Cluster analysis based on sensory characteristics of children with autism spectrum disorder and its impact on emotional and behavioral manifestations and parenting stress.

Autism spectrum disorder (ASD) exhibits substantial sensory processing heterogeneity, linked to diverse emotional-behavioral manifestations and caregiver challenges. Sensory-based subgroups may reveal distinct clinical profiles and inform targeted interventions, yet their associations with parenting stress remain underexplored. While prior work has examined sensory features, emotional-behavioral manifestations, and parenting stress in autistic children, few studies have characterized sensory subgroups and their correlates. This study employed K-Means cluster analysis combined with the elbow method to categorize autistic children into distinct subgroups based on the three The Short Sensory Profile (SSP) dimensions with the highest variability, aiming to explore the sensory characteristics of different subgroups and their impacts on emotional and behavioral manifestations and parenting stress. The research included 225 autistic children and 228 comparison group participants, using SSP, The Strengths and Difficulties Questionnaire (SDQ) and The Parenting Stress Index-Short Form (PSI-SF) to assess sensory features, emotional and behavioral manifestations and parenting stress in both groups. The results showed that the three dimensions with the highest proportions of sensory differences in children with ASD were auditory filtering (the capacity to filter out irrelevant background sounds) had the highest rate at 68.44%, followed by low energy/weak (66.67%), and movement sensitivity (51.56%), which were significantly higher than those in the control group (26.32%, 24.56%, 27.19%) (all P<0.01). Using the K-Means clustering algorithm combined with the elbow method, children with ASD were classified into three subgroups: Group 1 as the "sensory adaptive type", Group 2 as the "motor-sensitive/weakness type" and Group 3 as the "auditory filtering type". Structural equation modeling results showed no significant association between sensory features and emotional and behavioral manifestations or total parenting stress scores in Group 1 (all P > 0.05). In Group 2, auditory filtering had a significant direct negative effect on both the SDQ total difficulties score and PSI-SF total parenting stress score (β = -0.25, -0.38, P < 0.05), while movement sensitivity had a significant direct negative effect on the SDQ total difficulties score (β = -0.26, P < 0.05). In Group 3, auditory filtering exerted a significant direct negative effect on the PSI-SF total parenting stress score (β = -0.25, P < 0.01) and also indirectly influenced it through the SDQ total difficulties score (β = -0.22, 0.31, P < 0.05). Additionally, sex had a significant direct effect on the total parenting stress scores of the PSI-SF in group 3 of children with ASD (β = 0.17, P < 0.05). Sensory differences are prevalent in ASD and correlate with emotional/behavioral manifestations and parenting stress. However, different types of sensory profiles influence emotional/behavioral characteristics and parenting stress through distinct pathways. Compared to the "sensory adaptive type" and "motor-sensitive/weakness type" subgroups, the "auditory filtering type" subgroup not only exerted a significant direct negative effect on parenting stress but also demonstrated a significant indirect negative effect through the mediating role of emotional/behavioral manifestations. Early identification of distinct ASD subgroups using sensory features may facilitate the timely development of targeted intervention plans and support policies, which improve clinical symptoms in children with ASD and alleviate parenting stress.