In 1944 Hans Asperger, an Austrian physician, described a group of children with normal intelligence that had significant problems in social engagement, unusual and/or restricted interest, and an abnormally strong dislike for particular touch sensations (e.g., the feel of the texture of some clothes). These children could not tolerate the roughness of new clothes or of mended socks. Bathing and having their nails cut were also times of tantrums and stress.
Hans Asperger further mentions extreme sensitivity to noise, but at other times the children would also appear to be under responsive to auditory input. He describes an incident where a child appeared to have an unusual response to pain and was said to be “thrilled” when he obtained a wound needing medical attention. Alternately, this same child was described as fearful of falling out of his chair and of fast moving vehicles on the road.
The prevalence of motor problems in Aspergers children ranges from 50% to 85%. So, at least half of children diagnosed with Aspergers will have some form of motor problem. These problems can involve both fine motor tasks (involves skills of the hands) and gross motor tasks (activities such as walking, running, postural control etc.).
Although the defining characteristics of Aspergers are problems in social engagement and restricted interests, it is apparent that motor and sensory problems can also have a major impact on functioning. Poor motor skills may limit a youngster from engaging in the typical activities of his peers. His peers may also tease him because he is awkward or clumsy. Difficulty putting thoughts on paper because of physical problems with writing can make school work a nightmare. Aspergers kids may also use excessive or unusual motor behaviors to help provide sensory information that may make them feel more comfortable.
Sensory problems, particularly those related to auditory and tactile sensitivity, can also increase the social isolation of an Aspergers youngster. The young person may avoid groups and have difficulty in noisy environments (e.g., a birthday party). Rage or meltdown behaviors to sensory events that are overwhelming to the child can occur. These behaviors may be misinterpreted by parents as purely a lack of control – or a child who just “needs more discipline.” The youngster does needs to learn strategies to control rage and meltdown behaviors, but an understanding of the possible triggers for these behaviors and an appreciation for the extra effort he must exert to control himself can make discipline more efficient and effective for both the youngster and parent.
There are several steps necessary in an assessment of sensory motor problems in Aspergers kids. The overall assessment process will be different depending on the age of the child and whether he is assessed in a school, hospital or private facility.
The first step in an assessment procedure is identification of the presenting problem. Parents who suspect that their child has a problem are usually the ones who participate in this first step. Parents should trust their instincts if they think there is a problem. They should observe and then document their youngster’s behaviors. Documentation is recommended for both the problematic behaviors and the positive behaviors exhibited by the youngster. An easy chart can be used for this purpose. After completing the chart, the parent may be better equipped to notice patterns and describe problems when she is ready to make the referral to a trained professional in the field of sensory integration dysfunction.
If the process of documentation is not the chosen method to help with identification, the parent can directly discuss her concerns with trusted specialists and professionals (e.g., teachers, pediatricians, day care providers, etc.) who know her child well. The parent can also contact a local agency that employs pediatric occupational therapists to discuss problems and whether a referral for a sensory motor assessment is appropriate.
Once the problems are identified, parents have several choices. They can take the “wait and see” approach; however, this approach is not advisable if there is a probability that sensory motor problems get in the way of the child’s everyday activities – life may only get more difficult.
Some professionals suggest trying to improve the youngster’s “sensory diet” before doing an assessment. A sensory diet would involve adding sensory activities to the youngster’s daily routine in order to help him achieve a more optimal level of alertness and attention, as well as to reduce stress. Developing an effective sensory diet that specifically addresses problems might best be developed with assistance from an occupational therapist that has knowledge and experience with Aspergers, as well as an in-depth understanding of the youngster. Sensory diet programs are usually provided after the assessment of sensory motor problems is complete. A sensory diet should not be a replacement for direct intervention.
Examples of Sensory Diet Planning—
-Behavior: Hand flapping
-Sensory Explanation: Seeking heavy work to muscles and joints
-Sensory Diet Activity: Provide fiddle toys; perform chair or wall push-ups; wear a weighted vest or blanket
-Behavior: Visual Stimulation such as finger flicking in front of eyes; over-focusing on small toys; moving eyes in odd ways
-Sensory Explanation: Multi-sensory sensitivity; Decreased vestibular processing; Difficulties with visual perception
-Sensory Diet Activity: Provide strong, varied movement input; limit extraneous visual stimuli; Perform activities that couple vision with movement: i.e. targeting from a swing
-Behavior: Excessive mouthing and chewing on non-food objects
-Sensory Explanation: Decreased proprioceptive processing, especially to the mouth; Decreased tactile discrimination, especially in the mouth
-Sensory Diet Activity: Use resistive chewy toys that the person can chew on; Use a mini-massager to the mouth area; Provide chewy and crunchy foods; Try using strong flavors such as lemon, peppermint, and cinnamon
-Behavior: Rocking in chair or seat
-Sensory Explanation: Decreased vestibular processing; decreased proprioceptive processing; strong need for rhythm
-Sensory Diet Activity: Provide a therapy ball to sit on; Provide movement breaks throughout the day; Sing rhythmical songs while person is swinging or moving; Provide a move and sit cushion or wedge for the seat (found in therapy catalogues and stores).
