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					 Sensory Processing 101

Implications of Sensory Challenges in ASD




             Chris Filler
         Transition Coordinator
Ohio Center for Autism and Low Incidence
• Sensory Processing challenges can influence
           how students respond to:
                   – Environment
                      – People
           – Instruction/Tasks/Activities


• Understanding these influences leads to the
      selection of effective interventions
           What is Your Response to……
Cold shower
Wool clothing
Panty hose
Sweatpants
The feel of Jell-O in your mouth
The sound of birds
Bright colored walls in the bedroom
The smell of perfume
Elevators
Roller Coasters
Sensory Processes

  Sensory Processes include:
        • Sound/Auditory
          • Sight/Vision
      • Smell/Olfactory
        • Taste/Gustatory
      The Power Senses
         • Touch/Tactile
           • Vestibular
        • Proprioception
 Research suggests that the following areas
of the brain are affected in Autism which can
     cause change in sensory processing:


               • Cerebellum
                – Purkinje Cells
             • Limbic System
                 – Hippocampus
                   – Amygdala
              • Frontal Lobes
            – Gray and White Matter
             • Occipital Lobes
A Process by which we:




                         1
           “Breakdowns”
• Breakdown may occur at any point
  – Challenges to the “intake system” are
    more easily recognized
  – Faulty operation of the “interpretation
    and integration” of information may be
    seen as a behavioral issue
• Negative consequences may only
  make the situation worse
           Sensory Processing Gone Astray

Struggles to stay alert or awake


              Overly alert, unable to attend

  Delays in processing and shifting attention

           Cannot stay focused …
           attention shifts continually
Sensory Processing Gone Astray

  Unable to touch many items,
  picky eaters



           Explores the
           environment by
           touching everything
 Luke, a 13 year old with AS had wandered away from his family at
the beach. In attempt to find Luke, his parents paged him overhead.
                           Luke writes…..

   “Coastguards, police, a pack of Brownies and
   every available person were all shouting my name
   over a loudspeaker. I didn’t hear a thing! I have a
   strange kind of hearing and can only concentrate
   on listening to things I know I am meant to.
   Distinguishing between background and
   foreground noise has always been a problem, so
   however loud they shouted I would have
   presumed that it was a background noise.”
                 From “Freaks, Geeks, and Asperger Syndrome
  Review of challenges/characteristics…..

• Slow Processing - Difficulty shifting
  attention

• Inattentive, Difficult to arouse

• Does not like change
  or transitions -
  Rigid – Demands routine
• Difficulty with, or seeks out, certain types of
  foods/textures
• Smells all food before eating - smells objects

• Unable to sit with anyone behind
  them in class

• Difficulty attending
  from the back of the room

                           • Explosive emotions
                           or lack of emotions or
                          incongruent emotional
                                       responses
• Aggression to self or others
• Compulsive Behaviors




                   • Difficulty with clothing,
                        type of clothing, and
                           change of clothing
• Perseveration on topic or activity -
  Fixation on sensory stimuli




