At least three-quarters of children that have autism also have some form of Sensory Processing Disorder (SPD). My son is doing his best not to miss out on anything connecting with autism. So of course, he has SPD. It wouldn’t be right otherwise. It is important to note though that the reverse doesn’t hold true – most children with SPD do not have autism. The best way to distinguish ‘sensory’ issues from ‘autism’ issues is to get an evaluation for SPD from a qualified occupational therapist with sensory integration training.
There are two types of SPD – under-responsive (hyposensitive) and over-responsive (hypersensitive). If a child is under-responsive it usually means they need a lot of work to make them pay attention to something. I remember when Michael started at the Lizard Centre, they spent months pretty much chasing him around the room with balloons and bubbles. He ignored everything and continued trying to lick the windows. He spends a lot of time trying to ‘stimulate’ his own senses. Things like stepping on objects on purpose (usually important folders with lots of very useful documents) are his way of meeting his sensory needs. Michael also loves licking/eating everything. Some of his favourite things to taste the moment my back is turned are: sand, chlorinated water in a pool, and week old bread that I haven’t noticed in a corner under the table.
If a child is over-responsive it means they might be super sensitive to outside sensations such as noises, lights, or maybe particular fabrics. When Michael was a newborn, he was very sensitive to sunlight. He also went through a stage of hating sweaters of any sort and has an intolerance for any kind of blanket. For a while he was also sensitive to foods. Michael only ate bread and drank soy milk for a horrible few months before we really got into our food program.
Often, as you can see, a child with autism will display signs of both types of sensory issues. And of course I know that Michael being only moderate, we probably get off easy with the sensory issues. He has never had a problem in a crowded supermarket, for example. In fact, he loves noise, lights, and tends to run at busy roads with cars.
Michael also has other sensory issues to do with his ADHD (he didn’t want to miss any co-morbid conditions). So I know this is confusing, since ADHD and the under-responsive form of SPD have very similar symptoms. 40% of children with symptoms of SPD will also have symptoms of ADHD. But technically ADHD and SPD are different and distinct conditions. ADHD is better known and is commonly treated with medication. I have a post coming up about ADHD so stay tuned.
Common Interventions for SPD
It is important to understand that children with SPD are often academically gifted and talented. In fact, in a study of the Gifted and Talented Centre in Denver run by the Star Institute, they found that out of 550 children 33% had significant SPD symptoms.
Once diagnosed, children often benefit from occupational therapy with a regulation, relationship, and sensory integration (SI) approach. This is called the STAR model and is different form ‘pure SI’ or ‘DIR Floortime’ (a common autism intervention). The STAR model will usually happen in a special environment called the ‘OT gym’. During such sessions, an occupational therapist will guide the child through fun and challenging activities. The point of it is to create activities that will enable children to meet their sensory needs in a functional way. A large part of it is training parents to be able to tell when their little one needs sensory stimulation and give them strategies to deal with it.
It is important to note that sensory integration is not an approved early intervention method for autism. At most it can be part of an approach, usually being used more to redirect behaviour or when looking for rewards within therapy.
For more information about SPD, have a look at the website of SPD Australia.
ABA Therapy and Sensory Problems
Michael has not been going to an occupational therapist, but we have been applying similar principles within our ABA program. Meeting a child’s sensory needs is one of the four functions of behaviour in ABA theory.
His ABA centre has a sensory gym that he goes to once a week. Michael’s favourite pieces of equipment are the balance beam, and a car he sits in that can be pulled along. We try the trampoline as well but he doesn’t know how to jump yet so he just kind of walks around it.
Our supervisor is always looking for ways to redirect Michael’s sensory seeking in a more functional way. The aim is always to make sure he is getting the sensory stimulation he needs. At the same time he is still learning, and not disturbing anyone else in the process. For example, he might learn to walk on steps rather than on his folder, or we might swing him around and give him piggy backs in the session as rewards instead of getting him to sit down for long periods of time.
She is also often helping us with sensory issues that arise from the over-responsive side of him. When Michael was extremely sensitive to us cutting his toenails, she introduced a program. We would first just touch his foot for a second, then two, then five. Eventually we would take off his sock. Once we could hold his foot for thirty seconds without him being uncomfortable, we would start to quickly cut his toenails. You get the idea. It took us a couple of months, but he is now completely comfortable with us cutting his toenails.
