Sensory processing differences

What it is

Differences in how the brain takes in and responds to input from the senses: sight, hearing, smell, taste, touch, balance and movement, body position, and internal body signals. Sensory processing challenges are not a diagnosis on their own (Understood), but sensory reactions are part of how autism is described, and they often occur with ADHD.

Common experiences

Ordinary places can be overwhelming: bright or fluorescent lights, background noise in a busy office, crowds, or certain fabrics. Other sensations can be hard to notice, such as someone calling your name. Sensitivity can vary with tiredness, stress, and health (National Autistic Society).

What helps

Ear defenders or noise-cancelling headphones, sunglasses, a quiet safe space, being told what to expect in advance, and time to recover after overload (National Autistic Society). Occupational therapy can be one part of a plan, but research on sensory integration therapy is limited and inconclusive (AAP, 2012).

Across life

Some people seek more input, such as movement or pressure, some avoid sounds, textures, or lights, and some show a combination (Understood). Autistic adults report sensory differences too (Crane et al., 2009).

Evaluation and treatment

Occupational therapists often identify sensory challenges (Understood), sometimes using questionnaires such as the Sensory Profile. The AAP advises pediatricians not to use sensory processing disorder as a diagnosis, so describe the specific difficulties and goals when asking for help.

Myth vs fact

Myth: sensory sensitivities are pickiness or drama. Fact: sensory overload happens when there is too much information for the brain to process (Understood), and a meltdown is not bad or naughty behaviour (National Autistic Society).

Full chapter

Terminology: sensory processing, sensory integration, and SPD

Sensory processing is how your brain interprets information received from your senses, which is known as sensory input (National Autistic Society). Intervention guided by sensory integration theory is commonly used by occupational therapists who work with children (Parham et al., 2011). Sensory processing disorder (SPD) is a term some clinicians use for sensory difficulties, but Understood says sensory processing challenges are not a diagnosis on their own, and the American Academy of Pediatrics (AAP) advised in 2012 that sensory processing disorder generally should not be diagnosed. This guide uses the broader phrase sensory processing differences, which describes how a person takes in and responds to sensory input without implying a diagnosis.

Diagnostic manuals and official guidance

The DSM-5-TR includes hyper- or hyporeactivity to sensory input, or unusual interest in sensory aspects of the environment, among the restricted and repetitive patterns of behavior used to diagnose autism. The CDC likewise lists having unusual reactions to the way things sound, smell, taste, look, or feel among its examples of restricted or repetitive behaviors or interests. Sensory processing disorder is not a stand-alone diagnosis in the DSM-5-TR. When the AAP wrote its 2012 policy statement, some experts had proposed expanding the DSM-5 definition of autism to include associated sensory issues, and the committee preparing the manual had asked for more studies before sensory processing disorder could be officially recognized. The AAP concluded that, because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed, and it noted that it remains unclear whether children with findings described as sensory processing difficulties have an actual disorder of the sensory pathways (AAP, 2012). A proposed nosology, meaning a classification for diagnosis, was published in the field of sensory integration in 2007 (Miller et al., 2007), and the STAR Institute says it is no longer using the 2007 nosology as the organizing schematic in its own frame of reference. A 2012 statement is more than a decade old, so ask clinicians what current guidance they follow.

The senses involved

The five main senses are sight, hearing, smell, taste, and touch. Other senses include balance and movement (the vestibular sense), spatial awareness (proprioception), and awareness of internal states (interoception), which means knowing whether you are hungry, thirsty, hot or cold, need the toilet, or are ill or injured (National Autistic Society). Understood likewise counts interoception, body awareness (proprioception), and the vestibular sense as three senses beyond the main five that affect body and space awareness and movement, and it says sensory processing challenges can involve all of them.

Patterns: more sensitive, less sensitive, seeking, and avoiding

The National Autistic Society describes hyper-sensitivity as being much more sensitive than other people and hypo-sensitivity as being much less sensitive, and says some people seek out more intense sensory experiences in order to get more input. Understood calls oversensitivity the most common type, in which the information coming in through the senses is overwhelming, and describes undersensitivity as not getting enough input from the environment. It describes sensory avoiding as overreacting to input and becoming overwhelmed, and sensory seeking as underreacting to input or needing more of it to function. Its examples of seeking include standing too close when talking to others, walking with loud, heavy steps, enjoying jumping and bumping and crashing into things, and chewing on shirt sleeves or collars and other non-food items. Its examples of avoiding include not liking to be hugged or kissed even by family, being startled by unexpected sounds and bright lights, refusing scratchy or tight clothes, and preferring quiet places and avoiding crowds. Not everyone is clearly a seeker or an avoider, and some people show a combination (Understood). The Sensory Profile, an assessment used by occupational therapists, reports four quadrants: sensation seeking, sensory sensitivity, sensation avoiding, and low registration (Shirley Ryan AbilityLab). The words used for these patterns are debated: the STAR Institute page quotes a critique that terms such as over- or under-responsive are not neuro-affirmative.

