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Sensory Differences Overview Every day we are exposed to thousands of sensory experiences that come to us through our senses of vision, hearing, touch, movement, smell, taste, and proprioception (our sense of position in space). There are birds chirping, horns honking, air conditioners running, and lights humming. Our clothes have different textures; we get into cars and move forward, stop, start, and turn; and we smell foods, perfumes, and deodorants. Among all these experiences, most of us are able to tune out the things that are irrelevant to what we are currently engaged in and tune into the things we need in order to be able to navigate and respond to our environment. However, some individuals with autism spectrum disorder (ASD) often react differently. Some find these experiences to be confusing and overwhelming, while others may be unresponsive to these experiences in a way that may be different from most individuals. In this module, you will learn about the senses and how our bodies use sensory information to contribute to and support critical life functions such as our ability to recognize and react to danger, regulate our level of alertness, and facilitate our engagement in meaningful life activities. We will then focus on the sensory differences that may be present in persons with ASD and how they may impact their day-to-day behavior and performance. Pre-Assessment Pre-Assessment Our senses give us the information we need to function in the world. Select an answer for question 420 A child with sensory processing disorder has the ability to effectively and efficiently organize sensory information. Select an answer for question 421 A child that is under responsive to touch may Select an answer for question 422 A child that is over responsive to touch may Select an answer for question 423 A child that is over responsive to visual experiences may Select an answer for question 424 An individual who is under responsive to sound may Select an answer for question 425 Being overly responsive to smells might be demonstrated by which of the following behaviors in an individual Select an answer for question 426 All individuals with ASD have auditory sensory issues. Select an answer for question 427 Individuals with ASD who exhibit sensory processing difficulties can have more than one sensory area affected. Select an answer for question 428 Defining Sensory Differences in Individuals with ASD Do you enjoy... the smell of new shoes? the sound of rain hitting the roof? the feel of new clothing? the taste of Italian food? the sights and sounds of fireworks? riding in a car? For most people, these sensations are pleasing or at least fully acceptable. However, some individuals with ASD find these experiences overwhelming, others may not even take notice of them, and still others may struggle with feeling overly sensitive to these activities on some days and under-sensitive on other days. Abnormalities in processing incoming sensations such as light, sound, touch, taste, pain, smell, movement, or temperature are reportedly experienced by 70-80% of the ASD population (Harrison & Hare, 2004; Myles, Cook, Miller, Rinner, & Robbins, 2000; Volkmar, Cohen, & Paul, 1986). In some, the differences affect only one sensory area, while in others multiple senses are impacted. Our Seven Senses Most people are familiar with at least five basic senses. These senses are hearing (auditory), seeing (visual), touch (tactile), taste (gustatory) and smell (olfactory). Each of the senses has receptors that are located in specific places within the body. Receptors are nerve endings in the body that receive the messages from our various senses, which they transfer to the appropriate pathway to send the information to the brain. The brain then uses the information to tell our bodies how to respond. The two other senses are vestibular and proprioception. All seven senses will be discussed within this section of the module. Five of Our Senses Let's look more specifically at each of these five senses and how they contribute to our daily functioning and life skills. Tactile/Touch The skin is one of the largest sensory receptors in the human body. The skin is filled with touch receptors that are activated when contact is made with the skin. There are many different types of touch receptors, including those for pressure, temperature, and pain, as well as different types of touch sensations. A large concentration of receptors for the sense of touch are located in our mouth, hands, and the soles of our feet. Behaviors such as mouthing objects and chewing hands are probably related to the large number of receptors in these areas. The tactile system is comprised of two distinct systems-protective and discriminative. The protective system tells us when we are in contact with something dangerous, and can cause a flight, fright, or fight response. This type of response makes our hearts beat faster and our breathing quicken, and gives us a feeling of being afraid. It can also make us feel angry like we want to fight, or make us feel like we want to run or move away from the sensation. For example, if we feel a light unexpected touch it may make us jerk our body away from the source of the touch wondering if a spider or other poisonous insect has landed on us. The protective system is the most primitive of the two tactile systems and is necessary for basic survival. The other system, the discriminative system, allows us to determine where we are being touched and what is touching us. It contributes to our ability to identify objects by size and shape without the need to look directly at an object. For example, in the morning when our alarm sounds, we are able to keep our eyes closed for just a few more minutes but still locate the alarm to shut it off by feeling around on the