Autism the Facts, How to Help Sensory Processing in Autism Aims of the Training Improve your knowledge about Sensory Processing Increase your understanding and empathy for those living with sensory difficulties Provide some strategies for working with your child if they have sensory difficulties Dyad Restricted interests and repetitive Behaviours Core feature - unusual sensory responses 1
THE SENSES Auditory and Visual (Hearing and Sight): Auditory (Hearing) Receptor: Inner ear- stimulated by air/sound waves Provides information about sounds in the environment (loud, soft, high, low, near, far) Closely linked to speech and language and our social world. Visual (Sight) Receptor: Retina of the eye- stimulated by light Provides information about objects and persons. Helps us define boundaries as we move through time and space. Our sight works very closely with our sense of movement Can be a dominant system for function Gustatory and Olfactory (Taste and Smell) Gustatory (Taste) Chemical receptors in the tongue- closely entwined with olfactory (smell) system Provides information about different types of taste (sweet, sour, bitter, salty, spicy) Olfactory (Smell) Chemical receptors in the nasal structure- closely associated with the gustatory system Provides information about different types of smell (musty, acrid, putrid, flowery, pungent) Both are strongly linked to emotion and memory 2
Tactile System (Touch) Tactile (Touch) Receptors are located in the skin. Sensitivity to touch varies e.g. Hands and mouth areas are more sensitive than back/arms Provides information about the environment and object qualities. Includes light touch, firm touch and the discrimination of different textures including dry to wet and messy. Homunculus It is also has protective (defensive) functions such as the processing of pain and temperature. Has major links to protection and safety, attachment and bonding, emotional regulation, body control and planning etc. Vestibular System (Balance and Movement) Vestibular (Balance and Movement) Receptors are in the inner ear- stimulated by head movements and input from other senses, especially visual. Provide information about where our body is in space in relation to gravity. Tells us whether or not we or our surroundings are moving. Tells us about the speed and direction of movement. Closely linked to our visual system Contributes strongly to postural skills, balance, ocular motor control, spatial awareness and gravitational security. Proprioception (Body Awareness) Proprioception (Body awareness) Receptors are located in the joints, muscles and tendons. activated by muscle elongation, compression or traction Provides information about where a certain body part is and how it is moving. Has major links to postural skills, balance skills, motor control, body scheme, and motor planning. It also has strong links to emotional regulation 3
Sensory Processing Sensory Processing refers to the ongoing activity in the brain to register, modulate, interpret and integrate all this information that is coming through our senses so that we can organise a response. Sensory Processing Plan and execute response: Interaction with the environment Detect/ Register: Senses take in information from the environment Interpret: Puts meaning/ emotion on information Integrate: Brain organises all the information together Modulate/Filter: Brain selects most important to focus on 05/10/2017 11 UNCONCIOUS Sensory processing is UNCONCIOUS! 4
BUT when it goes wrong!!! When the flow of sensations is disorganised, life can be like a rushhour traffic jam And it can feel out of your control! Many people living with sensory difficulties struggle to filter or tune in to the most relevant sensory information. Instead every sensation seems to be registering at once. But we can t see sensory processing...only the behaviours External behaviours: attention, emotional affect, arousal, activity level Internal: tactile, vestibular, proprioception, olfactory, gustatory, visual, auditory sensory processing 5
Personal Account 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) A Child s View of Sensory Processing GROUP WORK: 1.Discuss your sense 2.Think of your likes and dislikes in relation to this sense (Adult Sensory Checklist in pack) 3.Think of your child and their response to this sensory input 6
AND Remember! We ALL have sensory processing differences, likes and dislikes. It can only be considered a disorder when it causes significant difficulties in daily life, development, behaviour, and social interactions. Sensory modulation and regulation Sensory Modulation/Regulation Responsiveness patterns: the way child responds to sensory stimuli in the environment when the nervous system is responding too much: hyper-responsive (or overresponsive) when the nervous system is responding too little: hypo-responsive (or under responsive). Responsiveness patterns fluctuate these patterns can interfere with everyday life and cause difficulties. 7
Child s Sensory Response National Autistic Society video Too Much Information 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 difficulties Difficulties with sensory modulation/regulation patterns affect behaviour, learning, and overall daily functioning. Meaning: behaviour is inappropriate responses insufficiently matched to situation goals not easily achieved Extensive effort and attention are required for sensory regulation to occur. 8
Neurological Thresholds of Response Patterns The way the nervous system responds to sensory input 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 is alert and calm - THE TEACHABLE MOMENT Meet the characters - Neurological Thresholds of Response Patterns Low Arousal Sensory Seeking Sensory Sensitive Sensory Avoiding Gwen Wild - Sensational Brain 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 9
