Sensory Processing Disorder (SPD) is a term used to describe the challenges children (and adults) have when their brains are not interpreting the sensory messages they receive from their body and the environment effectively. Their brains might find some sensory inputs overwhelming. Or they might not notice sensory inputs as quickly as others. You can learn more about Sensory Processing Disorder by reading our article ‘What is SPD?’ here. On this page we are going to take a closer look at ASD and sensory processing challenges.
Autistic Spectrum Disorder/Condition
Autistic Spectrum Disorder (ASD) or Autism is a developmental disability which affects how a person communicates with others and experiences the world around them. Children or adults with autism will have difficulties with social communication and interactions. They will also have some form of restricted and repetitive patterns of behaviours, activities or interests. Responses to sensory information were included in the 2013 update of the DMS-5, a manual used by clinicians to make an autism diagnosis.
Whilst it had been known prior to this that ASD and sensory processing challenges often occurred together, this is the first time it had been formally recognised. The manual states that the patterns of behaviours, activities or interests may be due to ‘Hyper- or hypo reactivity 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).’ This means that a child or adult with autistic spectrum disorder is likely to process sensory information in the environment differently to others.
How frequently do ASD and sensory processing challenges occur?
In one survey* of adults with autism, 83% of respondents said that they had some challenges with sensory processing. In the same survey respondents also listed sensory processing challenges as contributing to their increased levels of stress. The percent of children with ASD and sensory processing issues has been reported to be between 69% to 95% depending on the study**. It also occurs frequently enough for it to be included as part of the diagnostic criteria in the DSM-5 update in 2013.
What might the sensory processing challenges in autism feel like?
One description I found very useful in thinking about what it might feel like for a person with ASD who experiences sensory processing challenges is from Anita Lesko. She stated that:
‘Living with Asperger’s is like living with Dolby Surround sound, wearing 3-D glasses like those used in movie theatres and having your sense of smell and touch jacked up to the max’ Anita Lesko*
Difficulties with sensory processing can affect every part of a child or adult’s life.
Close your eyes for a minute and just think about all of the sensory input you are experiencing.
Are there sounds or smells? Can you feel what you are sitting on? Does your body know whether you are sitting up or lying down?
What about micro sensations? How do your clothes feel against your skin? What about your watch or jewellery? Can you sense the seams of your socks or tights? How does the faint tick of a clock sound, or the flicker of a light affect you?
Noticing micro sensations
Some of you who are reading this may have never noticed these micro sensations before. This is because your brain filters them out. For someone with Autistic Spectrum Disorder / Condition though, these micro sensations may be felt with greater intensity. This can often lead to distraction or avoidance. Over time, if these sensations become too much, this can lead to a meltdown or shut down. Children (or adults) that meltdown typically show their overload from these senses in more obvious ways than those that shut down. It is important to also keep an eye out for shut down as these children (and adults) can be overlooked. Withdrawal, going quiet and trying to hide can be indicators of shut down.
Considering all sensory inputs
These videos give a nice example of the sheer amount of sensory inputs in our environment every day and how someone with ASD and sensory processing challenges might experience the world.
Is there always a pattern of sensory sensitivity in autism?
Interestingly, despite there being a lot of attention on sensory sensitivity in autism, the research gives a mix of sensory patterns. Results show that there is no clear pattern of responses in autism to sensory information. Different studies have given different results but most find that there is a mixed sensory profile in autism.
This is a good reminder that every person with autism is an individual. Whilst some brains are more sensitive, others could be slower to respond to sensory inputs and others might seek out more sensory inputs. There can also be differences with each sense. One common finding in all studies is auditory sensitivity, so sensitivity to sounds. I see this clinically too. Touch sensitivity is also frequently reported.
Overall, however, research does not support a specific pattern of responses. Every child or adult with autism will have their own unique sensory profile and need their own individualised supports.
What might ASD and sensory processing challenges look like functionally day to day?
On a typical day, as the videos show, there are many different sensory inputs that our brains need to process. The brain needs to decide whether to respond or to ignore. The world is full of noises, so, if you’re sensitive to noise then sirens, clocks ticking, loud vehicles, dogs barking, music class, playground noises, vacuum cleaners and hand dryers might be an issue. It is also full of things to look at and smell. This can prove very distracting if you are more sensitive to visual inputs or smells.
