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High-Functioning Autistic Students and Problems in Physical Education Classes

"My child (with HFA) struggles in PE class... he's clumsy... gets teased as a result... and the teacher doesn't intervene to try to stop the teasing. SO then my son takes matters in his own hands and starts acting out towards the kids who are teasing. Then he's the one that gets in trouble. It's a bad cycle.  Any suggestions? Would there be any helpful advice I could give his teacher so he'll understand my child's challenges?"

Including kids with High Functioning Autism (HFA) and Asperger’s in gym classes is not an uncommon occurrence. More and more, kids with “special needs” have gym alongside typically developing kids. Most physical education (PE) instructors teach young people on the autism spectrum although they have little knowledge about the disorder and how PE classes affect those who have it.

Successfully educating kids with HFA involves a deeper understanding of the disorder and how it directly affects the students’ ability to participate fully. When developing instructional programs for kids on the autism spectrum in gym class, educators should examine (a) emotional and behavioral characteristics, (b) academic and cognitive functioning, (c) physical and gross motor development, and (d) social deficits in relation to peer interactions. Rooted within these areas may be such issues as language and speech delays, social skills deficits, and teasing/bullying issues.



Children with HFA demonstrate a wide variety of behavioral characteristics. In educational settings, they often experience anxiety, depression, aggression, and hyperactivity because of frustration during the learning process. They also display a limited number of interests, which can lead to a strong preoccupation with “sameness.” This sameness can cause a predisposition to obsessive routines, repetitive rituals, and difficulty when transitioning.

Parents and teachers often notice the predisposition to sameness in behavior rigidity, since this rigidity affects both the thoughts and behavior of HFA children. Novel situations often produce anxiety for these kids. They may be uncomfortable with change in general, which can result in behavior that may be viewed as defiant and can lead to “meltdowns.”

One main area of concern for kids with HFA is socially inappropriate behavior stemming from lack of social understanding, which can range from simply annoying to highly disruptive behaviors. Unfortunately, most young people on the autism spectrum have difficulty communicating their emotional state or understanding the emotional states of others. This inability further exacerbates socially inappropriate behaviors.

On an emotional level, students with HFA have difficulty accepting that they make mistakes and become easily stressed because of their inflexibility. They also tend to have lower self-esteem than their same-aged peers. Such vulnerabilities may lead them to become targets for bullying and teasing.

PE teachers should actively participate in programs for preventing bullying and should employ various strategies within the gym setting. However, to be effective, ALL educators should employ the same strategies across all academic settings. Also, the PE teacher should work closely with other members of the Individualized Education Program (IEP) team to achieve this goal. Through effective collaboration, all educators can be consistent with the goals related to preventing bullying and the strategies necessary to achieve those goals.

Strategies that PE teachers can use to prevent bullying during gym class include:
  • being consistent in handling situations in which bullying takes place
  • being proactive
  • focusing on the needs of students with “special needs”
  • modeling appropriate behavior
  • talking with students about bullying
  • telling students to report situations

Another identified area of concern is called a “meltdown.” Meltdowns are most frequently related to frustration, being thwarted, sensory sensitivities, and difficulties in compliance when a particularly rigid response pattern has been challenged or interrupted. Educators frequently overlook the underlying antecedent when they address the meltdown. When the youngster does engage in a specific behavior problem, he may be experiencing feelings of stress and a lack of control. In addition, the youngster may exhibit a high incidence of attention problems. Many children on the spectrum have difficulty determining those elements in their environments to which they should attend, so they attend to the wrong things. In some cases, they may even receive a diagnosis of ADHD as a coexisting condition.



Physical and Gross Motor Development—

Many kids with HFA do not possess highly athletic motor skills. Researchers are more and more recognizing that motor functioning is a deficit area for kids on the autism spectrum. These young people typically have low fitness and low activity levels as compared to their “typical” peers. This problem occurs because of the high incidence of children with developmental disorders who have a sedentary lifestyle.

HFA teens are significantly less active than typically developing teens, and few engage in extracurricular activities. Clearly, promoting physical activity in this population is of high importance; however, because of the challenges that these children face, encouraging them to be physically active at acceptable levels may be difficult. Specifically, motor skill deficits may hinder successful participation in gym classes if educators do not address these deficits through effective intervention plans.

Kids with HFA generally have difficulty with tasks requiring balance and coordination, and they often display a generalized muscular weakness (called “hypertonia”), which affects posture, movement, strength, and coordination. They may have difficulty judging distance, height, and depth, or may engage in self-stimulatory behaviors. They may also have problems with manual dexterity, and have impaired dynamic balance, or an inability to perform rapid, alternating movements. An inability to alternate hand and limb movements can directly affect an HFA student's ability to fully participate in physical activities that involve such skills.

Another common impairment for children with HFA is developmental coordination disorder (DCC). DCC often coexists with autism. It appears to be a problem involving the process of motor planning. Common deficits that kids with this disorder experience include clumsiness, abnormal gait, and fine-motor skill deficits. Behaviors attributable to these deficits include difficulty riding a bike, playing ball games, throwing, catching, and kicking. Not only do these physical challenges lead to problems participating in gym class, but they can also lead to social integration problems in teenagers with HFA.

