Sensory Dysfunction & Autism

Also known as Praxis Greek for doing, action, practice (Kranowitz, 1998). Motor planning is dependent on efficient sensory integration. It involves conscious attention to the task while relying on stored information about sensations that are unconscious (Ayers, 1991). Motor planning also involves three components that interact and help to accomplish the overall goal: ideation, planning, and execution (Ibid). 1. Ideation: having an idea of what to do. This is relies on recalling past information about the same or similar experience to understand the present sensory experience. 2. Planning: using the stored information to plan a course of action to interact with the environment. 3. Execution: carrying out the cognitive plan physically so that the individual is interacting with the environment. Motor planning is aided by the tactile and vestibular systems. These two systems provide knowledge about how the body moves and how it can be used to act on the environment (Ayers, 1991). Developmentally motor planning begins very early in life as one begins to move in and learns from his/her environment these memories are stored and continuously used and built upon. The more a child explores and interacts with the environment the more ways he/she learns to move in different ways and as a result his/her motor skills improve. By gaining confidence with some environmental stimuli, the child may begin tackling new stimuli based on learned knowledge e.g. (Kranowitz, 1998). Poor Motor Planning (Dyspraxia) Dyspraxia is a sensory processing problem affecting the ability to perform coordinated actions (Kranowitz, 1998). This child will have problems coordinating movements and moving smoothly. Therefore the child may avoid activities which could improve motor skills. Tactile dysfunction/defensiveness plays a large role in motor planning and carrying out activities in the environment. If an object is aversive to the child this experience will not participate in the activity and lose out on the experience. As a result the information will not be stored in the childs motor repertoire, he/she does not gain the motor stimulation and cannot use this information for future experiences. Movement Disorder
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An individual may have difficulty initiating movements. As a result of being unable to initiate movement, he/she may have difficulty continuing or maintaining movement or stop once movement has begun. Combining movements or switching from one to another may also prove very difficult. Therefore these difficulties may affect speech, thoughts, perceptions, and emotions in addition to physical movements (Geneva Center). Specific motor problems that may result from a movement disorder or motor planning difficulties are: poor balance clumsy locomotion underdeveloped basic skills e.g. manipulating a ball poor manual dexterity e.g. ability to put on clothes difficulty in writing difficulty with rapid movements e.g. cutting lax joints and low muscle tone poor ability to imitate actions

THE SENSORY SYSTEMS

We interpret information about the environment through our sensory systems. It is the process in the brain which organizes sensory Experiences touch, movement, body awareness, sight, Sound [taste] and pull of gravity into unified Information which the individual uses in learning about and reacting to the [environment]. It is the ability or inability to construct useful information from sensory experiences (King, 1991) Our sensory processes take place unconsciously in the nervous system and the brain where information is interpreted about touch, pain, temperature, pressure, and movement (Ayres, 1986). Sensory stimulation is acknowledgement that a sensory system has been activated (e.g. something has touched the skin). Therefore it is important to note that sensory stimulation is different that sensory integration (King, 1991). What is Sensory Integration? Sensory integration is the organization of sensory input for use (Ayres, 1986). It is the organization, processing of input information from different senses and manipulation of this information for an output response to the environment
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(Yack et. al, 1998). A person relies on the ability to organize the sensory stimulation information that comes into the nervous system and organize this information so that it makes sense (is the information a positive or negative experience). The individual then relies on the ability to take this information and act on the environment in a positive or negative way ensuring comfort and security at all times using all the information provided by the different senses. However not all individuals are able to integrate and utilize the information from his/her senses for his/her benefit. Problems with sensory integration often require the need for sensory integration intervention. How Sensory Integration Occurs (Adapted from Yack et. al, 1998) 1. Sensory registration: when the individual first becomes aware of a sensory event. This is often dependent on the intensity of the event. Individuals with PDD may have a much higher (hypo-sensitivity) or much lower (hyper-sensitivity) threshold to sensory stimulation. 2. Orientation: enables the individual to pay attention to the incoming sensory information. Individuals with PDD may not be able to follow instructions because they are focusing on meaningless sensations. Other individuals with PDD may be overwhelmed and uncomfortable with sensations showing fear or anxiety. 3. Interpretation: the ability to interpret sensory information and understand/describe the qualities of the sensation. Individuals with PDD may have trouble interpreting sensory information because of poor orientation and therefore he/she is not accurate with the description of the sensory event. 4. Organization of a response: the ability to use the information received to react to the event or environment. An individual can choose to respond to the information in three ways; a) physical response (e.g. hitting), b) emotional response (e.g. to be scared), c) cognitive response (e.g. choosing to ignore the situation). Individuals with PDD because of problems with the previous steps, may respond in an inappropriate way to the stimulus. 5. Execution of response: the ability to carry out the response in reaction to the environment. For individuals with PDD often poor motor planning subtracts from the ability to execute a response accurately.

