Personality and Individual Differences 92 (2016) 80–86

Contents lists available at ScienceDirect

Personality and Individual Differences

journal homepage: www.elsevier.com/locate/paid

Making sense of it all: The impact of sensory processing sensitivity on

daily functioning of children
Sofie Boterberg ⁎, Petra Warreyn
Ghent University, Ghent, Belgium

a r t i c l e i n f o a b s t r a c t

Article history: Previous research on sensory processing sensitivity and related concepts showed an association with internaliz-
Received 8 July 2015 ing problems. The current explorative study investigated the underlying factor structure of the parent-report
Received in revised form 11 December 2015 Highly Sensitive Person Scale (HSPS) and its association with problems in daily functioning. Caregivers of 235
Accepted 14 December 2015
children (3–16 years) completed the HSPS as well as questions on daily functioning. First, the factor structure
Available online 29 December 2015
of the HSPS was explored and evaluated. Second, both differences in reported problems between a high SPS
Keywords:
and a control group, and in SPS factors between children with few versus many problems, were examined. Re-
Sensory processing sensitivity sults suggested that the scores of the HSPS have good internal consistency and supported a two-factor structure
Children which distinguishes Overreaction to Stimuli (OS) and Depth of Processing (DP). Children with high SPS were re-
Highly sensitive person scale ported to have more internalizing problems. High OS was more common in children who cried excessively as a
Daily functioning baby, children with medically unexplained physical symptoms (MUPS), sleeping, eating and drinking problems
Temperament while high DP was more common in children with MUPS and sleeping problems. This study provides the first em-
pirical evidence that the parent-report HSPS may add valuable information to the assessment of children with
problems in daily functioning.
© 2015 Elsevier Ltd. All rights reserved.

1. Introduction than most other people. In addition, they would respond more to cues
in the environment by comparing them to previous experiences with
Aron and Aron (1997) described Sensory Processing Sensitivity similar cues. This may result in taking more time to observe and react
(SPS) as a genetically determined temperamental or personality trait slower whereby they seem less prone to act when confronted with a
which is present in some individuals and reflects an increased sensitiv- new situation and have more aversion towards risk-taking (Aron
ity of the central nervous system and a deeper cognitive processing of et al., 2012). Further, research in evolutionary biology provides evidence
physical, social and emotional stimuli (Aron, Aron, & Jagiellowicz, that the trait of SPS can be observed in over 100 nonhuman species in
2012). The terms “hypersensitivity” or “highly sensitive”, which are the form of sensitivity, responsiveness, plasticity and flexibility (Wolf,
popular synonyms for the scientific concept of SPS, are increasingly van Doorn, & Weissing, 2008).
used in psychological practice both with adults and with children. How- Aron et al. (2012) state that both introversion (the inhibition of
ever, despite the rising popularity of the concept in general society and social behaviors) and neuroticism (the reporting of intense negative
previous research on different genes, patterns of brain activation, emotion) could theoretically, in some cases, be aspects of a general
behaviors, and physiological reactions associated with high SPS (see sensitivity. Both Aron and Aron (1997) and Smolewska, McCabe, and
Aron et al., 2012 for an overview), there is still a lack of fundamental, Woody (2006) undertook systematic statistical comparisons of the sen-
empirical and independent scientific evidence for the temperamental sitivity measure and several measures of traditional personality traits of
concept of SPS. The present study has to be considered as exploratory introversion and neuroticism to examine similarities and differences
since it is, to our knowledge, the first which examines SPS in children. between SPS, introversion and neuroticism. Their findings indicated
Aron and Aron (1997) suggested that the trait would be present that SPS is a unique personality trait which deserves to be examined
in 15 to 20% of the population. Individuals with high SPS are believed separately. This is an important finding, since the trait of sensitivity
to be easily overstimulated by external stimuli because they have a has often been confused with introversion and neuroticism in previous
lower perceptual threshold and process stimuli cognitively deeper research on personality (see also Aron et al., 2012).
A low sensory threshold, an important characteristic of high SPS, is
also present in different sensory processing patterns and disorders,
⁎ Corresponding author at: Ghent University, Department of Experimental Clinical and
Health Psychology, Henri Dunantlaan 2, B-9000 Ghent, Belgium.
such as “Sensory Sensitivity” and “Sensory Avoiding” (Dunn, 2001),
E-mail address: Sofie.Boterberg@UGent.be (S. Boterberg). “Sensory Defensiveness” (Ayres, 1963) and “Sensory Over-
URL: http://www.ekgp.ugent.be (S. Boterberg). Responsivity” (SOR; Miller, Anzalone, Lane, Cermak, & Osten, 2007). It

http://dx.doi.org/10.1016/j.paid.2015.12.022
0191-8869/© 2015 Elsevier Ltd. All rights reserved.
 S. Boterberg, P. Warreyn / Personality and Individual Differences 92 (2016) 80–86 81

