I have put off writing this post for some time. The main reason is that I still haven’t completely got my head around the sensory side of autism. There are so many factors, it essentially becomes lots of trial and error until you find what is right for you. Having said that there are many things that are worth considering and understanding about the senses and autism. Having lots of autism sensory strategies up your sleeve is really important so lets have a look at the sensory side of autism!
The majority of autistic people have sensory processing difficulties. The hard thing is these difficulties change and fluctuate all the time. A person can be over and under-sensitive to the same thing on different days in different situations. Some sensory processing issues will be obvious, some will be very difficult to identify.
When my son was first diagnosed with autism I was very focused on his lack of speech and communication. I didn’t see any obvious sensory difficulties and I dismissed most information about sensory issues as I didn’t think it was a problem. It was much later on that I realised some challenging behaviour (biting for example) might be sensory related. And it was later still that I began to realise my son’s hyperactivity in certain situations was a sensory response.
Sight (vision) is often an area of strength for autistic people, many are very visual learners. This is why some will use picture exchange communication (PECS) and many children will rely on visual aids.
If you asked me what the senses are I would list you the five senses:
So it turns out I wasn’t paying enough attention at school as there are actually 7 senses. If like me this is news to you the other two senses are:
Vestibular – this is the sense of movement (balance) that links our body in relation to gravity. It is the sensory system that supports balance and spatial orientation. Examples of the vestibular system in action would be walking along a balance beam or knowing that you are moving when you are in a lift.
Apparently the vestibular sense is centered in the inner ear? It links the speed and direction of movements, where our body is in a space. It is how we know if it is us or our surroundings that is moving.
Proprioception – is body awareness. The sense of your own body in space without using touch or sight. Examples of proprioception in action are clapping your hands with your eyes closed, navigating across a crowded room and knowing how much pressure to apply to write with a pencil. It is the sense we use to plan our movements, it tells us where our body parts are in relation to space around us.
There is further debate about more senses that affect us such as pain, temperature, vibration, balance and the internal stimuli such as hunger and thirst sensors.
How we process information
The dominant sense we tend to use is sight (usually 80-90% of our information comes from our vision). When we see information it is then transferred to our brain where it is processed. The majority of information is immediately filtered out and deleted, we only pay attention to a very small amount of the information we come across.
For many autistic people they don’t have the ability to filter the information and can find themselves overloaded by too much information. The National Autistic Society campaign Too Much Information has some great videos that explain this well. If you are bombarded with lots of information it becomes very difficult to focus or concentrate. This is where focus is important, working on attention and focus with autistic children can be very beneficial. A great activity for this is Attention Autism.
The two sides of our brains hold different categories of information. The left side of the brain is organised. This is where we hold language information such as our dictionary and spelling. The right side of our brain is less organised, it is where we hold music, rhythm and melody. Often children with speech difficulties are trying to process language on the right side of the brain when it should be done on the left. You may also find that they have weak connections between the two sides of the brain making it harder to process language and tone for example.
Everyone needs good connections between the two sides of your brain and apparently it is very easy to improve yourself. Simple exercises where you use your right hand to touch your left leg and then do the same with the opposite sides can build up these connections. If you want to find out more about this look into ‘crossing the midline’.
We did some work on this with my son using sound. In his sleep we played music and speech through headphones to the correct sides of the brain. This was to try and improve the habit of listening to language on one side and music on the other. We did this with SAS Boost – Sensory Activation Solutions. I do think it made a difference for my son as his awareness certainly improved after we did it.
Processing sensory input
Most of us process sensory input all the time with very little awareness of it. For some it is a harder process. Breaking down the steps may help you to see there are many opportunities for sensory processing to be different:
- The initial sensory input, this may be getting touched
- You then need to register that input, so registering that you have been touched
- This is impacted by our awareness, which can be different depending on the environment or situation
- It is also impacted by our attention or focus on that input (for example someone talking to us)
- Interpretation – We may interpret based on past experience, this can also cause a fear and fight or flight response.
