BLOG #5K – a. & b. – SENSORY INTEGRATION  (a. SENSORY ROOM, b. SENSORY ACTIVITIES)
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a. SENSORY ROOM –

A sensory room is a designated space in your home (or school, or community, or public place) specifically designed with tools and equipment to help a child regulate their senses, especially when they are experiencing sensory overload or a meltdown.

Many kids on the autism spectrum have sensory issues. This could mean some senses are heightened — a small amount of sensory input feels overwhelming, which may make a child  become sensory-avoidant in certain areas. Other senses may be lowered — a large amount of sensory input is needed, so a child may be sensory-seeking.

1. Swing – to provide vestibular stimulation, sense of movement or gravity. There are different types, such as a deep pressure cocoon that hangs; a platform swing that sits on the floor, net swings much like a hammock.

2. Bean Bag Chair or Crash Pad – A large object, something which provides a safe and soft landing for those who need to jump or throw themselves around. Or, for those who just want to cuddle up somewhere and read or listen to music.

3. ‘Weighted’ Blanket, Lap Pad, Vest, or Toy – Heavily weighted things which provide therapeutic relief derived from deep pressure. Used to regulate sleep, calm anxiety and/or stressful moments.

4. Therapy Ball or Trampoline – of various sizes and shapes to satisfy bouncing and big-movement sensory seekers.

5. Soothing Light – calming or exciting lighting for those who need one or the other. From a string of Christmas lights to projection or wave lamps can be helpful. < My Thoughts > Strobe or strobe-like activity lights tend to start seizures for Sonny. Some lamps tend to get hot or have an electrical smell to them. Just saying you may want to avoid these.

6. Bubble Tube – bubblers or tubes with visuals like fake jellyfish or angelfish… or lava lamp-like tubes which are soothing or exciting, depending on visual needs. < My Thoughts > Again, some tend to get hot, have an electrical smell to them, or safety issues. Just saying you may want to avoid these... do your homework before you buy... and, look for UL approval mark.

7. Fidget Toys – to keep fingers and minds busy, varieties of these available out there. < My Thoughts > Personally, I DON’T allow these out of the sensory room for a long list of ‘distraction’ reasons. I DO allow Rubik cubes, though. Just saying.

8.  Body Socks – Sensory socks provide some compression, allowing body movement at the same time. < My Thoughts > there are also ‘wraps’ that can be used for heavier compression, but the person is NOT to be left alone while in one. The idea of the body sock is the person is allowed creative movement, according to their sensory needs. Back in the day, we let kids put pillowcases on their feet and walk around, well supervised of course. Smiles.

9. Sensory Bins – containers filled with different textures; water beads, kinetic sand, dry rice and/or beans. Safety caution… find a container designed to put hands in, but not able to get objects out. < My Thoughts > Supervising this activity is a must! Creative kiddos love to stick beans in their mouths, ears, up their nose, and in other unmentionable places. Trust me on that!

10. Tent – a small table covered with a sheet or blanket will work. Or, there are indoor tents, anything to provide  a nest where one can hide out for awhile. < My Thoughts > may want to be able to control the lighting inside the tent… some like it dark and some need a light to be either soft or bright. I’ve heard that even Batman uses a nightlight. Smiles.

11. Noise-Blocking Headphones – there are noise- muffling and noise-cancelling headphones, depending on the sensory need. < My Thoughts > these can be ‘pricey’ depending on the function. If you can, try to consider exchanging headphones with those used for quality ‘Calming Music’. Just saying.

12. Calming Music – this is effective for dealing with anxiety, soothing unwanted feelings, and blocking out the world. Can also generate ‘white noise’ and stimulate those with sensory seeking needs or lethargy. < My Thoughts > Whale sounds, ocean waves, bird, cricket and nature sounds are affective to change moods. For days when Sonny needs inspiration we have Rafi songs like Baby Baluga. Or, bluesy and jazz tunes which get him humming. Smiles.

Retrieved from – 12 Items You Can Use to Create a Sensory Room for Kids on the Autism Spectrum by Ellen Stumbo, (Creator of  ‘Disability Matters’; March 13, 2019). https://themighty.com/2019/03/create-sensory-room-kids-autism/
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Adrienne Warber tells us to organize our home environment to assist our child’s progress. She emphasizes that one should arrange furniture in a way that allows a child to understand and cooperate more easily with tasks and directions. Like labeling common household items that you child sees and used daily. Use signs to give directions, establish boundaries in the house, making it easier to establish a comfortable routine and to learn.

Warber suggests a ‘sensory room’ where your child can have activities and objects that utilize the senses. A swing for vestibular input, aromatherapy for olfactory input, and various types of music for auditory input. She believes that environment influences behavior and that you can shape the environment to discourage destructive behaviors and encourage positive ones for the child with autism.

Here are some important components she mentions –

• Safety: the environment must always be childproof.
• Structure: children with autism often prefer strict routines.
• Peace: a calm environment can sooth anxiety issues.
• Stimulation: provide opportunities that stimulate the child’s senses within the environment.

Reminding us that children have several environments to acclimate to (home, school, community or public place), Warber asks that we make sure that each one will address the child’s needs and will nurture them.

< My Thoughts >       “…will address your child’s needs and will nurture them.”

Giving you child (or student) a choice is one way to address this. Sometimes when I think Sonny (or students) need to calm down… what is really needed is stimulation. As a parent or teacher, inform and educate yourself about your child’s sensory wants and needs. Consult an Occupational Therapist, or read their articles and blogs. Listen to their podcasts and look at YouTube videos. Make the room a ‘responding’ place where choices can be made. An ‘ever changing’ place where overcoming the sensory challenge being faced is the purpose. Remember that ‘one time’ something works… doesn’t mean that ‘every time’ it will work. Just saying. Smiles.
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Retrieved from – Environment for Autistic Children, https://autism.lovetoknow.com/Environment_for_Autistic_Children
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Sensory Room on a Budget –

This mom tells us that six months ago, she created a sensory room at home for her daughter Raelyn. She did it on a budget and with things she already had around the house. She knew her autistic daughter would benefit from such a  room, but first she wanted to know what it was, exactly.