• Clumsy, awkward, difficulty in sports
• Over or Under-reaction to pain
• Unsure of group situations, cautious, or
  a loner
                                         2
UNDER-RESPONDER
Poor Awareness & Low                                      SEEKER
Sensitivity to Stimulation.          Heightened Awareness with
Misses Environmental Cues           Low Sensitivity to Stimulation
Slow Processing (Acts as if                  Will Seek Out Input
does not hear, misses                 (Frequently and Intensively
gestures and cues,                              Moving, Jumping,
sedentary)                                    Spinning, Touching)
                            Summary of
                            Processing
OVERWHELMED                 Challenges            ACTIVE AVOIDER
Heightened awareness,
                                           High Awareness, with
High Sensitivity but
lacks active response,
                                      High Sensitivity and Active
Can become easily overwhelmed.       Responses. Will actively avoid
( Complains of things “bothering”   (Searching out Escape Areas,
Frequently anxious/upset,                    Covering ears/eyes,
overreacts to small changes
                                     Aggression to “Protect” self)
in the environment)
    Seeker and                               SEEKER
                        Heightened Awareness with
  Active Avoider
                       Low Sensitivity to Stimulation
 can appear similar             Will Seek Out Input
                         (Frequently and Intensively
                                   Moving, Jumping,
  •Both may move                 Spinning, Touching)
     frequently
•Seekers are looking                 ACTIVE AVOIDER
 for the stimulation          High Awareness, with
                         High Sensitivity and Active
     •Avoiders are
                        Responses. Will actively avoid
attempting to escape
                       (Searching out Escape Areas,
    the stimulation
                                Covering ears/eyes,
                        Aggression to “Protect” self)
UNDER-RESPONDER
Poor Awareness & Low                  Under-Responder and
Sensitivity to Stimulation.           Overwhelmed can also
Misses Environmental Cues              have some similarities
Slow Processing (Acts as if            •May not appear as
does not hear, misses                 “sensory needy” as the
gestures and cues,                        seeker/avoider
sedentary)
                                    •Overwhelmed are vigilant
                                    and will have anxiety to the
OVERWHELMED                          environment and will resist
Heightened awareness,                         change
High Sensitivity but
                                     •Under-responders also
lacks active response,
                                       may not respond to
Can become easily overwhelmed.
                                      environmental cues,
( Complains of things “bothering”
                                     however due to lack of
Frequently anxious/upset,
                                       awareness and not
overreacts to small changes
                                            vigilance
in the environment)
UNDER-RESPONDER
Poor Awareness & Low                                      SEEKER
Sensitivity to Stimulation.          Heightened Awareness with
Misses Environmental Cues           Low Sensitivity to Stimulation
Slow Processing (Acts as if                  Will Seek Out Input
does not hear, misses                 (Frequently and Intensively
gestures and cues,                              Moving, Jumping,
sedentary)                                    Spinning, Touching)
                            Summary of
                            Processing
OVERWHELMED                 Challenges            ACTIVE AVOIDER
Heightened awareness,
                                           High Awareness, with
High Sensitivity but
lacks active response,
                                      High Sensitivity and Active
Can become easily overwhelmed.       Responses. Will actively avoid
( Complains of things “bothering”   (Searching out Escape Areas,
Frequently anxious/upset,                    Covering ears/eyes,
overreacts to small changes
                                     Aggression to “Protect” self)
in the environment)
     The “Sensory Diet”
         includes„.
• PROVIDING SENSORY EXPERIENCES
 – A combination of sensory experiences
   needed by a person to adaptively interact
   with the environment (“make it through the
   day”).


• MAKING ENVIRONMENTAL
  MODIFICATIONS
 – Modification and organization of the
   environment in order to decrease stress on a
   fragile sensory system.
   Those with sensory processing challenges

      • May not be able to filter and focus


               • May attempt to adjust in a
                          maladaptive way
                           (Ex: Escalation of Mood,
                                    Shutting Down)

• Will require a “sensory diet” enriched
  with unique sensations and experiences
 Creating The Sensory D.I.E.T.


D …..Do an Informal Assessment
I …..Individualize
E …..Environmental Supports
T …..The Power Senses
  Do an Informal Assessment
Assess the Environment and the Individual’s
response to a variety of sensory experiences

                • Seeker?
            • Active Avoider?
          • Under-Responder?
             • Overwhelmed
Individualize the Sensory Diet

What has worked for one
person may not work at all
    for someone else!
UNDER-RESPONDER                     SEEKER
Increase the use of                 Provide sensory
visual supports and routines.       experiences frequently &
Structure the environment.          proactively
Time to respond                     May need to limit
Careful encouragement to            excitatory experiences
try new experiences
                       Considerations for
                        the Sensory Diet

OVERWHELMED                         ACTIVE AVOIDER
Control the environment             Modify the environment
Limit stimulation                   to reduce the need
Limit change but
                                    to escape
prepare for changes
when they need to occur.
                                    Gentle introduction to
                                    new experiences
   Environmental Supports
• Other People
• Organization
            • Predictable, Structured,
                Consistent Environment
                  • Task or Curriculum
• Visual Supports
• Escape Environments
         The Power Senses
• Vestibular
  – Movement

