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Sensory Integration Dysfunction in Kids on the Autism Spectrum


"Is it common for children on the autism spectrum to react strongly to one or two things (certain noises for example) - yet not react at all to other things that ordinary kids would react strongly to (such as a broken bone)?"

Many young people with High-functioning Autism (HFA) have a dysfunctional sensory system. Oftentimes, one or more senses are either over-reactive or under-reactive to stimulation. Such sensory issues may be the underlying reason for certain behaviors associated with autism spectrum disorders (e.g., rocking, spinning, hand-flapping, etc.). Although the receptors for the senses are located in the peripheral nervous system, the problem appears to stem from neurological dysfunction in the central nervous system.

Sensory integration refers to the accurate interpretation of sensory stimulation from the environment by the child’s brain. Conversely, sensory integrative dysfunction is a disorder in which sensory input is not organized appropriately in the brain, thus producing varying degrees of problems in development, information processing, and behavior.

Sensory integration focuses primarily on 3 basic senses: (1) proprioceptive, (2) vestibular, and (3) tactile. Their interconnections start forming before birth and continue to develop as the child matures and interacts with his environment. These 3 senses are also connected with other systems in the brain, and even though they are less familiar than other senses (i.e., taste, smell, sight, and hearing), they are critical to basic survival.

==> Preventing Meltdowns and Tantrums in HFA Children

Dysfunction within these 3 senses manifests itself in many ways. For example, the child:
  • has an activity level that is either unusually high or unusually low
  • is in constant motion or fatigues easily 
  • is over- or under-responsive to sensory input
  • becomes impulsive, easily distractible, or shows a general lack of planning
  • experiences gross and/or fine motor coordination problems
  • has difficulty adjusting to new situations and may react with frustration, aggression, or withdrawal
  • has speech and/or language delays

Let’s look at each of these 3 senses in greater detail...

Proprioceptive—

The proprioceptive system refers to components of muscles, joints, and tendons that (a) provide the child with a subconscious awareness of her body position, which is automatically adjusted in different situations (e.g., sitting properly in a chair, stepping off a curb smoothly, etc.), and (b) allow the child to manipulate objects using fine motor movements (e.g., writing with a pen, using a spoon, buttoning a shirt, tying shoe laces, etc.). In addition, proprioception involves motor planning, which is the ability to plan and execute different motor tasks.



Some common signs of proprioceptive dysfunction include the following:
  • tendency to fall
  • resistance to new motor movement activities
  • odd body posturing
  • minimal crawling when young
  • lack of awareness of body position in space
  • eating in a sloppy manner
  • difficulty manipulating small objects (e.g., buttons, snaps)
  • clumsiness

Therapy may include:
  • bouncing on a trampoline or a large ball
  • skipping or pushing heavy objects
  • wearing weighted belts
  • weighted blankets
  • weighted vests

Vestibular—

The vestibular system refers to structures within the inner ear that detect movement and changes in the position of the head (e.g., tells the child when his head is upright or tilted, even with the eyes closed).

Dysfunction within the vestibular system may manifest itself in two different ways:
  1. Hyposensitivity: The HFA youngster may actively seek very intense sensory experiences (e.g., excessive body whirling, jumping, spinning, etc.). This type of youngster demonstrates signs of a hypo-reactive vestibular system (i.e., he is trying constantly to stimulate himself).
  2. Hypersensitivity: The youngster may (a) be extremely susceptible to vestibular stimulation; (b) have fearful reactions to ordinary movement activities (e.g., swings, slides, inclines, ramps. etc.); (c) have trouble learning to climb or descend stairs or hills; (d) be apprehensive about walking or crawling on uneven or unstable surfaces; and (e) appear clumsy.

