The Autism Helpline often receives calls from parents where the root of the call can be directly related to the sensory difficulties the person on the autism spectrum is experiencing or being exposed to. Although universally acknowledged as being a characteristic of the autism spectrum, the sensory problems of individuals are often overlooked.

This information sheet aims to give you a basic understanding of sensory integration, providing examples of possible difficulties individuals on the spectrum may have and strategies to help. Overall it aims to provide people with an awareness of the sensory world of people with autism.

To function and participate in the world that surrounds us, we need to use our senses. Senses provide individuals with unique experiences and allow us to interact and be involved with the rest of society. They help us to understand the environment around us and respond within it. They play a significant role in determining what actions we take in a particular situation. Imagine what happens when one, or all, of your senses are intensified or are not present at all, often referred to as sensory integration dysfunction. This is the case for many individuals on the autism spectrum.

There are several definitions of autism but they rarely state what a person with autism feels. It is only through personal accounts from individuals themselves who can express and describe their unique and often painful sensory world that we find out more. Everyday functions, which the majority of individuals take for granted, can for people with autism be negative and upsetting experiences. Behaviours presented by someone with autism will often be a direct reaction to their sensory experience. It is therefore understandable why they create rituals, or have self-stimulatory behaviours such as spinning, flapping and tapping, because this makes them feel they are in control and feel safe in their unique world.

"If I get sensory overload then I just shut down; you get what's known as fragmentation... it's weird, like being tuned into 40 TV channels."

Ayres (1979, in Smith Myles et al, 2000) defined sensory integration as 'the organisation of sensation for use'. It involves turning sensation into perception.

The central nervous system (brain) processes all the sensory information sent from various sensory systems in the body and helps to organise, prioritise and understand the information. From this it is able to action a response: these may be thoughts, feelings, motor responses (behaviour) or a combination of these. Throughout our bodies we have receptors, which pick up on sensory stimuli. Our hands and feet contain the most receptors. Most of the time the processing of sensory information is automatic.

The sensory systems can be broken down into six areas. These can be divided into two main areas: hyper (high) and hypo (low) sensitivity. However, it is important to remember that the difficulties/differences may for some individuals fall into both areas.

Situated in the inner ear, this provides information on where our body is in space and its speed, direction and movement, all in relation to the pull of gravity. It is fundamental in helping us to keep our balance and posture. For an individual on the spectrum, difficulties/differences may be:

Hypo

• the need for rocking, swinging, spinning.

Hyper

• difficulties in activities which include movement, such as sport
• difficulties in stopping quickly or during an activity
• car sickness
• difficulties with activities where the head is not in an upright position, or where feet are off the ground.

Situated in the muscles and joints, our body awareness system tells us where our bodies are. It also informs us where our body parts are and how they are moving. For an individual on the spectrum difficulties/differences may be:

Hypo

• proximity - standing too close to others/not understanding personal body space
• navigating rooms - avoiding obstructions
• bumping into people.

Hyper

• difficulties with fine motor skills, manipulating small objects (buttons, tying shoe laces)
• moves whole body to look at something.

Processed through chemical receptors in the nose, this tells us about smells in our immediate environment. Smell is a sense that is often neglected and forgotten about. It is, however, the first sense we rely upon. For an individual on the spectrum difficulties/differences may be:

Hypo

• some individuals have no sense of smell and fail to notice extreme odours
• some people may lick things.

Hyper

• smells can be intensified and overpowering
• toileting problems
• dislike of individuals with distinctive perfumes, shampoos, etc.

"Smells like dogs, cats, deodorant and aftershave lotion are so strong to me I can't stand it, and perfume drives me nuts." Gillingham, G. (1995). page 60

Situated in the retina of the eye and activated by light, our sight helps us to define objects, people, colours, contrast and spatial boundaries. For an individual on the spectrum difficulties/differences may be:

Hypo

• may see things darker, lose features, lines
• for some they may concentrate on peripheral vision because their central vision is blurred; others say that a main object is magnified and things on the periphery become blurred

• poor depth perception - problems with throwing and catching, clumsiness.

Hyper

• distorted vision occurs and objects and bright lights can jump around
• fragmentation of images, as a consequence of too many sources
• focusing on particular detail (sand grains) more pleasurable than looking at something as a whole.

