Sensory Issues with the child with an Autism Spectrum Disorder

Sensory Issues with the child Sensory Issues with the child with an Autism Spectrum with an Autism Spectrum

DisorderDisorder

Why so many kids with Why so many kids with Autism?Autism?• Possible causes can include:Possible causes can include:

• Pruning during normal developmentPruning during normal development

• Cell migrationCell migration

• Brain stem structuresBrain stem structures

• Abnormal cerebellum, faulty volume controlAbnormal cerebellum, faulty volume control

• Hypothalamus issues related to body Hypothalamus issues related to body temperature, hunger, thirst, circadian temperature, hunger, thirst, circadian rhythms and hormone regulation.rhythms and hormone regulation.

CausesCauses

• Neurotransmitters play a role in sensory Neurotransmitters play a role in sensory issues. Dopamine, norepinephrine and issues. Dopamine, norepinephrine and serotonin affect CNS and impact arousal, serotonin affect CNS and impact arousal, sleep, attention and motivation.sleep, attention and motivation.

• Recent studies have shown that children Recent studies have shown that children with Sensory Processing Problems have with Sensory Processing Problems have nervous system disturbances.nervous system disturbances.

Other Contributing Factors:Other Contributing Factors:

• GeneticsGenetics

• PrematurityPrematurity

• Birth Trauma and HospitalizationBirth Trauma and Hospitalization

• Adopted ChildrenAdopted Children

• Heavy Metals Ingested during Heavy Metals Ingested during PregnancyPregnancy

Wake Up your senses!Wake Up your senses!

• Fast moving activity!Fast moving activity!

• Activity analysis, what did we just do?Activity analysis, what did we just do?

• How fast our brains worked to make How fast our brains worked to make this happen?this happen?

• Rapid firing neurotransmission taking Rapid firing neurotransmission taking place and of course we saw it as being place and of course we saw it as being fun because we were moving and fun because we were moving and thinking!thinking!

Every Child with Autism Is Every Child with Autism Is UniqueUnique

• ASD casts a wide netASD casts a wide net

• What people on the spectrum do have in What people on the spectrum do have in common is that they almost always have common is that they almost always have significant sensory problems.significant sensory problems.

• Geneva Centre for Autism study in Toronto Geneva Centre for Autism study in Toronto found 8 out of 10 were hypersensitive to found 8 out of 10 were hypersensitive to touch and sound and had vision problems touch and sound and had vision problems and nearly 1/3 had taste or smell and nearly 1/3 had taste or smell sensitivities.sensitivities.

Stanley Greenspan StudyStanley Greenspan Study

• 200 children with ASD 94% had sensory issues 200 children with ASD 94% had sensory issues including:including:

• 39% were underreactive( 28% did not respond to 39% were underreactive( 28% did not respond to sensory stimuli while 11% engaged in sensory sensory stimuli while 11% engaged in sensory seeking behaviors)seeking behaviors)

• 19% were oversensitive19% were oversensitive• 36 % both over AND undersensitive36 % both over AND undersensitive• 100% had auditory processing dysfunction100% had auditory processing dysfunction• 100% had motor planning dysfunction ( 48 % with 100% had motor planning dysfunction ( 48 % with

severe motor planning problems and 17% with severe motor planning problems and 17% with low muscle tone and related problems)low muscle tone and related problems)

Significant Sensory Significant Sensory DifferencesDifferences

• Tactile SensitivityTactile Sensitivity

• Taste/Smell SensitivityTaste/Smell Sensitivity

• Movement SensitivityMovement Sensitivity

• Under responsive/Seeks SensationUnder responsive/Seeks Sensation

• Auditory FilteringAuditory Filtering

• Low Energy/weakLow Energy/weak

• Visual/Auditory SensitivityVisual/Auditory Sensitivity

Tactile SensitivityTactile Sensitivity

• Would rather touch others than be Would rather touch others than be touched by otherstouched by others

• Fuss or resist hair washing/cutting/nail Fuss or resist hair washing/cutting/nail trims clothing changes/tags/labels/seamstrims clothing changes/tags/labels/seams

• Crowds or body space/being bumped intoCrowds or body space/being bumped into• Dirty or messy handsDirty or messy hands• May seem unnecessarily roughMay seem unnecessarily rough• Bump or crash into things seeking Bump or crash into things seeking

sensation or seem under responsive to sensation or seem under responsive to certain sensations or paincertain sensations or pain

Fun or yuck?Fun or yuck?

Taste/Smell SensitivityTaste/Smell Sensitivity

• Smell is primitive, we smell dangerSmell is primitive, we smell danger• Smell travels thru the Limbic system, Smell travels thru the Limbic system,

which is the center of our emotions, which is the center of our emotions, memory, pleasure, and learning.memory, pleasure, and learning.