Yet another issue for children on the autism spectrum is the coexistence of sensory integration disorder. These young people often have heightened sensitivity to touch, tastes, smells, sounds, and sights. Avoidance of touch, pressure, warmth, and other contributing factors can foster avoidance in participating in specific games or activities. Oversensitivity to sound can also affect routines and procedures, especially in situations in which a coach or PE teacher uses a whistle or bell. PE teachers should be sensitive to the HFA student's sensory needs, and should modify or adapt group-designed activities (e.g., by using verbal signals instead of using a whistle).

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

PE teachers can use the following strategies in the gym setting to reduce high levels of frustration in students with HFA:

1. Use simplistic and literal rules for HFA kids to understand and follow.

2. Reinforce appropriate social interactions and skill performance with a consistent behavior management system, which can include internal and external reinforcers. PE teachers should reinforce appropriate social interactions, as well as reinforcing the HFA student for meeting classroom expectations.

3. The PE teacher should keep his/her interactions with the youngster predictable (e.g., plan the same warm-up procedures every day, and give the youngster advance notice about activities planned for that day). "Insistence on sameness” can be helped through providing a predictable environment, avoiding surprises, and telling the “special needs” student about changes as soon as possible.

4. Provide exercise and activities on the basis of individual interests. Building on the interests of the HFA student can serve as a motivator and bring meaning to the activity.

5. Provide a visual schedule. Kids on the spectrum benefit from using a visual schedule, because it serves as a cue to them about upcoming activities.

6. One way to deescalate frustration is to allow the HFA youngster to use a quiet or “private area” so that she can compose herself or think through an activity. In the gym, PE teachers have limited spaces that provide reduced noise levels or are less stimulating. However, the perimeter of the gym is more desirable than the center. If a youngster needs to regain control of her behavior, and the distractions within the gymnasium are hindering her ability to do so, the teacher can consider placing a beanbag chair just inside the office. Regardless of the designated area, the student should always be within the view of the teacher.

7. The most difficult time during gym class is unstructured time. If unstructured time exists, provide more structure by directing the HFA student to work in his own areas of interest. Simply instructing him in activities that reinforce his areas of interest encourages and motivates him to be more active.

8. Establish clear rules and consequences. The use of clear rules and consequences helps provide a more predictable environment.

9. The PE teacher can use effective data collection to monitor the behavioral progress of the youngster. The information obtained through effective data collection is a valuable tool in developing IEP objectives and determining specific skill deficits.

10. Collaborate with the HFA youngster's other teachers. Collaboration allows the PE teacher to be consistent in the way that he/she interacts with and instructs the youngster. The PE teacher can then adopt the same type of behavior management system for the youngster that other teachers are using throughout the youngster's day.

11. Provide opportunities for the HFA student to acquire skills through multiple means (e.g., when working with the youngster to promote better awareness of vestibular input and balancing skills, ask her to use a variety of equipment that incorporates movement such as swings, slides, balance beams, and rockers).

12. Use sensory stimulation to decrease self-stimulation and to help the HFA student remain attentive to the task presented.

13. Use repetition and re-teaching. Kids with HFA are frequently unaware that their skill levels are not equal to those of their peers, or that they perform a task incorrectly. In this case, the student may continue using the same movements, thus not reaching the appropriate level of the skill. Teaching a new skill may require many attempts and considerable practice. The youngster may also need a considerable amount of re-teaching of skills.

14. When teaching skills that include several component parts, break the parts up and have the HFA student practice them separately. The PE teacher should demonstrate skills in this manner (e.g., a backward chain of “part practice” when teaching a youngster the skills involved in bowling would be to first teach him how to swing his arm with the bowling ball in hand before asking the youngster to attempt the approach used in performing the overall skill). Once the youngster masters the first skill (e.g., the swing), then he can begin to practice the approach without using the bowling ball. After the youngster has addressed both skills, he can combine the skills and execute bowling in its entirety.

15. To have a successful gross motor plan, the HFA youngster needs to have (a) a mental picture of what needs to occur, (b) clear vestibular and proprioceptive feedback regarding movement, and (c) the ability to make automatic, reflexive adjustments to moving in time and space. In addressing gross motor planning, the PE teacher may need to help the youngster set specific personal goals. Although the child’s goals may differ from those of her peers, the goals should be clear, realistic, and attainable.

16. Try to provide alternative activities (as indicated on the IEP). The physical demands of many activities taught in gym classes involve physical interactions among classmates (e.g., hand holding, spotting for gymnastics, leaning against one another, etc.). Kids with HFA may exhibit hypersensitivity or hyposensitivity during this time. Accommodations may be necessary, and the youngster may need an alternative activity if the degree of sensitivity is greatly affecting his ability to participate.

17. When possible, limit competitive and team sports. Team sports demand an ability to quickly understand, process and respond to social cues under the pressure of competition. Expecting an HFA student to function - or be accepted by peers - in this setting is unrealistic.

18. Utilize individual fitness activities. The tendency for kids on the spectrum to do well with repetitive activities can be an opportunity to teach individual fitness activities (e.g., bicycling). Researchers have found that these young people prefer such activities as running, cycling, and rowing.

19. Most PE teachers select activities geared toward team sports. They should use caution when determining placement on a team. The teacher himself/herself should assign teams instead of using peer-selection.

20. Assess developmental readiness in the student with HFA. When determining the sequence for introducing skills, the PE teacher should examine previously mastered developmental skills and determine new skills by using a sequential manner and rate that is predictable.

