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Asperger - Practical Interventions for Build Basic Social Skills
Asperger: Practical Interventions to Build Basic Social Skills - 6 CEUs

Section 10
Sensory Processing and its Role in Asperger Syndrome

CEU Question 10 | CEU Answer Booklet | Table of Contents | Asperger
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Low Registration
Children who have low registration patterns seem uninterested, self-absorbed, and sometimes dull in affect. They do not notice what is going on around them and miss cues that might guide their behaviors. We Autistic Child  Asperger Practical Interventions  mft CEUhypothesize that most events in daily life do not contain a sufficient amount of intensity to meet these children's thresholds; their passive strategies lead to their being somewhat oblivious to activities. Some families report that their child does not respond to initial auditory information. For example, parents may be concerned about a hearing problem because their child does not respond to his or her name (Marks, Schrader, Tongaker, & Levine, 2000).

Weimer, Schatz, Lincoln, Ballantyne, and Trauner (2001) reported a deficit in proprioception (sensory input from the muscles and joints) for children with AS, which may contribute to the characteristic of "clumsiness" cited by multiple authors (Attwood, 1998; Bonnet & Goa, 1996; Gillberg, 1989; McKelvey, Lambert, Mottron, & Shevell, 1995; Tatum, 1988; Wing, 1981). From a sensory processing point of view, these children may need a high amount of proprioceptive input to successfully participate in physical activities. This would be achieved by adding weight to the child's body or to objects the child interacts with. For example, we might have the child wear a weighted vest, or wrist and ankle weights, during specific activities. The added weight provides additional body sensory input so the child can be more aware of body parts. Authors have also reported increased attention and decreased fidgeting using weighted vests for children with autism and attention-deficit/hyperactive disorder (Fertel-Daly, Bedell, & Hinojosa, 2001; VandenBerg, 2001; see Figure 2).

Sensation Seeking
Children who have sensation-seeking patterns are very active, continuously engaging, and excitable. They take pleasure from sensory experiences and so generate additional sensory input for themselves. We hypothesize that they are engaging in active strategies to increase input as a means to meet high thresholds. For children who have AS, sensation seeking may manifest as the need to move about the environment, for example, pacing back and forth when others remain seated.

Peculiarities that others might classify as speech and language issues also have a sensory-seeking quality. For example, the child might overuse hand gestures or nod his or her head when speaking, or might stand closer to others than is necessary during conversation. Children with AS also make repeated noises and words that create a certain feel and sound as the word flows across the tongue and mouth. Shore (2001) reported that these actions are pleasurable for children with AS. They may seek sensation by putting unusual, nonedible objects in their mouths, chewing whole sugar packets, using their teeth to shave sand from emery boards, or crunching up tin foil in their mouths. These activities provide scratchy and gritty texture sensations beyond those a typical diet might provide (Willey, 1999).

Sensory Sensitivity
Children who have sensory-sensitivity patterns are distractible, are hyperactive, and can be complainers. They notice many more sensory events than others do and comment about them with regularity. We hypothesize that they have low thresholds that enable them to have a heightened awareness of what is going on around them. These children use passive strategies in that they allow things to happen and comment rather than removing themselves (as a sensation avoider is likely to do). Children with AS and their families frequently report sound and touch sensitivities. These children may, for example, report hearing the sound of an approaching train or airplane some time before others notice it. Some children with AS have reported being distracted by butterflies or another person's teeth to the point that it interferes with maintaining a conversation (Attwood, 1998).

Sensation Avoiding
Children who have sensation-avoiding patterns are rule bound, ritual driven, and uncooperative. They engage in behaviors to limit the sensory input they must deal with. We hypothesize that they are engaging in these active self-regulation strategies because unfamiliar sensory input is difficult to understand and organize or might even be "threatening" to their nervous systems. Predictable patterns of behavior provide a high rate of familiar sensory input while simultaneously limiting the possibility of unfamiliar input.

For children who have AS, avoiding patterns interfere with their use of typical materials and lead to the design of specific ways to achieve an outcome. Frequently, these specific ways restrict the child's willingness to participate in typical daily routines. The potential of dealing with threatening input often leads a child to impose rules and restrictions upon others, as well. For example, while shampooing, a child who is a sensation avoider might want to avoid the unexpected splash of water on his or her face. The child's parent may have learned to use a dry washcloth to wipe shampoo away from the child's face, therefore becoming the only person who can help with this routine. Another child may refuse to participate in small cooperative-group educational activities because working with others on the floor poses too many opportunities for accidental bumping. For others, the feeling of certain fabrics is an aggravation that leads to limitations of clothing choices. Emotional reactions that seem extreme or incongruent to the situation may result if escape from the sensation is not possible.

