Many people with Autistic Spectrum Disorder (ASD) not only face problems with the Triad of Impairment (socialisation, communication, and inflexibility of thought) but can also have difficulties processing everyday sensory sensations such as sound, sight, smell and touch. It is well documented that the Triad of Impairment does requires an addition, given that some individuals are also diagnosed with Sensory Integration Disorder (SID).

Sensory processing difficulties observed in those with ASD, include hypo- or hyper-responsiveness to sensation (under or over-reaction to sensation) but most often the difficulty is that of poor Sensory Modulation. This refers to a fluctuating and changeable response to sensation, which is often misinterpreted as a behavioural problem or a negative attitude.

All learning occurs through the brain responding to sensation - be it touch, sound, light, smell, taste or movement. When the brain's response to sensation is disorganised, learning is disrupted. This can impact greatly on a person with ASD, making everyday tasks and life in general more difficult and in some extreme cases, impossible to carry out.

Auditory System (Hearing)

Hypo-responsive behaviours include:

• appear not to hear or seem to be ignoring others

• make noise to block out or control the pitch of the other noise

• listen to music/tv on a loud volume

• have difficulty differentiating pitch and tone

• benefit from having their name said before anything further is said to them

Hyper-responsive behaviours include:

• dislike unexpected or loud noises

• covers ears with hands

• have difficulty staying on task due to noise distractions, such as a ticking clock, passing transport, other people, vacuum cleaner

• may benefit from wearing ear defenders or headphones

Visual System (Sight)

Hypo-responsive behaviours include:

• like bright, contrasting colours

• stare and be unaware that this can be deemed rude or make people feel awkward

• rub or poke eyes to get the visual stimulation of the lights they see from doing it

• flap hands/fingers in front of their eyes to see the contrast of light

• benefit from having visually stimulating work and environments to meet the high need for visual information

Hyper-responsive behaviours include:

• be sensitive to light preferring to be in the dark

• may switch off lights or prefer blinds closed

• have difficulty differentiating things on busy backgrounds which can cause anxiety

• have difficulty coping in a typical classroom environment

• have difficulty reading things with very busy backgrounds

• benefit from having uncluttered and distraction-free work and environments

Tactile System (Touch)

Hypo-responsive behaviours include:

• be unaware of pain or have reduced awareness and are therefore more likely to get injured or burned

• have an unusual need to touch and feel objects often to process information

• like to be barefoot to feel floor/ground texture

• be unaware when hands/face get messy

• need more supervision to help keep them safe

• like to be touched firmly

• benefit from enhanced tactile input for learning, i.e. textured materials in clothing or in objects and tasks engaged in; enhancing tactive input during learning experiences

Hyper-responsive behaviours include:

• be fussy about cleanliness

• dislike of differences in temperature or varying textures

• negative reaction to being touched, preferring firm touch

• dislike self-care activities such as bathing/showering, cleaning teeth, brushing or combing hair

• be a fussy easter

• become irritated by certain textures of clothing and/or labels in clothes

• may prefer having labels cut out of clothes, or wearing socks inside out so seams do not irritate

Pain

Some people with ASD have a high pain threshold and therfore may be unaware they are injured or unwell and for this reason they will need to be closely watched so that any serious injury or illness can be treated accordingly.

Others may have a very low pain threshold and any scratch or knock can cause them considerable pain and distress and they may require a lot of reassurance. Both of these responses are a result of a disordered sense of touch.

Olfactory System (Smell)

Hypo-responsive behaviours include:

• don't notice strong smells and may not seek out strong smells like perfume/aftershave

• may seek out smell by using it as a tool to find out more about their environment - people and objects.

Hyper-responsive behaviours include:

• may gag, retch or vomit as a result of smelling something they dislike

• dislike eating in the school dining room due to the different smells

• benefit from toiletries with mild or no smell

• be sensitive to smells that others may not notice

• dislike shops/corridors at school due to so many smells

• dislike strongly flavoured foods such as mints

Gustatory System (Taste)

Hypo-responsive behaviours include:

• smell, mouth or lick items including food to gain more information, like a toddler would

• have a preference for certain smells and tastes

• crave certain foods

• seek more flavour, such as hot chillies, strong curries, spicy food since most food tastes bland to them

• prefer finger foods

• be unaware of temperature and inadvertently eat or drink hot things

Hyper-responsive behaviours include:

• gag, retch on food or even cutlery

• be picky eaters particularly regarding textures which could lead to a restricted diet

• avoid highly flavoured or aromatic foods prefering bland foods

• limit themselves on certain foods and may become distressed when offered alternatives

• dislike other people touching their food but may tolerate pre-packed shop bought sandwiches and snacks, providing they are the only one to open the packaging

• many prefer to cover all food with a particular flavour e.g. tomato sauce, mayonnaise, chocolate sauce to avoid having to smell or taste the less preferred substances

Vestibular and Proprioceptive Systems (Movement and Body Awareness)

Hypo-responsive behaviours include:

• may execute large movements in order for the brain to register them

• may enjoy movement activities with play equipment, spinning around, moving toys

• may wriggle and fidget or unconsciously rock back and forth and rock on chairs

• may use too much or too little force

Hyper-responsive behaviours include:

• become disorientated with moving in certain ways, therefore can become restricted in movement

• avoid play equipment, sports apparatus, heights and moving toys

• dislike activities such as gymnastics/swings

• suffer from motion sickness

• caution when using steps, ramps or moving around unfamiliar environments

Occupational Therapy

Children and young people may benefit from occupational therapy to help them in coping with their sensory difficulties or by adapting activities to compensate. In addition, an Occupational Therapist trained in Sensory Integration Therapy will be able to offer help in overcoming some of the sensory difficulties by those with ASD.

A report from an Occupational Therapist can form part of a Statement of Special Educational Needs, help with a DLA claim, help to get support from social services, etc.

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