Associations among sensory hyperresponsiveness, restricted and repetitive behaviors, and anxiety in autism: An integrated systematic review

Abstract Background Autistic individuals exhibit core and co-occurring features that can be disabling to daily functioning and impede quality of life. The combined expression of three closely related features: sensory hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety, may be a sign to practitioners that experiences in the environment are particularly challenging. These are investigated through many approaches, including animal modelling, neurological or physiological measures, behavioral observation, and first-hand accounts. However, little work has been done to review evidence across approaches to better understand their expression. Method This study was an integrated systematic review to identify factors that contribute to the collective expression of three constructs of interests (COIs; hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety). Twenty-two articles were analyzed for both structural and thematic patterns. This review is unique in its inclusion of articles from a variety of disciplines and grouping of studies based on similarities over methodological techniques (i.e. quantitative, qualitative, or mixed methods). Results Three overall structural approaches relating the constructs of interest were identified (parallel, relational, and contingent). Three overarching themes also emerged: 1) the broader social context, 2) predictability of environmental factors, and 3) overlap with cognitive and behavioral coping strategies. Conclusions Results highlight clinically relevant information about the combined expression of the three COIs and demonstrate possibilities for increased collaboration across disciplines through common themes and study structures to further understand the experiences of autistic people.