After researching, she found out that, “A sensory room is a special room designed to develop a person’s sense, unsually through special lighting, music, and objects.” Mom picked out a few essentials that she thought would work for them. Here they are –

• Things that spin, like pinwheels, fans, or fidget toys.
• A cozy corner, a perfect little place with a soft toy, blanket and pillow.
• A sensory swing. Spinning and swinging would be used to stimulate the brain and focus Raelyn.
• A yoga ball to sit on while doing puzzles or coloring
• A slide for climbing and of course, sliding.
• A sensory bin, sectioned and things like a knee-high nylon filled with beans/or/rice, objects of different textures, shapes, and colors.
• Calm-down bottles & soothing lights. Or, you can set-up a projection lamp to rotate shapes and colors on the walls and ceiling.
• Something to help with rocking and spinning. Can be a toy, a chair, or?

Raelyn likes magnets and spinning things, so mom rigged up magnetic objects that move around on a metal cookiesheet.

< My Thoughts >       “…mom rigged up…”
Just a reminder to consider ALL safety issues, when 'rigging up' things for your Sensory Room. Smiles.

Retrieved from – DIY Sensory Room on a Budget 2 BY INACTIVE BLOGGER ON JUNE 8, 2016 SPECIAL NEEDS; http://www.myatlantamomsclub.com/diy-sensory-room-budget/
 
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b. SENSORY ACTIVITIES
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The need for sensory activities is influenced by one’s sensory processing thresholds. And, how quickly one detects and self-regulates sensory input. Reynolds, et al. (2011) tell us that one’s sensory responsiveness can determine a person’s level of competence in their participatory roles.

In other words, children with autism may choose to limit engagement in types of activities because of their social and motor deficits. Even requested chores, they say, may be limited making the child seem opositional or defiant because of sensory issues. Even overall academic performance of students is associated with auditory filtering and under-responsivity/sensation seeking, according to these authors.

They report that children with ASD rarely engage in dramatic play activities, such as – playing army, playing school, playing house, playing Star Wars action figures, or other imaginative play requiring skills that could attract playmates. Also, saying that sensory over-responsive kids are often anxious and aggressive when forced into play with others, due to their sensory issues.

< My Thoughts >       “…requiring skills that could attract playmates.”

There are times when as a teacher, the curriculum calls for students to work in a group to solve a problem, or share information while learning. And, even when you ‘hand-pick’ group participants, it still makes it difficult for those students with sensory issues, not to become anxious or aggressive. Sometimes, with more structured teaching, you can assign tasks and props to give each person a task, depending on grade level.

My Elementary School, Middle School, and Special Education students liked what we called ‘Cooperative Group’ where each person had a role and a prop to use during a lesson. The props had the group members’ role printed on it. For instance… ‘Claire the Clarifier’ had a prop with a picture of a magnifier on one side and a script for what was to be asked ‘in group on the other side of the prop. Smiles.

OT Toolbox author tells us that proprioception is the body’s awareness system which allows us to walk around objects in our path, to move a spoon to our mouth without looking, brush our hair with just the right pressure, and to stand far enough away from others for comfort, and not to press too hard on a pencil when writing. Some gross motor proprioception therapy activities might be –

• At home… carry bags or laundry basket, rake leaves, vacuum or mop floors.
• At school… stack chairs or books, do chair and/or wall push-ups.
• Outside… jump rope or on a trampoline, climb trees, pull a wagon, bounce a ball, play twister or run.

​Try doing these things when kids seem fidgety, unsure, overwhelmed, clumsy, awkward, uncoordinated or unmotivated. The proprioception system is alerted through heavy work activities that involve heavy pressure, large and forceful motor movements and pushing or pulling activities. These activities can calm and organize those struggling with their body’s spatial awareness versus clumsiness. Retrieved from – OT Toolbox – How to Use Proprioception Activities to Help with Body Awareness,
https://www.theottoolbox.com/2017/09/proprioception-activities-improves-body-awareness.html
 
< My Thoughts >       “At school proprioception activities might include….”
 
Some students have sensory activities written into their Individualized Educational Plan (IEP). For instance, one boy, we’ll call him Sam, had a choice when doing a task, that if feeling anxious he could ask to have a 1 minute back rub, head rub, or tickle session, first.

​Some may say “Wait…what?” Instead of doing a task Sam can ask to be tickled? But this is an intervention which only takes a minute or so out of his learning time, and may keep him from having a severe sensory meltdown. Just saying that sometimes it pays to pick your battles. Smiles.
 
References used are:
 
Reynolds, S., Bendixen, R., Lawrence, T., & Lane, S. (2011). A Pilot Study Examining Activity Participation, Sensory Responsiveness, & Competence in Children with High Functioning Autism Spectrum Disorder; Journal of Autism & Developmental Disorders; V41, p1496-1506.
 
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​#5K – SENSORY INTEGRATION    (a. Sensory Room, b. Sensory Activities)
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Classic Sensory Integration Therapy (SIT), according to the meta-analysis reported on by Leong, et al. (2014), delivers intervention for an individual in a small group session. Various forms of sensory stimulation are used, such as the individual being rubbed with brushes or other textured items. Or, being swung or spun in a hammock, being rocked back and forth while lying on a gym ball; or being moved on a scooter board. There could be joint compression from wrist weights. Different practices, interpretations and theories have been explored since the A. Jean Ayres’ Sensory Integration strategies began to be known in 1972.
 
< My Thoughts >       “…Various forms of sensory stimulation are used.”
 
The sensory stimulations being used are determined from the various forms of sensory information derived from the person’s ‘sensory profile’. From there, the therapist develops a ‘sensory diet’ of sensory-based activities for home and for school. For instance, some integration activities might be developed to help the person with sensory seeking stimulation needs, sensory avoidance or aversion situations, and/or sensory balance requirements.
 
Thompson (2012) tells us that the Ayers’ method of satisfying sensory needs through sensory integration ranged from the calming input of massage and weighted vests, to listening to music to which massages the middle ear hair cells in the cochlea. These various sensory-based stimulation techniques are incorporated into programs or used in isolation.
 