• Proprioception
  – Input through
    joints and muscles

• Tactile
  – Deep Pressure Touch
To“fill the                Proprioceptive
                               Input        Tactile Input
 sensory      Vestibular
 bucket”        Input
quickly use                                         Taste,
                                                    Smell,
the Power                                           Vision,
  Senses                                            Auditory




   Three Power Senses
       will provide:
       • more input
      •more quickly
    •to make changes
   that are more rapid             Based on Work of Bonnie Hanshu
                                       www.sensoryprocessing.com
        Proactively Schedule
         Sensory Activities
• Use the Power Senses throughout the day in
             order to help a person
         alert, attend, act, and react

  • Activities should be non-contingent on
                  behavior!

• At times, additional activities or input
    may be needed based on the behaviors
                  observed
    The Power Senses

Tactile System

Proprioceptive System

Vestibular System
    The Power Senses

Tactile System
Two Tactile Systems
        Tactile System


• Pertains to the sense of touch
       • Alerts to danger
   • Gives body boundaries
• Helps provide a basis for body
               image
         Protective System

 Activates “Fight, Fright, or Flight”
 Born with this system- “Primal”
 Stimulated by light touch, pain, temperature
 Processed through the emotional, excitatory portion
  of the limbic system
 NOT a cognitive response
            Discriminative
           Pressure Touch
• Deep touch/pressure, and vibration
• Activates Parasympathetic System
• Calms and organizes
• Allows for more cognitive
  response
• Helps us learn and think
   Dysfunction of the Tactile System
• Distractibility
• Hyperactivity
• Over/Under Sensitivity
      •   Hyper-vigilant
      •   Inappropriate pain sensation
      •   Avoids getting hands dirty
      •   Difficulties with clothing/textures
      •   Avoids whole hand
      •   Disorganized when touched
      •   Intolerant of wearing glasses/hearing aide
• Difficulty with Social Space
          Tactile Defensiveness is when…
- Sensitive to light touch
- Touch causes difficulty                organizing
  behavior and            concentration
- Touch causes negative emotional responses
   - Can become aggressive, if feeling threatened or
                                             stressed
 Interventions for Tactile Defensiveness
• Brushing Protocols
               – Wilbarger Protocol
                      – PRR
   Brushing over arms, legs, back with a soft
   brush , followed by joint compressions
• Caution
  – A brushing protocol should
   only be implemented after
   an assessment and training by a
   qualified professional
Program Supports Specific to
     Tactile Challenges
     Environmental Supports
• Access to an escape/private area


• Caution with placement.
  Student may want to sit where no one
  is behind him

• Some feel secure with boundaries that
  keep others at a distance…..
                   • Others need space in
          order to make a “quick escape”
The “Front Porch”
Quiet Sensory Area
Other Tactile
 Supports
Choose carefully…..
        Other Tactile Supports
• Consider the type of clothing and
  the way it fits
  – Tight?
  – Loose?
                                Remove
  – Fabric?                    tags from
                                clothing
                     • Swimming/Water Play

• Body Sock
     People Supports: What Others Can Do
• Avoid unnecessary touch
  and Ask Permission

• Avoid touching face to gain attention

• Move slowly and                          provide
   “Waiting Time”-                        up to 10
                                           seconds

• When touch is necessary, use               Deep
  Pressure Touch
   The Power Senses




Proprioceptive System
             Proprioceptive System

               Muscles, joints, and tendons
               provide a person with a
subconscious awareness of
body position via the feedback
from receptors in the muscles,
tendons and joints
       Proprioceptive System
                           Motor Planning




Awareness of body in
time and space without
constant visually monitoring
Dysfunction of Proprioceptive System

• Clumsiness, a           • Disorganized…..
  tendency to fall          Materials & Thoughts

• Lacks awareness of      • Poor or resistance to
  body position/odd         handwriting
  posture                 • Eats in a sloppy manner
• Difficulty with small   • Resists new motor
  objects (buttons/         movement activities
  snap)
 What Happens when
Proprioception Occurs?

