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Sensory Differences
Research Digest
Do we have sensory profiles of all students?
Apupil’ssensoryprofilewouldbeputtogetherbyamemberoftheOccupationalTherapyteam
alongsidestaffwhoworkwiththatpupil.Inputfromparentswillalsobesought.Notallpupilswill
haveasensoryprofile,onlythosewho,basedontheprofessionaljudgementofthestaffand
therapyteam,mightrequiresupportoverandabovethatwhichisprovidedtosupportthesensory
needsofallourpupils.Thisbaselinelevelofsensorysupportisinplaceasweknowthatallofour
pupils,tovaryingdegrees,experiencedifferencesinthewaytheyreceiveandmanagesensoryinput.
Thisweekwewilllookatsensorydifferencesandtheirimpact(thiswillbeatwoparter!).
Sensorydifferences
Therelationshipbetweendifferencesanddifficultiesinprocessingandintegratingsensory
informationandautismiswellestablishedinboththeresearchliterature(Ben-Sassonetal.2008;
Minshew,Sweeney,&Luna2002;Rogers,Hepburn,&Wehner,2003;Rogers&Ozonoff2005)and
first-handaccounts(e.g.Grandin,2006;Higashida,2013;Kirby,Dickie&Baranek,2015;Williams,
1992;1994).Sensoryfeaturesarealsonowincludedinthediagnosticcriteriaforautism(American
PsychiatricAssociation,APA,2013).Specifically,‘‘hyper-orhypo-reactivitytosensoryinputor
unusualinterestinsensoryaspectsoftheenvironment’’qualifiesasoneoffoursub-criteria(two
sub-criteriaarerequired)inthe‘restricted,repetitivepatternsofbehavior,interests,oractivities’
diagnosticdimension(CriteriaB)oftheDSM-5(APA,2013).However,thetypesofsensory
difficultiesexperiencedareoftenhighlyidiosyncratictoeachindividual(Ausderauetal.,2014Lane,
Molloy,&Bishop,2014).
AsinmanyotherareastherehasbeenlessworkonexaminingsensorydifferencesinPMLD,partly
becauseourPMLDstudentsdifferfromeachothertoanevengreaterextentthanourautisticpupils.
Wedoknow,however,thatthesensoryworldexperiencedbyourPMLDpupilscanalsobemoreor
lessintensethanneurotypicalpupilsoftenasaresultofspecificsensoryimpairmentsandthe
resultantdifferenceinperceptioninothersensorysystems(soundforexampleinthosepupilswho
arevisuallyimpaired)(Gougoux,etal.,2005).Multisensoryapproachestocommunicationand
learningarealsowellestablishedmethodsforsupportingpupilswithPMLD(Goldbart,Chadwick&
Buell,2014).
IllustrationfromSmith-Myles,Mahler&Robbins,2014
Typicallythefocus,inautism,hasbeenonlookingat
differences(hyperorhyporesponsiveness)acrosssevensenses–sight,smell,taste,
touch,hearing,vestibular(balance)andproprioception(awarenessofbodyin
space).However,anewareaofresearchhasbeenexaminingtheimpactof
IllustrationfromSmith-Mylesetal.2014
differencesin‘theeighthsense’–interoception.
Heartfelt,gutfeeling
Thebasicprocessofinteroceptionrelatesto
howsensorysignalsrelatingtointernalbody
experiencessuchaspain,temperature,itch,
sensualtouch,muscularandvisceral
sensations,heartrate,hunger,thirst,
fullness,nausea,needforthetoilet,tickle
andemotionalstatessuchasanger,
calmness,distraction,orfearreachour
consciousawareness(Craig,2003;2015).
Interoceptionhelpstoallowustoanswer
thequestion,"HowdoIfeel?".