is important to note that, although SPS seems to be associated with cut-off score of the top 20%. This cut-off score is based on previous re-
these sensory processing patterns and disorders, it concerns a tempera- search which suggested that SPS in adults is best considered as a dichot-
mental trait and should therefore not be confused with these disorders. omous category variable with a visible break point in the sample
However, the conceptual overlap between these various constructs distribution around the 10 to 35% (for an overview of the studies on the
shows the extensive interdisciplinary interest in characteristics of hy- sample distribution of SPS see Aron et al., 2012). The dimensionality of
persensitivity and emphasizes the theoretical and practical importance the HSPS in adults was examined by three independent studies. Liss
of the concept. et al. (2008) and Smolewska et al. (2006) revealed a post-hoc three-
The processing of sensory events, as a part of everyday life, is sug- factor structure, with a strong intercorrelation between the factors sug-
gested to have a significant impact on human experience and behavior. gesting a single higher order construct. Evans and Rothbart (2008) how-
In adults, high SPS is associated with high levels of stress, symptoms of ever, proposed a two-factor solution very similar to their model of adult
ill-health, alexithymia, anxiety and depression (Benham, 2006; Liss, temperament (Evans & Rothbart, 2007). More recently, Aron theoretical-
Mailloux, & Erchull, 2008; Liss, Timmel, Baxley, & Killingsworth, 2005), ly redefined the different facets of SPS using the acronym “DOES” (Aron
and in combination with a negative childhood environment, also with et al., 2012; Aron, 2010, 2012). “Depth of Processing” includes features
negative affectivity and shyness (Aron, Aron, & Davies, 2005). Sensory like empathy, conscientiousness, having intensive feelings for others,
processing may interfere with the participation in daily activities, and having living dreams and a rich imagination, and the presence of a gener-
social, cognitive, and sensorimotor development in children as well al thoughtfulness or awareness of long term consequences (i.e. “pause-
(Dunn, 2001). Despite the fact that no research seems to directly exam- to-check approach”). “Overstimulation” refers to the presence of a more
ine the association between high SPS and problems in the daily func- frequent and stronger autonomic arousal towards situations which are
tioning of children, a number of studies examined the relationship perceived as stressful. “Emotional Intensity” refers to the presence of
with different sensory processing patterns and disorders. Although both more intense negative and positive emotional responses. Finally,
temperamental SPS and the different sensory processing patterns and “Sensory Sensitivity” refers to the presence of a low pain threshold and
disorders are not the same, they do have a low sensory threshold in a low tolerance of high levels of sensory input, and noticing subtle differ-
common and can thus provide preliminary insight into the association ences. It can be assumed that the presence of these four characteristics
between high SPS and problems in daily functioning. Research showed has a considerable influence on the daily functioning of children and is as-
that “Sensory Sensitivity” is associated with sleeping and behavioral sociated with different internalizing and externalizing behavioral prob-
problems (Reynolds, Lane, & Thacker, 2012; Shochat, Tzischinsky, & lems. According to Aron and colleagues, these four factors would load
Engel-Yeger, 2009), and ritualism and obsessive compulsive disorder together on the unidimensional construct of SPS. However, until now
(OCD) symptoms (Dar, Kahn, & Carmeli, 2012). “Sensory Defensive- there has been a lack of empirical evidence to support this theoretical
ness” is related to eating, learning and other social, emotional and be- four-factor model. Moreover, there is no explicit model available of
havioral problems (Smith, Roux, Naidoo, & Venter, 2005; Stephens & which items from the HSPS load on the different theoretical factors, and
Royeen, 1998). “Sensory Over-Responsivity” is related to internalizing some items seem to have a conceptual overlap which makes it impossible
and externalizing problems, impaired emotion regulation, and less adap- to compose an a priori factor model.
tive social behavior, and seems to be more frequently present in children In analogy with the adult questionnaire, a 23-item parent-report