21. Break skills into smaller component parts, thus helping the student with HFA to focus his motor planning in relation to the part rather than to the whole. Sequentially linking (or chaining) the component parts can then help the youngster acquire proficiency in performing the required skill.

The gym setting often includes a greater number of kids than the typical number in the general academic setting. This increased number of kids may result in higher than average noise levels. Modifying the physical environment can reduce the onset of a behavioral outburst in a youngster with HFA.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism
 
The following are examples of ways to modify the environment:

1. Use nonverbal visual cues to accompany auditory messages. These cues can help the HFA student to refocus attention to the task.

2. Simplify the task. If the “special needs” student is misbehaving while attempting a task, he may be frustrated. Simplifying the task may help the student to succeed – and simultaneously reduce inappropriate behaviors. Performing a task analysis on the specific skill can enable the PE teacher to break the larger task into smaller components that he/she can teach independently, yet in sequence.

3. Reduce excessive noise when possible. Use “nonverbal signals" (e.g., colored light systems, hand signals, pictorial cues) to reinforce appropriate noise levels, including the intensity and pitch of vocalizations. In addition, minimize background noises and fluorescent lighting, because many students on the spectrum have heightened sensitivities to these elements.

4. PE teachers can organize the physical structure of the classroom to decrease anxiety levels (e.g., clearly label materials and the location of the activities, which helps ensure that the structures within this environment are consistent).

5. Maintain routines as much as possible. Routines should include "sameness" in activities, including using the same equipment and the same class organization.

6. Try to limit visual distractions. Reducing the number of visual distractions helps the student to maintain focus on the delivery of instruction.

7. Lastly, always encourage and reward progress and achievement by using verbal praise.

There's a lot for kids on the autism spectrum to worry about while at school, and gym class is usually at the top of the list. Gym class can be very different in middle and high school than it is in elementary school, and because autistic kids are often so self-conscious, gym class is often the most feared part of the day. If a youngster is dreading gym, there's plenty teachers and parents can do to help. The ideas listed above will help prepare him or her for all the challenges that gym class can bring.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
By

Cognitive and Behavioral Inflexibility in Kids on the Spectrum

“Why are transitions so difficult for my autistic child (high functioning)? It’s impossible to get him to stop what he’s doing at the time without a huge row. What are some strategies which can help when moving from one thing to the next?”

One frequently observed feature of High-Functioning Autism (HFA) and Asperger’s is inflexibility in thought and behavior. Inflexibility seems to pervade so many areas of the lives of children on the autism spectrum. Novel situations often produce anxiety.

These kids may be uncomfortable with change in general, which can result in behavior that may be viewed as oppositional and can lead to emotional meltdowns. This general inflexibility is what parents and teachers often label as “rebellion.”



There are two types of inflexibility:
  1. Cognitive inflexibility occurs when the child is unable to consider alternatives to the current situation, alternative viewpoints, or innovative solutions to a problem. The child with inflexible thinking tends to view things in “either-or” terms (e.g., things are either right or wrong, good or bad). He or she wants concrete, black and white answers. The “gray areas” of life are very uncomfortable (e.g., the child often has an exact way of doing things with no variations). 
  2. Behavioral inflexibility refers to a child’s difficulty maintaining appropriate behavior in new and unfamiliar situations. Flexibility enables children to shift effortlessly from task to task in the classroom, from topic to topic in conversation, from one role to another in games, etc.

Children with HFA may have many fears in addition to those related to unexpected changes in schedules. Large groups of people and busy/noisy environments (e.g., school hallways, cafeterias, playgrounds, bus stations, etc.) tend to overwhelm children with HFA. They may also be overwhelmed by unexpected academic challenge or by having too many things to remember or too many tasks to perform.

They often have limited frustration-tolerance and may display tantrums when thwarted. Routines and rules are very important to kids with HFA in providing a sense of needed order and structure, and thus, predictability about the world.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Another form or inflexibility is moralism, a kind of self-righteous and strict adherence to nonnegotiable moral principles that is often out of context with practical reality. An example may be a youngster who criticizes a parent who has run a yellow traffic light when the parent is on the way to the emergency room for treatment of a severe injury.

Inflexibility is also found in the rigidity over matters that are of little consequence, such as arguing about whether the route to the emergency room was the quickest when it might be the difference between a few hundred yards by choosing to take one turn over another. In the classroom, this may be found when an HFA student fixates on a perception that a teacher has not enforced a rule consistently. Such fixations on moral correctness can escalate and interfere with availability for instruction.

Reasons for Inflexibility—
  1. Transitioning from one activity to another. This is usually a problem because it may mean ending an activity before the HFA child is finished with it.
  2. The need to engage in - or continue - a preferred activity (usually an obsessive action or fantasy). 
  3. The need to control a situation. 
  4. The need to avoid or escape from a non-preferred activity (often something difficult or undesirable). Often, if the child can’t be perfect, she does not want to engage in the activity.
  5. Other internal issues (e.g., sensory, inattention (ADHD), oppositional tendency (ODD), or other psychiatric issues may also be causes of behavior. 
  6. Lack of knowledge about how something is done. By not knowing how the world works with regard to specific situations and events, the child will act inappropriately instead. 
  7. Immediate gratification of a need. 
  8. Anxiety about a current or upcoming event (no matter how trivial it may appear to the parent or teacher). 
  9. A violation of a rule or ritual (i.e., changing something from the way it is “supposed” to be). When someone violates a rule, this may be unacceptable to the HFA youngster. 
  10. A misunderstanding or misinterpretation of another's action.

