Sensory sensitivities: clothes, haircuts, noise and new things

Background: what sensory sensitivities are

Many children have strong dislikes: the label in a new jumper, the buzz of clippers, a hand dryer, a noisy hall, the feel of new shoes. When reactions to everyday sensations are strong enough to disrupt daily routines, researchers call them sensory symptoms (Lane, 2020). The most studied pattern is sensory over-responsivity (SOR): reacting faster, more strongly or for longer than expected to touch, sound or other input. Other patterns are under-responsivity and sensation seeking (Ben-Sasson, Hen, et al., 2009).

The terms are contested. The American Academy of Pediatrics advises that "sensory processing disorder" should generally not be diagnosed, because there is no accepted diagnostic framework, and notes that sensory difficulties occur in autism, ADHD, developmental coordination disorder and childhood anxiety (Zimmer et al., 2012).

How common is it? In a representative sample of 925 children aged 7 to 11, 16% of parents said at least four touch or sound sensations bothered their child, and elevated SOR went with more emotional and behavioural problems and less adaptive social behaviour (Ben-Sasson, Carter, & Briggs-Gowan, 2009). In 338 children aged 7 to 10 from a birth cohort, 21.2% had elevated SOR, most without a psychiatric diagnosis, and SOR alone was linked to as many restrictions on family life as an emotional or behavioural disorder (Carter et al., 2011). A kindergarten survey estimated between 5.3% and 13.7%, depending on assumptions about families who did not reply (Ahn et al., 2004). In autism, a meta-analysis of 55 questionnaire studies (4,606 autistic people) found large differences from typical peers in over-responsivity, under-responsivity and seeking; only over-responsivity also distinguished autistic people from other clinical groups (Ben-Sasson et al., 2019). Sound sensitivities and other auditory differences were reported for more than 70% of autistic children at ages 3, 6 and 9, and at age 3 predicted behavioural difficulties at age 9 (Lau et al., 2023).

Links with anxiety. SOR and anxiety often occur together, and researchers have proposed that either may cause the other or that both share a common cause (Green & Ben-Sasson, 2010). In 149 autistic toddlers followed for a year, SOR predicted later increases in anxiety, but anxiety did not predict later SOR (Green et al., 2012). What looks like fussiness about clothes or noise may therefore be an early source of worry worth taking seriously.

How the research has been done

Most studies measure sensory symptoms with parent questionnaires such as the Short Sensory Profile; few tools cover the whole range of symptoms (Lane, 2020), and some trials add skin conductance, a physiological stress signal. Interventions fall into five families: Ayres Sensory Integration (ASI), a clinic-based occupational therapy using sensory-rich, child-led play (Case-Smith et al., 2015); single sensory-based strategies, such as weighted vests, therapy balls, brushing or sound therapies, meant to change a child's arousal; changes to the environment; behavioural approaches, such as graded exposure (also called systematic desensitisation: meeting the feared sensation in small, manageable steps), shaping and reinforcement; and preparation through stories.

Trials of ASI usually include Goal Attainment Scaling (GAS), in which families set individual goals and rate progress; it is sensitive to change but hard to blind. Behavioural studies mostly use single-case designs, such as a changing-criterion design, where the target is raised step by step, or a multiple baseline, where the intervention starts at different times for different children or sounds (see our glossary of research terms).

What the reviews and trials found

Ayres Sensory Integration: small positive trials, one large null trial

In a randomised trial of autistic children aged 4 to 8, 17 who received 30 sessions of manualised ASI scored higher on GAS than 15 in usual care (Cohen's d 1.2, a large effect) and needed less caregiver help with self-care (Schaaf et al., 2014). A Brazilian replication with 17 children found similar gains (Omairi et al., 2022). In a pilot with 24 children with sensory modulation difficulties, not specifically autistic, the therapy group improved on goals and attention, while sensory and behaviour scores moved in the expected direction without reaching significance (Miller et al., 2007).

Reviews diverge. One applied special-education quality standards to three studies and concluded ASI meets the criteria for an evidence-based practice for autistic children aged 4 to 12; several of its authors co-authored earlier trials of the approach (Schoen et al., 2019). The US national review lists Sensory Integration® among 28 evidence-based practices for autism (Steinbrenner et al., 2020). A review of 19 studies found two RCTs with positive GAS effects but called for more rigorous trials (Case-Smith et al., 2015). A review of 24 studies, only 3 at low risk of bias, judged that sensory integration approaches improved sensory and motor measures with low strength of evidence, and that effects were modest, short-term and of unclear durability (Weitlauf et al., 2017).

