Sensory Differences

Sensory differences

Differences in reactions to sensory input have been included in the Diagnostic Statistical Manual (DSM) criteria for Autism Spectrum Disorder since the fifth edition was published, in 2013. This recognises that a person with autism is likely to show: 

‘Hyper’ or ‘hypo-reactivity’ (i.e. over or under reactions) to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).’ (DSM 5) 

Information is constantly received, registered and processed via our senses. The 5 most recognised senses are: 


•    Sight 
•    Hearing 
•    Taste 
•    Smell  
•    Touch 

It is helpful to think about at least 3 more senses: 

Body position or ‘proprioception’ (click here)

A sense of where the parts of our body are in relation to each other, and the surroundings. Our brains work this out using information from our muscles, joints, along with the sensation of touching things, e.g. the ground.

Movement or ‘vestibular’ (click here)

A sense which lets us know if we are moving, and, if so, in what direction and how fast. Information for this mostly comes from balance organs, deep inside our ears.

Internal sense or ‘interoception’ (click here)

A wide range of information is sent to our brain about hunger and thirst or when we have eaten and drunk enough, any pain or illness, body temperature, if we need to sleep, use the toilet, etc. Our internal body sense also includes the changes in heart rate, breathing, alertness and feelings like “butterflies” or a sinking feeling (often in our gut) which come with and signal strong emotions. 

Individuals with neurodevelopmental differences may process and experience sensation differently in unique and sometimes complex ways: for example,  they may be: 

  • very sensitive and may avoid, be unable to ignore or become overwhelmed by  sensations, sometimes to extremes where they ‘shut down’, show extreme anger, fear and/or attempt to escape (sometimes referred to as “fight, fright or flight, adrenaline fuelled reactions). 
  • very sensitive to some things, but don’t show this, or strongly seek other sensations to block out “unpleasant” sensations, reduce anxiety and feel calmer. 
  • Under-sensitive and may not register or react to even very powerful sensations. 
  • passive and slow to respond to sensations. 
  • under sensitive, and may seek intense input from one or many senses. 

(Based on the work of Winnie Dunn, e.g. 2007; For a short video about this look HERE)  

Sensations are the foundations for learning and actions. Differences in sensory processing can profoundly affect skills and abilities in daily life, play, and learning. 

Sensory processing in an education setting

Within an education context, you may notice  some children cover their ears or eyes, retreat, or become intensely upset. This can happen when the classroom, lunch hall or playground gets busy, or ‘simply’ because they expect or think they detect a disliked sound, smell, taste, sight, or when an internal sensation becomes unbearable. They may feel the need to rock, flap, chew, jump, run, hide, be squeezed, or hugged, make their own sounds, or focus on one thing, to help themselves feel better. If they can, they may learn to supress these feelings, but suppression has costs and there will still be signs they are struggling such as avoiding being near others, difficulty seeing objects or text, staying on task, etc. It is worth noting that they will react differently and cope more or less well, depending on prior events. 

 
Children might seem ‘tuned out’, or ‘dazed’; slumping in their seat, or lying down. They may not notice obstacles, how much force they’re using, if they are hurt or hurting others. They may seek prolonged intense movement, including banging, chewing or hitting hard, spinning or swinging. They may have an irresistible fascination and urge to touch, smell, taste, chew, hear or see something. Some children may learn and try to do this more subtly – reading, watching video or persisting in talking about the sensations they seek.                                       

All these ‘behaviours’ are not intended to upset, challenge or provoke others. Fundamentally, they are signals that a child is trying to keep calm and cope with internal and external sensations that may be extremely and overwhelmingly unpleasant.  

In the film below an occupational therapist talks about the impact of sensory differences on everyday life and school experience.

 

Transcript

All occupations, from working out how to suck our thumbs in the womb, to doing somersaults while solving a rubix cube, rely on processing and integrating sensations and using them to plan and organise our actions. Autistic people experience, process and respond to sensations differently. This can have a profound effect on all aspects of life. It brings joy and inspires deep fascinations. However, being over or under responsive and having reduced ability to process and organise sensations also makes learning more challenging, so extra support and accommodations will be needed too.

Most people would say they have 5 senses – vision, hearing, taste, smell and touch.. We now recognise at least another 3 – One is Position (which comes from sensors in our muscles, joints and where our body touches other things) A second is Movement (which is mostly detected by our vestibular system, especially the balance organs deep inside our ears). Thirdly, Interoception or our internal sensations, which are pervasive and powerful. Internal sensations include hunger, thirst, pain or illness, temperature, need to sleep, or use the toilet. It also includes the changes in heart rate, breathing, alertness or feelings like ‘butterflies in your tummy’ which come with and signal emotions. For autistic individuals, any or all of these may be processed differently, so they are likely to need supports for a wide range of aspects of body functions and emotional regulation.