Inflexibility is often the result of anxiety. The cause of anxiety in the HFA child has a lot to do with the fact that she does not have the ability to understand the world like “typical” kids do.

Because of the neuro-cognitive disorder, the child:
  • will have difficulty understanding rules of society
  • needs explicit instructions
  • does not understand social cues
  • does not understand implied directions
  • does not know how to “read between the lines”
  • does not “take in” what is going on around her

“Facts” are what kids with HFA learn and feel less anxious about. Since these “special needs” kids have a hard time with all the normal rules of society, having “rules” has a calming effect on them. They think, “This is the rule. I can handle it o.k.”

Facts also have to be from someone they think is an “expert” in their eyes. Teachers and doctors may have this leverage with them, but moms and dads are, for the most part, not considered “experts.”

Understanding what causes so much anxiety, tantrums, meltdowns, shutdowns, and out-of-control behavior helps parents to know where their HFA child is coming from, and with that, parents will be able to help their kids less stressed-out.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Parenting Strategies—

Here are some strategies for dealing with an inflexible-thinking youngster:

1. While helping your HFA child to deal with change, be prepared to weather the storm. There will be sadness, tears and tantrums – followed by parental guilt. It’s all part of the process. Remain calm, and accept your youngster for who and what she is.

2. Turn the “change” into an adventure. For example, turn “Are you ready to start a new school year” into “Wow, just think. You’ll get to see all your classmates again.” Since any change can seem frightening to children on the spectrum, the language you use can turn the change into a fun adventure. Changing the tone to one of excitement can make a world of difference in your child’s attitude.

3. Read articles and books about the change in question. Almost any change that your child is going through has been written about (e.g., new siblings, moving to a new neighborhood, starting a new school year, etc.). Go to the library and get as many books as you can on the topic and read together. Reading helps open the lines of communication to talk about the difficulties of the change that is coming.

4. Prepare your HFA youngster for what may happen – and be honest. Voice your plans in a reassuring tone. Explain to him in concrete terms where you will be going, or what may happen along the way, so that he is prepared well before and ready for the change. Also, answer your child’s questions, and tell him the truth (i.e., don’t sugar-coat the situation) so that trust develops. Many tantrums and meltdowns can be avoided, because you keep reminding him throughout the day of what’s going to happen. In this way, there are no unwanted surprises.

5. Many kids on the spectrum have difficulty with the concept of time. But, you can provide your child with simple strategies to measure time (e.g., use an alarm clock or kitchen timer for task transitions, clean up times, or evening rituals). Let your child place a calendar centrally, and help her keep track of important dates (e.g., birthdays, holidays, vacations, the first day of school, etc.). Signal your child verbally or set countdowns for when she must leave an activity that she is enjoying (e.g., “I’m going to turn off the computer in 10 minutes because we are getting close to lunch time”).





 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

6. Let your HFA youngster know of some changes in life YOU have undergone – and how you managed them. Your examples are a way of helping your child cope with change in the future. Relate to his situation. Tell stories about when you have had to weather the storms of change. Also, you can talk about what you might have done differently – something that could have facilitated a better outcome. Alternatively, you can talk about the changes within the other family members and how they changed with circumstances.

7. Kids on the autism spectrum love to follow a routine. Anything away from that worries them. They feel best when they are able to predict things. They feel safe when they know what is on the agenda for the day or what they have to do next. They want to know how other people are likely to behave or react, and what will happen from day to day. So, if you and your youngster are undergoing a significant period of change, try to keep most of his routine the same.

8. Help create sameness by repeating a similar “comfort phrase” (e.g., “Sometimes we have to change our plans, and we will be O.K. when that happens”). Use this exact phrase (or something similar) every time flexibility is needed. This helps to bring a sense of control and predictability during chaos. Your youngster will remember that you said that the last time a change was needed – and everything eventually turned out just fine.

9. Focus on just a few areas where flexibility is needed most. For example, if your youngster is constantly distressed when you’re out running errands, this is the place to start. If he is upset over having a babysitter, start there. If he won’t leave the grandparents’ house without a tantrum, focus on that issue.

10. Encourage your HFA youngster to explore and engage in new activities and interests. In this way, you help her cope with change that will come later in life. When she goes through various new experiences, it provides a fundamental base that strengthens her emotional muscles. It helps her feel good about herself and develops self-confidence.

11. Don’t unintentionally reward your youngster for acting-out due to an unwanted routine change. Uncontrolled anger warrants a predictable, swift consequence. Losing a particular privilege may be the best consequence for HFA children. Be firm. Don’t underestimate your youngster’s ability to manipulate you. Even severely autistic kids can be master manipulators.

12. Create behavior incentives using something that is the same each time (e.g., tokens, tickets, stickers, etc.). Let the sameness of the identical token be the familiar thing during the unfamiliar situation. You can also use marbles dropped into a jar (the smooth texture and “clicks” when they drop is satisfying to most autistic kids). For example, explain to your youngster, “When we leave the park today, if you don’t cry, you’ll get a marble to put in the jar when we get home.” Let her cash in the marbles for a reward at the end of the day.

