Sensory Issues In Autism

Dr. Wendy Lawson

What to expect from this talk

Definition of ‘senses’ and sensory issues

Relationship to life in ASCWhat might helpResources

Definition

What are your senses (touch, taste, smell, sight, hearing, spatial awareness & intuition)

Connection to Brain?Feelings – awareness – readiness

and integration of attentionFOR MORE INFO...

Enzymes for Autism and other Neurological Conditionsby Karen DeFelice (2002)

Brain connection

Sensory Integration Issues and Gut Reactions

Seems to be a connection for some with Autism and the GI Tract - 'Sensitivity' Issues Food, Taste, Texture, PainPaul Shattock; Timothy Buie, MD - paediatric gastroenterologist(works at Harvard and is active clinician)

Brain Gut Connection

Painful Stimulus -> Magnification of message.- There can be a magnification of the pain message. This magnification can be termed 'increase in sensitivity'. Or explained as the system over-reacting.

Brain Gut Connection

After an original painful event, a much smaller event might cause a painful reaction that is out of proportion to the actual event. Example: if the first event or two was eating a lot of crunchy food resulting in cramping of the stomach and gagging, there may be a magnification of the sensation.

Brain Gut Connection Afterwards, a very small amount of that

crunchy food, or any type of crunchy food, may cause the same huge cramping and gagging when it is eaten.

seen in child who gags on anything cold, or chewy, or crunchy, or with certain smells, etc...no matter how small an amount is given, the system has the 'pain memory' and reacts inappropriately. The reaction can be triggered by smells, sights, textures, temperatures, even sounds.)

Sensory IntegrationSensory Integration: senses integrate

'Non-painful' stimulus -> Causing magnification of sensation to

an extreme and unpleasant level...(PAIN?)[Note: The point here is that there is a real physical event that results in a physical event that may be painful or at least uncomfortable. The person is reacting appropriately to the physical event as they feel it.

Brain Connection

It is the sensory response system that is acting inappropriately. It is definitely not just bad behaviour or an attempt for attention. Unfortunately, children and especially someone with a communication impairment, is not able to accurately express this.

Brain Connection

Often it takes the form of poor behaviour, 'over-reacting' to what others around them perceive as a little thing, stimming, tantrums, or other behaviours.

Brain Connection

Eg: light tough causing a person to jerk away their arm like it had been hit. The nerves are responding inappropriately. Something like the brushing technique helps because it re-trains the nerve response.

Retraining?

Retraining the sensory system can produce very good results. In working with autism 'moulding' and re-training the system is a foundation of many of the therapies that help correct various conditions.

Known affiliations

Down syndrome- Gastroesophageal reflux(Hiatus hernia)

- Cornelia DeLange Syndrome- Celiac Sprue- Food Allergy

Down Syndrome

Chromosomal abnormality- Known abnormalities structurally in the brain- Known association with autism (~8%) of down syndrome children have autism- Known association with GI problems (~30%) with gastroesophageal reflux

Hiatus Hernia in infants

In infancy this is more common in boys, twins, premature brains- thought most commonly to be a function of delayed stomach clearance, which is controlled, for the most part, by the brain.- It is a developmental condition not evident at birth, like ASC, that generally develops between 2 weeks and 2 months of age.

Cornelia DeLange Syndrome

Congenital malformation of the brain- Known autism frequency (high)- Frequent GI issues (GE reflux may be as high as 90%)- Personal observation: self-injurious behaviour diminishes dramatically when treating reflux.

Coeliac Disease

Known GI disease with genetic predisposition (gluten sensitivity)- Known associated neurological symptoms include depression, ataxia, CNS calcifications, peripheral neuropathy among others

Food Allergy

multiple neurological problems in children with food allergy including anxiety, behavioural abnormality, and even psychosis which have been reported as being resolved with food restriction.- Incidence of food allergy is cited at 8% in general paediatrics, best small study in ASC states incidence at 36%

Causes ASC?

No evidence that any gut problems CAUSE autism conditions. But although correcting the gut problems will not cure autism, being in discomfort would likely make symptoms much worse. Treat these problems and the person with autism will feel better and have a better quality of life

Hypo or Hyper?

Reactions to things seen, touched, heard or movement can either be too much or too little:

Auditory hypersensitivity results in tantrums or the covering of ears when certain sounds are heard; Auditory hyposensitivity seems like selective hearing and there is often concern of hearing loss

Visual SystemThis is the sense that we use to ‘see’

the world around us.Some of us find this sense

uncomfortable, so we might try to interfere with it (look out the sides of our eyes; look through gaps in our fingers; look upside down; sideways) to make it less uncomfortable, or we might try to block it out all together (fingers in front of eyes; hide beneath material).

