Sensory Perceptual Issuesin

ASD

Colin Smith

Purpose of presentation

• Reminder that sensory issues offer one possible explanation for challenging behaviour

• Sensory issues are very important in ASD• Interventions should acknowledge importance of sensory issues

and organise environments and approaches accordingly• Nature of sensory issues often misunderstood

– they are not uncommon– not just about hypersensitivity

Some behaviours associated with ASD that may be linked to sensory issues:

Outbursts following crowded environments or group conversations Bright lights uncomfortable/ dimness preferred Disorientated in environments rich with visual stimulation Plays with lights and shiny objects Repetitive humming or loud outbursts Discomforted by loud or low frequency noise Delayed response or over reaction to sudden noises Over reaction to smells –especially those no one else can detect Flapping, spinning Walking on tip-toes

Further behaviours: Sensory?

Preference or insistence on (same) bland food Fascination with how people smell Aversion to perfumes and air fresheners Strong preference for gentle or firm touch or pressure Unusually high or low response to pain Unusually high or low response to temperature Unhappy in new clothes, sensitive to how clothes/ bedding

feels

Anna Jean Ayres (1920-1989)

• Occupational Therapist and developmental psychologist known for her work in the area of sensory integration dysfunction, a term she coined in the 1960s to describe a theory used in occupational therapy

The science bit! Sensory receptors (various parts of the body)

Sensory nerve in these receptors recognises a stimulus

Sensory Transduction to brain (which may be confused or misinterpreted)

Arousal (timescales)

Response

The sensory system

Sight

Hearing Taste

Smell Touch

Vestibular

Proprioceptive

Sensitivity

• Hyper sensitive - (overpowering registration) sensation avoidance

• Hypo sensitive – (low registration) sensation seeking

Prevalence – increasing trends

• Studies in early part of millennium suggestive of 30% in ASD

• Schoen, S. Miller L. Brett-Green, BA. & Nielsen, DM. (2009) suggest 90% of individuals with an ASD have sensory differences

• DSM-V & ICD-11 Incorporating it within diagnostic criteria circa. 2013

Smell/Taste (Olfactory/Gustatory System)

Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Ignores bad smells

Eats inedible objects

Can eat strong foods with no adverse effects

Fascination with how people smell

Overwhelmed

Panic

Refusal to go into particular environments Intolerance to people

Sight (Visual System)Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Things appear darker

Relies on peripheral vision

Blurred vision

Clumsiness

Terror in dimly lit places

Things appear brighterDistortion of objectsHighly sensitive to light(particularly fluorescent light)Reacts violently to lightObjects jump around Distorted perspectiveInsistence on gloom

Hearing (Auditory System)Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Sounds partially heard

Sounds are muffled

No response to sound (may appear deaf)

Enjoys/seeks loud noise

Sound distorted or magnified

Inability to filter or discriminate

Acute painful hearing

Overwhelmed by sound

Reacts violently to sound

Holds hands over/fingers in ears

Disturbed or distracted by background sound (e.g. fridge)

‘Tunes out’

Touch (Tactile System)Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Low response to pain

Poor reporter of illness

At risk of harm (burns)

Clumsy

Cannot handle tools

Weak grasp

Overwhelmed

Avoids certain fabrics

Reacts violently to touch

Refusal to wear clothes

Avoids hair/nail cutting

Even light touch may be painful

BUTMay enjoy and seek out firm consistent pressure/ touch

Balance (Vestibular System)Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

HyperactivityRestlessnessRockingSpinning TwirlingSwingingJumpingHitting self

Fear of being movedPanic if feet leave floorRefusal to travel in vehiclesPreference for sitting or lying Avoidance of all physical activityMarked reaction to movement(vomiting)

Body Position (Proprioceptive System)Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Poor body awarenessCrashes into thingsFalls over a lotWeak compared to same age Tires easilyProps self up during activityClumsyChews clothing

Fidgety

Difficulty with fine motor control and manipulation of objects e.g. Laces, buttons

Rigid body posture and movement- will turn whole body around to look at something

Poor or erratic sleep

Hyperactivity

Other related factors:Body Temperature

Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Feels cold

Insists on warm or heavy clothing whatever the weather

Active

Thirsty

Distractible

Strips off

Prefers light clothing whatever the weather

Other related factors:Central Auditory Processing

Hypo (low registration/sensation seeking) Hyper (sensitive/ sensation avoidance)