13. Change itself can come quickly or slowly, but adjusting to the new state of affairs takes time. Make sure you give your youngster – and yourself – the luxury of having time to adjust. Try not to expect too much too soon. Some changes are easy to adjust to, others aren’t. Some HFA children adapt quickly to change, some don’t. As the parent, simply keep doing what you are doing, and know that most changes eventually leave everyone in better places than where they began.

14. Attempt to see things from your child’s point of view. Ask her how she perceives a particular change. A child who airs her misgivings about unwanted changes is more likely to cope better. Talk about the details of what will happen, where she will be, and what she will have to do. Doing so repeatedly helps your child feel prepared.

15. Lastly, always demonstrate love and appreciation when your child “tries” to accept a new situation with courage – even if he is unsuccessful. In other words, be sure to reward “effort” with acknowledgment and praise, regardless of whether or not the desired outcome occurred.

Treatment—

An effective treatment program for inflexibility and “insistence on sameness” actively engages the HFA youngster’s attention in highly structured activities, builds on his interests, offers a predictable schedule, provides regular reinforcement of behavior, and teaches tasks as a series of simple steps. This type of program generally includes the following:
  • specialized speech/language therapy to help kids who have trouble with the pragmatics of speech (i.e., the give-and-take of normal conversation)
  • social skills training, a form of group therapy that teaches HFA kids the skills they need to interact more successfully with their peers
  • parent-training and support to teach moms and dads behavioral techniques to use at home
  • occupational or physical therapy for kids with sensory integration problems or poor motor coordination
  • medication for co-existing conditions (e.g., depression and anxiety)
  • cognitive behavioral therapy, a type of “talk” therapy that can help the more explosive or anxious kids on the spectrum to manage their emotions better and cut back on obsessive interests and repetitive routines

In summary, due to the fact that change causes anxiety in young people with HFA, they will want to live by inflexible rules that they construct for themselves. One of their main rules goes something like this:  “My routine must NOT be disrupted, and involves X, Y and Z. Each time I can do X, Y and Z – in that order – my life has some predictability. When I don’t have this predictability, I feel anxious, which is a very painful emotion that needs to be avoided at all costs!”


More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
By

Help for Tactile Sensitivity in Children with High-Functioning Autism and Asperger’s

“My 9 year old daughter was diagnosed with high functioning autism last year. She has major trouble wearing anything but shorts and very soft t-shirts on a daily basis. Is it wrong to force her to wear things that she doesn't like? I forced her to wear a dress for picture day at school earlier this year - and it was horrible. I don't know if I'm doing the wrong thing by forcing her.”

I wouldn’t say it is “wrong.” Inconsiderate may be a better term. A common thread discussed by parents of children with High-Functioning Autism (HFA), or ASD level 1, is sensory issues. These children can have either Hyper- or Hypo-sensitivity. Some of them even express the sensory issues from birth. The sensory issues can be specific to one sense or across several senses.



Oftentimes, these “special needs” children report that some – or most – of their clothes are “tickly.” They are often in the state of “red alert”. Many of the sensations that we take as meaningless, they view as a physical threat. They experience tactile sensations differently than others. Something that we experience as smooth can seem to them painful, and this may negatively affect their behavior.

To give you an idea of how HFA kids experience the world, imagine the feeling you have when someone scrapes his nails along a blackboard, or the feeling you have when you cut your nails too short. This is how a touch sensitive youngster might experience a warm caress. There is a difference, however. When you cut your nails too short, it bothers you for a while, but the discomfort goes away. If a child is touch sensitive, the discomfort never goes away.

The HFA youngster may not be able to wear his dress pants because the feel of wool is too uncomfortable to bear. He may not be able to concentrate in school because he is enduring the hardness of the chair or the rush of air blowing on him from the ventilation system. He may be quick to lash out when another child bumps him because of the perceived attack by the other child. He may be unable to make friends because of the fear of being bumped prevents him from interacting in a normal fashion.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Here are some of the things that may indicate that your HFA youngster is touch-sensitive:
  • Craves certain sensations the he finds calming, like rocking or firm pressure
  • Fights irrationally when you are combing or shampooing his hair, cutting his fingernails, or brushing his teeth
  • Gets distracted because of the things that are touching him are bothering him
  • Insists on having certain textures of clothing
  • Makes you cut all the tags and labels out of his clothing
  • Reacts strongly to sensations that most people don't notice
  • Soles of feet, mouth and tongue are usually most sensitive areas
  • Tries to avoid tactile experiences
  • Won’t eat certain foods because of their texture

Other examples of hyper-sensitivities (i.e., high sensitivity) to sensory input may include:
  • Avoids hugs and cuddling, even with parents
  • Avoids standing in close proximity to others
  • Doesn’t enjoy a game of tag
  • Doesn’t like her feet to be off the ground
  • Extreme response to - or fear of - sudden, high-pitched, loud, or metallic noises (e.g., flushing toilets, clanking silverware, other noises that are not offensive to others)
  • Extremely fearful of climbing or falling, even when there is no real danger
  • Fearful of surprise touch
  • Has poor balance, and may fall often
  • May notice and/or be distracted by background noises that others don’t seem to hear
  • Overly fearful of swings and playground equipment
  • Seems fearful of crowds
  • Does not respond to temperature appropriately
  • Overreacts to pain
  • Has difficulty using particular materials (e.g., glue, paint, clay)
  • Complains of a small amount of wetness (e.g., from the water fountain, a small spill)

High Levels of DBH—

“Typical” (i.e., non-autistic) children are physiologically equipped to limit the amount of stimuli entering their brain, thus preventing the brain from becoming overloaded. However, children with autism have a hyper- or hypo-sensitivity to stimuli.

