Following the series of articles dedicated to Family Conduct Tips we come to the first trigger. Many boys and girls with communication disorders also have Sensory Integration Disorders (SPD). What does this mean? That they don't respond to the world the way most people do. Some may register few stimuli or need many to be activated. Others will present hypersensitivity to the slightest variation of these stimuli. This can occur in one or more sensory modalities such as touch, smell, hearing and everything related to the Proprioceptive, kinesthetic and vestibular body. We will treat each of these modalities as unique later due to the importance they have. Now we will give some generalities to get into the matter later.

That is also why we are surprised that families are surprised by totally unexpected reactions to music, to a caress, to dressing them, to some foods, to cleaning them... Some moments end up being pitched battles, with screams, tantrums and cries with the respective anguish of the child. child and the frustration of his parents and this is where the cause is in everything related to these sensory integration processes

Sensory Processing Disorder (SPD) in autism impacts the person in various ways. Knowing how to identify the signs of SPD will help us prepare a better intervention, reduce stereotypies, problematic behaviors and we will be able to improve the quality of life of the person and all the people around them.

Very frequently this TPS is the cause of learning, behavior and motor coordination problems in children. It can affect social relationships, the development of play patterns, care skills and personal autonomy, and communication.

What is Sensory Processing Disorder?

Dr. Jean Ayres, an American occupational therapist, was the first to describe a set of atypical behaviors related to poor sensory processing. Who in 1972 defined sensory integration as “ the organization of sensory information for use.” It is a neurological process that allows us to make sense of our world, by receiving, registering, modulating, organizing and interpreting the information that reaches our brain from our senses. Ayres was based on the hypothesis that some children have a deficit in sensory integration that manifests in the difficulties observed in intentional behavior. This dysfunction in sensory integration may explain why some children have problems learning new skills, self-organizing, regulating their attention, participating in activities and games at school, or in positive social experiences . Ayres, and many who have followed his theory, have worked to establish the validity of this theory through research in clinical and basic sciences.

SPD is a complex brain disorder that affects the way sensations (sight, sound, touch, smell, taste, and movement) are experienced and their organization within behavior. TPS can affect one or more senses (sight, taste, touch, smell, hearing, proprioception and/or vestibular sense/balance). Some children with this disorder feel bombarded by sensory information and avoid it . Others, on the contrary, seem to be unaware of the stimuli that surround them and appear indifferent. Sensory processing is a term used primarily by occupational therapists to describe children who have trouble integrating different types of sensory information, such as sights, sounds, tastes, and smells.

In simple words, it is a lack of synchronization and/or regulation of the different senses, either individually or together . So sensory information is not processed adequately and the interactions between the different senses are altered. This means that, whether due to excess or defect, the information is not processed properly and the response is therefore incorrect. According to some studies (1,2), it is estimated that between 60 and 95% of people with autism have SPD, which is also present in a multitude of development, communication and socialization difficulties.

We can divide sensory problems into the following groups:

1. Auditory: Hypersensitivity to sounds, for example.
2. Visual: 80% of the stimuli we receive have a visual origin. Today we know that the asynchrony between vision and hearing (for example) in autism is common. Also aspects related to spatial location or aspects related to focal vision.
3. Tactile: They do not allow themselves to be touched or hugged or have exaggerated reactions to certain textures.
4. Olfactory : Certain everyday smells cause strong rejection.
5. Gustatory: Problems reacting appropriately to everyday flavors, or looking for strong or spicy flavors.
6. Vestibular: For example, performing a swing to improve balance.
7. Proprioceptive: Problems with spatial location, motor skills or even synesthesia .

We can find hypersensitivity or hyposensitivity, and even a mixed response. For example, hypersensitivity to sounds is very common, but there are cases where there is hypersensitivity to certain sounds and hyposensitivity to other different frequencies. This mixed response is, on some occasions, somewhat more complex to detect, but adequate observation of the responses to the stimuli can give us more than enough indicators.

How does sensory disorder impact?

The postulate that autism and other associated disorders have a highly impactful sensory disorder is gaining more and more strength. Since the most affected areas are strongly related to aspects linked to sensory processing. A greater impact on sensory disorder is usually associated with the severity of the disorders. Today we know that this does not always have to be the case, although the impact will obviously condition many of the child's responses. Yes, we can see that the greater the number and intensity of the senses affected, the greater the difficulties of the girl or boy, but that does not mean that these aspects cannot be addressed and, with adequate intervention, eliminated or attenuated.

Communication and language are one of the most quickly detectable aspects, along with behavior and low social interaction. Curiously, language is sensory and motor, and in autism the reception and processing of the visual and auditory stimuli of language are not processed adequately . Children who cover their ears for a certain sound, those who have anxiety processes when faced with changes in clothing or environment, to give just a couple of examples. These types of situations generate states of anxiety in the child , which, added to the communication problems, lead to a very complex and generally problematic behavioral situation. A significant percentage of behavioral problems have their origin in these sensory aspects and, in many cases, they can be a trigger.

