The perceived causal relations between sensory reactivity differences and anxiety symptoms in autistic adults

Background: Rates of anxiety are inordinately high in autistic adults. Sensory reactivity differences, such as hyperreactivity (e.g., strong reactions to sound), hyporeactivity (e.g., no, or slower reactions to pain), and seeking (e.g., fascination with spinning objects), are a diagnostic criterion of autism and have been linked with anxiety. Understanding how individuals perceive these to be causally related can impact the assessment and treatment of anxiety. Therefore, we examined the perceived causal relations (PCR) between sensory reactivity differences and anxiety in autistic adults. Method: Two hundred forty-six autistic adults aged 18–76 years took part in an online study. They completed self-report assessments of sensory reactivity differences, and anxiety, followed by the PCR scale, indicating whether they perceived their sensory reactivity differences to be more of a cause or an effect of their anxiety symptoms. Results: We found sensory reactivity hyperreactivity, hyporeactivity, and seeking to be significantly correlated with anxiety. Further, we found total sensory hyperreactivity, and visual, auditory, and olfactory hyperreactivity, to be perceived as significantly more of a cause of anxiety than an effect, and total sensory seeking, and tactile and vestibular seeking, to be perceived as significantly more of an effect of anxiety than a cause. Conclusion: Future individualized approaches to treating anxiety in autistic individuals may benefit from differentiating between potential sensory causes of anxiety (e.g. hypersensitivities) vs. potential sensory effects of anxiety (e.g. sensory seeking behaviors)

Soothing dementia carers: a pilot evaluation of an imagery-based wellbeing app feature to support family carers of people with dementia during the COVID-19 pandemic

Background: The COVID-19 pandemic has presented unprecedented risks to the health of people living with dementia. Confinement to their homes and extra pressure on the health and social care system, left people with dementia and their carers with reduced access to care services. Accordingly, family carers assumed more caring responsibilities and faced a greater risk of social isolation and loneliness, negatively affecting their mental wellbeing. In response, we developed a new imagery-based feature called Project Soothe within an existing app, CogniCare, which aimed to support the wellbeing of family carers looking after someone with dementia at home. Methods: This new feature aimed to test the utility of our previous research which has shown that viewing soothing images has positive mood benefits on users. In this pilot, we examined the usage of the Project Soothe feature over a one-year period. Results: Our results indicate the feasibility of the imagery-based app feature as we found that most users found viewing the soothing images to have a positive influence on their mood. Conclusions: This finding illustrates feasibility of this imagery-based wellbeing app in this population of interest, and suggests that, upon further replication and research, the Project Soothe feature within the CogniCare app has potential to be developed as a digital wellbeing tool for family carers of people with dementia

Project Soothe: A pilot study evaluating the mood effects of soothing images collected using a citizen science approach

Background: Mentally-generated soothing imagery is a therapeutic technique to support mental wellbeing, but some individuals may require support using externally presented stimuli. Project Soothe was launched to collect soothing images using a citizen science approach. This online pilot study evaluated the first 575 soothing images collected, examining: 1) if the images were perceived to be soothing; 2) if viewing the images had a positive impact on mood; and 3) if mood effects were influenced by individual differences in age, gender and depressive symptoms. Methods: We recruited 1152 participants (13 – 79 years, M = 35.62, SD = 14.60; 77% female). Participants were randomly allocated to one of 23 sets, each containing 25 images (n = 50 per set) and asked to rate their emotional response (soothed, excited, and anxious) to each image. Participants also reported their mood states pre- and post-viewing the images (using the International Positive and Negative Affect Schedule – Short Form). Results: Project Soothe images were rated to be significantly more soothing than anxiety- or excitement-inducing. Further, viewing 25 images was significantly associated with an increase in positive affect and decrease in negative affect. These effects were associated with age and depressive symptoms, with older individuals and those with lower depressive symptoms being associated with more positive changes in mood. Conclusions: This pilot study provides preliminary evidence that these soothing images can promote positive mood changes. Further work can now replicate these findings in larger-scale studies with comparison groups and extended outcome variables. The images and associated data have been made available in a data repository (OSF) as a free resource for researchers and practitioners. It is hoped that these images can be developed into useful therapeutic resources

