Many of the characteristics of a child with autism also mirror those of a child with sensory processing disorder. Autism as a sensory issue is very tricky, so many things over lap and intertwine. The classic indicators seem to almost be the same. However, it is important to differentiate between the two. The following lists help to illustrate the similarities and the differences between the two conditions.
Sensory Integrative issues may be characterized by:*
- Either be in constant motion or fatigue easily or go back and forth between the two.
- Withdraws when being touched.
- Refuse to eat certain foods because of how the foods feel when chewed.
- Be oversensitive to odors.
- Be hypersensitive to certain fabrics and only wear clothes that are soft or those they find pleasing.
- Dislikes getting his or her hands dirty.
- Is uncomfortable with some movements, such as swinging, sliding, or going down ramps or other inclines. Your young child may have trouble learning to climb, go down stairs, or ride an escalator.
- Have difficulty calming him or her after exercise or after becoming upset.
- Jumps, swings, spins excessively.
- Appears clumsy, trips easily, poor balance; odd posture
- Social skill issues/authority issues.
- Overly sensitive to criticism
- Either always on the go or very sedentary
- Memory difficulties and/or problems following directions
- Has difficulty with buttons or snaps.
- Is overly sensitive to sound. Vacuum cleaners, lawn mowers, leaf blowers, or sirens, etc.
- Lacks creativity/variety in play; plays with the same toys in the same manner over and over etc.
While Autism and or PDD issues may be characterized by:
- Insistence on sameness; resistance to change
- Difficulty in expressing needs; uses gestures or pointing instead of words
- Repeating words or phrases in place of normal, responsive language
- Laughing, crying, showing distress for reasons not apparent to others
- Prefers to be alone; aloof manner
- Difficulty interacting with others
- May not want to cuddle or be cuddled
- Little or no eye contact
- Unresponsive to normal teaching methods
- Sustained odd play
- Spins objects
- Inappropriate attachments to objects
- Apparent over-sensitivity or under-sensitivity to pain
- No fear of danger
- Noticeable physical over-activity or extreme under-activity
- Uneven gross/fine motor skills
- Not responsive to verbal cues; acts as if deaf although hearing tests in normal range.
(*complied from various sources)
Not every child on the spectrum will exhibit all of these issues. However there will be areas of relatedness and it is in these similarities an understanding of unique interventions can be found.
For example let’s look at “Patrick”:
Five-year old Patrick is always on the ‘go’. His teachers do not know what to do about him. He has few friends and those he makes he cannot keep. He cannot sit in circle time. Lining up to go out to recess is unpredictable. And even worse, he talks about not liking himself and how he hates everyone and “everyone” hates him.
He has his favorite toys and his favorite clothes and that is what he plays with and wears, with little to no deviation.
School is a challenge. He seems to either escalate or get so lethargic that he cannot move. He seems unable to “reset” himself, he stays “on guard” and anxious. He does not like to go to PE or to lunch because he says that the other kids “pick on him and hit him”. On the playground he plays mainly with girls, and the boys seem to ignore him. When he runs he does so with abandon bumping into people and things and barely noticing. His gait is awkward and when he runs his arms are up and sometimes he runs on his tip toes. He does not seem to respond to facial expressions or to be able to register empathy for others. He complains that things “hurt” him even when there is no evidence of that.
Making eye contact and following a slow moving object is impossible for him without accompanied very cues. Hyper sensitive to smells, he complains about odors in art class, the lunchroom and on the school bus.
Recall of academic information is difficult and varied repetition seems to be the best learning path at this time.
Easily upset and emotionally labile, he seems uncomfortable in his own “skin”.
Children on the spectrum often have pronounced sensory issues. To understand Johnny’s primary areas of concern, how therapy helps, and what can parents do at home, please refer to the following chart.
|Presenting Issue||Behavioral Manifestation||Sensory Processing Concern||Treatment Approach*||Anticipated Outcomes|
Easily startled by unexpected noises
|Screams and yells and has temper tantrums||Not hearing sounds with auditory figure ground discrimination or with sound/activity relationships
Attention floats and does not stay on topic
|The Listening Program ™
Games that incorporate unexpected noises with the “warnings” of noises decreasing as tolerance increases
|Increased noise tolerance
Increase attention to task with diminishing supports
Does not seem to see objects in his immediate visual field
|Bumps into people and things and falls a lot||Visual figure ground and visual constancy issues
Does not use visual motor ideation to plan movements
Use of weight appropriate free weights during gross motor games to increase sense of body in space
|Increased motor planning in familiar situations—translating this into less familiar tasks as tolerated|
Always on the go
Takes risks during play
|Does not know how to slow self down and he just builds momentum until outside forces slow him (teacher, etc.)||Perseverative quality to his movements
Skewed motor planning
Depressed vestibular processing
|Quick change activities where increasingly the sequence or order of things changes and he has to make movement, planning and/or postural adjustments||Slow it down! Have the child make a “plan” keep it to a maximum of 4 things—1stdo____
2nd , 3rd and 4th ___
stick to the plan and make choices for the next time
Habituates wearing the same clothes
Expresses discomfort when touched
Demonstrates exaggerated responses to touch
|Tantrums if “right” clothes not available
Will not try to put on anything new even if pre-washed
Gets into fights when he is trying to make friends
|Tactile defensive behaviors
This causes adverse emotional reactions both in school and home
|Timed trials for adjusting to new fabrics: i.e. “you only have to wear this for 3 minutes” or only while you are brushing your teeth and increase time tolerances
Provide “expected” unexpected touch and rate with child the reactions
|Increased ability to tolerate new fabrics and to try new pieces of clothing
Modulated reactions to touch
Smell in lunchroom, art class, etc. are noxious to him
|Nutrition issues and he becomes lethargic in the afternoons due to lack of food and this impacts his school work||Textures in mouth may be a negative trigger and over-sensitivity to smell is operating here||Make a dinner “Tapas” bar where he gets to eat whatever he usually chooses but must also take a taste and intentionally smell a new food||Increase repertoire of tolerated foods
Will eat in the lunchroom with support—first place him near the door and then slowly move him into the room
Difficult for him to self-regulate
Labile mood swings
Hard for him to enter into group play
Uncomfortable with who he is
|Unpredictable behaviors make it hard to anticipate his needs
Peers see him as “weird” so he is often not asked to play and when he asks he is often rejected
Isolated from others in classroom group time due to behaviors
|Almost absent self-regulation skills
Chaotic responses not always fitting the circumstance
|Make a game together where he is in charge of making the rules (but you are in charge of making it reasonable) and “rig” it so (gently) he is not always “winning”. Warn him of this in advance and talk about reactions and choices make a “reaction box”©***||Use gross motor games to create simulated social and motor planning actions and activities and get him into a new comfort zone!|
*Treatment Approaches are suggested ones there are many ways to address these issues
**The Listening Program ™–available commercially
***The “reaction box”—exclusive to Children’s Special Services, LLC Get a heavy cardboard man’s shoe box; decorate it with paint, contact paper, etc. put in it on separate slips of paper good behavior choices ONLY. When he is upset let him pound on the box for a while and then he picks a choice out of the box and you help him achieve that “choice”.
So what do you treat first? Everything! That is Occupational Therapy, changing the context in which one lives so that life can be lived with greater ease.