< My Thoughts >       “…incorporated into programs or used in isolation.”
 
One of A.Jean Ayers' early publications was Improving Academic Scores Through Sensory Integration; Journal of Learning Disabilities (1972). This article described her idea that ‘identifiable types of sensory integrative dysfunction’ could be included in a remedial program. Thus improving a students’ learning and academic performance by changing unwanted sensory responses. The Ayers’ method  is well known among therapists and teachers alike.
 
Others, such as Winnie Dunn, with her ‘Sensory Profile’, added to the development of a child’s sensory processing abilities and/or disabilities. Dunn felt that these undesirable sensory responses, plus the individual’s temperament, may negatively impact their daily life as well as their academic learning.

The Dunn Sensory Profile is intended to create a comprehensive picture of the person’s sensory performance; thus combined with other data will help with diagnostic and intervention planning. You can have a look at one assessment portfolio on this website – Retrieved from – https://otforchildrenassessmentportfolio.blogspot.com/2013/04/sensory-profile.html
 
Sensory integration, according to a study made through the University of Belfast, Northern Ireland, and explained by Doumas, et al. (2015) saying that sensi-motor control processes affect the person with Autism Spectrum Disorder. We receive sensory information from three main channels, our eyes, our ears, and our touch. These authors state that control in a task does not rely equally on all three channels simultaneously, but rather on information from the channel relied upon most for information.

For instance, one uses their sight to see where they are going, until it becomes dark. Then the other two sensory channels of hearing and touch are relied upon, or needed the most for sensory information because there is no longer reliable visual information available in the dark.

< My Thoughts >       “We receive sensory information from three main channels.”
 
Sensory information impairments are now part of the Diagnostic & Statistical Manual of Mental Disorders, 5th Edition (DSM-5). This includes ‘hyper’ or ‘hypo’ reactivity to sensory input or unusual interest in sensory aspects of the environment. It is known that impaired sensory processing or deficits in sensory channels make it difficult for children with ASD to perform ordinary tasks. Considerably more difficult than for those typically developing (TD) children and adults.

Author Amelia Tiedemann tell us that the A. Jean Ayres' definition of ‘sensory integration’ as the neurological process that organizes sensations from one's body and from the environment. In order to thrive within the environment, one’s body must make the appropriate adaptive responses. To direct the body, the brain must register, select, interpret, compare, and associate sensory information in a flexible, constantly-changing pattern,” Ayres (1989).

​Pediatric Occupational Therapist, Cara Koscinski asks you to close your eyes and imagine yourself swinging on a warm sunny day. Feel the breeze blowing past you and the fluttering butterflies in your stomach as the swing reaches its highest point. The freedom of flying sensation is why swings continue to be used by therapists, and remain the staple in backyards and playgrounds all over the world. Retrieved online from: https://harkla.co/blogs/special-needs/sensory-swings-autism

Yet another explanation of Sensory Integration refers to how people use the information provided by all the sensations coming from within and from outside the body and from the external environment. We usually think of the senses as separate channels of information, but they actually work together to give us a reliable picture of the world and our place in it. Your senses integrate to form a complete understanding of who you are, where you are, and what is happening around you. Because your brain uses information about sights, sounds, textures, smells, tastes, and movement in an organized way, you assign meaning to your sensory experiences. Retrieved from: https://www.familyeducation.com/school/sensory-integration-dysfunction/what-sensory-integration
 
< My Thoughts >             “…assign meaning to your sensory experiences…”
 
Thompson (2012) states that there is no consistent evidence that sensory-based treatments have specific lasting effects on the behavior of children or adults with ASD. But, he says the lack of evidence does not necessarily prove that a treatment is ineffective…
 
While Leong, et al (2014) thinks that the problem of authenticating the value of Sensory Integration Therapy may lie with the integrity of the trials, or with ‘pre’ and ‘post’ test validity. They point out that the difference could also be with the state of brain ‘plasticity’ of the child/adult receiving the therapy.
 
Just as there are hundreds of thousands of educators trying to make a difference in the world, there are just as many therapists trying to do the same. Some students are lifelong learners, while some just want to attain a certain level to get by. Those on the Autism Spectrum may feel the same way, according to their personality, temperament, and abilities. I applaud the teachers and therapists who continue to find ways to give those in their path the opportunity to move toward greater independence. Just saying.
 
< My Thoughts >             “…the opportunity to move toward greater independence.”
 
Ever wonder why your child does the things s/he does? How many times have you said in frustration – “Why in the world did you just do that?” Seems that some of us have five thumbs, while others have green thumbs. It all may be about our sensory perception of the world. Some of us are destined to take a chance, those are the risk-takers.

​While others of us spend life on the sidelines, observing from afar. Take this one step farther and think about what it must be like to have Sensory Processing Disorder. Either your world is filled with exciting opportunities… or, your world if filled with one terrifying event after another. Just saying…
 
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BLOG #5F – SENSORY IMPAIRMENTS
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In the May 2013 Edition of DSM 5th Edition (DSM-5), the realm of restricted, repetitive patterns of SENSORY behavior, interests, or activities has been expanded to include abnormalities in ‘sensory processing impairments.’ The objective of adding this to the behavioral domain was to help clinicians perform diagnosis more accurately, thus identifying cases requiring treatment with greater accuracy.

The DSM-5 is a living document which provides a common language for clinicians, patients, and researchers to communicate information about symptoms, as well as to accurately diagnose mental, behavioral, and personality disorders. Retrieved from: https://www.steppingstonesca.com/single-post/2016/09/22/A-Quick-Guide-To-The-DSM-5-Criteria

< My Thoughts >       “perform diagnosis more accurately, thus identifying cases requiring treatment with greater accuracy.”

As a parent and/or teacher, you will become a trained observer, learning to recognize ‘sensory impairments’ in your child or student. This in turn, will help clinicians find just the right diagnosis, treatment, and intervention for that child.

Remember that the DSM-5 is a ‘living document’, that is because the ‘bar’ gauging ‘severity’ is forever changing. Your child, student, or patient is also forever changing. As observers, you are identifying the ‘current’ pattern, behavioral crisis, or behavioral activity. Just saying.

