Transcript What is Sensory Processing? - Ohio Center for

Sensory Processing 101
Implications of Sensory Challenges in ASD
Chris Filler
Transition 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……
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
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”
• 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
Overly alert, unable to attend
Delays in processing and shifting attention
Cannot stay focused …
attention shifts continually
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
UNDER-RESPONDER
SEEKER
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 with
Low Sensitivity to Stimulation
Will Seek Out Input
(Frequently and Intensively
Moving, Jumping,
Spinning, Touching)
Summary of
Processing
Challenges
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)
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 and
Active Avoider
can appear similar
•Both may move
frequently
•Seekers are looking
for the stimulation
•Avoiders are
attempting to escape
the stimulation
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)
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
UNDER-RESPONDER
SEEKER
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 with
Low Sensitivity to Stimulation
Will Seek Out Input
(Frequently and Intensively
Moving, Jumping,
Spinning, Touching)
Summary of
Processing
Challenges
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)
ACTIVE AVOIDER
High Awareness, with
High Sensitivity and Active
Responses. Will actively avoid
(Searching out Escape Areas,
Covering ears/eyes,
Aggression to “Protect” self)
The “Sensory Diet” includes….
• PROVIDING SENSORY EXPERIENCES
– A combination of sensory experiences
needed by a person to adaptively interact
with the environment (“make it through the
day”).
• MAKING ENVIRONMENTAL
MODIFICATIONS
– Modification and organization of the
environment in order to decrease 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!
UNDER-RESPONDER
Increase the use of
visual supports and routines.
Structure the environment.
Time to respond
Careful encouragement to
try new experiences
SEEKER
Provide sensory
experiences frequently &
proactively
May need to limit
excitatory experiences
Considerations for the Sensory
Diet
OVERWHELMED
Control the environment
Limit stimulation
Limit change but
prepare for changes
when they need to occur.
ACTIVE AVOIDER
Modify the environment
to reduce the need
to escape
Gentle introduction to
new experiences
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
To“fill the
sensory
bucket”
quickly use
the Power
Senses
Vestibular
Input
Three Power Senses
will provide:
• more input
•more quickly
•to make changes
that are more rapid
Proprioceptive
Input
Tactile Input
Taste,
Smell,
Vision,
Auditory
Based on Work of Bonnie Hanshu
www.sensoryprocessing.com
Proactively Schedule
Activities
Sensory
• Use the Power Senses throughout the day in order to help a person
alert, attend, act, and react
• Activities should be non-contingent on 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, temperature
 Processed 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
Tactile Defensiveness is when…
- Sensitive to light touch
- Touch causes difficulty
organizing
behavior and
concentration
- Touch causes negative emotional responses
- Can become aggressive, if feeling threatened or
stressed
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
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 Area
Other Tactile
Supports
Choose carefully…..
Other Tactile Supports
• Consider the type of clothing and
the way it fits
– Tight?
– Loose?
– Fabric?
• Body Sock
Remove
tags from
clothing
• Swimming/Water Play
People Supports: What Others Can Do
• Avoid unnecessary touch
and Ask Permission
• Avoid touching face to gain attention
• Move slowly and
“Waiting Time”• When touch is necessary, use
Pressure Touch
provide
up to 10
seconds
Deep
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
Proprioceptive System
Motor Planning
Awareness of body in
time and space without
constant visually monitoring
Dysfunction of Proprioceptive System
• Clumsiness, a
tendency to fall
• Disorganized…..
Materials & Thoughts
• Lacks awareness of
body position/odd
posture
• Poor or resistance to
handwriting
• Difficulty with small
objects (buttons/
snap)
• Resists new motor
movement activities
• Eats in a sloppy manner
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
ear
The vestibular system refers to
structures within the inner
(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-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
Hypo-sensitive
Under-Responders and Seekers
• 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
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
Selected Strategies
• 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!
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?