with clinically significant anxiety (Ben-Sasson, Carter, & Briggs-Gowan, questionnaire for children was developed and published in Aron's
2009; Conelea, Carter, & Freeman, 2014). Further, research from book “The Highly Sensitive Child (HSC)” (Aron, 2002). It is important
Gourley, Wind, Henninger, and Chinitz (2013) found that in a sample of to note that the items of the HSPS for children have a different content
children with a wide range of developmental and behavioral diagnoses and number compared to the adult HSPS. Unlike its adult counterpart,
the presence of sensory processing difficulties was related with more the reliability, distribution, validity and dimensionality have not yet
internalizing and externalizing behavioral problems. Furthermore, been investigated. Given the increasing use of the concept of “high sen-
in children with an autism spectrum disorder (ASD), ‘Sensory Sensi- sitivity” in children, an instrument objectively measuring this trait is ur-
tivity’, ‘Sensory Avoiding’, ‘Sensory Defensiveness’ and ‘Sensory Over- gently needed.
Responsivity’, are related with more negative emotional reactions and The first goal of the present study was to explore the underlying fac-
more fear (Baranek, David, Poe, Stone, & Watson, 2006; Ben-Sasson, tor structure of Aron's 23-item parent-report HSPS for children. Until
Hen, et al., 2009; Green, Ben-Sasson, Soto, & Carter, 2012; Green & now, research only focused on the factor structure of the HSPS for
Ben-Sasson, 2010; Kientz & Dunn, 1997; Pfeiffer, Kinnealey, Reed, & adults, resulting in a three- or two-factor model. However, based on
Herzberg, 2005). Overall, it can be concluded that different aspects of the fundamental differences between the HSPS for children and the
increased SPS seem to be mainly associated with internalizing prob- HSPS for adults, and the lack of an explicit model for the DOES-theory
lems. This emphasizes the need for a fundamental scientific framework in SPS, there was no a priori factor model for the HSPS in children avail-
for understanding the temperamental trait of SPS in children. able that could be tested, except for the one-factor structure as pro-
To measure individual differences in SPS in adults, Aron and Aron posed by Aron and Aron (1997). The second goal was to investigate
(1997) developed the self-report 27-item Highly Sensitive Person the association between high SPS and problems in daily functioning.
Scale (HSPS), containing items that measure sensitivity to a large variety First, differences in problems in daily functioning such as antisocial be-
of stimuli, the extent to which an individual quickly feels overwhelmed havior, medically unexplained physical symptoms (MUPS) and,
by intense sensory input, and artistic and emotional sensitivity. For re- sleeping, eating and drinking problems between a group of children
search purposes, the items of the HSPS are rated on a 5- or 7-point Likert with high SPS and a group of children with average or low SPS were
scale. However, there is also a yes/no response format available in the examined. Based on different studies including partial aspects of SPS
popular books and on the website of Elaine N. Aron. Despite the variety such as “Sensory Sensitivity” (Dunn, 2001), we expected that chil-
of types of sensitivity in the items, the HSPS was initially reported to dren in the high SPS group would have more problems in their
have a one-dimensional structure (Aron & Aron, 1997) and was shown daily functioning, especially internalizing problems. Second, differ-
to have adequate reliability, content-oriented validity, and validity re- ences in the factors of the HSPS and the total 23-item HSPS, as used
garding relationships with conceptually related constructs (American in clinical practice, were identified between children with few versus
Educational Research Association, American Psychological Association, many problems in daily functioning. Again, children with especially
& National Council On Measurement In Education, 2014; Aron & Aron, more internalizing problems were expected to have higher SPS in
1997; Benham, 2006; Evans & Rothbart, 2008; Liss et al., 2008; general and more specifically, were also expected to have higher
Smolewska et al., 2006). To determine whether a person has high SPS scores on the characteristic of SPS that is associated with sensory
or not on a group level, Aron and Aron (1997) propose to use a relative (hyper)sensitivity.
82 S. Boterberg, P. Warreyn / Personality and Individual Differences 92 (2016) 80–86