Therapy can include:
  • cartwheels
  • dancing
  • hanging upside down
  • rocking chairs
  • rolling
  • somersaulting
  • spinning
  • swings

All of these actions involve the head moving in different ways that stimulate the vestibular system. The therapist will observe the youngster carefully to be sure the movement is not over-stimulating. The most stimulating movement tends to be rotational (i.e., spinning) and should be used carefully by the therapist. Merry-go-rounds, being tossed on to cushions, or jumping on trampolines can be favorite activities with some HFA kids. Back and forth movement is typically less stimulating than side-to-side movement. A rocking motion will usually calm a youngster, while vigorous motions like spinning will be stimulating. Ideally, therapy will provide a variety of these movements.




 ==> Discipline for Defiant HFA Teens

Tactile—

The tactile system includes nerves under the skin's surface that send information to the brain (e.g., light touch, pain, pressure, temperature, etc.), which plays an important role in perceiving the environment – and protective reactions for survival.

Dysfunction in the tactile system can be seen in the following:
  • avoiding getting one's hands dirty (e.g., with glue, sand, mud, finger-paint, etc.)
  • complaining about having one's hair or face washed
  • refusing to eat certain textured foods 
  • refusing to wear certain types of clothing
  • using one's finger tips rather than whole hands to manipulate objects
  • walking with heels of the feet off the floor
  • withdrawing when being touched

A dysfunctional tactile system can lead to a misperception of touch and pain, and may lead to self-imposed isolation, general irritability, hyperactivity, and distractibility. Tactile defensiveness is a condition in which the child is extremely sensitive to touch, which can result in behavior problems, inability to concentrate, and negative emotional response to touch sensations.

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

Sensory processing functions on a continuum. Everyone has difficulty processing certain sensory stimuli (e.g., a certain touch, taste, smell, sound, movement etc.) – and everyone has sensory preferences. Processing difficulties only become a Sensory Processing Disorder when an individual is on extreme ends of the continuum or experiences disruptive, unpredictable fluctuations which significantly impact developmental skills and everyday functioning.

If you believe your HFA child may be experiencing some form of sensory integration dysfunction, ask your child’s doctor for a referral to an occupational and/or physical therapist for treatment.

 
 
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16 Simple Ways to "Prevent" Meltdowns in Kids on the Autism Spectrum

"Is there a way for parents of children with ASD to prevent meltdowns from happening in the first place? I ask because once my autistic son (level 1) gets up a head of steam, there's no way of getting him to calm down."

It is much easier to prevent meltdowns than it is to manage them once they have erupted.

Here are 16 tips for preventing meltdowns and some things parents can say to their high-functioning autistic children:


1. When visiting new places or unfamiliar people explain to the youngster beforehand what to expect. Say, “Stay with your assigned buddy in the museum.”

2. Signal kids on the autism spectrum before you reach the end of an activity so that they can get prepared for the transition. Say, “When the timer goes off 5 minutes from now it will be time to turn off the TV and go to bed.”

3. Reward them for positive attention rather than negative attention. During situations when they are prone to meltdowns, catch them when they are being good and say such things as, “Nice job sharing with your friend.”

4. Provide pre-academic, behavioral, and social challenges that are at the youngster’s developmental level so that the youngster does not become frustrated.

5. Make sure that kids on the spectrum are well rested and fed in situations in which a meltdown is a likely possibility. Say, “Supper is almost ready, here’s a cracker for now.”

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

6. Keep off-limit objects out of sight and therefore out of mind. In an art activity keep the scissors out of reach if kids are not ready to use them safely.

7. Keep a sense of humor to divert the youngster’s attention and surprise the youngster out of the meltdown.

8. Increase your tolerance level. Are you available to meet the youngster’s reasonable needs? Evaluate how many times you say, “No.” Avoid fighting over minor things.

9. Give them control over little things whenever possible by giving choices. A little bit of power given to the youngster can stave off the big power struggles later. “Which do you want to do first, brush your teeth or put on your pajamas?”

10. Establish routines and traditions that add structure. For teachers, start class with a sharing time and opportunity for interaction.

11. Do not ask them to do something when they must do what you ask. Do not ask, “Would you like to eat now?” Say, “It’s suppertime now.”

12. Distract them by redirection to another activity when they begin to meltdown over something they should not do or cannot have. Say, “Let’s read a book together.”