Whilstthereisagrowingbodyofresearch
lookingathowemotional
Illustration:ElanaRyznar
experienceisgovernedby
interospectiveawareness(Bechara&Naqvi,2004;Seth,2013)andtherelationshipbetween
interoceptionandstress(Garfinkel&Critchley,2016a;Schulz&Vögele,2015)ithasonlyrecently
beguntobeexaminedinchildrenandyoungpeople.Forexample,arecentreviewintosensory
factorsandtheirimpactondailylifeforchildrenbyDunnandcolleagues(Dunn,Little,Dean,
Robertson&Evans,2016)didnotincludeanyexaminationofinteroception,despitethegrowing
evidencetosupportthevitalroleitplaysinourunderstandingofourselves,ouremotions,other
peopleandthewiderworld(Murphy,Brewer,Catmur&Bird,2016).Inlightofthisunderstanding
andsensorydifferencesexperiencedbyautisticindividualstherehasbeenanewfocusonlookingat
therelationshipbetweeninteroceptiveawarenessandautism.
Theimportantroleinteroceptionplaysintermsofoursocio-cognitiveability,andourabilityto
distinguishselffromother(Quattrocki&Friston,2014;Sowden,Brewer,Catmur&Bird,2016)
suggeststhissensemaybeexperiencedsignificantlydifferentlyinautisticindividuals.Therefore,
despitethehugevarietyinwhichitisexpressed,theremaybeacommoninteroceptivefoundation
toautism(Seth&Friston,2016).Arecentreviewofresearchoninteroceptionandautismwhilst
limitedtojustfivestudies,doessuggestthatdifferencesininteroceptiveawarenessmayunderpin
manyofthedifficultiesourautisticpupilsexperience(DuBois,Ameis,Lai,Casanova&Desarkar,
2016).However,theresearchtodateislimitedtolowerneedindividuals,partlyduetothefactone
ofthemainmeasuresofinteroceptiveawarenesscomesthroughself-reportquestionnairesortasks
suchasanindividualhavingtorateifamusicalbeatortonematchestheirheartbeat(Garfinkelet
al.,2016b).Alotmoreresearch
isneeded,particularlywith
higherneedindividuals,tolook
attheextenttowhichthere
maybeatendencytowards
hyperorhyporesponsivityto
interoceptivesensationsbut
also,moreimportantly,howto
supportindividualstomanage
andunderstandthishighly
Image:IanKelckneradaptedbyGraceBullock
influentialsensoryinformation-toknow‘howdoIfeel?’
Sensorysubtypesinautism?
Sensorybehaviourshave
historicallybeendividedinto
fourpatterns,includingsensory
hypo-reactivity,hyper-reactivity,
sensoryseeking,andsensory
avoidance(Dunn,2001;BenSassonetal.,2009).However,
manyautisticindividualswill
experienceseveralofthese
patternsatonetime,withmixedpatternsbeingdisplayedacrosssensorydomains(taste,touchetc.)
(Baraneketal.,2006;TomchekandDunn,2007;Lidstoneetal.,2014).Recentresearch,therefore,
hastriedtoclassifysensoryprocessingdifferencesintospecificsubtypes(Laneetal.,2011,2014;
Uljarevićetal.,2016),suchassensoryadaptive,sensorymoderate,andsensorysevere(Uljarevićet
al.,2016),withaviewtoensuringsupportcanbeindividualisedfurther.
Whilstresearchershavecautionedagainstover-generalising,areviewpublishedthisyearsuggested
thatbetweenthreetofivesensorysubtypeswasanappropriate‘fit’toencompassthedifferent
patternsofsensoryresponsivityseeninchildrenwithautism:asubgroupmayhavetypicalsensory
functioning,whilstanothersuggestedsubgroupincludedchildrenwithsignificant,globalsensory
differences(DeBoth&Reynolds,2017).Thereweremixed,lessconclusiveresultsforthosechildren
whomayfallinbetweenthesetwo‘end-points’–thosewhohavespecificversusglobaldifferences
inresponsivity(i.e.,hyper-orhypo-responsivityorsensoryseeking),orwithinspecificsensory
domains(vestibular,tasteetc.)(DeBoth&Reynolds,2017).
