A brief cognitive reframing technique has been shown to dampen neural responses to aversive sensory input in autistic children and teens, according to a new study published in the Journal of Child Psychology and Psychiatry. Led by Urvi T. Shah, with senior author Shulamite A. Green, the research finds that a short session of cognitive reappraisal reduced activity in brain regions that process touch and sound, even if participants did not immediately report less distress.
Sensory over-responsivity is a common feature for many with neurodevelopmental or psychiatric conditions, including autism. It can interfere with daily routines, social interactions and emotional well-being, yet evidence-based treatments to alleviate this distress remain limited.
The study builds on a history of research showing that autistic individuals can exhibit heightened activity in primary sensory areas and the amygdala when exposed to uncomfortable stimuli, alongside weaker communication between regulatory regions such as the prefrontal cortex and the amygdala. Previous work has suggested that regulation of sensory responses may mature differently in autistic youth, compared with typically developing peers.
Researchers analysed data from 47 autistic youths and 45 typically developing youths aged 8 to 15, all with an average age of 13. The groups were matched on age and IQ, with Full-Scale IQs averaging 110. After screening for head movement and other exclusions, all included participants completed a practice scan and a single training session on cognitive reappraisal before entering the MRI.
Inside the scanner, participants experienced twelve 20-second blocks of touch to the inner left forearm using two mildly unpleasant materials: artificial grass and scratchy wool, separated by rest periods. In the “React” trials, they simply felt the sensation; in the six “Reappraise” trials, they were instructed to describe the texture as if they were an objective reporter, distancing themselves emotionally from the discomfort.
Participants rated how badly they felt after each block on a four-point scale. Grass was judged more unpleasant overall than wool, with average distress scores of 2.34 versus 1.44 across groups. However, only the typically developing group showed a small decrease in distress during reappraisal, and only for the grass texture.
Neurally, autistic youths altered how they processed touch during reappraisal. When reacting naturally, autistic participants showed higher activity in the cerebellum, but during reappraisal the two groups no longer differed significantly in whole-brain activity. Direct comparisons revealed that in the autistic group, reappraisal reduced activity in the somatosensory cortex and in the insula. By contrast, typically developing youths did not show reductions in these sensory regions; in fact, their somatosensory activity edged up slightly during reappraisal.
Auditory processing also shifted in the autistic group, with reduced activity in the primary auditory cortex during reappraisal, despite the task involving tactile stimuli. The typically developing group did not show a similar pattern.
Frontal regions of self-regulation told a complementary story. In typically developing youths, reappraisal increased activity in the dorsomedial prefrontal cortex and language areas. The autistic group, overall, did not show a statistically significant rise in these frontal areas, though the combined sample showed a trend towards greater dorsomedial prefrontal engagement during reappraisal that did not reach significance between groups. The orbitofrontal cortex responded in both groups, particularly on the left; in the right orbitofrontal cortex, autistic youths showed a sharper decline in activity during reappraisal, which may reflect a prioritisation of left-sided regulation.
Within the autistic group, brain responses varied with everyday sensory symptom severity, even after accounting for anxiety. Those with milder sensory over-responsivity demonstrated larger reductions in sensory cortex activity during reappraisal, whereas participants with more severe symptoms showed smaller reductions in sensory regions and greater increases in frontal control areas. The authors suggest that youths most sensitive to sensory input may require more practice to use the strategy effectively, though reappraisal could still be beneficial for those with milder symptoms.
Age-related patterns emerged as well. Younger autistic children displayed more visual-area activity during React, a pattern not seen during reappraisal, while older autistic teens showed greater activation during reappraisal in frontal regions such as the frontal pole and orbitofrontal cortex. The authors note this may indicate delayed maturation of frontal circuits underpinning sensory regulation in autism, compared with typically developing peers.
“Teaching autistic kids to use a common emotion regulation technique seems to help reduce their brain’s sensory responses to aversive sensory stimulation,” Green said. “This suggests that when they think about sensory stimuli more objectively, such as focusing on the ‘facts’ of the sensory stimulus, their brain may not respond as strongly in regions that usually process basic sensory information. In particular, older teens with autism may engage more of the prefrontal brain regions that help with emotional and behavioural regulation. This type of emotion regulation strategy could be incorporated into interventions and tested to see if it helps with sensory over-responsivity in everyday life.”
“I was surprised that while on the whole, the group of autistic kids all reduced reactivity in sensory brain regions when using reappraisal, only the older autistic kids engaged prefrontal regulatory regions,” Green noted. “This is in contrast to the typically developing controls who, as a group, engaged prefrontal cortex, regardless of age. This is consistent with some of our prior research that autistic teens may take longer to develop sensory regulation compared to typically developing teens. However, our results suggest that reappraisal can be helpful in reducing sensory responses even for younger autistic youth who don’t engage regulatory regions as much.”
The authors caution that the training was brief and clinical therapies typically require weeks of practice before perceptible changes occur. They also note that interoception differences and rapid task switching could have affected results, and that the study’s inclusion criteria (IQ 75–146 and ability to respond verbally) may limit generalisability to autistic individuals with intellectual disabilities or limited language. Future work should test cognitive reappraisal outside the MRI environment and assess whether multi-week cognitive behavioural therapy could yield lasting relief in daily life.
“This reappraisal task was difficult for younger kids or those with more cognitive challenges, so while it is promising as an intervention, it may be most useful for autistic individuals with cognitive and verbal skills in the average range or higher,” Green added.
The study, Cognitive reappraisal modulates neural responses to aversive sensory stimulation in autistic youth, was authored by Urvi T. Shah, Karrin Evans, Megan Banchik, Apurva Chaturvedi, Sapna Ramappa, Katie Wong, Jennifer A. Silvers, and Shulamite A. Green.
