Sensory Processing & Children on the Autism Spectrum

Jenny Clark Brack, OTR/L

Learning ObjectivesLearners will...

1. Review sensory systems and the signs/symptoms of Sensory Processing Disorder as well as current research in this field.

2. Discuss practical ideas for implementing sensory strategies into learning environments and within the context of a child’s daily routine.

3. Explore how SPD affects children with ASD.

4. Understand how trans-disciplinary teams work together for the success of a child with ASD.

What is Sensory Processing?

Definition: The organization of sensory input for use. The “use” may be a perception of the body or world, or an adaptive response, learning process, or development of some neural function. A. Jean Ayres, PhD, OTR, FAOTA Sensory Integration and the Child

…Correctly interpreting everyday sensory information, such as touch, sounds, sights and movement, from our environment and from our body so that we can participate in daily activities.

Introduction Sensory Processes take place at an unconscious

level. All sensory systems work together to help us learn-attend, read, write, math and participate in daily activities.

Inhibition vs. Facilitation = MODULATION Effects attention & behavior Sensory overload causes a “Fight, Flight, or Freeze”

reaction. Autonomic Nervous System (sweat glands, heart

rate, digestion, blood vessels, release adrenaline & cortisol)

Sensory Defensiveness/Sensory Diet Patricia Wilbarger PhD, OTR

Identifying Sensory Processing Disorder at school & home

Observation Teacher/Parent interview SPD checklist Occupational Therapy Evaluation Sensory Profile

Effects attention & behavior Over-responsive vs. Under-responsive Interferes with participation

Environments Impacted

Classroom Recess Cafeteria School Bus Music Class Library Transitions Home Restaurant Grocery Store Movie Theatre Birthday Parties

Sensory Systems

1. Vestibular System 2. Proprioception System 3. Tactile System 4. Visual System 5. Auditory System 6. Olfactory System 7. Taste/Oral Sensory Processing 8. Motor Planning

Characteristics:Vestibular System Part of our inner ear that is stimulated by any

slight tipping of the head. It helps us know the direction and speed in which we are moving & where are body is in space.

Linear=Calming/Organizing or Rotary=Alerting Over-responsive avoid input vs Under-responsive seek input Vestibular input is cumulative Avoid rotary input for child w/ seizure disorder

Characteristics:Vestibular System

Over-responsive system: Avoids playground equipment, fear of heights, car sick.

Under-responsive system: Rocks/tips chair, difficulty staying seated, constantly in motion, twirls/spins/rocks self.

Negative Responses from rotary input: nausea, headaches, excessive yawning or hiccupping, irregular breathing, color change/face pallor, sweating, motor agitation, pupil dilation, significant changes in arousal level.

Practical StrategiesVestibular System Over-responsive: Place books level with desk Use cup in place of water fountain Recess time: swings, slide sitting up

Under-responsive: Ball chair Move-n-sit, tennis balls, beach ball “chair” Movement breaks (exp. Office errand, stand at desk) Do not take recess privileges away to finish work. Recess time:

Merry-go-round, slide on tummy Schedule movement prior to seatwork Incorporate movement in teaching

Characteristics:Proprioception System

Receptors in joints, muscles, and tendons perceive contraction, stretching and compression.

Sends calming messages to the brain.

Position sense: Body awareness Kinesthesia: Movement awareness Allows us to grade touch pressure Stays in nervous system 1 ½ - 2 hours Sometimes described as “Heavy Work” or “Deep

Pressure Touch”

Characteristics:Proprioception System

Difficulty grading amount of pressure, for example: (Coloring with heavy pressure, pushing scissors rips paper, holds pencil too tight, breaks pencil lead)

Clumsy, falls out of chair, slumps at desk, poor body awareness in space

Likes hugs, tight fitting clothing Kicks heels against chair/desk legs Rubs hands together, bites fingernails

Strategies:Proprioception System

Weighted vest (wearing schedule) www.OTvest.com Neoprene pressure vest Weighted lap bag Beanbag chair Therapy band wrapped around chair legs Mechanical pencil Weighted wrist band Clay tray Weighted pencil, Vibrating Pen Lycra under clothes Heavy “work” activities

Characteristics:Tactile System

Receptor cells in our skin give us information for feeling light touch, pain, temperature, vibration, and pressure.