Regarding motor skills, both fine and gross, the topic of the motor clumsy boy or girl is also common. The kind of kid who trips over a pencil line painted on the floor. To this we can also add muscle hypotonia. And we have a child who is generally bad at a motor and coordination level. And here again we have sensory aspects. Vision is one of the big problems in sensory disorders, and certainly little known and little treated.

In turn, many stereotypies have a strong sensory component, they are used as a stabilizer or regulator, in some cases to control hyperstimuli , in others, such as swings , to improve spatial or body sensation. Walking on tiptoe is another stereotype that has a lot of sensory aspects, from visual to vestibular aspects. And in the vestibular area we can also see how children who are hypersensitive to vestibular stimuli will present behaviors of fear towards playgrounds , they will have problems going down stairs or they will always do so holding on to the railings or holding someone's hand. And on the opposite side will be those with vestibular hyposensitivity, and they will seek a high level of arousal by all means, such as turning around on themselves, some of them with kamikaze -type behaviors .

Carrying out an adequate evaluation is important to be able to know what and how to intervene, as well as to properly measure the impact of this problem on proprioception.

We have seen how the sensory aspects cover a large number of interactions, and therefore, when they are altered, the problems that are generated can lead to the development of other problems. It is important to note that mixed reactivity , where the child can have a hypo response to some things and a hyper response to others, can also present fluctuations; That is, on certain occasions, the child responds to a stimulus differently depending on the situation . Sometimes you may not know how to integrate the whole of a situation, and may only be able to identify parts, which will also create confusion. In situations where the child has sensory overload , they may perceive their environment and sensations in a distorted way, there is nothing better than getting a “time out” so that they can regulate themselves.

As always, the advice of professionals with accredited training is always important . Sensory disorders may require specific, person-based interventions; what works for one person may not work for another.

Movement is a medicine, to create physical, emotional and mental change. (C. Welch)

What activities can we work from home?

• Bounces on the Pilates ball , both sitting and standing. Sing a song, that always helps to measure time, and if they want to continue bouncing they just have to ask appropriately. With the ball you can work on trunk control and postural adjustments while sitting; It can be used to add an object such as small colored balls and while it bounces, it picks it up and puts it in a box (it works on attention, inhibition of stimuli and eye-manual control).
• Pull the sheet . The seated child has to adapt his body to the different postural changes. You can take it down the hallway or dining room until you take it to the sofa or mat.
• Mat or mattress . Take advantage of that soft surface to crush every part of their body with the ball or pillows, make them fight to try to get out of there, make them use force (do not press excessively hard).
• Raise and lower objects (chair, sofa, bed...); also let them pass under them dragging their body. All of this will help work on proprioception and body awareness.
• In the Hammock you can work, apart from linear movement and relaxation, attention and eye-manual control. The airplane position is also very useful to work on vestibular stimulation inside the hammock: with the little arms facing outwards, pass him a rope and have him pull forward, also working on the scapular muscles, grip strength and bilaterality.
• With the scooter , stand on your belly and move with both hands forward to work on bilaterality, strength in the upper limbs and coordination of both limbs. You can also place a rope and have the child pull forward from the scooter.
• The roller is an object that can also be added to the circuit; The child can be placed on his stomach and moved forward and backward, propelling himself with his feet and hands in a pronated position. Likewise, you can place different textures on the parts of the hands and in that position look for different objects. This will also help tone the scapular muscles. The roll can also be used sitting as if it were a horse and moving it with both feet to the right and left. This will help work bilaterality and balance.
• You can use the lights as a way to relax in the calm corner, as a game: “I hide them and once you finish the circuit you have to look for them” or as a way to initiate communication and joint attention.
• The vibration is a rather calming object. You can pass the stimulus throughout the body and have it say the name of each part. Also to relax with the ball bouncing.
• Weight bags can also be used for relaxation. While the child is in the hammock or lying on the mat, they can be placed on top of the child's body to apply deep pressure. Also to play fetch or throw them in a bucket by exerting finger-palm strength.

They are always games that motivate the child ; Never force, since that is where the neural work is most effective. Let the child choose what he wants to play with and how. Help them develop not only initiative in functional play and problem solving, but also in the ideation, planning and autonomous execution of an activity. This will then translate into the environment around you. They must be adapted to their abilities , neither easier nor more difficult, with small challenges that they have to achieve. It always helps to create stories that motivate children to play games and achieve sensory regulation.

Don't miss the following article where we will talk specifically about Communication and Language Problems as the second cause of behavioral problems in children with developmental difficulties!

Text adapted by Cristina Oroz Bajo

Sources: Recenit and Autismo Diario