-Behavior: Head banging and Ear flicking
-Sensory Explanation: Decreased vestibular and proprioceptive processing
-Sensory Diet Activity: Allow regular use of a therapy ball or mini-trampoline; Provide opportunities for strong movement throughout the day; Do chair/wall push-ups; Have client engage in activities that provide strong vestibular and proprioceptive input such as swimming, skiing, hiking, biking, sailing, swinging, rock climbing, etc.
-Behavior: Humming or other vocalizations
-Sensory Explanation: Decreased proprioceptive and vestibular processing; Decreased auditory processing
-Sensory Diet Activity: Mini-massager to mouth, face and ear; Blow toys such as whistles and bubbles; Wear a walkman with calming music
-Behavior: Smelling and sniffing
-Sensory Explanation: Decreased gustatory and olfactory processing
-Sensory Diet Activity: Provide strong flavors such as lemon, peppermint, and cinnamon
-Behavior: Spinning Self
-Sensory Explanation: Decreased vestibular processing (especially in the rotary plane)
-Sensory Diet Activity: Provide very strong rotary input on a sit and spin; vary the direction and speed of movement on swings; hold hands with person while they spin in circles
-Behavior: Complains about clothing, hair washing, finger nail cutting, and the texture of food
-Sensory Explanation: Tactile defensiveness
-Sensory Diet Activity: Provide deep touch pressure to the whole body through wrapping the person tightly in a sheet or blanket; engaging in a therapeutic brushing program (monitored in direct intervention); give squeezes in between pillows; cut tags out of clothes; buy seamless socks; stick to all-cotton fabrics; give strong touch input to shoulders when giving a haircut or cutting nails; lotion massages
-Behavior: Poor eye contact
-Sensory Explanation: Visual defensiveness or sensitivity
-Sensory Diet Activity: Reduce extraneous visual stimuli; Allow person to finish talking or listening before making eye contact; show person pictures of people that will be at a party or event ahead of time if possible to help them become acquainted with a variety of faces; provide strong vestibular input and encourage interaction during the movement
-Behavior: Difficulty maintaining personal space
-Sensory Explanation: Decreased proprioceptive and vestibular processing
-Sensory Diet Activity: Provide a cushion or carpet square that delineates the person’s space; have person stand at the end of the line in school; Provide strong all-over-body proprioceptive input; Provide strong movement input on swings, sit and spin, ziplines, etc.
-Behavior: Voice volume is either too high or too low
-Sensory Explanation: Decreased auditory processing
-Sensory Diet Activity: Tape record the person’s voice to give them feedback regarding volume; provide blow toys such as whistles and bubbles; listen to rhythmical, calming music over headphones
-Behavior: Irrational fear of heights; strong aversion to movement; car-sickness
-Sensory Explanation: Decreased visual and vestibular processing
-Sensory Diet Activity: Provide chewy foods or candies in the car; Lemon drops and ginger snaps can help nausea; Provide a safe place for the person to try climbing or moving without other people present; couple vestibular activities with heavy work and stay in close proximity to person while they are moving
Once it’s clear that the problem is likely a sensory and/or motor problem, it’s important to refer to an occupational therapist to complete the screening and/or assessment. Possible sources for locating a specialist include:
• American Occupational Therapy Association
• occupational therapists in early intervention or public schools
• occupational therapy department of the local children’s hospital
• private practitioners listed in the telephone directory
Poor Sensory Processing in Aspergers Children—
When the child has a “low arousal” level, the nervous system has a decreased reaction to the sensory input coming in and therefore doesn’t react or respond as quickly, or at all, to the input. Children with low arousal level find it hard to remain alert and focused, tend to seek out a lot of input in order to better register and respond to it. They may be hard to motivate and get moving, or may be in perpetual motion.
Children with a “high arousal” level often respond to sensory stimuli with a strong response, frequently a fight/flight/fright response. They may flee from sensory input and seek a smaller, quieter space to get away from too much input, or they might scream in fright when confronted with too much sensory input.
Sometimes Aspergers children become aggressive when dealing with an overabundance of sensory stimuli and strike out against the person or object producing the input. They also may have a hard time remaining focused or calm in busier environments (e.g., grocery store, mall, social gathering, school cafeteria, etc.).