What sensory differences can feel like

The National Autistic Society gives these examples of things autistic people may be hyper-sensitive to. Sight: bright or fluorescent lighting, bright sunlight, visually crowded or cluttered environments, patterned wallpaper or carpets, and eye contact. Sound: loud speech, music, electrical technology humming, unexpected noises such as alarms and sirens, and background noise such as in a busy office. Touch: crowded places, unexpected touch, wind or rain on the skin, fabric textures such as clothing, furniture coverings, and bedding, and some food textures such as soft or slimy foods. Smell: perfumes and deodorants, body odours, and cooking odours. Taste: certain flavours. Internal states: feeling too hot or cold. For hypo-sensitivity it gives the example that you may not notice sounds, such as people calling your name. It also says sensitivity may vary over time, in different environments, or because of other factors such as mental and physical health.

Sensory overload, stimming, and meltdowns

The National Autistic Society defines sensory overload as being overwhelmed by sensory inputs: the person has taken in too much sensory information and cannot process any more. Understood describes it as happening when one or more senses is overstimulated, so that there is suddenly too much information coming in for the brain to process. Autistic people have said the signs of sensory overload include not speaking or communicating, appearing disengaged or closed off, having difficulty focusing, stimming, feeling over-excited, pacing, or rocking (National Autistic Society). The NAS also says some autistic people can tolerate certain sensory triggers for a time, but that how long is affected by factors including being tired or low on energy, being stressed, and having anxiety or other mental health problems. It defines a meltdown as an intense response to an overwhelming situation, in which someone becomes completely overwhelmed and temporarily loses control of their behaviour. It says a meltdown is not the same as a temper tantrum and is not bad or naughty behaviour, and it lists sensory differences, changes in routine, anxiety, and communication difficulties as common triggers. It notes that some people instead refuse to interact or withdraw. Recovery can take a while, and the NAS advises giving the person time and creating a quiet, safe space.

How common it is

Because the AAP found there is no universally accepted framework for diagnosing sensory processing disorder, this guide does not give a single overall figure for how many people have sensory processing difficulties. The National Autistic Society says exactly how many autistic people experience sensory processing differences is not known, and that research suggests it is between 53 percent and 95 percent. A meta-analysis of 14 studies found a significant, high difference between autistic and typical groups in the presence or frequency of sensory symptoms, with the greatest difference in under-responsivity, followed by over-responsivity and sensation seeking, and it identified age, severity of autism, and type of control group as factors that reduced the variability between studies (Ben-Sasson et al., 2009). In a study of autistic adults using the Adult/Adolescent Sensory Profile, 94.4 percent reported extreme levels of sensory processing on at least one sensory quadrant, and the patterns varied widely between individuals (Crane et al., 2009). Understood says sensory processing challenges often occur with ADHD and autism and may also occur with anxiety.

Sensory processing sensitivity

Researchers also use the term sensory processing sensitivity (SPS) for a trait describing differences between people in sensitivity to both negative and positive environments. A 2019 critical review described SPS as a common, heritable, and evolutionarily conserved trait. It concluded that SPS increases the risk of stress-related problems in response to negative environments but also brings greater benefit from positive and supportive experiences, and its authors said the field needs more reliable and objective ways to assess SPS and a deeper understanding of its mechanisms to tell it apart from other traits (Greven et al., 2019). Popular writing often calls this the highly sensitive person trait. It is a different idea from the sensory processing disorder label discussed above.