 How Does it Work?
     Activities that Provide
     Proprioceptive Input

• Joint compression or extension
   • “Heavy work” activities
• The larger the joint, the more
      proprioceptive input
      Examples of “Heavy Work”
• Passive Joint Compressions
• Jumping/Trampoline
  (floor may be better..)
• Stacking Chairs
• Weight Lifting
                 • “Bungee Cord” on Chairs
                           • Chewing Gum
                          • “Pretzel Hugs”
           Fine Motor Supports
• “Hand-prep” exercise
• Limit Handwriting
  Requirements
• Alternatives to
  handwriting            • Alternatives &
  –   Keyboarding          Accommodations
  –   Software             – Options in Word and
  –   Set of notes           PowerPoint
  –   Grips
  –   Velcro on Shoes    • Sensory Breaks
                           between tough fine
                           motor activities
• Organizational Supports
     •Visual Supports
     •Color coding
     •Timers/Watches
     •Written directions
     •Written rule reminders
   What Can Others Do


– Stay on schedule
– Pace language
– Use Concrete Language
– Use Wait Time
   The Power Senses




Vestibular System
       Vestibular System
        The vestibular system refers to
             structures within the inner
ear          (the semi-circular canals)

These structures detect movement
and changes in the
position of the head.
• The brain needs
  vestibular input in
  order to function


                           • Vestibular input
                                provides the
                        Strongest Sensation
• Movement can change an individual’s
  attention, arousal and alertness in the
  shortest period of time




• The effects from vestibular input can last
  longer than any other input.
                Hyper-sensitive
      Active Avoider and Overwhelmed
• Fearful reactions to ordinary movement activities
• Apprehensive walking or crawling on uneven or
  unstable surfaces
• Seem fearful in open space
• Appear clumsy
• Want their feet on the ground!

• These folks need gentle experiences and support as
  they become more comfortable
                  Hypo-sensitive
          Under-Responders and Seekers
• Seeker: Actively seek and demonstrate a
  need for intense movement experiences
  (whirling, jumping, spinning, spinning objects,
  pacing)
• May includes visual stim
• Be aware: Seeker can become over-excited
  – Needs monitoring
  – “Cap-off” vigorous vestibular activity with
    proprioception (“heavy work” or joint
    compression)

• Under-Responder may need gentle
  encouragement to engage in movement
  activities
     Activities that Provide Vestibular Input
• Seeker/Avoider/Overwhelmed
  – Linear, Calm, Slow, Controlled movement to
    gain attention


• Under-Responder
  – Unpredictable, multi-directional, spinning (if
    individual requests), to alert and orient
    someone who is under-responsive
  – Be very cautious imposing vestibular
    movement – can be very frightening
         Selected Strategies
• Swinging
• Rocking Chair
• Sit & Spin/Dizzy Disc

                   • Therapy Balls as Chairs
                       • Moveable Cushions
                     or Deflated Beach Balls
                          as Chair Cushions
          Selected Strategies
• Delivering Messages or Packages (or any
  job that requires walking, moving,
  bending, etc.)
• Running Track or possible a Treadmill
• Movement breaks placed proactively in
  the day
  – Non contingent on behavior or work
    completion!
           Remember„„
• Do NOT withhold recess/gym based on
  the child’s behavior or
  inability to complete work

• Movement and activity
  may be the input the
  child needs in order to
  maintain behavior, concentrate
  and learn!
Alecia Video Example
      “Monday”
 Creating The Sensory D.I.E.T.


D …..Do an Informal Assessment
I …..Individualize
E …..Environmental Supports
T …..The Power Senses
           Post-Assessment
                                  • More alert?
                            • More “tuned in”?
              • Able to respond more quickly?
                       • Able to focus on task?
           • Able to attend for longer periods?
• Less “explosive” or unpredictable?
• Calmer?
             • More interactive?
              • Less stressed?