Sensory Processing in Autism Professional Training Dyad Restricted interests and repetitive Behaviours Core feature - unusual sensory responses Sensory processing - a neurological process: unconscious & automatic www.medical-illustrations.ca 1
www.middletownautism.com/research/ Bulletin No. 11 Sensory Processing 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 2
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. TED: Adam Harris - An Insider's Perspective Anecdotal evidence Temple Grandin Reported anxiety in response to sensory stimuli Discovered that she felt calmed with deep pressure input Hug machine 3
Dr. Temple Grandin Sensory Needs in School Sensory Modulation/Regulation The ability to independently manage/regulate the sensory input from within the environment and from our own bodies...the nervous system s process of self-regulation ability to focus on the important/relevant input and to filter out the background/irrelevant input. Many children with autism have difficulty modulating or regulating sensory input, leading to emotional and behavioural responses. Sensory Modulation/Regulation: Responsiveness Patterns Responsiveness patterns: generally function around a normal threshold of response - alert, but without feeling overwhelmed when the nervous system is responding too much: hyper-responsive (or over responsive) when the nervous system is responding too little: hypo-responsive (or under responsive) Responsiveness patterns fluctuate can interfere with everyday life and cause difficulties The ideal state for learning and interacting is alert and calm THE TEACHABLE MOMENT 4
Sensory difficulties Difficulties with sensory modulation/regulation patterns affect behaviour, learning, and overall daily functioning. Meaning: behaviour is inappropriate responses insufficiently matched to situations goals not easily achieved Extensive effort and attention are required for sensory regulation to occur. Adult Sensory Processing Neill An Insiders Perspective of Sensory Processing 5
Response Patterns - Sensory Input (Miller et al, 2009) Response Patterns Sensory Profile (Dunn, 1999) Meet the characters - Neurological Thresholds of Response Patterns Low Arousal Sensory Seeking Sensory Sensitive Sensory Avoiding Gwen Wild - Sensational Brain 6
Thresholds of response patterns: Low Threshold Low threshold: over-responsive or hypersensitive to sensory input Indicators of over-responsive Defensive Avoidant Anxious Distractible Passive Dunn et al, (2001) child with autism is significantly more likely to engage in a high amount of sensory avoidant behaviour. Dunn et al, (2001) child with autism is significantly more likely to engage in a high amount of sensory sensitivity patterns Thresholds of response: High threshold High threshold: Hypo-sensitive or under-responsive to sensory input 2 types of behaviour : i. Sensory-seeker o Appears to be hyperactive and on the go o Distractible o Fidgets o Disruptive ii. Under-responsive o Ignores sensory input o Unresponsive o Lethargic Dunn et al, (2001) that individuals with autism are significantly more likely to experience underresponsiveness Sensory Profile (Dunn, 1999) PASSIVE ACTIVE HIGH THRESHOLD Low registration Sensation seeking LOW THRESHOLD Sensory sensitivity Sensation avoiding 7
Low Registration in autism is unaware of others in the environment does not actively engage in interaction or activities appears to be socially withdrawn engages in non-challenging repetitive activity due to limited motivation and engagement is slow to respond to adult/teacher s voice may have motor difficulties e.g. low muscle tone, poor coordination Sensory Seeking in autism engages in repetitive behaviours engages in self-stimulatory behaviours e.g.: Rocking Spinning Hand flapping Echolalia; repetitive noises Fidgeting follows intense interests and becomes fixated on these tends to be overactive is likely to have attention difficulties Sensory Sensitivity in autism becomes distressed with changes and transitions becomes distressed in response to specific sensory stimuli dislikes auditory and tactile input is very distractible in the learning environment is very distractible during social interactions is cautious in new experiences 8
Sensation Avoiding in autism prefers routine and familiar environments avoids social interaction and communication creates rigid rituals engages in repetitive play in order to avoid new and unfamiliar activities may engage in stereotyped behaviours as a means of blocking out distressing stimuli 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 et al, 2009) 9
Sensory systems 5 sensory systems Visual: sight Auditory: sound Gustatory: taste Tactile: touch Olfactory: smell Additional sensory systems Vestibular Proprioceptive What sensory input are you receiving in this environment? What are you attending to? What are you ignoring? What sensory input would your teen receive in this environment? Think of your classroom/school: What sensory input is your student with autism receiving from it? What are they attending to? What are they ignoring? 10
Child s Sensory Response National Autistic Society Too Much Information Before we start Desensitisation Before starting, teach pupil coping strategies Gradual exposure to stimuli 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 pupil s distress is genuine so immediately stop the activity. Provide calming activity Visual Sensitivity 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. 11
Visual: Support Strategies Reduce visual distractions in the environment Reduce clutter Consider storage toys and preferred items Turn off computer, TV, ipad and other IT gadgets when not in use Consider lighting - fluorescent lights flicker Cap with a peak Consider distractions when pupil needs to eat - break/lunch times Consider where classwork is completed Consider amount of tasks/information on page Auditory Sensitivity: 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 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 12
Control Noise Level Harberton School Strategies to Independently Manage Noise Level Headphones/Ear Defenders Some pupils like to use ear defenders to block out unwanted noise, for example: during independent work to reduce auditory distraction when noisy equipment in class is used in noisy places e.g. school hall, yard, canteen etc. Be mindful that overuse can increase noise sensitivity Teach socially appropriate use of headphones / ear defenders 13