"... she was Mrs Marek, a face upon which light danced maniacally, turning her into more of a cartoon than a human being. Welcome to Toon town... I'd like you to enter this torture chamber I call my kitchen and meet my wife who is a 3D cartoon." Gillingham, G. (1995). page 51

Situated in the inner ear, this informs us about sounds in the environment. It is the most commonly recognised aspect of sensory impairment. For an individual on the spectrum, difficulties/differences may be:,/P>

Hypo

• sounds may only be heard with one ear, the other ear either only having partial hearing or none at all
• the person may not acknowledge particular sounds,/LI>
• enjoys crowded noisy places, kitchens, bangs doors and objects.

Hyper

• volume of noise can be magnified and surrounding sounds distorted and muddled
• inability to cut out particular sounds - difficulties concentrating
• they may have a lower hearing threshold, which makes them particularly sensitive to auditory stimuli, for example hearing conversations in the distance.

Their hearing impairment can have a direct effect on their ability to communicate and may also affect their balance.

"Do you hear noise in your head? It pounds and screeches. Like a train rumbling through your ears." Powell, J. (1995, in Gillingham, G. 1995) page 41

Situated on the skin, the largest organ of the body, it relates to touch, type of pressure, level of pain and helps us distinguish temperature (hot and cold).

Touch is a significant component in social development. It helps us to assess the environment we are in and enables us to react accordingly. For an individual on the spectrum difficulties/differences may be:

Hypo

• holds others tightly
• has high pain threshold - temperature/pain
• self-harming
• enjoys heavy objects on top of them.

Hyper

• touch can be painful and uncomfortable and they will often withdraw from aspects of touch, which can have a grave effect on their relationships with others
• low temperature threshold
• dislike of having anything on hands or feet
• difficulties in brushing and washing hair
• only likes certain types of clothing or textures.

"Every time I am touched it hurts; it feels like fire running through my body." - Gillingham, G. (1995). page 3

Processed through chemical receptors in the tongue it tells us about different tastes - sweet, sour, bitter, salty and spicy. Individuals will often have restricted diets as a result of their taste buds being extra sensitive. For an individual on the spectrum difficulties/differences may be:

Hypo

• likes very spicy foods,/LI>
• eats everything - soil, grass, materials.

Hyper

• some flavours and foods are too strong and overpowering for them
• certain textures also cause discomfort; some children will only eat smooth foods such as mashed potatoes or ice-cream.

This is a rare condition, separate from autism, which some individuals on the spectrum say they experience. This is when confusion in the sensory channels occurs. A sensory experience goes in through one system and out through a different system. For example an individual hears a sound (auditory system) but sees colours (visual system).

A greater understanding of the sensory world of individuals on the spectrum allows you to help them develop in a more comfortable environment.

The following ideas and strategies will hopefully help when trying to create a comfortable environment for an individual on the spectrum to avoid their senses being overloaded.

General points to remember:

Knowing that sensory dysfunction may be the reason for the problem, always examine the environment.

Use your imagination to come up with positive sensory experiences and/or strategies.

Always warn the individual of possible sensory stimuli they may experience, eg loud crowded places.

Sensory integration therapy involves the gentle exposure to various sensory stimuli. The aim of this therapy is to strengthen, balance and develop the central nervous systems processing of sensory stimuli. Delacato (1974), who introduced the concept of Sensory Integration Therapy, focused the therapy on the five core sensory systems - vision, taste, smell, auditory and tactility. Today, occupational therapists continue to focus on these areas, as well as incorporating the vestibular and proprioception systems, when creating and planning a schedule of activities for an individual.

Hypo

• encourage activities which help them develop their vestibular system - rocking horse, swing, roundabout and see-saws.

Hyper

• break down activities into small steps, use visual cues such as a finish line or prompts.

Hypo

• position furniture around the edge of the room to make navigation easier
• put coloured tape on the floor to indicate boundaries
• use the arm's-length rule.

Hyper

• threading activities
• lace boards.

Hypo

• use strong-smelling products as rewards and to distract them from possibly inappropriate strong-smelling stimuli (faeces).

Hyper

• use unscented detergents or shampoos, refrain from wearing perfumes, make environment as fragrance free as possible.

Hyper

• reduce fluorescent lighting by using deep-coloured light bulbs instead
• sunglasses
• create a work station in the classroom: a space or desk with high walls or divides on both sides to block out visual distractions from the front and sides
• use blackout curtains.