bedside table, locating the alarm, and finding the button to turn it off. Accurate discrimination requires that we register sensory input without sensory defensiveness. In other words, we need to be able to touch and explore objects in detail without feeling like we are afraid, angry, or need to pull away. Thus, it is this discriminative exploration that allows us to gain knowledge about objects and people in our environment. A tactile system that is functioning effectively allows us to experience cuddling as enjoyable, and as a result allows young children to develop attachments to their caregivers. It plays a role in our ability to understand our personal space in relation to others impacting our social interactions, and as adults it can impact our ability to develop intimate relationships. Visual/Sight The receptors for vision are located in the eye, specifically the retina, and they are activated by light. The function of the eye is to give us information about objects and people around us, such as multidimensional awareness, patterns, and colors. Vision also provides us with an awareness of our surroundings beyond arm's reach, such as distance, proximity, and depth perception. Effective visual processing helps us to identify and interpret the physical features of people, events, and objects, as well as to navigate our environment safely. It also plays a role in the development of pattern recognition, which contributes to our early ability to recognize others. Pattern recognition also makes things memorable, which helps us to learn and retain information. Auditory/Hearing The hearing receptors are located in the structures of the ear, and are activated by vibrations produced by sound. They process sound so that speech, music, or noise can be distinguished and interpreted by the brain. Hearing provides the basis for developing oral language skills. Being able to hear the sounds allows us to imitate and play with sounds to develop our own language skills. It is the effective development of these oral language skills that provides the foundation for spelling and grammar, which contributes to the later development of written language as well. Olfactory/Smell The smell receptors are located in the nasal cavity, and are activated by chemicals called odors. The function of the sense of smell is to assist us in discriminating people and things. They also help to alert us to volatile and dangerous substances, such as poisons, leaking gas, or smoke. In addition, our sense of smell has a strong connection to long-term memory. Gustatory/Taste The receptors for the sense of taste are located on the tongue. The human tongue detects only four or five basic taste components, sweet, sour, salty and bitter, with the taste of savory recently added to the list by some scientists. So you might wonder how it is possible that we can taste and identify so many different foods. Whereas the human tongue can distinguish only among four or five distinct qualities of taste, the nose can distinguish among hundreds of substances, even in minute quantities. It is the work of the tongue and the nose together that allows us to enjoy and identify different flavors. Our Two Additional Senses We have just discussed five senses that are familiar to most people, but there are two additional senses that are important to include because they provide major contributions to our ability to move about and interact effectively with our environment. These two senses are the vestibular system and the sense of proprioception. These senses work together to shape our motor movements and to help us understand where our bodies are located in space. Let's look at these two senses. Vestibular The vestibular receptors are located in the inner ear, and are activated by movement of our head. We have probably all had the sensation of lifting our head too quickly and finding the room briefly spinning. That is the work of the vestibular receptors. The vestibular system gives us information about where we are in space, as well as how fast and in what direction we are moving. It also contributes to our posture and overall muscle tone. When we are infants, an effective vestibular system allows us to find gentle rocking soothing. Later, it helps us to maintain our balance when we walk, jump, run, and climb so we can feel confident and safe to engage in these activities. It also allows most of us to ride in cars, planes, trains, and boats without feeling uncomfortable. Proprioception Proprioception provides information about our position in space and general body awareness. The receptors for this system are located in the joints, tendons, and muscles. They are activated by bending, straightening, compressing, pulling, contracting, and stretching the receptors. This sense contributes to an infants' knowledge about their body position so they can mold to a caregiver's body to cuddle. As children get older, proprioception contributes to the development of coordinated crawling, walking, and running as well as our ability to imitate body movements. As adults, we rely on the sense of proprioception to help us participate in sports, dance, and other life activities requiring coordinated movement. Propriception is critical for the development of motor skills and motor planning, or in other words, our ability to move our bodies in a coordinated fashion in all of our life tasks and activities. Sensory Processing What is Sensory Processing? Sensory processing refers to the ability to take in the information we receive from our senses, both external and internal, and then use that information to function effectively. Specifically, our bodies send information from the senses to our brains through neural pathways, which are much like roads. Once the information reaches the brain, it is interpreted, and we can then act on the information. Effective sensory processing