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Original Article

DOI: 103126/JNPS.V4113

Sensory Profile of Nepalese Children with or without Autism

Introduction: Sensory Integration Dysfunction (SID) is common in children 
with Autism Spectrum Disorder. If SID is detected early and intervened, there 
is a decrease in autistic mannerisms and an improvement in the areas of 
sensory processing and regulation, social-emotional function, and fine motor 
skills. Thus, this study was conducted to compare the sensory profile of 
children with or without autism spectrum disorder (ASD) in Nepal.

Methods: Thirty five parents of children with ASD and 43 parents of 
children without ASD (non ASD) completed Short Sensory Profile (SSP) 
questionnaire. 

Results: Definitive sensory issue was identified in 66% in ASD and 23% in 
non ASD group. Common sensory issues in ASD group were auditory 
filtering sensitivity (74.3%), movement sensitivity (37%), under responsiveness 
/ seeks sensation (45.7%). In non ASD group, common sensory issue was 
under responsive/seek sensation. The internal consistencies between the 
sub-scales ranged from 0.70 to 0.83.

Conclusions: Two third of the children with ASD have sensory issues. 
Identifying different sensory problems with SSP would be helpful for further 
management of children with ASD.

Abstract

1 Associate Professor, Department of Child Health, Tribhuvan University Teaching Hospital, Maharajgunj Medical Campus, 
Kathmandu, Nepal.
2 Assistant Professor, Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal.

Merina Shrestha1, Rena Shrestha2

*Corresponding Author

Merina Shrestha
Department of Child Health, 
Tribhuvan University Teaching Hospital, 
Maharajgunj Medical Campus,
Kathmandu, Nepal.
Email: drmerinashrestha@gmail.com

Article History 
Received On: 16 Jan, 2022
Accepted On: 15 Dec, 2022 

Funding sources: None

Conflict of Interest: None

Keywords: 
Autism Spectrum Disorder, Children, Short 
Sensory Profile, Nepal.

Online Access

DOI:
https://doi.org/10.3126/jnps.v42i3.42421

Copyrights & Licensing © 2022 by author(s). This is an Open Access article dis-
tributed under Creative Commons Attribution License (CC BY NC )

Introduction
Sensory Integration Dysfunction (SID) is the condition in which the brain is 
unable to process the information that it receives through different senses. 
In SID, the brain has difficulty analyzing, organizing and connecting, 
or integrating sensory messages.1 This might lead to learning difficulties 
because of difficulty in using sensory information to plan and organize for 
the task to be completed.1 When there is delay and inefficient neurological 
processing of the sensory signals, they often manifest as inappropriate 
motor and behavior responses and are misinterpreted as behavioral 
problems.1 Whenever the brain is unable to integrate sensory inputs 
like sights, sounds, touch, body position, or movements that it receives 
from sensory systems, effective responses cannot be generated.2 Because 
of the altered responses and poor behavior, it creates difficulties with 
academic and motor learning as well.3 The SID may be tactile, olfactory 
hypersensitivity, and hypo or hyper-reactivity to sensory stimuli.4-7 When 
auditory or vestibular system dysfunctions are present, it affects speech 
development causing speech delay and articulation disorder.1 It is seen 
that young children with speech disorders have reduced functions in 
the vestibular, proprioceptive, and tactile sensory systems compared to 

Original Article

DOI: 103126/JNPS.V4113



J Nepal Paediatr Soc | VOL 42 | ISSUE 03 |SEP-DEC,  202244

Original Article Sensory profile in children

children without speech disorders.8

Individuals with autism spectrum disorder (ASD) often 
display atypical responses to sensory stimuli and this 
condition is considered one of autism’s defining features.9 
Different kinds of researches show that the prevalence of SID 
in children with autism ranges from 42% to 88%.10 When 
children with autism were compared with children without 
autism, there was a significant difference in their sensory 
profile with the greatest differences in under-responsiveness 
/seeking sensation, auditory filtering, and tactile sensitivity 
scales.11 Symptoms of SID are categorized mainly into 
four patterns: “Visual perception and Auditory- Language 
Disorders,” “Tactile Defensiveness,” “Disorders involving 
the Vestibular System,” and “Developmental Dyspraxia”. 
Children with ASD may not display all the symptoms of a 
certain dysfunction but they usually have several signs of 
these four patterns.12 When SID is present in children with 
autism, it negatively impacts the performance of daily life 
activities.13,14 