The enzyme “dopamine beta hydroxylase” (DBH) is released from nerve endings during “stimulation” via the five senses (i.e., touch, sight, taste, smell, sound). DBH is essential for cell communication and regulating neurons in the central and peripheral nervous systems. An increase in stimulation results in an increase in the level of this enzyme. Scientific research has shown that children with autism have much higher levels of DBH in their system than found in “ordinary” kids. The presence of this enzyme is also linked to certain behaviors (e.g., repetition, agitation, aggression, etc.).

Repetitious activity (e.g., rocking, flapping, pacing, etc.) results in the release of endorphins through the system. Endorphins reduce the sensation of pain and have the ability to block pain. Through the use of repetitious activity, kids on the spectrum have the ability to purposely (but unknowingly) overload their sensory system in order to shut it down completely.

Treatment—

If you feel that your HFA youngster may have touch sensitivity, you should first try to confirm the diagnosis by going to someone who is trained in diagnosing sensory integration problems. You should first consult your doctor with your concern and try to get a referral to a “Pediatric Occupational Therapy Service” for diagnosis and treatment. They will manage your HFA child’s treatment plan and teach you what you can do at home to help your child.

Therapy may include the following:

For HFA kids who enjoy the feel of sticky textures, the therapist may use certain materials (e.g., glue, stickers, play dough, rubber toys, sticky tape, water, beans, rice, and sand). On the other hand, kids who are very sensitive to touch may go through a brushing program that attempts to desensitize them to touch by systematically brushing their body at regular intervals throughout the day.

Some HFA kids enjoy a sense of firm overall pressure. This can be provided by weighted blankets, weighted belts, being squeezed by pillows, and firm hugs. Also, making tunnels or tents from blankets over furniture can be soothing to these “special needs” children.

Other therapeutic approaches for HFA children with dysfunctional sensory systems may include the following:
  • Difficulty with using both sides of the body simultaneously can occur in some of these young people. The therapist may encourage the youngster with hopscotch, crawling, skipping, playing musical instruments, playing catch, or bouncing balls with both hands to help with bilateral integration.
  • Hand and eye coordination can be improved with activities such as popping bubbles, hitting a ball with a bat, beanbags and balloons, and throwing/catching balls. 
  • Skills such as riding a bike or tying shoe laces can be difficult for some HFA children, because they involve sequences of movements. Therapy to help in this area may include obstacle courses, swimming, mazes, constructional toys, and building blocks.

Evaluation and treatment of sensory integrative dysfunction is performed by an occupational and/or physical therapist. The therapist's general goals are to:  
  • assist the youngster in inhibiting and/or modulating sensory information
  • assist the youngster in processing a more organized response to sensory stimuli
  • provide the youngster with sensory information which helps organize the central nervous system

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Applied Behavioral Analysis (ABA) is an important therapeutic technique used with all forms of autism spectrum disorders. Its main principle is to break tasks into tiny steps and to reward correct responses with treats, stickers or small toys (e.g., if a youngster manages to keep working despite a distraction placed near his desk, his therapist may give him a reward). ABA therapists praise the child specifically (e.g., saying, "You did a good job answering the phone" ...rather than just saying, "Good job"). ABA therapists also help kids who don’t know how to break jobs into small steps (e.g., if the child needs a book, it may never occur to him to ask his mother to take him to the library as a first step).

Another method to address Sensory Integration Disorders is called Dialectical Behavior Technique. The therapist helps the youngster learn how to tolerate higher levels of frustration and to control his emotional responses to conflict or frustration.

Many kids with AS and HFA have success with Occupational Therapy. They learn through "hands-on" methods how to translate visual and auditory input into motor tasks (e.g., handwriting, tying shoes, opening a milk carton, sports activities, etc.). Therapists often use specialized equipment (e.g., Thera-putty, camping pillows, T-stools, inflatable discs, etc.) to help these young people better orient themselves in space.

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

What Can Parents Do?

A common approach is to spend the time and money needed to find alternative fabrics and styles of clothing. Tolerance for fabrics will vary from child to child. So take your HFA son or daughter with you to the clothing store and have him/her experiment with different clothing items. For each shopping excursion, plan on spending at least two hours. You may have to go to several stores. And if you find only one item that your HFA child can tolerate per trip – consider yourself very lucky!

Help for over and under-sensitivity to tactile experiences:
  • Cook meals with different size pieces of vegetables and different texture foods.
  • Encourage and offer tight squeezes and hugs, but warn the child if you are about to touch him; always approach him from the front. Remember that a hug may be painful rather than comforting, so adjust accordingly.
  • Encourage gardening and patting down soil and working with sand.
  • Provide clothing the child is comfortable in.
  • Supply a bag of different textured items such as feathers, leather, silk, tinfoil, sandpaper and sponge and encourage the child to rub them and feel the different surfaces. 
  • Use tactile-rich decor such as cork, sisal rugs and furry blankets.
  • Allow the child to complete activities themselves (e.g., hair brushing and washing) so that he can do what is comfortable for him.

In addition, consider setting up a sensory room. Sensory rooms might include: 
  • bubble tubes
  • disco lights 
  • equipment that is activated by switches, movement, sound or pressure so that the child can learn about cause and effect
  • fiber optics 
  • mirror balls 
  • projectors 
  • soothing music 
  • tactile walls 
  • vibrating cushions 
  • water beds

Lastly, keep a diary of your HFA child’s frustrations in terms of sensory issues. There are usually three columns in the diary. The first is a record of the incident (e.g., parent writes, "Michael had a meltdown getting dressed"). The second column is the possible reason for the meltdown (e.g., "Michael says he can’t tolerate tags on clothes"). The third column is the intervention (e.g., "Cut off tags on all of Michael’s shirts).





Other Sensory Issues—

Help for over and under-sensitivity to oral experiences: 
  • Encourage bubble blowing.
  •  Ensure the child is on a multivitamin to make up for any dietary deficiency.
  • Offer chewing gum, lollipops and hard candy.
  • Supply simple wind instruments such as recorders and harmonicas.
  • Supply straws or cups with built in straws.

Help for children with auditory sensitivity: 
  • Expose the child to a variety of music and see which is most enjoyed.
  • Supply earplugs or earmuffs when at a loud event or sports match.
  • Take the child to quiet places on outings such as the library, art galleries, coffee shops and parks.
  • Teach the child how to cope with or move away from loud noises such as a passing train or screaming children.

Help for children with olfactory sensitivity: 
  • Don’t bring home magazines with perfumed pages.
  • Give permission for the child to leave the room if an odor is too strong and try and make the same provision at his school.
  • Supply a small vial of a perfume the child likes that he can sniff if he needs to.
  • Teach a child to breathe through his mouth to minimize unwanted smells.

Help for children with visual sensitivity: 
  • Build 3D models.
  • Do jigsaw puzzles with the child.
  • Encourage activities where the child sorts items into shapes and sizes.
  • Work on collages.
  • Work with an ophthalmologist as different color and strength lenses can help.

It is helpful to get the child assessed professionally and then integrate the occupational therapist’s suggestions into everyday routines.

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

Conclusion—

Understanding the way children with HFA experience the world will help parents and teachers to respect them in their attempts to survive and live a productive life in a “sensory-unfriendly” world. If we understand how the HFA youngster experiences the world and how she interprets what she sees, hears, feels, etc., we can design treatment programs in accordance with her perceptual abilities and deficits. Understanding each particular child’s specific difficulties and how they may affect her functioning is vital in order to adopt methods and strategies to help her function at home, school and in the community.


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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COMMENTS:

