Hyper & Hypo Sensory Challenges

Here I am writing about the sensory challenges for children and adults living with autism; Sensory Integration Therapy (SIT), what it is and how and why it can help some children with autism who have hyper and hypo-sensitivity issues.

My daughter had 9 months of Sensory Integration Therapy. When she started she was not able to be placed in an open ended play barrel. By the time her sessions ended she was happy to be put in to the barrel and a sheet placed over the top which also made it darker.

In my opinion it is important to stay with your child during their therapy sessions, if they are happy for you to do so, as you can learn why the therapist is doing things and what areas of your child's difficulties are being addressed. This way you can think of ways to adapt the activities at home and continue them to get the best out of the therapy for your child. I would use some of the strategies I learned in the local park on the swings, in the soft play venues we visited and anywhere else I found the opportunity.

How does sensory overload happen?

All our sensory input comes from all our senses both internally and externally, vision - our eyes: what we see, imagine and visually remember; auditory - our ears: what we hear, say to ourselves in our heads (think) and remember what we heard; kinaesetic - our feelings: what we touch,  memories of touch and the sensations we fill inside our bodies; olfactory - our smell: what we smell, remember we smelt; gustatory - our taste : our sensations of taste and memories of what we have tasted. Somatic (movement);balance and spatial sensory feedback/input also comes from the body to the brain as well as emotional feedback from the heart and instinctive feedback from the gut; both of which have neurons and communicate to the 'head' brain.

These sensory inputs are transported to parts of our brain called the Cerebellum and the Thalamus where it is normally filtered and in an instant the thalamus knows whether we have time to reason and logically consider or whether we need to fight, run or freeze. If we are in danger the signals get sent to the Amygdala which is the oldest, in evolution terms, reptilian part of our brain and we will automatically fight, run for our life or freeze. If we have time to logically consider and make a decision, the Thalamus sends the sensory information to our prefrontal cortex where our 'executive functioning' happens and we will have time to think what is the best action to take (O'Malley, 2015; James, 2013).

There is evidence to suggest, that in children and adults with ASD, the cerebellum and Thalamus are not 'filtering' the sensory input sufficiently and therefore all the sensory information is flooding the Thalamus at times and when this happens, its repsonse is to send a signal to the amygdala which creates a flight, fight or freeze behavioural response in the person and this is one 'autistic' behaviour often described as either a meltdown or a tantrum or something else others describe based on what they are observing from the person reacting to this sensory overload.

Other sensory feedback and behaviours:

Hypo-sensitivity is reduced sensory feeback to the brain and this is one reason you will sometimes observe some behaviours such as hand flapping, finger flicking infront of the person's eyes and other behaviours to stimulate feelings of spatial awareness, calmness and other sensory experiences. 

What helps?

As mentioned above, my daughter had nine months of sensory integration therapy by an occupational therapist which really made a difference to her sensory processing. I stayed with her and the therapist whilst he worked with her and learned what he was doing and why during the sessions so I could adapt the exercizes into our everyday life. I highly recommend this, staying with your child as often as you can during all therapies and interventions. This included, using similar techniques at the local park and in our garden on the swing and slidefor example; adapting the home environment where necessary but not exclusively for her (because the aim is to de-sensitize the child graudually not make it impossible for them to be included in everyday environemnts!). Gradually desensitizing her to things she found overwhelming by exposing her to it very very slowly in very small steps and at her pace to enable and empower her to become included in every aspect of her environment and our family and her childhood and now adult life.

It is also important to give a simple running commentary of what your child/adult is experiencing and only in the same amount of words they can use. no words to one word would mean you use one word! two=two and so on and so forth. When you do this you are connecting and associating auditory sounds to their experience which will enhance their understanding and later their communication. If your child/adult uses Makaton (or another sign language), use this too. However your child/adult is repsonding to communicating, use that to associate their experinces with language.

When the sensory overload is not too severe and the child is not totally absorbed in it,a weighted waist jacket can help. The weight of the jacket on the shoulders can have a calming effect on the connecting spine which can dampen the heighted stimuli travelling to the Thalamus and will have a claming effect on the person; enabling them to feel more grounded. Weighted blankets are also useful for calming, just like the pressure from the cattle hold that Temple Grandin felt calmed her. The weight of the weighted waist jacket can also have a 'grounding effect' on the child/adult.

Creating a muddle free and structured environment at home and in the classroom will also help reduce over-sensitivity and related behaviours. Using non-fluorescent lighting will help as well because children and adults with autism can often see the flickering that the typical eye cannot and hear the buzzing the typical ear cannot and this is very distracting, and sometimes even painful; especially for a person being asked and expected to 'pay attention' in the classroom or work environment where there are likely many other sensory distractions as well. Over head projectors and other electrical equipment which generate noise can also often be heard by a person with autism and may need to wear a pair of sound reducing headphones to muffle this.

Stong odours, perfumes and other scents can be overwhelming and the same is true for taste and textures. Some children may gag on pulses, peas or any other foods because they cannot bare the texture, taste, smell or sensation in their mouth. Some children will notice that their teacher is not 'smelling the same' as they usually do (because they have changed their perfume) and this can unsettle or confuse them and can set off a display of behaviour which others cannot relate to anything specific. 

A person with autism can have very sensitive skin and what may feel comfortable to you, will feel sratchy to them or the label or stitching may have a scratchy feel on their skin but because they cannot tell or describe this to you, can only communicate through their behaviour that something is uncomfortable.

This is the reason I call the 'autistic' behaviours, communicating behaviours. When you cannot verbally communicate or use written text to communicate, you can only show through your behaviour what you are experiencing.

My suggestion for what appears to be unknown, sudden, 'out of the blue' behaviours is to keep a diary and make notes to consider:

• the environment (where the behaviour took place)
• the time (when the behaviour happened)
• what happened prior to the behaviour
• what does it look like the person is trying to communicate through the behaviour
• who was with them at the time
• what was different in the environment or about the person with them

You may be able to see a pattern and make any necessary adjustments to prevent the situation occuring again.

References:

JAMES, J. (2013). Genes/Environment Interactions. [on-line] Available from: https://www.youtube.com/watch?v=dKQ4gMEhSmk&list=PLQG9JDezq1z3qrMgiTEqOjds_ILwm6F-7 [Accessed April 4th 2015].

O'MALLEY, A. (2015). The Art of BART. London. Karnac Publishing.