• Collaborative

Autism and Intellectual deficiency: Taking into account the sensory particularities of your child

Noémie Cousin (psychomotor therapist), Mathilde Canavesio (special educator), Angeline Charmet (psychologist) and Dr Anna Maruani

Center of Excellence for Neurodevelopmental Disorders, Robert Debré Hospital, Paris.


In this situation of confinement, the daily environment may become more difficult to understand for your child with an autism spectrum disorder and / or intellectual deficiency. We all need to have a familiar space in which we feel safe. It therefore seems important for children with sensory particularities to make the environment as stable as possible, in order to allow them the best accommodation possible, during this period.



We have access to seven sensory modalities:



If your child has a sensory integration disorder, their brain information about the environment is probably different:

They may then encounter modulation difficulties (ability to modulate the intensity of responses according to the stimuli in the environment. Example: the child can no longer follow the conversation because their T-shirt label is scratching them), self-regulation (ability of the child to increase or decrease the degree of stimulation they receive from their environment and maintain their homeostasis [balance, well-being]. Example: we are at the table, there is a lot of noise, my child closes their eyes and adopts a breathing technique to soothe themselves) and present defense reactions (the strategies that my child implements when the stimuli are too strong. Example: I turn on the hair dryer, my child puts their hands on their ears).


· Your child may be hyper-sensitive: Some sensory stimuli are experienced as dangerous and invasive by the brain. The behavior adopted by the child is avoidance (seeks to stop, remove the unpleasant source of stimulation).





· Your child may be hypo-sensitive: sensory stimulation does not reach the child's perception threshold. The behavior adopted will be the search for sensations.




Your child can be hyper-sensitive and hypo-sensitive for the same modality!

· Does not like tickling BUT like deep pressure;

· Does not support strong artificial lights BUT self-stimulates with the rays of the sun;

· Does not like the noise of the hair dryer BUT sticks sound games to his ear;

· Does not accept the contact of the toothbrush BUT brings other objects to its mouth ...

· Etc.

Your child's sensitivities can vary over time, depending on their mood, physical well-being, and sometimes depending on factors that are difficult to identify...

View:

o Hyper: doesn’t like bright lights, flashes, often looks on the ground or closes their eyes o Hypo: attracted to light, wiggles his fingers or objects in front of his eyes, intensely stares at people, objects

Hearing o Hyper: light sleeper, afraid of loud noises, distracted by weak sounds o Hypo: likes vibrations, loud music, noisy environments, produces loud sounds

Smell: o Hyper: annoyed by kitchen smells, moves away from people, problem going to the toilet o Hypo: smells their own smell and sniffs others, likes strong odors or does not seem to notice them

Taste: o Hyper: very selective, dislikes new foods, vomits easily, likes bland food o Hypo: eats inedible elements (pica), eats very spicy, salty, puts objects in the mouth

Touch: o Hyper: dislikes being touched, showering, brushing teeth, sensitive to cold, pain, texture of food, clothes hurt o Hypo: likes strong pressures, tight clothes, being shrouded

The vestibular system: o Hyper: fear of movement around him, difficulty on unstable surfaces, fear of falling o Hypo: always in motion, turns in a circle, likes to jump, sways frequently

The proprioceptive system: o Hyper: adopts strange positions, difficulty picking up small objects, tiptoeing o Hypo: bumps into furniture, little muscle tone, gnashes on teeth, nibbles on objects, clothes


So what can I try every day?

· List your child's sensory characteristics.

This will allow you to better understand how they work. It is important to share this information with the rest of the family so that everyone can, at best, take into account their specific needs and facilitate everyone's daily life.

You can, for example, list the different situations that require special vigilance for your child. This list can be hung in a common place, visible to everyone (in the living room, on the fridge, etc.).

Example of list:



Once your child’s particularities have been listed, post the lists in strategic places.

· Define clear resource areas for your child that are easy to integrate into everyone's daily life.

It is important that the whole family can identify each space as having its own function, meeting the sensory needs of your child but also the space and privacy needs of each member of the family.

Rest / quiet space (bed in the room, bedroom): this space is associated with calm, soothing activities, where your child can isolate themselves if they feel the need. It is important that they use a space for them without encroaching on the space of their siblings or parents and vice versa.