The National Institute of Health (NIH) website tells us that maladaptive behaviors such as ‘stereotyped behaviors’, i.e. sensory impairments, are predictable as a ‘severe sensory feature’ of autism. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727194/

Banda, et al. (2014) in a review studies of individuals with Autism and Sensory Impairments, having the overlapping condition/characteristics of sensory impairments. These impairments varied in the levels of severity, as well as the number of impairments; to include – vision, hearing, and/or communication. In addition, four of the studies targeted problem co-existing behaviors such as self-injury, aggression, vocal disruption, and self-stimulatory activity.

Fuentes, et al. (2010) talk about studies using questionnaires which revealed general differences in sensory experience of auditory, visual, tactile, and movement processing in those children with and without Autism. This study noted that there was no significant difference in IQ between the groups.

They found that the sense of position and movement of parts of the body, proprioception, played a crucial role in successfully interacting with the environment. The general tone of responses from study participants was conveyed in these two statements –

“I could not point at objects for many reasons. The most important reason is that I had very little sensation of my body.” (Tito Mukhopadhyay), And, “ In childhood I had real problems in knowing exactly where my connectional limbs and trunk were… where they would move to next, and even more frighteningly, where they had last been positioned.” (Lucy Blackman).

Sensory impairments in the ASD group were significantly worse than those in the group without an autism diagnosis. Researchers said that successful ‘skill’ performance on the PANESS assessment involved good sensory processing and rapid execution of finely controlled movements; such as tool use and skill imitation.

< My Thoughts >       “the PANESS assessment…”

​The official title of the PANESS assessment is Positive And Negative Syndrome Scale; Positive meaning ‘productive’ symptoms, and Negative to mean showing ‘deficit’ features. According to an online interview with Lewis Alan Opler, Long Island University, one of the co-authors of PANESS, said that their PANESS assessment is still valid, reliable, and user friendly instrument. An accompanying comment by Bajouco, Hospitais da Universidade de Coimbra, stated that for another assessment of negative symptoms of diminished emotional expression, and motivation/pleasure one could use is the Brief Negative Symptoms Scale (BNSS). Retrieved from: https://www.researchgate.net/post/What_is_the_best_alternative_to_PANNS_in_assessing_psychosis
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 BLOG #5J – SENSORY DIET
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Nancy Penske may surprise us by saying that the Sensory Diet is actually NOT about food, but about sensory enriched activities to fulfill a person’s sensory needs. Occupational Therapist, Patricia Wilbarger devised a personalized activity plan which was soon called a Sensory Diet Plan. The purpose of this individualized plan, when followed for 10-20 minutes per day, would help to assist with adaptive, positive responses to environmental stimuli. Retrieved from:https://www.sensorysmartparent.com/sensory-diet

These activities are designed to keep the brain’s neuro-chemicals flowing steadily throughout the day to improve learning. But before you can create a Sensory Diet, it helps to know what sensory issues are at risk. Enter the ‘Sensory Profile’ devised by Winnie Dunn. Gay & Baranek (2008) draw the conclusion that Dr. Dunn believed we are ‘seekers’ of sensations in our environment. Dunn believing that understanding how bodies differ, allows for respect and even embracing of those differences in ourselves and others. (The Sensory Profile was discussed in BLOG #5I.)

Sensory enriched activities, aka Sensory Diets help those with Autism Spectrum Disorder which are somewhat predisposed to anxiety created by their many sensory avoidance and arousal issues, according to Rosen, et al. (2016). They feel that anxiety seems to be mostly associated with higher intellectual function and higher social functioning persons. And, that deficits in these areas can be difficult to detect in those with limited verbal ability, as well.

They found that behavioral intervention targeting anxiety should be evidence-based and provided by well-established treatments. Experienced professionals, they say, will be able to distinguish the individual’s current functioning levels and create an affective Sensory Diet.

< My Thoughts >       “…Experienced professionals…”

Some of us have a high threshold when sensation seeking, while others of us have a low threshold. How can you tell the difference, or how can you tell if your child is having sensory processing problems? Really, it takes a clinician or team of people in the field to make that diagnosis. Parents can look online for examples of Sensory Profile questionnaires to get some idea of how data collection works for developing a Sensory Diet.

In an article on Sensory Defensiveness – Sensory Processing Disorder (Copyright 2004), author Michelle Morris tells us some of the following about the types of

Sensory Defensiveness –

• Oral Defensiveness
• Gravitational Insecurity
• Postural insecurity
• Visual Defensiveness
• Auditory Defensiveness
• Olfactory Defensiveness

Retrieved from: https://www.sensory-processing-disorder.com/sensory-defensiveness.html

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​BLOG #5I – SENSORY PROFILE     

​Creating  a person’s (child, student, adolescent, adult) Sensory Profile may be necessary in order to better understand their behavioral disorders and how that relates to their sensory issues… such as being over-sensitive, under-sensitive, passive, and/or balanced. Persons may become less or more extremely sensitive over time, as a result of many of their experiences and/or interactions; or how they discriminate and regulate incoming sensory information. (3 bears… just right). 

Mays, et al. (2011) begins with an example of a completed ‘Teacher Observation’ form used to begin a case study.

The example gives the student’s name, the observer’s name, and the date and time length of the observation.
There are 7 choices which the observer may circle to indicate the ‘sensory system(s)’ involved in the behavior they observed at that time. The Sensory Systems are:

• Vestibular (sense of movement)
• Proprioceptive (spatial body awareness)
• Visual (sight)
• Tactile (touch)
• Auditory (hearing)
• Gustatory (taste)
• Olfactory (smell)

Next, the observer rates the intensity of the behavior. Rating on a scale of 1 = not intense, to 5 = very intense.
The part (s) of the body involved are noted.

The number of these behaviors, per minute, are recorded.

The duration time the person is engaged in stereotypy is recorded.