•    Anonymous said… Choices within acceptable options. Spend a little more for comfortable fabrics.
•    Anonymous said… Find comfy clothes she will wear. Buy multiple in 2 sizes and colors.
•    Anonymous said… I have learned that you can't force these kids to do anything. They can also be super sensitive to certain materials, etc. See if you can find out exactly what she doesn't like about certain things. May not be that she won't dresses at all but maybe something soft and cottony? My son is 15 and only wears shorts and tshirts too even in freezing weather and won't wear a jacket this year. Last year he wore a hoodie everyday even in 90 degree weather, so go figure!
•    Anonymous said… I think making our little people wear things they don't like is like saying your not a real person, your feelings don't count. I think even neurotypical children should have a say in what they wear. (within reason) My mother in-law tries to get my daughter to wear a dress for Church. (I don't even wear a dress for Church) She even bought her a pretty and super soft dress for Christmas (A for effort) but she DOES NOT WANT TO WEAR A DRESS! It has been hanging in the closet unworn. (money well spent)
•    Anonymous said… I would NEVER force my child to wear something he was uncomfortable with. How do you know how it feels?? There are much bigger things to worry about than clothing. Pick your battles carefully, life is too short!
•    Anonymous said… I wouldn't force it unless it is a weather issue. Too cold etc
•    Anonymous said… I wouldn't force it. My 8 year old is like this also.
•    Anonymous said… I wouldn't force it. :) I think it's easy for us to underestimate how irritating (even physically painful) it must be to wear certain fabrics if we don't have sensory trouble ourselves. My son will tear shirts to shreds if it "itches" or is a material he can't stand, not in anger, but trying to relieve the pain. He tells me it hurts his skin, sometimes even just regular tshirt material. It's tough finding things he will wear.
•    Anonymous said… I wouldn't force small things like that. chose the battles and have empathy rather than forcing anything..gentleness and understanding goes a long way.
•    Anonymous said… I wouldnt. Let her be comfortable. You will likely get a happier kid. She likely doesnt care what the others wear. It is hard. You feel the judgement of others. But you have to accept it. I think most people who care to notice look at other aspects of our life and relieze we are doing our best.
•    Anonymous said… If dressing up is that important to you, find jersey knit/t-shirt dresses and soft stretchy leggings for dress up occasions and see if she will try it. Other than that,  🎶 let it gooooo, let it gooooo  🎵 and let her wear what works for her. My daughter has an aversion to jeans - which she used to wear as a toddler with no problem, but when she hit 6 she suddenly HATED them. So I let her wear stretchy leggings under skirts and soft t-shirts. We got a ton of them at Children's Place. When she turned 11 she tried on boy jeans and decided they were ok. So now she will wear khakis and loose jeans. Just because there is a sensitivity issue now does not mean that your child will ALWAYS be super sensitive. As they mature, a lot of children grow out of sensitivities, or learn to cope with them in order to achieve a certain look they want.
•    Anonymous said… If you read any of Temple Grandin 's articles she always says you have to push things with your child to get over the sensitivities... We had horrendous aversion to socks and bit by bit , we continued working on it - like uniforms etc shirt/tie etc You have to keep working at it... And then you look back and realise how far you have come... There is always a solution if you look for it!
•    Anonymous said… Labels and seems on socks bothered my son. I'd let her wear whatevers comfortable for her. I did see a post the other day about underclothes designed for autistic children, a vest and long shorts then everyday clothes on top might be an idea.
•    Anonymous said… Labels, socks, seams, waistbands, itchy fabric... we've had it all. my daughter will wear leggings And shirts out of school, till they're threadbare... go with the flow I say - she's comfortable, I'm calm  :)
•    Anonymous said… Let her decide pick your battles not worth upsetting her x
•    Anonymous said… Let it go. You will have many battles and you have to chooses wisely.
•    Anonymous said… Love this. Relax mom for me going with the flow has been best for my child.
•    Anonymous said… My 7 year old daughter is similar. I've given up and just let her choose what she wants to wear. Even at school they are lenient on her. We've had tantrums from before she could speak on clothing so I feel your pain. Just let her choose what to wear but give her guidelines. Xmas jumper day... I bought her a poncho style jumper so it wasn't tight round the arms. She loved it. Good luck xx
•    Anonymous said… My boy is the same with clothing. He'll only wear soft material and doesn't like jumpers or anything heavy. I think it's understandable because when I think about it, I wouldn't like rough clothing and am not a fan of sleeves so I can see where my boy is coming from. I used to make him wear these sorts of clothes but after having that realization, I stopped. Let your girl be comfortable in what she chooses to wear, maybe just be on the look out for soft dresses etc  :)
•    Anonymous said… My son goes to a private school where they have to wear a uniform. Collared shirts and all. We compromised, he wears a tshirt underneath and as soon as school is out, off comes the collared shirt. This has worked so far.
•    Anonymous said… My son has started to wear jeans.....occasionally to ride his horse, so if the need out weighs the pain I believe they will get there. He wore undershirts under his school shirts for years!!!! Even on the hottest day, but one day felt really proud of himself and stopped. We could NEVER force him
•    Anonymous said… My son won't wear shorts even in the hottest of summer days. He insists on wearing fleece pants and sweaters pretty much year around. Additionally because he is tall and thin, he has to wear a smaller size pant and they are always too short. I wish all pants including sweatpants had an adjustable waist or came in more sizes for his sake. I have given up fighting for him to look more "cool" and just let it be..as long as he wears the correct footwear and a jacket in winter, I have to let him make his own choices overall.
•    Anonymous said… Never force clothes I learnt that had it for yrs my girl hf autusm bad sensory issues with clothes. She now at 16 trys diffrent clothes and is progressing slowly. Used to live in one to shirt and shorts lol x
•    Anonymous said… Nope it desensitizes them.My 7 year old spd son will now on special occasion will rock a cute dress shirt and a bow tie.Its no diffrent then hand dryer. sweeper. alarm. lawn mower.My son has overcome most of these.He definitely loves those stretchy Levi denizens from target 20 buck's. Worth it to see him in some jeans that are cozy.If they made leggings for boy's. My guy would so rock em!
•    Anonymous said… Our other child that is not HFA has many clothing issues. To me it's just not worth it. If she looks clean and that's the goal. We have found a nice cotton dress that is soft that she would wear but she wouldn't wear it in the car. We had to bring it and change into it. Spend 40 minutes arguing and screaming from the child over a non-discipline issue so she looks like other children is not worth it.
•    Anonymous said… Such an awesome article-! What I've learned is - He gets to choose what he wants to wear-! At first I had no idea so when we would spend 30 min of him crying over his sock drawer or when he was smaller me cutting off labels on all his shirts I had no idea why! I just did it out of common sense! Now I realize his struggles everyday now that he's diagnosed. All he must go through trying to manage at school. so letting him wear what makes him comfortable is so key- that's the one area I can take the anxiety out of. That he can control. So we have drawers full of under armour! Not kidding! Everyday he gets to wear one -! I feel like a sitcom episode where the closet is full of same cloths for each day! Lol! And Jeffries seamless socks have saved our world! He actually goes to the drawer and says where are my " Aspie " socks. I think it's good to teach him why he feels the way he does and to teach him how to soothe and make hisself comfortable. So important for him later in life when I'm not there .. That's his design ! Love this article  ❤- backs up my inner knowing
•    Anonymous said… We do better if he shops with me. Of course, he HATES doing it. However, I find he'll accept more textures and styles if he helps choose them himself.
•    Anonymous said… Yes! Oh my goodness yes it's wrong. Now imagine your wearing clothes made of sand paper with brillo pads under your arms and behind your knees. And imagine your walking around with very binding cactus shoes on your feet. And ppl insisting you must keep wearing those items even when they're hot, and itchy and it feels like your skin is crawling. And like you have something scratching and poking the back of your neck where there's a tag. But once again imagine you are told you have to wear it to look pretty, or because it's what all the boys/girls are wearing, or because it's what the school requires you to wear. Now imagine having to sit and concentrate and do school work or listen all the while your body is put of sorts. You brain screams and your hands want to itch and pull at the clothes, but that's fidgeting and your supposed to be sitting still and do your school work or sit still while I'm church. How very very awful. 

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