autism is a profound developmental disorder that appears in childhood , and is considered a 
 severe lifelong - affliction for both affected individuals and their families . most children with autism have relatively distant relationships 
 with others and interact in a rigid , mechanical , and idiosyncratic manner2 , 3 . 
 the symptoms of autism include difficulties with communication , social interaction , play , 
 behavior , and sensory processing4 . sensory processing dysfunction ( spd ) involves difficulties in receiving , organizing , and 
 interpreting sensory stimuli from the different sensory systems5 . to understand spd , it is necessary to clarify how the 
 central nervous system ( cns ) codes and interprets sensory information and uses this 
 information to generate motor output6 . it 
 is hypothesized that the cns modulates information by creating a continuous interchange 
 between habituation and sensitization7 . young children with poor sensory modulation between habituation and sensitization exhibit 
 maladaptive behaviors , such as hyperactivity , excessive lethargy , and inattentiveness6 . moreover , it has been observed that 
 children with autism exhibit problematic behaviors such as irritability , lethargy , 
 stereotypy , and hyperactivity8 . sensory 
 and motor problems often present additional challenges to children with developmental 
 problems9 . neurological evidence suggests the existence of abnormal brain connectivity in children 
 with autism , which may result in abnormal sensory processing10 . several studies also have reported an association between spd and 
 unfavorable events during pregnancy , delivery , and the neonatal and infant stages11 . the prevalence of spd among children with 
 autism is derived from parental reports , retrospective videotape analysis , and firsthand 
 accounts from affected individuals12 . several studies have reported that spd affects the ability of children with autism to lead 
 normal lives , hinders active exploration of the environment , and impairs activities of daily 
 living ( adl)13 . children with 
 developmental disorders including autism exhibit deficits in sensory perception and motor 
 functions , such as difficulties in performing fine motor activities involving vision and 
 body awareness14 . furthermore , the 
 inclusion of sensory aspects in the diagnosis of autism in the latest diagnostic and 
 statistical manual of mental disorders ( dsm-5 ) is evidence of the prevalence of 
 sensory dysfunctions in this population15 . rehabilitation therapists have used many forms of sensory - based 
 theories , including sensory integration techniques , to assess and treat children with 
 sensory dysfunctions16 . greenspan and weider ( 1997 ) reported that 100% of the participants diagnosed with autism in 
 their study demonstrated difficulties with auditory responding3 . in a comparative study , tomchek and dunn ( 2007 ) reported that 
 difficulties with the processing of auditory , taste , and olfactory stimuli are the most 
 common sensory processing dysfunctions12 . a recent study reported that children with autism who exhibited spd - like auditory 
 hypersensitivity also exhibited excessive sympathetic responses to repeated loud noises17 . visual and tactile processing 
 dysfunctions have also been reported in the literature18 , 19 . in addition , studies 
 have reported other sensory processing difficulties in children with autism , such as sensory 
 seeking , the inability to register or avoid sensations , and sensory sensitivity20 , 21 . previous studies have shown differences in the commonly involved 
 sensory processing functions among different study groups . culture is a dynamic set of goals , beliefs , and attitudes shared by a group of people22 . thus , it is important to gain a better understanding of autism in the western 
 cultural context and across different cultures23 . professionals should also avoid the assumption that there is a 
 universal set of attitudes and practices related to autism when working with culturally 
 diverse families24 . professionals must 
 develop cross - cultural competence and sensitivity to serve children with autism . ( 2002 ) suggestion that a treatment method can be developed in the west and  exported  
 elsewhere is inherently flawed . non - western cultures may offer valuable explanations and 
 treatments for culturally diverse children and families . daley ( 2002 ) observed that although 
 there is much evidence to support the need for cross - cultural research in the area of autism 
 spectrum disorders ( asds ) , few researchers have attempted a comparative approach or 
 explicitly addressed cultural factors25 . a recent review on the influence of culture and environment on the sensory processing 
 experiences of children with and without autism in two countries , israel and the united 
 states ( u.s . ) , reported that israeli children exhibited unusual responses to sensory 
 experiences less frequently than u.s . children with autism demonstrated 
 significantly greater difficulty in auditory filtering and on the visual / auditory 
 sensitivity domains than israeli children did26 . another study compared the sensory processing dysfunctions of 
 chinese children from hong kong were compared with children in the u.s . population ; the 
 study revealed that the chinese children differed from the u.s . the results from these 
 two studies reveal that sensory processing differs in children from various cultural 
 backgrounds , and thus highlight the need to assess sensory processing in children from every 
 culture . therefore , this study aimed to investigate the most commonly involved sensory 