Then, whether or not the person completed the assignment/participated in an activity, during observation time. YES or NO.
There is a place for the observer to include any NOTES for review.
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SENSORY OBSERVATION FORM
Student: Bobby S.
Date: 01-12-2012 Observer:  Teacher
Behavior:  bouncing
Observation began: 9:00 am ended: 9:30 am
Sensory system involved(circle):

• Vestibular (movement)
• Proprioceptive (pressure)
• Visual
• Tactile
• Auditory
• Gustatory (taste)
• Olfactory (smell)

Description of behavior: While sitting in a chair or on the floor, Bobby’s torso bounces up & down, repeatedly, with his bottom leaving & returning to the chair/floor.

Intensity (Rate on a scale of 1 = not intense, to 5 = very intense.) 5 Bobby bounces up & down hard enough that the legs of the chair sometimes come off the floor.
 
Body part: The part (s) of the body involved are noted. Mostly torso, but his whole body moves.
 
Number of behaviors: The number of these behaviors, per minute, are recorded. Counted 3 different 1 minute intervals –
30 per min. /33 per min. /27 per min.
 
Activity & time duration:The duration time the person is engaged in stereotypy is recorded. Bounced 24 of the 30 min. during Circle Time activity.
 
Activity or task completed? Did the person complete the assignment/participated in an activity, during observation time?   YES or NO.
 
Notes:  N/A
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BLOG #5H SENSORY CATEGORIES

4.         EP-ACTIVITY…  Enhanced Perception (EP) activity has emerged as the fourth proposed pattern of sensory response possibly unique to individuals with ASD in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-5). This DSM-5 version of the psychiatric manual is currently used by clinicians for the diagnosis of Autism Spectrum Disorders.

EP activity is characterized by sensory strengths in visual and auditory perception; plus, enhanced low-level discrimination or low-threshold detection, and hyper-systemizing cognitive styles. These powers could be enhanced motion perception, superior visual perception and/or auditory processing.

< My Thoughts >       “…These powers could be enhanced perception, as in the following intelligences –“

• Musical – become proficient without previous training or practice.
• Mathematical – intuitively develop calculations quickly & accurately without aids or devices.
• Kinesthetic/tactile – knowing and working on the exquisite details of machinery without prior knowledge.
• Spatial & pictorial – creation of 3-diamensional drawings, paintings, sculptures and memorization of maps & geography without first studying them.
• Linguistic – ability to understand, read, write, speak & translate multiple previously unknown languages quickly & accurately.

One way teachers are encouraged to present the school curriculum in the classroom, is by addressing the child’s learning styles or preferences. We design lesson plans to reach the basic learning styles of visual (sight), auditory (sound), tactile (touch), & kinesthetic (movement & doing). Added to that, personally I’ve found that students with musical interests tend to learn math concepts more easily. Although, it isn’t always easy to convince a Music Teacher to welcome Special Education students into their classes. Just saying. Smiles.

Hagmann, et al. (2016) believe that their visually enhanced perception may allow for searching superiority by individuals with autism, compared to their typically developing peers. The study found that this enhanced ‘local’ processing was related to both detection and discrimination abilities, including performance on visual search tasks. Persons with these powers of enhanced perception were better at detecting a target in an array of distracters which shared common features, or in disembedding figures quickly and efficiently.

< My Thoughts >       “…disembedding figures.”

When hearing about disembedded figures, my mind jumped to the game of ‘Finding Waldo’, or of finding the ‘Hidden Picture’ in the puzzles we love. And, the term ‘local processing, or ‘locally oriented’ brings to mind the idiom… “Can’t see the forest for the trees.” The person with EP will most likely uses their ‘local’ processing to immediately search out the tree. While their peers, without EP, using their ‘global’ processing to automatically see all the trees as a forest. Smiles.

Bouvet, et al. (2013) tell us that persons with enhanced auditory perception possess superior talents and abilities. An atypical pattern of expression resulting in being able to see enhanced perceptual patterns. These can be the discrimination of superior pitch among multiple musical examples. This ability allows for the person to recognize the differences in the increase and decrease in frequencies between two melodies. But, these individuals with superior perceptual processing are NOT always able to filter out auditory information from background noise.

< My Thoughts >       “NOT always able to filter out auditory information…”

So this may be like visual pattern discrimination of finding the dark purple letter among the solid black ones. Only, this is auditory pattern discrimination - finding the superior pitch among several melodies with partially 'pitchy' refrains. Smiles.
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BLOG #5H SENSORY CATEGORIES

3. SIRS-ACTIVITY
                        c. Seeking Behavior
'Sensory seeking' behavior has its own criteria which is the ASD brain craving more sensory stimuli than what it is already getting. But, sensory ‘seeking behavior’ also includes ‘sensory avoidance’ behavior, as you will see.
 
Sensory Seeking Behavior –
Bogdashina & Casanova (2016) introduce us to  sensory ‘seeking behavior’ by saying that sometimes the brain just seeks more sensory stimuli, like when we feel more comfortable having ‘white noise’ in the room while we’re reading. Each person it seems has different thresholds for their sensory seeking needs.
 
The problem comes in when that 'need', or ‘sensory seeking’ leads to inattentive or overfocused behavior, due to the inability of the person to modulate their needs. They say that ‘sensory seeking’, ‘sensory craving’ are very common in autism. This can also seem to be influenced by the person’s high or low energy and/or activity levels.
 
Typical ‘sensory seeking’ behaviors, as these authors see it, are those seeking sensory input by twirling, chewing, and needing constant auditory input (sounds). In a play setting, the ‘sensory seeking’ child will choose to play roughly with nearby individuals.
 
Kranowitz (2006) gives examples of recognizable ‘sensory seeking’ behaviors –

• Splashing in mud, seeking types of play in dirt 
• Dumping toy bins rummaging through them aimlessly
• Chewing on objects or clothing
• Rubbing against walls or furniture and bumping into people
• Loves spinning in circles, amusement rides, and is constantly moving
• Fidgets, has difficulty sitting still and takes bold risks
• Frequently wants bear hugs and vigorous playground activities
• Seeks visually stimulating things, shiny objects, strobe lights, or sunlight
• Loves loud noises, TV or music volume, crowds and places with lots of action
• Problems sleeping
• Enjoys strong odors, even unattractive ones
• May lick or taste inedible objects and prefers spicy or hot foods
• Frequently attempt to engage in rough play, such as wrestling

She suggests that you begin by figuring out what your child craves. Brainstorm with another person who knows your child well (parent, grandparent, caregiver, etc.) so you have a long list. Your list may look something like this: 'blue things', 'ocean sounds', and 'funny faces'. Ask your child, siblings and your child’s friends and teachers what your child likes as well. Determine how you can engage in sensory integration to fit desired experiences into your child's routine.