2. Method excessively or is it sometimes difficult to stop him/her from eating?”,

“Does your child sometimes drink excessively or is it sometimes difficult
2.1. Procedure and participants to stop him/her from drinking?” and “Does your child not drink at all
during an entire day?” Furthermore, the presence of antisocial behavior
The present study was part of a broader online survey on tempera- was also explored: “Does your child often lie to others or deceive
ment and behavioral functioning and was approved by the appropriate others?”, “Does your child sometimes steal things?” and “Does your
ethics committee in April 2013. Participation was voluntary and anony- child often argue or fight with other children, or does he/she bully
mous. Caregivers of 235 children and adolescents (53.20% boys) be- them?” Finally, the question “Did your child cry often when he/she
tween 3 and 16 years (M = 8.27, SD = 3.28) fully completed the 23- was a baby?” was asked. In accordance with the HSPS, each item
item HSPS along with questions about their children's problems in was rated from one to five (1 = “almost never true”; 5 = “almost al-
daily functioning. Initially, 258 respondents started to fill out the survey ways true”).
but 33 (14%) did not complete it. Based on the exploratory nature and
the relatively large sample size of the present study, we decided to not 2.3. Statistical analyses
impute the missing data. The survey was distributed in Flanders,
Belgium. Most questionnaires (n = 223; 94.89%) were filled out by First, Cronbach's alpha was computed as a measure of internal con-
the biological mother of the child, 11 (4.68%) by the biological father sistency and the distribution of the HSPS total scores was examined to
and one (0.43%) by the grandmother. Most respondents (n = 189; validate if SPS in children can be considered as a dichotomous variable.
80.43%) and also their partners (n = 145; 61.70%) had a higher educa- Second, to extract the underlying factor structure of the HSPS in chil-
tion. To examine differences in problems in the daily functioning, two dren, an Exploratory Factor Analysis (EFA) with oblimin oblique rota-
independent samples were selected from this original sample: a sample tion was applied to 60% of the sample. To select the number of factors
of children scoring high on SPS (i.e. high SPS group) and a control group to retain, both the Scree Plot (Cattell, 1966), the Velicer (1976) mini-
scoring average or low on SPS. First, the 20% children (N = 48) with the mum average partial (MAP) test and Horn's Parallel Analysis (Horn,
highest total scores on the HSPS (range 98–114) were selected for the 1965) were conducted. Third, a Confirmatory Factor Analysis (CFA)
high SPS group, as theoretically suggested by Aron and Aron (1997). was conducted on the other 40% of the sample to evaluate and compare
Since problems in daily functioning could be associated with the pres- the fit of the exploratory factor solution with a one-factor solution.
ence of a clinical diagnosis instead of temperamental sensitivity, we Fourth, the proportion of children in the high SPS and in the control
excluded all children (n = 7; 14.58%) with externalizing, internalizing, group with problems in daily functioning was compared using chi-
or developmental disorders. Based on parental report, clinical diagnoses square tests. Finally, we compared the HSPS total (23-items) and the
were determined by a multidisciplinary team or by accredited psychol- HSPS factor scores, based on the results of the exploratory analysis, of
ogists, speech therapists, child psychiatrists, pediatricians and pediatric children with no or little problems to children with some or many prob-
neurologists. This resulted in a high SPS group of 41 children with lems in both groups using independent sample t-tests. As a measure of
19 boys and 22 girls between 4 and 15 years (M = 7.33, SD = 2.43). practical significance, Cohens' d was reported (Cohen, 1988).
The remaining 80% of children (N = 187) with an average or low total Within the group analyses, assumptions for parametric testing
score on the HSPS (range 39–97) comprised the control group. Again, (additivity and linearity, normality, homogeneity of variance and inde-
all children with a clinical diagnosis (n = 45; 24.06%) were excluded, pendence, see also Field, 2013) were met. Further, since most of the
resulting in a control group of 142 children with 69 boys and 73 girls items about problems in daily functioning lacked sufficient variation
between 3 and 16 years (M = 7.95, SD = 3.47). No significant gender of scores or suggested a bimodal distribution, it was decided to dichot-
(χ2(1) = .065, p = .799), respondent (χ2(1) = .575, p = .750), respon- omize the items (0 = “no or little problems” and 1 = “some or many
dent education (χ2(1) = 1.886, p = .930) and age (U(183) = 3000; p = problems”). The item about stealing was removed from further analyses
.765) differences were found between the high SPS group and the con- due to a floor effect of the scores. Most analyses were executed in IBM
trol group. Since the scores on the variable age were not normally dis- SPSS Statistics for Windows, Version 20.0 (IBM Corp., 2013). Both the
tributed (D(183) = .160, p b .001), a non-parametric Mann–Whitney Velicer MAP test and Horn's Parallel Analysis were conducted in SPSS
U-test was used. using a syntax from O'Connor (2000). The CFA was conducted in
Amos 7.0 (Arbuckle, 2006) and to test for multivariate normality we
2.2. Measures used the program R (R Development Core Team, 2008).

The 23-item parent-report Highly Sensitive Person Scale (HSPS; Aron, 3. Results
2002). In the present study the 23-item parent-report HSPS, designed
for measuring SPS in children and adolescents, was used. The question- 3.1. Internal consistency and distribution of the HSPS
naire was published in a book about high sensitivity in children (Aron,
2002) and was based on the adult version of the HSPS (Aron & Aron, The scores of the 23-item parent-report HSPS had a Cronbach's alpha
1997). The Dutch translation of the questionnaire was published by of .91 (N = 235; 95% CI [.90,.93]) suggesting excellent internal consis-
Aron (2004) and Daele and T'Kindt (2011). In order to obtain sufficient tency (DeVellis, 2012). The total scores of the HSPS did not deviate
variation in scores and according to previous research on the HSPS in from the normal distribution (D(235) = .912, p = .376).
adults, we decided to rate each item on a five-point Likert scale (1 =
“strongly disagree”; 5 = “strongly agree”). 3.2. Exploratory factor analysis of the HSPS
Measures of problems in daily functioning. Medically unexplained
physical symptoms (MUPS) were explored with the question: “Does The sample selected randomly for the EFA consisted of 140 cases and
your child often complain about headaches, stomach ache/abdominal had an alpha coefficient of .91 (95% CI [.89,.93]) for the scores of the
pain or nausea without apparent medical reason?” Items that investi- HSPS. Assumptions (non-multicollinearity, sampling adequacy and
gated sleeping problems were: “When going to bed, does your child factorability) for EFA were met. The Kaiser–Meyer–Olkin measure of
often fall asleep within ten minutes?” and “Does your child have prob- sampling adequacy evaluates tests of fit, and findings were very good
lems to fall back asleep when he/she wakes up at night?” Further, ques- at 0.874 (Hutcheson & Sofroniou, 1999). Bartlett's test of sphericity
tions regarding eating and drinking problems were: “Does your child was significant (χ2(253) = 1501,133, p b .001). Using the MVN package
sometimes refuse eating different kinds of food, e.g., certain tastes or in R, the p-values for Mardia's multivariate skew and Mardia's multivar-
textures, such as food with lumps?”, “Does your child sometimes eat iate kurtosis were b.001 which indicated that the data are not
 S. Boterberg, P. Warreyn / Personality and Individual Differences 92 (2016) 80–86 83

multivariate normally distributed. Therefore, it was decided to use the Table 2

principal axis factors method to extract the factors (Costello & Proportion of the high SPS and control group with reported problems.