Our Behavioural Strategies For Michael’s Sensory Problems
In general, Michael has lots of sensory toys that we are teaching him to play with. Special needs shops like this one will stock a huge variety. There’s light up toys, liquid timer toys, stretchy toys and various kinds of sensory squares. Michael also loves musical instruments and things like climbing frames or swings. At all times, our supervisor is getting us to try new and different sensory toys and experiences for Michael. She has suggested things like pouring pasta in a large box and getting him to walk around in it, or kinetic sand. At all times we are trying to find functional ways of redirecting his self stimulatory behaviour.
We have tried these things with him, as we are always looking for potential rewards to motivate him to learn. Unfortunately so far we have been quite unsuccessful. He does enjoy some of these items for a short time but only if I reward him for it. There are very few ‘sensory’ toys he will sit down for. But we’ll keep trying!
Diet has also helped with some of his issues. He used to run around and lick everything (the glass, the sofa, the floor!) and we thought it was just the SPD. In fact, it must have been partially iron deficiency because since his diet has improved, he is licking random things a lot less.
With his sensitivities, our strategy has been to gradually introduce them to him. For example, let him get some sun in his face for a few seconds at a time, and gradually increase it. Now, he is completely comfortable playing in the sun (though I don’t let him stay for long). And we only go up to the point where he is slightly uncomfortable, and draw back. He needs a lot of breaks. We also pick our battles – some things we work on, some things we leave alone.
Stimming is very common with children on the spectrum and more common with Michael than with others. I think he spends almost every minute of the day when he is awake, stimming in some way. It might be flapping his fingers in front of his face, or picking up balls or bottles and banging them. He will do it in the middle of a task or even while watching TV. With him, it is because he needs constant stimulation and can’t get it in any other way. It is easier than playing with toys, and he often can’t concentrate on them anyway. He gets bored, therefore he stims. It is a vicious cycle – because he stims he can’t pay attention to his environment to learn to play with toys.
Of course, we all stim at some point. When I was little, I used to take the plastic bits off edges of paper and play with them. Or I would play with pens, or twirl my hair. Most of the time I didn’t even know I was doing it.
Stimming can be good or bad. It can help children on the spectrum deal with their sensory issues or overload by giving them something else to focus on for a time. Stimming can also help if they are undersensitive by stimulating their senses. Another use for it is to calm their anxiety. On the other hand, it can distract children from learning opportunities and even put them in danger if they do it in a busy environment.
Our Behavioural Strategies For Stimming
Our strategy is usually to leave Michael alone if he is stimming in his free time, and redirecting if he is doing it during a task.
He does not have any other ways of playing at the moment, so interrupting him constantly would only needlessly upset him. In our programs however, we work on replacing this behaviour. We work on teaching him play skills so he has something else to do. If his stimming interrupts his learning, we will redirect it. For example, I will stop him waving puzzle pieces in the air and encourage him to put them in the right place in the puzzle.
The way we draw the line for him is to have a mat in the middle of his therapy room. On this mat, are his favourite prizes. His cartoons, or food, or any toys he is especially interested in. To get them, he needs to play in a functional way. But he can leave at any time by giving us the ‘GO’ card, and then he is free to stim in a corner or play with one of the other toys in the room.
We also have lots of periods of physical activity to break up his therapy sessions. Our job as parents, and therapists, is to stimulate him so much ourselves that he doesn’t need to stim. We might take him to the park to go on the swing for half an hour. Or let him run around if he is getting restless in the session. Leisure and physical activity is incredibly important to young children, and we will use it to break up the session as much as we can. He doesn’t stim if he is chasing me around the house or getting a piggyback.
Patience is the Key
Whatever sensitivities (whether over or under) that Michael is displaying, the key to dealing with them is always patience and calm. I always think – he is having a much tougher time than me right now. I also listen to all the mums of older kids that have overwhelmingly told me these sensitivities and self stimulatory behaviours do decrease with time.
If Michael is feeling overwhelmed, we will have ‘safe’ spaces for him. When we are out, this tends to be his pram. If we are at home, he likes to go to his high chair (mostly because he associates it with food and food is good).
And of course, as with many other things in his life, sometimes the best strategy is just to hug him as much as possible. Hey, I’m just providing him with the stimulation he so badly needs! If I happen to like it too, then well, that’s just a win-win situation.