Sensory ‘seeking behavior’ has its own criteria which also includes ‘sensory avoidance’ behavior. This behavior may preclude persons from a natural social interaction with others, because they tend to avoid some, but not all, of the following sensory experiences; according to Green, et al. (2016) –
 
Sensory Avoidance Behavior –
Tactile avoidance:

• Touching or getting too close to someone
• Being groomed or grooming self
• Going barefoot
• Being splashed with water
• Rubbing or scratching a spot that’s been touched

Taste/smell avoidance:

• Certain foods
• Certain tastes
• Certain textures or temperatures
• Covers mouth or won’t open it

Movement avoidance:

• Feet leaving the ground
• Heights
• Being tipped upside-down
• Holds on to things

Auditory avoidance

• Distracted by noise (near or far away)
• No background noise
• Doesn’t respond to name when s/he hears it called
• Covers ears

Visual avoidance

• Refuses eye contact
• Bothered by lights
• Concerned with a lot of movement
• Covers eyes

Green (2016) goes on to say that atypical responses to sensory stimuli are a new criterion in DSM-5, and using the Short Sensory Profile (SSP) is still acceptable, but that so many things remain to be seen about how to compare and affirm findings. As well as how these altered responses may impact function and participation in learning and daily living; or, how they may change over time.
 
Amanda Morin (2018) feels that most ‘sensory seekers’ are undersensitive (hyposensitive). They look for more sensory stimulation in order to make them feel less sluggish and more ‘in their bodies’ and ‘in their space’. They may stand too close, keep touching people or objects, like loud noises, and chew on whatever is handy.

Saying that there are also ‘sensory avoiding’ (hypersensitive) kids that experience sensory input more intensely.
 
They avoid it because it’s overwhelming to them. They may seem timid, be picky eaters, and be fussy about what they wear. They may be able to calm themselves down… or, may have many, many meltdowns, because they cannot cope with tactile, visual, taste, and noise sensitivity.
 
< My Thoughts >       “…fussy about what they wear.”
 
“Keep your clothes on until Mom or Dad tells you to take them off!” Smiles.
 
Morin continues, “It’s not always one or the other.” Some kids show a combination of the two reactions, both 'hyper' and 'hypo' reactivity. She says that responses can change based on their level of arousal or ability to self-regulate. That knowing your child’s reactions and triggers can help. Amanda Morin – classroom teacher and early intervention specialist.  www.everythingkidslearning.com
 
Mays, et al. (2011) tell us that it becomes critical for teachers to intervene and decrease or replace self-stimulatory behaviors so the student may attend to instruction and learn new skills.
 
Bobby’s teacher laments, “He is constantly rocking, flapping his hands, and hopping in his chair!” When a student is engaged in ‘stereotypy’, it can be difficult to gain his or her attention or engage him or her in a learning activity because of the reinforcing nature of the self-stimulatory behavior. Note: One of the defining characteristics of autism is the presence of ‘stereotypy’ behavior. This is a behavior, which when it is repetitive, does not appear to serve a purpose and appears inappropriate for the environment.
 
This teacher, Mays relates, one day decides to let Bobby jump on the trampoline before reading group. This helps, but still his rocking time is up to 30 minutes. She tries replacing the trampoline jumping with rocking in a rocking chair. This slower, more controlled movement works so well, she lets him sit in it and rock during reading group. He is now completing more assignments and participating in class activities more frequently without rocking.
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NOTE: Next time... 4. EP-ACTIVITY (Enhanced Perception).
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BLOG #5H SENSORY CATEGORIES

​3. SIRS-ACTIVITY
                        b. Repetitious Behavior – 
 
Raulston & Machalicek (2017) point out that within the repetitive behavior literature, there are generally two categories described – Lower-order: involving motor stereotypy like hand flapping, rocking, lining up toys, or flipping pages of a book; usually found in those very young children. Higher order: including obsessive preoccupation with odd interests and excessive question asking; usually found in those with advanced language skills.
 
Also, telling us that the latest edition of the Diagnostic & Statistical Manual of Mental Disorders – DSM-5, describes four areas of Restrictive & Repetitive Behaviors (RRB) to include:

1. Stereotypy – repetitively tapping or banging an object on a surface; clutching, spinning, rolling, moving, or placing objects in a stereotypical manner.
2. Insistence on sameness – inflexible adherence to routines or ritualized patterns of verbal (echolalia) or non-verbal behavior.
3. Perseverative interests – uncontrollable repetition of a word, phrase or gesture despite the absence or cessation of a stimulus. Insisting to continue an act or activity without purpose.
4. Hyper or hypo activity to sensory input or unusual interest in sensory aspects of the environment

They give an example of a child spinning only one wheel of a toy car very closely in front of his or her eyes, over and over again. Thus not engaging in a more appropriate imaginative play or including others; becoming physically aggressive if his or her preferred activity is interrupted or stopped. Parents included in this study commented that these kinds of repetitive behavior were the most difficult aspects of autism for them. And, that they felt higher levels of stress as a result of this behavior.
 
< My Thoughts >         “…four areas of Restrictive & Repetitive Behaviors in the newer DSM-5.”
 
One of the reasons clinicians say this is an important part of the newer DSM-5 is because it changes how they arrive at an accurate diagnosis for persons with autism.
 
The Centers for Disease Control & Prevention (CDC) put it this way –

• Stereotyped or repetitive motor movements
• Insistence on sameness, inflexible patterns.
• Highly restricted &  fixated interests of abnormal intensity
• HYPO (under) or HYPER (over) activity to sensory input

Based on social communication impairments & restricted, repetitive patterns of behavior as noted in the CDC website – https://www.cdc.gov/ncbddd/autism/hcp-dsm.html
 
In an Overview of Repetitive Behaviors in Autism, expert and parent, Lisa Jo Rudy tells us that repetitive, purposeless behaviors, like lining up toys, spinning objects, or opening and closing drawers or doors can become a problem when getting in the way of ordinary daily activities.
 