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 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 10
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 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 11
In reality: Fluctuation 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) 12
Responses to Sensory Input: Across environments INTERVENTION STRATEGIES 1.Understanding and Education 13
Example: Scenario: Toni is hypersensitive to noise, and refuses to go to event in local community hall AIM: For Toni to sit quietly with family for duration of event in local community hall. Steps in desensitisation Toni will sit in foyer of hall for duration of event with one parent Toni will sit at the back of the community hall for at least 15 minutes of event Toni will sit at the back of the hall for the entire event Toni will sit with family for the second half of the event Toni will sit with his family for the entire event. Visual 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. 14
Visual System 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 used Consider lighting (fluorescent lights flicker) Consider distractions at meal times and at times when teen needs to complete other functional skills. Consider where homework it s completed + amount of information on homework page Physical Environment: Thoughts?? Other Environments: 15
Why do We Use Visual Supports? Auditory Sensitivity Some children are slow to respond to auditory instructions because they are in a state of under-arousal may get agitated in noisy places e.g. shops, restaurants, cinema distracted by background noise of household appliances may turn the TV to a very high volume or turn the volume off Controlling Auditory Input Control the noise using a sound scale and have strategies to empower child independently manage auditory input in noisy environments Use of visual communication strategies e.g. visual cue card for time out Short simple instructions Allow time to process Desensitisation 16
Strategies to independently manage noise level Headphones/Ear Defenders Some young people like to use an ipod/mp3/phone or ear defenders to block out unwanted noise, for example: during homework to reduce auditory distractions when washing machine, vacuum cleaner etc. are being used in noisy places e.g. shopping centre, restaurant, park, party Be mindful that overuse can increase noise sensitivity Teach socially appropriate use of headphones / ear defenders Social Script auditory I am going out with dad today. We are going to the shopping centre. Someone might talk through a loud speaker in the shopping centre. I will put on my headphones until they finish speaking. I will have a good time at the shopping centre with dad. 17
Taste Olfactory Sensory system responsible for the perception of taste and flavour. It allows us to recognise the five basic taste sensations of sweet, sour, salty, bitter, and savoury. When the gustatory system is over responding parent/carer may see a range of disruptive behaviours: child may constantly put inedible objects into mouth may be seeking oral input child may refuse all but a select few foods experiencing too much oral stimuli Food / Taste Child may present with strong likes and dislikes regarding the tastes of foods Or 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 Check childs weight and health with GP/dietitian Allow preferred food at mealtimes = a relaxed time! Introduce new food outside mealtimes Use desensitisation strategies Gradual exposure to different textures, tastes and temperatures. Use the preferred texture; do not simultaneously introduce a new taste and texture 18
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 Other ideas Give time for changes to occur Have designated area/s for eating Reduce social demands and noise Use smaller cutlery With some increasing cognitive awareness of food, share info on how food is made, health benefits etc. NB. It s not useful to criticise food Do Not coerce child into trying or eating new foods. do not hide new food/medicine in food child already eats increase stress at mealtimes expect child to imitate from others use food as reward or contingent on trialling new foods 19
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 Tactile System Receptors located on skin to detect light touch (surface), pressure (deep), temperature (hot & cold) and pain. These play an important role in how child perceives and responds to stimuli in the environment. If child s processing of tactile input is distorted, this can cause them great discomfort. 20
Tactile hypersensitivity Avoids personal care tasks Dislikes certain clothing Very aware of labels, seams etc. Avoids personal contact with others Dislikes getting hands dirty/wet etc. Strong preference for specific food textures or avoids involvement in food preparation Personal Care Activities Avoid running or trickling water Put water in the sink instead Use a facecloth or wipes Use deep pressure when washing hair etc. Try different materials for bathing e.g. sponge, loofah, brush Nail cutting Use visual support Firm pressure Use of sock/glove Example: Hair Cutting Provide deep pressure input before and during hair cutting Allow child to chew e.g. sentiochew Provide a distractor- a high preference item Use a First/Then reward system Use of social stories www.offwego.ie Desensitisation frequent visits to hairdresser/barber to familiarise child with the environment gradually increase time spent inside hairdresser/barber sit in chair not get hair cut Allow hairdresser/barber to touch head etc. 21