Osborne, 2005). The EFA was followed by an oblique rotation (direct % High SPS (n = 41) % Control (n = 142) χ2(1)
oblimin) to get a theoretically more accurate and reproducible solution MUPS 82.93 47.89 15.833a
(Costello & Osborne, 2005). The Scree Plot (Cattell, 1966) indicated that Problems falling asleep 56.10 32.39 7.610a
a two factor solution was optimal (eigenvalues: 8.06, 2.57, 1.38, 1.24, Problems falling back 80.49 48.59 13.120a
1.13). Further, both the Velicer (1976) MAP test and Horn's Parallel asleep
Eating problems 68.29 34.51 14.900a
Analysis (Horn, 1965) also suggested extraction of two factors. Hence,
Excessive eating 56.10 58.45 .072
a two-factor solution was specified and accounted for 41,38% of the var- Excessive drinking 53.66 44.37 1.104
iance in the items (32.55% and 8.83%). Individual items were retained as Not drinking enough 63.41 54.23 1.092
indicators of a factor if their loading on that factor was larger than .364 Lies or deceives 31.71 52.11 5.312⁎
(Stevens, 2002). When an item loaded higher than .364 on two factors, Argues, fights or bullies 19.51 33.10 2.794
Excessive crying 48.78 42.25 .551
it was also eliminated from further analysis (Costello & Osborne, 2005).
These criteria resulted in the elimination of four items: “My child no- Note. SPS = Sensory Processing Sensitivity; MUPS = Medically Unexplained Physical
Symptoms.
tices the slightest unusual odor.” (item 7), “My child notices subtleties.” a
Significant after Bonferroni–Holm correction.
(item 20), “My child considers if it is safe before climbing high.” (item ⁎ p b .05.
21), and “My child feels things deeply.” (item 23). Table 1 shows the ro-
tated factors and their respective items and provides mean inter-item acceptable for the CFI (Hu & Bentler, 1999). First, we examined the orig-
correlations and alphas for each of the two factors. There was acceptable inal one-factor model as suggested by Aron and Aron (1997). According
internal consistency for both factors (DeVellis, 2012). Since the scores of to traditional cut-offs, the fit was not acceptable: χ2(230) = 589.216
factor two were not normally distributed in this sample, Spearman's (p b .001), RMSEA = .129, CFI = .65. Next, a CFA was conducted to ex-
correlation coefficient was calculated (Hauke & Kossowski, 2011), amine the two-factor solution: χ2(151) = 362.906 (p b .001), RMSEA =
showing a moderate intercorrelation (ρ = .48, p b .001) between factor .122, CFI = .73. Although the two-factor solution also fell short on the
one and two. Although the two factors accounted for nearly half of the traditional fit indices, the χ2 test comparing the difference between
variance in the items, Cronbach's alpha of the remaining 19 items was the one- and the two-factor model showed that the latter model fits
.89 (95% CI [.86,.91]), suggesting good internal consistency for the scores the data better [χ2 (79) = 226.31 (p b .001)].
on the HSPS.
3.4. The association between SPS and problems in daily functioning
3.3. Confirmatory factor analysis of the HSPS
Differences in reported problems between high SPS and control children.
The sample selected randomly for the CFA consisted of the other 95 Table 2 shows the percentages of children in the high SPS or control
cases and had an alpha coefficient of .92 (95% CI [.89,.94]) for the scores group with reported problems. Within the high SPS group there were
of the HSPS. The fit of a one-factor model was evaluated and compared proportionally more children with medically unexplained physical
statistically to the fit of a two-factor model, based on the foregoing EFA. symptoms (MUPS) (χ2(1) = 15.833, p b .005), problems to fall asleep
The χ2, root mean square error of approximation (RMSEA) and compar- (χ2(1) = 7.610, p b .008) and fall back asleep (χ2(1) = 13.120, p b