- Response – We need to decide what that response should be and then act on that response or ignore it
Our responses to sensory input are impacted by many factors such as environment, mood, and situation. In addition individuals tend to have different thresholds to different sensory input which is also variable.
You can be Hypersensitive or under-sensitive (hyposensitive):
- Hypersensitive: this is when a person is highly sensitive and may have unusual or extreme reactions to touch, taste, smell, sounds. It is commonly linked to anxiety and stress.
- Hyposensitive: this is when a person is under-sensitive or underwhelmed by touch, taste, smell and sound and are likely to seek out additional sensory activity.
The table below looks at the different thresholds someone may have. Whilst every situation is different you may find your child tends to sit somewhere in this table. My son for example tends to be a sensory seeker.
Sensory Issues & Sensory processing disorder
Children with autism can be over or under-sensitive to sounds, light, texture, smell and other sensory input. Sensory processing issues happen when the brain has difficulty organising information from the senses. If someone is unable to process sensory information effectively they may have a sensory processing disorder.
Some may also have Monotropism where someone may not be able to use more than one sense at a time. An example is not being able to look and listen at the same time. If this person is then demanded to look at something, they will be focused on that and will be unable to listen at the same time.
There are so many different sensory issues a person may have, here is a list of some of them:
- Can find light and unexpected touch painful, making crowds and queues very hard
- May need deep pressure touch
- Can be over or under sensitive to pain
- Sensitive to lights, colours, contrast, shape, movement
- May dislike florescent lighting or bright sunlight
- Be easily distracted visual stimuli
- Might seek bright lights and or bright clothing
- Avoids loud noise, can be painful such as hoovers, alarms and hand dryers.
- May often ask people to be quiet as sensitive to sound
- Loud environments such as shopping centres and soft play may be too much noise and cause overloads.
- A sound seeker may love loud noise but can appear oblivious to what is happening around them. Often young children can appear deaf as they don’t respond to noise even in quiet environments. They may enjoy loud environments like the supermarket and become overexcited.
- May hate to touch messy things like paint and food.
- Clothing can be too tight, scratchy may feel seams and labels as very uncomfortable
- Walks on toes
- Hair washing and baths can be traumatic
- Different tastes can be too much such as too sweet, sour, bitter, salty or spicy.
- Avoidance of food textures, smells or touch can cause restricted diet
- Can have difficulty sucking, chewing, swallowing to avoid tastes
- Hates brushing teeth as toothpaste taste is too much (you can get flavourless toothpaste).
- Can seek taste – prefers certain tastes sour / spicy. Over fills mouth, drools excessively, chews everything.
- Needs to avoid smells –dislikes certain places with strong smell like swimming pools.
- Can identify people or place by smell, can refuse to go to specific places due to smell.
- Others may struggle to notice smells and can eat inappropriate substances
- Some will excessively smell things
- Many will also have communication difficulties linked to senses – difficulty with eye contact, understanding tone of voice, difficulty with social interaction
- Lack of awareness of temperature
- Poor spatial awareness
- Unaware of own body smell
In relation to the 6th and 7th senses:
Those avoiding vestibular input might:
- Avoid rapid movements
- May be ridged in posture
- Avoids swings, slides, lifts and escalators
- Afraid of heights
- Can lose balance easily
- Gets car sick
- Disorientated bending over
Whilst those seeking vestibular input might:
- Be a thrill seeker
- Loves playground and physical play
- Likes sudden movements
- Has difficulty stopping
- When spinning may not appear to get dizzy
- Tends to balance on chairs
Those with Low Proprioception may:Fidget often:
- Have poor posture
- Have poor body awareness
- Like tight clothing
- Be slow to get dressed
- Miss mouth with food and drops things
- Uses too much or too little pressure
- Loves to be wrapped in blankets
- Grinds teeth
Children naturally seek out sensory movement of the body like jumping or spinning as it promotes development. The majority of toddlers will do many things on the lists above. The difference is in its intensity, a child with a sensory processing issue will either be very distressed by certain things or will be repeating the same behaviour over and over.