 processing functions among saudi arabian children with autism . a convenience sample of saudi arabian children with and without autism voluntarily 
 participated in this study . a total of 46 children ( 7 girls and 39 boys ) who were officially 
 diagnosed with autism ( mean age , 6.50  2.40  years , range 3 to 10  years ) were recruited from 
 the autism center in the northern area of riyadh . these children received special education 
 services and speech and language therapy session s day from 7:30 am to 12:30 pm , but had 
 never received any kind of formal sensory integration therapy by an occupational therapist . a total of 30 children ( 6 girls and 24 boys ) without autism ( mean age of 6.40  2.14  years , 
 range 3 to 10  years ) , age and gender matched to the children in the autism group were 
 recruited in the control group . in both groups , the parents came from northern riyadh , and 
 at least one parent understood english and had a college degree . the aims and procedures of the study were explained to the parents of all the participating 
 children , and written informed consent was obtained prior to the study . the protocols of the 
 study were approved by the research ethics committee of the college of applied medical 
 sciences , king saud university , riyadh . the main instrument used in this study was the short sensory profile ( ssp)28 , which is a standardized parent 
 questionnaire that was developed as a screening instrument to identify children with sensory 
 processing difficulties and associated behaviors13 . likert scale that is used to score each of 38 ssp 
 items on a scale from 1 to 5 ; a score of 1 is assigned to behaviors that  always  occur and 
 a score of 5 is assigned to behaviors that  never  occur . the raw scores are used to produce 
 composite scores for seven domains : tactile sensitivity , taste / smell sensitivity , movement 
 sensitivity , under - responsive / seeks sensation , auditory filtering , low energy / weak , and 
 visual / auditory sensitivity . the total ssp score ranges from 38 to 190 with cutoff points to 
 define classification categories ( i.e. , typical performance = total score 155 ; probable 
 difference = total score between 142 and 154 ; and definite difference = total score 141 ) . these cutoff points are based on the normative values ( collected by dunn 1999 ) from 1,200 
 typical children . initial studies on the validity of the ssp demonstrated a discriminant validity 
 of > 95% in identifying children with and without sensory modulation difficulties28 . the internal reliability for the ssp , 
 calculated using cronbach s alpha , ranges from 0.70 to 0.907 . ( 2012 ) have reported that the most reliable score 
 is the ssp total score13 . together these 
 findings provide support for the use of the ssp as a valid and reliable measure of sensory 
 processing . the ssp was introduced and explained to the parents of the participating 
 children in this study . the parents were provided with a copy of the ssp to be completed at 
 home and returned to the researcher . thirty - nine ( 84.8% ) children with autism demonstrated clinically significant sensory 
 dysfunction with a mean ssp score of 118.74  24.22 ( tables 1table 1.comparison of ssp performance between children with and without autismsection typical performance probable differencedefinite differenceautismwithout autismautism without autismautism without autismtactile sensitivity 17.40%36.60%21.70%30%60.90%33.30%taste / smell sensitivity 28.26%80%19.60%16.60%52.20%3.30%movement sensitivity 34.80%76.70%15.20%3.30%50%20%under - responsive / seeks sensation 8.70%63.30%2.20%13.30%89.10%23.30%auditory filtering 17.40%63.30%8.70%23.30%73.90%13.30%low energy / weak 30.40%83.30%10.90%10%58.70%6.70%visual / auditory sensitivity 45.70%80%19.60%10%34.80%10%total ssp score 6.50%66.70%8.70%10%84.80%23.30% , 2table 2.mean ssp scores of children with and without autismsectionmean scores autismwithout autismtactile sensitivity24.7  5.127.5 4.4taste / smell sensitivity11.7  516.6  2.5movement sensitivity10.3  3.612.5  2.8under - responsive / seeks sensation17  5.327.3  5.4auditory filtering16.9  524  3.5low energy / weak20.7  7.427.6  3.3visual / auditory sensitivity17.7  4.620.7  3.9total ssp score118.7  24.2156.4  17.4 ) . the most prevalent sensory processing dysfunctions in this group were found 
 for the under - responsive / seeks sensation ( 89.13% ) , auditory filtering ( 73.9% ) , tactile 
 sensitivity ( 60.87% ) , low energy / weak ( 58.7% ) , and movement sensitivity ( 50% ) domains . however , a 
 further analysis revealed that the most prevalent sensory processing dysfunctions were found 
 for the tactile sensitivity ( 33.3% ) , under - responsive / seeks sensation ( 23.33% ) , and movement 
 sensitivity ( 20% ) domains ( tables 1 , 2 ) . this study revealed that saudi arabian children both with and without autism exhibit some 
 degree of sensory dysfunction . however , the prevalence of sensory processing dysfunction in 
 children with autism was greater than that in children without autism . the most common sensory processing 
 dysfunctions in children with autism involve the under - responsive / seeks sensation , auditory 
 filtering , tactile sensitivity , and low energy / weak domains . in contrast , the most common 
 sensory processing functions in healthy children involve the tactile sensitivity , 
 under - responsive / seeks sensation , movement sensitivity , and auditory filtering domains . in this study , the prevalence of clinically significant sensory differences in children 
 with autism was 83.8% , which is within the published range ( 4088% ) for the prevalence of 
 clinically significant sensory differences across various communities and cultural 