• No other sense taps into our No other sense taps into our emotions like our sense of smellemotions like our sense of smell

• Senses of taste and smell are Senses of taste and smell are intimately connectedintimately connected

Common signs of Taste and Common signs of Taste and Smell SensitivitySmell Sensitivity

• Avoids most foods children their age Avoids most foods children their age enjoyenjoy

• Have limited repertoire of accepted foodsHave limited repertoire of accepted foods• Crave or become upset by certain smells Crave or become upset by certain smells

or tastesor tastes• Hold their nostrils closed even when Hold their nostrils closed even when

nothing smells bad to younothing smells bad to you• Gag, nauseated and even vomit at the Gag, nauseated and even vomit at the

sight of the foodsight of the food

And this is just a typically And this is just a typically developing childdeveloping child

Oral DefensivenessOral Defensiveness

• Avoid placing toys in their mouthAvoid placing toys in their mouth

• Refuse bottles or breastRefuse bottles or breast

• Resulting in poor weight gain, use of Resulting in poor weight gain, use of g-tubes and long term feeding g-tubes and long term feeding problems if gone un detectedproblems if gone un detected

It starts even before this first It starts even before this first spoonfulspoonful

Motor HomunculusMotor Homunculus

Movement SensitivityMovement Sensitivity

• Postural Insecurity this is the fear Postural Insecurity this is the fear and avoidance of certain movement and avoidance of certain movement activities due to poor postural activities due to poor postural mechanisms.mechanisms.

Gravitational InsecurityGravitational Insecurity

• Irrational fear of change of position Irrational fear of change of position or movement. These children are or movement. These children are often fearful of having their feet often fearful of having their feet leave the ground, or having their leave the ground, or having their heads tipped backwards.heads tipped backwards.

Auditory DefensivenessAuditory Defensiveness

• This reflects an over sensitivity to This reflects an over sensitivity to certain sounds and may involve irritable certain sounds and may involve irritable or fearful responses to noises like or fearful responses to noises like vacuum cleaners, motors, fire alarms, vacuum cleaners, motors, fire alarms, blow dryers.blow dryers.

• Sometimes children may noise to block Sometimes children may noise to block out these sounds and their attention can out these sounds and their attention can be disrupted because of these noises.be disrupted because of these noises.

It hurts my earsIt hurts my ears

Visual DefensivenessVisual Defensiveness

• This may involve an oversensitivity This may involve an oversensitivity to light and visual distractibility.to light and visual distractibility.

• They may avoid going outside in They may avoid going outside in certain light and may need certain light and may need sunglasses and hats to block out the sunglasses and hats to block out the lightlight

• They may startle more easily and They may startle more easily and appear to avoid eye contact.appear to avoid eye contact.

Identify the purpose of Self Identify the purpose of Self stimulating behaviors and how stimulating behaviors and how to address themto address them• Coping MechanismsCoping Mechanisms• Some more socially acceptable might include:Some more socially acceptable might include:• RationalizationRationalization• Ex: Creating a logical justification for an action. Buying a new Ex: Creating a logical justification for an action. Buying a new

outfit when you are broke to help you find a better job.outfit when you are broke to help you find a better job.• IdealizationIdealization• Ex: Overestimating the positive qualities of someone/something Ex: Overestimating the positive qualities of someone/something

while underestimating the negatives. She is so beautiful and while underestimating the negatives. She is so beautiful and successful but always manages to forget her wallet when it is time successful but always manages to forget her wallet when it is time to pay the bill.to pay the bill.

• SublimationSublimation• Ex: Channeling unwanted impulses into something more Ex: Channeling unwanted impulses into something more

constructive.constructive.• Ex: Cleaning the house when you are anxious or upset is Ex: Cleaning the house when you are anxious or upset is

sublimation.sublimation.

Coping MechanismsCoping Mechanisms

These coping mechanisms we all use are These coping mechanisms we all use are worth learning about and help us to worth learning about and help us to deepen our self understanding of deepen our self understanding of ourselves.ourselves.

Children with Autism can demonstrate three Children with Autism can demonstrate three key forms listed below. These we consider key forms listed below. These we consider unacceptable and wish to reduce and fade unacceptable and wish to reduce and fade over time and eventually extinguish.over time and eventually extinguish.

Maslow’s HierarchyMaslow’s Hierarchy

Self Stimulatory BehaviorsSelf Stimulatory Behaviors

• Tuning OutTuning OutHe may want to hear you but his sensory He may want to hear you but his sensory issues are so intense , that he may feel he issues are so intense , that he may feel he has to block out external input by shutting has to block out external input by shutting down and becoming completely self down and becoming completely self absorbed. Maslow’s Hierarchy, Safety needs.absorbed. Maslow’s Hierarchy, Safety needs.