allows the brain to locate, sort, and make sense of incoming sensory information. The brain helps to decide if the input is something that should make us be afraid and move away, if it is information we need to function in the environment, or if it is something we should just disregard as not important to either of those functions. In short, effective sensory processing provides us with protection from danger, and helps us to attend, be appropriately alert, and engage in meaningful activities. We need a certain amount of sensory input to maintain life functions. It is that "just right" amount of sensory input and our brain's processing of it that makes us appropriately alert so we can engage in meaningful life activities during the day and yet allows us to peacefully sleep at night. If we experience extreme sensory input for extended lengths of time, it can have detrimental effects on our well-being, making us feel overwhelmed and frightened, leading to behavior that is either frenzied or causes us to shut down. Conversely, too little sensory input can make us dull, lifeless, and disengaged. What is Sensory Processing Disorder? Sensory processing disorder refers to the inability to modulate, discriminate, coordinate, or organize sensations effectively. It can affect the way we learn, our behavior, movement, relationships, and how we feel about ourselves. When a person has a sensory processing disorder, she processes sensory input from the senses in a way that is different from most people. Some people are overly responsive to sensory input such that they often do not filter routine experiences and, therefore, interpret sensory experiences as painful and overwhelming. Others seem relatively under-responsive to sensory input and, therefore, don't appear to notice when they are injured, for example. Still others have difficulty regulating their responses to input so their behavioral responses are unpredictable from hour to hour and day to day. For example, in the morning a person may fall and injure himself without noticing but by the afternoon he is agitated over the small tag in the back of his shirt, demanding that someone remove it because it hurts. Overly Responsive to Sensory Input Let's talk about different types of sensory processing difficulties. There are several theories and frameworks for identifying sensory processing disorders; we will look at the core issues. As mentioned earlier, most of us can filter out the sensory experiences we receive during the course of our days using what we need and disregarding the rest, but some individuals are not able to filter out the stimuli, and the impact of this perceived intense input can be frightening, tiring, and anxiety-producing. We say these people are over-responsive to sensory input. They may be sensitive to only certain types of sensory experiences or to all types of sensory experiences. Some are sensitive to just touch whereas, others may be sensitive to all of the sensory areas, including touch, smell, movement, vision, hearing, taste, and body position. For the latter group, a small amount of sensory input can create feelings of being overwhelmed and elicit responses such as shutdown. They may exhibit behaviors such as distractibility or hyperactivity, or the opposite-limited and constrained actions. These individuals may also be irritable, impulsive, defensive, defiant, overly reactive, anxious, demanding routine and/or rituals, resistant to change, have negative attitudes, or demonstrate emotional outbursts. Here are some examples of behaviors we might see in the various senses if an individual is overly responsive to sensory input. Tactile (Touch) o doesn't like certain types of clothing materials/designs/tags o may remove socks and shoes frequently o becomes irritated when bumped by other or if others are in close proximity o dislikes being dirty o resists tooth brushing o doesn't like certain textures and temperatures of food Visual (Sight) o squints or complains about typical indoor lighting o may like to wear sunglasses indoors o may prefer cooler colors (blues, greens, etc.) o may be confused by complex visual designs Auditory (Hearing) o dislikes the sounds of a toilet flushing o holds hands over ears when hearing what seems like normal noise to others o may be fearful of the vacuum cleaner o finds car horns and outside noises painful and frightening o dislikes fire drills, possibly responding with major behavioral meltdowns o prefers to wear headphones with selected music rather than dealing with environmental sounds Gustatory (Taste) o has limited tolerance for eating a variety of foods o prefers bland food with little taste o dislikes the taste of toothpaste Olfactory (Smell) o doesn't like the smell of perfumes/deodorant/food cooking o notices smells in the environment more than others o may gag as a result of smelling certain odors Vestibular/Proprioception o is fearful of movement activities o prefers to keep feet on the ground o dislikes riding toys or extended car rides o may be delayed in typical motor milestones Under Responsive to Sensory Input Other people are under-responsive to sensory input and, therefore, need a large amount of sensory input to be able to attend and respond. For example, they may not respond when their name is called out due to poor auditory processing. They may have difficulty sitting appropriately in their seat, holding on to their pencil, or completing simple motor skills because they are not getting the appropriate feedback to their muscles from their sense of movement and position in space. They also might not notice if they are injured, due to poor tactile or touch sensations. These individuals may try to meet their need for additional input by demonstrating a tireless pursuit of sensory input, with associated behaviors of lacking caution in play, fidgeting, and/or becoming