13. Create a safe environment that kids can explore without getting into trouble. Childproof your home or classroom so kids can explore safely.

14. Choose your battles. Teach these "special needs" children how to make a request without a meltdown and then honor the request. Say, “Try asking for that toy nicely and I’ll get it for you.”

15. Change environments, thus removing the youngster from the source of the meltdown. Say, “Let’s go for a walk.”

16. Avoid boredom. Say, “You have been working for a long time. Let’s take a break and do something fun.”
Resources for parents of children and teens on the autism spectrum:
 
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Effective Social Interventions and Supports for Children on the Autism Spectrum

Kids and teens with Asperger’s (AS) and High-Functioning Autism (HFA) often have difficulty understanding social situations, which can cause stress and anxiety. Social situations that seem to be most problematic include:
  • Interpreting nonliteral language (e.g., idioms and metaphors)
  • Knowing how and when to use turn-taking skills (e.g., focusing on the interests of peers)
  • Recognizing that others' intentions do not always match their verbalizations
  • Understanding facial expressions and gestures
  • Understanding the “hidden curriculum” (i.e., those complex social rules that often are not directly taught)

Even when a youngster with AS or HFA receives effective instruction in social skills, situations will arise that require “interpretation.” Unless interpreted, these situations become a source of stress and do not support future learning. However, with interpretation, perceptions of seemingly random actions can be altered into meaningful interactions. Interpretive strategies include:
  1. the Situation-Options-Consequences-Choices-Strategies-Simulation (SOCCSS) strategy
  2. the Power Card
  3. Social Autopsies
  4. Cartooning





Situation-Options-Consequences-Choices-Strategies-Simulation—

One interpretive technique, the Situation, Options, Consequences, Choices, Strategies, Simulation (SOCCSS) strategy, was developed to help AS and HFA kids with social interaction problems put interpersonal relationships into a sequential form. It helps them understand problem situations and lets them see that they have to make choices about a given situation, with each choice having a consequence. The steps of SOCCSS are:

1. Situation: When a social problem arises, the parent or teacher helps the youngster to understand the situation by first identifying:
  • who was involved
  • what happened
  • the date, day, and time of occurrence
  • reasons for the present situation

2. Options: The youngster, with the assistance of the parent or teacher, brainstorms several options for behavior. At this point, the parent or teacher accepts all of the child’s responses and does not evaluate them. This step encourages him or her to see more than one perspective and to realize that any one situation presents several behavioral options.

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

3. Consequences: Then the youngster and parent or teacher work together to evaluate each of the options generated. The parent or teacher is a facilitator, helping the youngster to develop consequences for each option rather than dictating them.

4. Choices: The youngster selects the option(s) that will have the most desirable consequences for him or her.

5. Strategy. Next the youngster and parent or teacher develop an action plan to implement the selected option.

6. Simulation: Finally the youngster is given an opportunity to role-play the selected alternative. Simulation may be in the form of:
  • writing a plan
  • visualization
  • talking with a peer
  • role play

The SOCCSS strategy offers many benefits to the AS or HFA child. It allows him or her to:
  • understand that many options may be available in any given situation
  • realize that each option has a naturally occurring consequence
  • develop a sense of empowerment by acting on the environment (i.e., these children realize that they have choices, and by selecting one, they can directly determine the consequences of their actions).

The Power Card—

Figure 1 - Click to enlarge
The Power Card is a visual aid that helps AS and HFA kids and teens make sense of social situations, routines, and the meaning of language. The Power Card uses their “special interests” to help them make sense of a specific situation and motivates them to engage in a targeted behavior.

In using this strategy, the parent or teacher develops a brief script written at the youngster's level of comprehension, which details a problem situation or a target behavior and its relationship to the youngster's special interest. Power Cards also provide a solution, relying on the youngster's special interest. This solution then is generalized back to the youngster. A card the size of a business card or trading card containing a picture of the special interest – and a summary of the solution – can be carried with the youngster to promote generalization.

