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I have four children with autism who have unique sensory processing challenges and needs. Over the past 11 years, my children and I have grown in our understanding of the unique way in which they process the world around them.

Before my daughters were diagnosed, I could not understand why they acted certain ways in certain settings. They would pace back and forth, jump in place, hum, remove clothing, want only certain foods, and mouth non-food items.

When my daughter Emma was 2, she would routinely remove all of her clothes and her diaper. When we were at home, that was a challenge. When we were out, it was a serious issue. One time in church, I turned around to see Emma standing on the pew in just her diaper. I was amazed at how quickly she could take off all of her clothes!

Not too long after that, a friend encouraged me to reach out to an occupational therapist. If you are a parent who is concerned about your child’s sensory needs, here are some steps you can take:

• Take observations and note the repetitive behaviors that your child displays.
• Talk to your child’s primary doctor or pediatrician about getting a physician’s order for a sensory evaluation.
• Locate an occupational therapist who has knowledge and experience in working with sensory issues and challenges for children with autism.
• Schedule an appointment for your child’s evaluation. Bring notes and information about your observations of repetitive behaviors and when you notice them.
• Complete the sensory profile assessment provided by the occupational therapist.

 

Learning sensory basics

The occupational therapist asked me to complete a sensory profile on how Emma responded to stimuli around her. In completing the profile and working with the OT, I learned that Emma sought certain sensations and avoided others. Sensory seekers often behave or act in certain ways because they are looking to experience a certain sensation. Sensory avoiders are those who avoid or fear experiencing a certain sensation.

When we think of our senses, we acknowledge five: sight, sound, taste, touch, and hearing. There are also some areas of sensations that can be categorized into the following areas:

• Tactile: an experience through the skin by touch or by eating
• Vestibular: a sensation that is experienced through the inner ear or through balance
• Proprioceptive: sensations felt within joint and muscles

Individuals with autism may have greater awareness of stimuli around than neuro-typical individuals. Some may avoid lights, sounds, and touch. Others may seek the sensation of certain stimuli.

 

Developing a sensory diet

Over the next few months, the therapist reviewed my information and observed Emma. The OT was able to determine Emma’s sensory needs and make recommendations to meet those needs. Emma benefited from wearing a compression vest. While wearing it, she no longer sought to take off her clothes. Emma also enjoyed deep pressure activities such as bouncing on a yoga ball and jumping on a trampoline. The therapist created a document called a sensory diet, listing activities to support Emma’s sensory-seeking behaviors.

Once you have a sensory diet for your child, you can choose activities for your home. Some will help to calm your child down, others will help them in regulating their sensory systems, and others will help energize your child. For example, Emma often became anxious while completing homework, so we implemented five-minute sensory breaks for her to bounce on a yoga ball or trampoline. These activities have been built into Emma’s day and help her to regulate her mood and emotions.

To provide structured sensory breaks:

• Schedule in a structured time frame
• Provide visuals, such as a timer, for transitions to and from the sensory break

Many types of sensory equipment are advertised for individuals on the spectrum. Not every child will respond the same and sensory equipment can be expensive, so I encourage you to connect with a pediatric occupational therapist who has experience with ASD. Talk to the OT about purchasing similar equipment from stores at a lower cost. Show the product details to the OT before purchasing.

If your child receives Innovations waiver services, look at your LME/MCO website to see whether they offer grant funding for the purchase of sensory equipment. You will need an OT letter of recommendation and a prescription to access many of these grants.

 

Expanding food preferences

The occupational therapist also worked with Emma on exploring and expanding her very limited eating preferences. Emma seemed to prefer eating things in the shape of a circle. The therapist would try different types of food that she could craft into circles: hot dogs, sausage patties, bagels, blueberry muffins, etc. This therapy was incredibly helpful because of the way in which the therapist offered the food. Emma sat with other children, and they would all be trying the same foods. Emma would examine the food and even roll it over her lips before she would choose to consume it. This therapy helped me understand how to present food in a manner that would make Emma comfortable.

If you have concerns about your child’s diet, you can share information with an occupational therapist:

• What your child will and will not eat
• Your child’s eating schedule: How often? How long does it take?

Then you can ask the therapist for suggestions on introducing and reintroducing new foods and whether your child could benefit from feeding therapy.

 

Gradual exposure to challenging environments

We also worked on activities and environments that brought out sensory avoidance in Emma. She was not able to tolerate shopping because of the noise, people, and overall stimulating environment. To work on these challenges required us to address them incrementally.

For a long time, a successful shopping trip with Emma meant walking into a grocery store and out again without a meltdown. Then I introduced the shopping cart. We would walk a few steps into the store and then turn around and walk out. The staff at my friendly neighborhood Food Lion probably raised their eyebrows a few times, but to me, each time we made it further into the store meant progress.

We would also shop at times when the store was fairly empty and the noise level was low. The first time we went shopping and were able to get two out of the 10 items we needed was another success. I could tell when she was starting to get uncomfortable and would head to the checkout. My thought as a parent was that I must continue to give Emma exposure to this environment in a way that she could be successful.

Now, I can happily report that we have had many years of shopping success. Emma still says things like “I am glad to get out of there,” or “I am tired of being in the community, can we go home now,” but she tolerates it and no longer has meltdowns. Emma will need to shop for groceries as she gets older, so it was critical to me to work on that environment.

 

Strategies for sensory avoidance

When dealing with your child’s sensory avoidance, consider the following and consult the occupational therapist for suggestions:

• What types of environments cause your child meltdowns?
• What does the meltdown look like?
• Ask the OT how to introduce or reintroduce uncomfortable sensory experiences in a limited or modified way.
• Provide opportunities for your child to experience the stimuli in small doses and provide positive reinforcement.

We can probably all identify places that make us uncomfortable. For some, it may be the DMV or shopping at the mall. There will be times when our child struggles in environments. Sometimes we choose to avoid the environment. Sometimes, we can take a chance and give them exposure to something that may make them a little uncomfortable.

If you are finding that your child is struggling in a particular place, try to determine what makes them uncomfortable. Noise sensitivity often presents itself by a child covering their ears. A child may hide their face from bright lights. Sometimes we may be unable to pinpoint the exact experience in an environment that is making them uncomfortable. In those situations, the therapist may be able to offer strategies. Understanding and meeting your child’s sensory needs can help alleviate their anxiety.

 

Katie Holler, an ASNC Autism Resource Specialist in the Eastern Region and mom to five daughters, four of whom have autism, can be reached at kholler@autismsociety-nc.org or 252-756-1316.

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