Common living space (living room, kitchen, dining area, bathroom, hallway): this space has a higher level of stimulation. The family lives there every day, at different rates for different activities. It can be defined as a motor activity zone (running in the corridor, playing hide and seek, catching, tickling, watching TV etc.).

· Adapt the child's environment and daily life to the confinement period.

Some examples if your child is hyper-sensitive,

❏ Consider installing them next to their quieter brother or sister, or even isolate them if necessary at mealtimes, during table activities or quiet times etc.

❏ During times of homework or table activities, minimize stimulation as much as possible so that they maintain their concentration: turn off the television in the living room, close the door of their bedroom while they are working, check that the lighting suitable for the environment, clear the work surface of any unnecessary object as much as possible, noise-canceling helmet may be available, etc.

Some examples if your child is hypo-sensitive:

In a situation of confinement, it is normal for your child to develop new self-stimulations or to produce them more frequently, due to the lack of variety in the activities (fewer outside activities, less interaction with their peers, the professionals, etc.) and the disruption of their habits. It is important to structure these times of sensory research while remaining flexible and being indulgent with them and with yourself!

❏ Before starting a planned activity or a daily task (shower, meal, brushing teeth, etc.), give your child enough time to stimulate themselves. This stimulation time can be limited by setting up a timer. It is important to meet their needs in terms of sensory research before starting the activity.

Your child's sensory needs should not be used as a reward system as they are essential for their well-being.

❏ If your child has self-stimulations that hamper the functioning and well-being of the family because they are repetitive, invasive for others, dangerous, offer alternatives that meet the same sensory need.

Example: your child repetitively hugs you very hard → looking for deep pressure (hypo-sensitive proprioceptive) → offer them a big cushion that they can tighten against them, wrap them in a duvet, offer them a limited massage time while using a timer.


Idea box


Calming strategies · Diminish ambient noise, put on soft music · Dim the lights · Propose relaxation and / or breathing times · Massage, deep pressure, rocking movements · Propose propioceptive motor activities (which stress the muscles): push with your feet or hands, pull, crush, lift · Give something to chew (chewing gum, chewy tube, plastic ring)

Stimulating strategies · Increase the brightness · Play catchy music and dance · Propose brightly colored, bright, vibrant, fast-moving objects · Tickle, cat games · Give foods and drinks with different textures and tastes (crisp, cold, sparkling, sour, sweet) · Give to manipulate objects with varied textures (sand, water, painting with hands) · Propose motor courses with somersaults, jumps, turn on a swivel chair

Despite the adaptations put in place, why can difficult behavior appear or increase?

You have already implemented many adaptations, but despite this your child shows signs of sensory overload.

· Identify the signs of sensory overload: when a child is sensory overload, they may present agitation, manifestations of anxiety, tantrums, an increase or appearance of self-mutilation, an increase in stereotypes, being tired, having behavioral problems…

Before anything else, make sure to eliminate a possible physiological cause (pain, fever, etc.). If in doubt, do not hesitate to contact your doctor.

When certain warning signs of a crisis appear, you can ask yourself the following questions:

1. Are there too many sensory stimuli?

2. Are too many different senses being called upon?

3. Is the sensory stimulation too intense?

4. Does sensory stimulation last too long?

Identifying the triggers for the crisis will allow you to propose a strategy adapted to your child's needs.

❏ If your child has a good understanding of their internal feelings, you can briefly discuss it with them, and think with them about the possible adaptations to put in place to relieve them (move them away from the unpleasant stimulation, stop it if possible, isolate them while they calm down, etc.);

❏ If your child is having difficulty understanding what is bothering them, what they are feeling, try, from your experiences with them, strategies that can soothe them (isolate them, offer physical contact, give them an appreciated sensory object, etc.). There is no ready-made answer, each situation is unique, proceed by trial and error.

· But above all, trust yourself!

You know your child well and their sensory particularities, confinement can exacerbate some. By remaining attentive to the changes in behavior and mood of your child on a daily basis you will be able to suggest suitable strategies to appease them but also to appease the daily life of the whole family!

If you are facing difficulties do not hesitate to contact the professionals accompanying your child, they are there to support you!

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris