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Autism and Sensory Integration

Understanding a child with autism's world, and what to do to improve communication, sensory regulation and relationships

Laura Latimer

on 20 November 2013

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Transcript of Autism and Sensory Integration

Autism =
Special, Unique World that is full of awesomeness

What are our goals for today?
Who am I?
My name is Laura
I'm an occupational therapist, a photographer, and a lover of life and learning
I graduated with my masters in OT from Texas Tech University
I moved to Australia and specialized in Autism, communication and sensory integration in children. That's when I found my passion in OT!
After today you will know about:
1. Signs of Autism
2. Sensory Integration and Regulation
3. Improve reading a child's behaviors as communication
4. Fostering self regulation in children with regulation challenges
5. Improve how to react to difficult behaviors
What is Autism?
It's a Sensory World
3 Things Doctors Look for to make a Diagnosis:
1. Delays in communication including his understanding of language (receptive) and his use of language (expressive)

2. Resistance to change and repetitive behaviors

3. Delays in the development of social interactions

Must have all three to be diagnosed
Communication Delay Examples
Doesn't use gestures, eye contact to get what they need. (like pointing, looking at you and then the toy and then back to you)
Does not engage in pretend play- doesn't feed baby doll, doesn't have conversation sounds during babble
Has trouble understanding simple instructions- "give the block to me"
Resistance to Change and Repetitive Behaviors Examples
Repetition of words, sounds or actions
Has an intense interest in certain objects- becomes stuck on particular toys
focuses narrowly on objects and activities such as turning the wheels on a toy car
Repetitive movements
easily upset by change - must follow routines
Repeats body movements or has unusual body movements like back arching, hand flapping, and walking on toes.
Examples of Delays in Social Interactions
Doesn't consistently respond to name
Doesn't smile at caregivers
Doesn't wave bye bye
Doesn't show interest in other children
Decreased eye contact
2 other very important core symptoms that doctors look for to make a diagnosis:
1. Unusual Sensory Responses

2. Difficulty with motor planning
Unusual Sensory Responses
Meaning the child's (or adult's) sensory perceptions are disordered.
This symptom is the most pervasive and debilitating symptom over all the rest, and the most crucial to understand today
It means that ordinary sights, sounds, touch, and tastes of everyday (that you may not even notice) can be downright painful, confusing, anxiety provoking and scary.
Difficulty with Motor Planning
The ability to use hands and body in a skilled task, like using a pencil or fork, getting a drink of water, etc.
Difficulty with planning, fine tuning, sequencing and timing body movements
New activities need more skills than routine activities
Motor planning requires accurate processing of sensory information
Every child is very different, the saying goes..
"If you've met one child with autism, you've met one child with autism."
This is a spectrum, and kids that have the diagnosis of autism are very different from each other.
1. 75% of children with Autism have mental retardation
2. Autistic children are unable to experience empathy
Medical Issues:
1. GI Issues- leaky gut/digestion
2. Hyper Activity
3. Sleep Problems
4. Epilepsy in approximately 1/3 of kids with Autism
•Hearing •Vision •Touch •Taste •Smell •Vestibular •Proprioceptive •Interoception
Hyper Responsive (Over Sensitive)
Hypo Responsive (Under Sensitive)
How to figure out someone's Sensory Profile
Over Responsive:
May hear an airplane long before anyone else
Often cover ears, which may hurt frequently or turn red
Difficulty at transitioning from quiet to loud environments
Difficulty tolerating and/or easily startled by loud noises
Fear of vacuums, sirens, toilets, coffee grinder, etc
Under Responsive:
Doesn't Seem to notice someone speaking directly to him
Doesn't look around for the source of sounds
Often misses noises that are alarming to others
Crave loud noises
Likes to hum and make noise
Auditory Processing is a challenge for most kids on the spectrum. It involves understanding speech (receptive) and using speech (expressive)
Receptive Language: Requires proper functioning of the ear and proper connections to the brain.
Many times ASD children will have trouble processing foreground noise, but are able to process noise in the background.
Over Responsive:
Avoids direct eye contact
Difficulty tolerating bright lights
May squint at ordinary light
Distracted by florescent lights

Under Responsive
Bumps into moving objects
Delayed response to visual Information
Often seem to miss what is right in front of you

Seeks visual stimulation (finger flicking, bright lights, direct sunlight, staring at moving fans, wheels)
Not unusual to see things nearly twice as far away- making it hard to focus on relevant information
Spacial relations are challenging - ie navigating stairs, doorways
Focus on details over big picture
Some kids have the uncanny ability to absorbed enormous amounts of info with just one glance
Prefer watching mouths over eyes
Over Responsive:
Dislikes being touched especially light touch or gentle caress
Dislikes nails being cut, or hair washing
Avoids touching messy substances
Complains about tags or seams in clothing