Withregardstoautisticindividualswithhigherneeds,includingthosewithadditionalintellectual
difficultiesand/orlimitedverbalcommunication,therehasbeensomeconsensusthattheymay
experiencehypo-responsivityandhigherratesofsensoryseekingbehaviour(Patten,Ausderau,
Watson,&Baranek,2013;Watts,Rodgers&Riby,2016).Hyper-responsivityontheotherhandhas
beenassociatedwithsleepproblems(MazurekandPetroski,2015)andfooddisorders(Cermaket
al.,2010;Nadonetal.,2011),particularlyinveryyoungchildrenandinfants,suggestingearly
sensorybasedsupportsmayhelpaddressthesedifficulties(Taumanetal.,2016).Sensoryhyperresponsivenesshasalsobeenlinkedtogastrointestinal(GI)problems(Mazureketal.,2013)more
externalizingbehaviors,andincreasedparentingstress(Ben-Sassonetal.,2013).Again,the
implication,therefore,isthatabetterunderstandingofdifferentsensoryprofilesandtherefore
moreindividualisedsensoryinterventions
andsupportmayhelptoaddressthese
difficulties.Thereisalsoawidercallfor
futureresearchtolookatsensorysubtypes
ineverybodytohelpunderstandifsensory
subtypesinautisticindividualsare
representativeofgeneraldifferencesin
sensoryprocessing(DeBoth&Reynolds,
2017).
Illustration:BenConnors,retrievedfromhttp://crae.ioe.ac.uk/post/145502740383/making-sense-of-sensory-differences Impactofsensorydifferences
Overtwentyyearsagointheirbookontheimportanceofsensoryintegration,Williamsand
Shellenbergerputforwardadevelopmentalmodeloflearning,thefoundationsofwhicharesensory
(althoughtheydidnotincludeinteroception)(Williams&Shellenberger,1996).
PyramidofLearning(Williams&Shellenberger,1996)
Whilstthismodelprovidesagreatvisualreminderoftheroleofphysiologicalprocessesincognition
ingeneral,theimpactofsensorydifferencesforautisticindividualsisfarmorepervasiveand
understandingthesedifferencesineachindividualisevenmorecrucialtounderstandingtheir
specificneedsandbehaviour(Schaaf&Lane,2105)
Managingsensorydifferencesprovidesoneofthemostchallenging
obstaclesforchildrenandyoungpeoplewithautism,impactingupon
adaptivebehaviour,participationinactivitiesinthecommunity,and
reducingqualityoflife(Baraneketal.2006;Bakeretal.2008;BenSassonetal.2013;O’NeillandJones1997;O’RiordanandPassetti2006;
Schaafetal.2011).
Difficultywithsensoryregulationhasalso
beenconsideredtobemotivatingstereotypic
behaviour.Indeed,repetitivebehavioursinautism,havelongbeenassociatedwithfluctuatingstates
ofunder(hypo)andover(hyper)sensoryarousal,andstereotypicorrepetitivebehavioursarea
meansoftryingtofiximbalances(self-regulate)inarousalinthefaceorunpredictable,potentially
overwhelmingsensoryinputtoachieveoptimalstimulation‘calmalert’(Lidstoneetal.,2014;
Matsushimaetal.,2016;Zentall&Zentall,1983).
Illustration:KellyDillon
However,differenttypesofrepetitivebehavioursmayservedifferentfunctionsforregulating
sensoryarousalwithvaryinglevelsofsuccesstheseare:InsistenceonSameness(IS)andRepetitive
SensoryandMotorBehavioursRSMB).