The largest trial, SenITA, randomised 138 autistic children in mainstream primary schools in Wales and England to 26 weeks of manualised sensory integration therapy or usual care. There was no significant effect on problem behaviour at 6 or 12 months (adjusted mean difference in irritability 0.40, 95% CI −2.33 to 3.14), and the therapy was not cost-effective. Carers' ratings of individual goals rose across sessions, but goals were not measured in the control group (Randell et al., 2022). A 2025 trial found that ASI and applied behaviour analysis improved individual goals comparably over no treatment, but neither significantly improved daily living skills compared with no treatment (Schaaf et al., 2025). The pattern: individual goals often improve; standardised outcomes much less clearly.

Weighted vests, brushing and sound therapies

Classroom sensory-based strategies showed few positive effects (Case-Smith et al., 2015). A review of seven studies concluded that weighted vests are, on balance, ineffective and cannot be recommended (Stephenson & Carter, 2009); a later review found limited evidence for them, alongside strong evidence for Qigong massage and moderate evidence for adapting the dental environment (Bodison & Parham, 2018). A 2024 rapid review of school supports (61 articles, only 15% good-quality evidence) advised against weighted vests and found some support for sound amplification, alternative seating and multisensory environments in certain conditions (Unwin et al., 2024). We found no controlled trials of brushing protocols in children; the American Academy of Pediatrics describes research on sensory integration therapy as limited and inconclusive (Zimmer et al., 2012). A Cochrane review of seven trials (182 participants) found no evidence that auditory integration training or similar sound therapies help autistic people (Sinha et al., 2011).

Changing the environment

Ten parents and five teachers of autistic children aged 6 to 12 with sound sensitivity said noise-attenuating headphones increased participation at home, in the community and at school; preparing children to use them reduced barriers, and many children learned to predict when they needed them and asked (Pfeiffer, Erb, & Slugg, 2019). In six children aged 8 to 16, skin conductance fell once headphones were introduced (Pfeiffer, Stein Duker, et al., 2019). In 21 autistic children aged 4 to 16, goal scores improved with standard earmuffs but not significantly with noise-cancelling headphones, and four children refused both (Ikuta et al., 2016). At the dentist, a sensory-adapted room lowered physiological stress and observed distress in a crossover trial of 162 autistic children (Stein Duker et al., 2023) (see preparing for doctors and dentists).

Gradual exposure and reinforcement

For sounds, three young autistic children were helped through graded steps with household noises such as a vacuum cleaner, blender and flushing toilet until they were comfortable, and the comfort was maintained at follow-up; the authors suggested such reactions may resemble a phobia rather than pain (Koegel et al., 2004). In a virtual-reality game offering graded exposure to target sounds, 20 autistic young people aged 8 to 15 reported fewer negative reactions, maintained 4 to 5 weeks later, although outcomes were self-reported and not measured in daily life (Johnston et al., 2022).

For haircuts, one autistic child received a preferred snack and short breaks for sitting, with the required time raised step by step, until his mother could cut his hair regularly; this lasted more than two months (Schumacher & Rapp, 2011). Two autistic adolescents moved through a hierarchy from clippers being present to clippers against the scalp, with food rewards for each calm step, and tolerated full haircuts at 6-month follow-up (Buckley et al., 2020). Reinforcement-based methods also increased wearing of prescription glasses in four people with intellectual disability: distraction alone worked for one, and the others needed added steps such as briefly blocking attempts to remove them (DeLeon et al., 2008). These are single-case studies with very few participants.

Social stories for sensory situations

A practitioner review named Social Stories™, with ASI, Qigong massage and the Alert Program, as the interventions with the strongest current evidence for sensory symptoms (Lane, 2020). Direct studies are few. In a multiple-baseline study of three preschoolers, individualised stories describing desired behaviours and sensory self-regulation strategies increased the desired behaviours for all three, while use of the strategies varied (Thompson & Johnston, 2013). A zoo combined staff training, sensory bags, social stories and quiet zones, and 200 families reported more visits and better experiences, though the package was uncontrolled (Kong et al., 2017). We found no controlled trial of a social story for haircuts, clothes or noise specifically (see our review of social stories evidence).