The recent global data shows the prevalence of ASD is 1 
in 100 children.15 When this data is projected in Nepal’s 
population, there may be about three lakh children with 
ASD. In these children along with diagnosis of ASD if SID 
is detected early and intervened, there is a decrease in 
autistic mannerisms (a component of social responsiveness) 
and improvement in the areas of sensory processing 
and regulation, social-emotional function, and fine motor 
skills.16 To identify and detect SID in children, the sensory 
profile can be assessed through clinical examinations and 
parents’ interviews. The sensory profile is a parent-based 
questionnaire originally developed as a screening tool to 
identify children with sensory processing difficulties.13 It 
includes 125 items in three categories, namely sensory 
processing, modulation, and behavioral and emotional 
responses.17 The shorter version, Short Sensory Profile 
(SSP) is mostly used for screening programs and research 
purposes.11,17 The SSP has good psychometric properties 
with a satisfactory internal consistency with Cronbach alpha 
ranging from .68 to .92 and good convergent validity of 
over 95% in identifying children with and without sensory 
modulation differences.18 The tool has been translated 
into several languages such as Spanish, Arabic, Turkish, 
Indian, and Chinese.19 The primary objective of the current 
study is to assess the sensory profile of children with ASD 
and compare them with children without ASD using SSP. 
We also aimed to measure the internal consistency of the 
questionnaire. 

Methods
For the current study, a convenient sample of parents 
of children with and without ASD was selected from 
Autism Care Nepal Society (ACNS), a non-governmental 

organization that provides clinical and social services to 
families with children with autism, and Tribhuvan University 
Teaching Hospital (TUTH), a tertiary level hospital, both 
based in Kathmandu, Nepal. Thirty-five parents of the 
ASD group were identified from the ACNS registry and 
the first author’s neuro-developmental clinic at TUTH. For 
comparison, children without ASD (non-ASD group) and 
any known physical, neurological, or behavioral disorders 
were identified from well-child visits and pediatric out-patient 
clinic register at TUTH. Other interested parents were also 
invited to participate in the study using the researcher’s 
social network. The inclusion criteria for enrollment were 
children below 16 years in both groups. In the ASD group, 
children with autism but without any other associated co-
morbidities including any physical impairment or disability 
like cerebral palsy, Down syndrome were excluded. 
Altogether 48 parents in the non-ASD group agreed 
to participate in the study. Of them, five children were 
excluded as three had visual impairment, one child had a 
motor impairment and one child was recently diagnosed 
with Asperger’s syndrome which was diagnosed after 
parents completed SSP and sought help. Hence, a total 
of 43 parents was enrolled in the non-ASD group. Parents 
completed a demographic questionnaire that included 
information on the child’s age, gender, and any impairment 
or disability. For children with ASD, an additional question 
on age at diagnosis of autism was also asked. The SSP 
is a questionnaire-based screening tool to identify sensory 
processing difficulties, patterns, and effects on functional 
performance.16,17  The SSP consists of 38 items organized 
into seven subscales; i) tactile sensitivity (7 items), ii) taste /
smell sensitivity (4 items), iii) movement sensitivity (3 items), 
iv) under-responsive / seeks sensation (7 items), v) auditory 
filtering (6 items), vi) low energy / weak (6 items), and vii) 
visual / auditory sensitivity (5 items). Each item is rated on a 
5-point Likert scale. The response options are from Always 
=1 to Never = 5. Each item score is summed up to obtain 
the total score for each subscale which is then classified 
into one of the three possible ranges: Typical Performance 
corresponds to 1 SD below the mean (better than the lowest 
16%), Probable Difference corresponds to 2 SD below the 
mean (performed like children in the lowest 14%), and 
Definite Difference corresponds to 3 SD below the mean 
(performed like children in the lowest 2%). For the SSP, 
a total score above 155 indicates typical performance, 
142 to 154 indicates probable difference and below 
141 indicates a definite difference. Because there is no 
standardized and validated sensory profile assessment tool 
in Nepal, the SSP English version was chosen as this tool is 
simple and easy for parents to respond to. The questionnaire 
along with the consent form was sent to the parents through 
closed social messaging tools such as WhatsApp and Viber 
Chat services. Participants were encouraged to reach out 
to the research team if they had questions about the survey. 
The contact information of the research team was provided 



