Sensory Interventions with the Autistic Child

Many of the characteristics of a child with autism also mirror those of a child with sensory processing disorder.  Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same. However, it is important to differentiate between the two. The following lists help to illustrate the similarities and the differences between the two conditions.

Sensory Integrative issues may be characterized by:*

  1. Either be in constant motion or fatigue easily or go back and forth between the two.
  2. Withdraws when being touched.
  3. Refuse to eat certain foods because of how the foods feel when chewed.
  4. Be oversensitive to odors.
  5. Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.
  6. Dislikes getting his or her hands dirty.
  7. Is uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.
  8. Have difficulty calming him or her after exercise or after becoming upset.
  9. Jumps, swings, spins excessively.
  10. Appears clumsy, trips easily, poor balance; odd posture
  11. Social skill issues/authority issues.
  12. Tantrums
  13. Overly sensitive to criticism
  14. Either always on the go or very sedentary
  15. Memory difficulties and/or problems following directions
  16. Has difficulty with buttons or snaps.
  17. Is overly sensitive to sound. Vacuum cleaners, lawn mowers, leaf blowers, or sirens, etc.
  18. Lacks creativity/variety in play; plays with the same toys in the same manner over and over etc.

While Autism and or PDD issues may be characterized by:

  1. Insistence on sameness; resistance to change
  2. Difficulty in expressing needs; uses gestures or pointing instead of words
  3. Repeating words or phrases in place of normal, responsive language
  4. Laughing, crying, showing distress for reasons not apparent to others
  5. Prefers to be alone; aloof manner
  6. Tantrums
  7. Difficulty interacting with others
  8. May not want to cuddle or be cuddled
  9. Little or no eye contact
  10. Unresponsive to normal teaching methods
  11. Sustained odd play
  12. Spins objects
  13. Inappropriate attachments to objects
  14. Apparent over-sensitivity or under-sensitivity to pain
  15. No fear of danger
  16. Noticeable physical over-activity or extreme under-activity
  17. Uneven gross/fine motor skills
  18. Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.

(*complied from various sources)

Not every child on the spectrum will exhibit all of these issues.  However there will be areas of relatedness and it is in these similarities an understanding of unique interventions can be found.

For example let’s look at “Patrick”:

              Five-year old Patrick is always on the ‘go’. His teachers do not know what to do about him.  He has few friends and those he makes he cannot keep.  He cannot sit in circle time. Lining up to go out to recess is unpredictable.  And even worse, he talks about not liking himself and how he hates everyone and “everyone” hates him.

           He has his favorite toys and his favorite clothes and that is what he plays with and wears,  with little to no deviation.

          School is a challenge. He seems to either escalate or get so lethargic that he cannot move. He seems unable to “reset” himself, he stays “on guard” and anxious.  He does not like to go to PE or to lunch because he says that the other kids  “pick on him and hit him”.  On the playground he plays mainly with girls, and the boys seem to ignore him.  When he runs he does so with abandon bumping into people and things and barely noticing. His gait is awkward and when he runs his arms are up and sometimes he runs on his tip toes. He does not seem to respond to facial expressions or to be able to register empathy for others. He complains that things “hurt” him even when there is no evidence of that.

         Making eye contact and following a slow moving object is impossible for him without accompanied very cues. Hyper sensitive to smells, he complains about odors in art class, the lunchroom and on the school bus.

         Recall of academic information is difficult and varied repetition seems to be the best learning path at this time.

       Easily upset and emotionally labile, he seems uncomfortable in his own “skin”.

 Children on the spectrum often have pronounced sensory issues. To understand Johnny’s primary areas of concern, how therapy helps, and what can parents do at home, please refer to the following chart.

Presenting Issue Behavioral Manifestation Sensory Processing Concern Treatment Approach* Anticipated Outcomes
Auditory Concerns:

Easily startled by unexpected noises

Easily Distracted

Screams and yells and has temper tantrums Not hearing sounds with auditory figure ground discrimination or with sound/activity relationships

Attention floats and does not stay on topic

The Listening Program ™

Games that incorporate unexpected noises with the “warnings” of noises decreasing as tolerance increases

Increased noise tolerance

Increase attention to task with diminishing supports

Visual Concerns:

Does not seem to see objects in his immediate visual field

Bumps into people and things and falls a lot Visual figure ground and visual constancy issues

Does not use visual motor ideation to plan movements

Obstacle courses

Use of weight appropriate free weights during gross motor games to increase sense of body in space

Increased motor planning in familiar situations—translating this into less familiar tasks as tolerated
Movement:

Always on the go

Takes risks during play

Seeks movement

Does not know how to slow self down and he just builds momentum until outside forces slow him (teacher, etc.) Perseverative quality to his movements

Skewed motor planning

Depressed vestibular processing

Quick change activities where increasingly the sequence or order of things changes and he has to make movement, planning and/or postural adjustments Slow it down!  Have the child make a “plan” keep it to a maximum of 4 things—1stdo____

2nd , 3rd and 4th ___

stick to the plan and make choices for the next time

Tactile:

Habituates wearing the same clothes

Expresses discomfort when touched

Demonstrates exaggerated responses to touch

Tantrums if “right” clothes not available

Will not try to put on anything new even if pre-washed

Gets into fights when he is trying to make friends

Tactile defensive behaviors

This causes adverse emotional reactions both in school and home

Timed trials for adjusting to new fabrics: i.e. “you only have to wear this for 3 minutes” or only while you are brushing your teeth and increase time tolerances

Provide “expected” unexpected touch and rate with child the reactions

Increased ability to tolerate new fabrics and to try new pieces of clothing

Modulated reactions to touch

Olfactory/taste:

Smell in lunchroom, art class, etc. are noxious to him

Nutrition issues and he becomes lethargic in the afternoons due to lack of food and this impacts his school work Textures in mouth may be a negative trigger and over-sensitivity to smell is operating here Make a dinner “Tapas” bar where he gets to eat whatever he usually chooses but must also take a taste and intentionally smell a new food Increase repertoire of tolerated foods

Will eat in the lunchroom with support—first place him near the door and then slowly move him into the room

Emotional:

Easily upset

Difficult for him to self-regulate

Labile mood swings

Few friends

Hard for him to enter into group play

Uncomfortable with who he is

Unpredictable behaviors make it hard to anticipate his needs

Peers see him as “weird” so he is often not asked to play and when he asks he is often rejected

Isolated from others in classroom group time due to behaviors

Almost absent self-regulation skills

Chaotic responses not always fitting the circumstance

Social isolation

Organizational deficits

Make a game together where he is in charge of making the rules (but you are in charge of making it reasonable) and “rig” it so (gently) he is not always “winning”.  Warn him of this in advance and talk about reactions and choices make a “reaction box”©*** Use gross motor games to create simulated social and motor planning actions and activities and get him into a new comfort zone!

*Treatment Approaches are suggested ones there are many ways to address these issues

**The Listening Program ™–available commercially

***The “reaction box”—exclusive to Children’s Special Services, LLC  Get a heavy cardboard man’s shoe box; decorate it with paint, contact paper, etc. put in it on separate slips of paper good behavior choices ONLY. When he is upset let him pound on the box for a while and then he picks a choice out of the box and you help him achieve that “choice”.

So what do you treat first?  Everything! That is Occupational Therapy, changing the context in which one lives so that life can be lived with greater ease.