2. Sensory Processing 101 Implications of Sensory Challenges in ASD Chris Filler Transition Coordinator Ohio Center for Autism and Low Incidence

3. Sensory Processing challenges can influence how students respond to: –Environment –People –Instruction/Tasks/Activities Understanding these influences leads to the selection of effective interventions

4. What is Your Response to……  Cold shower  Wool clothing  Panty hose  Sweatpants  The feel of Jell-O in your mouth  The sound of birds  Bright colored walls in the bedroom  The smell of perfume  Elevators  Roller Coasters

5. Sensory Processes Sensory Processes include: Sound/Auditory Sight/Vision Smell/Olfactory Taste/Gustatory The Power Senses Touch/Tactile Vestibular Proprioception

6. 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

7. A Process by which we: 1

8. “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

9. 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

10. Sensory Processing Gone Astray Unable to touch many items, picky eaters Explores the environment by touching everything

11. 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

12. Review of challenges/characteristics….. Slow Processing - Difficulty shifting attention Inattentive, Difficult to arouse Does not like change or transitions - Rigid – Demands routine

13. 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

14. Aggression to self or others Compulsive Behaviors Difficulty with clothing, type of clothing, and change of clothing

15. 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

16. SEEKER Heightened Awareness with Low Sensitivity to Stimulation Will Seek Out Input (Frequently and Intensively Moving, Jumping, Spinning, Touching) ACTIVE AVOIDER High Awareness, with High Sensitivity and Active Responses. Will actively avoid (Searching out Escape Areas, Covering ears/eyes, Aggression to “Protect” self) UNDER-RESPONDER Poor Awareness & Low Sensitivity to Stimulation. Misses Environmental Cues Slow Processing (Acts as if does not hear, misses gestures and cues, sedentary) OVERWHELMED Heightened 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

17. SEEKER Heightened Awareness with Low Sensitivity to Stimulation Will Seek Out Input (Frequently and Intensively Moving, Jumping, Spinning, Touching) ACTIVE AVOIDER High Awareness, with High Sensitivity and Active Responses. Will actively avoid (Searching out Escape Areas, Covering ears/eyes, Aggression to “Protect” self) Seeker Active Avoider Seeker and Active Avoider can appear similar Both may move frequently Seekers are looking for the stimulation Avoiders are attempting to escape the stimulation

18. UNDER-RESPONDER Poor Awareness & Low Sensitivity to Stimulation. Misses Environmental Cues Slow Processing (Acts as if does not hear, misses gestures and cues, sedentary) OVERWHELMED Heightened 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-Responder Overwhelmed Under-Responder and Overwhelmed 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

19. SEEKER Heightened Awareness with Low Sensitivity to Stimulation Will Seek Out Input (Frequently and Intensively Moving, Jumping, Spinning, Touching) ACTIVE AVOIDER High Awareness, with High Sensitivity and Active Responses. Will actively avoid (Searching out Escape Areas, Covering ears/eyes, Aggression to “Protect” self) UNDER-RESPONDER Poor Awareness & Low Sensitivity to Stimulation. Misses Environmental Cues Slow Processing (Acts as if does not hear, misses gestures and cues, sedentary) OVERWHELMED Heightened 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

20. Work Sheet Which is your student/child? Identify the sensory type (or types) that you observe to be true of your student or child

22. The “Sensory Diet” includes…. PROVIDING SENSORY EXPERIENCES combination of sensory experiences adaptively interact –A combination of sensory experiences needed by a person to adaptively interact with the environment (“make it through the day”). MAKING ENVIRONMENTAL MODIFICATIONS decrease stress –Modification and organization of the environment in order to decrease stress on a fragile sensory system.

23. 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

24. Creating The Sensory D.I.E.T. D …..Do an Informal Assessment I …..Individualize E …..Environmental Supports T …..The Power Senses

25. D o an Informal Assessment Assess the Environment and the Individual’s response to a variety of sensory experiences Seeker? Active Avoider? Under-Responder? Overwhelmed

26. I ndividualize the Sensory Diet What has worked for one person may not work at all for someone else!

27. SEEKER Provide sensory experiences frequently & proactively May need to limit excitatory experiences ACTIVE AVOIDER Modify the environment to reduce the need to escape Gentle introduction to new experiences UNDER-RESPONDER Increase the use of visual supports and routines. Structure the environment. Time to respond Careful encouragement to try new experiences OVERWHELMED Control the environment Limit stimulation Limit change but prepare for changes when they need to occur. Considerations for the Sensory Diet

28. E nvironmental Supports Other People Organization Predictable, Structured, Consistent Environment Task or Curriculum Visual Supports Escape Environments

29. T he Power Senses Vestibular –Movement Proprioception –Input through joints and muscles Tactile –Deep Pressure Touch

31. 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 Hanshu www.sensoryprocessing.com

32. Proactively Schedule Sensory Activities throughout the day Use the Power Senses throughout the day in order to help a person alert, attend, act, and react non-contingent on behavior! Activities should be non-contingent on behavior! At times, additional activities or input may be needed based on the behaviors observed

33. The Power Senses Tactile System Proprioceptive System Vestibular System

34. The Power Senses Tactile System

35. Two Tactile Systems

36. Tactile System Pertains to the sense of touch Alerts to danger Gives body boundaries Helps provide a basis for body image

37. Protective System  Activates “Fight, Fright, or Flight”  Born with this system- “Primal”  Stimulated by light touch, pain, temperature  Processed through the emotional, excitatory portion of the limbic system  NOT a cognitive response

38. Discriminative Pressure Touch Deep touch/pressure, and vibration Activates Parasympathetic System Calms and organizes Allows for more cognitive response Helps us learn and think

39. 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

40. - S ensitive 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…

41. Interventions for Tactile Defensiveness Brushing Protocols – Wilbarger Protocol – PRR Brushing 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

42. Program Supports Specific to Tactile Challenges

43. 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”

48. The “Front Porch”

49. Quiet Sensory Area

50. Other Tactile Supports

51. Choose carefully…..

52. 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

54. 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

55. The Power Senses Proprioceptive System

56. 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

57. Motor Planning Awareness of body in time and space without constant visually monitoring Proprioceptive System

58. 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

59. What Happens when Proprioception Occurs? How Does it Work?

61. Activities that Provide Proprioceptive Input Joint compression or extension “Heavy work” activities The larger the joint, the more proprioceptive input

62. 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”

63. 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

64. Organizational Supports Visual Supports Color coding Timers/Watches Written directions Written rule reminders

65. What Can Others Do –Stay on schedule –Pace language –Use Concrete Language –Use Wait Time

66. The Power Senses Vestibular System

67. 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.

68. The brain needs vestibular input in order to function Vestibular input provides the Strongest Sensation

69. 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.

70. Hyper-sensitive Active Avoider and Overwhelmed 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

71. 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-sensitive Hypo-sensitive Under-Responders and Seekers

72. 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

73. Selected Strategies Swinging Rocking Chair Sit & Spin/Dizzy Disc Therapy Balls as Chairs Moveable Cushions or Deflated Beach Balls as Chair Cushions

74. 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 completion! Selected Strategies

75. 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!

76. Environmental Supports Firm Supportive seating Feet on floor Desk and chair that fit Railings on step Cushion for movement Space to move and pace and stretch or Items within comfortable reach and area.

77. Alecia Video Example “Monday”

78. Creating The Sensory D.I.E.T. D …..Do an Informal Assessment I …..Individualize E …..Environmental Supports T …..The Power Senses

79. 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?