Hypo

• increase the use of visual cues.

In the early 1980s Dr Guy Berard created a machine that tests and exercises individuals auditory system. This approach believes that behaviours are a consequence of difficulties in the auditory system. By producing and altering various sounds the machine is able to use its auditory filters to maximize the volume without causing discomfort. The aim is to train the auditory system and balance its input. Research into this approach is very limited. For further information see contacts/recommended reading.

The benefits of music therapy have been recognised, and it is often used with individuals on the spectrum. Music therapy provides individuals with a unique opportunity to communicate, interact and express. For further information see contacts/recommended reading.

Hyper

• shut doors and windows - to reduce the external sounds they have to deal with
• prepare them before they go to a noisy place or crowded situations
• ear plugs
• Walkman
• create a work station.

Hypo

• use visual cues to back up verbal information.

Hypo

• weighted blankets
• sleeping bags.

Hyper

• warn the child if you are about to touch him or her; always approach him or her from the front
• remember a hug may be painful rather than comforting
• gradually introduce different textures - have a box of materials available
• sllow the individual to complete the activities themselves, enabling them to regulate their sensitivity (eg, hair brushing and washing).

Sensory environments are aimed at providing individuals with the opportunity to stimulate, develop or balance their sensory systems.

They are located mainly in specialist schools or hospitals so access is quite limited. However, many families have chosen to adapt a room in their home to create a space for sensory stimulation or reload.

Hulsegge and Verheul (1986, in Pagliano, 2000) developed the concept of the sensory room in the Netherlands. Drawing from the work of Clark (1966, in Pagliano, 2000) who established the idea of 'SNOEZLEN' rooms, this is a combination of two words, to 'smell' and to 'doze'. The terms more commonly used in the UK are sensory rooms or multisensory environments.

Rooms or sensory spaces can take various forms, for example white, dark, sound, interactive, water, softplay or garden. Their main functions tend to be therapeutic, educational and relaxation, all in relation to development.

Equipment used in the rooms varies depending on the type, function and needs of the individual using it. The following list gives examples of equipment to provide stimulation for all sensory systems. Stimuli can include soothing music, vibrating cushions, fibre optics, mirror balls, bubble tubes, waterbeds, tactile walls, disco lights and projectors to name just a few. Equipment can be set up using switches, pressure, sound and movement which then activate a piece of equipment in the room. The child comes to recognise cause and effect.

The reported benefits of sensory rooms at present come mainly from personal experiences and observations, as there is only a limited amount of research.

Occupational therapist - they play a fundamental role in sensory difficulties by designing programmes and often making adaptations to environments to ensure individuals are able to live as independently as possible.

Sensory impairment team - accessed through local social and health services, these teams specialise in sensory difficulties. Although they are not autism-specific some local authorities do cover individuals on the spectrum.

>B>Speech and language therapist - often use sensory stimuli to encourage and support the development of language and interaction.

Music therapist - use instruments and sounds (auditory stimuli) to encourage and develop the sensory systems, predominantly the auditory system.

Problem - possible sensory reasons - ideas

• Picky eater - sensitive to taste or texture, maybe unable to feel the food around mouth - slowly introduce different textures around the individual's mouth, eg flannel, toothbrush, foods, introduce small portions, change texture of the food, purée it. Encourage activities that involve the mouth, such as whistles, bubble wands, straw painting.
• Chews on everything, including clothing and objects - may find this relaxing, enjoys the tactile input of the item - latex-free tubes, straws, hard gums (chill in fridge).
• Smearing - may like the texture in their hands or be hypo sensitive to smells - try and introduce similar materials such as jelly, cornflour and water.
• Refuses to wear certain clothes - dislike the texture or pressure on their skin, turn items inside out so there is no seam - remove any tags or labels; allow them to wear clothes that they are comfortable in.
• Difficulties getting to sleep - may have difficulty shutting down senses, in particular visual and auditory - use blackout curtains, allow child to listen to music to cut out external sounds, weighted blankets.
• Finds concentrating in the classroom difficult - may have too many sensory distractions: too noisy (talking, bells, chairs scraping the floor), lots of visual stimuli (people, pictures on the wall), may also find holding a pencil uncomfortable (hard/cold) - position them away from the doors and windows, use furniture in the room to create an area free from distraction or if possible an individual workstation, try different textures to make the pencil more comfortable.