Autism and Sensory Processing Issues. Presented by: Heather Stolp Autism Specialist SWWC

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2 Autism and Sensory Processing Issues Presented by: Heather Stolp Autism Specialist SWWC

3 Overview of Autism Spectrum Disorder An Autism Spectrum Disorder (ASD) is a brain-based or neurobiological disorder of development. ASD causes differences in the way the brain processes ASD affects understanding and use of language to interact and communicate with people. ASD is best considered as a disability on a continuum from mild to severe and impacts every individual differently

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6 Medical vs. Educational Classification Medical Diagnosis: Based on a set of clinical criteria found in the DSM-5. Used in a private or clinical setting. May be determined by a team or an individual. Educational Classification: Based on the federal law (IDEA) and specific behavior criteria. Used only in the public school systems. Must be determined by a team through a comprehensive evaluation that includes a teacher licensed in ASD and/or a school psychologist plus other related services as appropriate.

7 Diagnosis and Eligibility are not synonymous terms and there are different criteria used in each field. There are legal requirements, different purposes and different practices in the Medical and Educational communities. MDE developed the ASD criteria to be broader than the DSM diagnostic criteria, so as to allow access to special education services for children with milder and atypical symptoms, who are educationally disabled by their social and communication deficits. *Note: a clinical/medical diagnosis does not automatically guarantee that a child will receive special education services in the public school. A child must meet MDE criteria and show EDUCATIONAL need in order to receive special educational services. Conversely, a child does not need a clinical diagnosis to receive services in the public schools. Schools conduct their own evaluations to determine eligibility and identify needs.

8 MN School Criteria The following are the core features of an Autism Spectrum Disorder (student must exhibit patterns of behavior in two of the core areas, one of which must be social interaction): 1. Core Area 1 - Qualitative impairment in social interaction (two or more characteristics): limited use of facial expressions towards others; gross impairment in ability to make friends; appears to prefer isolated or solitary activities; misinterprets others behaviors and social cues; significant vulnerability and safety issues due to social naiveté; does not show or bring things to others to indicate interest in activity; limited joint attention; difficulty relating to people; other:

9 2. Core Area 2 - Qualitative impairment in communication (one or more indicators): not using finger to point or request; absence or delay of spoken language; inability to initiate or maintain conversation; odd production of speech (intonation, rhythm, rate); showing lack of spontaneous imitations or lack of varied imaginative play; limited understanding of nonverbal communication skills (gestures, facial expressions, tone of voice) using others hand or body as a tool; repetitive, idiosyncratic language; other

10 3. Core Area 3 - Restricted, repetitive or stereotyped patters of behavior, interests, activities (one or more indicators): repetitive hand or finger mannerisms; rigid, rule-bound thinking; lack of true imaginative play vs. reenactment; insistence on following routines or rituals; demonstrating distress or resistance to change; overreaction or under-reaction to sensory stimuli; intense, focused preoccupation with a limited range, interests, or conversation topics; other:

11 There is no single cause or cure for autism, however the symptoms are treatable. Autism is a lifelong disorder, but early diagnosis and intervention can lead to significantly improved outcomes for children.

12 Children with an autism spectrum disorder may have difficulty with social interactions such as: Not engage with other children Lacks cooperative play Difficulty taking turns Unable to take others perspective Withdrawals Unaware of social norms/rules Poor eye contact Difficulty joining others

13 Children with an autism spectrum disorder may have impairments in communication such as: Late to develop speech or does not talk at all Limited joint attention Lacks imitation or imaginative play Flat/limited tone and facial expressions Limited or odd gestures Difficulty understanding non verbal expressions Echoes others speech Poor conversation ability Stands too close Interrupts others Talks too much about their own interest

14 Children with an autism spectrum disorder may have restrictive or repetitive patterns of behavior such as: Repetitive or rigid play Dependent on routines Odd or restricted interests Very concrete thinking Lacks imagination Preoccupation with unusual objects Overly focused on facts Overly sensitive Sensory stimulating behaviors

15 Children with an autism spectrum disorder may have: Strong visual abilities Good memory for information Poor attention, planning, and organization skills Difficulty with comprehension Highly active or impulsive behaviors Inattention/distractibility Obsessive thinking patterns Intense fear and/or anxiety Meltdowns-difficulty regulating their emotions Acting out behaviors such as running away Difficulty with coordination, handwriting, motor and planning skills. Possible tics or other movement disorders.