She tells us that the DSM-5 lists abnormal, intense focus on repetitive motor movement of objects, speech and highly restricted fixated interests, or preoccupation with unusual objects. Focus on such things as – ritualized patterns of verbal or nonverbal behavior, flipping objects, echolalia, and/or idiosyncratic phrases. As well as, insistence on sameness; or, inflexible adherence to routines, and extreme distress at small changes. Above text by Lisa Jo Rudy; retrieved from: https://www.verywellhealth.com/repetitive-behaviors-in-autism-260582
 
< My Thoughts >         “…focusing on things…”
 
Sonny is nonverbal, he makes sounds and laughs, but no language, so all of his repetitive behavior is nonverbal. We purposely give him ‘interactive’ toys so that he can engage in ‘purposeless behaviors’. “Wait, what?” My reasoning is that, much like the autistic child or adult who repeats video scripts as a type of communication, Sonny can use his ‘See and Say’ toy. Of course, this is where the perseverance comes in.
 
“Someone poisoned the waterhole!” “Someone poisoned the waterhole!”  “Someone poisoned the waterhole!”…  (Courtesy of Tom Hanks’ voice, Toy Story 3) Sometimes accompanied by Sonny’s laughter… and sometimes by his sounds of frustration if his juice cup is empty.
 
Pushing the same button, over and over and over, for no apparent reason, can make the listener crazy. But, we have taken a cue from Sonny’s playbook, and just tune out what we don’t want to hear. Or, in the case of some really irritating sounds or phrases we just make a slight adjustment to that ‘See and Say’ button. Sometimes, I laugh, move him over and start hitting the button that yells “HELP MEEEE! HELP MEEEE! Smiles.
 
What perseverating may look like would be for the child to continue to have an adverse reaction to a noise, an action, or some undesirable stimuli… long after that stimuli has ceased. They may be unable to bring themselves out of prolonged stimming, even though the stimming isn’t calming them.
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BLOG #5H SENSORY CATEGORIES
3. SIRS-ACTIVITY, a. Sensory Interests, continued –
                           (a.1.)  Self-Injurious Behavior
 
In the DSM-5, part of, and listed under Sensory Interests, is Self-Injurious Behavior (SIB). Thompson (2012) states that the most common emergent forms of self-injury are finger, hand, and wrist biting and hitting head with fists or against hard surfaces. Once self-injury becomes entrenched behavior, it is often difficult to eliminate.
 
A parent reports that there were periods that her son struck his head so hard and so often, it caused severe bruising on the back of his head. His only form of communication, as soon as she gave him what he wanted he stopped.
 
Often SIBS are found to be included in ‘Challenging Behavior’, or ‘Behavioral Disturbances’ instead of a stand-alone sensory issue. Soke et al. (2017) the reasons may be that studies find both environmental and biological factors have been implicated in studies of SIBs since 1977.
 
These authors say that generally SIBs are difficult to manage and may result in hospitalizations, exclusion from educational or vocational activities, admission to residential facilities, and even in death. They believe that previous studies are lacking and SIBs have been associated with everything from maternal smoking, sensory issues, gastrointestinal problems, aggression, insomnia, age and gender, severity of co-morbid behaviors; and everything in between.

Chezan et al. (2017) claim that SIBs is a relatively common problem behavior among children with Autism Spectrum Disorder (ASD). This review covers a broad category of problem behaviors, including verbal and physical aggression, property destruction, and tantrums. Severe SIBs require an intervention that is both effective and efficient.
 
Without effective interventions, they say, it can have a negative impact on children’s quality of life, limiting development and even leading to health-related problems. Interventions have the potential to prevent or reduce the frequency and severity of SIB, but if allowed to persist across time may continue until adolescence and adulthood.
 
Sicile-Kira  (2014) thinks that some children with autism participate in self-aggressive behavior because they could be in pain and don’t have any other way of communication this. She also has seen ASD persons self-injuring in the throes of a PTSD flashback.
 
She defines SIBs as hitting, biting, head banging, flicking fingers, or slapping oneself as a possible method of sensory seeking stimulation to relieve anxiety, pain, or frustration. Others believe that there is something missing in their diet or something they are getting in their diet that they should avoid.
 
Those lacking stimulation from their environment may seek it through self-abuse. Some self-abuse is in response to smells, being touched, auditory and visual overstimulation or under-stimulation. Still others believe medication can be found to counteract symptoms.
 
< My Thoughts >       “Others believe medication can be found to counteract symptoms.”

Some of the things that Sonny does, as a result of his autism, is self-injurious behavior (SIBs). With him, this seems to be compulsive, ritualistic, and some sort of stimulation or communication. This was before finding a method of communication and a therapeutic dosage of medication to help him, too. He would strike out to bite or hit himself and others. He would stick a finger in his eye, poking and poking until restrained. When Sonny is under medicated, stressed, and/or can’t get what he wants he will tantrum and bite himself until his needs are satisfied.

He has other undesirable and even dangerous behaviors, which I will not go into here. I’m sure you get the idea of how frightening this can be. The caveat with Sonny is that as well as sad or mad, he can and will often do this self-injurious behavior as a result of being happy and excited about something he’s thinking about or doing. So first, we must stop the risky behavior and then try to find out why. Smiles.

Bogdashina & Casanova (2016) believe self-stimulating behaviors can occur when autistic children are seeking control of their Autonomic Nervous System. One intervention can be a desensitization intervention of the affected areas performed by a qualified and experienced therapist. Another intervention can be exploring deep pressure, squeezing by cushions, or a weighted blanket may help.
 
They say that when excessive aggression, anxiety meltdowns and panic attacks occur, physical exercise like swinging, climbing, or pushing heavy objects relieve some people. Self-monitoring behavior and other coping mechanisms can be taught for less severe cases of SIBs, to help your child feel safe, trusting their environment.
 