Combined Patterns of Sensory Processing
It is important to remember that children do not have a single sensory processing pattern but, rather, have several patterns in their repertoires (Dunn, 2001). A child might be a sensation avoider for auditory stimuli and yet have more moderate responses for other sensory-system input. For intervention planning, knowledge about sensory systems (e.g., visual, auditory, touch) and sensory processing patterns are helpful.

A Sensory Processing Perspective on the Characteristics of Daily Life Settings
During a typical day, a child gets ready in the morning, participates in learning opportunities throughout the school day, and accompanies family into the community for errands or leisure activities after school. Each setting, and each activity within those settings, contains unique characteristics that can support children and/or create challenges for their performance. Although it is more common to consider cognitive, social, and motor opportunities, these settings and activities also contain inherent (or, in the case of intervention planning, constructed) sensory features. For this section we will emphasize the sensory characteristics of particular settings and activities, acknowledging that cognitive, social, and motor characteristics intersect with those we are discussing here. 

Home
The home offers familiar sensory information. Family members' voices are recognizable, as are sounds related to meal preparation, laundry tasks, and other household routines. The visual system of the child's room has an anticipated setup. The furniture feels the same from day to day. Household activities and chores have established patterns that generate vestibular and proprioceptive sensations as family members move about to complete them. The family typically structures routines around the child's preferences (Gillberg, 1991; Wing, 1991); for example, the family establishes a pattern of agreed-upon foods at mealtime. Family members engage in similar routines in their home, including preparing and eating meals, getting ready for the day, and interacting with each other. Typically, the activities have a pattern that is acceptable to most members. When families have a member with AS, establishing these patterns can be challenging. Conversely, once a pattern is established, children with AS can be very resistant to changes. Sensory processing knowledge can help make this process more successful.

School
School environments include sensory information that is familiar, but different in intensity or duration. Students come across additional sensory experiences that are not typically within the home. "One size fits all" desks and chairs made for durability and efficient management of school materials are difficult to tolerate for the child who needs movement to stay focused. Colorful materials on bulletin boards and art projects hanging from ceilings, meant to provide information or visually motivate students, distract some students from their learning tasks. Children with sound and smell sensitivities may find it difficult to manage encounters with school cafeterias serving hundreds of lunches daily.

The environment of the middle school-age child or high school student includes multiple passing periods and classrooms, myriad hallways, lockers that continuously open and close, and a number of teachers with individual teaching styles and expectations. For the child overresponsive to touch sensations, unexpected bumping by other students within cooperative learning activities, in lines, or during passing periods creates anxiety and irritation that can lead to a meltdown. The effective modulation of sensations that is required by increased sensory demands is difficult for the individual with AS in school, where sensation is not as familiar or readily changeable.

Community
Transportation, shopping, eating out, and attending community events pose an even greater variety of inherent sensations, many unpredictable and beyond the control of the participating public. Children often need to accompany parents as they tend to the necessities of daily life. Shopping for groceries can be an overwhelming sensory experience for the child sensitive to smells, overhead lighting, and unexpected intercom messages. The everyday activities that many families take for granted become struggles requiring management planning for the individual with AS.

Summary
Creating successful supports that enable individuals to participate more fully requires consideration of the sensory processing needs of the individual and the inherent sensory characteristics of the task and context. Persons with autism spectrum disorders, including those with AS, are often unable to report their own sensory preferences and needs (Baranek, 1997), making it difficult for family, teachers, and other individuals to understand the basis for challenging behaviors. Gaining an understanding about the child and his or her environment through skilled observation and ecological assessment (including checklists, histories, and questionnaires) is the first step to creating meaningful changes. The authors propose to link Dunn's model for understanding sensory processing patterns with several instructional strategies found to be effective for persons with AS.
- Dunn, Winnie, Saiter, Jessica & Louann Rinner; Asperger syndrome and sensory processing; a conceptual model and guidance for intervention planning; Focus on Autism & Other Developmental Disabilities; Fall 2002; Vol. 17, Issue 3.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #3
The preceding section contained information about sensory processing and its role in Asperger Syndrome.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 10
What is a problem for an Asperger child in school who is over-responsive to touch sensations? Record the letter of the correct answer the CEU Answer Booklet

 
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