Inefficient Sensory Integration

When too much information is entering the brain and nervous system the individual is unable to cognitively process what is coming in. Kranowitz (1998) has identified three causes of poor sensory integration. 1. Inefficient sensory intake (hyper or hypo sensitivity). 2. Neurological disorganization (a failure to receive information, inconsistent reception of information, or an inability to integrate the information with other sensory information to make the information useful). 3. Inefficient motor, language, or emotional output (this may be due to inefficient processing of sensory information to produce feedback and allow for meaningful behavior). Individuals with sensory integration difficulties as mentioned above often partake in sensory integration intervention/therapy. There are three goals to such an intervention; a) help the individual attain a state of calm alertness, b) enhance the organization of sensory information and translate it into useful information and, c) to help acquire the concepts that underlie and aid in learning (King, 1991).

DUAL MODAL PROCESSING Dual modal processing is the ability to process more than one modality/sense at one time. The information from each sense is processed and used in conjunction with information from other senses to understand, describe and act on the environment.

THE SEVEN SENSES (OVERVIEW AND APPLICATION) The Proprioceptive System (Proprio, Latin for ones own) The proprioceptive system is the unconscious awareness of ones own body position relative to other body parts and to the environment (Yacks et. al, 1998). This system provides information that helps the individual integrate touch and movement (Kranowitz, 1998). Primarily the system provides information about the sensations from muscles and joints, how and when the muscles are contacting , extending or compressing (Ayres, 1986). It is an unconscious sense, contributing to the development of motor planning. By receiving proprioceptive stimulation, hyper-reactivity to other sense stimuli may decrease (Yack et. al, 1998). Often proprioceptive sensations are pleasurable and have both calming and alerting components (e.g. stretching to stay alert or stretching to relax). Rarely does proprioceptive input overload the nervous system and cause
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anxiety. The proprioceptive system is connected with both the tactile and vestibular systems. Tactile-proprioceptive (somatosensory) is the simultaneous stimulation of touch and body position (Kranowitz, 1998) for example, holding a pen to write requires hand, arm and body position while also focusing on pressure on the pen to write and to hold. While the vestibular-proprioceptive perception is the simultaneous awareness of head and body positions while moving in the environment, for example walking up or down a staircase.