Invisible Disabilities in Education and Employment

More than 1 in 5 UK adults are disabled. Disabilities that are not immediately obvious are known as ‘invisible disabilities’, such as mental health conditions, neurodivergences and energy-limiting conditions.1 Evidence on this topic is limited as most research focuses on disability in general, or on a few specific conditions. Those with invisible disabilities may face challenges due to a lack of awareness and difficulty accessing support and services. Strategies aimed at increasing access and inclusion for adults with invisible disabilities in employment, and in higher and further education, could include: increasing awareness and understanding via training and reciprocal mentoring schemes; introducing ‘passports’ for transfer of adjustments to avoid repeated disclosure; inclusive design that considers sensory and informational barriers to access; maintaining online access to events and services post-pandemic; updating policy and guidance with examples of less recognised invisible disabilities; and promoting flexible working and learning arrangements. The 2021 National Disability Strategy set out the actions the Government would take to improve the lives of disabled people, including making workplaces more inclusive and accessible. However, the High Court ruled in 2022 that the strategy was “unlawful due to inadequate consultation”, which the Government has sought permission to appeal. Fourteen policies in the strategy are currently paused

Mutations disrupting neuritogenesis genes confer risk for cerebral palsy

In addition to commonly associated environmental factors, genomic factors may cause cerebral palsy. We performed whole-exome sequencing of 250 parent-offspring trios, and observed enrichment of damaging de novo mutations in cerebral palsy cases. Eight genes had multiple damaging de novo mutations; of these, two (TUBA1A and CTNNB1) met genome-wide significance. We identified two novel monogenic etiologies, FBXO31 and RHOB, and showed that the RHOB mutation enhances active-state Rho effector binding while the FBXO31 mutation diminishes cyclin D levels. Candidate cerebral palsy risk genes overlapped with neurodevelopmental disorder genes. Network analyses identified enrichment of Rho GTPase, extracellular matrix, focal adhesion and cytoskeleton pathways. Cerebral palsy risk genes in enriched pathways were shown to regulate neuromotor function in a Drosophila reverse genetics screen. We estimate that 14% of cases could be attributed to an excess of damaging de novo or recessive variants. These findings provide evidence for genetically mediated dysregulation of early neuronal connectivity in cerebral palsy

Genetic architecture of gene expression in ovine skeletal muscle

In livestock populations the genetic contribution to muscling is intensively monitored in the progeny of industry sires and used as a tool in selective breeding programs. The genes and pathways conferring this genetic merit are largely undefined. Genetic variation within a population has potential, amongst other mechanisms, to alter gene expression via cis- or trans-acting mechanisms in a manner that impacts the functional activities of specific pathways that contribute to muscling traits. By integrating sire-based genetic merit information for a muscling trait with progeny-based gene expression data we directly tested the hypothesis that there is genetic structure in the gene expression program in ovine skeletal muscle. Results The genetic performance of six sires for a well defined muscling trait, longissimus lumborum muscle depth, was measured using extensive progeny testing and expressed as an Estimated Breeding Value by comparison with contemporary sires. Microarray gene expression data were obtained for longissimus lumborum samples taken from forty progeny of the six sires (4-8 progeny/sire). Initial unsupervised hierarchical clustering analysis revealed strong genetic architecture to the gene expression data, which also discriminated the sire-based Estimated Breeding Value for the trait. An integrated systems biology approach was then used to identify the major functional pathways contributing to the genetics of enhanced muscling by using both Estimated Breeding Value weighted gene co-expression network analysis and a differential gene co-expression network analysis. The modules of genes revealed by these analyses were enriched for a number of functional terms summarised as muscle sarcomere organisation and development, protein catabolism (proteosome), RNA processing, mitochondrial function and transcriptional regulation. Conclusions This study has revealed strong genetic structure in the gene expression program within ovine longissimus lumborum muscle. The balance between muscle protein synthesis, at the levels of both transcription and translation control, and protein catabolism mediated by regulated proteolysis is likely to be the primary determinant of the genetic merit for the muscling trait in this sheep population. There is also evidence that high genetic merit for muscling is associated with a fibre type shift toward fast glycolytic fibres. This study provides insight into mechanisms, presumably subject to strong artificial selection, that underpin enhanced muscling in sheep populations

Examining the Latent Structure and Correlates of Sensory Reactivity in Autism: A Multi-Site Integrative Data Analysis by the Autism Sensory Research Consortium