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

The Power Card can be carried in a pocket, purse, or wallet, or it can be velcroed inside a book, notebook, or locker. It also may be placed on the corner of the youngster's desk. Figure 1 provides an example of a Power Card for a 6-year-old female student with HFA who had problems focusing. Her special interest was Dora the Explorer.

Social Autopsies—

Figure 2 - Click to enlarge
This technique was created to help AS and HFA children with severe learning and social problems to develop an understanding of social mistakes. In the traditional sense, an autopsy is the examination and inspection of a dead body to discover the cause of death, determine damage, and prevent recurrence.

Similarly, a social autopsy is an examination and inspection of a social error to discover the cause of the error, determine the damage, and prevent it from happening again. When a social mistake occurs, the youngster meets with the parent or teacher to discuss it.

Together, in a non-judgmental way, they identify the mistake. Then they discuss who was harmed by the error. The final step of the autopsy is to develop a plan to ensure that the error does not occur again. Figure 2 is an example of a social autopsy worksheet.
Cartooning—
Figure 3 - Click to enlarge

The visual area is a strength for kids on the autism spectrum. Therefore, visual systems often enhance their ability to understand their environment. One type of visual support is cartooning. This strategy has been implemented by speech/language pathologists for many years to enhance their clients’ understanding.

Cartoon figures play an integral role in a number of other intervention techniques (e.g., pragmaticism, mind-reading, and comic strip conversations). Each of these strategies promotes social understanding by using simple figures and other symbols (e.g., conversation and thought bubbles) in a comic strip-like format. This visual representation of a conversation helps AS and HFA kids analyze the social exchange.

Although cartooning has limited scientific verification, some evidence suggests that learners with AS and HFA may be good candidates for social learning based on using a comic format to dissect and interpret social situations and interactions. Figure 3 provides a cartoon depicting a social interchange.


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==> 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

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==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism
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Problems with "Disruption of Routine" in Kids with Asperger’s and HFA

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Parents' Problem-Solving Skills for Hostile Teens with Autism Spectrum Disorder

“My wife and I are struggling dealing with our angry, increasingly aggressive 14 yr old son with high functioning autism. He's now refusing to hand over his electronics at night and shouting occurs. He is testing the boundaries, of course, but physical confrontation is something we don't know how to cope with.”

Addressing hostility and aggressiveness in teens with Asperger’s (AS) and High-Functioning Autism (HFA) can be a frustrating and demanding process. The challenge for parents and teachers is to address the behavior in a constructive manner, rather than simply reacting to it.

When AS and HFA teens are exhibiting hostile behaviors, it is often a sign that they are not receiving adequate support in mastering their environments, both at home and school. In addition, their aggressiveness does not necessarily reflect willfulness, rather they lack the social skills needed to “fit-in” and to be accepted by others – especially their peers.



What makes AS and HFA teens act-out may lie in the way they process social information, including what aspects of the social environment they pay attention to, and how they interpret what they perceive. These “special needs” teens need help in altering the way they process social information so that they do not view hostility as justified or useful.

The development of an “emotions vocabulary” is an important component in addressing aggressive behaviors so that feelings can be put into words leading to social skills development, identifying feelings, fostering cooperation, emphasis on empathy, discussions of future desires, conflict resolution, and assertive communication.

If the AS or HFA adolescent is acting-out, it is irrational for parents and teachers to assume that he knows more favorable alternatives. If adults are always telling this adolescent what NOT to do, when are they telling him what he SHOULD be doing and helping him to learn how?

Why Teens with Asperger's and HFA Can Be Moody and Depressed--




 ==> Disciplinary Strategies for Asperger's and HFA Teens


Teaching Problem-Solving Skills—

Developmental deficits in cognitive processes are often associated with aggressive behavior, and social development requires mastery of cognitive and behavioral skills for communicating with others, assessing social circumstances, and resolving conflicts without aggressiveness. These skills empower AS and HFA teens to make friends and flourish socially.

Teaching problem-solving skills is useful in addressing hostility and aggressiveness in these adolescents. Below are 6 effective steps to teaching problem-solving skills. Each step requires different approaches to discovering - and linking - the missing skills in social situations.