Protection=Alert to danger=Survival vs. Discrimination=Orienting to an object=What is it?

Where is it?

Characteristics:Tactile System

Over-responsive:Tactile defensiveness (aversion to light touch, striking out/withdrawing, clothing tags, haircuts, nail cutting.

Under-responsive: High pain tolerance, excessive touching of people, hands constantly “fidgeting”, clumsy with fine motor materials.

Cold, rough, light touch – Alerting Warm, soft, deep pressure touch – Calming

Practical Strategies:Tactile System Sensory Seekers: Hand fidgets, sensory tubs

Tactile Discrimination: Wikki Stix letters, Sandpaper letters

Tactile Defensive: Mark personal space with carpet squares and seat at edge of circle/group, approach from front, use firm touch not light touch, line placement front or back, Tag-less clothing, heavy sweatshirts, long sleeves

Characteristics:Visual System Focusing, eye-movements, eye-hand coordination, visual

perceptual skills. Low Vision Online - home Has neuronal connections to vestibular system. Over-responsive: Visual defensive (sensitive to fluorescent

lights, bothered by objects close to face), difficulty finding materials in desk/backpack/locker, difficulty focusing on books or puzzles.

Under-responsive: Does not notice detail, written work incomplete.

Illegible handwriting, cuts off lines, colors outside boundary lines, visual perceptual delays could effect reading skills (reversal errors or loses place on page), difficulty copying from chalkboard.

Practical Strategies:Visual System Decrease wall decorations (exp. Flip chart) Adjust lights/ Cozy shades Visor Table easel /slant board Window “guide” for reading Adapted handwriting paper Avoid copying from the board/copy from page on desk Thicken cutting lines Tactile boundary for coloring Sticky note spacer b/w words Be careful of glare on reading surfaces Tape letter strip to desk for handwriting reference Write on white board with thick black marker for contrast Sit child close to chalkboard facing squarely

Characteristics:Auditory System

Hearing, auditory processing (misinterprets instructions), discriminating between sounds for phonics, auditory figure-ground for attention, auditory defensive.

Has connections to vestibular system due to anatomical proximity.

Characteristics:Auditory System Over-Responsive: Covers ears to loud sounds,

distracted by background noise (auditory figure-ground) such as noise in the hallways, humming of fluorescent lights or children playing out side, poor attention in busy environments.

Under-Responsive: Oblivious to being spoken to, history of ear infections/allergies, permanent hearing loss, delayed speech/language skills.

Practical Strategies:Auditory System Have child use headphones/earplugs Incorporate music/environmental sounds http://www.route2greatness.com/ Simplify language, slower rate Seating preference away from doors/windows Give one direction at a time Allow longer response time Stand close to child when speaking Pair directions with physical/visual prompts

Characteristics:Olfactory System

Chemical receptors have direct neuronal connections to limbic system responsible for emotional memory.

Discrimination: What is that smell? Vs. Protection: Aversive reactions to typical

smells, loss of appetite, headaches, limited diet.

Practical Strategies:Olfactory System Vanilla/Lavender are calming Peppermint/Citrus are alerting Use scented play dough or finger paints &

scented markers for memory Avoid perfumes, Scent-free laundry

detergent. For negative response to scents, smell

cinnamon, cloves or coffee bean.

Characteristics: Taste/Oral Sensory Processing Over-responsive: Gags easily on textured foods Picky eater, limited diet Sensitive to tooth brushing

Under-responsive: Constantly chews on non-food objects, such as

shirts, fingernails, pencils Messy eater

Practical Strategies:Taste/Oral Sensory Processing

Allow child to chew GUM Snacks with variety of taste/textures Oral motor fidgets (exp. Chewlery) Suck thick liquids through straw Electric toothbrush

Characteristics:Motor Planning

What is Motor Planning? Also known as “Praxis”. Voluntary coordinated movement dependent upon unconscious body sensations.

