Sensory Perceptual Issues in ASD
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Transcript of Sensory Perceptual Issues in ASD
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Sensory Perceptual Issuesin
ASD
Colin Smith
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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
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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
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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
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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
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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
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The sensory system
Sight
Hearing Taste
Smell Touch
Vestibular
Proprioceptive
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Sensitivity
• Hyper sensitive - (overpowering registration) sensation avoidance
• Hypo sensitive – (low registration) sensation seeking
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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
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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
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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
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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’
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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
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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)
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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
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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
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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
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A personal view
Stephen Shore
‘Beyond the Wall: Personal experiences with Autism and Aspergers Syndrome’
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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
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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
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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
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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
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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’
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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
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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’
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Intervention ideasproblem specifically factors possible
interventionSelf injury Punches head Low
registration
Sensory seeking
Pressure on head e.g. Tight baseball cap or headscarf Bandana
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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)
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Sensory Assessment
• Occupational Therapist
• NHS Lanarkshire
• Education (Additional Support for Learning) (Scotland) Act 2004 vs Co-ordinated Support Plan
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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
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Thank you
• Please complete evaluations