Tag Archives: Sensory Processing Disorder

Sensory Processing Issues: Touch

Today, I listened to a Dutch video about sensory processing and creating a sensory valuable environment for clients with challenging behavior due to sensory processing issues. As I may’ve shared, the Center for Consultation amd Expertise (CCE) coordinator asked whether I’d ever had a sensory integration assessment. I haven’t and figuring out my sensory needs by myself is really tough.

It doesn’t help that I have little memory of my sensory needs growing up. As you might know, my parens don’t believe I’m autistic, believing instead that I choose to misbehave out of a will to manipulate. As such, I cannot ask them (particularly my father) to provide insights into my sensory needs. As the video presenter didn’t say whether sensory needs can change over time, and I am unsure about my childhood, I do not know whether my needs are valid.

After finishing the video, I read The Realistic Autistic’s post on touch-based sensory processing issues. This was really insightful. I could relate to a lot of the issues Sarah, the post author, describes. For example, growing up, I do remember hating the seams in socks and possibly the tags in clothes too. Now that I’m an adult, I don’t experience this issue that much anymore.

Like Sarah, I also prefer deep pressure to light touch, but I don’t have a problem with light touch usually when I’m okay mood-wise. Unlike Sarah, I’m more sensitive to cold than to heat.

One particular aspect of touch that Sarah didn’t touch on (no pun intended), is the experience of tactile stimuli in the mouth. I seem to have a lot of issues with this and always have.

In some respects, I seek extra stimulation in this sense. As a child, I’d very often chew or suck on my clothes and, later, my hair. I still chew on my hair on occasion (though, having had a haircut a few weeks ago, I no longer can).

On the other hand, I hate the feel and taste of teeth-brushing, particularly with toothpaste. I couldn’t stand brushing my teeth with toothpaste until I was eighteen and even now, I want it over with quickly.

What I also notice is that, if I have control over the stimulus, I may seek out more stimuli or avoid them less than when others impose them on me. For instance, Sarah talked about the issue of having a haircut. I hate this. Interestingly though, hair-twirling is one of my main stims.

In the Dutch video, it was mentioned that between eleven and thirteen million stimuli get to our brains each second. Most are immediately filtered out, but roughly 4,000 are processed on some level. For this reason too, the presenter said eliminating all stimuli is not possible. I find that sometimes adding a stimulus will help me deal with overload. For example, I recently discovered some weighted stuffed animals at day activities. These provide a form of deep pressure that helps me feel calmer when overstimulated.

Keep Calm and Carry On Linking Sunday

Describing My Limitations

Many years ago, an online friend of mine was part of a disabled people’s ministry that explored what it meant to be disabled. She wanted to get me involved too, but at that point, the ministry was closing down, so she started her own discussion group. The first question we got was to introduce ourselves without mentioning our disabilities. I don’t know whether I did this with my last post, but I don’t want to do things over again. The second question was to describe your limitations. We could mention diagnoses, but the focus was on how disability limited us. I am now trying to answer this question in this post.

My first disability is blindness from retinopathy of prematurity. My vision is measured as light perception only. Technically, this means i can see the eye doctor’s flashlight when it’s brought into my visual field but I cannot tell what direction it comes from. This commonly leads to the misconception that people whose vision is measured as light perception only, are essentially completely blind. In truth, I can orient to light – just not the eye doctor’s flashlight. I can visually locate windows and see whether a light is on or off. With that last one, I do often need to check twice to be sure and I often find it easier to memorize the position of the switch than to depend on my vision.

Then it gets hard. I used to have a diagnosis of autism, but since that was removed, I now have to describe my limitations without depending on a catch-all label. Let me try. I have sensory processing difficulties. I am oversensitive to sounds and textures. With regards to taste, I am a sensory seeker, in that I crave spicy food. I can also be a seeker in the vestibular sense. I used to love to swing and when the movement therapist at my old institution had a trampoline set up, I was over the moon.

I may also have auditory processing issues. I have trouble understanding speech sometimes, especially in a crowded place. I haven’t had a hearing test in forever, so can’t be sure that it’s processing and not my hearing itself. Sometimes though, I do hear something, ask the other person to repeat it and then before they repeat themselves, I process what was said.

I also have social difficulties. I can keep a reasonably normal-sounding conversation but it takes me a lot of energy. I have trouble with reciprocity, in that soetimes all I do is listen and sometimes all I do is talk. I can’t do group conversations, because I get overwhelmed.

I have mild communication issues too. Sometimes, when anxious or overwhelmed, I go mute or stutter or have trouble finding the right words. I remember going mute in high school too, but not sure whether I had these issues before that. It could be anxiety, since I also have that. My psychologist is considering diagnosing me with generalized anxiety disorder, which basically means you worry to an extreme degree about all sorts of things. There are also additional symptoms, like difficulty concentrating, physical tension, etc.