ative fit index (CFI) are reported. An RMSEA of .08 or less is generally .005), and eating problems (χ2(1) = 14.900, p b .005). On a 5% signifi-
considered an acceptable fit, and fits of .90 or greater are considered cance level, there were proportionally less children in the high SPS
group who were reported as sometimes or regularly lying and deceiving
(χ2(1) = 5.312, p b .05).
Table 1
Differences in SPS between children scoring low vs. high on reported
Exploratory factor analysis with oblimin direct rotation (pattern matrix).
problems. Children with a high level of MUPS had significantly higher
Items Factors scores on the HSPS-total, HSPS-OS and HSPS-DP ((t(181) = 5.392,
1 (OS) 2 (DP) p b .002, d = .8), (t(181) = 5.010, p b .002, d = .7), and (t(181) =
n = 10 n=9 4.764, p b .002, d = .7), respectively). Regarding sleeping problems, chil-
19. My child is bothered by noisy places.d .82 dren with a high level of problems falling asleep had higher scores on
11. My child doesn't do well with big changes.b,c .79 the HSPS-total (t(181) = 3.712, p b .002, d = .6) and HSPS-OS
3. My child doesn't usually enjoy big surprises.b,c .74 (t(181) = 4.214, p b .002, d = .6), and on a 5% significance level also
1. My child startles easily.b,d .67
22. My child performs best when strangers aren't present.b .65
on the HSPS-DP (t(181) = 2.508, p b .05, d = .4). Children with a high
2. My child complains about scratchy clothing, seams in .60 level of problems falling back asleep had also higher scores on the
socks, or labelsagainst his/her skin.d HSPS-total, HSPS-OS and HSPS-DP ((t(181) = 6.467, p b .002, d =
12. My child wants to change clothes if wet or sandy.d .50 1.0), (t(181) = 7.433, p b .002, d = 1.1), and (t(181) = 3.647,
16. My child prefers quiet play.b,d .44
p b .002, d = .5), respectively). Further, children with a high level of eat-
10. My child is hard to get to sleep after an exciting day.b,d .43
18. My child is very sensitive to pain.d .42 ing problems had higher scores on the HSPS-total and HSPS-OS
9. My child seems very intuitive.a .75 ((t(181) = 4.606, p b .002, d = .7), and (t(181) = 6.001, p b .002,
17. My child asks deep, thought-provoking questions.a .74 d = .9), respectively). On a 5% significance level, children who drink ex-
5. My child seems to read my mind.a .69 cessively during the day had higher scores on the HSPS-total (t(181) =
8. My child has a clever sense of humor.a .68
2.052, p b .05, d = .3) and HSPS-OS (t(181) = 2.099, p b .05, d = .3).
6. My child uses big words for his/her age.a .62
15. My child notices the distress of others.a,c .60 Children who do not drink enough had higher scores on the HSPS-
13. My child asks a lot of questions.a .52 total (t(181) = 3.905, p b .002, d = .6) and HSPS-OS (t(181) = 3.922,
4. My child learns better from a gentle correction than strong .41 p b .002, d = .6) and on a 5% significance level also on the HSPS-DP
punishment.a,c
(t(181) = 2.871, p b .05, d = .4). Furthermore, on a 5% significance
14. My child is a perfectionist.a .38
Cronbach's alpha .86 .85 level, children with a high level of lying and deceiving had lower scores
Cronbach's alpha 95% CI [.82, .89] [.81, .89] on the HSPS-total and HSPS-DP ((t(181) = 2.643, p b .05, d = .4) and
Mean inter-item correlation .38 .39 (t(181) = 2.897, p b .05, d = .4), respectively). Children with a high
Note. N = 140; (OS) Overreaction to Stimuli; (DP) Depth of Processing; aDepth of Processing; level of arguing, fighting and bullying had lower scores on the HSPS-
b
Overstimulation; cEmotional Intensity; dSensory Sensitivity, according to the DOES-model. total (t(181) = 2.953, p b .05 d = .4), HSPS-OS (t(181) = 2.219,
84 S. Boterberg, P. Warreyn / Personality and Individual Differences 92 (2016) 80–86