easily overly stimulated. They appear to be sensory seeking in their behaviors. Conversely, others, who are under-responsive, may appear as sedentary, withdrawn, uninterested, difficult to motivate, and having very low energy. Here are some examples of behaviors we might see in the various senses if an individual is under-responsive to sensory input. Tactile (Touch) o doesn't appear to notice when injured o plays roughly with others o is messy eater; doesn't seem to notice food on face or hands o may appear disheveled; doesn't notice when clothing is askew o may not recognize personal space and sits too closely to others o may refuse to wear seasonally appropriate clothing; may seek heavy, warm clothing on hot days Visual (Sight) o focuses of shiny or colorful objects o shows strong preference for certain colors o sits close to the TV when watching a program o looks directly at room lights for extended periods of time Auditory (Hearing) o turns volume of TV/music up o if engaged in other activities, often does not respond to name if called o may not respond to verbal directions unless given multiple times o does not seem responsive to fire drill bells, class change bells, car horns, etc. o may talk loudly with little understanding of the need to modulate voice volume for various environments Olfactory (Smell) o attempts to smell objects o doesn't seem to recognize noxious odors o may wear excessive amount of perfumes/fragrances o may not be alert to odors that have protective functions such as smoke and poisons Gustatory (Taste) o may eat non-edibles o may not recognize noxious tastes of poisons o may not recognize temperatures of hot foods o may eat spicy foods without notice Vestibular/Proprioception o doesn't understand body position in space, and may have difficulty imitating motor movements o may have difficulty sitting with appropriate posture in a chair for a long periods of time (slouches) o may appear clumsy and awkward o may unintentionally injure others through excessive movements o may unintentionally break toys/objects by grasping and manipulating with too much pressure o hugs others too hard o climbs and takes risks in play, appearing fearless o seeks out movement activities such as swinging, spinning, etc. Is It Under Responsive or Over Responsive? It is sometimes difficult to know if an individual is under- or over-responsive to sensory input. You may have noticed in the descriptions of behaviors related to under- and over- responsiveness that some of the behaviors are similar for both areas. Therefore, we must be cautious not to make quick decisions about an individual's sensory processing based on observing behavioral responses. Some children demonstrate behaviors that would lead us to believe they are both under-and over-responsive to sensory input. They may demonstrate these differences among the different senses or within one sense. For example, a student might be resistant to various foods, which would lead us to believe she is overly responsive to taste sensations or the feel of food within her mouth. But that same student might not respond when her name is called or if there are loud noises, leading us to believes she is under-responsive to sound input. Additionally, a child may appear to be distracted by even minor sounds, which might indicate over-responsiveness, but a little while later we may have difficulty gaining her attention when we call her name, indicating she may be under-responsive at that time. An occupational therapist can assess and determine appropriate interventions for individuals who have difficulty with sensory processing. Occupational therapists have specialized knowledge and skills in addressing sensory needs and work in a variety of settings such as schools, clinics, homes, or community agencies. Cumulative Effect of Sensory Input As mentioned, the behavioral responses to sensory experiences can appear to fluctuate from hour to hour and day to day. For example, what is overwhelming one day may not have the same effect the next day. Illness, fatigue, stress, and hunger can all impact our response to sensory input. Further, sensory input tends to have a cumulative effect. As a result, it may take numerous sensory experiences for an under-responsive child to pay attention or for an overly responsive child to reach the breaking point. Such variance can make it difficult to determine which type of sensory input is impacting the child. Case Study Example The following example of a child who is overly responsive to sensory input demonstrates how she attempts to manage her sensory experiences as they occur throughout her day. Sally Case Study: Sally When Sally gets up in the morning and starts to get dressed, she finds a new shirt provided for her by her mother. The shirt feels scratchy, and there is a tag in the back. The tag is all Sally can think about during breakfast. Later she boards the bus. She hates all the talking, laughing, and shouting on the bus. Not only that, soon a student sits down next to her, accidentally bumping her and sitting so close they are touching. It hurts when somebody bumps into her, and it makes Sally angry the other student is sitting so close. When the bus arrives at school, she gets off, and soon the bell rings. It is loud ... really loud. The students line up, and in the process accidentally bump into each other. Sally tries to get to the end of the line so she can keep an eye on the other students to avoid getting bumped. But she feels increasingly anxious because students have filed in behind her at the last minute, and she can't tell how close they are. One of them bumps her. It hurts, and Sally is feeling angrier. When she gets to class, she discovers that her teacher is wearing a new perfume. It smells really strong. The other kids are complimenting the teacher on the perfume ... but not Sally. It is giving