We are sensory beings. We experience life through our senses. Through seeing, hearing, tasting, smelling, feeling or moving around – sensors receive information and send it to the brain. The prime aim of our senses is to look after our body.
People respond in different ways on a continuum to sensory input. It may depend on the way we feel from day to day or from person to person. People with autism can have extreme reactions to stimuli that they cannot control and this can interfere with daily life. Sensory issues can cause issues with concentration, distraction or agitation.
When sensory input is not organised appropriately in the brain we can it sensory processing dysfunction. People have different levels of processing that can cause them to over or under react to stimuli. Difficulties may be noticed if there is difficulty in maintaining an alert but relaxed state, an avoidance of movement or touch, self-stimulation (“stimming”) or self-injury, rigidity or inflexibility, difficulties in toleration or adjusting, unpredictable explosions of emotion or stereotypical behaviours.
How we feel can fluctuate over the day. We may be able to maintain a calm and functional state, but over stimulation will cause anxiety and start to affect our behaviour. Some individuals may exhibit hypersensitivity in some areas and hyposensitivity in others. They may even move between the two based on individual circumstances.
As we look around we build a memorable picture of the world around us based on size, colour and shape, and we learn to notice differences, bigger and smaller, nearer or far away, and use this visual map to move around successfully.
Visual sensory dysfunction.
Hypersensitivity may be noticed with sensitivity to certain bright colours, such as red and yellow. Eye contact may feel painful and they may prefer to look at you through their peripheral vision, may squint or look at things with quick glances. Sometimes this also means they are afraid of speed and heights. It may appear that someone is making eye contact but they may be giving fleeting glances, looking at something close to your eyes, such as the tip of your nose, or actually looking through you. There may be hypersensitivity to bright lights and sunglasses may be worn even in dull weather. I have found grey/blue lens most effective at shutting out the over stimulating brightness and colour. Avoid bright colours or large tonal contrasts and fluorescent lighting.
Hyposensitivity may lead to deliberate attempts to create the sensation. They may not see small things or water in a glass. They may have obsessions about moving parts of objects, such as wheels. They may spin or twirl objects to capture the sensation of movement or stare to create optical illusions. They may be fascinated by small details and parts of things, such as ripples in a puddle or grooves on their fingertips. Lighting a room with only 40-watt bulbs may help, as may coloured lights. Be aware of edges of objects and allow activities that encourage visual stimulation.
We notice where sound is coming from by which ear we hear it in loudest. Some people are sensitive to sound and notice sounds not heard by others. Some sounds may be comforting and some irritating or even painful and causing anxiety. We can get a sense of whether or not something is safe by memory recognition of the sound and pattern matching to other sounds we have heard and stored in our memory.
Sound sensory dysfunction.
Hypersensitivity may be noticed by the placing of hands over ears. There may be sleep disturbances as sounds continually wake them. They may notice sound frequencies that others do not, grimace at certain sounds, or enjoy making their own noises as they are predictable and drown out other less predictable or acceptable sounds. Try using earplugs or headphones. Listen to soothing music or sounds, or favourite music on an ipod/mp3 player. Speak clearly. Try to pre warn about noises. If possible avoid crowds. Remove any offending sounds if safe to do so. Try to make their room as sound proof as possible. Avoid surfaces that create echoes, keep tone of voice low, calm and neutral. And teach coping strategies such as safe place and breathing/relaxation for unpredictable sounds.
Hyposensitivity may be seen in ignoring loud noises or making their own. They may tap surfaces, be fascinated by vehicles, engines and traffic. They may deliberately place their ears near to vibrating surfaces or like noises such as vacuum cleaners and flushing toilets. They may do things such as tearing paper or slamming doors for the sounds they create. It is necessary to allow the stimulation so noisy toys may help to guide away from some activities towards those more appropriate.
Smell and Taste.
This is closely linked to memory in the brain. We can often have an emotional reaction to smell bringing memories of similar smells to the present. Some people can have extreme reactions to certain smells.
Taste works closely with smell. Our mouths can offer a huge number of sensations and our tongues can taste bitter, sour, salty and sweet.
