This study examined the clinical specificity and neural correlates of sensory over-responsivity (SOR) in 15,728 children ages 6–17.9 years across five datasets (three community, two autism-enriched), assessing associations with anxiety, ADHD, depression, conduct disorder, ODD, and autistic traits, plus resting-state fMRI functional connectivity (FC) in ABCD subsamples (n=4,195 discovery; n=4,190 replication).
SOR was consistently linked to higher autistic traits and anxiety symptoms, and — in community samples — lower conduct disorder symptoms, but not reliably associated with any other psychiatric conditions. Neuroimaging found reduced FC between the cingulo-parietal network and bilateral caudate nucleus; this pattern replicated across independent ABCD subsamples and extended to severe SOR, but was non-significant in smaller samples (n=356).
- Brain-behavior FC effects required very large samples (n~4,000+) to detect reliably and did not replicate in smaller samples (n=356), limiting immediate clinical translation. - Cross-sectional design prevents causal inference about whether SOR drives or results from co-occurring traits. - SOR measurement varied across datasets, which may introduce inconsistency in how severity was operationalized.
Children presenting with sensory over-responsivity should be screened for both anxiety and autistic traits as co-occurring concerns, while conduct disorder symptoms appear less likely to co-occur. Clinicians should not assume SOR signals ADHD, depression, or ODD without additional evidence.
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