her a headache. The bell rings again; it is loud. As the teacher begins the lesson, Sally suddenly blurts out as she covers her ears with her hands, "That bell is just too loud!" The teacher reminds Sally to raise her hand to comment in class. Sally becomes even angrier, and starts arguing with the teacher. The "meltdown" described above did not occur because of the loud bell, but because Sally had reached her limit, or threshold, for sensory input or the combination of events that occurred at school and at home. Sally had endured continued random challenges to her sensory system since the moment she woke up, and the cumulative effect was eventually too much for her to manage. This scenario illustrates the importance of making observations of a student over a period of time, considering many things that may be hidden in the environment and perhaps not obvious to most of us but that add to a child's sensory challenges. Common Sensory Differences in Individuals with ASD: What is the Research Saying? We learned earlier in this module that many people with ASD demonstrate behaviors that could be interpreted as being based in sensory processing difficulties. Research studies conducted over a number of years clearly support the view that children with ASD demonstrate behaviors that are indicative of sensory processing difficulties more often than their neurotypical peers (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987; Kern et al., 2008; Ornitz, 1983). Yet, even though sensory differences seem to have a powerful impact on these individuals, sensory processing difficulties are not considered one of the core deficits of ASD. Many researchers are now working to identify the specific types of sensory processing difficulties that may be associated with ASD. Following is an overview of some of the recent research trends that are emerging related to ASD and sensory processing. Thinking back to our discussion about over- and under-responsiveness to sensory input, not surprisingly, much of the research has reported that children with ASD exhibit variable and mixed responsiveness to sensory experiences (Adamson, O'Hare, & Graham, 2006; Kern et al., 2007a; Kern et al., 2008; Lane Young, Baker, & Angley, 2010; Leekam, Nieto, Libby, Wing, & Gould, 2007). Because of this variability, researchers are attempting to identify unique patterns of sensory processing in ASD. Some have found that young children tend to exhibit more under-responsiveness or nonresponsiveness to sensory input (Baraneck, David, Poe, Stone, & Watson, 2006; Baraneck, Boyd, Poe, David, & Watson, 2007; Ben-Sasson et al., 2007; Rogers & Ozonoff, 2005), whereas older children with ASD tend to exhibit more sensory-seeking behaviors (Ben-Sasson et al., 2009; Liss, Saulnier, Fein, & Kinsbourne, 2006). Other researchers are looking toward the specific sensory domains (auditory, taste, smell, tactile, etc.) to determine if there are specific, unique connections with ASD. For example, a recent study suggests that taste and smell sensitivities as well as movement-related sensory behaviors are possible sensory subtypes associated with ASD (Lane et al., 2010). Yet other researchers are examining the relationship between the core deficits of ASD and sensory processing. To date, relationships have been found among the presence of sensory processing difficulties and the severity of ASD and the incidence of difficult behaviors and severity of communication deficits (Baker, Lane, Angley, & Young, 2008; Gabriels et al., 2008; Kern et al., 2007b; Liss et al., 2006). Researchers have identified many pieces to the puzzle related to sensory processing difficulties and ASD. However, there is still much work to be done to determine the specific contributions of sensory processing and the effectiveness of sensory intervention strategies for persons with ASD. Summary Our senses give us information about the world around us; our brain processes the input, and we respond based upon how we process that information. Our senses keep us safe, provide us pleasure, and help us function. Individuals on the autism spectrum may not receive, process, and react to sensory stimuli the same way as neurotypicals. Some are overly responsive whereas others are under-responsive to sensory experiences in the environment. Students with sensory differences may benefit from services from an occupational therapy practitioner who can provide assessment and intervention strategies to help them manage their sensory differences and improve their access to successful home, school, social, and work experiences. Frequently Asked Questions Q. What is sensory processing disorder? A. Sensory processing disorder is a neurological disorder causing difficulties with processing information from the senses: vision (sight), auditory (hearing), tactile (touch), olfactory (smell), gustatory (taste), the sense of movement (vestibular system), and the positional sense (proprioception). Unlike blindness or deafness, a person with sensory processing disorder receives sensory information, but the information is processed by the brain in an unusual way that may cause distress or confusion. As a result, it may be difficult to process and act on information received through the senses, and many struggle to perform everyday tasks. Q. Why does a child prefer certain sensory activities one day, but often not the next? A. Understanding and identifying sensory processing disorder is key to answering this question. As you work with an occupational therapist, keep in mind that sometimes the child shows characteristics of more extreme sensory difficulties one day, but very mild difficulties the next day. For instance, the child with proprioception problems may trip over every bump in the pavement on Friday, yet score every soccer goal on Saturday. He may have difficulty modulating his responses to sensory