J Nepal Paediatr Soc | VOL 42 | ISSUE 03 |SEP-DEC,  2022 45

Original ArticleSensory profile in children

in the consent form. Frequencies and descriptive statistics 
were performed to assess the demographic characteristics 
of the children. The internal consistency of the total score 
and subscales were measured using Cronbach’s alpha (). 
The internal consistency is considered high when  > 0.80; 
satisfactory when  = 0.60 – 0.80; and moderate when  = 
0.40 – 0.59. In both groups, children were categorized in 
a typical performance, probable difference, and definite 
difference for each of the sensory scales. This was further 
analyzed in each item of the sensory scales. The analysis 
was performed in Stata version 16. 

Results
A total of 78 parents, 35 in the ASD group and 43 in the 
non-ASD group participated in the study. The mean age 
of children was 7.8 (SD = 4.3) and 7.5 (SD = 3.6) years 
in the ASD group and the non-ASD group, respectively. 
Majority of the children (80%, n = 35) were males in ASD 
group while in non-ASD group, 53% (n = 43) were males. 
Children in the ASD group had a clinical diagnosis as per 
the Diagnostic and Statistical Manual of Mental Disorders, 
Fifth Edition (DSM-V; American Psychiatric Association 
2013). The mean age of diagnosis of ASD was 32.89 
months ( Range = 18 - 72 months, SD =14.61). More than 
half of the parents (57%, n = 35) in the ASD group and 
only 2%, n =43) of parents in the non- ASD group reported 
that their child may have sensory issues. Almost a quarter of 
parents in the ASD group were unsure about the presence 
of sensory issues of their child (Table. 1).    
 

     

Table1. Demographic characteristics and presence of 
sensory issue in a child according parents 

ASD Group
N = 35

Non ASD 
Group N = 43

Age in years (SD) 7.8 (4.3) 7.5 (3.6)

Gender
Male (%) 28 (80) 23 (53.4)

Sensory Issue

Yes
No
May be

20 (57.2)
6 (17.1)
9 (25.7)

1 (2.3)
37 (86.0)
5 (11.6)

 Table 2. Standardized Cronbach’s alphasa for the SSP
total score and scores for each subscales for ASD and non-
ASD group

 ASD
Group

 Non ASD
Group

Tactile sensitivity 0.70 0.76

Taste / Smell sensitivity 0.75 0.80

Movement sensitivity 0.72 0.81

Under-responsive / Seeks sensation 0.68 0.80

Auditory filtering sensitivity 0.70 0.81

Low energy / Weak 0.72 0.83

Visual auditory sensitivity 0.69 0.80

Overall 0.74 0.83

a > 0.80 — high; = 0.60–0.80 — satisfactory; and = 
0.40 – 0.60 — moderate internal consistency

Table 3: Comparison of subscales of SSP between ASD group and non ASD group
 Typical Performance Probable Difference Definite Difference

 

Autism Without Autism Autism Without Autism Autism Without Autism

N = 35 N = 43 N = 35 N = 43 N = 35 N = 43

(%) (%) (%) (%) (%) (%)

Tactile sensitivity 12 (34.3) 31 (72.2) 11 (31.4) 6 (13.9) 12 (34.2) 6 (13.9)

Taste / Smell sensitivity 18 (51.4) 23 (53.5) 6 (17.1) 8 (18.6) 11 (31.4) 12 (27.9)

Movement sensitivity 12 (34.2) 30 (69.8) 10 (28.5) 8 (18.6) 13 (37.1) 5 (11.6)

 Under responsive / Seeks
sensation

13 (37.1) 27 (62.8) 6 (17.1) 2 (4.6) 16 (45.7) 14 (32.6)

Auditory filtering sensitivity 7 (20) 32 (74.4) 2 (5.7) 7 (16.3) 26 (74.3) 4 (9.3)

Low energy / Weak 21 (60) 39 (90.8) 2 (5.7) 2 (4.6) 12 (34.3) 2 (4.6)

Visual / Auditory Sensitivity 15 31 (72.2) 12 (34.3) 6 (13.9) 8 (16.3) 6 (13.9)

Total 9 (25.7) 23 (53.6) 3 (8.5) 10 (23.2) 23 (65.7) 10 (23.2)