BACKGROUND: Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these supra-modal traits in the autistic population. METHODS: Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a general response pattern factor for each supra-modal construct and determine the added value of modality-specific response pattern scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs. RESULTS: All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ω LIMITATIONS: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many real-world sensory experiences. CONCLUSION: Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations

Elucidating the relationship between sensory reactivity and anxiety in autism

Sensory reactivity differences are commonly experienced by autistic individuals, including sensory hyperreactivity (i.e., strong reactions to sensory input), hyporeactivity (i.e., no, or slower reactions to sensory input), and seeking (i.e., fascination or fixation with sensory input). Sensory hyperreactivity can be particularly distressing and has previously been linked to anxiety in autism, and intolerance of uncertainty (IU) has been suggested to be an interlinking transdiagnostic construct. However, limited research has included sensory hyporeactivity or seeking, or examined links to certain anxiety symptomology, and research in young children and adults is especially lacking. Therefore, the four studies presented in this thesis had the primary aim of 1) elucidating the relationship between sensory reactivity difference and anxiety symptomology in autistic individuals, and secondary aims of 2) understanding the role of IU in this relationship, and 3) understanding more about the sensory experiences of autistic adults. The first study examined the relationship between sensory reactivity differences and anxiety in autistic children ages 3 – 14 years; the second study examined the relationship between sensory reactivity differences, anxiety, and IU in preschool-age autistic children ages 3 – 5 years; the third pair of studies examined the relationship between sensory reactivity differences, anxiety, and IU in autistic adults ages 18+ years; and the final study, examined the sensory experiences of autistic adults using a coproduced, mixed-methods approach. The findings robustly support an association between sensory hyperreactivity and anxiety symptomology in autistic individuals, and most notably, a consistent relationship across studies with separation anxiety. Furthermore, IU was found to be a mediating factor associated with anxiety and sensory hyperreactivity in children and adults. Although sensory hyporeactivity and seeking were linked with anxiety in some studies, this was not consistent across the studies. The findings from the mixed methods study provided enriched insights into the findings in this thesis from the perspective of autistic adults and highlighted the complex nature of sensory reactivity differences. This informed the creation of an enhanced model, which could further guide future directions. Overall, the results in this thesis advance understanding of the relationship between sensory reactivity differences and anxiety symptomology. Understanding the risk factors for anxiety in autism has importance for the development and adaptation of effective interventions for autistic children and adults

In our own words: The complex sensory experiences of autistic adults

Autistic adults commonly experience sensory reactivity differences. Sensory hyperreactivity is frequently researched, whilst hyporeactivity and seeking, and experiences across domains, e.g., vision, are often neglected. Therefore, we aimed to understand more about the sensory experiences of autistic adults. We conducted a mixed-methods study, co-produced with stakeholders; recruiting 49 autistic adults who completed an online survey. Firstly, quantitative results and content analysis enhanced our understanding of sensory input/contexts associated with sensory hyperreactivity, hyporeactivity, and seeking across modalities. Secondly, thematic analysis developed themes relating to 'Outcomes', 'Control', 'Tolerance and management', and 'The role of other people', informing a theoretical model of sensory reactivity differences in autistic adults. These findings have implications for support services and improving quality of life for autistic adults. [Abstract copyright: © 2021. The Author(s).

The relationship between sensory reactivity differences and mental health symptoms in preschool-age autistic children

There is growing evidence for an association between sensory reactivity and mental health in autism. This study set out to explore the relationship between sensory reactivity and mental health in pre-school aged autistic children. In total 54 preschool-aged children with an Autism Spectrum Condition (ASC) took part. Sensory and mental health symptoms were obtained from the Sensory Processing Scale Inventory, Sensory Assessment of Neurodevelopmental Differences and the Behavioural Assessment System for Children – 3. Correlational analyses showed a relationship between sensory reactivity and mental health symptoms in autistic preschool-aged children. Results also indicate divergence in sensory-mental health profiles between autistic preschool-aged children who are verbal and those who use few to no words. For the first time this study has revealed a relationship between sensory hyperreactivity, as well as sensory seeking, and mental health symptoms outside of anxiety in autism. Of note, this relationship between sensory hyper-reactivity and internalising symptoms appears to be driven by those with few to no words. This has implications for both research and clinical interventions, in particular for our understanding of the factors underlying mental health symptoms in different autistic phenotypes, as well as the possible role of functional communication in mitigating the development of mental health symptoms