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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