The Psychometric Properties of a New Measure of Sensory Behaviors in Autistic Children
The Psychometric Properties of a New Measure of Sensory Behaviors in Autistic Children
Louise Neil 0 1 2
Dido Green 0 1 2
Elizabeth Pellicano 0 1 2
0 School of Psychology, University of Western Australia , Perth , Australia
1 Centre for Rehabilitation, Oxford Brookes University , Oxford , UK
2 Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London , 55-59 Gordon Square, London WC1H 0NU , UK
Unusual reactions to sensory input became part of the diagnostic criteria for autism spectrum disorder in the DSM-5. Measures accurately assessing these symptoms are important for clinical decisions. This study examined the reliability and validity of the Sensory Behavior Questionnaire, a parent-report scale designed to assess frequency and impact of sensory behaviors in autistic children. The scale demonstrated excellent internal consistency and concurrent validity, and was a better predictor of autistic symptoms than the Short Sensory Profile within a group of 66 school-age autistic children. The scale also successfully discriminated between autistic and typical children of similar age and ability. The Sensory Behavior Questionnaire has potential as a measure of sensory behaviors in children on the autism spectrum.
Sensory Questionnaire; Sensory behaviors; Sensory sensitivities; Autism
Atypical sensory experiences are a defining feature of
autism (APA 2013). These experiences are diverse, span
multiple sensory domains (Kern et al. 2007) and vary
widely between and within individuals. Although many
autistic people1 enjoy aspects of their sensory experiences,
they can also be distressing and lead to difficulties in
everyday life (Grandin 2009; Leekam et al. 2007; Zachor and
Ben-Itzchak 2014). The accurate measurement and
treatment of debilitating sensory sensitivities is therefore a
The most frequently used measure of sensory symptoms
in autism, the Sensory Profile (Dunn 1999), was developed
and tested primarily with a group of 1037 typical children
from North America, alongside smaller groups of children
diagnosed with particular conditions such as autism and
ADHD, with the aim of identifying sensory processing
difficulties within a classroom context. The short version of
the scale, the Short Sensory Profile (SSP: McIntosh et al.
1999) has been shown to discriminate autistic and typical
children. For example, in one study, 5- to 8-year-old
autistic children were rated as having significantly more sensory
behaviors than their age-matched typical peers (p < .001) on
92% of items as well as total and subscale scores (Tomchek
and Dunn 2007). Nevertheless, the SSP features few items
relating to hyposensitivity (only two items reflecting
underresponsivity) and sensory seeking behaviors. Additionally,
some sensory responses that are frequently reported by
parents of autistic children, such as lack of response to pain,
are not detailed in the SSP. Therefore the SSP may not
optimally account for the full range of sensory symptoms
in autism. The relatively recent recognition of atypical
sensory responses and interests as a core feature of autism
1 The term ‘autistic person’ is the preferred language of many people
on the spectrum (Kenny et al. 2016). In this article, we use this term
as well as person-first language to respect the wishes of all
individuals on the spectrum.
in the DSM-5 (APA 2013) underscores the importance
of developing suitable tools with which to assess sensory
behaviors so that appropriate interventions can be
identified. At the same time, it is important to recognise that not
all sensory behaviors cause distress or difficulty to
individuals with autism and their families. Measures that consider
the impact of these behaviors on participation in daily life,
rather than simply identify the frequency of such behaviors,
may also prove useful for clinicians and educators.
The current study assessed the psychometric properties
of a new questionnaire designed to address these issues.
The Sensory Behavior Questionnaire (SBQ: Green 2009)
was initially designed to assess sensory behaviors in
individuals with a moderate-to-severe learning disability or
pervasive developmental disorder, with or without a
physical disability, as both a clinical and research tool. A focus
group of expert clinicians developed the items, with the
original intention of creating a sensory inventory featuring
an item checklist alongside a behavior observation. In line
with recommendations for best practice for development of
health measurement scales (Streiner and Norman 2003),
face validity and expert opinion were used to select items
from this development work and create a questionnaire that
assessed both the frequency and impact of sensory
behaviors in a variety of sensory modalities.