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17 Spectrums within the spectrum Awkward Social Interactions Pass for Typical Non Speaking Communication Typical Under responsive Sensory Over responsive Intelligence Low IQ Average High IQ Agile Motor Skills Awkward Adaptive Functioning Low Variable High in Areas

18 Autism and Sensory Sensory processing disorders affect 5-16% of the general population and 90% of individuals with an Autism Spectrum Disorder.

19 Using our senses to make sense of the world around us. Sensations give us information about the environment and ourselves as well us help us understand the world and how to act within it. Our interpretation of sensation is individual. As a result, reactions to a given sensation (behavior) can be very different among people even when they are experiencing the same information. Sensory inputs evoke physiological changes in the body.

20 The typically developing central nervous system involves ongoing, dynamic interplay and comparison of information from all sensory systems. The outcomes of this process are seen in the responses we make to given situations and reflect multiple contributing factors.

21 We learn about the world through our senses Sensory processing is the neurobiological process by which we transform sensory information into meaningful messages. The process of converting sensory information/sensations into meaningful messages often occurs automatically for most of us. If there are unusual connections or faulty wiring in an individual s nervous system, they are unable to take in sensory information in a typical way. Therefore, they may have difficulty with learning and behaviors due to the lack of accurate and reliable information about their bodies and the environment.

22 Sensory processing deficits fall on a continuum from minor sensory annoyances to sensory jumble, white outs, and extreme pain. White outs occur when there is so much input coming into a person through their senses that they simple feel like things are so jumbled as if they are watching static on a tv. Some behaviors of students with sensory processing disorder could potentially be attributed to a low level of constant pain. Sensory processing disorders affect 5-16% of the general population and 90% of individuals with an autism spectrum disorder.

23 Think about a child s behavior. All behavior has a purpose. What is their purpose? Is that child trying to get your attention? Trying to communicate something to you? Are they overstimulated? Is there another sensory issue?

24 For instance: A student is having a meltdown in your classroom. You could ask yourself Is the student overstimulated by the bright lights/noise/all the people? Did you change your routine and do something in a different order? Is the chair that they always sit in being occupied by another student? Are they trying to communicate that they want something? Do they need to use the bathroom? Do they want to leave? Are they in pain or not feeling well?

25 If your child is overly sensitive to touch, movements, sights or sounds, you may notice behaviors such as irritability or withdrawal when touched; strict avoidance of certain clothes or foods solely on the basis of texture; and/or a fearful reaction to ordinary activities such as bathing and brushing teeth. A child who is under reactive to sensory stimuli will usually seek out sensory experiences. They may constantly have their hands all over you or seem oblivious or unaware of pain. Some children fluctuate between being under responsive to over responsive.

26 Tactile/Touch Vestibular/Balance Proprioception/Body Awareness Visual/Sight Auditory/Hearing Gustatory/Taste Olfactory/Smell

27 Location: Skin-density of cell distribution varies throughout the body. Function: Provides information about the environment and object qualities such as touch, pressure, texture, hard, soft, sharp, dull, heat, cold, pain, etc.

28 Location: Inner ear-stimulated by head movements and input from other senses, especially visual. Function: Provides information about where our body is in space and whether or not we or our surroundings are moving. Tells about the speed and direction of movement.

29 Location: Muscles and Joints- activated by muscle contractions and movements. Function: Provides information about where a certain body part is and how it is moving.

30 Location: Retina of the eye- stimulated by light. Function: Provides information about objects and people. Helps us define boundaries as we move through time and space.