Behaviours

Slow processing of language

Getting stuck

Repetitive thoughts

If interrupted - having to go back to beginning

Need for prompting

Catatonic type states

Thoughts jumbled

Excitable

Poor concentration

Unable to process language unless written down

Unable to discriminate foreground from background Interrupting/ speaking over people

ADHD type problems

A personal view

Stephen Shore

‘Beyond the Wall: Personal experiences with Autism and Aspergers Syndrome’

Shore: An inside viewSense Possible sensitivity What it feels like Common reaction

sight Bright lights The full wattage of the lights are visible. Feels like sitting in a room with a strobe light

Person may try to escape

sound Birds tweeting Feels like birds beaks scraping the eardrum

Person may cover his ears

taste Avoidance of strong tasting food

Tastes like acid or other unpleasant strong taste

Person spits food out

smell perfume Feels like taking a deep breath from a Clorox bottle

Sneezing, burning eyes, other reactions, person tries to escape

touch Light touch Feels like touching an open wound or electric shock

Sensory defensiveness, brushing away light touch, jumping excessively at unexpected touch, seeking deep pressure

Shore: An inside viewSense Possible

sensitivityWhat it feels like Common reaction

Vestibular (INNER EAR – BALANCE)

Low tolerance for activities involving movement

How most people would feel after spinning around at high speeds for a while. Dizziness or light headed feel

Avoidance of any movement involving sharp changes in direction or the feet leaving the ground

Seeking vestibular stimulation

Losing oneself in space-loss of co ordination

Attracted to roller coasters and similar rides

Proprioceptive (HOW MY BODY FEELS IN THE WORLD)

Clumsy movementsPerson like bull in a china shop

Body made of syrup- movement is tiring

Person appears fatigued-difficulty in modulating muscular force in everyday activities

Some phenomenon

• Allochiria – stimuli presented to one side are perceived as presented in the other

• Sensory agnosia – experiencing something out of context

• Topographical agnosia – inability/difficulty recognising landmarks

• Two sensory synaesthesia – stimulation of one modality triggers perception in another

• Multiple sensory synaethesia – further complexity of two sensory synaethesia

Intervention Ideasproblem specifically factors possible

interventionEating

Eating

Picky eater

Eats clothes/ rubbish/toiletries

Sensitive mouth?Sensory avoiding

Sensory seeking?

Soft foodWooden or familiar eating utensils

Incorporate strong tasting foods in diete.g. Marmite Hard Pastilles

Intervention ideasproblem specifically factors possible

interventionSmearing Handles and

smears faecesLow registrationSmellTouchSensory seeking?

Introduce similar materials e.g.•Clay•Aroma dough•Paste•Pungent aromas e.g. ‘LUSH’

Intervention ideasproblem specifically factors possible

interventionRefuses clothes

Strips off Sensory sensitivity

Sensory avoiding

Other factorsBody temp

Exclude irritant fabrics e.g. wool, nylonUse silk or very light cotton next to skinRemove labels from clothingCheck seams

Intervention ideasproblem specifically factors possible

interventionSleep Problem in

falling asleepDisturbed or erratic sleep pattern

Sensory sensitivitySensory avoiding

Blackout blindsSound insulationBedding materials•Avoid duvets•Use of weighted blankets‘Bed tent’

Intervention ideasproblem specifically factors possible

interventionSelf injury Punches head Low

registration

Sensory seeking

Pressure on head e.g. Tight baseball cap or headscarf Bandana

Intervention ideasproblem specifically factors possible

interventionSelf injury Bites wrist Low

registrationSensory seeking

Tight wrist bandsWeighted cuffsWeighted jacket/ body warmerBack packTight body clothing Personal massager (vibration)

Sensory Assessment

• Occupational Therapist

• NHS Lanarkshire

• Education (Additional Support for Learning) (Scotland) Act 2004 vs Co-ordinated Support Plan

Further reading

• http://www.falkirk.gov.uk/services/social_work/children_and_family_services/support_for_children_affected_by_disabil/making_sense_of_sensory_behaviour.pdf

Thank you

• Please complete evaluations