Visual Sense

Visual detail scrutiny occurs when a specific object or group of objects, are chosen to be visually inspected repeatedly (i.e. Wiggling string)

Description Some of the discomforts we experience: Vision allows too much information ‘in’

and we feel over whelmed Vision lets in pieces of disconnected

information Vision allows information through which

appears not to make any sense Vision mixes inappropriately with other

senses and distorts information causing us to see in patterns or misrepresenting what’s ‘there’; giving rise to sudden ‘seeing’ or seeing after event has passed.

Scotopic SensitivityApprox 70% of information is

accommodated visually.

visual perceptual problems may not be identified via traditional eye tests.

If discovered, may be remedied by the use of tinted lenses (Irlen lenses).

Vision Therapy (specific eye exercises) often very helpful

Sensitive vision.Some autistic individuals can see

the flicker of florescent lights. (Lawson, 2001) Coleman et al.(1976) found that florescent lights increased repetitive behavior in some children with autism.

FOR MORE INFO...

Wendy’s books; Temple Grandin’s story; Donna Williams and other personal accounts. Literature on Sensory dysfunction & Autism.

Outcomes of visual discomfort eye contact avoidance, blackboard visual

avoidance, poor and uneven handwriting, inability to listen and look simultaneously, over use of peripheral vision, a stiff-legged walk and poking at the sides of the eyes (Audrey Adams).

Picky eaters- choosey about appearance of food on plate;

Seems to ‘scan’ environment & items Visual processing difficulties (Jackie

Jackson, 2005)

Resources go straight to a developmental

optometrists, not an ophthalmologist. (one with a developmental background is able to diagnose correctable vision problems and give a referral for therapy). Don't assume that your child can't be tested; a really good eye doctor can tell you a lot about the vision performance of even non-verbal individuals. If the optometrists tells you that your child is untestable, find one that is willing to try.

Procedures Do all sensory therapies FIRST and THEN

behavioural therapies and interventions. choose an eye doctor who is Board

Certified in Vision Therapy. The initials FCOVD (Fellow of the College of Optometrists in Vision Development) will follow their name. Make sure that, during the exam, the doctor makes a series of near-point tests. No eye drops can be used for that procedure.

Schedule

Identify & Review problems

FOR MORE INFO...

Visit developmental optometrist; read any literature on Autism and sensory dysfunction

Physical & environmental

sensory

Mental & emotional

things that might help

To improve visual discomfort: Use natural lighting, not fluorescent Use colored over lays or Irlen lenses Employ visual activities (exercises)

– Hand to eye coordination; catching of balls; following finger to and from nose; walking along straight lines whilst eyes looking at a fixed point; fixing on and off of spinning objects; counting objects; specific program put together by developmental optometrist or occupational therapist.

Tactile sense (touch)

Tactile detail scrutiny occurs when there is a fixation on the tactile qualities of an object (i.e.. The smooth silk on the blanket)

Strategies

Slowly, increase contact with tactile discrepancies. For example: brush arms gently; pull soft material across the individuals body; Try clothing on, take off again. Aim is to increase tactile coping and decrease tactile defensiveness.

Peca (everything goes into mouth)

Taste sensory stimulation occurs when things are put in the mouth but not eaten (i.e.. Gravel, twigs, leaves)

Some children require more sensory legitimate ‘play’ with things like dough, to help with this. Other’s need pictorial support for what is allowed in the mouth and what is not.

Smell and movement

Smell fixations occur when objects are smelled as a way of exploring them

Movement over reactivity occurs when there is a strong like or dislike to experiencing movement (i.e.. Swinging, jumping)

Fragrance

Some fragrances are experienced as over whelming so we need to desensitize the individual as much as possible.

Other fragrances are experienced as under stimulating, and the individual wants much more of these. We can work on this too.

Role of Attention

What we know about ASC is that we use single attention

If attention all in one place then sensory issues will take precedence when they exist

I won’t have spare attention for learning,

My senses are occupied!

Free up attention

Attention can be ‘freed up’ as we attend to the sensory profile of the individual and deal with the difficulties:

SocialEnvironmentalPhysical

Social

Less demandBuild conceptsCreate fellow feeling and value via

shared interestUse stimuli reduced teaching aids:Computer- IT

Environmental

Check lighting for appropriatenessFloor coveringsFurniture – crowdingPeople factorTextureColorStructure

Physical

Check healthCheck for food allergyMetals in the blood streamClothingBrain gut connections

Physical Activity

Hand stretchingLeaning forward to assist with

concentrationOpen them close them….Relax Sucking thro a strawsoft brush to skin

Resources

www.wendylawson.comBooks dealing with sensory issuesPublished by Jessica Kingsley:www.jkp.comWendy’s books