean score

Hypo-social score
Hyper-social score
Hypo-nonsocial score
Hyper-nonsocial score

Differences

Autism

PDD

DD

Typical

AT

APDD

ADD

PDDT

PDDDD

DD-T

2.94
2.17
2.35
2.21

2.52
2.12
2.19
2.24

2.35
1.97
2.02
2.04

1.95
1.71
1.89
1.69

.99***
.46***
.46***
.52***

.42*
.05
.16
).03

.59***
.20
.33**
.17

.58***
.41**
.30*
.55***

.17
.16
.17
.20

.41***
.26*
.13
.35***

PDD Pervasive Developmental Disorders, DD Developmental Delay Combined, A Autism, T Typical.

*p < .05; **p < .01; ***p < .001; Adjusted for mental age.

functions mature rapidly during the preschool years

and provide increased inhibitory functions and
flexibility in behavior which may allow better coping
in response to stressful experiences, or better abilities to discriminate novel stimuli. Using the SEQ in
longitudinal studies would further strengthen our
developmental perspective. Future studies should
include observational measures to corroborate parental reports; parents may underestimate sensory
processing difficulties even in verbal children (Parush, Doryon, & Katz, 1996). Thus, for children with
autism who are less verbally competent, the likelihood of underestimating sensory processing problems may be elevated.
The prevalence of sensory features in our sample
was high 69% of children with autism had elevated
sensory symptoms relative to means for typically
developing children. Even when applying a more
conservative metric (>2 SD above mean), 39%
demonstrated severe levels of overall sensory symptoms. These findings indicate that abnormal sensory
features are common but not universal in children
with autism. Furthermore, no specific participant
characteristics (e.g., race, education, gender) seemed
to predict which children within the Autism group
were more likely to have high levels of sensory
symptoms. Interestingly, both hyper- and hyporesponsiveness were evident simultaneously in about
38% of our sample, indicating that some children
show mixed patterns of response consistent with
other studies (Greenspan & Wieder, 1997). Our
prevalence rates need to be interpreted cautiously
since it is not known whether our convenience
sample reflects the general population of children
with autism.
Our findings also confirm that preschool children
with autism reflect a unique pattern of sensory features hyporesponsiveness that discriminated
children with autism from children with typical
development as well as children with DD. This pattern
held up under both social and nonsocial contexts on
the SEQ, indicating a more general deficit in sensory
hyporesponsiveness than previously proposed (Corona et al., 1998). Studies investigating physiological
underpinnings of these features may wish to deemphasize specific sensory symptoms or modalities,
focusing rather on the multisensory nature of
response patterns, particularly hyporesponsiveness

in children with autism. Sensory gating, discrimination, attention, and/or motivation systems hypothetically connected with behavioral features of
sensory hyporesponsiveness across social and nonsocial contexts deserve further study. Deficits in
disengaging attention and shifting attention, perhaps
related to cerebellar functions, are often reported in
the autism literature (Allen & Courchesne, 2001;
Landry & Bryson, 2004). Also, lack of orienting to
stimuli in children with autism has been evidenced in
both social and nonsocial sensory contexts, and appears related to neural functions in the amygdala and
fronto-striatal systems (Dawson, Meltzoff, Osterling,
& Rinaldi, 1998).
Furthermore, this study revealed that a pattern of
hyperresponsiveness (social and nonsocial) is similarly characteristic of children with autism and DD.
The pattern was less characteristic of typically
developing children as a whole, although younger/
less mature children evidenced slightly higher levels
of aversive reactions to novel sensory stimuli. This
brings up two issues. First, the presence of hyperresponsiveness at similar rates in children with
autism and DD points to a general maturational
deficit that perhaps is shared among these clinical
groups. Researchers studying fragile X syndrome
have pointed to problems in arousal modulation or
habituation (Roberts, Boccia, Bailey, Hatton, &
Skinner, 2001). Second, even though sensory hyperresponsiveness may not be specific to autism and
may be less useful for differential diagnosis, one
cannot underestimate the effects that these behaviors may have on adaptation for a given individual.
Our data demonstrated that although mean rates of
hyper-responsiveness did not differentiate the two
groups, there were more children with autism than
DD with severe levels of hyperresponsiveness. Phenomenological descriptions from individuals with
autism and their parents describe myriad negative
influences of sensory hyperresponsiveness resulting
in limited social participation or problematic behaviors (Jones et al., 2003; Williams, 1994), and may
warrant appropriate interventions.
Given the nature of correlational data from a
parent-report measure, etiology of these symptoms
and their relation to social-communicative features
of autism remain speculative. However, our findings
indicate that hyporesponsiveness to sensory stimuli

