Beyond Fire Drills and Shirt Tags: Childhood Autism and the Other Sensory Sensitivities
Updated: Sep 24, 2019
These are often what we think of when we think of the Senses-The 5 Senses.
The tone for what we consider to be the senses was set by Aristotle who termed the senses as the “5 Outward Wits”. Since that period, we have considered the senses to be independently operating phenomena that arise from our interaction with the world outside of ourselves.
How we think of the senses is of crucial importance if we are supporting autistic children as challenges with regulating sensory input is a common occurrence in *autism. These challenges often result in sensitivities to various forms of sensory input.
*for a metanalysis of the prevalence of sensory problems in autism see Ben-Sasson, A., Hen, L, Fluss R., et al (2009).
Why Address Sensory Sensitivities
Sensory sensitivities often result in anxiety and distress. These feelings can contribute to behavioral challenges in children. Such feelings can also lead to avoidance of situations and, thus, interfere with functioning and independence.
In the anxiety management work that I do with autistic kids, I often find that sensory factors are a major contributor to anxiety and often impact personal growth. For example, it is not unusual for the teens that I am working with to report that they desire to be part of social situations but that they find the sensory factors involved in social settings (e.g. parties, playground) to be overwhelming and thus they avoid them.
My own observations are supported by the research. Hochhauser and Engel-Yeger (2010), for example, found a correlation between atypical sensory processing abilities and participation in social, physical, and informal activities.
Which Senses are Problematic for Kids on the Spectrum
As noted above, when we think of Senses we often think of the 5 traditional senses: hearing, sight, touch, taste, and smell. Indeed, there are times when sensory processing difficulties can be attributed to these senses in a fairly straightforward way. A classic example is the child who becomes distressed when the fire alarm goes off. In this case there is a clear trigger (the sound of the fire alarm) paired with a clear response (the child holding his/her ears and/or becoming noticeably distressed). However, in other cases, it’s a little less clear. For one thing, senses don’t always work in isolation. A good example of the interaction between senses is the case of food aversions. A child on the spectrum may be sensitive to eating certain foods for a combination of reasons: he/she may not like the way it looks, the way it smells, the way it tastes, and the texture.
The Other Senses
In addition to complex interactions between the traditional senses, there are other senses that can be problematic for autistic children. The traditional 5 senses pertain to our interaction with the external environment. However, neuroscience (and accounts from persons having sensitivities) demonstrates that our senses also include the ways in which we experience our bodily, internal environment. This includes senses related to body position and senses related to our internal states.
In regards to the experience of our body positioning we have:
Vestibular Sense: Our sense of balance.
Proprioception: The sense of the positioning of our body parts in relation to each other.
Kinesthesia: the sense of how our body is moving through space.
The experience of sensing our internal states is referred to as Interoception. In regards to our internal states there are a range of sensations we experience including (but not limited to):
· Barometric Pressure
· Sensing an oncoming illness
Interoception has drawn the attention of autism researchers and there is data indicating impaired processing in this area for autistic individuals (e.g. Fiene & Brownlow, 2015). Research evidence is corroborated by firsthand accounts from autistic adults. Such accounts have proven invaluable in terms of understanding the impact of sensory processing challenges.
How do we know if a child is experiencing sensory overload and how can we tell which senses are being impacted?
1) Ask. Children with more developed language ability may be able to express which kinds of stimulation they find to be aversive. However, it is important to bear in mind that sensory overload often involves multiple sensory channels and it may be difficult (for anyone) to fully explicate the different factors involved. Secondly, it is also important to remember that it may be difficult for a child or adolescent to convey the reason (s) for overload while they are distressed. It may only be afterward, when the immediate distress is alleviated, that the child can reflect on the factor or factors that were distressing.
2) Infer. For children with less developed language ability, we may need to infer sensory factors by observing signs of distress or behavioral changes. This often takes some detective work. Some sensory factors may be obvious (e.g. clear, immediate reactions to loud sound). Other factors, however, may be more subtle. Look for patterns and consistencies.
3) Awareness. Be aware that there are many different sensory channels. In addition to the research base, I find it useful to read first-hand accounts from autistic individuals through books, blogs, and social media postings. These help me to appreciate the many different sources of stimulation that may pose challenges for a child on the spectrum. Of course, sensory profiles are highly individualistic and what causes one person to be distressed may not cause another-but it helps to be aware of the range of possibilities.
What can we do to relieve distress from sensory overload?
1) Prevent or minimize exposure to distressing stimuli. In some cases, you may be able to eliminate or adjust adversive stimulation. Changes to the environment (for example, using more natural lighting, turning down noisy machines, buying soft clothing) can sometimes be of enormous help.
2) Help your child to anticipate challenging situations. Knowing that a potentially distressing event is coming up can help the child to prepare and will help prevent the child from being caught off guard. Although this won’t eliminate distress, it can help both child and support persons to problem solve for getting through the situation.
3) Teach and practice coping and problem solving strategies. It can help to develop strategies for dealing with sensory hypersensitivity. For example, when planning to go to a noisy, crowded event look for quiet areas beforehand. Encourage the child to use (or request to use) these areas as necessary. In addition, relaxation strategies can help to ease the anxiety that may occur in challenging sensory situations (Totally Chill: My Complete Guide to Staying Cool is a stress and anxiety management workbook that I have developed for kids with sensitivities and includes a range of relaxation strategies that children can use when distressed).
4) Work with a professional Occupational Therapist (OT) to develop overall sensory regulation skills. An OT can help to develop a plan that can be used consistently across home and school environments.
Sensory processing problems are prevalent in autism.
Sensory sensitivities can result in significant distress, contribute to challenging behavior, and impede functioning.
Our sensory systems extend beyond the traditional 5 Senses and include balance, movement, and internal sensations (interoception).
Awareness and strategies can help to mitigate the impact of sensory sensitivities.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of autism and developmental disorders, 39(1), 1-11.
Fiene, L., & Brownlow, C. (2015). Investigating interoception and body awareness in adults with and without autism spectrum disorder. Autism Research, 8(6), 709-716.
Hochhauser, M., & Engel-Yeger, B. (2010). Sensory processing abilities and their relation to participation in leisure activities among children with high-functioning autism spectrum disorder (HFASD). Research in Autism Spectrum Disorders, 4(4), 746-754.