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Sensory Processing in AutismProfessional Training

Dyad

Restricted interests and repetitive Behaviours

Core feature - unusual sensory responses

An Insider's Perspective

• “Imagine in the morning you’re placed in a spaceship and blasted into outer space and suddenly you’re on a planet not built for you. When you step off your spaceship keen to explore, you’re instantly overwhelmed by your surroundings. Every noise, every smell, every texture isn’t just something that’s unpleasant, it’s something that you actually cannot bear.”

(Adam Harris, 2015)

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Anecdotal Evidence

• ‘Grinding my teeth kept disturbing, unpredictable, and meaningless outside noise from coming in. Singing a repetitive tune and humming continuously did the same. The tapping gave a continuous rhythm and stopped the unpatterned movement of others from invading’. (Williams, 1994)

Anecdotal evidence

• Temple Grandin• Reported anxiety in response to sensory stimuli• Discovered that she felt calmed with deep pressure input• ‘Hug machine’

Temple Grandin Video

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www.medical-illustrations.ca

Research Bulletin 11: Sensory Processing

•Green and Benson (2010) Sensory Overresponsiveness and Anxiety

•Mattard-Labrecque et al (2013) Vision and touch affect adaptive skills. Auditory Processing affects conceptual skills

•Brown and Dunn (2010) Children maintain self control during restrictions of school day.

•Tseng et al (2011) Anxiety and withdrawal-underlying sensory avoidance, sensory seekers likely to have externalising behavioural difficulties

Research evidence

• Piller and Pfeiffer (2016) found that Sensory aspects of the environment moved a child towards avoiding a task. Environmental modifications and sensory supports are essential to enable participation for the child with autism in the classroom.

• Kinnealey et al. (2012) conducted a study which involved examining the effects of environmental adaptations, results included increased frequency and stability of attending and engagement.

• Mills et al. (2016) studied the effectiveness of a sensory activity schedule in increasing classroom task performance in students with autism. It was found that it had a positive effect on classroom task mastery.

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Sensory Modulation

•The sensory processing difficulties associated with ASD tend to be sensory modulation difficulties

• ‘The capacity to regulate and organize the degree, intensity and nature of responses in a graded manner to support performance’ (Miller and Lane, 2000)

• ‘..the nervous system’s process of self-regulation’

•A balance of facilitation and inhibition

Thresholds of response

•We generally function around a normal threshold of response

•The normal amount of sensory input in the environment is enough to keep us alert, but without feeling overwhelmed

•We focus on relevant input and ignore irrelevant input

•The ideal state for learning and interacting:

ALERT AND CALM-

‘THE TEACHABLE MOMENT’

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Sensory Overload

• Video simulation of sensory overload-National Autistic Society

Thresholds of response: Low threshold

• Low threshold: Hypersensitive or over-responsive to sensory input

• Indicators of hypersensitivity–Defensive

–Avoidant–Anxious–Distractible

Thresholds of response: high threshold

• High threshold: Hyposensitive or under-responsive to sensory input

• 2 types of behaviour related to a high threshold:

1. Sensory-seeker– Appears to be hyperactive and ‘on the go’

– Distractible

– Fidgets

– Disruptive

2. Under-responsive– Ignores sensory input

– Unresponsive

– Lethargic

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Sensory Profile (Dunn, 1999)

Sensory Seeking

Sensory Avoiding Sensory Sensitive

Low Arousal

Sensory Sensitivity in ASD

• child becomes distressed with changes and transitions• child becomes distressed in response to specific sensory

stimuli•Many children with ASD dislike auditory and tactile

input• child is very distractible in the learning environment• child is very distractible during social interactions• child is cautious in new experiences

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Sensation Avoiding in ASD

•child prefers routine and familiar environments•child avoids social interaction and communication•child creates rigid rituals•child engages in repetitive play in order to avoid new and unfamiliar activities•child may engage in stereotyped behaviours as a means of blocking out distressing stimuli

Sensory Seeking in ASD

• child engages in repetitive behaviours

• child engages in self-stimulatory behaviours e.g.:• Rocking

• Spinning

• Hand flapping

• Echolalia; repetitive noises

• Fidgeting

• child follows intense interests and becomes fixated on these

• child tends to be overactive

• child is likely to have attention difficulties

Low Registration in ASD

• child is unaware of others in the environment

• child does not actively engage in interaction or activities

• child appears to be socially withdrawn

• child engages in non-challenging repetitive activity due to limited motivation and engagement

• child is slow to respond to teacher’s voice etc.

• child may have motor difficulties e.g. low muscle tone, poor coordination

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Repetitive Behaviours

•Some children with autism use repetitive behaviours to get more sensory input

•Examples:• Hand flapping• Biting hand

•These children may in fact be sensitive to sensory input but use these behaviours to block out unwanted stimulation and to regulate themselves

Responses to sensory input

(Miller LJ et al)

Sensory systems

•5 sensory systems–Visual–Auditory–Tactile–Olfactory–Gustatory

•Additional sensory systems–Vestibular–Proprioceptive

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What sensory input are you receiving in this room?