2005 The Authors

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2006 Association for Child and Adolescent Mental Health.

SEQ

appeared exacerbated under social contexts for

children with autism; thus, developmental models
explaining transactions of sensory processing with
core social features of autism would be useful to
guide future research. Rubenstein and Merzenich
(2003) presented a neurobiological model, suggesting that early neuromodulatory deficits affecting
cortical organization may lead to an increased ratio
of excitation to inhibition in key neural systems that
underlie both hyperresponsiveness to stimuli and
resultant social-communicative deficits in autism.
However, this model does not address hyporesponsiveness specifically. Waterhouse et al. (1996) proposed a transactional model whereby several
overlapping neurofunctional impairments interact to
disrupt complex human behaviors across social and
nonsocial domains that could account for both
hypo- and hyperresponsiveness. Further research is
needed to understand the relation of sensory
experiences to core features of children with autism
across development.
There are several limitations in this study to be
considered. Although our findings demonstrate
adequate psychometrics to support using the SEQ
for its intended purpose, further validation would be
helpful. First, items across the SEQ subscales varied
in number, thus a revised version is in progress to
better balance items across subscales (including
more sensory seeking items), while maintaining the
SEQs utility as a brief evaluation tool. Second,
cross-sectional data provide some understanding of
the developmental nature of sensory features in
young children, but longitudinal measures would
provide more robust conclusions. Third, although we
did not predict specific differences between the Autism and PDD groups, it is interesting to note that one
of the subscales (hypo-social responsiveness) was
found to significantly discriminate between these
two related groups. It is not known whether the relatively small sample or diagnostic heterogeneity in
the PDD group may have obscured additional differences, or whether these groups differ predominantly in their level of social engagement.
The subjective nature of parent report data may
also be construed as a methodological limitation.
Convergence of similar findings with observational or
physiological measures would strengthen our interpretations; development of complementary observational measures using a similar conceptual model is
in progress. Further research is also in progress to
evaluate aspects of parental responses and coping
strategies gathered from additional parts of the SEQ
(not analyzed in this study) which may have a moderating effect on childrens sensory experiences.
Finally, research studying the relationship of SEQ
patterns of hyper- and hyporesponsiveness to functional outcomes in children with autism and other
developmental delays is needed to further elucidate
etiologies of these intriguing behaviors, and inform
potential avenues for intervention.

599

Acknowledgments
We thank the families that participated and appreciate contributions to data collection by Vesna Costello, Stephanie Beers, Jim Tignor, Heather Parsons,
Lisa Guckian, Kristin Carbine, Marisa Houser, and
Jen Neitzel. This study was partially funded by:
NICHD (RO1-HD42168), CAN, N.C. Div. MH/DD/
SAS, and OSERS (H324C990039). Preliminary analyses were reported at AOTA Conferences in 2001/
2002.

Correspondence to
Grace Baranek, Department of Allied Health Sciences Room 111 Medical School Wing E, University of North Carolina at Chapel Hill, Chapel Hill,
NC 27599-7120, USA; Tel: 919.843.4467; Fax:
919.966.9007; Email: gbaranek@med.unc.edu

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2005 The Authors

Journal compilation
2006 Association for Child and Adolescent Mental Health.