31 Location: Inner ear- stimulated by air and sound waves. Function: Proves information about sounds in the environment. For example are they loud, soft, high, low, near or far away, etc.

32 Location: Chemical receptors in the tongue. Closely entwined with the olfactory (smell) system. Function: Provides information about different types of taste. Sweet, sour, bitter, salty, spicy, etc.

33 Location: Chemical receptors in the nasal structure. Closely associated with the gustatory (taste) system. Function: Provides information about different types of smells. For example, musty, acrid, putrid, flowery, pungent, etc.

34 Within each system are thresholds. They can vary between systems and depending on other factors as well. Factors may include: time of day, emotional state, stress level, physical health, level of hunger, genetic predisposition, environmental influences, and past experiences. It is possible to have a low threshold for a particular sense and high for another Low threshold= hypersensitive and may cause an overactive response The nervous system responds frequently to stimuli. It doesn t take much to reach the threshold and activate the system. High threshold= hyposensitive and may cause an underactive response

35 Low Hypersensitive/Overreactive High Hyposensitive/ Under-reactive May Experience: Distress with sound Sensitivity to light Discomfort with certain textures Smell and taste aversions Insecurity with height and movement Increased startle response Sensitive to stimuli and may act to avoid sensory sensations May Experience: Lack of attention to sound Decreased awareness of pain or injury Disregard of people or things in the environment. Delayed reactions and responses Poor registration to stimuli and may seek out sensations.

36 Tactile/Touch Hypersensitive: an individual may feel physical discomfort when coming into contact with someone or something that the rest of us are barely aware of. Cannot tolerate the roughness of new shirts or elastic on their pants Cutting fingernails can lead to tantrum behaviors Refusal to participate in activities that involve bubbles, glue, shaving cream, etc. Standing too close to others may be a problem for them. They may have trouble holding a ball Hygiene may be an issues as they may not like the feeling of a washcloth on their face or perhaps the soap feels like sand paper on their face or body.

37 Hyposensitive: May not feel or notice touch unless it is very firm or intense. A light hand on the shoulder by a teacher to signal the student to quiet down may not be effective. The child may constantly touch others Bite themselves, bite their nails down to nothing, pick at their skin, and wear clothes that are too tight.

38 Vestibular/Balance Students with vestibular hypersensitivity tend to have a low tolerance for activities that involve movement. They may also have difficulty with changing direction and speed or maintaining a body position other than upright with their feet on the floor. These things will impact a child s ability to participate in a variety of physical sports and activities. Hyposensitivity may be observed by a child rocking back and forth or swinging to the extent that we would become dizzy or nauseous. A student who is hyposensitive may be clumsy and have difficulty starting and stopping activities that include movement.

39 Proprioception/Body Awareness Our muscles and joints send messages to help us move, sit, hold items, and balance. Because of the proprioception system, we are able to do activities without thinking about them. Think about how your body adjusts when you pick up a heavy box of books and it needs to rebalance.

40 Visual/Sight Compared with other sensory areas, the visual system appears to be more of a strength for children with an Autism Spectrum Disorder. Difficulties may occur when a child is unable to find what they re looking for. May have difficulty with staying in the lines and appropriate spacing with letters. Visual over-sensitivities may occur. For example some children can see the fluorescent of the light pulsating. Reading may be difficult if it appears that the words are moving around on the page or the child is skipping lines when reading.

41 Auditory/Hearing Hypersensitivity: May respond negatively to loud noises. Loud noises may be painful. Even small noises can be irritating such as the brushing sound of corduroy or a fork scraping a plate or the sound of someone chewing. Hyposensitivity: May not appear to hear what is being said to them.

42 Gustatory/Taste Hypersensitive: May avoid certain tastes or textures. Brushing teeth may be challenging due to the taste of the toothpaste. Hyposensitive: May constantly want items in their mouth

43 Olfactory/Smell Think of the various smells at home: cooking, cleaning supplies, laundry detergent, pets, perfume, soaps, make up, etc. Think about a locker room. Hypersensitive: Even slight smells bother them, give them headaches, etc. Hyposensitive: They are wanting to smell everything or smell a particular thing.