J Nepal Paediatr Soc | VOL 42 | ISSUE 03 |SEP-DEC,  202246

Original Article Sensory profile in children

Table 4:  Comparison of individual item in each subscale of SSP between ASD and Non ASD Group
ASD N = 35 (%) Non ASD N = 43 (%)

Tactile sensitivity

a. Expresses distress during grooming e.g. fights or cries during hair-cutting, face    wash-
ing, finger nail cutting)

9 (25.7) 3 (6.9)

b. Prefers long sleeves when it is warm and short sleeves when it is cold 3 (8.5) 3 (6.9)

c. Avoids barefoot, specially in sand or grass 4 (11.4) 10 (23.2)

d. Reacts emotionally or aggressively to touch 4 (11.4) 3 (4.6)

e. Withdraws from splashing water 3 (8.5) 1 (2.3)

f. Difficulty in standing in line or close to other people 12 (34.3) 2 (4.6)

g. Rubs or scratches out on a spot that has been touched 4 (11.4) 1 (2.3)

Taste / Smell sensitivity

a. Avoids certain tastes or food smells that are typically part of children’s diet 9 (25.7) 7 (16.2)

b. Will only eat certain tastes 13 (37.1) 13 (30.2)

c. Limits self to particular food textures/temperature 11 (51.4) 9 (20.9)

d. Picky eater, especially regarding food textures 8 (22.8) 10 (23.3)

Movement sensitivity

a. Becomes anxious or distressed when feet leave the ground 6 (17.1) 1 (2.3)

b. Fears falling or heights 11 (31.4) 3 (6.9)

c. Dislikes activities where head is upside down (e.g.; somersaults) 11 (31.4) 1 (2.3)

Under-responsive / Seeks sensation

a. Enjoys strange noises/seeks to make noise for noise’s sake 11 (31.4) 7 (16.3)

b. Seeks all kinds of movement and this interferes with daily routines (figidity) 9 (25.7) 7 (16.3)

c. Becomes overly excitable during movement activity 12 (34.2) 9 (20.9)

d. Touches people and objects 8 (22.8) 7 (16.3)

e. Does not seem to notice when face or hands are messy 5 (14.2) 7 (16.3)

f. Jumps from one activity to another so that it interferes with play 15 (42.8) 5 (11.6)

g. Leaves clothing twisted on body 8 (22.8) (4.6) 2

Auditory filtering

a. Is distracted or has trouble functioning if there is a lot of noise around 16 (45.7) 6 (13.9)

b. Appears to not hear what you say (seems to ignore) 15 (42.8) 3 (6.9)

c. Can’t work with background noise (fan, freeze) 4 (11.4) 1 (2.3)

d. Has trouble completing task when radio is on 4 (11.4) 2 (4.6)

e. Doesn’t respond when name is called but you know child’s hearing is OK 10 (28.6) 5 (11.6)

f. Has difficulty paying attention 20 (57.1) 2 (4.6)

Low energy / Weak

a. Seems to have weak muscle 4 (11.4) 0

b. Tires easily, especially when standing or holding particular body position 3 (8.5) 2 (4.6)

c. Has a weak grasp 5 (14.2) 0

d. Can.t lift heavy objects (weak as compared to other children of that age) 5 (14.2) 0

e. Props to support self (even during activity) 6 (17.1)) 4 (9.3)

f. Poor endurance/tires easily 6 (17.1) 0

Visual/ Auditory sensitivity

a. Responds negatively to unexpected or loud noises (cries or hides at noise from 
vacuum, dog barking etc)

(20) 7 (4.6) 4

b. Holds hands over ears to protect ears from sound 12 (34.2) 4 (4.6)



J Nepal Paediatr Soc | VOL 42 | ISSUE 03 |SEP-DEC,  2022 47

Original ArticleSensory profile in children

?c. Is bothered by bright lights after others have adapted to the light 3 (8.5) 0

d. Watches everyone when they move around the room 8 (22.8) 12 (27.9)

e. Covers eyes or squints to protect eyes from light 3 (8.5) 9 (20.9)

The Cronbach’s alphas for the current sample on the SSP 
was .74 for the ASD group and .83 for the non-ASD group, 
indicating a satisfactory to high reliability. Cronbach’s 
alphas on all scales for ASD ranged between .76 - .83 
whereas it ranged between .68 -.75 for the non-ASD group. 
In all the subscales, the internal consistency was low in the 
ASD group as compared to the non-ASD group (Table 2).