Proprioceptive Dysfunction Hyper-sensitivity A difficulty in receiving or processing information from muscles and joint is a sign of hyper-sensitivity and often results in a difficulty of interpreting such information. These individuals often suffer from a lack of feedback about movement and body position and as a result he/she will have poor body awareness and will often be clumsy(Yack et. al, 1998). Other difficulties include an inability to determine the amount of force needed to move objects, writing with appropriate pressure, lifting heavy objects, and an avoidance of putting weight onto joints (e.g. jumping) (Wilbarger, 1997). Hypo-sensitivity An individual who is hypo-sensitive to proprioceptive sensations has a high threshold, meaning he/she needs more input gain sensation. As a result such individuals may seek out additional proprioceptive sensations to increase his/her knowledge of where his/her body is in the environment. Some individuals may rock back and forth, bang his/her head, or run into furniture (crashing). Such behavior may also be seen as an escape from hypersensitivity to other sensations (remember proprioceptive input is often calming). Things We May See Biting or Grinding Teeth This may be a calming strategy or an effort to stabilize balance. When a child is biting another person place the flat part of your index finger and middle finger against the space between the upper lip and nose, press firmly. (Please refer to Oral stimulation for more on biting and grinding of teeth). Crash and Bumping For most this activity is soothing proprioceptive stimulation. The therapist
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should make sure that there is no other aggravation sources (e.g. an ear infection). Provide the Wilbarger Protocol for tactile stimulation and joint compression. Always provide deep pressure as part of ongoing reinforcement. The child may also be required to wear weighted clothes (e.g. vest with weights inside) or carry heavy things during sessions.

VESTIBULAR SYSTEM The vestibular system is the sensory system that responds to the position of the head in relation to gravity. The neck, eyes and body adjust constantly with movement of the body (Ayres, 1986). In general stimulation of the vestibular system does not cause any conscious sensation, although some low frequency stimulation may cause nausea, dizziness or rhythmic eye movements (Carlson, 1995). There are two components of the vestibular system: a) Defensive/protective (uh oh!) component which helps us discriminate visual stimuli and help us listen to the environment, maintain our balance and aids in the automatic reflex to protect our bodies. b) Discriminative (Aha!) component helps us to react to the environment with more mature motor responses (Kranowitz, 1998; Yack et. al, 1998). This system has a close relationship with the auditory and visual systems and therefore has a critical role in the modulation of other sense systems (Yack et. al, 1998). Through vestibular information individuals can discriminate between acceleration and deceleration, rotary movements, fast and slow movements (Ibid.).

Vestibular Dysfunction Inefficient processing in the brain of sensations perceived through the inner ear(Kranowitz, 1998). A malfunctioning vestibular system often results in problems with balance, maintaining muscle tone, coordination of the body (Ayres, 1986), an inability to focus on moving objects, gaze instability, clumsiness, attention and emotion (Kranowitz, 1998). A child may be hyposensitive, hyper-sensitive or both causing the child to become anxious for different reasons. Hyper-sensitivity There are two main results of hyper-sensitivity and the brain cannot regulate movement because of being bombarded with stimuli (Kranowitz, 1998). The

first is intolerance of movement where the individual has a fear of changing head position or moving, moving his/her head forwards or backwards, rotary movements and certain movement experiences (e.g. bike rides) (Wilbarger, 1998). The second is gravitational insecurity, when the individual has a fear of falling, moving in the environment is anxiety provoking and overreacts to changes in gravity (Kranowitz, 1998). Two types of behavior responses to a hyper-sensitive vestibular system are the fight and flight responses. A child may fight and become defiant exhibiting very negative behavior or flight, the child will leave activities that require much movement and proceed through other activities with extreme caution. As a result, child who has a hypersensitive vestibular system may be seen to avoid car rides, imposed movements, and stair climbing. For these children the introduction of non-threatening vestibular activities is very important but at a SLOW rate, then move to harder activities once the child is acclimated. Games with movement, proprioceptive stimulation and movement with purpose should be introduced and vestibular input should be provided throughout the day.

Hypo-sensitivity The child does not receive enough vestibular input and the child seeks this input through different means. Often a child will seek both vestibular and proprioceptive input at the same time. Some things that we can see these children do are running, spinning, or repetitive purposeful movements (e.g. rocking back and forth). Things that we can do to provide meaningful vestibular input are: play games with a lot of movements and provide opportunities throughout the day to receive input. More specifically: Jumping on a trampoline Hopping Swinging (stop & start) Balance beam work Row your boat horsey rides have the child lay on stomach and move him/her back and forth use a large therapy ball have the child lay on his/her stomach and roll back & forth

TACTILE FUNCTIONING (SOMATOSENSORY)

The sense of touch is critical in helping us function in the environment on a daily basis(Ayres, 1986). Constant tactile stimulation is necessary for all individuals, it has the ability to keep us organized and functioning (Kranowitz, 1998). Through sensory receiving cells (receptors) we feel sensations of pressure, vibration, movement, temperature and pain (Yack et. al, 1998). This system provides information to aid in visual processing, motor planning, body awareness, cognitive learning, emotional security and social skills (Kranowitz, 1998). There are two components to the tactile system: A) the protective (defensive/ uh oh! System) is a more primitive component that alerts us when something potentially dangerous is touching our bodies. The body reacts against the environment to protect itself from being harmed by evoking a fight or flight response while at other times will simply alert the nervous system (Kranowitz, 1998; Yack et. al, 1998). B) The discriminative system (Aha!) is more advanced and provides us with details about touch (e.g. when we are touching something or something is touching us, where the touch is, pressure of the touch and different attributes of the object touching us) (Kranowitz, 1998; Yack et. al, 1998). Yacks and others (1998) note that a successful tactile system depends on a balance between both the protective and discriminative systems. When this system is not balanced tactile defensiveness or under-responsive tactile discrimination results. Poor tactile discrimination is a result of an immature ability to discriminate between tactile experiences and remembering past experiences. This child will mostly likely have fine motor problems, resistance to exploring the environment, and a problem using tools to perform everyday tasks (Kranowitz, 1998). However the extent to which the object is aversive to or desired by the child is dependent on the child him/herself. Further the child may also be hyper and hypo sensitive to tactile sensations and as a result may shy away from soft touch but be unaware of broken bones.

Tactile Defensiveness (hyper-sensitivity)

Tactile sensations can create negative emotional reactions (Ayres, 1986) whereby the child may over-react to certain tactile experiences (e.g. touching squishy materials) (Wilbarger, 1997). Such an experience may trigger a fight or flight response from the child. Behaviors We May See Taking off Clothing- the clothing may be uncomfortable therefore, provide soft loose clothes, provide calming stimulation and deep touch.
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Avoidance of Handling Sensory Material This is a common form of tactile defensiveness where the temperature and consistency of materials may make a difference in how well the object is tolerated. As a result the instructor should find different ways to introduce new tactile experiences (e.g. accidental touching) but also provide tactile experiences that the child does crave. Limited Use of Hands for Grasping This is also a common form of tactile defensiveness where the child exhibits a flight response by not participating fully in the activity. However this may also be a sign of poor proprioceptive functioning (Yack et. al, 1998). Things that we can do to promote tactile awareness are; include tactile activities during sessions so that the child must use his/her hands (e.g. open doors, pull chairs).

Under-responsive (hypo-sensitive) Tactile Discrimination

This child under-reacts to tactile stimulation and needs extra stimulation by touching other people and objects. Both soft and painful tactile stimulation may not be felt leaving the child defenseless in dangerous situation because he/she may not react to the experience (Kranowitz, 1998). This child needs very intense touch stimulation to receive adequate information about objects and textures that may result in the child exhibiting certain behaviors. Behaviors We May See Hitting, Slapping, Pinching, Squeezing, Grabbing, Pulling The child may do this to him/herself or to other people or objects to receive intense tactile sensations. This type of sensory input to the palm of the hand may also override painful responses to light touch (Yack et. al, 1998). Things that we can do to help the child meet these needs in a more productive way are to provide joint compressions, deep touch, and provide opportunities for the child to do heavy work (e.g. push, pull, carry weighted objects). When the child is engaging in these activities because of anxiety, provide calming stimulation and touch that he/she craves. Masturbation This is strong pleasurable tactile stimulation where the feedback is immediate and predictable. This activity provides rhythmic movements that are calming and easily learned (Yack et. al, 1998). During sessions we can provide

opportunities for the child to receive tactile stimulation to other body parts, deep pressure, weighted activities, appropriate seating and redirection.