Challenging behaviour will have a reason behind it- the real skill lies in identifying what that reason is. Sometimes it’s obvious and other times it will take months or even years to work out. I tend to use the STAR model (actions, settings, triggers and results) to try and analyse behaviour, find out more about this in my challenging behaviour post.
Sensory issues can build up over the day. An example being a visit to the supermarket where you can’t have something you wanted, products are different to last time, a loud tannoy announcement followed by a light flicker, then someone brush past with a light unexpected touch. A slow build up of issues can lead to a blow up or meltdown particularly when the child is unable to communicate the issues they are having.
The difficult thing for us is recognising all those issues, especially when they may have happened hours ago to when you are seeing the distress. This is one of the reasons it is hard to identify all the sensory issues a child may be having. Reflecting on the day and being aware of our environments over time you will discover what those issues are but it is likely to take a long time.P
Stimming or a Stim is self-stimulating behaviour that is common in autistic people. This is usually the repetition of sounds or physical movements. It is a way to get sensory input this may be for fun or to calm anxiety. It is self-regulating behaviour and can be for many reasons.
Examples of stimming include jumping, flapping hands, rocking, spinning and repetitive use of an object.
Sometimes stimming may be an attempt to gain sensory input e.g. rocking to get vestibular input or hand flapping to provide visual stimulation. Therefore introducing more opportunities to gain that sensory input can reduce the stimming. If stimming is being used as a self-calming method it is best to look at what is causing the anxiety in the first place.
It is important to bear in mind that stimming can be a very useful tool to self-regulate and I would advise against trying to stop a child from stimming. If a particular stim is a problem causing self-injury such as head banging then those behaviours need to be addressed – can they be replaced by something? However if a behaviour is not harmful to others such as hand flapping then let them flap away. Some children will stim just because it is fun.
Your child may be referred to see an Occupational Therapist / OT. Occupational therapy is to assess and assist people to carry out everyday activities that are essential to health and wellbeing which they may otherwise find difficult. In the case of autism OTs may focus on fine motor and daily living skills to help create independence for that individual.
You may also find some occupational therapists that specialise in sensory issues and autism. If you need to have a sensory assessment you will need to see an OT. We have seen the local OT a few times but we are now seeking some help from a private OT that specialises in sensory diets for autism. I will let you know how we get on with that another time.
Initially we were referred to the occupational therapy team by our speech therapist when my son was nearly 3 years old. At nursery my son was going through a phase of biting people (thankfully it was short lived).
The local occupational therapy team was based at my nearest hospital. They did an informal play assessment at the hospital and also at nursery. They looked at how he was playing (posting, ability to colour match, mark making). They talked to me and to staff at nursery where they also looked at how he interacted with others. They provided a report that supported much of the speech therapists recommendations such as a need for routine and 1-1 support at nursery. In addition to this they assessed his hand function and motor skills. They also looked at sensory processing and self –care.
They provided recommendations of areas that we could work on at home as well as at nursery. This included sensory and messy play, mark making activities, dressing and toileting. They have since provided recommendations included in my sons Education, Health and Care plan such as movement breaks.
Would you be able to focus on a whiteboard if there was a strobe light on? The difficult thing is if we processes sensory information differently it is hard to see why someone else has a problem with a light that you don’t.
We have all experience a heighted sense, the smell of mouldy food, flashing strobe lighting, very loud music. For some who are hypersensitive the discomfort of heightened sense can be very overwhelming and painful all the time. Finding ways to alleviate this discomfort is really important. At the other end sensory seekers can get overwhelmed or overexcited trying to get sensory input thus making it impossible to focus on other things.
Have some strategies for preparation and calming down.
Visual aids and social stories are great to help prepare your child. We use a range of visual aids and social stories to prepare my sons for events or activities that may be difficult such as getting a haircut or going shopping.
Allowing a child time to relax after school or busy social activities. You may want to look at calming sensory toys. Some have sensory boxes or bags a child can access with favourite toys or aids that they may need. I always try and have something in my bag that can be pulled out when we are out and about. Allowing fiddle toys at school can also improve concentration.
- Using routine and structure can reduce anxiety in young children. Having a consistent bedtime routine can make a big difference to getting to sleep.