Table 3
Descriptives of HSPS factor and total scores for children scoring low versus high on the reported problems.

HSPS-OS (n = 10) HSPS-DP (n = 9) HSPS-total (n = 23)

M(SD) M(SD) M(SD)

Low High t(181) d Low High t(181) d Low High t(181) d

a c a c a
MUPS 32.20(6.84) 37.53(8.01) 5.010 .7 32.89(6.10) 37.14(5.37) 4.764 .7 79.81(13.54) 90.99(14.22) 5.392 .8b
n = 81 n = 102 n = 81 n = 102 n = 81 n = 102
Problems falling asleep 33.32(7.80) 38.22(7.29) 4.214a .6c 34.39(6.02) 36.68(5.90) 2.508⁎ .4 82.96(14.81) 91.14(13.87) 3.712a .6c
n = 114 n = 69 n = 114 n = 69 n = 114 n = 69
Problems falling back asleep 30.86(7.13) 38.59(6.87) 7.433a 1.1b 33.48(6.66) 36.67(5.15) 3.647a .5c 78.79(15.02) 91.80(12.20) 6.467a 1.0b
n = 81 n = 102 n = 81 n = 102 n = 81 n = 102
Eating problems 32.42(7.44) 38.96(7.06) 6.001a .9b 34.58(5.90) 36.19(6.19) 1.794 .3 81.92(14.30) 91.71(14.04) 4.606a .7c
n = 106 n = 77 n = 106 n = 77 n = 106 n = 77
Excessive eating 35.53(8.03) 34.91(7.93) .525 .1 35.73(6.77) 34.92(5.51) .894 .1 87.23(15.67) 85.18(14.44) .917 .1
n = 77 n = 106 n = 77 n = 106 n = 77 n = 106
Excessive drinking 34.03(8.60) 36.48(6.97) 2.099⁎ .3 34.72(6.66) 35.87(5.26) 1.278 .2 83.95(16.31) 88.46(12.92) 2.052⁎ .3
n = 98 n = 85 n = 98 n = 85 n = 98 n = 85
Not drinking enough 32.65(8.25) 37.13(7.16) 3.922a .6c 33.83(6.61) 36.37(5.37) 2.871⁎ .4 81.33(15.85) 89.71(13.18) 3.905a .6c
n = 80 n = 103 n = 80 n = 103 n = 80 n = 103
Lies or deceives 36.21(7.97) 34.02(7.82) 1.869 .3 36.47(6.08) 33.92(5.79) 2.897⁎ .4 88.78(15.18) 83.02(14.19) 2.643⁎ .4
n = 96 n = 87 n = 96 n = 87 n = 96 n = 87
Argues, fights or bullies 36.02(8.02) 33.20(7.50) 2.219⁎ .3 36.11(5.74) 33.27(6.39) 2.963⁎ .4 88.14(15.07) 81.16(13.62) 2.953⁎ .4
n = 128 n = 55 n = 128 n = 55 n = 128 n = 55
Excessive crying 33.62(7.64) 37.16(7.96) 3.055⁎ .5c
35.23(6.11) 35.29(6.04) −.060 .0 84.18(14.98) 88.44(14.68) 1.922 .3
n = 103 n = 80 n = 103 n = 80 n = 103 n = 80

Note. HSPS = Highly Sensitive Person Scale; OS = Overreaction to Stimuli; DP = Depth of Processing; MUPS = Medically Unexplained Physical Symptoms.
⁎ p b .05.
a
Significant after Bonferroni–Holm correction.
b
Cohen's' d ≥ .8 (large).
c
Cohen's d ≥ .5 (medium).

p b .05, d = .3) and HSPS-DP (t(181) = 2.963, p b .05, d = .4). Children included 10 items and seemed to be related with the following charac-
who often cried when they were a baby had higher scores on the HSPS- teristics of SPS: “Overstimulation”, “Emotional Intensity” and “Sensory
OS (t(181) = 3.055, p b .05, d = .5). See Table 3 for details. Sensitivity”. The second factor included 9 items and was mostly related
to the characteristic “Depth of Processing” (DP). As expected, there was
4. Discussion no clear conceptual overlap with previously found factor structures in
research with adults (Evans & Rothbart, 2008; Liss et al., 2008;
4.1. The 23-item parent-report HSPS for children Smolewska et al., 2006). Next to the fact that the items differ in number
and content between the adult and child version of the HSPS and the use
The first goal of the present study was to explore the underlying fac- of parent-report in children versus self-report in adults, a possible expla-
tor structure of Aron's 23-item parent-report HSPS (Aron, 2002). Anal- nation could be that SPS in childhood is expressed in a different way
ysis of internal consistency suggested that the scores of the parent than in adulthood. It is possible that SPS in adulthood is influenced by
form of the HSPS are a reliable measure of SPS in children. Previous different factors such as education, the social environment, life stressors,
studies of the latent structure of SPS in adults have suggested that the and other various aspects in an individual's life (cf. differences between
variable is best considered as dichotomous with a break point around temperament and personality, see e.g., Evans & Rothbart, 2007;
10 to 35% (Aron et al., 2005, 2012; Aron & Aron, 1997). Hence, to decide Rothbart, Ahadi, Hershey, & Fisher, 2001). The moderate positive inter-
which children could be considered as having ‘high SPS’ in the present correlation among the factors is consistent with a general, higher-
study, the recommendation of Aron and colleagues to consider the top order construct of SPS that was also found in previous research with
20% of the population as ‘highly sensitive’ was followed. However, sim- adults (Liss et al., 2008; Smolewska et al., 2006).
ilar to the findings from another independent study on SPS in adults
(Benham, 2006), the results of the present study demonstrated that 4.2. The association between SPS and problems in daily functioning
SPS in children is best considered as a continuous variable without a
clear cut-off. Further research in both adults and children is needed to A second goal of this study was to examine the relationship between
determine whether the trait of SPS is best considered as normally dis- SPS and problems that may arise in the daily functioning of children.
tributed or as a dichotomous (binominal) trait. Children with high SPS showed more MUPS (i.e. headaches or stomach
In contrast to Aron and Aron's (1997) conclusion that the HSPS mea- ache without an apparent medical reason) and more sleeping and
sures a unidimensional construct, the present results supported a two- eating problems compared to children with average or low SPS. In ac-
factor structure. Although the two-factor solution was retrieved in a cordance, children with more MUPS, sleeping, eating and drinking prob-
very robust way in the exploratory analysis, it did not have a good tra- lems showed high SPS in general and, more specifically, high OS. Crying
ditional fit in the confirmatory analysis. However, confirmatory analysis excessively as a baby was only related with high OS. Hence, this factor
showed that the two-factor solution fits the data better than the one- seems to be related with more problems in the daily functioning com-
factor solution. Possible explanations for the bad fit of the models pared to the second factor DP. We can assume that a high OS, which in-
could be the fact that the data are not multivariate normally distributed cludes also (hyper)sensitivity for sensory stimuli (a characteristic which
and/or the rather small sample size (only 40% of the total sample was is associated with different sensory processing disorders), has a nega-
analyzed). Hence, further research on the fit of the underlying factor tive influence on the life of some children in making their daily function-
structure of the HSPS in children is recommended. In the present ing more difficult, even as a baby. However, children with more MUPS
study, the two factors could be theoretically interpreted according to and sleeping problems showed also high DP, which is consistent with
the recent DOES-conceptualization of SPS (Aron et al., 2012; Aron, the idea that DP refers to a general thoughtfulness or a sense of long-
2010, 2012). The first factor, labeled “Overreaction to Stimuli” (OS), term consequences (Aron et al., 2012; Aron, 2010, 2012), possibly
 S. Boterberg, P. Warreyn / Personality and Individual Differences 92 (2016) 80–86 85

