Focus on Sensory Processing Strategies at Annual Conference

 

King-Thomas

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

Sensory-seeking behaviors

  • 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.

Managing Frustration and Anxiety

 

baker

Dr. Jed Baker, noted autism expert and author, shared some of his expertise with parents and professionals last week at a one-day conference in Raleigh. His presentation was titled “Managing Frustration and Anxiety and Teaching Social Skills” and provided strategies for individuals with Autism Spectrum Disorder, ADHD, anxiety, mood disorders, and learning challenges.

For those who could not attend, we are sharing highlights of the portion of Dr. Baker’s presentation on managing frustration and anxiety. You can also learn more with his award-winning books, available in the ASNC Bookstore at www.autismbookstore.com.

Keep Your Cool

Dr. Baker’s first tip was that caregivers must learn to control their own emotions. “If you can be cool, you can get someone else cool,” he said. Reacting to someone having a meltdown by either giving them what they want or forcing their compliance is not effective, he said. Giving in doesn’t last; it feels good in the moment but has disastrous long-term consequences. Getting angry comes from not feeling respected. Caregivers can use fear and unpredictability to scare individuals into complying, but in the long run, the individuals don’t trust you anymore, they don’t want to be in your home or class, and they will not like you, he said.

“90 percent of teaching and parenting is tolerance,” Dr. Baker said. Caregivers must tolerate their own discomfort long enough to think about what to do and not give in or get angry.

So how do caregivers control their own emotions? Number one, by having hope! Tthink of challenges as a temporary issue that can be fixed, not a character flaw. Know that things will get better eventually as long as you stick to strategies. Studies have shown that parents who are optimistic stick to strategies and therefore bad behaviors lessen over time.

Two other things to keep in mind when attempting to control your own reactions: Realize that the individual’s behavior is not intended to challenge your authority but is rather a reflection of their lack of coping skills. Also, do not worry about what other people think. Most observers understand that a child having a meltdown in public is not a reflection of your competence, and they do not blame you. You can gain respect by controlling yourself, not the child.

Lastly, be sure to take care of yourself and maintain balance in your life. What are you doing to make yourself happy? Dr. Baker suggested trying yoga, meditation, and exercise as great ways to reduce your own stress and enable yourself to maintain control of your emotions in the face of meltdowns.

Build a Positive Relationship

The first step to managing an individual’s behavior is to build a positive relationship, Dr. Baker said. It is very important for children to know that adults around them actually do care about them; show warmth and caring.

Ensure that the individuals know what is expected of them by using structure, visual supports, and differentiated instruction. Fair is giving everyone what they need, not teaching everyone at the same level, Dr. Baker explained.

You can also build confidence through the 80/20 rule. Enable individuals to succeed by starting with tasks or lessons they already grasp, then move on to new or more difficult material for the last 20 percent. If you start with the difficult material, they will feel defeated, Dr. Baker said. If you don’t let them make a mistake or fail the first eight times, they will believe they can succeed.

And finally, avoid power struggles. For example on homework, allowing breaks or limiting the amount of time they spend on it is not giving in, it is managing the work. You could also try doing the work with them or doing the first problem for them.

Manage Crises

When an argument, meltdown, or crisis does come up, first be willing to take some time to manage it. Listen to their side of the situation, agree, and apologize when necessary. Show some sympathy; there is always a kernel of truth in why they are acting out. Then collaborate and ask them “what do you want? Let’s find the right way to get that.”

If the individual is too distraught to use logic or reason, try to distract them and change their mood or focus with novel items, special interests, or sensory activities. Dr. Baker said that when he is working with individuals on the spectrum, he always keeps his pockets full of things he can use to distract them. Distraction is not rewarding the behavior as long as you don’t give them what they were having a tantrum over. If the individual is trying to avoid a task, distraction helps them avoid it, so give them a legitimate way such as taking a short break or breaking the task into pieces.

Once the crisis is over, make a plan for next time.

Work on Repeat Behavior Problems

If the individual is repeating unwanted behavior, explore why it happens. Observe and keep a journal so that you know what happened before, during, and after the behavior. The difficulty is that causes for the behavior come before the behavior, when you might not be paying attention. But with practice and time, you should be able to discover the trigger for the behavior.

Some of the typical triggers Dr. Baker listed were:

  1. Internal issues – hunger, exhaustion, illness
  2. Sensory issues – noise light, touch, overstimulation, boredom
  3. Lack of structure – not enough visual supports to give expectations
  4. Challenging or new work, feared situations
  5. Having to wait, not getting what one wants, disappointments
  6. Threats to self-esteem such as losing, mistakes, criticism
  7. Unmet wishes for attention – being ignored, wanting others to laugh

Once you have data on the trigger(s), you can develop a prevention plan. Dr. Baker mentioned his No More Meltdowns app that will help caregivers keep track of behaviors. The app allows you to upload to www.symtrend.com/nmm, which will analyze data and give you a prevention plan.

