Do you have…
- Concerns regarding your child’s ability to tolerate changes in their daily structure or transitions?
- Concerns with your child’s ability to make eye contact, focus their eyes on an object or person, or use their eyes to guide movements?
- Concerns about the limited amount of motor tasks and activities that your child is willing to engage in and your childs’ ability to engage in novel and non-repetitive play?
- Concerns about your child’s ability to execute motor tasks that their same age peers are doing? Does your child seem uncoordinated and clumsy in their movements?
- Does your child seem disconnected to themselves or to their environment?
- Does your child become easily overwhelmed or reactive to sensory input, such as sounds, touch, visual information, or movement?
- Does your child often seem anxious, even during everyday activities?
Children with autism often struggle with adaptability, functional vision deficits, over-reactions to their environment, body control, and praxis deficits affecting activity tolerance, peer interactions, and emotional regulation. These issues often have a foundation in difficulties with integrating and interpreting sensory information.
Adaptability
Children with autism often have difficulties being flexible and adapting to new situations. This may be stemming from having difficulty understanding and integrating sensory information from the environment in order to adapt their motor and behavioral responses. This carries over to difficulty transitioning from one place to another or from one activity to another due to being unsure of what is coming next. Sensory integrative intervention goes beyond providing picture cues and sequencing supports to improving a child’s ability to tune into, adapt, and respond more appropriately to their environment. This leads to expanding play skills, exploration of the environment, and better ability to engage in goal-directed activity without disorganization and overwhelm. Further identifying your child regulation and sensory support strategies can improve his/her ability to recover from skill demands, maintain a more optimal level of arousal, and be more available for learning.
Vision
It is common for people with autism to present with trouble making eye contact, not looking at an object when reaching for it, and not using vision to carefully guide movement when navigating the environment. Yet they also may stare intensely at objects, excel in visual perceptual skills, or perseverate on preferred visual stimuli at close range. They often rely on their ambient vision rather than engaging their focal vision to interact with the world, which can make the world seem overwhelming.
Praxis
Praxis develops through adequate sensory processing combined with higher-level cognitive abilities. It consists of the following components: 1. Ideation 2. Planning and Sequencing 3. Feedforward 4. Execution 5. Feedback. Ideational praxis is the ability to recognize object/environmental affordances to generate a goal for a purposeful action of some idea of how to accomplish the goal. It’s also the ability to generate ideas with variation, in high frequency, and in a timely manner. Children with praxis deficits often have trouble coming up with ideas of what to do with their body and/or objects in the environment, completing multi-step sequences, and/or adapting in response to repetition and feedback. Praxis needs to be efficient for the development of higher-order planning and organizational skills. Praxis deficits may make a child seem impulsive, disorganized, or awkward in their approach to tasks. They often need supervision to manage daily task completion or have trouble following directions due to difficulty visualizing what is being asked of them. In play, deficits can manifest as controlling/repetitive/avoidant behaviors to keep the environment predictable and manageable due to an inability to quickly adapt to changing task demands. Motor tasks that may come natural to their peers, such as putting their hair in a ponytail or getting dressed may be very difficult for these children to execute.
Auditory
The auditory system provides information regarding where a sound is coming from (sound localization), allows us to differentiate between foreground and background sounds (auditory filtering), hear the details in directions, and follow both group and 1:1 conversations.
Children with autism may become easily overwhelmed by certain noises, loud noises, crowds, or multiple auditory inputs occurring at the same time. This can make it difficult to engage in community activities. They also may appear as though they are not attending to auditory stimuli as they may not visually orient to an auditory stimulus (ex: person talking). Children with autism may require special accommodations and strategies to manage auditory environments as well as direct intervention to remediate over-responsivities and management of auditory stimuli.
