Obsessive–Compulsive Symptoms in Children Are Related to Sensory Sensitivity and to Seeking Proxies for Internal States

Symptoms of obsessive–compulsive disorder are related to atypical sensory processing, particularly sensory over-responsivity, in both children and adults. In adults, obsessive–compulsive symptoms are also associated with the attenuation of access to the internal state and compensatory reliance on proxies for these states, including fixed rules and rituals. We aimed to examine the associations between sensory over-responsivity, the tendency to seek proxies for internal states, and obsessive–compulsive symptoms in children. Parents of 404 children between 5 and 10 years of age completed online measures of obsessive–compulsive symptoms, seeking proxies for internal states, sensory over-responsivity, and anxiety. Linear regression, dominance analysis, and network analysis were used to explore the unique associations between these variables. The tendency to seek proxies for internal states was more strongly associated with obsessive–compulsive symptoms than with anxiety symptoms and uniquely associated with all major obsessive–compulsive symptom dimensions except obsessing. Both the tendency to seek proxies for internal states and sensory over-responsivity were significantly associated with obsessive–compulsive symptoms, but the association was significantly stronger for the tendency to seek proxies for internal states. While limited by the sole reliance on the parent-report, the present study shows that the tendency to seek proxies for internal states could help clarify the developmental processes involved in the onset of obsessive–compulsive symptoms during childhood and that sensory sensitivity may be important to consider in this process.