• Acting OutActing OutBecoming loud and aggressive. He may be Becoming loud and aggressive. He may be in a panic mode not thinking of the in a panic mode not thinking of the consequences of biting etc. He is trying to consequences of biting etc. He is trying to protect himself. Safety needsprotect himself. Safety needs

Engaging in Self stimulating Engaging in Self stimulating BehaviorsBehaviors• Why they do this?Why they do this?• They help block out the world and its overwhelming They help block out the world and its overwhelming

demands. Too much sound, too much visual, I hate your demands. Too much sound, too much visual, I hate your patterns on your shirt! It is all just too much!patterns on your shirt! It is all just too much!

• Stimulation can regulate a poorly functioning CNS. What we Stimulation can regulate a poorly functioning CNS. What we might do, wiggle your ankles, pump your legs, chew gum, might do, wiggle your ankles, pump your legs, chew gum, these all help us keep our arousal in check and socially these all help us keep our arousal in check and socially acceptable . Ex: Lining up trains might give the child more acceptable . Ex: Lining up trains might give the child more organization and control in what she experiences as a organization and control in what she experiences as a chaotic world.chaotic world.

• Lastly, Gym Euphoria versus natural high that occurs with Lastly, Gym Euphoria versus natural high that occurs with self stimming they trigger the body’s natural painkillers “ self stimming they trigger the body’s natural painkillers “ endogenous opioids” which include endorphins and endogenous opioids” which include endorphins and enkephalins.enkephalins.

Common Stim BehaviorsCommon Stim Behaviors

• Visual- flicking fingers, lining up toys Visual- flicking fingers, lining up toys spinningspinning

• Vestibular-rocking, spinning, pacingVestibular-rocking, spinning, pacing• Auditory- humming, singing, unusual Auditory- humming, singing, unusual

vocalizationsvocalizations• Tactile- touching, rubbing, scratching, Tactile- touching, rubbing, scratching,

chewing nailschewing nails• Proprioceptive-tooth grinding, biting, Proprioceptive-tooth grinding, biting,

chewing, body slamming, crashing.chewing, body slamming, crashing.• Taste and Smell- licking or smelling objects, Taste and Smell- licking or smelling objects,

others or their own body parts.others or their own body parts.

Questions to ask about self Questions to ask about self Stimulatory Behaviors.Stimulatory Behaviors.

• In what situations and under what In what situations and under what circumstances does the child stim?circumstances does the child stim?

• What does the child get out of the What does the child get out of the behavior?behavior?

• What sensory system is most What sensory system is most involved?involved?

• Is there and underlying Medical Issue?Is there and underlying Medical Issue?

• What would help?What would help?

Optimal Level of ArousalOptimal Level of Arousal

Moderate anxiety produces Moderate anxiety produces optimal performanceoptimal performance

The Human Function Curve , The Human Function Curve , Nixon 1979Nixon 1979

Identify resources available to Identify resources available to develop a sensory diet, develop a sensory diet, improve sleep, enhance self improve sleep, enhance self regulation and improve social regulation and improve social skills.skills.• Weighted blankets and lap padsWeighted blankets and lap pads

• Activities to help sleep readinessActivities to help sleep readiness

• Temperature and smells to prepare Temperature and smells to prepare for the eveningfor the evening

• Social stories and routineSocial stories and routine

• ROUTINE is so importantROUTINE is so important

Keeping Therapy Practical and Keeping Therapy Practical and ConcreteConcrete

• Use of idioms versus concrete Use of idioms versus concrete statementsstatements

• Just a little bit or a whole lot, what do Just a little bit or a whole lot, what do they mean to our children with Autism?they mean to our children with Autism?

• Use of a 1-5 rating scale maybe more Use of a 1-5 rating scale maybe more useful. 1 being a minor annoyance and useful. 1 being a minor annoyance and 5 being unbearably uncomfortable.5 being unbearably uncomfortable.

Parenting the Child who has Parenting the Child who has Autism and Sensory IssuesAutism and Sensory Issues

The Need for Physical Activity The Need for Physical Activity and Sensory Dietsand Sensory Diets

Heavy workHeavy work

Changes in Routines and Changes in Routines and InteractionsInteractions

• RoutineRoutine

• New classroom and teacherNew classroom and teacher

• Moving houses, starting a new Moving houses, starting a new school, school,

moving into a new room or bed.moving into a new room or bed.

Adapting the EnvironmentAdapting the Environment

Thanks to Dr. A Jean AyresThanks to Dr. A Jean Ayres

Thanks to Temple GrandinThanks to Temple Grandin

Patricia WilbargerPatricia Wilbarger