Clothes: mostly practice wisdom

We found no intervention studies of clothing tolerance in children. The research comes from autistic adults: ten adults interviewed with fabric samples described how some fabrics affected their wellbeing (Kyriacou et al., 2023), and in a survey of 86 UK autistic adults, tactile hypersensitivity predicted dissatisfaction with appearance and was linked to lower self-esteem; strategies included buying several of the same comfortable item and checking clothes before buying (Ferrer Knight & Birtles, 2025). Common advice, such as cutting out labels, choosing seam-free socks, washing new clothes first, letting the child choose fabrics and wearing new items at home for short spells, is reasonable but untested. Food selectivity has its own literature and is beyond this review.

For whom and under what conditions

Autistic and non-autistic children. SOR is common in the general population, but almost all intervention trials involve autistic children; the main exception is a 24-child pilot (Miller et al., 2007).

Age. Sensory differences between autistic and typical children were largest in studies of 6- to 9-year-olds (Ben-Sasson, Hen, et al., 2009), and SOR appears before anxiety (Green et al., 2012), which argues for early, practical support.

What counts as success. Therapies look better on goals families choose than on standardised scales (Randell et al., 2022). SenITA's possible differences by sex and ADHD are hypothesis-generating only.

Acceptance. Some children refuse headphones (Ikuta et al., 2016); preparing children to use them helped, and many learned to ask for them (Pfeiffer, Erb, & Slugg, 2019).

Who delivers. ASI requires trained occupational therapists; graded exposure has been carried out in a residential school (Buckley et al., 2020) and, for sounds, within family routines (Koegel et al., 2004).

What this means in practice

• Name the specific trigger. Note what, where and how strong. Specific goals are where interventions show effects.
• Accommodate where it is cheap and harmless: comfortable clothes, ear defenders for loud events, a quiet corner. Agree when headphones are used so the child learns to choose them, not to hide in them.
• Build tolerance in small steps for what must happen (haircuts, dental care, school uniform): start at a level that is easy, practise briefly, praise or reward, and step up only when your child is calm.
• Prepare with a story. One situation, what will happen, what the sensation is like and what helps.
• Be cautious about weighted vests, brushing protocols and sound therapies, and ask any provider what evidence they rely on and how progress will be measured.
• Involve an occupational therapist or doctor if reactions limit eating, dressing, washing, sleep, school or outings most days, if distress is severe or new, or if worry seems to be growing. Ask for a time-limited trial with clear goals (Zimmer et al., 2012).

What this means for short personalised cartoons

For a haircut or new clothes, a cartoon can do what a social story does: describe the situation, show a character noticing the sensation, using a coping tool such as ear defenders, a countdown or a break, and finishing. It might also act as a gentle first step before real practice, for example hearing clippers in the cartoon before hearing them in the chair, but that is untested.

The limits are clear. Over-responsivity is a bodily reaction, and in the studies above it was gradual real-world practice, not watching, that changed tolerance. A cartoon should present accommodations as normal and avoid suggesting that a child must simply endure discomfort. No study has tested our personalised cartoons for sensory situations.

Limits of the evidence

• Most outcomes are parent-reported, and families usually know which treatment their child received.
• Many trials are small, and several are run by teams closely associated with the therapy.
• Few trials include non-autistic children, despite how common SOR is in the general population.
• Behavioural evidence comes from a handful of children in single-case studies, with follow-up of months at most.
• For clothing, research in children is almost absent.
• Terms such as "sensory processing disorder" and "sensory integration" are used inconsistently across disciplines.

Open questions for research

1. Does a short story or video about a haircut, combined with graded practice, reach the goal faster than practice alone? A multiple-baseline study across children could test this.
2. Can graded wearing at home increase tolerance of school uniform or new clothes compared with accommodation alone, and how should clothing tolerance be measured in 5- to 9-year-olds?
3. Do headphones in loud places maintain, reduce or increase sound sensitivity over a year?
4. Does early support for SOR reduce later anxiety, as longitudinal data suggest it might?
5. Which children benefit from ASI? SenITA's subgroup findings (sex, ADHD) need a pre-registered test.
6. Can child-reported measures of sensory distress be developed for young children?

Frequently asked questions

References

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Spotted an error, or know a study we should add? Email hello@calalunakids.com. Every study we draw on is in the research library; research terms are explained in our methods glossary.