Overview of Sensory Integration

for Autism Spectrum Disorders

01.04.2021
Autism Spectrum Disorder
 What is Autism?
Autism Spectrum Disorder is a neuro developmental condition in which the child
exhibits delayed or deviant development in the following areas-

1. Human social interaction (Deficits in social-emotional reciprocity)

2. Nonverbal and verbal communication used for social interaction
3. Deficits in developing, maintaining and understanding relationships
4. Restrictive, repetitive patterns of behavior, interests or activities
5. Sensory Integration
What is Development
 Milestone

 Delay

 Deviancy

 Neuro regression
Delay vs Deviancy
Which is more sinister?
Why is early intervention essential?

Development:
Neurotypical

Achievement
of
Skills } Development:
Atypical

}
Age
Myths about Autism

 Autism is speech disorder –

Do not focus exclusively on speech development, focus on social development
first

 Autism starts after 2 years of age –

It starts right from birth, be watchful

 The only problem is that my baby doesn’t speak, its not like he doesn’t
understand – hence it can not be autism –
look carefully for signs, meaningful and purposeful
To summarize

 Autism is
1. Not a speech problem
2. Starts early after birth
3. Intervention should start as early as possible
4. Autism requires interdisciplinary treatment approach
5. Vaccination do not cause Autism
Sensory Integration and Autism
 Most children with Autism exhibit sensory concerns referred to as sensory
integration disorders in ASD.

 Sometimes one or more senses are either over- or under-reactive to

stimulation.

 Such sensory problems may be the underlying reason for behaviors as rocking,
spinning, and hand-flapping.

 It occurs frequently enough for it to be included as part of the diagnostic

criteria in the DSM-5.
What is sensory Integration
 It is a process of organizing sensations from the environment for use in our
everyday life.
 Sensations are used for
Survival, learning and functioning smoothly in daily life
Sensory Integration Loop
Sensory
Input
Stimuli

Feedback/Previous
CNS integration
Experiences

Adaptive
Output
response
Fundamentals of SI
 First identified by Anna Jean Ayres (1920-1988)
 Discovered that children had a neural disorder resulting in inefficient
organization of sensory input received by nervous system
 She also developed diagnostic tools for identifying the disorder and proposed
therapeutic approach
Tactile System
 The tactile system includes nerves under the skin’s surface that send
information to the brain.
 This information includes light touch, pain, temperature, and pressure.
 These play an important role in perceiving the environment as well as
protective reactions for survival.
 A dysfunctional tactile system may lead to Tactile
a misperception of touch and/or pain Dysfunction
(hyper- or hypo-sensitive ) and may lead to
self-imposed isolation, general irritability, Hyper-
sensitivity
distractibility, and hyperactivity.

Hypo- Poor tactile

sensitivity discrimination
Hyper-sensitivity
 Withdraws from being touched
 Refuses to eat certain ‘textured’ foods
 Refuses to wear certain types of clothing
 Complains about having one’s hair or face washed
 Avoids getting one’s hands dirty (i.e., glue, sand, mud, finger-paint)
 Uses one’s fingertips rather than whole hands to manipulate objects
Hypo-sensitivity

 Touch people and objects constantly

 Seems unaware of touch unless it is intense
 Physically hurt other people not comprehending the pain
Poor Tactile Discrimination
 Unable to identify what body parts have been touched
 Unable to identify familiar objects solely through touch
 Sit on edge of the chair etc.
Proprioceptive System
The proprioceptive system refers to components of muscles, joints, and tendons
that provide a person with a subconscious awareness of body position.

Some common signs of proprioceptive dysfunction are:

 clumsiness
 a tendency to fall
 a lack of awareness of body position in space
 odd body posturing
 minimal crawling when young
 difficulty manipulating small objects (buttons, snaps)
 eating in a sloppy manner
 resistance to new motor movement activities
Activities
Vestibular System
 The vestibular system refers to structures within the inner ear (the semi-
circular canals) that detect movement and changes in the position of the
head.
 Controls balance, co-ordination and maintain muscle tone.

Vestibular
Dysfunction

Over Under
responsive responsive
Over responsive – Avoiding behavior

 Over responsive children have fearful reactions to ordinary movement

activities (e.g., swings, slides, ramps, inclines).
 They may also have trouble learning to climb or descend stairs or hills; and
they may be apprehensive walking or crawling on uneven or unstable
surfaces.
 As a result, they seem fearful in space.

 They appear anxious when feet leave the ground

 Become disoriented after bending over
 Avoid playground equipment
Under responsive – Seeking behavior

 The child may actively seek very intense sensory experiences such as
excessive body whirling, jumping, and/or spinning.
 This type of child demonstrates signs of a hypo-reactive vestibular system;
that is, they are trying continuously to stimulate their vestibular systems.

 Constantly wanting to experience movement

 Seems floppy
 Likes movement related equipment like swings, slides, car or bike rides
 Spinning, climbing, running is observed
Activities
Activities
Principles of Intervention
 Maintaining optimum levels of senses
 Controlled input, active participation, eliciting ‘ just right challenge’

 Play based intervention is safe and sensory rich environment

 Balance between structure and freedom to get an adaptive response

 Focus on functional outcome (goal directed inputs)

Providing Sensory diet
 All individuals require a certain quality and quantity of sensory experiences to
be skillful, adaptive and organized in everyday life. (Wilbarger,1995)

 Individualized controlled sensory input help to attain and maintain

appropriate arousal states throughout the day and positively impact
functional abilities by
- Reducing self stimulation and helping the child to get better regulated

 It is a diet protocol that needs to be in sync with the child and family’s goals,
resources, limitations and priorities.
Examples
 A sensory diet should be a balance between calming, organizing and aleting
activities.
 Calming: resistive work, firm touch, gentle swinging, swimming, water play
 Alerting activities: we need to be careful because child may have hard time
calming down Fast music, bright lights, lots of movement, fast swinging in
different directions etc.
 Organizing activities to bring the child back to the ‘just right’ level
Proprioceptive based activities like stretches, resistive work, deep pressure are
organizing and help reducing challenging behavior

 Help parents to analyze the child’s good day

Why do you think it was?
What worked – activities, diet, events?
Take home Message
 Every child with autism has different abilities and needs
 Early diagnosis and intervention is crucial
 Detailed evaluation is required to formulate a goal oriented, individualized
intervention plan by interdisciplinary team
 Parents are integral part of the child’s development

 Sensory demands of the child needs to be assessed in detailed

 Sensory diet has to be planned for therapy session as well as for the home
environment and school setting.
 Co-ordination with parents and teachers at school is essential.
Questions….