Calm Breaks Include on schedule e.g. before and after a group activity Or allow pupil to request a calm break Provide pupil with a visual card Consider where pupil will go for calm break Consider whether pupil needs calming items e.g. favourite fidget toy, ipod, weighted item Example of a social script auditory 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. Auditory System: Under-responsiveness Some pupils 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 14
Example of Auditory Desensitisation: Scenario: Toni has sensory needs and refuses to go to events in school hall. Goal: For Toni to sit quietly with class for duration of an event in hall. Steps in Auditory Desensitisation Toni visits school hall when empty. Toni sits in foyer of school hall for part/full duration of event with staff member. Toni sits at back of school hall for at least 5, 10, 15 etc. minutes of event. Toni sits at the back of the hall for the entire event Toni sits with class for the second half of the event Toni sits with class for the entire event. Gustatory/Taste Sensory system responsible for the perception of taste and flavour. Some pupils with autism may present with strong likes and dislikes regarding the tastes of foods: Some may prefer very bland foods, leading to a restricted diet Others like strong flavours and may become more alert after eating strongly flavoured foods (e.g. sour sweets, strong mints) 15
Gustatory/Taste: Introducing new food Support for parents of a pupil: Seek support from Dietician/medical professional 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 Tactile Sensitivity Receptors located on skin to detect touch Light - surface Deep - pressure Temperature hot, cold etc. Pain Receptors play an important role in how pupil perceives and responds to stimuli in the environment. If pupils processing of tactile input is distorted, this can cause great discomfort and/or responses insufficiently matched to situations. 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 16
Tactile: Desensitisation Increase participation in tactile activities by gradually increasing the time and intensity of the task e.g. Messy Play: Allow pupil to wear gloves and then gradually cut the fingers off the gloves and then remove completely Painting: Allow pupil to use a long brush, then a short brush, then finger brushes, then small pieces of sponge and then fingers! Use a visual timer Use First/Then schedule Immediately follow with a favourite activity Tactile system: sensory seeking Some pupils fidget to seek tactile input to stay alert and calm Provide fidget objects during class/lessons when out and about Use lots of tactile activities e.g. sand and water play tactile boxes/trays dough, art and craft Tactile 17
Olfactory: Smell Some pupils get distressed in new environments because they are hypersensitive to smells Others like to smell people and objects and seek out this input Provide a cloth with a strong scent Provide scented/fragranced objects. 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 Vestibular: 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 18
Avoidance of Movement Activities Prepare child for movement Avoid spinning and backward movements if possible Provide alternatives during movement activities Use deep pressure input if the child 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 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 Movement Hypersensitivity: Desensitisation Desensitisation strategies can be used to increase child s tolerance of movement However, desensitisation to movement 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 activities Stop movement if teen is distressed 19
Vestibular: Sensory Seeking Some pupils will seek out movement during the day to keep themselves alert This leads to impulsive and hyperactive behaviours difficulty staying in seat walking around room 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 Specialised Seating 20
Provision of Movement Examples... Gym equipment Running around yard Trampoline Jobs e.g. deliver water/books etc. to staff Walking during some class work e.g. reading, spellings Sensory Diets 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 21
Proprioceptive System Almost all students enjoy proprioceptive input; generally do not see dislike or avoidance of proprioceptive input Proprioceptive input will alert pupil who is under-responsive Proprioceptive input will calm pupil who is hypersensitive to sensory input Proprioceptive Activities Any activities which involve resistance or weight bearing 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 Proprioceptive Activities Wall push outs Carrying books (e.g. in backpack) Stress ball or chewy tube Jumping (e.g. on trampoline) Crawling, wheelbarrow walks, animal walks Cardiovascular activities Pushing and pulling activities Cleaning tables and brushing floor Passive input (e.g. massage/deep pressure input from external source) Hot dog Oral motor activities 22
Proprioceptive: 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. Oral tools Aim is self-regulation Educate pupil to recognise his/her own sensory needs and how to independently meet these needs in an appropriate way. E.G. Visual cards to prompt appropriate activities The Alert Program Self-Regulation Made Easy How does your engine run? https://www.alertprogram.com/ 23
Remember! For pupil with sensory difficulties, daily functioning does not come as easy as for their peers. Can be exhausting and frustrating because of energy and effort required to maintain attention listen perform organise and manage self transition between activities throughout the day interact with peers. With all of this energy being spent on functions that should come naturally to a person s nervous system and body on a daily basis, it s no wonder that kids with sensory difficulties demonstrate inappropriate behaviours in the classroom (Edwards, 2010) Useful Resources Henry OT-Diana Henry TOOL CHEST- filled with activities for home and school TOOLS for parents-everyday home activitieshomework place, holiday helpers Tools for Tots www.asensorylife.com understanding your child s sensory signals www.lemonlimeadventures.com http://sensory-processing.middletownautism.com/ 24
Suggested Reading The Out-of-Sync Child (Carol Kranowitz) The Goodenoughs Get in Sync (Carol Knanowitz) Sensational Kids (Lucy Jane Miller) Raising a Sensory Smart Child (Lindsay Biel & Nancy Peske) Too Loud, Too Bright, Too Fast, Too Tight (Sharon Heller) Asperger Syndrome and Sensory Issues (Brenda Smith-Myles et al) Living Sensationally (Winnie Dunn) Max and Me (Ines Lawlor) The Scared Gang (Eadaoin Bhreathnach) Learn to Have Fun with Your Senses (John Taylor) 25