Step 1: Help the teen to attend to social cues that are often missed or misinterpreted.

Methods: 
  • Help the teen identify his own feeling states through self-report and observation.
  • Enhance sensitivity to verbal and nonverbal social cues through games and role play, teaching the teen to identify social cues in body language and pitch of voice.
  • Have the teen make a video of his own nonverbal cues, and then have him explain his feelings on the basis of cues demonstrated in the video (e.g., hand gestures, facial expressions, voice intonation, and other indicators of social intent).

Step 2: Help the teen to assign meaning to social cues. This step is necessary because hostile teens commonly interpret neutral interactions as threatening – and then respond defensively. Unlike “typical” teenagers, AS and HFA teens do not intuitively know how to exhibit socially acceptable behavior, and the level of their required assistance depends on the social supports they have previously encountered.

Methods: 
  • With the help of videotapes of social encounters, the teen should be taught to identify the sources of the problems and the feelings of participants with emphasis on correctly identifying friendly and neutral – as well as hostile – intent on the part of others.
  • The teen should learn to identify and classify social cues by friendly, neutral, and hostile categories of intent. The teen can practice by assuming the roles of his peers in disputes.

Step 3: Help the teen to define goals that enhance social relationships with an awareness of the consequences of behavior.

Methods: 
  • Brainstorming example: The teen is rewarded for having ideas about goals for various situations. Goals can be rated as to whether they are likely to enhance or damage interpersonal relationships with peers.
  • The teen should be given opportunities to practice identifying and fitting pro-social goals to various situations.

 ==> Disciplinary Strategies for Asperger's and HFA Teens

Step 4: Help the teen to develop ideas about how to respond to each social circumstance he encounters. This step is necessary because compared with “typical” teens, AS and HFA teens identify fewer alternatives and seem unaware of the various options that may be open to them when confronted by a social problem. These “special needs” teens need help identifying their options and possible outcomes (this is why constantly telling them what they are doing wrong does not increase the likelihood of improved future performance).

Methods: 
  • Help the teen to develop skills to control arousal and to generate behavioral responses in which anger and use of force are only two of many response possibilities.
  • Help to increase the teen’s skill in identifying alternatives to the use of force to solve social problems.

Step 5: Help the teen to assess likely outcomes of potential responses and to select a response that can be initiated given the limitations of the situation. Compared to non-hostile teens, hostile ones tend to evaluate pro-social responses less favorably. Thus, they are not behaving a certain way to purposely hurt those around them, rather they are simply making decisions based on social skills deficits.

Methods: 
  • Evaluation of each alternative: The teen should be given opportunities to discuss likely gains and losses associated with each identified alternative in specific social situations.
  • Like goals, gains may be described as short and long term, material and social, or affective and concrete.
  • In addition to benefits, look at costs (i.e., negative outcomes) of each alternative.

Step 6: Help the teen to implement a response. This step is where a teen with hostile tendencies joins a group, negotiates deals, offers and/or receives positive feedback, and bargains for the exchange of social opportunities by implementing a strategy from previous steps. Practicing this step will be intimidating and challenging for the AS or HFA teen. Any attempts – successful or not – should be praised and reviewed to identify areas of strength as well as need for improvement.

The development of problem-solving skills includes the AS or HFA teen as a contributor in planning and execution. Thus, be sure to include his input in all the steps listed above. The methods described are something you are doing WITH the teen, rather than TO him. Addressing hostility in these “special needs” young people demands an understanding of their perspective. Any approach to correcting hostility that does not include the teen himself is not going to have long-term benefits.

Behind every behavioral problem is a skill deficit – and a need to acquire that skill. Identifying with whom, over what, where and when behavioral problems occur will highlight specific circumstances so that appropriate problem-solving skills can be taught. Including the teen in the plan to address his aggression and hostility is allowing him to be assertive in a positive way; it gives him a sense of control that is often craved when he is lacking a skill and acting-out aggressively.
 

 
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Understanding Theory of Mind Deficits in Autistic Children: Misbehavior or Misunderstanding?

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