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Aspergers - Sensory Processing Interventions

Aspergers - Sensory Processing Interventions

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T
he
Diagnostic and Statistical Manual of Mental Disorders– Fourth Edition–Text Revision 
(
DSM-IV-TR 
; American Psychiatric As-sociation [APA], 2000) contains themost widely used diagnostic criteria foridentifying Asperger syndrome (AS) as acategory of Pervasive DevelopmentalDisorders (PDD). This document con-tains three behavioral criteria—qualita-tive social impairment, repetitive and re-strictive stereotyped patterns of behavior,and significantly decreased social func-tion—and three exclusion criteria—lan-guage delays, cognitive delays, or othersignificant diagnoses, including schizo-phrenia or autism (APA, 2000).It is interesting to note that these cri-teria do not contain any explicit referenceto differences in sensory processing, eventhough the original work on this disor-der by Hans Asperger (1944) containeddescriptions about distinct sensory pro-cessing behaviors (Dunn, Myles, & Orr,2002). Asperger studied four childrenand recorded the unique characteristicsthey exhibited (Frith, 1991; Wing,1991), including a range of hypo- andhypersensitivities to taste, tactile, and au-ditory stimuli. For example, male chil-dren discussed in his case studies pre-ferred very sour or strongly spiced foods.Similarly, they strongly disliked tactileinput (e.g., textures of some fabrics, fin-gernail cutting) and were also very sensi-tive to noise in certain situations butoblivious to noise in other environments.Each of these sensory problems inter-fered with their daily routines.More recently, consideration has beengiven to the possibility that sensory pro-cessing is an underlying feature of AS(Attwood, 1998; Fling, 2000; Myles &Simpson, 1998; Myles & Southwick,1999; Stagnitti, Raison, & Ryan, 1999; Willey, 1999). Practitioners and scholarshave anecdotally reported about the re-lationships between sensory processingfunctions in daily life, including learning,play, work, and socialization (e.g., Ad-
FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES VOLUME 17, NUMBER 3, FALL 2002PAGES 172–185
Asperger Syndrome andSensory Processing:
A Conceptual Model and Guidancefor Intervention Planning
 Winnie Dunn, Jessica Saiter, and Louann Rinner
The purpose of this article is to discuss sensory processing concepts and their applica-tion to the needs of children who have Asperger syndrome (AS). First we will outlinethe basic characteristics of the sensory systems, then discuss a model for sensory pro-cessing, and, finally, present a summary of the data supporting the application of thismodel in work with children who have AS. A framework is outlined for incorporatingsensory processing concepts into practice and research programs that address theneeds of children with AS. Finally, we will present case studies demonstrating theapplication of sensory processing principles.
reon & Myles, 2001; Anderson & Em-mons, 1996; Ayres, 1972, 1979; Cook & Dunn, 1998; Fisher, Murray, &Bundy, 1991). There is some preliminary empirical evidence suggesting that thereare significant differences in the sensory processing patterns of children who have AS (Dunn et al., 2002). Some authors view the specific criteria listed under theheading “Repetitive and RestrictedStereotyped Patterns of Behavior, Activ-ities, and Interests” (p. 84) to be reflec-tive of difficulty with sensory processing,including (a) a preoccupation with oneor more stereotyped and restricted pat-terns of interest that is abnormal either inintensity or focus; (b) inflexible adher-ence to specific, nonfunctional routinesor rituals; (c) stereotyped and repetitivemotor mannerisms; and (d) persistentpreoccupation with parts of objects(Frith, 1991; Gillberg, 1992; Huebner,2001; Zero to Three, 1994).The purpose of this article is to discusssensory processing concepts and their ap-plication to the needs of children whohave AS. We will outline the basic char-acteristics of the sensory systems, discussa model for sensory processing, and pre-sent a summary of the data supportingthe application of this model in work  with children who have AS. Then we willoutline a framework for incorporatingsensory processing concepts into practiceand research programs that address the
 