Emotional Dysregulation
Emerging evidence has shown that people with ASD who may appear over-responsive to certain sensory inputs may actually be more behaviorally over-responsive than have a true difficulty with modulation of certain sensory inputs. Research shows that sometimes the over-reactions may be a function of emotional-dysregulation due to difficulty adapting and responding to environmental demands. Common ways to support regulation include respiration activities, vestibular input (movement), and proprioception (deep pressure). Additionally, improvements in emotional self-regulation may result from improved praxis and motor planning skills or improved tolerance of visual demands as well. Each child is unique regarding the amount, type, delivery, and possible combinations of input that they need to increase self-regulation. Parents can also facilitate or initiate these regulation techniques. Increasing regulation helps to decrease feelings of anxiety and helps children to avoid becoming overwhelmed, allowing for more successful participation in activities that are important to them and their families.
Therapeutic Intervention
SI treatment is tailored to each child’s sensory profile. Treatment occurs in sensory-rich gym environments with specialized suspended equipment and therapists trained in sensory integration theory and practice. Through playful and supportive interactions with the child, he/she learns how to explore and engage in sensory experiences that foster appropriate responses to sensory information. Treatment often begins with a focus on balancing self-regulation and skill development. As adaptive motor responses and postural control emerge, the body is then ready to engage in more complex demands. Vestibular input is used via use of suspended equipment (swings etc) to increase the connection between the vestibular (movement) system and the body to activate the muscles needed for dynamic postural control as well as the connection to the visual system for development of vestibular-mediated functional visual skills. Use of suspended equipment allows the therapist to facilitate a myriad of movement combinations to develop more efficient saccadic eye movement, gaze stability, visual fixation, and dynamic postural responses. Treatment then progresses to integrating postural and visual demands while building motor planning, praxis skills, and bilateral coordination.
To address functional visual skills, it is important to know that the vestibular system is the first mediator of eye movements. Therefore, we use suspended equipment to enhance feedback to this system and train a child’s visual skills. By addressing foundational sensory integration and motor deficits that are often seen in children with autism, functional visual skills can be improved to engage focal vision, monitor the environment, shift attention in space to make choices, use communication devices, and reference peers.
Improving praxis skills requires a sensory-rich environment to enhance feedback to the body through the senses to support motor planning, explore and gain feedback about how to use objects in the environment, and support a child’s ability to select and combine multiple motor plans for execution of task demands.
Additionally, when a child can’t translate verbal directions or visual demonstrations into a motor plan, it is imperative that we utilize body-based experiences to pair language and visual information for access to teaching modalities. We also work on functional skills to teach older children and adolescents with dyspraxia how to break down activities into discreet motor plans so they can do such things as tie their shoes, put a hair tie in, manage school supplies, and prepare simple meals.
Subscribe to our YouTube Channel for access to our training videos to learn how to break down tasks for people with dyspraxia.
What about auditory deficits?
For children with auditory challenges, Sensational Achievements offers the Tomatis Method, a stand alone auditory intervention which can be implemented during treatment sessions or at home. Aubrey Schmalle, OTR/L, Owner, is a Level 3 Tomatis Consultant, which allows her to create custom listening programs designed specifically for your child’s Listening Profile and areas of need. Rachel Butler, COTA/L is a Level 1 Practitioner is also trained in the Method and implementation. To learn more about the Tomatis Method, Click Here.
What about fine motor and handwriting?
While many families often initially seek occupational therapy for help with fine motor skills, adequate postural-ocular control is necessary to create proximal stability and support visual attention. Therefore, focusing on fine motor and writing demands may not be appropriate until this foundation is in place or may only be embedded in short bursts during sessions to maximize the therapeutic benefit and improve overall outcomes.
How long does it take?
Research tells us that the first significant milestone for progress is around 30 hours of intervention. This includes not just treatment sessions but also how consistent you are with home programming and implementation of sensory support programs utilizing the Body Activated LearningTM framework. Keep in mind that children with Autism present with a wide range of abilities and combination of needs that can impact progress with intervention. It is important to keep in mind that medical issues, food sensitivities, severity of autism symptoms or maladaptive behaviors should all be factored in to set manageable expectations for progress.
While sensory integration therapy and the Tomatis Method are not a cure for Autism, these interventions can significantly improve many of the commonly seen behaviors and functional concerns that overlap with the diagnosis of Autism. It starts with understanding your child’s unique profile and areas of need to create a targeted intervention plan.
