The Autism Society of North Carolina held its annual conference March 24-25 in Charlotte. We will be sharing information from conference presentations in upcoming blog posts.
Linda King-Thomas, a co-founder of Developmental Therapy Associates in Durham, presented on “Sensory Processing Issues and Practical Strategies” on the second day of the conference. Sensory integration is the neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment.
In addition to the sensory systems with which we are all familiar (touch, hearing, sight, smell, and taste), we also have vestibular, which relates to movement and gravity, and proprioceptive, which is about “heavy work,” or input to our muscles and joints.
Everyone has differences in their sensory processing, Ms. King-Thomas said. About 5-10 percent of people have sensory processing issues, and it is much more common among boys. A lot of children with autism have a narrow band of sensory input that they can handle, she said; receiving too much input or too little can be a challenge.
Sensory processing disorder has three categories, and an individual can be diagnosed with more than one:
- Sensory modulation disorder: difficulty regulating the intensity of response to sensory input
- Sensory discrimination disorder: difficulty interpreting the temporal and spatial characteristics of sensory stimuli
- Sensory-based motor disorder – dyspraxia: difficulty conceiving, planning, and executing a novel motor action
Sensory modulation disorder
Ms. King-Thomas then focused on sensory modulation disorder, describing three ways that individuals can react to sensory input: over-responsivity, under-responsivity, and sensory-seeking. To help parents understand which category their children might be displaying, Ms. King-Thomas provided some examples for each.
Sensory over-responsivity behaviors:
- Covers ears with loud noises
- Sensitive to bright lights
- Fears movement or changes in position
- Avoids touching certain textures (grass, sand, finger-paints, squishy)
- Does not like to get messy
- Has strong clothing preferences
- Does not like to be touched unexpectedly (They are willing to touch others, but it must be their idea, so they know it is coming.)
- Has a poor tolerance to grooming (We have lots of receptors on hands, feet, and where our hair is. If you are trying to get them accustomed to touch, start therapy elsewhere.)
- Often irritable, aggressive, impulsive, and moody
- Has a poor tolerance to transitions
- Frequently cries and is hard to console
- Does not like to be held or cuddled
- Needs help to fall asleep and stay asleep
- Exhibits extreme separation anxiety
- Has difficulty with transitions to new foods
Sensory under-responsivity behaviors
- Has delayed reaction time
- Is slow to respond to name
- Seems unaware of environment, wanders
- Has a high pain tolerance
- Does not sense when diaper is wet
- Does not feel clothing twisted on body
- Does not feel food on face or dirt on hands
- Does not seem to notice when touched
- Has flat affect much of the time
- Is hard to engage, may observe but not participate
- Is unaware of body sensations (temperature, hunger)
- Does not seem to notice noxious odors
- Appears slow, unmotivated, or withdrawn
- Has a high activity level, seldom sits still
- Touches everything
- Hangs on people
- Smells or mouths everything
- Takes excessive risks that compromise personal safety
- Prefers foods with strong flavors
- Seeks loud noise
- Likes to watch bright or spinning objects
- Is excessively affectionate
- May be demanding or hard to calm
- Is a risk taker
- Intrudes on others
- May be kicked out of child care or expelled from school
To make things even more complicated, Ms. King-Thomas said, one person can have all three of these because each sensory system may be under- or over-reactive, independent of the other sensory systems.
These issues can affect an individual’s play skills, self-care and feeding, school-related activities, and social participation. If we can understand how behavior is affected, we can help children by modifying their environment, she said. For example, a child who is averse to unexpected touch could be allowed always to line up at the end of the line in school so that no one bumps into him unexpectedly.
Sensory processing strategies
Individuals with sensory processing issues can be treated with therapy using a sensory integrative approach. But Ms. King Thomas said families also can work on these issues at home, focusing on the sensory diet.
Your sensory diet is your daily intake of sensory and motor experiences needed to adaptively interact with the environment. Sensory and motor experiences help maintain optimal arousal and attention for learning. Once an individual is assessed by professionals to determine how much input they need, a plan is made to provide it throughout the day. Intensity, frequency, duration, and rhythm of input are all figured into the formula.
The goal is to keep the individual in the band of optimal arousal, so that will determine whether an alerting or calming input is used. For example, light touch is alerting, and deep pressure is calming; more sensation is not always better. The individual should be closely monitored to see how they respond.
Ms. King-Thomas mentioned some activities and items that could be used or done at home.
- Movement: unstable surfaces such as a therapy ball, calisthenics, jumping, swinging, bouncing, dancing
- Heavy work: carrying heavy objects such as a weighted backpack, digging in a garden, working out with weights, pushing a grocery cart
- Deep pressure touch: weighted vest or blanket (make your own with rice), massage, tight exercise clothing worn under clothes
- Oral motor: sucking through a long straw or using a thicker liquid, blowing bubbles or on a whistle, chewing gum
- Womb spaces: small, dark, quiet spaces such as a cupboard; closet with pillows; tent; claw bathtub with pillows
- Tactile: cheap toys such as squishy balls, silly putty, and bendable figures; phone cord; kneading bread; sand play. (These all help to take the place of moving the entire body)
Ms. King-Thomas also had some strategies to share, depending on the input your child may need:
- Note preferences in clothing, temperature, and bed linens
- Use music, white-noise machines, and sound-canceling headphones
- Adapt walls with either bright or muted colors
- Use natural light and avoid fluorescent light
Ms. King-Thomas, MHS, OTR/L, C/NDT, has worked in a variety of pediatric and developmental disabilities settings and has presented numerous lectures on sensory integration, fine motor, and feeding, including speaking to the counselors at ASNC’s Camp Royall for over 20 years.
For more resources, see the sensory category in the ASNC Bookstore.
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