44 The sensory integration process is never ending and the events are not separate It takes about 1 second to go through the process of: Registration Orientation Interpretation- fright, flight, fight Organization Execution

45 Registration: awareness. When we are aware of the sensation The awareness level can fluctuate depending on the time of day, degree of stress, our emotional state, physical health, hunger, past experiences, etc. Orientation: Focus on the input. A shift in attention Interpretation: Relate our past experiences to what is happening now. Potential fright, flight, or fright reaction Organization: When we determine what response, if any, is necessary. Execution: Carrying out the response

46 Some sensory messages or inputs have a facilitating effect on our overall nervous system, resulting in a state of alertness or readiness to respond. Other sensory messages may be disregarded or inhibited, decreasing the possibilities that a response will occur. Modulation is the critical balance or regulation of facilitating and inhibiting effects. When a person is aware that they need to energize or calm down, they may chose a sensory strategy to facilitate or inhibit the sensory message.

47 Most of the time the sensory integration process is effective. We take in information, process it, and act on it appropriately. We register, orient, interpret, and execute a response in a manner that is well matched to the situation.

48 Individuals with ineffective sensory processing can experience problems in one or more of the sensory areas at any point in the sensory integration process. If there are difficulties with effective registration of sensory input, then subsequent steps in the integration process will be disrupted. Poor modulation of input may result in responses that are not balanced to meet the situation. Individuals who have modulation difficulties often over or under react to situation.

49 Imagine Imagine you re an individual with an Autism Spectrum Disorder. We know there are some characteristics that you may have such as: poor frustration tolerance, sensitive to criticism, don t do well with changes in plans, expectations or routines, are unable to perceive others body language and expressions correctly, etc. Now factor in sensory issues. Tactile (touch): You don t understand the concept of space and feel uncomfortable standing in lines or being too close to others. This creates more anxiety. You have difficulty with fine motor skills such as writing and the sound of the pencil on your paper is harsh (auditory). Loud noises also bother you and you re constantly on alert as to when the bell is going to ring as it is painful. You have difficulty copying from the chalkboard because it takes a lot of concentration and you constantly have to re-position your body (vestibular). The smell of the lunch or the gym or locker room at school is overwhelming and physically makes you feel ill. How long.with all these factors going on.would it take you to explode or withdraw?

50 What can you do for these students?

51 Visual Ideas Limit the amount of visual materials hanging from the ceiling or walls Store manipulatives inside containers Organize and label all materials to identify where they belong Put pictures on containers for students with poor visual memories use a lamp instead of an overhead or florescent lighting Don t require eye contact Items to calm may include: a kaleidoscope, eye mask, look and find book, lava lamp, sensory bottle, etc.

52 Auditory Ideas Minimize verbal directions Use ear plugs or head phones Allow time for the student to listen to their favorite music Use more visuals with pictures or words Use social stories about what might happen or sounds that can be heard in the room Desensitize a student to an area by slowly integrating him or her on numerous visits. Sound machine or white noise

53 Tactile Ideas When a student indicates that a touch hurts or pulls away acknowledge their feelings and stop touching Experiment with different types of clothing that are comfortable Provide easy access to small hand fidgets Allow students to sit in a different type of chair (bean bag, ball, video rocker) Refer to the occupational therapist for additional ideas and resources (weighted vest, brushing utensils, etc.)

54 Taste and Smell Ideas Reward students with foods that you know they like Keep all poisonous substances locked up safely Talk with a nutritionist about diet Have a scented lamp, candle, lotions, liquid soap, scented markers or stickers available to smell and calm the student. Be mindful of scented objected that a student may act aversely to Use minimal amounts of cologne or perfume Be aware of soaps and detergents; use scent free laundry products

55 Thank you!

56 Myles, B.S., Cook, K.T., Miller, N.E., Rinner, L., Robbins, L.A. (2000). Asperger syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, Kansas: Autism Asperger Publishing Co.