behaviour needs of individuals with ASC: suggestions for supportive interventions.

Dr. Wendy Lawson Cpsychol

2013

What to expect from this talkWhat to expect from this talk

An insight into some of the difficulties those of us with ASC have

Sensory issuesCommunication issuesThinking/processing issuesStrategies/interventions that

might help

CHANGE Change, change and more change, Of context, place and time. Why is it that Life’s transient stage Plays such havoc with my mind?  You said, “We’ll go to McDonald’s” But this was just a thought. I was set for hours, But the plan then came to naught.  My tears and confused frustration, At plans that do not appear, Are painful beyond recognition, And push me deeper into fear. 

How can life be so determined? How can change be so complete?With continuity there is no end,Security and trust are sweet. So, who said that change would not hurt me?Who said my ‘being’ could not be safe?    

CHANGE

CHANGE

Change said, “You need continuity”In order to find your place. For change makes all things different,They no longer are the same.What was it that you really meant?All I feel is the pain.

Cognitive differencesCognitive differencesNancy Minshew and others

have demonstrated our brains are ‘wired up’ differently to typical individuals.

“The way people with autism think forms the basis for their behavior” (June 2003).

FOR MORE INFO...

Google current research on ‘brain and autism’. Local autism support groups. Email Wendy: lawson_wendy@hotmail.com

Cognitive differencesCognitive differences

scientists examined brain tissue . They focused on structures within the

brain known as cell minicolumns which play an important role in the way the brain takes in information and responds to it.

the minicolumns of autistic individuals were found to be significantly smaller, but there were many more of them.

Dr Casanova said the increased amount of cell minicolumns could mean a constant state of overarousal. (January, 2004)

Increased Number of Minicolumns in Autism

Casanova et al., 2006

Memories are built from connectionMemories are built from connection

As chemicals flow in and between Synapses information is exchanged.

The neurons present in the brain that connect the sensory and the motor neurons.

Uni-sensory & Multi-sensory connections allow for different concepts/experiences/memories and will lead to different behavioural outcomes.

GAMMAGAMMA

Excess GAMMA in ASC Anchored GAMMA in NT

Sensory ConnectionsSensory Connections

Neuro-feedbackNeuro-feedback

+----------------------------------------------------

_ATTENTION______________

Highly focused Interests take precedence

Multiple diffuse interests

ASC NT

otherinterest

attention

Cognitive differencesCognitive differencesautism is a system-wide brain difference

that limits the coordination and integration among brain areas. This is the paradox of autism: Some people with autism have normal or even superior skills in some areas, while many other types of thinking are disconnected. The team's study is published in the August (2004) edition of the British journal Brain and is available online at www.brain.oupjournals.org.

ImplicationsImplications–Cognition (being single minded )

impacts upon:–Sensory experience–Leads to uneven ability–Interferes with the gaining of

concepts–Complicates understanding of self –And understanding of ‘other’

Background to behaviourBackground to behaviourBefore considering practical

interventions we need to understand:What does the behaviour achieve?

– Gets wants/needs met? Is the behaviour the problem?

– Sensory/physical/Environment?Is there something else we need to

change:– Ourselves; our demands; the

environment or situation…

Brain connectionBrain connectionIf we operate one sense at any one

time: Integration Issues may lead to system

dysphoria (some studies show genetic link to autism & gut issues)

Possibly connections in autism and the GI Tract - 'Sensitivity' Issues to food, Taste, smell = Pain

Brain Gut ConnectionBrain Gut ConnectionPainful Stimulus -> Magnification

of message (Pain makes associations louder).There is a magnification of the pain message. This magnification is an 'increase in sensitivity‘, explained as the system over-reacting.

Brain Gut ConnectionBrain Gut ConnectionE.g. After a painful event, a much

smaller event might cause a painful reaction that is out of proportion to the actual event.

If the first event or two was eating crunchy food causing tummy cramps and gagging, future events cause same response, sometimes by sensation and/or association.

Brain Gut ConnectionBrain Gut ConnectionAfterwards, a small amount of

crunchy food, may cause the same huge cramping and gagging. seen in child who gags on anything cold, chewy, or crunchy etc...no matter how small an amount the system has the 'pain memory' and reacts inappropriately. The reaction can be triggered by smells, sights, textures, temperatures, even sounds.

Sensory IntegrationSensory IntegrationThe sense/pain become one, even

though the 'Non-painful' stimulus is not a problem in itself… but is the trigger -> Magnified sensation to an extreme and unpleasant level...(PAIN)(Note: The point here is that there is a real physical event that results in another physical event that may be painful or at least uncomfortable. The person is reacting appropriately to the physical event as they feel it).

Brain ConnectionBrain ConnectionIt is the sensory response system

that is acting inappropriately. It is definitely not just bad behaviour or an attempt for attention. Unfortunately, children and especially someone with a communication impairment, is not able to accurately express this in usual ways.

Brain ConnectionBrain Connection

Often it takes the form of poor behaviour, 'over-reacting' to what others around them perceive as a little thing, stimming, tantrums, or other behaviours.

Brain ConnectionBrain ConnectionEg: light tough causing a

person to jerk away their arm like it had been hit. The nerves are responding inappropriately. Something like the brushing technique helps because it re-trains the nerve response.

ReRetraining?training?

This can produce very good results in working with autism. ‘Moulding' and re-training the nerves is a foundation of many of the therapies/conditions housing a number of interventions.