Comparison of parent-reported sensory processing scores 
on the SSP for both groups is summarized in Table 3. 
About 66% (n = 35) of the children in ASD group had 
definitive sensory issues compared to 23% (n = 43) in non 
ASD group. About half of the children (54%, n = 43) in 
the non-ASD group had typical performance to sensory 
stimuli as compared to one-quarter (25%, n = 43) of 
children in the ASD group. In the ASD group, more than 
30% (n = 35) had definitive sensitivity to tactile, taste, 
and smell, movement sensitivity, under-responsive or seek 
sensation, and low energy scales. Almost 75% of the ASD 
group had auditory filtering sensitivity. Amongst the non-
ASD group, about 30% of them had a definitive sensory 
problem with taste/smell and under-responsive or seeking 
sensation scales. However, only a few children in both the 
groups (ASD group: 16% (n = 35), the non-ASD group: 
14% (n = 43) had visual sensitivity issues. When individual 
items were explored in each sensory scale, about 30% of 
children in the ASD group had a sensory issue when they 
come closer to another person in the queue and prefer only 
certain tastes; they were fearful of height and very excitable 
during movement. Almost 50% (n = 35) of children in the 
ASD group had inattention or difficulty in paying attention 
and jumping from one activity to another. Similarly, about 
50%(n = 35) of these children had auditory filtering issues 
in the form of getting distracted or trouble functioning with 
noise and sometimes like to produce noise. About 34% (n 
= 35) also had a habit of closing ears to protect themselves 
from noise. 

Amongst the non-ASD group, about 30% (n = 43) of the 
children eat only certain tastes and are aware of people 
around and watch them move.

Discussion
To the best of our knowledge, this is the first study 
investigating and comparing the sensory profile of Nepali 
children with or without ASD. The mean age of children 
in both groups was about seven years. The mean age of 
diagnosis of ASD was 36 months, indicating a decreased 
mean age of diagnosis of ASD as compared to the previous 
findings of 56 - 58 months.20 The earlier age of diagnosis of 
autism in recent years might be because there has been an 
increase in the number of awareness programs conducted 

by ACNS as well as the increased knowledge about ASD 
among health professionals and the general public. 

Although general awareness about autism is improving, there 
remains a huge gap of knowledge on sensory processing 
disorders.21 Although more than half of parents of the ASD 
group knew that their child had sensory problems, about 
one-third of parents were unsure about it. In the non-ASD 
group, only one-tenth of parents indicated that their child 
may have some sensory issues. SSP when applied by parents 
to their children, definite sensory issue was found in about 
three-quarters of the children in the ASD group. The finding 
is consistent with many previous SSP studies that stated 
42% to 95% of children with autism have a sensory issue 
reported by parents.11,22 In the non - ASD group, almost a 
quarter of the parents reported definitive sensory issues. This 
finding is comparable with the study from Saudi Arabia that 
showed similar proportions of their children without autism 
that displayed definite sensory issues, especially with tactile 
and under-responsiveness scales.23 In Indian neuro-typical 
children also, the definite sensory issue was seen in about 
30% of the children.24 The presence of sensory issues in 
neuro-typical children from Nepal, India and Saudi Arabia 
is higher as compared to studies from developed Western 
countries that ranged from 8.3% in population-based child 
survey 24 to 5 -13% in elementary school-aged children 
in the United States.25 About 16% of neuro-typical children 
from the US are over-responsive to certain auditory and 
tactile sensations  as compared to Nepalese neuro-typical 
children who were more sensitive to taste.26 This difference 
may be because of cultural differences in parenting style 
and perception of sensory issues of Nepali parents. Even 
health care professionals rarely discuss sensory issues 
as this issue is not integrated into the medical curricula. 
Along with that, the sensory experiences felt by children are 
different from how parents perceive them in their children. 
Parents often find it difficult to understand the actual sensory 
experiences of their children.27

In the current study, we found that about 65% of the children 
in the ASD group had sensory issues as compared to 83% 
of the children with ASD in the study from the USA.11 The 
most common sensitivity was seen in under-responsiveness 
and auditory filtering. According to parents’ report, children 
in this study within this group seemed to have problems in 
standing in a queue, aversion of certain tastes and texture 
of food, fear of height, inattention, easily distractible and 
negative response to unexpected sounds and sometimes 
appearing deaf. Parents also reported that their children got 
more excited during activities and were easily distractible. 
However, the visual / auditory sensitivity was found to be in 
only 16% as compared to about 44% from a study among 