A good behavior plan will change or remove the triggers as much as possible, teach the individual skills to deal with the triggers, and reward new skills. If the individual is not already frustrated, you can also use a loss system when they do not use new skills to deal with the triggers.

Demands for Work

When an individual is frustrated by demands for work, there are several ways you can change that trigger. First, model and prompt rather than test. This goes along with the 80/20 rule mentioned previously. “Teach” them something they already know first, so they succeed. You also can give them a choice of which work they do, or use their special interests to make the work more appealing. Visual supports, such as instructions, outlines, and labels are helpful for many individuals. Finally, try reducing the length of time and using a timer so they can see how long they must keep doing the task.

To help individuals deal with demands for work, teach “trying when it’s hard,” Dr. Baker said. For some individuals, the fear of the work is the trigger, and this can be overcome with gradual exposure. Get them to try a small portion of the work. Teach them to ask to watch first or to ask for help. Tell them that they may take a break for a certain amount of time and then come back to try again. Finally, be willing to negotiate how much they do (unless you know you are working with an individual who will keep negotiating, which Dr. Baker referred to as a “congenital attorney,” much to the audience’s amusement).

Dealing with Fear

Some individuals fear situations that can just be avoided, but many must face their fears because situations cannot be avoided. Start by persuading these individuals that they must deal with their fears. Talk about their strengths and their optimistic future, and then bring up that they should deal with their fears so that the challenge is not in their way anymore. It can be a relief for them to learn that they do not have to change fundamentally, they just have to make it so that the challenge does not stand in the way of their success, Dr. Baker explained.

Then explain anxiety and true vs. false alarms. Being anxious means that the brain lies to you and makes you afraid all the time, rather than just keeping you out of true danger, he said. Help them to think like a scientist and do research on their fears. For example, if they wash their hands constantly because they are afraid of germs, they should research the likelihood of contracting a disease. Let them convince themselves through logic that their anxiety is overblown.

You can also try gradual exposure to their fear. A visual aid of a fear ladder with rungs of exposure can allow for rewards as they reach each rung.

To reduce individuals’ overall anxiety, add exercise, mindfulness meditation, and relaxation techniques. Dr. Baker recommended the resource www.fragrantheart.com. Focusing on the moment means they are not worrying, and it recharges and re-energizes, he said. The best time for many is at night, because they are less occupied, and so that’s when all the worries come out.

Finally, if anxiety is debilitating and other methods are not working, Dr. Baker said neurofeedback and medication can be useful options.

Waiting, Accepting No, Stopping Fun

Dr. Baker offered several strategies for individuals who have meltdowns because they are unable to wait, accept no for an answer, or transition away from preferred activities. A visual timer can help them understand how long they will have to wait or when they must start a new activity. A visual schedule also helps with transitions. “Prime ahead” by discussing what they will gain by waiting or accepting no, and talk about disappointments that might occur during an upcoming period.

Help them accept no by providing what they want or something else that they want at a later time. Use a reward system such as a “disappointment poster” and give them points for waiting, accepting no, and stopping fun.

Self-esteem: Mistakes, Losing, Teasing

For individuals who are upset by losing or mistakes, again the 80/20 rule is useful, Dr. Baker said. Let individuals win or succeed 80 percent of the time to build up goodwill. You also can talk ahead of time about mistakes that might occur but remind them that mistakes help us learn and grow; if you are not making mistakes, you are not trying new things or learning.

For teasing, first protect the individual as much as possible by surrounding them with supportive peers. Peer buddy programs have been shown to be a very effective method of building children up and preventing teasing. When teasing does occur, help them to check it out first to make sure they understood correctly. Perhaps it was not meant to be teasing. Teach them that when they are teased, they should calmly ask the person to stop, showing that the teaser did not get to them and does not control them. If the person does not stop, they should report the behavior.

Unmet Needs for Attention

Some individuals act out to gain attention. To change this trigger, you can schedule attention or special time for the individual so they know they will get it. In the classroom, for example, you could use a timer to count down to when they may speak with the teacher rather than calling out in class. Dr. Baker also recommended looking for appropriate outlets for the individual, such as theater or standup comedy.

Also, teach the individual about positive ways to get attention, stressing that they want to be liked, not just gain attention. Teach them about public vs. private topics, and if in a classroom or other group setting, try to get peers in on it — if the peers laugh when the student says something inappropriate, that is a reinforcement of the negative behavior. Teach the individual the “rules of comedy”: Don’t make fun of vulnerable people. Use slapstick, random thoughts, and self-deprecation.

Sensory Needs

For individuals who engage in self-stimulation such as drumming, flapping, or chewing for sensory needs, you can try to change the triggers by avoiding boredom such as waits or group activities in which they are not engaged, or by modifying frustrating work.

Skills you can teach them include alternative ways and times to self-stimulate and how to be a self-advocate for a better environment, Dr. Baker said. Individuals need to know to ask for what they need, such as less noise or more interaction. On the other hand, they need to know they have a right to the environment that works for them but can’t impose it on everyone else. If they need it quieter, they can ask people nicely, and if they don’t get it, the individual should ask to leave and take a break.

