sensory processing 101 implications of sensory challenges in asd chris filler transition coordinator...
TRANSCRIPT
Sensory Processing 101Sensory Processing 101
Implications of Sensory Challenges in ASD
Chris FillerTransition 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……What is Your Response to……Cold showerWool clothingPanty hoseSweatpantsThe feel of Jell-O in your mouthThe sound of birdsBright colored walls in the bedroomThe smell of perfumeElevatorsRoller 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”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
Cannot stay focused … attention shifts continually
Overly alert, unable to attend
Delays in processing and shifting attention
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
SEEKERSEEKERHeightened Awareness with
Low Sensitivity to StimulationWill Seek Out Input
(Frequently and Intensively Moving, Jumping,
Spinning, Touching)
ACTIVE AVOIDERHigh Awareness, with
High Sensitivity and Active Responses. Will actively avoid(Searching out Escape Areas,
Covering ears/eyes, Aggression to “Protect” self)
UNDER-RESPONDERPoor Awareness & Low Sensitivity to Stimulation.Misses Environmental CuesSlow Processing (Acts as if does not hear, misses gestures and cues, sedentary)
OVERWHELMEDHeightened awareness, High Sensitivity but lacks active response, Can become easily overwhelmed.( Complains of things “bothering”Frequently anxious/upset,overreacts to small changes in the environment)
Summary of
Processing
Challenges
SEEKERSEEKERHeightened Awareness with
Low Sensitivity to StimulationWill Seek Out Input
(Frequently and Intensively Moving, Jumping,
Spinning, Touching)
ACTIVE AVOIDERHigh Awareness, with
High Sensitivity and Active Responses. Will actively avoid(Searching out Escape Areas,
Covering ears/eyes, Aggression to “Protect” self)
SeekerSeeker and Active AvoiderActive Avoider can appear similar
•Both may move frequently
•Seekers are looking for the stimulation
•Avoiders are attempting to escape
the stimulation
UNDER-RESPONDERPoor Awareness & Low Sensitivity to Stimulation.Misses Environmental CuesSlow Processing (Acts as if does not hear, misses gestures and cues, sedentary)
OVERWHELMEDHeightened awareness, High Sensitivity but lacks active response, Can become easily overwhelmed.( Complains of things “bothering”Frequently anxious/upset,overreacts to small changes in the environment)
Under-ResponderUnder-Responder and OverwhelmedOverwhelmed can also have some similarities
•May not appear as “sensory needy” as the
seeker/avoider
•Overwhelmed are vigilant and will have anxiety to the environment and will
resist change
•Under-responders also may not respond to environmental cues,
however due to lack of awareness and not
vigilance
SEEKERSEEKERHeightened Awareness with
Low Sensitivity to StimulationWill Seek Out Input
(Frequently and Intensively Moving, Jumping,
Spinning, Touching)
ACTIVE AVOIDERHigh Awareness, with
High Sensitivity and Active Responses. Will actively avoid(Searching out Escape Areas,
Covering ears/eyes, Aggression to “Protect” self)
UNDER-RESPONDERPoor Awareness & Low Sensitivity to Stimulation.Misses Environmental CuesSlow Processing (Acts as if does not hear, misses gestures and cues, sedentary)
OVERWHELMEDHeightened awareness, High Sensitivity but lacks active response, Can become easily overwhelmed.( Complains of things “bothering”Frequently anxious/upset,overreacts to small changes in the environment)
Summary of
Processing
Challenges
The “Sensory Diet” includes….
• PROVIDING SENSORY EXPERIENCES– A combination of sensory experiencescombination of sensory experiences
needed by a person to adaptivelyadaptively interactinteract with the environment (“make it through the day”).
• MAKING ENVIRONMENTAL MODIFICATIONS– Modification and organization of the
environment in order to decrease stressdecrease 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!
SEEKERProvide sensory experiences frequently & proactivelyMay need to limit excitatory experiences
ACTIVE AVOIDERModify the environment to reduce the need to escape Gentle introduction to new experiences
UNDER-RESPONDERIncrease the use of visual supports and routines. Structure the environment. Time to respondCareful encouragement to try new experiences
OVERWHELMEDControl the environmentLimit stimulation Limit change but prepare for changes when they need to occur.
Considerations for the Sensory
Diet
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
Vestibular Input
Proprioceptive Input Tactile Input
Taste, Smell, Vision, Auditory
To“fill the sensory bucket”
quickly use the Power
Senses
Three Power Senses will provide:• more input
•more quickly •to make changes
that are more rapid Based on Work of Bonnie HanshuBased on Work of Bonnie Hanshuwww.sensoryprocessing.comwww.sensoryprocessing.com
Proactively Schedule Sensory Activities
• Use the Power Senses throughout the throughout the dayday in order to help a person alert, attend, act, and react
• Activities should be non-contingent on non-contingent on behavior!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, temperatureProcessed 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
- Sensitive to light touch- Touch causes difficulty
organizing behavior and concentration
- Touch causes negative emotional responses
- Can become aggressive, if feeling threatened or stressed
Tactile Defensiveness is when…
Interventions for Tactile Defensiveness
• Brushing Protocols– Wilbarger Protocol
– PRRBrushing 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 AreaQuiet Sensory Area
Other Tactile Supports
Choose carefully…..Choose carefully…..
Other Tactile Supports
• Consider the type of clothing and the way it fits– Tight?– Loose?– Fabric?
• Swimming/Water Play
• Body Sock
Remove tags from
clothing
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
Motor Planning
Awareness of body in time and space without constant visually monitoring
Proprioceptive System
Dysfunction of Proprioceptive System
• Clumsiness, a tendency to fall
• Lacks awareness of body position/odd posture
• Difficulty with small objects (buttons/ snap)
• Disorganized….. Materials & Thoughts
• Poor or resistance to handwriting
• Eats in a sloppy manner
• Resists new motor movement activities
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– Keyboarding– Software – Set of notes– Grips– Velcro on Shoes
• Alternatives & Accommodations– Options in Word and
PowerPoint
• 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-sensitiveHyper-sensitiveActive Avoider and Active Avoider and
OverwhelmedOverwhelmed• 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
• 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
Hypo-sensitiveHypo-sensitive Under-Responders and Seekers
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
• 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 Non contingent on behavior or work
completion!completion!
Selected Strategies
Remember……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?