 backgrounds10 , 32,33,34,35,36 . this result confirms that clinically significant sensory 
 differences are a common problem among children with autism in various communities . subsequently , this result suggests that autism and sensory processing disorders are 
 genetically and structurally ( i.e. , physiologically , neurologically , and biochemically ) 
 linked . however , the involvement of other factors , such as culture , child - rearing style , and 
 social experiences , may also play roles in sensory experiences and sensory integration and 
 processing abilities26 , 27 . current study have also established the association 
 between autism and sensory processing disorders and the variation in prevalence across 
 different sensory processing factors and populations . it has been reported that cultural and community lifestyles have some degree of effect on 
 the severity and percentage of involvement of sensory processing dysfunctions in children 
 with autism26 , 27 . tomchek and dunn ( 2007 ) reported that 58.0% and 55.9% of children 
 with autism score within the range of typical performance on the low energy / weak and 
 movement sensitivity domains of the ssp , respectively10 , whereas in our study 58.7% and 50.0% of the children with autism 
 demonstrated definite differences on the low energy / weak and movement sensitivity domains of 
 the ssp , respectively . the parenting style of saudi arabian parents tends toward the 
 protection and nurturing of their children , as mentioned in a previous study describing the 
 cultural belief systems of muslim parents of children with autism37 . this parenting style could decrease the child s 
 opportunity for vestibular / proprioceptive / motor stimulation . in this study , the results of the control group are comparable with the results of the 
 tomchek and dunn study ( 2007)10 , which 
 indicates that children without autism across different communities may develop some sensory 
 differences . together these results highlight the need for the screening of sensory 
 processing dysfunction in children without autism to avoid or minimize any spd 
 complications . the results also emphasize the importance of the availability of occupational 
 therapy services in school - based settings , general practitioner offices , and community 
 health clinics , as some of our study participants may have an unrecognized spd , attention 
 deficit hyperactivity disorder ( adhd ) , or both . moreover , an unrecognized diagnosis of one 
 or both of these disorders may have affected the results in our group of children without 
 autism . finally , the results confirm the need for programs to educate parents , teachers , and 
 health care providers about spd . the presence of spd may be responsible for poor social participation and socio - emotional 
 maturation . a study that performed a comparison of the physical activity levels between 
 children with asd and typically developing children found that children with asd engaged in 
 fewer physical activities and for a shorter period of time than typically developing 
 children , according to parental reports ; these results suggest that some of the activity in 
 children with asd is not captured by standard questionnaire - based measures38 . dysfunction in the ability to process 
 sensory stimuli from the surrounding environment reportedly affects the ability in a general 
 population of children to lead productive lives , hinders active exploration of the 
 environment , and impairs daily living activities13 . this study confirmed that a low percentage of saudi arabian children without autism and a 
 high percentage of saudi arabian children with autism have clinically significant sensory 
 differences . further studies also are 
 necessary to identify the patterns of sensory processing in people living with autism 
 globally and locally , and examine the effectiveness of sensory integration strategies in 
 saudi arabian children with autism . moreover , these results suggest that the frequent 
 screening of sensory processing function is needed even among children without autism to 
 avoid or minimize any health complications .
[ purpose ] there is a dearth of studies that have examined the occurrence of sensory 
 processing dysfunction and its components in saudi arabian children with autism . 
 therefore , this study investigated the manifestation of sensory processing dysfunction in 
 autism and compared the functional components of sensory processing between saudi arabian 
 children with and without autism . 
 [ subjects and methods ] a convenience sample of 46 saudi 
 arabian children with autism and 30 children without autism participated in this study . 
 the sensory processing functions of both groups were assessed with the short sensory 
 profile . 
 [ results ] the overall findings indicated that 84.8% of children with autism 
 demonstrated definite sensory processing dysfunction . 
 the most prevalent sensory 
 processing dysfunctions involved the under - responsive / seeks sensation ( 89.13% ) , auditory 
 filtering ( 73.90% ) , and tactile sensitivity ( 60.87% ) domains . 
 most of the children without 
 autism ( 66.66% ) demonstrated typical sensory function ; the most prevalent sensory 
 processing dysfunctions involved the tactile sensitivity ( 33.3% ) , under - responsive / seeks 
 sensation ( 23.33% ) , and movement sensitivity ( 20% ) domains . 
 [ conclusion ] saudi arabian 
 children with and without autism have clinically significant sensory dysfunctions . 
 however , the prevalence of those sensory dysfunctions in children with autism is 
 significantly higher than in the children without autism .