Self-Calming

Dr. Baker also discussed ways to prepare for unexpected triggers. Collaborate with the individual on ways to distract and soothe themselves in the case of upsets. Have them compile a folder of relaxation techniques. Establish safe people whom they can turn to when they need support. Teach them this self-talk: “All problems can be solved if you can wait and talk to the right person.”

Jed Baker, Ph.D. is the director of the Social Skills Training Project, an organization serving individuals with autism and social communication problems. He is on the professional advisory board of Autism Today, ASPEN, ANSWER, YAI, the Kelberman Center and several other autism organizations. In addition, Dr. Baker writes, lectures, and provides training internationally on the topic of social skills training and managing challenging behaviors; he was the keynote speaker at ASNC’s 2015 annual conference.

 

IPads and Autism: A Perfect Match?

autism app for that logo

This article was contributed by Amy Perry, an Autism Resource Specialist for the Autism Society of North Carolina. A version of the article was originally published in the summer 2013 edition of  the Spectrum magazine.

For those who would like to learn more about autism and iPads, Amy Perry will present a workshop during the ASNC annual conference, “Autism: Planning for Success,” Feb. 21-22 in Charlotte. For more information about the conference or to register, click here.

On April 3, 2010, Apple released the first generation iPad. Steve Jobs called it a “magical device,” and in many ways, that is exactly what it is: a slate of glass possessing the power of a computer, the vast content of the Internet, and a bottomless well of software applications or “apps.” The iPad literally puts the world at your fingertips, requiring only the operator’s fingers and imagination. Simply put, the real magic of the iPad is that it is truly a blank slate, designed to be customized by each user for his or her unique needs. It was clear to everyone that this new and powerful technology had the potential to be world-changing, but few knew just how many worlds it would change for those with autism.

The iPad is, in many cases, a natural match for people with autism. Stories are told every day of people who had been locked in their own worlds, unable to communicate, finding a portal in the iPad to reach out and interact with their families for the first time. Children who were thought to have severe intellectual disabilities are able to show intelligence and awareness no one thought was possible. A child who refused to hold a pencil or write on paper now draws and writes freely on the iPad using the magic of his fingertip. What is it about the iPad that makes it such a natural match with autism?

Design

The design of the iPad is simple: a 9.7-inch glass screen with one circular button at the bottom. Power and volume controls are on the sides and out of the main view; there are almost no visual distractions on the outside body. The layout of the screen is a natural grid made up of approximately 1-inch icon squares, each activated by a single touch. The number and layout of icons on any screen can be customized by the user so that a screen can contain only one or two choices, or as many as 25. The ability to customize the number of choices and the amount of information on a page can be very helpful. Many people find that iPad screens mimic the “choice boards” that the autism community has been using for years.

Interaction

The beautiful simplicity of the iPad is that it is operated by the touch of a finger; this is also what makes it such an ideal tool for people with autism. One of the skills that is looked for in early childhood development is the ability to point to indicate interest. The iPad requires the user to do exactly that, providing children with autism with many opportunities to develop this skill. On the iPad, the finger can play musical instruments, write words, turn a page, pop balloons, make choices, complete puzzles, and even launch angry birds at towers of blocks. The mere interactive nature of the iPad can create a natural gateway for more gesture-based communication and even joint attention activities.

Portability and Accessibility

Before iPads, the closest thing we had to portable technology was laptop computers. But laptops are heavier and more cumbersome, making them less accessible to young children and people with physical challenges. Laptops also require a touchpad or a mouse, which can be a barrier to use. Laptops typically can run four hours or less before requiring a recharge; iPads have up to 10 hours of battery life on a single charge. Software or “apps” for iPads are also much more readily available than computer software, new content can be purchased from the App Store instantly on the iPad with just a few taps, and there are no disks or system requirements to keep up with. Additionally, more and more programmers are developing apps specifically for the autism community.

What can’t the iPad do?

For all of the terrific things the iPad can do, there are many things it cannot do. It cannot “cure” autism, it is not a “magic bullet,” and simply placing it in the hands of a person with autism isn’t necessarily any more beneficial than putting them in front of a computer or a television. An iPad should never be a substitute for personal interaction, nor should it replace opportunities to practice real world skills. It should never be imposed on a child who is uninterested or unwilling to use it. When iPads are used by caring parents and professionals to help people with autism reach their highest potential, wonderful things can happen.

I teach iPad workshops all over the state, and one of the most common questions I get is, “How do I keep my child from using the iPad as a toy? All he wants to do is play games.” The bottom line is there is no substitute for parental involvement. While there are tools to limit app access, it’s up to the adults, not the child, to decide where, when, and why the iPad is used.

Amy Perry can be reached at 910-864-2769, ext.1206, or aperry@autismsociety-nc.org.