Sarris (2012) tells parents that early symptoms of autism may be among the most puzzling. Some are barely noticeable, such as response to lights, heat, cold, or physical discomfort. Using their hands or body to manipulate things is not always seen as problematic behaviors.
 
 < My Thoughts >      “Some are barely noticeable…”
 
Sometimes the sensory response causing the self-injurious behavior is an attempt to fix what’s wrong. But often, they don’t know what is wrong or how to fix it. A child who bites themselves because they are too hot or too cold, doesn’t know that putting on or taking off a sweater can make them more comfortable. Of course, trying to get a sweater on or off, may be a challenge of its own! Sonny just reacts as if there is some sort of task assignment taking place. Smiles.
 
Sarris (2015) cautions that self-injury can persist into adolescence. Violent episodes of challenging repetitive behavior can lead to cuts, bruises, dental problems, and even broken bones, concussions, and detached retinas. She tells how frightening this is because it seems to violate our basic instinct of self-preservation. Those parents are deeply challenged to protect their offspring. They childproof their homes, buckle their seat belts, walk them to school, shielding them from outside harm. But she questions how they can protect them from themselves?
 
Wright (2018) believes that a behavior consultant is able to offer new insight for the entire family to digest and begin to shift the perspective needed to track and record behavior. An example would be – The family is concerned that Johnny seems to be an aggressive child, frequently hitting those in his environment. Through BEHCA data collection the behavior consultant is able to find that Johnny is NOT doing this on purpose but as a sensory response to his environment. He is also NOT aware of how hard he is hitting.
 
Taking this further, she says that perhaps Johnny’s behavior is due to his NOT knowing what his body is doing. He is lacking spatial awareness. Or, by slamming his body/arms into things or people, he is seeking sensory input. But, he is NOT intentionally trying to hurt anyone.
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BLOG #5H - SENSORY CATEGORIES
​
3.         SIRS-ACTIVITY… (a. sensory interests, b. repetitious behavior, & c. seeking behavior).
 
Occupational therapists often observe that some children demonstrate extreme behaviors which have been labeled ‘sensory interests’, ‘repetitious’ behavior, and ‘sensory seeking’ behaviors; according to Kirby, et al (2015). Multiple types of behaviors, include – spinning, flapping hands while fixation on spinning objects, fascination with certain noises, interest in bright lights, moving objects, mouthing and smelling objects.
 
Therapists say that interestingly, 59% of children whom they have observed, did not display many expressions of enjoyment while engaging in sensory activity. Yet, finally considering that few conclusions can be drawn from this about what emotional associations children may have when participating in these sensory activities.
 
Ausderau, et al. (2014) believe that while for Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5) define sensory features uniquely and distinctly, they say that –
 
Their research suggests that certain patterns of HYPO & HYPER activity can co-occur within individuals in reaction to stimulus from the environment. Saying that within each sensory pattern there are underlying concepts. For instance, SIRS activity is characterized by fascination with or craving the sensory stimulation such as with flickering lights or rubbing textures. And, movement, especially jumping up and down, as on a trampoline.
 
Depriving a person of engaging in intense repetitive behaviors, experts expect may increase anxiety, and depression. This may even cause separation anxiety. Cautioning that those with higher ‘sensory seeking needs’ will often disengage from the behavior more slowly.
 
< My Thoughts >       “…within each sensory pattern there are underlying concepts.”
 
These are thoughts I have gathered while pursuing information about ‘sensory activity’ on gossamer wings. Smiles. Sensory activity is considered to be part of:

• A biological process
• ‘Attentional’ disengagement, of sorts
• Weak stimulus, creating a strong reaction, and/or
• Strong stimulus, creating a weak reaction
• Feelings of being overwhelmed by irrelevant stimuli
• Change in brain activity, topography, and function

Wigham, et al. (2015) say indications are that intolerance of uncertainty plays an important role in sensory activity. That sensory activity can be ‘heightened and unpleasant’ and/or ‘reduced and under responsive’, alternately. And, that the same modalities can be fluctuating within the individual at any time.

Kirby, et al. (2015) states that a personal account by Naoki Higashida (2013) corroborates an positive affect association of sensory behaviors – “in his book, The Reason I Jump” is because when I jump, it feels so good.”

REFERENCES used here are:

Ausderau, K., Sideris, J., Furlong, M., et al. (2014). National Survey of Sensory Features in Children with ASD: Factor Structure of the Sensory Experience Questionnaire; Journal of Autism Developmental Disorders; V44, p915–925.

Kirby, A., Little, L., Schultz, B., Baranek, G., (2015). Observational Characterization of Sensory Interests, Repetitions, and Seeking Behaviors; American Journal of Occupational Therapists; V69:3, published online.

Wigham, S., Rodgers, J., South, M., McConachie, H., Freeston, M. (2015). The interplay Between Sensory Processing Abnormalities, Intolerance of Uncertainty, Anxiety & Restricted & Repetitive Behaviors in Autism Spectrum Disorder; Journal of Autism & Developmental Disorders; V45:4, p943-952.
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< My Thoughts >       What I am offering here is a powerful story which may capture in a moment, what it is like to have this experience.
 
Ido in Autismland: Climbing Out of Autism's Silent Prison by Ido Kedar, eBook 2012 Edition; an Extended Review with < My Thoughts > by Sara Luker

(7% indicates location in the Kindle version of the book, instead of page numbers.)
 
7%       Ido (pronounced – ee-doh), a 15 year old boy, explains: Imagine being unable to communicate because you have a body that doesn’t listen to your thoughts. Imagine living in a body that paces or flaps hands or twirls ribbons when your mind wants it to be still or, freezes when your mind pleads with it to react.
 
8%       On the outside, the scream came out through his hands, vigorously flapping at the wrists. This was quickly redirected with the command, “Hands quiet.” He was trapped.
 
< My Thoughts >        “…the scream came out through his hands…”
 
Eventually, because his mother never gave up, Ido learned to communicate through those ‘screaming’ hands onto a letterboard created by Soma Mukhapadhyay. This, he says – “lifted him from darkness.”
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