The current study tested the reliability and validity of
the SBQ as a parent-report measure of sensory behaviors in
cognitively-able autistic children. Specifically, we assessed
the internal consistency of the SBQ’s frequency and impact
subscale and total scale scores, as well as its concurrent,
discriminant and predictive validity. We hypothesised that
the SBQ would have (1) excellent internal consistency, (2)
good concurrent validity with another parent-report
measure of sensory sensitivities, the SSP (McIntosh et al. 1999),
(3) good discriminant validity with a parent-report measure
of anxiety, the Spence Children’s Anxiety Scale (Spence
1988) and (4) good predictive validity, as assessed by its
ability to predict diagnostic status (autistic, typical). Given
that the scale was developed with individuals with
developmental conditions in mind, and includes items relating to
impact as well as frequency, we also hypothesised that the
SBQ might offer an advantage over the SSP as a measure
of sensory behaviors in autism. To investigate this issue,
we examined the extent to which scores on the two scales
could predict autistic symptoms.
The parents of 66 autistic children (male = 57; female = 9)
and 70 typically developing children (male = 36;
female = 34) aged from 6 to 17 years matched on age
t(134) = 0.88, p = .38, and full-scale IQ, t(99)2 = 1.01,
p = .313 (see Table 1 for scores), as assessed by the
Wechsler Abbreviated Scales of Intelligence, Second
Edition (WASI-II; Wechsler 2011) took part in this study by
completing questionnaires. Participants were recruited
through advertisements, the Autism Spectrum
DatabaseUK (http://www.ASD-UK.com), mainstream and special
schools and parent support groups in the Greater London
area. All parents completed a screening measure for autism,
the Social Communication Questionnaire (SCQ: Rutter
et al. 2003). All autistic children had previously received an
independent clinical diagnosis of an autism spectrum
condition according to ICD-10 (World Health Organisation
1992) or DSM-IV (American Psychiatric Association
2000) criteria and further met criteria on either the Autism
Diagnostic Observation Schedule (ADOS-G: Lord et al.
1999, 2012; ADOS-2:) using the revised algorithm
(Gotham et al. 2007, 2008) or the SCQ (see Table 1).
The Sensory Behavior Questionnaire (SBQ; Green 2009;
Gringras et al. 2014)
The 50-item SBQ was uniquely designed to measure
both frequency (e.g., ‘How often have you noticed your
child show an unusual response to bright lights in the last
month?’) and impact (e.g., ‘How much of a problem is it?’)
of 25 sensory behaviors in the following domains: auditory
processing, visual processing, movement (vestibular and
proprioceptive) processing, tactile processing, oral motor
(including gustatory and olfactory) processing and general
reactions and organisation. The items and their scoring do
not divide hyper- from hypo-responsiveness. Rather, the
majority of items ask whether the child shows an unusual
response to a series of different sensory
stimuli/environments. Respondents can provide more information by
circling the sort of response their child exhibits (e.g.,
preoccupation/avoidance) and one or more of the examples of
that stimulus given e.g., ‘Does your child show an unusual
response to bright lights (preoccupation/avoidance) e.g.,
spotlights, fair ground/neon strip lights?’ There is a parallel
design for the frequency and impact scales, with each being
2 Levene’s test of equal variances was significant, thus we report the
adjusted independent t test results where equal variances were not
3 In the larger typically developing group from which this matched
sample was drawn (n = 104; male = 54), there was no significant
difference in Sensory Behaviour Questionnaire total scores by gender
(t(102) = 0.61, p = .54) so the autistic and typical groups were not
matched on this variable.
Table 1 Descriptives for
autistic and matched typically
aVerbal IQ, Performance IQ and Full Scale IQ were measured using the WASI-II (Wechsler 2011)
bSocial Communication Questionnaire (Rutter et al. 2003). A score of 15 or above indicated elevated levels
of autistic symptomology
cADOS = Autism Diagnostic Observation Schedule (Lord et al. 1999, 2012). Scores of 7 or above indicate
the presence of an ASD
dSBQ = Sensory Behavior Questionnaire (lower scores reflect greater levels of sensory behaviors)
eSSP = Short Sensory Profile (lower scores reflect greater levels of sensory behaviors)
fSCAS-P = Spence Children’s Anxiety Scale (higher scores reflect greater levels of anxiety)
scored on a scale from 1 (all the time/an extreme problem)
to 6 (never/not at all). In line with the SSP (see below),
lower scores indicate greater levels/impact of sensory
behaviors. Individual frequency/impact items are summed
to create total frequency and impact subscale scores
(ranging from 25 for the greatest possible frequency/impact of
symptoms to 150 for the least possible frequency/impact of
symptoms). An overall total score is created by summing
Short Sensory Profile (SSP; McIntosh et al. 1999)
The 38-item Short Sensory Profile is an adapted version of
the original Sensory Profile (Dunn 1999) measuring
sensory symptoms in seven domains: tactile sensitivity, taste/
smell sensitivity, movement sensitivity, under-responsivity/
seeking sensation, auditory filtering, low energy/weakness
and visual/auditory sensitivity. Parents rate the frequency
of each item on a scale from 1 (always) to 5 (never). Scores
are summed to create a total score in which lower scores
reflect greater levels of sensory sensitivities. SSP total
scores can range from a minimum of 38 (greatest frequency
of sensory symptoms) to 190 (no sensory symptoms).
