Differences in reactions to sensory input have been included in the Diagnostic Statistical Manual (DSM) criteria for Autism Spectrum Disorder since the fifth edition was published, in 2013. This recognises that a person with autism is likely to show:
‘Hyper' or 'hypo-reactivity' (i.e. over or under reactions) 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).’ (DSM 5)
Every person with intact sensory organs constantly receives, registers and processes information from their senses. The 5 most recognised senses are:
It’s helpful to think about at least 3 more senses:
- Body position or Proprioception - a sense of where the parts of our body are in relation to each other, and the surroundings. Our brains work this out using information from our muscles, joints, along with the sensation of touching things, e.g. the ground.
- Movement or Vestibular sense – lets us know if we are moving, and, if so, in what direction and how fast. Information for this mostly comes from balance organs, deep inside our ears.
- Internal body sense or Interoception – a wide range of information is sent to our brain about hunger and thirst or when we have eaten and drunk enough, any pain or illness, body temperature, if we need to sleep, use the toilet, etc. Our internal body sense also includes the changes in heart rate, breathing, alertness and feelings like “butterflies” or a sinking feeling (often in our gut) which come with and signal strong emotions.
Autistic learners and children with neurodevelopmental differences may process and experience sensation differently in unique and sometimes complex ways: e.g. they may be:
- very sensitive and may avoid, be unable to ignore or become overwhelmed by sensations, sometimes to extremes where they ‘shut down’, show extreme anger, fear and/or attempt to escape (sometimes referred to as “fight, fright or flight, adrenaline fuelled reactions).
- very sensitive to some things, but don’t show this, or strongly seek other sensations to block out “unpleasant” sensations, reduce anxiety and feel calmer.
- under sensitive and may not register or react to even very powerful sensations. Can seem quite passive and slow to respond to sensations.
- under sensitive, and may seek intense input from one or many senses.
(Based on the work of Winnie Dunn, e.g. 2007; For a short video about this look HERE)
Sensations are the foundations for learning and actions. Differences in sensory processing can profoundly affect skills and abilities in daily life, play, and learning.
Examples of what we might see:
Children may cover their ears or eyes, retreat, or become intensely upset. This can happen when the classroom, lunch hall or playground gets busy, or ‘simply’ because they expect or think they detect a disliked sound, smell, taste, sight, or when an internal sensation becomes unbearable. They may feel the need to rock, flap, chew, jump, run, hide, be squeezed, or hugged, make their own sounds, or focus on one thing, to help themselves feel better. If they can, they may learn to supress these feelings, but suppression has costs and there will still be signs they are struggling such as avoiding being near others, difficulty seeing objects or text, staying on task, etc. It is worth noting that they will react differently and cope more or less well, depending on prior events (See video on Anxiety and the Losing it Line).
Children might seem 'tuned out', or 'dazed'; slumping in their seat, or lying down. They may not notice obstacles, how much force they’re using, if they are in a mess, hurt or hurting others. They may seek prolonged intense movement, including banging, chewing or hitting hard, spinning or swinging. They may have an irresistible fascination and urge to touch, smell, taste, chew, hear or see something. Some children may learn and try to do this more subtly – reading, watching video or persisting in talking about the sensations they seek.
All these 'behaviours' are not intended to upset, challenge or provoke others. Fundamentally, they are signals that a child is trying to keep calm and cope with internal and external sensations that may be extremely and overwhelmingly unpleasant.
In the film below an occupational therapist talks about the impact of sensory differences on everyday life and school experience.
The diagnosis of Autism Spectrum Disorder includes being under or over reactive to sensory input, or having unusual interests in sensory aspects of the environment. This means that an autistic person is likely to process and respond to sensory information differently to other people. This can have a profound affect on all aspects of their life.
Most people would say they have 5 senses – vision, hearing, taste, smell and touch. We now recognise at least another 3 – One is body position (which is drawn from sensors in our muscles, joints and where our body touches other things) A second is movement (which is mostly picked up by our vestibular system, especially the balance organs deep inside our ears). Thirdly, interoception or our internal sensations, which can be incredibly powerful. These include hunger, thirst, when we have eaten or drunk enough, pain or illness, whether we are too hot or cold, need to sleep, or use the toilet. Interoception also includes the changes in heart rate, breathing, alertness or feelings like butterflies in your tummy which come with and signal strong emotions. For children with autism, any or all of these may be processed differently.
So, how can this information help teachers and others support children with autism?
Simply by recognising how powerful these sensory differences are, we are taking an important first step towards helping a child feel comfortable enough to learn. We are also more able to prevent, support and manage ‘meltdowns’ more effectively.
