Prevalence and Significance of Abnormal Tactile Responses in Young Children with Autism

Louisa MT. Silva, MD, MPH, Mark Schalock, BS


With the inclusion of sensory abnormalities in the DSM-V criteria for autism, the multifocal touch/pain abnormalities reported in young children with autism are no longer comorbid symptoms, and it has become an urgent priority to identify their nature and significance. A recent study differentiated children with autism from typical and otherwise developmentally delayed groups on the two-fold basis of mixed allodynia and hypoesthesia, and severe global self-regulatory delay.  In this study, we retrospectively analyzed case records for 266 pre-school children with autism and typical development to verify recent findings, assess the prevalence and location of tactile abnormalities in the autism group, and explore the relationship between tactile abnormalities and self-regulatory delay. Results differentiated the autism group by severity of tactile abnormality [F(1,262) = 172.8, p < .001] and self-regulatory delay [F(1,262) = 232.8, p < .001].  Allodynia was reported in 100% of the autism group by parent report and 98% by therapist report; hypoesthesia was present in 65% by parent report. Tactile abnormalities were directly, linearly related to self-regulatory delay (r = .727, p < .001) in both groups. The sense of touch has not been fully evaluated in autism, and there is insufficient quantitative evidence to conclude that it is intact.  Mixed allodynia and hypoesthesia are typical signs of sensory neuropathy.  Evidence of their near universal presence in young children with autism, and direct relationship to self-regulatory delay underscores the urgent need to fully evaluate the sense of touch in autism and rule out sensory neuropathy.

[N A J Med Sci. 2013;6(3):121-127.   DOI:  10.7156/najms.2013.0603121]


autism, autism spectrum disorder, children, hypoesthesia, allodynia, abnormal tactile responses, self-regulatory delay

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Rogers SJ, Ozonoff S. Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence. J Child Psychol Psychiatry. 2005;46(12):1255–1268.

Foss-Feig J, Heacock J, Cascio C. Tactile responsiveness patterns and their association with core features in autism spectrum disorders. Res Autism Spectr Disord. 2012;6(1):337–344.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington: American Psychiatric Publishing; 2013.

Marco EJ, Hinkley LBN, Hill SS, Nagarajan SS. Sensory Processing in Autism: A Review of Neurophysiologic Findings. Pediatr Res. 2011;69(5 Part 2):48R–54R.

Meier PM, Berde CB, DiCanzio J, Zurakowski D, Sethna NF. Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents. Muscle Nerve. 2001;24(10):1339–1345.

England JD, Gronseth GS, Franklin G, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005;64(2):199–207.

Blakemore S-J, Tavassoli T, Calò S, et al. Tactile sensitivity in Asperger syndrome. Brain Cogn. 2006;61(1):5–13.

Güçlü B, Tanidir C, Mukaddes NM, Unal F. Tactile sensitivity of normal and autistic children. Somatosens Mot Res. 2007;24(1-2):21–33.

Cascio C, McGlone F, Folger S, et al. Tactile perception in adults with autism: a multidimensional psychophysical study. J Autism Dev Disord. 2008;38(1):127–137.

Silva LMT, Schalock M, Ayres R, Bunse C, Budden S. Qigong massage treatment for sensory and self-regulation problems in young children with autism: a randomized controlled trial. Am J Occup Ther. 2009;63(4):423–432.

Silva LMT, Schalock M, Gabrielsen K. Early intervention for autism with a parent-delivered Qigong massage program: a randomized controlled trial. Am J Occup Ther. 2011;65(5):550–559.

Silva LMT, Schalock M, Ayres R. A model and treatment for autism at the convergence of Chinese medicine and Western science: first 130 cases. Chin J Integr Med. 2011;17(6):421–429.

Liu Y. The essential book of traditional Chinese medicine: Vol. 1. Theory. New York: Columbia University Press; 1988.

Posner MI, Rothbart MK. Toward a physical basis of attention and self regulation. Phys Life Rev. 2009;6(2):103–120.

National Research Council (U.S.). From neurons to neighborhoods: the science of early child development. Washington, D.C: National Academy Press; 2000.

Montagu A. Touching: the human significance of the skin. 2d ed. New York: Harper & Row; 1978.

Silva LMT, Schalock M. Sense and self-regulation checklist, a measure of comorbid autism symptoms: initial psychometric evidence. Am J Occup Ther. 2012;66(2):177–186. 18. Baron R. Neuropathic pain: A clinical perspective. In: Canning B, Spina D, Hofmann F, eds. Handbook of Experimental Pharmacology.Vol 194. Sensory Nerves. New York: Springer; 2009:3–30.

Devigili G, Tugnoli V, Penza P, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain J Neurol. 2008;131(Pt 7):1912–1925.

Silva L. Qigong massage for your child with autism: a home program from Chinese medicine. London; Philadelphia: Singing Dragon; 2011.

Tomchek SD, Dunn W. Sensory processing in children with and without autism: a comparative study using the short sensory profile. Am J Occup Ther. 2007;61(2):190–200.

Kaffman A, Meaney MJ. Neurodevelopmental sequelae of postnatal maternal care in rodents: clinical and research implications of molecular insights. J Child Psychol Psychiatry. 2007;48(3-4):224–244.

Ardiel E, Rankin C. The importance of touch in development. J Paediatr Child Health. 2010;15(3):153–156.

Schultz RT. Developmental deficits in social perception in autism: the role of the amygdala and fusiform face area. Int J Dev Neurosci. 2005;23(2-3):125–141.

Kwon S, Kim J, Choe B-H, Ko C, Park S. Electrophysiologic Assessment of Central Auditory Processing by Auditory Brainstem Responses in Children with Autism Spectrum Disorders. J Korean Med Sci. 2007;22(4):656.

Low VA, Sandroni P, Fealey RD, Low PA. Detection of small-fiber neuropathy by sudomotor testing. Muscle Nerve. 2006;34(1):57–61.

Silva LMT, Schalock M. Treatment of Tactile Abnormalities in Young Children with Autism: Results with Qigong Massage. Int J Massage Bodyw. [In press]

Porges SW, Furman SA. The Early Development of the Autonomic Nervous System Provides a Neural Platform for Social Behavior: A Polyvagal Perspective. Infant Child Dev. 2011;20(1):106–118.

Porges SW. The polyvagal theory: neurophysiological foundations of emotions, attachment, communication, and self-regulation. 1st ed. New York: W. W. Norton; 2011.


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