OLFACTION This simply is the sense of smell and the ability to detect odors from various objects through the nasal passage. For some children a heightened sense of smell may lead to a habit of constant smelling or an aversion to strong smells.

Hyper-sensitivity The individual may be repelled by certain scents that are not necessarily pungent. However, as a result, such individuals may avoid certain objects or foods. The introduction of certain smells should be slow. First place the scent far away from the child then slowly move it closer during a session until it is no longer tolerated, and continue this over time. Hypo-sensitivity These individuals seek out very strong smells and may at times invade other peoples personal space. A repetitive habit may form where the individual constantly smells objects or people. During sessions we can provide activities that involve objects or materials with scents the child enjoys (e.g. playing with lotions). Another suggestion by Yack and others (1998), is to provide a smelling box that contains different containers with various scents, the child can smell the containers on a break. VISION Kranowitz (1998) states: Vision is a complex process that enables us to identify sights, to anticipate what is coming at us, and to prepare for a response. Eyesight is one component of vision, however there are four other components that are also influenced by the vestibular system that aid in visual processing. The four other components are: fixation (ability to fix eye gaze on a stable object), b) tracking (ability to follow a moving object), focusing (ability to focus on one object without being distracted by others), and binocular-vision (ability to combine the two pictures from both eyes into one). Visual-spatial processing

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skills that evolve from these components are the ability to have visual discrimination, visual figure ground and visual spatial function. The vestibular system and vision work closely together helping the body to maintain an upright posture and balance (Yack et. al, 1998). When the visual sense is malfunctioning many problems could arise: coordination (body, hand-eye, balance) loss of binocularity nability to focus inaccurate visual perception poor spatial awareness inability to respond to visual cues because of an inability to coordinate all the sensory pieces neurologically. Overall learning problems (math, cognitive skills) Orientation of the body is difficult Hyper-sensitivity The individual becomes overexcited when there is too much visual stimuli in the environment. This individual may as a result perseverate on words, toys, other individuals, hair or shiny objects. He/she may cover his/her eyes, have poor eye contact with others, is inattentive when doing pen work, may overreact to bright light and is often hyper-vigilant, very alert and watchful (Kranowitz, 1998; Wilbarger, 1997). Hypo-sensitivity This individual uses touch to learn about objects and may often miss visual cues from others (both body and facial expressions). Further these individuals may often miss information from written directions. What Can We Do? Use different colored lighting Lower the intensity of the light Take away distracting objects Conduct eye contact shaping (required to turn his/her face to you before getting something then eventual eye contact) Engage the child in maze and dot to dot activities Use peg boards to make various designs Cutting and pasting activities (paste shapes onto a background to match)

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Puzzles Block building

HYPERLEXIA adapted from the Canadian Hyperlexia Association Hyperlexia is a self-taught ability to read words before the age of five and/or an intense fascination with letters, numbers, logos, maps or visual patterns (CHA). A delay in oral language development is common as well as difficulty interacting with peers. The hyperlexic learning style is also different than the learning style of a typically developing child. A child with hyperlexia generally has a strong visual memory, pays more attention to written instructions, constantly looks for and finds patterns in the environment or learning material, has difficulty learning language and therefore may be echolalic. How we can help a child with hyperlexia learn better: Label everything (both verbally and written) Keep lists, calendars, journals Use patterned language e.g. why? Because.. Use open-ended sentences e.g. the fork goes in my _____ Offer choices and model answers Write down and practise appropriate things to say in common social situations Write down and practice rules of conversation (adapted from CHA)

AUDITION

Audition involves both the process of hearing but also to process what is being heard. Hearing is important to understand spoken messages and listen effectively. Auditory processing aids in sound localization and lateralization, auditory discrimination, auditory pattern recognition [and other temporal aspects of audition] (Brassard, 1998). Therefore to hear is not to physically detect sounds but also to integrate and assimilate the sound information received by the environment (Brassard, 1998). Audition is also associated with the vestibular system and it has been noted that when incorporating strong vestibular input, an improvement in auditory processing is detected (Frik & Lawton Shirley, 1994).