So, how can knowing about sensory differences help practitioners support autistic children and young people?

Simply by recognising how powerful these sensory differences are, we are taking an important first step towards helping children and young people feel comfortable enough to participate. We are also more able to understand why autistic individuals may become overwhelmed and distressed, sometimes called shutdown or meltdown.

A good next step is to consider the environments we live and work in. Autistic people tell us that being in the busy, social world can be stressful or overwhelming for them and amplifies their sensory processing difficulties. We can start by doing whatever we can in our education setting to soften lighting, manage noise and smell, reduce clutter, the speed and amount of others movement, or the chance of unexpected touch. It’s also really helpful to do this in dining spaces, toilets, corridors; and any shared spaces. Many autistic children and young people appreciate having a “safe space” which they’ve helped design or is designed around observed preferences, where they can retreat to regulate themselves. They may cope better with the sensory aspects of new places or experiences, if introduced through photos, video, stories or visiting in advance, when its quiet and they are relaxed. Ideally, we’ll find ways to support everyone to stay together and to safely engage in their preferred ways of regulating or expressing feelings, sometimes called “stimming”. When we are dancing, watching sport or playing in open spaces; we all joyfully fidget, tap, rock, jump, stomp, hug, push or pull, hum or shout. Recognising this universality might promote understanding and tolerance for those who need to “stim” in quieter spaces. I’m delighted to have glimpses of a culture change in affirming others and enjoying our own sensory-movements.

That said, I do hear you, when you have a number of individuals with contrasting sensory preferences in one learning setting. Then you get the chance to be superbly creative! You can test out solutions like putting carpet tiles on desks and floor, so kids who need to drum or tap can still sit near those who prefer quiet. You could also try “whisper phones” – pieces of tubing – which a child with vocal stims can hold to their mouth and ear, so they can hear their sounds without the whole room hearing too. Collaborative and proactive solutions rule ok, and autistic children and young people will generally accept accommodations and “rules” if the reasons make sense and they are developmentally ready. Even our developmentally earliest autistic learners can participate if they understand why and what they are expected to do. For example, they should be able to stay longer in floor time, if it is meaningful to them, if they have a clearly marked consistent spot to sit, somewhere to lean, toys or fidgets to help focus, and enough of their body needs have been met, before we ask them to sit.

Every autistic person is different, and putting extra time and effort into understanding and honouring their unique sensory preferences and needs really does pay off.

Individuals will respond with deep engagement, if activities they are asked to do tap into their sensory interests. For example, if a child or young person is fascinated with water, you could teach numbers or other concepts through catching plastic fish in a tank. Learning activities can also honour sensory needs: Children and young people can get deep pressure touch from clay modelling as part of a project, or by stomping to flatten all old packaging, as the “recycling champion”?

It’s essential to embed desirable activities in personalised routines which are obvious to the child or young person. We know autistic individuals can find it hard to process language, so please provide a timetable they can see or touch, including objects, photos or symbols. They may never notice or be able to tell others when sensations become uncomfortable or, for example, if they need to drink, cool down, or go to the toilet, so we need to be vigilant and perhaps timetable these too.

Ros Blackburn, a wonderful autistic author, flies the world to speak at conferences with her “flappies” to stim, soft fabrics to regulate and communication cards which inform others “I can’t speak to you right now, as my senses are overwhelmed”. Our dream for the future is that everyone will appreciate their own and others sensory regulation needs and have creative ways to meet them, so there’ll be no more talk of “bad behaviour” and “good things will just happen” for all neurotypes.

The diagnosis of Autism Spectrum Disorder includes being under or over reactive to sensory input, or having unusual interests in sensory aspects of the environment. This means that an autistic person is likely to process and respond to sensory information differently to other people. This can have a profound affect on all aspects of their life.

Most people would say they have 5  senses – vision, hearing, taste, smell and touch. We now recognise at least another 3 – One is body position (which is drawn from sensors in our muscles, joints and where our body touches other things) A second is movement (which  is mostly picked up by our vestibular system, especially the balance organs deep inside our ears). Thirdly,  interoception or our internal sensations, which can be incredibly powerful. These include hunger, thirst, when we have eaten or drunk enough, pain or illness, whether we are too hot or cold, need to sleep, or use the toilet. Interoception also includes the changes in heart rate, breathing, alertness or feelings like butterflies in your tummy which come with and signal strong emotions. For children with autism, any or all of these may be processed differently.

So, how can this information help teachers and others support children with autism?

Simply by recognising how powerful these sensory differences are, we are taking an important first step towards helping a child feel comfortable enough to learn. We are also more able to prevent, support and manage ‘meltdowns’ more effectively.