Our touch sense is constantly working. Difficulties might occur with clothing fabrics, shoes and socks, haircuts, hair brushing or washing, teeth brushing, messy play and food textures for those who are sensitive to touch. If processing is slower it will take longer to respond to messages from the touch system.
Those who are slower to process proprioceptive sensory input have poor awareness of where their body is and poor coordination. Sometimes they find slow movements more difficult. This could mean seeking out more movement by constantly being on the go and fidgeting. There could also be sensitivity to movement, which often results in avoidance of moving surfaces, swings and other playground equipment. Our post on the vestibular system provides more information on this sense.
Consider the environment
Sensory inputs will change depending on the environment. Often at home the environment is more predictable so it can be easier to manage when compared to school. There are less children or sometimes no other children at home. The child has their own space they can retreat to. They have more choice over the activities they participate in. However, some children find the routine of school helpful. Others can find the sheer volume of sensory inputs at school quite overwhelming.
The larger and more unpredictable the space is, the more sensory input there is for the child or adult with ASD to process. So, think of a large supermarket compared to a small corner shop. There is so much more to look at, the lights are typically brighter. There are more people, there is more movement and much more noise in the supermarket. For those without sensory sensitivities, the brain again ignores and filters out the information it doesn’t need. This makes it much easier to be in the space. When the brain isn’t filtering out this information as well, such as in autism, the brain pays attention to everything. This is why sensory overload can occur. There is just too much information for the brain to process.
Responses can also change
Responses to sensory inputs can fluctuate and change. Children and adults with sensory issues can find these harder to manage towards the end the day. Or towards the end of the week or school term. Tiredness or ill-health can exacerbate sensory issues. Clinically I have seen a significant difference in children’s ability to manage sensory sensitivities when they are well compared to if they are unwell. Children with autism can often have even less reserve and reliance when they are unwell. This can lead to quicker sensory overload.
Another thing that will impact on sensory processing is stress. There some research in this area. It indicates that anxiety can increase sensory sensitivity. However, they also showed that sensory sensitivity can increase anxiety. The author (Pfeiffer, 2012) was unable to tease out which came first though. Liking it to a chicken and egg scenario.
How can I help support sensory processing difficulties in ASD?
The good news is that there are numerous sensory strategies that can be used and environmental adjustments that can be made. The challenge is that as every child or adult with autism has a different sensory profile, there is no hard and fast one size fits all solution. Each person with sensory challenges will require their own individualised set of supports. An occupational therapist (OT) is typically the best professional to provide you with support in this area.
The most recent recommendation from the American Journal of Occupational Therapy (AJOT) is that before sensory strategies are used, there must be documented assessment of need. Without assessment, a child may just be given what is available. For example, we have a wobble cushion that helped Jack last year, so let’s give it to Suzie this year. It is really important that those providing sensory strategies to children and adults with autism have a good understanding of which senses the equipment or activity helps. This is why we explain clearly why you might use each strategy and the safety considerations in our paid Sensory Processing Disorder training.
For children that experience sensory overload, heavy work can be a helpful strategy to try. We explore this further in our post – The Mystery of Heavy Work.
The following resources also provide numerous ideas and strategies to try.
Online SPD courses
GriffinOT’s online course – ‘Sensory Processing: What’s the Fuss?’, explores the sensory systems, sensory responses, and strategies to help in further depth. As we said above, we also give specific safety tips for using sensory strategies. Our goal is to help you really understand why you are using sensory strategies so you can use them correctly. You find out more information and access the course here.
Parent-friendly books on autism and SPD
- For a very simple introduction and lists of ideas more specific to Sensory Processing & Autism: Building Bridges through Sensory Integration by Yack, Aquilla & Sutton (2015)
- For a good introduction to Sensory Processing Disorder: The Everything Parent’s Guide to Sensory Processing Disorder by Terri Mauro (2014)
- Another good introduction to Sensory Processing Disorder written by a parent: The Out of Sync Child by Carol Kranowitz (2005)
- Although not specifically written on sensory processing, this book gives a lot of suggestions related to supporting sensory issues. It also provides a very honest and in my mind helpful account of what is like living with a child who has autism: Coming Home to Autism: A Room-by-Room Approach to Supporting Your Child at Home after ASD Diagnosis by Tara Leniston & Rhian Grounds (2018)
- For extra strategies: Been There. Done That. Try This! By Atwood, Evans, & Lesko (2014)
- For further information, however, if you’re completely new to ASD and sensory processing I would recommend you read an introductory book on the subject first. This book assumes some prior knowledge on autism and sensory processing: Sensory Perceptual Issues in Autism and Asperger’s by Olga Bogdashina (2003)
Teacher-friendly books on ASD and sensory processing disorder
The above books would be suitable for teachers. In addition, these books also provide extra information:
- Sensory Processing Challenges – Effective Clinical Work with Kids and Teens by Lindsey Biel (2014)
- A Buffet of Sensory Interventions by Susanne Culp (2011)
What does the evidence say?