We all have peaks and valleys in our arousal levels throughout the day. However most of us manage to maintain an appropriate level of arousal to interact effectively with the environment. Aspergers children have difficulty maintaining an appropriate level of arousal, spend more time in a high or low level of arousal, and may constantly seek or avoid input to try and regulate arousal.
The following list shows some of the behaviors that Aspergers children may exhibit due to decreased ability to modulate and discriminate various sensory input. There are both “sensory seeking” and “sensory avoiding” behaviors depending on the issues. For example, one youngster might seek out messy play as a way to keep his system alert and to learn new skills, while another youngster may avoid messy play at all costs because he is “defensive” to tactile input (i.e., the child has an emotional or behavioral response to a stimulus that is out of proportion to the stimulus itself). These two examples describe tactile dysfunction; however, they are representative of two different types of dysfunction:
1. A child with “sensory defensiveness” exhibits the avoidance behaviors listed below. This child’s sensory input feels excessive to the child (e.g., sounds are too loud; smells are too strong; lights are too bright, etc.).
2. A child with “sensory aggressiveness” exhibits the seeking behaviors listed below. This child’s sensory input feels barely detectable to the child (e.g., sounds are too quiet; lights are too dim; tastes are too bland, etc.).
1. Auditory—
Seeking Behaviors:
- Oblivious to loud noises
- Seeks out loud music or noises
Avoiding Behaviors:
- Covers ears around loud noises such as toilets flushing, sirens, music, vacuum, etc.
- Displays sensitivity to high-pitched noises
- Distracted by subtle background noises such as the hum of fluorescent lights or the refrigerator
- Easily distracted by noise
- Grinds teeth or hums especially in busy or noisy environments
- Pulls at ears even though no ear infection
2. Gustatory/Olfactory—
Seeking Behaviors:
- Licks everything
- Seeks out very spicy or very sour foods
- Smells everything
Avoiding Behaviors:
- Avoids any new foods with new colors, textures, or tastes
- Avoids foods with mixed textures – such as smooth foods with lumps
- Displays a very strong preference for temperature of food or drink
- Has a very limited diet
- Prefers only crunchy foods
- Reacts defensively to food in mouth – especially with certain textures
- Reacts defensively to the smell of certain substances
3. Proprioceptive—
Seeking Behaviors:
- Crashes constantly onto ground
- Enjoys activities that provide heavy work such as hanging, pushing, pulling
- Likes to squeeze objects
- May flap hands a lot, crack knuckles, press hands together, or otherwise stimulate self
- May masturbate frequently
- Seeks out a lot of rough and tumble play
Avoiding Behaviors:
People do not generally avoid proprioceptive input as it tends to be an overall “organizing" or pleasing input to the sensory system.
4. Tactile—
Seeking Behaviors:
- Constantly poking, pushing, or touching other people
- Constantly touching or mouthing non-food objects
- Oblivious to food on hands or around face
- Oblivious to injuries to self such as bruises
- Seeks out messy play
Avoiding Behaviors:
- Adverse reaction to light touch experiences
- Aggressive with other people
- Avoids busy places
- Exhibits picky eating habits
- May dislike or avoid many daily hygiene activities such as tooth brushing, washing, and dressing
5. Vestibular—
Seeking Behaviors:
- Constantly in motion
- Jumps much of the time on beds or other surfaces
- Loves being tipped upside down
- Loves go-fast carnival or amusement park rides
- Loves swinging and finds it hard to stop
- Spins self around a lot
Avoiding Behaviors:
- Avoids swings or playground equipment
- Does not like the feeling of falling or doing forward rolls
- Does not like to have head tipped backward
- Fear of heights, elevators, and escalators
- Fear of lifting feet off of the ground
- Gets carsick easily
6. Visual—
Seeking Behaviors:
- Hyperfocuses on Visual input
- Very drawn to certain colors
- Very drawn to television
- Visually stimulates on objects such as lights, patterns, etc
Avoiding Behaviors:
- Blinks at bright lights or appears sensitive to sunlight
- Easily distracted by visual input
- Makes poor eye contact
- Prefers to play in the dark
- Rubs eyes often
- Squints when doing puzzles or other highly visual tasks
Aspergers children have a whole host of needs – and sensory integration is only one of the many intervention approaches that can benefit these children. They often require other interventions as well including:
• academic assistance
• behavioral therapy
• psychological and neuropsychological intervention
• social skill building
• speech and language therapy
• vision therapy
It is important that parents, teachers, therapists and doctors work together as a team to improve the lives of Aspergers children. Intervention ideas and activities can be shared and reinforced. The child and his family are the most important and vital part of intervention.