input. Therefore, his behavioral responses can be unpredictable from hour to hour and day to day. Q. What is the sense of proprioception, and what is its function? A. The sense of proprioception uses information from the muscles and joints to give us an awareness of our body position. This is the sense that makes it possible to guide our arms and legs without watching the complete range of movement. Proprioception helps adjust body position to prevent us from falling out of a chair, and allows us to manipulate a pen or hairbrush. Q. What is the vestibular sense, and what is its function? A. The vestibular sense coordinates the movement of our body, head, and eyes. The brain in turn responds to the movement through space and body position. The vestibular sense allows us to balance, throw a ball, or stumble without falling. It maintains muscle tone, helps coordinate the two sides of the body, and enables us to hold our head up against the force of gravity. Q. What are some of the red flags parents and professionals should be aware of that might indicate somebody is experiencing sensory challenges? A. The following is a checklist of some of the signs of sensory processing disorder. But please keep in mind that some sensory challenges manifest themselves somewhat differently in each individual. o poor self-regulation: not able to calm themselves o overly sensitive to touch, sight, sound, movement, pain, temperature, smell, or taste o under-responsive to touch, sight, sound, movement, pain, temperature, smell, or taste o balance or coordination problems o activity level is unusually high or unusually low o poor organization of behavior o makes noises such as humming or singing frequently Q. Who should I talk with if I suspect my child might have sensory processing difficulties? A. In a school setting, begin by talking with the child's classroom teacher. The teacher can help to connect you with the school occupational therapist, who is the professional trained to assess sensory processing dysfunction in children. If your child does have some sensory processing issues, the occupational therapist can then provide intervention strategies. If your child is not currently in school, you might speak with your family physician about a referral to an occupational therapist. Discussion Questions [ Export PDF with Answers | Export PDF without Answers ] 1. An individual with ASD who has sensory processing disorder may be affected in many ways. List some of the ways their life may be affected. It can affect their behavior, their learning style, their movement, their relationships, and their feelings about themselves. 2. How would you describe an individual with ASD who is overly responsive to visual stimuli? An individual with ASD that is overly responsive to visual stimuli might cover their eyes frequently in bright lights and/or exhibit excessive squinting in normal lighting. 3. How would you describe an individual with autism who is under responsive to touch? This individual may not notice touch unless it is very intense. He/She may not move away when leaned on or crowded, and may hurt other children or pets during play due to not being able to comprehend the pain that others feel. They may show little or no response to pain from scrapes or bruises, even perhaps shrugging off significant injuries. 4. Describe a child who is both overly responsive to sound and under responsive to taste. The child who is overly responsive to sound may cover his/her ears to close out sounds or voices. He/She may complain about noises, such as telephones ringing, that don't bother others. The same child may be under responsive to taste by eating very spicy and hot foods without exhibiting the typical reaction. 5. Share a time when someone you know exhibited sensory processing disorder. Identify what sensory differences he/she may have displayed. Answers will vary. Post-Assessment Post-Assessment Our senses give us the information we need to function in the world. Select an answer for question 429 A child with sensory processing disorder has the ability to effectively and efficiently organize sensory information. Select an answer for question 430 A child that is under responsive to touch may Select an answer for question 431 A child that is over responsive to touch may Select an answer for question 432 A child that is over responsive to visual experiences may Select an answer for question 433 An individual who is under responsive to sound may Select an answer for question 434 Being overly responsive to smells might be demonstrated by which of the following behaviors in an individual Select an answer for question 435 All individuals with ASD have auditory sensory issues. Select an answer for question 436 Individuals with ASD who exhibit sensory processing difficulties may have more than one sensory area affected. Select an answer for question 437 Citation and References If included in presentations or publications, credit should be given to the authors of this module. Please use the citation below to reference the content. Rogers, J., & Short, J. (2010). Sensory differences: Online training module (Columbus, OH: Ohio Center for Autism and Low Incidence). In Ohio Center for Autism and Low Incidence (OCALI), Autism Internet Modules, www.autisminternetmodules.org. Columbus, OH: OCALI. References Adamson, A., O'Hare, A., & Graham, C. (2006). Impairments in sensory modulation in children with autistic spectrum disorder. British Journal of Occupational Therapy, 69, 357-364. Adrien, J. L., Ornitz, E., Barthelemy, C., Sauvage, D., & Lelord, G. (1987). The presence or absence of certain behaviors associated with infantile autism in severely retarded autistic and non-autistic retarded children and very young normal children. Journal of Autism & Developmental Disorders, 17, 407-416. 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