Food AllergyFood Allergymultiple neurological problems in

children with food allergy including anxiety, behavioural abnormality, and even psychosis which have been reported as being resolved with food restriction.- Incidence of food allergy is cited at 8% in general paediatrics, best small study in ASC states 36% incidence

Causes ASC?Causes ASC?No evidence that any gut problems

CAUSE autism conditions (but shared genetic codes). Although correcting the gut problems will not cure autism, being in discomfort would likely make symptoms much worse. Treat these problems and the person with autism will feel better and have a better quality of life

Dr. Lucy Miller Star InstituteDr. Lucy Miller Star InstituteSensory diet or sensory lifestyle?Play forms the basis for all sensory

and relational shared interaction.Children jumping on a trampoline,

riding their bikes, playing with water, sand, bubbles & so on.. All help to connect our senses.

Hypo or Hyper?Hypo or Hyper?Reactions to things seen, touched,

heard or movement can either be too much or too little:

Auditory hypersensitivity results in tantrums or the covering of ears when certain sounds are heard; Auditory hyposensitivity seems like selective hearing and there is often concern of hearing loss

Visual SystemVisual Systemwe use to ‘see’ the world around us.Some of us find this sense

uncomfortable, so we might try to interfere with it (look out the sides of our eyes; look through gaps in our fingers; look upside down; sideways) to make it less uncomfortable, or we might try to block it out all together (fingers in front of eyes; hide beneath material).

Visual SenseVisual Sense

Visual detail scrutiny occurs when a specific object or group of objects, are chosen to be visually inspected repeatedly (i.e. shiny leaves, wiggling string, corners etc)

DescriptionDescriptionVision allows too much information

‘in’ we feel over whelmedVision lets in pieces of disconnected

informationVision allows information through

which appears non-sensical Vision mixes inappropriately with

other senses and distorts information causing us to see in patterns or misrepresenting what’s ‘there’; giving rise to sudden ‘seeing’ or seeing after event has passed.

Scotopic SensitivityScotopic SensitivityApprox 70% of information is

accommodated visually. visual perceptual problems may

not be identified via traditional eye tests.

If discovered, may be remedied by the use of tinted lenses (Irlen lenses).

Vision Therapy (specific eye exercises) often very helpful

Sensitive visionSensitive vision..Some autistic individuals can

see the flicker of florescent lights. (Lawson, 2001) Coleman et al. (1976) found that florescent lights increased repetitive behavior in some children with autism.

FOR MORE INFO...

Wendy’s books; Temple Grandin’s story; Donna Williams and other personal accounts. Literature on Sensory dysfunction & Autism.

Outcomes of visual discomfort Outcomes of visual discomfort eye contact avoidance, blackboard visual

avoidance, poor and uneven handwriting, inability to listen and look simultaneously, over use of peripheral vision, a stiff-legged walk and poking at the sides of the eyes (Audrey Adams).

Picky eaters- choosey about appearance of food on plate;

Seems to ‘scan’ environment & itemsVisual processing difficulties (Jackie

Jackson, 2005)

ResourcesResourcesTrained OT.ShadesIrlen Lenses Educational Optomotrist

/exercises?Understanding FamilySupportive School environmentReducing visual over load

ProceduresProceduresDo all sensory therapies FIRST and

THEN behavioural therapies and interventions.

Check physical health, please don’t assume child is attention seeking or trying to avoid tasks for avoidance sakes.

Read sensational Kids (Lucy Jane Miller)

Educate, accommodate, facilitate!

things that might help things that might help To improve visual discomfort:Use natural lighting, not fluorescentUse colored over lays or Irlen lensesEmploy visual activities (exercises)

– Hand to eye coordination; catching of balls; following finger to and from nose; walking along straight lines whilst eyes looking at a fixed point; fixing on and off of spinning objects; counting objects; specific program put together by developmental optometrist or occupational therapist.

Tactile sense (touch)Tactile sense (touch)

Tactile detail scrutiny occurs when there is a fixation on the tactile qualities of an object (i.e.. The smooth silk on the blanket)

StrategiesStrategiesSlowly, increase contact with

tactile discrepancies. For example: brush arms gently; pull soft material across the individuals body; Try clothing on, take off again. Aim is to increase tactile coping and decrease tactile defensiveness.

Peca (everything goes into mouth)Peca (everything goes into mouth)Taste sensory stimulation occurs

when things are put in the mouth but not eaten (i.e.. gravel, twigs, leaves)

Some children require more sensory legitimate ‘play’ with things like dough, to help with this. Other’s need pictorial support for what is allowed in the mouth and what is not. Often both are needed.

Smell and movementSmell and movementSmell fixations occur when

objects are smelled as a way of exploring them

Movement over reactivity occurs when there is a strong like or dislike to experiencing movement (i.e.. swinging, jumping)

FragranceFragranceSome fragrances are

experienced as over whelming so we need to desensitize the individual as much as possible.

Other fragrances are experienced as under stimulating, and the individual wants much more of these. We can work on this too.

Role of AttentionRole of AttentionWhat we know about ASC is

that we use single attentionIf attention all in one place

then sensory issues will take precedence when they exist

I won’t have spare attention for learning,

My senses are occupied!

Free up attentionFree up attentionAttention can be ‘freed up’ as

we attend to the sensory profile of the individual and deal with the difficulties:

SocialEnvironmentalPhysical

SocialSocialLess demandBuild conceptsCreate fellow feeling and

value via shared interestUse stimuli reduced teaching

aids:Computer- IT

EnvironmentalEnvironmentalCheck lighting for

appropriatenessFloor coveringsFurniture – crowdingPeople factorTextureColorStructure

PhysicalPhysicalCheck healthCheck for food allergyMetals in the blood streamClothingBrain gut connectionsMuscle tone

Physical ActivityPhysical ActivityHand stretchingLeaning forward to assist

with concentrationOpen them close them….Relax Sucking thro a strawsoft brush to skin

ResourcesResources

www.wendylawson.comBooks dealing with sensory

issuesPublished by Jessica Kingsley:www.jkp.comWendy’s books