HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

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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 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) and Asperger’s 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.

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

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.

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.

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.

==> Parenting Children and Teens with High-Functioning Autism 


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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