- Avoid using light touch and allow a child to be at the end of a line or edge of a crowd.
- Cut labels out of clothing and think about fabric textures of clothing.
- Help to prepare a child for sudden noises in advance, this could be social stories about alarms or hand dryers. At school warning a child before a fire drill will help avoid unnecessary anxiety at sudden noise.
The hard bit is knowing which activity to do. When my son gets overly energetic sometimes he needs to be directed to a calming activity with sensory toys and other times he needs to jump it out on the trampoline. Yes sometimes I choose the wrong thing and make the situation worse. However over time I have got better at reading his signals. Having a ton of strategies, activities and aids to choose from makes a big difference.
Thinking about the environment
- Try to reduce background noise so it is easier to focus on one thing (turn the radio or TV off when doing other activities).
- Reduce the visual environment- an uncluttered area helps with attention and focus. Often classrooms can have too much on the walls that can create a distraction. Using visual aids to help support understanding of what is happening or expected in that area.
- Consider the lighting in a room, if a child is light sensitive they may need a dark tent they can retreat to when the lights get too much.
- Avoid strong smells including perfume.
- Consider the feel of surfaces and furniture in a room.
This is an interesting infographic about noise levels.
Messy play can be a great sensory activity. If a child has food aversions try messy play with food where there is no expectation to eat. This provides an opportunity to explore textures slowly. Playing with different textures (fabrics) or smells (herbs and spices) are other ways to explore senses.
A multi-sensory approach to mark-making is a good way to introduce pre-writing skills. This can include sand, paint, chalk even mud.
Making a den or tent is great although now my son does this all the time and my sofa cushions are rarely on the sofa itself!
You can make or buy sensory boards, my hairdresser has a lovely one.
There are lots of great ideas for sensory play on Pinterest. You may want to look into sensory gardens and sensory rooms too.
Movement activities are vital for my son and he needs movement breaks built into his school day. All movement can stimulate vestibular receptors but swinging, hanging upside down and spinning are the most intense. Other physical activities you can try:
- Sitting on wobble cushion
- Trampoline – having a good jump makes such a difference to my son. It can really help him readjust himself
- Gym ball – we have one in our living room and my son often sits on it instead of a chair
- A long walk, both my boys love a good walk in the woods.
- Carrying a heavy backpack – some need weight to help ground them particularly in busy places like school.
Some children will require specific sensory aids for support this may include:
- Weighted blankets, backpacks, lap pads or a weighted vest.
- Headphones to block out noise.
- If a child bites often they may need to chew more, try fruit roll ups or raisins. You may also need a chew toys we went through lots of these many my son chewed through with ease. The one we use now is the Chewigem Hexichew.
- Scissors, my son struggles with scissors but these easy grip scissors have been very helpful.
Self care skills / Independence
The main method I use for teaching self-care or independence skills is hand over hand and backward chaining. This is where you get the child to do the activity such as putting shoes on by standing behind and using their hand (with yours on top) to complete each step. You get the child to do the last step, such as fastening the Velcro on shoes themselves. Then as the progress you let them do another step from the end. Another way to practice dressing is to do lots of dressing up play.
Haircuts can be really difficult for many autistic children, this post looks at autism friendly haircuts. Nail cutting can also be difficult, we either try to do it when the boys are asleep or offer rewards when doing it in the day.
Trial and error
It’s not always the most obvious strategy that helps so trial and error it is. Think about what needs to change and what doesn’t for example do you really require eye contact? Strategies need to be available throughout the day as necessary. I have found over time my son will access the strategy he needs himself by seeking out the gym ball or asking to go to the trampoline. Introducing lots of different sensory strategies and keep them available will be helpful.
You may find the STAR behaviour analysis strategy helpful.
I do recommend taking a look at this sensory resource pack from Leicestershire and Rutland County Councils and The Leicestershire Partnership NHS Trusts. It is developed for early years settings with information to help identify sensory needs and strategies to support sensory requirements. A really useful document.
You may want to check out this post on how to make your home more autism friendly from Karen Wang.