McIntosh et al. (1999) demonstrated good psychometric
properties for the scale, including adequate internal consistency
of the total and subscale scores (Cronbach’s alpha ranged
from 0.68 to 0.92), good convergent validity with
physiological measures and a discriminant validity of >95% in
distinguishing children with and without sensory
Spence Children’s Anxiety Scale: Parent Report (SCAS‑P;
Nauta 2004; Spence 1998)
The SCAS-P is a 38-item parent report measure of
children’s anxiety, adapted from the child version of the Spence
Children’s Anxiety Scale (Spence 1997, 1998).
Respondents rate the frequency of each item on a 4-point Likert
scale ranging from 0 (never) to 3 (always). Responses to
each of the 38 items are summed to create a total score,
ranging from 0 to 114. Higher scores reflect greater
levels of symptoms. The parent version of the scale has been
shown to have good psychometric properties including
excellent internal consistency (Cronbach’s alpha of 0.89)
(Nauta et al. 2004).
This study was part of a larger investigation into sensory
differences in autistic children. Children were seen in one
or more face-to-face sessions where they were administered
the Wechsler Abbreviated Scales of Intelligence, Second
Edition (WASI-II; Wechsler 2011) and the Autism
Diagnostic Observation Schedule (ADOS-2; Lord et al. 1999,
2012). Parents were asked to complete the Social
Communication Questionnaire, the SBQ, the SSP and the SCAS-P.
This study was granted ethical approval by the University’s
Research Ethics Committee. Written informed consent was
obtained from all parents prior to their and their child’s
In cases where a participant had data missing, a total score
for that particular scale was prorated on an individual basis,
using that individual’s completed items. Total scores were
not calculated in cases where a participant missed more
than 10% of items on a particular scale. Cronbach’s alpha
was used to calculate internal consistency and correlation
coefficients were performed to assess concurrent validity
(SBQ vs. SSP) and discriminant validity (SBQ vs.
SCASP). We used logistic regression to investigate how well the
SBQ could predict children’s diagnostic status (autistic,
typical). Finally, we compared the predictive power of the
SBQ and SSP by performing hierarchical linear regression
analyses with Social Communication Questionnaire (SCQ)
scores as the dependent variable and children’s SSP and
SBQ scores as predictors.
The SBQ’s internal consistency was excellent—for all 50
items (Cronbach’s alpha = 0.97) and for the frequency
(α = 0.93) and impact (α = 0.94) scales separately. There
were no significant associations between total SBQ scores
and children’s gender (r = 0.02, p = .90), age (r = 0.18,
p = .15) or IQ (r = 0.05, p = .68). Total scores were
associated with a retrospective measure of autistic
symptomatology, the Social Communication Questionnaire (SCQ)
(r = −0.39, p = .001): increased sensory atypical responses
to sensory stimuli were associated with greater levels of
autistic symptoms. The link between the SBQ and current
autistic symptomatology, as measured by ADOS total
algorithm scores, did not reach significance (r = −0.24, p = .08),
and there was no correlation with ADOS severity scores
(r = −0.19, p = .16). Similarly, there was no association
between SSP scores and ADOS total (r = −0.06, p = .68) or
severity (r = −0.04, p = .78) scores.
Fifty-nine of the 66 parents of autistic children also
completed the Short Sensory Profile (SSP). Total SBQ scores
showed a strong positive correlation with scores on the SSP
(r = .79, p < .001), indicating good concurrent validity.
We assessed the SBQ’s discriminant validity by
examining the association between total SBQ scores and SCAS-P
scores, completed by parents of 58 autistic children. Total
SCAS-P scores showed a moderate correlation with total
SBQ scores (r = −0.58, p < .001); greater levels of anxiety
were associated with more sensory behaviors. A similarly
Table 3 Short Sensory Profile
scores and Sensory Behavior
Questionnaire scores as
predictors of autistic children’s
as measured by the Social
Table 2 Logistic regression predicting diagnostic group (autism:
n = 66; typical: n = 70) from Sensory Behavior Questionnaire scores
Comparison with the SSP
To assess whether the SBQ offered predictive power over
and above the SSP, we conducted a hierarchical linear
analysis on children’s SCQ scores5. Autistic children’s
SCQ scores did not correlate significantly with age
(r = 0.21, p = .10), gender (r = 0.04, p = .75) or full scale
IQ (r = − 0.22, p = .07); these variables were therefore not
aSSP = Short Sensory Profile Scores (lower scores reflect greater levels of sensory behaviors)
bSBQ = Sensory Behavior Questionnaire (lower scores reflect greater levels of sensory behaviors)
*p < .05
strong association was found between total SCAS-P and
total SSP scores (r = −0.64, p < .001).