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Auditory Defensiveness Some individuals may have an over-sensitivity to sounds with high or low pitches (Wilbarger, 1997). The individual may become anxious when these sounds begin abruptly or are sustaining over a period of time e.g. fire alarms, vacuums etc.. The individual may try to plug his/her ears or escape the sound. The sensitivity to sound however can be varied and inconsistent (Yack et. al, 1998). Hypo-sensitivity An individual seeks out certain sounds and finds ways to repeat them e.g. banging on a drum, table, crashing play symbols. These individuals also overattend to noises, fixated on voice pitch and tones. Auditory Integrative Training The Berard Method uses modulated music to attend to the pitch and tones that are found to be most irritating or over-stimulating to the individual. Over ten sessions of 2 hours each, it has been noted that the individual can become accustomed to the pitch and tones and then better focus on other environmental stimuli (McKean, 1993). It has been found that some improvements have been made due to the Berard Method such as: speech and language development, attending and focus, balance and movement perception (Frick & Lawton Shirley, 1994). However it must be noted that this is a specialized treatment. Things We Can Do For Hyper-sensitive children: Lower the volume on radios, TV. Take away distracting objects that make sounds Work on introducing certain high and low pitch sounds slowly (ensuring the child knows where the sound is coming from) Play with musical instruments Work on adjectives of loud and soft Chewing on gum for proprioceptive input to the jaw For Hypo-sensitive children: Work on loud and soft Play with musical instruments functionally Use of singing various songs in various pitch and tones use action imitation, verbal imitation and joint attention Chewing gum for proprioceptive input to the jaw ORAL STIMULATION/ TASTE

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One of the first ways we find out about the environment as infants is by our mouths. The lips, mouth, tongue, cheeks and gums are all stimulated and give us information about an object. Stimulation can also be achieved by chewing and sucking (Dworetzky, 1996). As we grow older we depend less on oral stimulation to understand the environment however this sense still plays a role in daily functioning. Hyper-sensitivity This is an avoidance of certain textures of food (textures may vary between individuals and may be inconsistent with overall eating habits). For example a child may avoid slimy things such as puddings or may avoid crunchy things such as chips. There may also be avoidance or inability to use the mouth for certain activities e.g. blow bubbles or suck on a straw.

Hypo-sensitivity

The individuals may seek out sensations with their mouths and may chew or suck on various non-edible objects (Wilbarger, 1997). Behaviors We May See Biting/teeth Grinding This may be behavioral for attention seeking, make sure that this is not the case. This often occurs in hypo-sensitive children and may be a calming strategy. However a brief rise in teeth grinding may be seen when tooth-brushing is introduced because more stimulation is being provided to the mouth than normal (Yack et. al, 1998). Things we can do: Provide a straw to chew on Incorporate crunchy foods during snack time Jaw compressions Jaw massages or holding the sides of the face to give a slight pressure Oral imitation games

Playing with Saliva or Mouth

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This generally occurs in children who are hypo-sensitive to oral stimulation. The child often plays with his/her mouth with fingers and puts various objects to the mouth for tactile input. This behavior may increase with oral imitation and stimulation (Yack et. al, 1998). What we can do: Oral motor exercises Tooth-brushing Jaw compressions Providing various textured snacks (if tolerated) Provide opportunities for many tactile experiences Pica (Eating of non-edible objects) This behavior often sees a child who is hypo-sensitive to oral stimulation eating non-edible objects such as paint, rocks, and dirt. This child needs strong taste, smell, tactile and proprioceptive experiences to receive stimulation. (Yack et. al, 1998). What we can do: Jaw compressions Tooth-brushing Vibrating chew toy (vibrating bug/ rotating tooth-brush) Crunchy foods for snack Always watch the child

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