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Sensory Modulation, Anxiety and Ritual Behaviors

Sensory Modulation, Anxiety and Ritual Behaviors

What comes first – difficulties with sensory modulation, anxiety or ritual behaviors?  In children, it can be very hard to determine how the three are all inter-connected if at all.  The Journal of Physical and Occupational Therapy published research investigating the relationships between sensory responsiveness, anxiety, and ritual behaviors in 48 boys (ages 5-9) with typical and atypical sensory responsiveness. Twenty eight of the boys had atypical sensory responsiveness which was defined as a score of ≤154 on the Short Sensory Profile.  Data was collected using the Sensory Profile (parents completed), the Screen for Child Anxiety Related Emotional Disorders, and the Childhood Routines Inventory.

The results indicated the following:

  • children with atypical sensory responsiveness had significantly higher levels of anxiety and a higher frequency of ritual behaviors than controls.
  • atypical sensory responsiveness was significantly related to both anxiety and ritual behaviors with anxiety mediating the relationship between sensory modulation and ritual behaviors.

The researchers concluded that there are potential consequences of atypical sensory responsiveness.  These consequences could support the idea that ritual behaviors develop as a coping mechanism in response to anxiety stemming from primary difficulty in modulating sensory input (Bart, 2016).

Previous studies have indicated a relationship between anxiety, sensory processing and rituals.  One study indicated a high rate of sensory over-responsivity (SOR) occurrence in a sample of children seeking anxiety treatment, suggesting that SOR may not be entirely independent of anxiety and may be closely associated with OCD (Coneea, 2014). Whereas another study reported that SOR is a dimensional feature that can influence the severity of obsessive compulsive symptoms and may characterize a unique sensory OCD subtype (Ben-Sasson, 2017).   Finally, there may be a strong relationship between sensory sensitivity, childhood ritualism and adult OCD symptoms with oral and tactile hypersensitivity in childhood being a pathway to adult OCD (Dar, 2012).

So it goes back to the original question of the post – which comes first?  Any thoughts? Comments? Experiences?

What? Why? and How? Series 3


The What? Why? and How? series helps to explain different topics to students, parents and teachers. Each hand out includes a definition of what the topic is, why it is important and how you can help.

What? Why? How? Series 3 includes one page hand outs on the following topics: Sensory Processing, Proprioception, Vestibular System, Tactile System, Sensory Registration, Sensory Modulation, Sensory Defensiveness, Sensory Diet, Self Regulation and Dyspraxia.







Bart, O., Bar-Shalita, T., Mansour, H., & Dar, R. (2016). Relationships among Sensory Responsiveness, Anxiety, and Ritual Behaviors in Children with and without Atypical Sensory Responsiveness. Physical & Occupational Therapy In Pediatrics, 1-10.

Ben-Sasson, A., & Podoly, T. Y. (2017). Sensory over responsivity and obsessive compulsive symptoms: A cluster analysis. Comprehensive Psychiatry, 73, 151-159.

Conelea, C. A., Carter, A. C., & Freeman, J. B. (2014). Sensory over-responsivity in a sample of children seeking treatment for anxiety. Journal of developmental and behavioral pediatrics: JDBP, 35(8), 510.

Dar, R., Kahn, D. T., & Carmeli, R. (2012). The relationship between sensory processing, childhood rituals and obsessive–compulsive symptoms. Journal of behavior therapy and experimental psychiatry, 43(1), 679-684.