•What are you attending to?•What are you ignoring?•What sensory input does a pupil receive in classroom?

Proprioceptive System

• Location• Receptors located in all muscles, joints, ligaments and

tendons

•Functions• Body scheme• Awareness of body position within the environment• Control over grading and force of movement

Proprioceptive System

•Almost all children will enjoy proprioceptive input; we generally do not see dislike or avoidance of proprioceptive input

•Proprioceptive input will alert child who is under-responsive

•Proprioceptive input will calm children who are hypersensitive to the sensory input

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Proprioceptive Activities

• Crawling, wheelbarrow walks, animal walks• Jumping (e.g. on trampoline)• Wall push outs• Pushing and pulling activities• Carrying books (e.g. in backpack)

• Cleaning tables and brushing floors• Passive input (e.g. deep pressure input)• ‘Hot dog’• Stress ball or chewy tube• Oral motor activities

Oral tools

Oral strategies:

• crunchy or chewy foods

•Use small straws, to drink smoothies or yogurt to provide resistive sucking input.

• chewing gum.

•Offer an electric toothbrush or other vibrating oral sensory tool.

•Encourage the use of mouth toys such as a harmonica, whistle, kazoo, recorder, etc.

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Remember!

•Use any activities which involve resistance or weightbearing

•Active (child-led) input is more effective than passive (adult-led) input

•Deep input with movement is often alerting e.g. Jumping on a trampoline

•Deep input without movement is often calming e.g. Head compressions

Tactile System

• Location–Receptors located over the skin–High concentration on hands and in mouth

•Functions–Protective–Discriminative–Fine motor skills–Speech and oral motor control–Eating

Tactile hypersensitivity

At school….

•May dislike hand washing

•Difficulty in practical classes which involve getting hands dirty/wet

•May dislike school uniform/PE kit

•Avoids personal contact with others e.g.•Corridors•PE activities•Playground/yard

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Tactile system: desensitisation

• Increase participation in tactile activities by gradually increasing the time and intensity of the task

•Example: Finger painting–Allow the pupil to wear gloves and then gradually cut the

fingers off the gloves and then remove completely–Allow the pupil to use a long brush, then a short brush, then

finger brushes, then small pieces of sponge and then fingers!–Gradually increase the time spent on the task (and use a

visual timer)–Immediately follow with a favourite toy or task (use

First/Then schedule)

Sensory Desensitisation Video

• Use of various textures – flour/paint/pasta etc.

Principles of Desensitisation

• Be patient! The process of desensitisation may take months (or even years) before achieving the long term goal.

• Celebrate small achievements. Recognise the small steps in the process.

• Recognise distress. The children’s distress is genuine so immediately stop the activity.

• Deep pressure input. Provide deep input during the activity to enhance a calm state (e.g. Deep pressure to the shoulders).

Increase participation in tactile activities by gradually increasing the time and intensity of the task

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Tactile system: sensory seeking

• Some children fidget as they are seeking tactile input to stay alert and calm

• Provide fidget objects• During class work

• Going out and about

• Use lots of tactile activities e.g.• Sand and water play

• Tactile boxes/trays

• Dough, art and craft

Sensory Needs

Vestibular System

• Location–Located in the inner ear; identical system in each ear

•Functions–Responds to gravity–Processing of movement–Control of head and eye movements (balance)

–Bilateral coordination–Muscle tone

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Vestibular System: Hypersensitivity

•Dislike and avoidance of:–Movement, especially rotary movement and backward

movements–Playground and P.E. equipment–Fearful when chair is moved unexpectedly, especially

backward movement

•Gravitational insecurity–Dislikes having feet off the ground–Prefers a stable base of support

•Preference for sedentary activities

•Motion sickness

Avoidance of movement activities

•Avoid spinning and backward movements if possible

•Prepare child for movement

•Provide alternatives in the playground

•Use deep pressure input if the children seems nauseous or upset after movement

•Use pressure garments during movement if appropriate e.g. weighted vest or blanket

Movement Hypersensitivity: Desensitisation

•Desensitisation strategies can be used to increase a child’s tolerance of movement

•However, desensitisation must be used with extreme caution:• Introduce vertical movements e.g. jumping• Avoid backward and rotary movements• Ensure movements are slow and gentle• Use a stable base of support• Follow with deep pressure/proprioceptive activities

• Stop movement if child is distressed

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Vestibular System: Sensory seeking

•Some children will seek out movement during the day to keep themselves alert

•This leads to impulsive and hyperactive behaviours–Difficulty staying in seat–Walking around–Fidgeting in chair

• It may also lead to ‘self-stimming’ behaviours such as rocking, spinning and hand flapping

Provision of Movement

•Seating (e.g. Movin’ Sit cushion, exercise ball)

•Sensory Diets (can be used to provide any form of sensory input to increase alertness during the day)