 VOLUME 17, NUMBER 3, FALL 2002
173
needs of children with AS. Finally, we willpresent case studies demonstrating theapplication of sensory processing princi-ples.
Basic Characteristics of theSensory Systems
There are seven basic sensory systems within the nervous system: sound, touch, vision, taste, smell, movement, and body position. Myles, Tapscott Cook, Miller,Rinner, and Robbins (2000) provided asummary of the characteristics of thesesensory systems and their function inhuman beings (see Table 1). The visualand auditory systems provide informa-tion about the world, the touch and body position systems provide informationabout the person’s body, and the move-ment system provides information aboutthe interaction of the body in the world.The taste and smell systems provide amechanism for sustaining the organismby accessing information for obtainingfood, and for protection.The sensory systems provide the routefor the brain to receive information. Thefunction of the input mechanisms them-selves produce sensory acuity (e.g., whether the person’s eyes receive light,etc.). The brain is responsible for makingmeaning out of this information and fordesigning and implementing a response(i.e., processing). For children who have AS, the sensory input structures are usu-ally intact; the difficulty with sensory processing occurs as the child tries to usethat sensory input (i.e., process it) to re-spond to task and environmental de-mands.
A Model for SensoryProcessing
Dunn (1997) proposed a model forsensory processing that characterizes pat-terns of responding based on a per-son’s neurological thresholds and self-regulation strategies. Figure 1 summariz-es these relationships and provides basicinformation about the characteristics of each pattern of sensory processing. Theneurological threshold continuum movesfrom low to high thresholds, whereas thebehavioral response continuum movesfrom passive to active self-regulation stra-tegies. When these continua intersect,four basic patterns of sensory processingemerge, representing the anchor points of the continua.The neurological thresholds contin-uum represents the amount of input thenervous system requires before respond-ing. When a person has high thresholds,this means that it takes a lot of input forthe nervous system to take notice andthen generate a response. When a personhas low thresholds, this means that ittakes very little input for the nervous sys-tem to take notice, and lots of responsesare generated.The self-regulation continuum repre-sents the range of strategies a personmight use in responding to task and en- vironmental demands. A person who re-sorts to passive strategies has a tendency to let things happen; a person who usesactive strategies reveals a tendency togenerate responses to control input.The intersection of these continua cre-ates four basic patterns of sensory pro-cessing: low registration, sensation seek-ing, sensory sensitivity, and sensationavoiding. Low registration represents thecombination of high neurological thres-holds with a passive self-regulation strat-egy. Sensation seeking represents thecombination of high thresholds with anactive self-regulation strategy. Sensory sensitivity is the combination of low neu-rological thresholds with a passive self-regulation strategy, and sensation avoid-ing represents the combination of low neurological thresholds with an activeself-regulation strategy.
Low Registration
Children who have low registration pat-terns seem uninterested, self-absorbed,and sometimes dull in affect. They donot notice what is going on around themand miss cues that might guide their be-haviors. We hypothesize that most eventsin daily life do not contain a sufficientamount of intensity to meet these chil-dren’s thresholds; their passive strategieslead to their being somewhat oblivious toactivities. Some families report that theirchild does not respond to initial auditory information. For example, parents may be concerned about a hearing problembecause their child does not respond tohis or her name (Marks, Schrader, Ton-gaker, &Levine, 2000). Weimer, Schatz, Lincoln, Ballantyne,and Trauner (2001) reported a deficit inproprioception (sensory input from themuscles and joints) for children with AS, which may contribute to the characteris-tic of “clumsiness” cited by multiple au-thors (Attwood, 1998; Bonnet & Goa,1996; Gillberg, 1989; McKelvey, Lam-bert, Mottron, & Shevell, 1995; Tatum,1988; Wing, 1981). From a sensory pro-cessing point of view, these children may need a high amount of proprioceptiveinput to successfully participate in physi-cal activities. This would be achieved by adding weight to the child’s body or toobjects the child interacts with. For ex-ample, we might have the child weara weighted vest, or wrist and ankle weights, during specific activities. Theadded weight provides additional body sensory input so the child can be moreaware of body parts. Authors have alsoreported increased attention and de-creased fidgeting using weighted vestsfor children with autism and attention-deficit/hyperactive disorder (Fertel-Daly, Bedell, & Hinojosa, 2001; Van-denBerg, 2001; see Figure 2).
Sensation Seeking
Children who have sensation-seeking pat-terns are very active, continuously en-gaging, and excitable. They take pleasurefrom sensory experiences and so gener-ate additional sensory input for them-selves. We hypothesize that they are en-gaging in active strategies to increaseinput as a means to meet high thresholds.For children who have AS, sensationseeking may manifest as the need tomove about the environment, for exam-ple, pacing back and forth when othersremain seated.Peculiarities that others might classify as speech and language issues also have asensory-seeking quality. For example, thechild might overuse hand gestures or
 
174
TABLE 1
Location and Functions of the Sensory Systems
SystemLocationFunctionTactile
(touch)
 Vestibular
(balance)
Proprioception
(body awareness)
 Visual
(sight)
Auditory
(hearing)
Gustatory
(taste)
Olfactory
(smell)
Note.
From
Asperger Syndrome and Sensory Issues:Practical Solutions for Making Sense of the World,
by B. S.Myles, K. T. Cook, N. E. Miller, L.Rinner, andL. A. Robbins, (p. 5). Copyright 2000 by the Autism Asperger Publishing Company. Reprinted with permission.
Skin
—density of cell distribution varies throughoutthe body. Areas of greatest density include mouth,hands, and genitals.
Inner ear
—stimulated by head movements andinput from other senses, especially visual.
Muscles and joints
—activated by muscle contrac-tions and movement.
Retina of the eye
—stimulated by light.
Inner ear
—stimulated by air/sound waves.
Chemical receptors in the tongue
—closely en-twined with the olfactory (smell) system.
Chemical receptors in the nasal structure
—closelyassociated with the gustatory system.Provides information about the environment and ob- ject qualities (touch, pressure, texture, hard, soft,sharp, dull, heat, cold, pain).Provides information about where our body is inspace, and whether or not we or our surroundingsare moving. Tells about speed and direction of movement.Provides information about where a certain bodypart is and how it is moving.Provides information about objects and persons.Helps us define boundaries as we move throughtime and space.Provides information about sounds in the environ-ment (loud, soft, high, low, near, far).Provides information about different types of taste(sweet, sour, bitter, salty, spicy).Provides information about different types of smell(musty, acrid, putrid, flowery, pungent).

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