To assess the predictive power of the SBQ, we performed a
logistic regression with diagnostic status (autistic, typical)
as the dependent variable. As shown in Table 2, the logistic
regression model was significant, χ2 (1) = 99.42, p < .001.
SBQ scores explained 69% (Nagelkerke R2 = 0.69) of the
variance in diagnostic group and correctly classified 87.5%
of cases4. There were significant differences between
autistic and typical children on their total SBQ scores,
t(922) = 11.95, p < .001, d = 2.03, and the frequency,
t(1022) = 12.67, p < .001, d = 2.16, and impact subscale
scores, t(832) = 10.39, p < .001, d = 1.76, with large effect
sizes for each (see Table 1 for means and standard
4 We also assessed the predictive power of the SSP in this sample
using a similar regression model. SSP scores explained 61%
(Nagelkerke R2 = 0.61) of the variance in diagnostic group (compared to
the SBQ’s 69%) and correctly classified 87.2% of cases, similar to
the SBQ’s correct classification of 87.5% of cases, χ2 (1) = 66.68,
p < .001.
entered as covariates in the analysis. When autistic
children’s scores on the SSP were entered in the first step of
the model (see Table 3), they significantly predicted
children’s SCQ scores (R2 change = 0.08, F (1, 56) = 5.12,
p = .03). When their SBQ scores were entered in the
second step, they made a small but significant improvement
to the model, explaining an additional 7% of the variance
in children’s SCQ scores (R2 = 0.15, R2 change = 0.07, F
(1, 55) = 4.53, p = .04). Moreover, when both scales were
entered together in the analysis, only children’s total SBQ
scores significantly predicted children’s SCQ scores
(β = −0.42, p = .04); children’s SSP scores did not
(β = 0.05, p = .82).
One of the defining—and unique—features of the SBQ
is that it measures not only the frequency of children’s
sensory behaviors, but also their impact on everyday life.
The SBQ frequency and impact scales were very strongly
associated with each other (r = 0.88, p < .001) with
individual correlations between the 25 item pairs ranging
from r = 0.70 to r = 0.90. The frequency and impact scale
scores also showed significant associations with the SCQ
and SCAS, but not the ADOS (see Table 4).
5 We use children’s SCQ scores as the dependent variable in this
analysis because these scores (1) were significantly associated with
SBQ and SSP scores (ADOS scores were not) and (2) showed greater
variation than ADOS scores, making them more suitable for
Table 4 Correlations between the frequency/impact subscale scores of the Sensory Behavior Questionnaire and scores on the Social
Communication Questionnaire, Autism Diagnostic Observation Schedule and Spence Children’s Anxiety Scale
SBQa Frequency Score
SBQa Impact Score SCQb
ADOSc Severity Score SCAS-Pd
*p < .05, **p < .01
a SBQ = Sensory Behavior Questionnaire (lower scores reflect greater levels of sensory behaviors)
bSCQ = Social Communication Questionnaire (higher scores reflect greater levels of autistic symptoms)
cADOS = Autism Diagnostic Observation Schedule (higher scores reflect greater levels of autistic symptoms
dSCAS-P = Spence Children’s Anxiety Scale (higher scores reflect greater levels of anxiety symptoms)
eSSP = Short Sensory Profile (lower scores reflect greater levels of sensory behaviors)
Hyper-and hypo-reactivity to sensory stimuli and sensory
seeking behaviors are now considered within DSM-5’s
restricted, repetitive and stereotypical behaviors domain for
autism spectrum disorder. Measuring the nature and impact
of sensory behaviors effectively is important for detecting
such behaviours and for identifying appropriate therapy
programmes. Here, we tested a newly developed
parentreport scale, the Sensory Behavior Questionnaire (SBQ)
(Green 2009; Gringras et al. 2013), within a group of
cognitively-able autistic children. The SBQ showed excellent
internal consistency, and good concurrent validity with
the Short Sensory Profile (SSP). It also discriminated well
between autistic children and typical children of similar age
and intellectual ability. These findings demonstrate that the
scale has potential as a psychometrically valid tool to assess
sensory behaviors in children on the autism spectrum.