Under Responsive:
Falling hard with no reaction
Not always aware of touch
Don't notice when hands, face, or other body parts get dirty or wet

Bumps into people or furniture to get physical contact
Seeks out messy substances
We have two types of touch sensors in our body- one for deep pressure and one for soft pressure. An ASD child could be oversensitive to one and seeking to the other (ie hates labels in shirts but craves deep pressure)
Over Responsive:
Aversion to certain tastes
Avoids certain textures
Gags often
Complains of strong odors, or odors that others do not smell

Under Responsive:
Eats most food with no reaction
No response to offensive odors

Licks non food items
Seeks items to go into mouth
Sniffs everything (eg hair and clothing)
Kids with ASD are known to be picky eaters- usually craving same foods, especially salty items and carbs
Their tongues may be oversensitive- a small lump in potatoes could cause a gag reflex or for the child to spit the food out.
Over Responsive:
Tantrums easy over hunger or thirst
Prefers wearing as little clothing as possible
Distressed by hunger, thirst, bladder or bowel sensations

Under Responsive:
Unaware of hunger, thirst, toileting needs
Will continue to eat when not hungry
May often go without eating or drinking because of failure to notice these sensations
Oblivious to body temperature

Craves strong tastes- very spicy or sour
Prefers baths and foods to be very hot or very cold
Over Responsive:
Avoid physical activities, such as sports, that may involve lots of running, jumping, crashing, etc
Have difficulty tolerating other people moving your body and hugging you

Under Responsive:
Poor body awareness
Low levels of energy and arousal, will usually prefer sedentary monotonous tasks
Often have floppy or poor posture

Bumps and crashes into objects and people
Rubs hands on table
Lays body on floor
Craves deep pressure (activities that require pushing and pulling, being squeezed)

Over Responsive/Sensitive
avoids, dislikes playground equipment, stairs, escalators
fear of falling, even with no risk
startled if someone else moves them
avoids swings, tire swing on playground
Easily made dizzy, very sensitive to dizziness, or may feel as though your body is moving even when it isn't

Under Responsive:
unlikely to try to protect themselves by putting their arms out
Don't seem to get dizzy
Don't mind, or don't even seem to notice being upside down or sideways

craves fast, spinning, and/or intense movement experiences
loves to swing as high as possible and for long periods of time
rocks body, shakes leg, or head while sitting
A specialized sensory nerve receptor that receives and responds to stimuli originating from within the body.
The ability to sense the position and location of your body and its parts.


Mono Processing
The neurological process that organizes sensations in the brain
The ability to regulate our responses proportional to the sensory stimuli.
If someone is only able to process with one sensory mode at a time- think about asking a child with this to look at my eyes (visual) and listen (auditory), they can't do both.
The Dance of Communication
Rhythm and Timing
Motor planning
When all these systems are not coordinated to orchestrate this dance, we make missteps
Non verbal cues
Intonation (Sarcasm, bullying, empathy)
Flow of Conversation (timing)
How Can We Help?
Give more time for processing
Be direct, specific. Remember these kids are very literal
Do not jump in and fill in the pause or re frame the question too soon
WAIT for response expectantly
MATCH his pace, this starts beautiful two way communication
With practice his speed and processing time will improve
Model appropriate things to say to a peer during play
Label what others are doing to help expand his understanding of the big picture
Give TWO choices and wait
The environment (Too loud, too busy, too bright, etc).
Tone of voice (calm vs high energy)
Affect (Use your voice to draw child in)
Look at his non verbal communication- this is communication.
Say what you see narrative style. Help him know what he is doing and what you think that means. Give him time to process. (e.g. Your arms are crossed and you are not participating today, your body is telling me you are upset. Are you upset? (And wait expectantly- let him process)
If the environment is loud and busy, interact in a calm and soothing manner.
Think about...
Our main goal today is to give you new skills and understanding when working with kids with sensory and communication challenges.
Peer Relationship

Help him initiate
Label what his peers are doing to draw him out of his world and see more of the big picture
I wonder where...
I wonder what... to help with initiating without telling him what to do
Why is this an important skill?
If a child/adult is unable to make sense of the world around him, then he will have problems with responding to his environment and to the people around him
Behavior as Communication
Often we focus too much on redirecting or stopping behavior instead of looking for the intended purpose
For individuals with autism, behavior may be the only means by which they have to communicate a need or frustration.
First- you must understand what you are feeling (Z.O.R)
Second- How much are you feeling this? (5-point scale)
Third- Why? What are my triggers? (Higher level)
Fourth- How to get back to 'green'- feeling good and focused again? (Sensory tool box)
By the time the kids get here they have already had a long exhausting sensory day, Ala Costa is a great time for reflection and practice in using the tools
Our balance system and our sense of spatial orientation,. It provides information related to movement and head position and is important for development of balance, coordination, eye control, attention and being secure with movement. In our inner ear.
Sensory Processing
People with Sensory Processing Disorder (SPD) misinterpret everyday sensory information, such as touch, sound and movement.
When there is a Sensory Processing dysfunction, it is hypothesized that the brain does not process or organize the flow of sensory impulses in a way that gives the child precise information about themselves and their world.