Misophonia and sound-specific reactions

An expert panel reached a consensus definition of misophonia using a modified Delphi method over four rounds, including a statement in the definition only after 80 percent or more of the panel agreed. The definition describes a disorder of decreased tolerance to specific sounds or stimuli associated with such sounds. These triggers are experienced as unpleasant or distressing and tend to evoke strong negative emotional, physiological, and behavioral responses that are not seen in most other people. Responses do not seem to be elicited by the loudness of the sound but by its specific pattern or meaning to the individual. Triggers are often repetitive and primarily, but not exclusively, come from another person, especially sounds produced by the human body. Once a trigger is detected, a person may have difficulty distracting themselves and may experience suffering, distress, or impairment in social, work, or school functioning, and symptoms are typically first observed in childhood or early adolescence (Swedo et al., 2022). A clinician can help work out whether misophonia, general sound sensitivity, or another cause fits.

Emotions, anxiety, and wellbeing

Understood says people with sensory processing challenges often feel anxious because they cannot control every aspect of their daily lives, and that anxiety is more common in people who are oversensitive, who often worry about what lies ahead. It gives the example of a grade-schooler who is oversensitive to food flavors and textures and may refuse a sleepover because she is worried about what she will have to eat. The National Autistic Society notes that being stressed, having anxiety, or having other mental health problems can affect how long a person can tolerate sensory triggers. Understood suggests learning what triggers a negative reaction, talking about what to expect before entering a situation that could be overwhelming, and finding a calm time to talk about ways to make things less stressful, and it says healthcare providers may refer a person to a psychologist or an occupational therapist. If you are struggling emotionally, the Crisis help page lists where to turn.

Assessment

Understood says occupational therapists often identify sensory challenges and also work with children who have them. A common tool is the Sensory Profile, a norm-referenced assessment used to identify sensory processing patterns and understand how they affect functional performance. Caregivers or educators complete it for children, and a self-report version is available for specific age ranges. Sensory Profile 2 covers ages 0 to 14 with infant, toddler, child, and school companion forms, and the Adolescent/Adult Sensory Profile is a self-report form for ages 11 and older (Shirley Ryan AbilityLab). AOTA's sensory integration and processing page lists this recommendation: do not provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information. Because the AAP advises pediatricians not to use sensory processing disorder as a diagnosis, a pediatrician may not use that label, and describing the specific difficulties and the goals you want to work on is more useful when asking for help. Rules about referral, who can assess, and funding vary by country, so check locally.

Occupational therapy and sensory-based therapies

The AAP statement says sensory-based therapies are increasingly used by occupational therapists, and sometimes by other therapists, to treat children with developmental and behavioral disorders, with brushes, swings, balls, and other specially designed therapeutic or recreational equipment used to provide sensory input. It says occupational therapy with sensory-based therapies may be acceptable as one component of a comprehensive treatment plan, but that parents should be informed that the amount of research on the effectiveness of sensory integration therapy is limited and inconclusive. It also says pediatricians can help families learn how to tell whether a therapy is effective, and that families should be told occupational therapy is a limited resource, particularly the number of sessions available through schools and insurance (AAP, 2012). Understood says occupational therapists help children find ways to be less overwhelmed by sensory input, and that they might create what is called a sensory diet. AOTA's sensory integration page links to practice guidelines and research on these approaches, so it is reasonable to ask a therapist which guidelines they follow.

Newer research on Ayres Sensory Integration

Ayres Sensory Integration (ASI) is a form of sensory integration intervention that has been manualized. A fidelity measure published in 2011 listed ten process elements for it: ensuring physical safety, presenting sensory opportunities, helping the child attain and maintain appropriate levels of alertness, challenging postural, ocular, oral, or bilateral motor control, challenging praxis and organization of behavior, collaborating in activity choice, tailoring the activity to present a just-right challenge, ensuring that activities are successful, supporting the child's intrinsic motivation to play, and establishing a therapeutic alliance (Parham et al., 2011). A small randomized trial of a manualized occupational therapy intervention for sensory difficulties in autistic children aged 4 to 8 found that the 17 children who received 30 sessions scored significantly higher on Goal Attainment Scales, the primary outcome, than the 15 children in a usual-care group, and also scored significantly better on measures of caregiver assistance in self-care and socialization (Schaaf et al., 2014). A 2026 systematic review of ten studies of children younger than 10 that reported adhering to the ASI process elements found positive outcomes in studies at higher risk of bias and in case studies, mixed results in the four studies rated low risk of bias, and limited current evidence for a positive effect. Its authors recommended using practices backed by higher levels of evidence to address the needs and functional goals prioritized by individuals and families, and modifying environments to support people with sensory difficulties (Kishida et al., 2026). Ask any therapist which goals are being targeted, how progress will be measured, and what evidence supports the approach.