Children’s SBQ scores also contributed significant,
additional information (7% of unique variance—over and above
the SSP), in regard to children’s autistic symptomotology.
These results imply that the newly developed scale is at
least as good at predicting autistic symptoms on a
screening measure for the condition, the Social Communication
Questionnaire, as the existing scale (the SSP), and might
even have an advantage in capturing autistic children’s
sensory experiences. It is noteworthy, however, that the SBQ
scores only explained a small amount of the variance in
autistic children’s SCQ scores, and did not correlate
significantly with their ADOS scores. This is perhaps
unsurprising given that the SBQ is a parent-report measure of only
one feature of autism, unusual sensory behaviors, and that
these and related non-social behaviors may not become
apparent during the brief (~40-min) observational ADOS
The SBQ showed a moderate association with the
measure of children’s anxiety, the SCAS-P. Although the
magnitude of this association was both similar to the
magnitude of the SCAS-P and SSP correlation and consistent
with that of previous studies investigating the relationship
between sensory behaviors and anxiety (Green et al. 2012;
Wigham et al. 2015), it nevertheless raises the issue of
whether the SBQ—or any other measure of sensory
behaviours—can discriminate fully sensory behaviors from
anxiety. Previous studies have shown that anxiety and sensory
sensitivities regularly co-occur and may be causally linked
(although the precise nature of this link is unclear; see Neil
et al. 2016) rendering the use of anxiety as a measure of
discriminant validity a potential limitation of this study. It
is of course possible that a lack of specificity in
questionnaire items used to measure these constructs and/or the use
of caregiver report to measure both constructs, might have
superficially inflated the association between anxiety and
sensory sensitivities here and in previous studies (Green
et al. 2012; Wigham et al. 2015).
The Sensory Behavior Questionnaire measures the
impact, as well as the frequency, of sensory behaviors.
Both scales showed a similarly-sized association with
autistic symptomotology and levels of anxiety. In fact,
the two scales were exceptionally closely associated with
each other, with even the most disparate item pair
showing a strong correlation (r = 0.70). Nevertheless, this aspect
of the questionnaire may prove useful on a case-by-case
basis, by providing further justification for the need for
intervention and helping guide clinical decisions in regards
to where best to direct treatment. Furthermore, the
frequency and impact components of the questionnaire may
afford occupational therapists providing support for
sensory features with useful outcome measures. Future studies
should investigate whether the impact scale better predicts
children’s day-to-day functioning and outcomes over time
using measures of adaptive behavior or quality of life.
In conclusion, we have demonstrated that the freely
available SBQ is a psychometrically valid assessment of
atypical sensory behaviors in cognitively-able autistic
children. Important next steps include assessing the scale’s
convergent validity with assessments of sensory
reactivity provided through a different type of measure (e.g.,
observation; see Tavassoli et al. 2016) or by a different
rater (e.g., self-report); assessing its test–retest reliability,
and examining its ability to discriminate between autistic
children and those with other conditions such as ADHD. It
may also prove fruitful to examine the factors and clusters
within the SBQ within a larger sample, as has been done
with the SSP (Lane et al. 2011, 2014) to develop further
our understanding of the patterns and subtypes of sensory
behaviors within the autism spectrum.
Funding This research was funded by a Medical Research
Council grant awarded to EP (MR/J013145/1). Research at the Centre for
Research in Autism and Education (CRAE) is also supported by The
Clothworkers’ Foundation and Pears Foundation. We would like to
thank all the children and their parents who so generously gave up
their time to take part in our research. We are also grateful to the
Autism Spectrum Database-UK team (http://www.ASD-UK.com),
funded by the UK autism research charity Autistica, for assistance
Author contributions Conceived and designed the study: LN DG
EP. Performed the study: LN. Analyzed the data: LN EP. Wrote the
paper: LN DG EP.
Compliance with Ethical Standards
Conflict of interest Louise Neil (Author A) declares that she has no
conflict of interest. Dido Green (Author B) declares that she has no
conflict of interest. Elizabeth Pellicano (Author C) declares that she
has no conflict of interest.
Ethical approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards. Informed consent: Informed consent was obtained from all
individual participants (parents) included in the study.
Open Access This article is distributed under the terms of the
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creativecommons.org/licenses/by/4.0/), which permits unrestricted
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