As a result, learning can be difficult and children may feel uncomfortable, or have difficulty coping with the stress of daily sensory and organizational demands. This often results in additional or behavioral difficulties.
What Goes in Effective Communication
Challenges for children
with Autism:
"Bad" Behaviors: Biting, mimicking, screaming/yelling, scripting, tantrums, covering ears, head banging, invading other's space
Kids that struggle with self regulation
Who is the Z.O.R. for?
His sensory system is often in chaos: neurons are consistently misfiring and many of the systems are overwhelmed
They have poor self awareness and poor coping skills = disregulation
This majorly contributes to behaviors
When a child misbehaves or displays bad behavior
they are having trouble controlling their sensory experience and emotions and
the demands of the environment exceeds their current abilities to cope
Screaming may not be effective, but it may be all a child can do to cope.
3 Questions to ask...
1. Is there any pain?
2. Is there sensory chaos?
3. Is there emotional stress?
Eg: Stimming could be relieving a pain or an ache
How you can respond to 'bad' behavior:
1. Tell a child to stop, however you MUST give a substitute behavior if you do this
2. Distraction- hugs, tickles, redirection
3. Ignoring- if the child is doing it for a reaction

What I would encourage you to do:
1. Positive reinforcement of the behaviors you want to see- say very specifically what you like, use visuals if you need to
2. Instruction and direct teaching- what is obvious to a typical child is not to a child with autism
3. Change the sensory input
Key to changing the sensory input:

Find the trigger!

We must be detectives and see beyond the behavior
Important: We must replace the sensory need with the same sensory intensity
Eg- if someone is biting their hand we must replace with a safer alternative that will match that intense sensory propioceptive feeling
Be realistic,
change your expectations
Set small, specific goals
Notice the positive: Label it, name it, praise it
Remember there are no quick fixes- it takes a while, minimum of 22-66 repetitions for a new neural pathway to be ingrained for someone off the spectrum!
...and thus behaviors become major communication mechanism
Autistic World:
Think of a radio with a lot of different channels coming in at once
Self Regulation: the ability to stay calmly focused and alert, which often involves – but cannot be reduced to – self-control.
The better a child can stay calmly focused and alert, the better he integrates the diverse information coming in from his different senses, assimilates it, and sequences his thoughts and actions.
The better a child can self-regulate, the better she can rise to the challenge of mastering ever more complex skills and concepts.
When to use

-As each kids walks in
-When a kid is feeling disregulated throughout the day. Note: A tantrum is too late. For higher level processing a child must already be around the green area. During tantrum/outburst help regulate with sensory needs. Help child process after.
-Use the ZOR language throughout the day: remember to not make green "good"- all are good descriptors to help us understand how we feel.

Ear Plugs
Go to the cozy corner
Calming or Alerting Music
Get the child's attention before speaking
Speak slowly and clearly
Give one instruction at a time in simple language
Pair instructions with gestures or visual demonstrations whenever possible
Change the volume of your voice
Allow extra time for the child to process the information and
Place child away from sources of noise such as the doorway, air conditioner, sink, bathroom, etc.
Tool Box
Tool Box
Sunglasses -dark or lightly tinted
Sit in Cozy Corner
Put on a baseball cap
Reduce clutter and a "busy" room appearance
Give less options
Reduce clutter on calendars
Have a simple, visual schedule each day
Fidget toys
Brush for skin
Vibrating toys
when touching the tactile-defensive child, always approach from the front (no surprises) and use a firm touch, never a light touch.
allow child to sit in the periphery of a group so that others are not behind him/her
define personal space with carpet squares or tape on the floor
Sip liquids through a sports bottle
Chewy foods
Crunchy foods
surgical tubing, fish tank or refrigerator tubing
"Chewelry" or rubber tubing as a necklace
scented cotton balls
Hold a vibrating toy or toothbrush around, or in, the mouth
Substitute inappropriate mouthing with one of the above
Weighted vest
Heavy Work Activities
Tug of War
Deep "bear" hugs or massages
Squeezing clay, play doh or therapy putty
Bean bag chair
Wrap up in a blanket
Deep pressure with pillows or ball
Animal crawls
Chair push ups
Wall push ups
Jumping Jacks
Finger Pulls
Jumping 20x
Spinning 20x
Playground - tire swing circles
Animal Walks
Jump Rope
Bouncing on swiss ball
Interestingly, many of the same heavy work activities that help reduce hyperactivity in children also help to engage children who appear tired or floppy.
Parents, lets learn a bit 'o their sensory world
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