implying that these children are more prone to worry and ruminate and Boniwell (2015) provided evidence that high SPS could predict a
about the present and the future, which may lead to internalizing prob- better treatment response, probably based on a deeper processing of
lems. In general, the present results are complementary to previous the content of the intervention than individuals scoring low on SPS.
studies addressing the association between problems in daily function- Therefore, during the diagnostic process in psychological practice, it can
ing and high SPS in adults (Benham, 2006) or other aspects of hypersen- be recommended to conduct a personality analysis which also contains
sitivity in children (e.g., Reynolds et al., 2012), supporting the idea that a measure of SPS such as the HSPS. By considering both subscales
high SPS in children may interfere with the participation in daily Overreaction to Stimuli and Depth of Processing of information, a
activities. broader perspective on the daily functioning of the child or adolescent
Further, in the present study, children with high SPS showed less an- could be obtained.
tisocial behavior. Children who were reported to lie, deceive, argue,
fight or bully regularly, showed low SPS and low DP and OS. However, 5. Conclusions
these results were only significant on a 5% level and must therefore be
interpreted with caution. Overall, it can be concluded that SPS seems In sum, the current exploratory study provided the first evidence for
to be associated with more internalizing problems. a two-factor structure of the 23-item parent-report HSPS for children,
Finally, despite the intercorrelation of the two subscales and a high together with the absence of a clear cut point. High SPS was associated
internal consistency for the overall scale, the present results suggests with more internalizing and probably also less externalizing problems.
that the subscales of the HSPS are valuable to consider separately both The first factor OS was associated with excessive crying as a baby,
on the level of interpretation and especially because of their different more medically unexplained physical symptoms (MUPS), more
associations with problems in daily functioning. However, since the sleeping, eating, and drinking problems while the second factor DP
two subscales only account for half of the variation in total scores, it re- was associated with more MUPS and more sleeping problems. Hence,
mains valuable to also include the total score in future studies using the OS seems to be associated with more problems in the daily functioning
23-item parent-report HSPS in children. compared to DP. The HSPS may therefore provide valuable information
in the assessment of children and adolescents with problems in daily
4.3. Limitations functioning.

There are some limitations in the present study. First, since the scope
of the current investigation was to examine the parent-report HSPS as it Acknowledgments
is currently used in clinical practice and on the internet, we decided not
to undertake an official translation process. However, undertaking an We would like to express our gratitude to the participating parents
official translation process may be useful in future studies. Second, in the present study and especially to the organizations who helped
given the cross-sectional, correlational nature of the present study, a with the recruitment: vzw Victor, SIG vzw and HSP Vlaanderen. Further,
causal relationship between measures of SPS and problems in the we would like to thank Emmanuel Abatih from FIRE Statistical Consult-
daily functioning of children cannot be inferred. Environmental factors ing at Ghent University for his help concerning the statistical analyses.
such as parental warmth and exposure to stressful life events, and Finally, we would also like to thank prof. dr. Herbert Roeyers, for his
child factors such as high neuroticism, may, at least partly, account for constructive feedback on a previous draft of the manuscript.
the observed correlations (Aron et al., 2005). Further longitudinal re-
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