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Werkman et al. 2022 — ID impact on sensory processing in autism (systematic review)

🔬ResearchPeer-reviewed

4 min read

Citation

Werkman, M.F., Landsman, J.A., Fokkens, A.S., Dijkxhoorn, Y.M., van Berckelaer-Onnes, I.A., Begeer, S., & Reijneveld, S.A. (2022). “The Impact of the Presence of Intellectual Disabilities on Sensory Processing and Behavioral Outcomes Among Individuals with Autism Spectrum Disorders: a Systematic Review.” Review Journal of Autism and Developmental Disorders, 10, 422–440. doi:10.1007/s40489-022-00301-1. Published online 19 January 2022.

What this paper is

This is the SGL project’s second major peer-reviewed output, following Werkman 2020 — Cognitive abilities moderate sensory–behavioural links. The author list reads like a roll call of the SGL network: Werkman and Reijneveld from UMCG Health Sciences, Landsman and Fokkens from UMCG TGO (Applied Health Research), Dijkxhoorn and van Berckelaer-Onnes from Leiden University, and Begeer from Vrije Universiteit Amsterdam. This is the SGL team doing what the 2018 synthesis called for — a formal, PRISMA-compliant systematic review on the specific question of how intellectual disability modifies sensory processing in autism.

Key findings

  • Eleven studies were included from an initial screen of 933, searching PubMed, PsycINFO, and ERIC.
  • The headline contradiction: studies using overall or broad sensory subscale scores reported no impact of the presence of intellectual disability on sensory processing. But studies using fine-grained subtype analysis reported that hyporesponsiveness and sensory seeking were specifically elevated when ID was present.
  • Hyporesponsiveness showed the poorest behavioural outcomes — worse than hyperresponsiveness or sensory seeking. This matters enormously for practice because hyporesponsive people are the quietest, easiest-to-overlook group.
  • The contradiction between gross-scale and subtype-level findings is itself informative: it means that summary scales wash out a real effect. The clinical implication is that any assessment that collapses sensory processing into a single score will miss the thing that most matters for the autism + ID population.
  • Most included studies used proxy-reported instruments (Short Sensory Profile most frequently; Vineland Adaptive Behavior Scale for outcomes). Methods for assessing ID varied widely across studies.
  • The review uses a three-pattern sensory processing taxonomy: (1) hyporesponsiveness, (2) hyperresponsiveness, (3) sensory seeking — sometimes supplemented with (4) enhanced perception.

Method in brief

PRISMA-compliant systematic review. Three databases searched (PubMed, PsycINFO, ERIC). Inclusion criteria: English-language, peer-reviewed, published 2000–2019, reporting association between sensory processing and at least one behavioural outcome, with ASD as a distinct group and ID (developmental functioning <70) represented in the sample. Exclusion: single-modality or single-pattern studies, intervention studies, neurophysiological studies. Quality assessed using the Quality in Prognosis Studies (QUIPS) instrument. Two independent reviewers screened and extracted.

Relevance to this wiki

This paper is the strongest peer-reviewed anchor for two core practical recommendations:

  1. “Treat hyporesponsivity as serious.” The review shows it has the worst behavioural outcomes and co-occurs specifically with ID — making it the subtype most relevant to autistic people with intellectual disability and the one most likely to be missed.
  2. “Use subtype-specific assessment, not gross scores.” The finding that gross measures show no ID effect while subtype measures do is a direct argument for the kind of individual prikkelprofielen (stimulus profiles) this wiki advocates.

The paper also fills a structural gap: the wiki was previously citing this review under a misattribution (“Vogel et al. 2022”). Corrected in this session.

Limitations

  • Only 11 papers met inclusion criteria from 933 screened, reflecting the thinness of the evidence base for this specific population.
  • All included studies relied on proxy-reported instruments — no first-person or direct-observation data.
  • Most studies included children only; the adult population with autism + ID is barely represented.
  • The review covers 2000–2019 and newer studies may have shifted the picture.
  • The three/four-pattern taxonomy (hypo/hyper/seeking/enhanced perception) is itself contested — the patterns may not be as separable as the taxonomy implies.

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