Smell and taste sensory dysfunction
Hypersensitivity. There may be sensitivity to smells. Typically these might be things like toilets, pets, perfumes or mown grass, but each person will have their own sensitivity. They may react to the smell of people or their breath. They will typically prefer to have bland food or use the tip of their tongue to test things. Let them know it is not just them – you smell things too. Fresh air and natural smells are best. Try to avoid strong smelling detergents, perfumes or deodorants. Move on from bland foods by adding small amounts of other flavours to attempt to gradually desensitise.
Hyposensitivity may be seen if the individual chooses strong flavours and may choose to eat faeces. They may lick themselves and then taste it or place objects into their mouths to taste them. They may love spicy food. Licking may be a desire for salt. Play smell games and find substitutes for faeces. Use scratch and sniff cards. Move chemicals away for safety.
Receptors in our skin tell the brain where parts of our body are. We may notice light touch, such as a feather or a stroke or deep pressure from a squeeze or a hug.
Touch sensory dysfunction
Hypersensitivity – may withdraw or avoid being touched by others, or flinch from touch, may strip off clothing, they may be very sensitive to temperature, perceiving heat and cold differently, or have food issues, mostly related to texture. They may turn socks inside out to avoid seams, cut labels out from clothing or only wear certain types of fabrics, often furry and soft. They may want loose and comfortable clothing. They may have a low pain threshold or find discomfort in sitting for too long. Fingertips may be especially sensitive so they may prefer to have long nails, or to cut/bite them very short to avoid feeling them. Be aware of the environment around the hypersensitive person and consider approach. Avoid touch. If you have to touch, keep it brief. Be aware of rough clothing and towels. Many respond better to deep pressure, but for each individual you need to find a method that is appropriate and acceptable to them. There are desensitisation programmes available if appropriate.
Hyposensitivity – may not react unless touch is intense. They may have poor tactile discrimination and a high pain threshold. They may crave excessive amounts of touch and place items in their mouths to feel them. They may play with inappropriate substances such as faeces. Experiment with tactile toys, such as sand trays, beads, messy play or vibrating toys. Use different textures. Use light touch immediately followed by firm pressure. Incorporate hugs and rough and tumble play into their daily routine. Try regular massage and brush or rub their skin.
There are movement sensors in your brain and ears. They tell you how fast you are going, whether you are balanced and standing upright, the direction in which you are going. Some people love the feeling of movement and others prefer stillness.
Vestibular hypersensitivity – individuals may be fearful of changes in position involving gravity. They don’t like heights and can’t tolerate changes in head position, often become dizzy and sick and show anxiety to movement. They may sit on the floor to avoid activities. Allow gradual linear movement that is slow and small. Things such as gentle rocking, allowing them to use self control for movement. Slow swinging or activities such as horse riding may help.
This is our position sense. It helps us feel where our arms, legs, head and body are, even when your eyes are shut. These sensors are in your muscles, tendons, and joints and we trigger these when we move, push or pull. People who do not manage these things so well may be described as clumsy or accident-prone.
Proprioception hypersensitivity – planning activities may be difficult. They may fatigue easily as they have to focus on keeping themselves upright, or applying the right amount of force to do an activity. Try activities that involve heavy work with movement, such as using a wheelbarrow, riding a bike or sweeping. Any activity that involves running jumping, pushing or pulling and carrying weighted objects will benefit them. Practice with everyday objects such as knives, forks, spoons, or toothbrushes. Swimming and trampolines are excellent ways of receiving proprioceptive feedback.
Offering choice and an ability to control their own environment is very important.
Self-directed activities help learning through exploration and an opportunity to build coping strategies and take control.
Understand, listen and empathise.
Modify environments if appropriate to ensure safety but allow experimentation. If it isn’t hurting them, someone else or someone else’s property – then it’s fine. Simplify tasks so there is an increasing feeling of success and progression.
Work on one skill at a time to avoid confusion or overload.
Keep a journal to record when and how behaviours happen and make use of this to notice patterns for future development.
Be aware of difficulties and change the approach as appropriate.
Build in structure and boundaries for a feeling of safety and security and warn of change in advance.
Remember, individuals are different and their sensory difficulties are unique to them.