Whilst there is a lot of research on the use of sensory strategies, much of the research is poorly designed. A recent review considering the use of sensory strategies with pre-schoolers (Bodison & Parnham, 2018) found 11426 potential articles. However, only 24 were suitable to review, and only eight were used in the report. These numbers show that, although there is a huge amount of information written about sensory strategies, there very few studies with a good research design.
The authors found that there was “Insufficient evidence supports the effectiveness of regularly incorporating specific sensory techniques into classroom routines for pre-schoolers with ASD” (p.9). Their recommendation was that the interventions are used cautiously. They found insufficient evidence for using weighted weighted vests with children on the autism spectrum. It is felt that this study supports AJOT recommendation for documentation and review when using sensory strategies.
There are two small case studies looking at sensory movement breaks. One case study (Mills & Chapparo, 2016) showed a drop in the number of daily behaviour incidents of a child with ASD after participating in sensory activity programme. The incidents dropped from 83 incidents prior to 14 incidents per day after the programme was used. Perez, Wong and Perryman (2019) were able to demonstrate that off task behaviour decreased in the three children that participated in their sensory activity schedule. It is important to note that in both of these studies the sensory programmes were created by an OT to support the children’s specific needs.
Ayres® Sensory Integration (ASI) treatment is very different to the use of sensory strategies, such as wobble cushions, fidget toys or weighted vests, commonly used in schools. One essential criteria of ASI treatment is that it is child led. A second essential criterion is that the child must be actively engaging in sensory experiences. There is a fidelity measure which aims to ensure that there is consistency with therapists using the ASI treatment approach (Parnham et al 2007).
Schaff, et al completed a review of research look at using ASI with children with autism in 2018. The authors only included studies where the sensory integration treatment met this fidelity measure. They reviewed five studies. Their results indicated strong evidence that ASI treatment provides positive outcomes for improving function and participation goals in children with autism. These goals were individualised for each child’s needs. They also found a moderate degree of evidence to support the use of ASI to help to improve behaviours, and increase independence with self-care activities. There was only emerging, but insufficient evidence to support the use of ASI to improve play, sensory motor and language skills.
An exciting piece of new sensory integration research in the UK
Whilst results are not yet available, an exciting piece of research is currently being completed at Cardiff University. Radell, et al (2019) are running a trial comparing ASI to usual care in children with autism. They aim to recruit 216 children within the UK to participate in the trial. Half of the children will receive two sessions of ASI therapy a week for ten weeks. The other half, a control group, will receive the usual care provided. All sensory integration therapy will be scored against the fidelity measure. The study aims to provide high quality evidence on the clinical and cost effectiveness of ASI. The results should give clear data on the true effectiveness of ASI for children with autism.
* Atwood, T., Evans, C., & Lesko, A. (2014). Been There. Done That. Try This! Philadelphia: Jessica Kingsley Publishers
Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72, 7201190040. https://doi.org/10.5014/ajot.2018.029413
** Hazen, E. et al (2014) Sensory Symptoms in Autism Spectrum Disorders Harvard Review of Psychiatry Volume 22 Number 2 March/April 2014
Parham, L. D., Cohn, E. S., Spitzer, S., Koomar, J. A., Miller, L. J., Burke, J. P., et al. (2007). Fidelity in sensory integration practice intervention research. American Journal of Occupational Therapy, 61, 216–227
Pfeiffer, B. A. (2012, June). Sensory hypersensitivity and anxiety: The chicken or the egg? Sensory Integration Special Interest Section Quarterly, 35(2), 1–4.
Randell, R. et al (2019) Sensory integration therapy vs usual care for sensory processing difficulties in autism spectrum disorder in children: study protocol for a pragmatic randomised control trial. BMC Trials. https://doi.org/10.1186/s13063-019-3205-y
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of occupational therapy using ASI: A systematic review. American Journal of Occupational Therapy, 72, https://doi.org/10.5014/ajot.2018.028431
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