InsistenceonSameness(IS)
ISbehavioursinclude:collectingorhoardingitemsofanysort,insistingonthingsremainingthe
same,gettingupsetaboutminorchangestoobjects,insistingonaspectsofroutineremainingthe
same,insistingondoingorre-doingthingsinacertainway,playingthesamemusic,game,video,
bookrepeatedly.Thesetypesofbehavioursarelinkedtoover-arousalasaresultofsensory
sensitivity(hyper-sensitivity).Therefore,thesebehavioursmayfunctionbybeingsensationavoiding
andallowtheindividualtonarrowsensoryinput–theyprovideafocustohelpblockoutother
sensoryinput.However,thelinkbetweentheseISbehavioursandanxietyindicatesthatthese
behavioursmaynotbethebestwayofregulatingarousalandtheymayevenservetocreateand
maintainanxiety.
RepetitiveSensoryandMotorBehaviours(RSMB)
RSMBsinclude:repetitivelyfiddlingwithtoysetc.,spinningselfaroundandaround,rocking
backwardsandforwards,pacing/movingaroundrepetitivelyandrepetitivehand/fingermovements.
Thesetypesofbehavioursmaybemuchbetterathelpingtoregulatearousalwithoutcreatingor
maintaininganxiety,byprovidingstimulationthroughsensationseekinginthecaseofunder-arousal
(hypo-sensitivity)andthroughsoothingandavoidanceoutcomesinthecaseofover-arousal(hypersensitivity).Howeverthesebehaviourshavealsobeenpositivelyassociatedwithparent-reported
sleepproblems(Hundley,Shui&Malow,2016).
Overall,whenlookingatritualisticbehaviourssuchasthosedescribedabove,currentopinionisthat
theydevelopasacopingmechanisminresponsetoanxiety.Thisinturncomesfromprimary
difficultiesinmodulatingsensoryinput(Bart,Bar-Shalita,Mansour&Dar,2016).Thisrelationship
betweenanxietyandsensorydifferenceswillbethemainfocusofPart2ofthisdigestwhich
exploresthecloserelationshipbetweensensoryregulationandanxietyfurther(Magiatietal.,2015;
Samsonetal.,2014).
Seephysicalthinksensory
Onefinalthingtokeepinmindisthatwemustconsiderthatmuchphysical
behaviourismotivatedbysensoryneedsand,asmentionedabove,maybea
childoryoungpersonmaybetryingtoregulatetheiranxietyorsensory
needs.Thismayincludeself-injuriousbehaviourswhichmaybeconsidered
moreintensestereotypic/repetitivebehaviours(Gal,Dyck&Passmore,
2009).
Foralongtimephysicalbehaviourinautismwasmisunderstood.Unlike
otherareasofdifferencesuchasTourette’s,asocialratherthananeurologicalinterpretationof
behaviourwasappliedsothat“whichiscalleda“tic”inapersonwithTourettesyndromeismost
oftenassumedtobea“behaviour”(andoftenaconsciouschoice)inapersonwithautism.For
symptomsinterpretedthroughaneurologicallens,individualstendtobeappropriatelysupported.In
autism,symptomsareviewedfrequentlyasbehaviourstobereducedoreliminatedoftenwitha
negativeinterventionandresults”(Donnellan,Hill&Leary,2013).Donnellanandcolleaguesfurther
pointoutthatasocialinterpretationofthesesensorymotivatedbehavioursoftenleavespeople
withtheassumptionthattheyoccurasamatterofchoiceorapathy,whereaspredominantlythe
behaviourisrelatedtostress,includingthestressofexcitement(Donnellan,Hill&Leary,2013).
Whilstunderstandingthattheremaybephysiologicaldifferencethatcouldbemotivatingsensory
behavioursitisalsoimportantthatwerememberthatwecanstillsupportourpupilstolearnother
waysofregulatingthemselves,andindeedtobecomemoreabletocopewithsensoryinputthat
maybeprovokinganxiety.Simplistic,neuroessentialist(biologicallybased)explanationsof
differencescanoftenleadtowardsanincreaseinstigma,lessempathyandaclosedmindset
towardsassumingthatdifficultiesindividualsmayfacearefixed(Lebowitz&Ahn,2014;Schultz,
2015).
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