Everyday strategies and environment changes

The National Autistic Society lists sensory items and activities that some autistic people use to manage sensory differences: ear defenders or noise-cancelling headphones, sunglasses or tinted glasses, sensory or fidget toys, weighted blankets or vests, swinging, and wobble cushions. Its general support advice includes providing a safe space away from sensory triggers and telling the person what to expect before going to places or doing activities that may have a lot of sensory triggers. Understood suggests planning trips for a time when there will not be many people, and gives the example of asking a relative for high fives instead of hugs. These are options people use, so notice what helps you and drop what does not, and ask a clinician about safe use of items such as weighted blankets or vests, especially for young children. The Toolkit page has a sensory check-in with general ideas, a sound machine, a fidget pad, and a calm plan you can fill in while you feel well.

At school

Under the Equality Act 2010, schools in the UK have a duty to make reasonable adjustments so that disabled pupils are not placed at a substantial disadvantage, and to decide in advance what adjustments a child may need, in time for the first day of the school year (National Autistic Society). The NAS lists these adjustments to reduce the impact of sensory differences for autistic pupils: allowing a slightly different piece of uniform; staggering the start or end of the school day; letting pupils in secondary schools leave classrooms early when changing lessons to avoid crowds; putting felt pads under chair legs to prevent scraping sounds; switching hand dryers off and providing paper towels; allowing ear defenders or headphones to block noises such as school bells; allowing sunglasses or blackout blinds; creating a safe place such as a play tent in the classroom; allowing a fiddle toy; a time out or stress alert card that gives permission to leave the room; different arrangements for breaks and lunchtimes, such as a quiet lunchtime club; uncluttered classrooms with minimal decor and wall displays; encouraging physical activity or breaks to help relieve stress; and allowing the pupil to stim. In the United States, Section 504 and the ADA can require reasonable accommodations at school, and IDEA covers special education. Laws and eligibility vary, so confirm locally, and see the Resources page.

At work

The Job Accommodation Network (JAN) says it is easy to see why workplace accommodations may be essential for people with sensory processing disorders to thrive. Its accommodation ideas include scent-free policies, air purification, or telework for fragrance sensitivity; private areas, lighting changes, or telework for fluorescent light sensitivity; private areas, sound machines, noise-canceling headsets, or telework for noise sensitivity; uniform or dress code modifications for touch sensitivity; and temperature adjustments, cooling or heating clothing, or flexible scheduling for temperature sensitivity (JAN). The National Autistic Society lists bright or fluorescent lighting and background noise in a busy office among the things autistic people may be hyper-sensitive to. In the United States the ADA can require reasonable accommodations at work, in the UK the Equality Act 2010 can require reasonable adjustments, and in Canada provincial and territorial human rights codes require accommodation to the point of undue hardship. Laws vary, so confirm locally, and see the Resources page, which lists JAN.

Identity and being understood

Sensory differences are not pickiness, drama, or bad behavior. The National Autistic Society says a meltdown is not bad or naughty behaviour, and it gives the example of people brushing past a person and a loud announcement at a train station causing pain and sensory overload. Understood describes sensory overload as the brain receiving too much information to process. The NAS lists allowing a pupil to stim, which it describes as self-stimulatory behaviour such as rocking, spinning, or hand or finger flapping, among its reasonable adjustments, and the Toolkit page's fidget pad says stimming is valid. Language is also changing: the STAR Institute page quotes a critique that terms such as over- or under-responsive are not neuro-affirmative. This guide uses its sources' own terms when reporting what they say and otherwise says more sensitive, less sensitive, seeking, and avoiding.

For families, teachers, and colleagues

Ask the person what bothers them and what helps, and learn their triggers, because Understood says knowing a child's triggers can help you find ways to help. The National Autistic Society advises telling the person what to expect before going to places or doing activities that may have a lot of sensory triggers, and providing a safe space away from sensory triggers. Plan outings for quieter times, and find a calm time to talk about ways to make things less stressful, for example offering high fives instead of hugs (Understood). After overload, give the person time to recover and make a quiet, safe space (NAS). Do not treat a reaction to sensory input as defiance or naughtiness. At school or work, make adjustments in advance rather than after a crisis, as the NAS notes UK schools are expected to do. If you are a parent considering sensory-based therapy, ask which goals are targeted, how progress will be measured, and what evidence supports the approach, because the AAP says pediatricians can help families work out whether a therapy is effective.

Sources

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Citations are listed so you can verify claims and read further. Guidance is revised over time, so check for newer editions.