Clothing Provision of tighter clothing next to the skin e.g. Cycling shorts Tight vests/t-shirts Socks with tight elastic Under armour garments or equivalent Introduce new clothes gradually Wear new items for a short time only and gradually increase Remove tags Tactile Desensitisation Increase participation in tactile activities by gradually increasing the time and intensity of the task Example: Food preparation Start with dry foods and gradually move to different textures Gradually increase time/number of steps in task Allow child to wear gloves when handling food Use visuals e.g. visual timer, written instructions Tactile system: sensory seeking Some children fidget as they are seeking tactile input to stay alert and calm Provide fidget objects Going out and about During un-preferred activities e.g. homework Use lots of tactile activities e.g. Tactile boxes Dough, art and craft activities 22
Gustatory System Some children 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: 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 during movement activities Use deep pressure input if the teenager seems nauseous or upset after movement Use pressure garments during movement if appropriate e.g. weighted vest or blanket 23
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 contribute 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 Vary positions when working e.g. standing, kneeling, lying Specialised seating 24
Sensory Diet A sensory diet is an intervention plan. It aims to attain and maintain appropriate sensory modulation throughout the day by using regulating activities. It is Individual to the child s sensory needs Planned and mainly preventative Takes into account different environments, tasks and activities Should fit with the school and family routine Sensory input should NEVER be withheld as a punishment So When do we do it???? Throughout the child s day. Aim is to achieve a just right fit help the child balance the see saw. Focus on prevention before distress occurs In response to early warning signs of distress preventative strategies Sometimes we may plan for the coming down stages of distress reactive strategies to speed up a return to baseline. However when a person is in full fight/flight response, at the highest level of arousal your focus will be: Safety of the person Your safety The environment Giving personal space (if the person is in control enough to come to you to request a cuddle/hug/activity this is a sign they are calming down; if they are seeking out a person to hit, consider that this may be behavioural/ social and communication seeking/ deep pressure seeking) Reducing demands on the person. This includes your communications 25
What to expect from a sensory diet? Improved attention Decrease in the intensity and frequency of unwanted sensory behaviours Happier and calmer Less avoidant/ able to tolerate difficult stimuli more Cope better with possible stressful situations Sensory Diets 26
Movement Breaks Examples... Running up and down stairs Running round garden Trampoline Bouncing on therapy/exercise ball Obstacle courses Household tasks Proprioceptive System Almost all children enjoy proprioceptive input; generally do not see dislike or avoidance of proprioceptive input Proprioceptive input will alert child who is underresponsive Proprioceptive input will calm child who is hypersensitive to the sensory input Proprioceptive Activities Use any activities which involve resistance or weight bearing we sometimes refer to them as heavy body work activities. 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 27
Proprioceptive Activities Crawling, wheelbarrow walks, animal walks Jumping (e.g. on trampoline) Wall push outs Cardiovascular activities Pushing and pulling activities Carrying books (e.g. in backpack) Cleaning tables and brushing floors Passive input (e.g. massage/deep pressure input from external source) Hot dog Stress ball or chewy tube Oral motor activities Deep Pressure Touch Pain, temperature, light touch all travels in the AL system from skin to brain and is linked to sympathetic danger response system Deep pressure travels up the DCML pathway to brain and can override the other information (e.g. putting pressure on a nettle sting) Activities include: Wrapping in a weighted blanket Massage Wilbarger brushing Scratching Joint compressions Sitting in a tight seat/ packed in with cushions Rolling a large ball on top of a child lying on the ground Mat rolls Other????? Aim is self-regulation Educate child to recognise his/her 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 - Activities should have the potential to be maintained in to adulthood e.g. weight training, progressive muscle relaxation, stress ball, breathing exercises, cardiovascular activities 28
Calm breaks Include on schedule e.g. before and after an event/activity Encourage 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 etc. Calm breaks allow for: Break from sensory stimuli/ input Time to re-regulate self Remember! For child with sensory difficulties, daily functioning does not come as easy as for their peers. can be exhausting and frustrating energy and effort to maintain attention to listen to perform Additional difficulties: energy and effort needed to regulate their arousal level, 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) Do you think sensory issues are at the root of what makes autistic people different? Grandin s reply? I think the core criterion is the social awkwardness, but the sensory issues are a serious problem. they make it impossible to operate in the environment where you re supposed to be social. TIME magazine interview (2013) 29
Useful Resources Henry OT-Diana Henry www.ateachabout.com TOOL CHEST- filled with activities for home and school TOOLS for parents-everyday home activities- homework, holiday helpers Tools for Tots www.asensorylife.com understanding your child s sensory signals www.lemonlimeadventures.com http://sensory-processing.middletownautism.com/ 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) www.middletownautism.com/research/ Bulletin No. 11 Sensory Processing 30
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