A good next step is to consider the environments we all live and work in. People with autism tell us that being in the busy, social world can be really stressful  and overwhelming for them. Softening lighting and managing noise and smell, reducing clutter, speed and amount of others movement, or the chance of unexpected touch in classrooms are all useful. It’s also really helpful to do this in dining spaces, toilets, corridors ; in fact, any public spaces. Many children with autism appreciate having a “safe space” of their design and choosing, where they can retreat to regulate themselves. They may cope better with the sensory aspects of new places or experiences, if introduced through photos, video, stories or visiting in advance, when its quiet and they are relaxed. Ideally, we’ll find ways to support them to stay with us and to safely display their less conventional ways of keeping calm or expressing their feelings. Fidgeting, tapping, rocking, jumping, hugging, pushing or pulling actions, humming or shouting are totally acceptable when dancing, singing, watching or playing games and recognising this may help classmates or others understand.

Every child with autism is different, and putting extra time and effort into understanding and honouring their unique sensory preferences and needs does really pay off. 

Children with autism can flourish when activities they are asked to do tap into their sensory interests (e.g. if a child is fascinated with water, why not teach concepts like number or colour through catching plastic fish in a tank). Learning activities can also honour their sensory needs (class projects could be adapted – perhaps to allow a child with autism to be outdoors more or to get deep pressure touch from modelling with clay?). 

It’s essential to embed desirable activities in personalised routines which are obvious to the child. We know children with autism find it hard to process language, so structure can be provided through a timetable they can see or touch, including objects, photos or symbols. 
Its important to remember that they may never notice or be able to tell others when sensations become uncomfortable or, for example, if they need to drink, cool down, or go to the toilet, etc, so we need to be vigilant and possibly timetable these.

Many autistic writers have eloquently illustrated why we need to think about sensory differences. I love Temple Grandin’s observations of how letting sand pour through her fingers, or squeezing herself in a device she built finally stopped sounds from being painful and allowed her, for precious, brief moments, to feel calm :
She said…
“The squeeze machine is not going to cure anybody, but it may help them relax; and a relaxed person will usually have better behaviour.”

Approaches to support

The first steps to individualised, effective support are to find out what’s desirable and regulating for the child or young person, then build it into a day that is as routine or predictable as possible. 

As soon as possible, ideally before an autistic leaner joins your class: 

  • Speak to parents, carers, whoever seems to really know and understand the child. Find out what supportive strategies and accommodations have been working recently. 
  • Get to know the child – If they are not yet using words, (social partner) you will have to rely on others’ reports, then watch their reactions very carefully as you ‘test’ what might work. If they have a few words (language partner) or more than 100 words (conversation partner), they may still need photos, symbols, objects or at very least, written choices, to communicate. 
  • Consider your whole school environment (see CIRCLE Inclusive Classroom Tool or AET Sensory Audit for Schools and Classrooms). How can you reasonably adjust the classrooms, corridors, gym hall, lunch areas, playground, toilets, etc. For example, can you switch off noisy air-con, or hand dryers or muffle bells? If not, can the child have headphones? Can we make their working space any better with partitions, less clutter, etc? Which toilet feels easier to use? Where are they comfortable eating lunch?   
  • Agree on a safe space (see NAIT Safe Space Guidance) or place they can go if they need to ‘escape’ for a while 
  • Think through a typical day at school. Can they arrive before or after others? Could they come in through a quieter door or corridor? Can they have a calming activity before joining the group? Can they leave classes early to avoid rush and crush? 
  • Communicate their timetable in a way they can understand. Do they need colours, symbols, photos? As far as humanly possible….stick to it. 
  • Consider other adjustments – for example,  own choice of clothing, which still looks ‘uniform’; a locker or safe place for things that help them calm; pocket sized items that help concentration or calming, sometimes called ‘fidget objects’; regular timetabled physical activity or ‘movement breaks’ (even when they seem calm – its ‘fuel for their tank!’); regulation ‘menu’ (photos, symbols or written list of choose regulating activities). 
  • Discuss helping the child’s peers understand that some people have sensory differences. It may help to teach how to support or react to unexpected behaviours like a child’s need to ‘stim’ or the likelihood of upset outbursts. 

 
Support is a marathon, not a sprint. Once strategies are in place, keep going. These should be reviewed regularly, but ideally changes should be made in tandem with those who know the child best and learning and information should be passed on to the learner’s next teacher or adults involved in their learning. 

Further information and support

Occupational Therapists Occupational Therapists have particular understanding of how sensory differences may affect all aspects of children’s daily lives and can offer advice and practical strategies.  

Audiologists have expertise in assessment and diagnosis of Hyperacusis (for further information, see the National Autism Implementation Team (NAIT) Hyperacusis Guidance: NAIT-Hyperacusis-Guidance-for-schools_0.pdf (autismtoolbox.co.uk)

National Autistic Society ‘Too much Information’ campaign and video clips Too much information (autism.org.uk) 

    References:
    American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA
    Dunn W (2007) Sensory Processing in Children with Autism