Dyspraxia: Difficulty executing unfamiliar motor actions, poor articulation, needs excessive practice for new motor tasks.

Practical Strategies:Motor Planning

Keep classroom arrangement consistent Break task into small steps and practice Use pictures to sequence students through

task Let other children go first to model action Give child checklist to i.d. task/schedule

Early Intervention for ASD Research supports

efficacy of EI Children with ASD

respond best to predictable environments Exp. Sensory strategies/ visual supports/routines

Effective curriculums focus on communication & social skills with typical peers

Infants/Toddlers

Apply during daily routines

Playtime Mealtime Bedtime Bath Time Dressing

Playtime “Heavy Work” activities

exp. Pulling wagon with blocks, climbing, roughhousing

Textured/scented toys for infants

Textured play mat (egg crate foam)

Light up/musical toys

Mealtime Oral motor exercises

between mealtimes Vibrating teether or

toothbrush Popsicle/sour sucker

(alerting) Spoon shape, size

texture? Food smell/texture

Bedtime

Lullaby music/white noise

Low light T-shirt sheets Snug pajamas Avoid over arousal

activities prior to bedtime

Bath Time

Lavender scented bath soap/shampoo

Textured wash scrubs/firm pressure touch

Water temp. Warm towel from dryer Fun foam soap Pouring toys

Dressing

Rub lotion on before dressing

Wear tight fitting clothing

Select bright colors/patterns

Be aware of laundry detergent smells

Early Childhood

Ready S.E.T. Go!

Program Philosophy Sensory Integration

Model

Theme & Literature-Based

Transdisciplinary Inclusive

Environments

School Readiness Skills

Cognitive

Language

Sensory

Motor

Social/Emotional

Trans-disciplinary Team Definition: An integrated team collaborates and often

shares treatments.

Members of various disciplines share each other’s roles or functions across disciplinary lines in order to provide efficient services.

Parents, Occupational Therapist, Physical Therapist, Speech Language Pathologist, Music Therapist, Adaptive P.E. (Modeling techniques for everyday use) Early Childhood Special Educator, Paraprofessionals.

Anatomy of an Autistic BrainTime Magazine May 15, 2006 “Inside the Autistic Mind”

Frontal Lobes – Higher reasoning: Enlarged Corpus Callosum – Links left/right

hemispheres: Undersized Amygdala – Plays role in emotion & social

behavior: Enlarged Hippocampus – Memory: 10% larger Cerebellum - Coordination: Overloaded white

matter Too many local connections

Occupational Therapy & ASD

50%-90% of children with ASD have problems with motor coordination…

Balance, bilateral coordination, motor planning, body scheme, and fine motor skills.

Affects activities: Handwriting, shoe tying, cutting, riding a bicycle, jumping rope, skipping, playing ball, and extracurricular sports.

Occupational Therapy and ASD

40% of children with ASD have sensory sensitivity to touch, sound, taste, light, and smell…

…and sensory Under-Responsiveness to vestibular, proprioceptive and tactile input.

= Poor MODULATION, Regulation, and Processing.

Occupational Therapy & ASD

OT intervention helps children improve FUNCTIONAL ENGAGEMENT and PARTICIPATION in every day life.

OT helps children with ASD physically, emotionally, and socially through sensory integration intervention, sensory diets, and environmental strategies…

Occupational Therapy & ASD

…which helps children:

modulate their nervous systems to “just right” improve motor coordination increase self-esteem through success acquire social skills, prevocational skills,

academic skills and play skills.

Occupational Therapy & ASD

Children learn coping strategies and self-regulation to help physical, emotional, and behavioral responses.

OT SUPPORTS families, school staff, community members by educating and collaborating.

It Takes a Whole Village to Raise a Child! We need to work

together!

School staff Administrators Therapists Families Community

members

For current resources and references search Jenny’s Website:

www.SPDconnection.com

Special Thanks to:

Three Lakes Educational Cooperative

Mr. Giebler’s 2nd grade students from Scranton

Attendance Center

Linda Baker Nobles, MS, OTR/L

Gloria Bowersox, SLP