•Movement breaks

•Therabands- whole class

•Vary positions when working e.g. standing, kneeling, lying

Movement Breaks

•Examples...•Gym equipment•Running around yard•Trampoline• ‘Jobs’ e.g. deliver a book to Norma•Walking during some class work e.g. reading,

spellings

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Sensory Diets

Auditory Over-responsiveness

• Avoids or becomes distressed in noisy environments

• Makes noise to block out background noise

• Distracted by background noises

• Difficulty attending to instructions

• Difficulties in practical classes at school

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Controlling Auditory Input

•Control the noise using a ‘traffic light’ system

•Visual cue card for ‘time out’

•Use of visual communication strategies

•Short simple instructions

•Allow time to process

•Desensitisation

Control noise level

Harberton School

COOL, RELAXED HAPPY ANXIOUS LETSGO!

CONCERNED VERY CONCERNED

Visual Cues for ‘Time Out’

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Calm areas

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Example: Assembly

•Scenario:•John is hypersensitive to noise, and refuses to leave the classroom to go to Assembly

•Long-term goal:•John will sit quietly with his class for the duration of Assembly

Short-term goals

• John will walk to the Assembly Hall with his class and will sit outside the Hall for the duration of the Assembly

• John will sit at the back of the Assembly Hall for at least 15 minutes of Assembly

• John will sit at the back of the Assembly Hall for the entire Assembly

• John will sit with his class for the first half of the Assembly and then move to the back

• John will sit with his class for the full Assembly

Example of a social story

I am going out with my teacher today.

We are going to the shopping centre.

Someone might talk through a loud speaker in the shopping centre.

I will put my hands over my ears and count to 10.

I will have a good time at the shops with my teacher.

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Use of calm corner

Calm corner token

-Pop up tent in class/designated area

-Break for sensory stimuli/ input

-Re-regulate self

Calm breaks

• Include on schedule e.g. before and after a group activity

•Or allow child to request a calm break• Use a visual card

•Consider where the calm place will be

•Consider whether you need calming items e.g. favourite fidget toy, iPod, weighted item

Auditory System: Under-responsiveness

•Some children are slow to respond to auditory instructions because they are in a state of under-arousal

•Provide increased sensory input to gain attention

•Use visual communication strategies

•Some children may hum, sing and chat to keep themselves alert

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Visual System

•Many children with autism have a visual learning style/preference

•However, they can become distracted by too much visual information

•They may also be hypersensitive to sunlight, bright light, fluorescent lighting etc.

• A walk in a neurotypical person’s shoes vs a person with ASD

Video

Visual System

•Reduce visual distractions in the class• Reduce ‘clutter’• Consider storage of toys and preferred items• Turn off computers and TV when not used

•Consider where classwork is completed

•Consider distractions at lunch time/break time

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Gustatory System

• children may present with strong likes and dislikes regarding the tastes of foods

•other children may prefer very bland foods, leading to a restricted diet

• some children like strong flavours and may become more alert after eating strongly flavoured foods (e.g. sour sweets, strong mints)

Introducing new food

•Parent directed

•Check child’s weight and health with GP/dietician

•Allow preferred food at mealtimes

• Introduce new food outside mealtimes

•Use desensitisation strategies

•Use the preferred texture; do not simultaneously introduce a new taste and texture

Introducing new food

•Select a consistent time and place

•Use same food each time until it is accepted

•Steps in desensitisation:• Tolerating food on plate• Smelling food• Touching food with finger•Holding food to lip• Touching food with tongue• Putting food in mouth• Chewing and swallowing

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Other ideas…

• Give time for changes to occur

• Ensure meal times are relaxed

• Reduce social demands and noise

• Have designated area/s for eating

• Use smaller cutlery, spoons

• With some increasing cognitive awareness of food, how its made, health benefits etc. can help• NB. It is not useful to criticise food

Olfactory System

•Some children will become distressed in new environments because they are hypersensitive to smells

•Other children like to smell people and objects and seek out this input

•Provide a cloth with a strong scent

•Provide jars in the classroom filled with different smells

A Child’s View of Sensory Processing

• Video

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Self-regulation

• Educate the young person to recognise his own sensory needs and how to independently meet these needs in a functional way

• Example: The Alert Program for Self-Regulation ‘How does your engine run?’

• Visual cards to prompt appropriate activities

Useful Resources

•Henry OT-Diana Henry

•TOOL CHEST- filled with activities for home and school

•TOOLS for parents-everyday home activities-homework place, holiday helpers

•Tools for Tots

•www.asensorylife.com understanding your child’s sensory signals

Suggested Reading

• The Out-of-Sync Child (Kranowitz, C)

• Sensational Kids (Miller LJ)

• Raising a Sensory Smart Child (Biel L & Peske N)

• Too Loud, Too Bright, Too Fast, Too Tight (Heller S)

• Asperger Syndrome and Sensory Issues (Myles BS et al)

• Living Sensationally (Winnie Dunn)

• Max and Me (Ines Lawlor)

• The Scared Gang (Eadaoin Bhreathnach)

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