J Nepal Paediatr Soc | VOL 42 | ISSUE 03 |SEP-DEC,  202248

Original Article Sensory profile in children

children in the US.11 The visual / auditory sensitivity in ASD 
and non-ASD was almost similar. Children in the non-ASD 
group seem to have more negative experiences with certain 
tastes, and textures of food. As many parents in the ASD 
group are associated with the autism support group and 
might have received orientation regarding SID, thus they 
might have reported only extreme responses and unusual 
behaviors of autism.

It is seen that many behavioral issues accompany SID and 
when together, it can cause a high level of stress level in 
parents with children having SID as compared to children 
without SID.28,29 However, when parents are educated 
regarding SID and when they have a better idea regarding 
the condition, families can adopt more meaningful family 
chores avoiding the sensory overload especially in cases of 
autism. The understanding of sensory issues helped parents 
to plan and prioritize the family occupations as well. In the 
case of neurotypical children, parents seem to emphasize 
more on unpleasant stimuli for the development of problem-
solving and coping skills.30 Thus, a better understanding of 
the sensory issues of the children and planning accordingly 
would be helpful for parents to reduce their stress. 

When internal consistency of SSP in the Nepalese context 
(including children with or without autism) was explored, it 
was found to be above 0.6 in all the scales with satisfactory 
reliability. Additionally, because SSP is simple and easy 
to administer, SSP can be filled in for each child with 
ASD so that the sensory issues can be considered when 
planning different activities for children. This would also 
help physicians, teachers, and parents to understand their 
children better. 

The study presents some limitations. Firstly, the findings of 
the study cannot be generalized. Most of the parents of 
children with ASD were associated with the autism support 
group where they have some orientation on SID and who 
are not associated with the support group, it is not known 
whether they have received any orientation on SID or 
not. Secondly, the data was collected through an online 
portal. Thus, only those parents who have access to the 
internet and knowledge on using such a portal participated 
in the study. Thirdly, the data is based on a screening 
survey instrument. Thus, it is not possible to determine 
the prevalence rate because of the lack of rigorous study 
assessing physiological and behavioral manifestations of 
SID in individuals through screening. It is recommended 
for more intensive diagnostic assessments for those who 
are identified to have SID through screening to validate 
the presence of a sensory processing disorder. Fourthly, 
the study used a small sample size which was not able to 
evaluate the presence or absence of other co-morbidities 
like attention deficit hyperactive disorder or other pure SID. 
Sensory over responsiveness is often associated with ADHD 
and anxiety.24 When treatment is targeted towards sensory 
modulation associated with hyperactivity and anxiety, 

sensory over responsiveness might show improvements in 
function and behaviors. Thus, when SID is explored, other 
associated co-morbidities should also be explored. The 
study excluded children with other disabilities like visual, 
hearing, and physical impairment. In such populations also, 
identifying and managing SID will help to manage their 
behaviors. As SID may rise or decline with age, conducting 
a longitudinal study would be helpful to find out the 
developmental trajectories of sensory processing disorders.

Conclusions
SID is twice as common in children with ASD as children 
without ASD. The most common sensory problem seen in 
children with ASD was auditory filtering sensitivity. Amongst 
the non-ASD group, the most common sensory problem was 
taste/smell and under-responsiveness. As SSP is an easy 
tool to identify the sensory issues, the Nepali version of SSP 
could be explored for further extensive researches in Nepal.

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https://doi.org/10.5014/ajot.61.2.135
https://doi.org/10.1002/1097-0355(199324)14:4%3c330::AID-IMHJ2280140407%3e3.0.CO;2-K
https://dx.doi.org/10.1007%2Fs10803-016-3018-8
https://doi.org/10.3389/fped.2017.00057
https://doi.org/10.1007/s10803-013-2005-6
https://dx.doi.org/10.1589%2Fjpts.27.1313
https://doi.org/10.3389/fnint.2020.00022
https://doi.org/10.5014/ajot.63.2.172
https://dx.doi.org/10.5014%2Fajot.2012.000604