A good next step is to consider the environments we all live and work in. People with autism tell us that being in the busy, social world can be really stressful and overwhelming for them. Softening lighting and managing noise and smell, reducing clutter, speed and amount of others movement, or the chance of unexpected touch in classrooms are all useful. Its also really helpful to do this in dining spaces, toilets, corridors ; in fact, any public spaces. Many children with autism appreciate having a “safe space” of their design and choosing, where they can retreat to regulate themselves. They may cope better with the sensory aspects of new places or experiences, if introduced through photos, video, stories or visiting in advance, when its quiet and they are relaxed. Ideally, we’ll find ways to support them to stay with us and to safely display their less conventional ways of keeping calm or expressing their feelings. Fidgeting, tapping, rocking, jumping, hugging, pushing or pulling actions, humming or shouting are totally acceptable when dancing, singing, watching or playing games and recognising this may help classmates or others understand.
Every child with autism is different, and putting extra time and effort into understanding and honouring their unique sensory preferences and needs does really pay off.
Children with autism can flourish when activities they are asked to do tap into their sensory interests (e.g. if a child is fascinated with water, why not teach concepts like number or colour through catching plastic fish in a tank). Learning activities can also honour their sensory needs (class projects could be adapted - perhaps to allow a child with autism to be outdoors more or to get deep pressure touch from modelling with clay?).
It’s essential to embed desirable activities in personalised routines which are obvious to the child. We know children with autism find it hard to process language, so structure can be provided through a timetable they can see or touch, including objects, photos or symbols.
Its important to remember that they may never notice or be able to tell others when sensations become uncomfortable or, for example, if they need to drink, cool down, or go to the toilet, etc, so we need to be vigilant and possibly timetable these.
Many autistic writers have eloquently illustrated why we need to think about sensory differences. I love Temple Grandin’s observations of how letting sand pour through her fingers, or squeezing herself in a device she built finally stopped sounds from being painful and allowed her, for precious, brief moments, to feel calm :
“The squeeze machine is not going to cure anybody, but it may help them relax; and a relaxed person will usually have better behaviour.”
Sources of support and information
Occupational Therapists have expertise in this area and are a good source of advice and information
Audiologists have expertise in assessment and diagnosis of Hyperacusis (see NAIT Hyperacusis Guidance)
National Autistic Society ‘Too much Information’ campaign and video clips https://www.autism.org.uk/get-involved/campaign/tmi.aspx.
What can we do in schools and early learning centres?
In a nutshell; find out what’s desirable and regulating, then build it into a day that is as routine or predictable as possible for your autistic learners.
In a bit more detail; as soon as possible, ideally before a child with autism joins your class:
- Speak to parents, carers, whoever seems to really know and understand the child. Perhaps ask them to fill out a sensory checklist*. Find out what supportive strategies and accommodations have been working recently.
- Get to know the child – If they are not yet using words, (social partner) you will have to rely on others' reports, then watch their reactions very carefully as you 'test' what might work. If they have a few words (language partner) or more than 100 words (conversation partner), they may still need photos, symbols, objects or at very least, written choices, to communicate.
- Consider your whole school environment (see CIRCLE Classroom Environment Tool or AET Sensory Audit for Schools and Classrooms). How can you reasonably adjust the classrooms, corridors, gym hall, lunch areas, playground, toilets, etc. For example, can you switch off noisy air-con, or hand dryers or muffle bells? If not, can the child have headphones? Can we make their working space any better with partitions, less clutter, etc? Which toilet feels easier to use? Where are they comfortable eating lunch?
- Agree on a safe space (see NAIT Safe Space Guidance) or place they can go if they need to ‘escape’ for a while
- Think through a typical day at school. Can they arrive before or after others? Could they come in through a quieter door or corridor? Can they have a calming activity before joining the group? Can they leave classes early to avoid rush and crush?
- Communicate their timetable in a way they can understand. Do they need colours, symbols, photos? As far as humanly possible….stick to it.
- Other adjustments? – own choice of clothing, which still looks 'uniform'; a locker or safe place for things that help them calm; pocket sized items that help concentration or calming, sometimes called 'fidget objects'; regular timetabled physical activity or 'movement breaks' (even when they seem calm – its 'fuel for their tank!'); regulation 'menu' (photos, symbols or written list of choose regulating activities); visual supports for regulation such as zones of regulation materials.
- Discuss helping the child’s peers understand that some people have sensory differences. It may help to teach how to support or react to unconventional behaviours like a child’s need to ‘stim’ or the likelihood of upset outbursts.
In Conclusion; support is a marathon, not a sprint. Once you’ve got strategies in place, keep going. Review regularly, but ideally make changes in tandem with those who know the child best and make sure you pass what you’ve learned on to the child’s next teacher.
Sources of support and information
- Occupational Therapists have particular understanding of how sensory differences may affect all aspects of children’s daily lives and can offer advice and practical strategies.
- Audiologists may assess and diagnose over-sensitive hearing or Hyperacusis ((see NAIT Safe Space Guidance).
- National Autistic Society ‘Too Much Information’ campaign (https://www.autism.org.uk/get-involved/campaign/tmi.aspx) includes video clips about sensory differences. The whole website has a wealth of information on related topics.
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA
Dunn W (2007) Sensory Processing in Children with Autism