I have cognitive issues too. This may sound stupid, because I have a high IQ. Maybe executive dysfunction is a better word. I appear lazy sometimes, because I get easily overwhelmed by relatively complex tasks and then end up not doing them at all. I also feel anxiety when people ask me to do things, but when I take the initiative, I feel more confident. I wrote earlier that this could be pathological demand avoidance. However, when for instance my husband asks me to do something, i’m fine with it unless it’s a complex task.

Then I have emotion regulation difficulties. I used to have a diagnosis of borderline personalty disorder, but that can’t co-exist with the brain injury I suffered from a brain bleed and hydrocephalus. I don’t have the relational instability that many people with BPD have. Mostly, my emotions are extreme. In this sense, I relate more to the profile for multiple complex developmental disorder (McDD) than to that for BPD. I have never been psychotic, but I do have some delusion-like thoughts.

Lastly, I have motor difficulties. I saw a physiatrist till I was about eight, but was too young to remember the diagnosis. I have a much weaker left side than right, although I recently found out that my grip strength is equal in both hands. The fact that I use my left hand much less could indicate mild hemineglect (lessened attention to one side of the body, usually left). I also have and have always had a lot weaker muscles than most people. I have however learned to live with that. I mean, what do you need to reach your toes for when in sitting position? I do have significant balance and coordination issues. MY gait is very wobbly. I recently learned that healthy people can climb stairs without even holding onto the railing. In my home, where the staircase has only one railing, I need to hold onto the railing with both hands and wobble sideways.

These are the limitations I can think of now. I have some others, but this post has been long enough. When I feel like it, I will answer the next question I remember, which was about adaptations for coping with your limitations.

What Sensory Overload Is Like

Today on The Mighty, there’s a story about people’s misguided perceptions of sensory overload. Mandy Farmer, the post author, describes several situations involving her son that are well-known to me. Though I’ve come to tolerate a grocery store, I still cover my ears when the music in a store is too loud. I still fidget and, though I don’t (usually) scream, I still react with frustration at my hair being cut. I still don’t attend many social events, because I find a baby’s crying or loud music or even lots of conversation overwhelming.

Overwhelming, exactly. But you see just behavior. I’ve actually had some nurses tell me that “this is behavior”. Duh! Every single action a person exhibits is behavior. You mean it is willful misbehavior, but 1. you don’t say so (this is my literal-mindedness acting up) and 2. I don’t think that it is.

People often see sensory overload as attention-seeking, as depriving the noise-making people of the right to make noise. *Yes, I’ve seriously been accused of that!) At best, like Farmer also seems to connote, they see it as anxiety, and anxiety is to be overcome with exposure.

I once, many years ago, read a description of what it is like to live with autism. The description of the sensory experience went something like this: imagine noise at the highest volume blasting in your ears, insects crawling under your skin, and bright lights shining in your eyes at the same time, while you’re having to eat the hottest type of peppers and the smell of rotten meat penetrates your skin. I bet those last two weren’t in there, but sensory overload affects all five senses. Now imagine not being able to escape any of these sensory experiences. Imagine what it’d be like having this experience 24/7. You’d go freakin’ nuts!

Sensory overload doesn’t always involve a cognitive appraisal of the sensory stimulation, like: “I don’t think people should be playing loud music.” It doesn’t even always involve fear-related appraisals, like: “This noise is a threat, I feel like it will damage my ears.” When it does involve these types of cognitive processes, we aren’t always aware of them. Older children and adults can learn to become aware of what is going on in their minds and register any fearful or angry thoughts they may have towards the sensory stimulus. Then they can begin to learn to adjust these thoughts. But when there are no such thoughts, or when the person is unaware of them, how will attributing their reactions to some type of willful behavior help them?

If noise were blasting at the loudest volume, bright lights were shining into your eyes, insects were crawling under your skin, etc., wouldn’t you feel pain? You would! Think of sensory overload as pain. And while cognitive and behavioral strategies can help people manage pain, attributing their pain-related behaviors to willfulness is not only insensitive, but ineffective as well.

Everyday Gyaan

#DearSoandSo: Psychological Evaluations

Dear evaluating psychologist,

You don’t know me yet. Soon, you’ll know me as the blind, autistic person who was born prematurely. Then, you’ll hopefully get to now me as Astrid. I was referred to you by the autism center’s consultation team for neuropsychological and intelligence testing.

You need to know that I am a survivor of psychological trauma. I won’t disclose any details, but it’s important that you know that psychological evaluations are a big trigger for me. They are very intimidating. As a result, I might dissociate and put on a mask, which might influence my performance.

I ddon’t know how exactly to prevent myself from dissociating or putting on a mask. I also don’t know for sure what you can do to help me. However, I would suggest you refrain from making assumptions about my performance prior to or during testing. I will try to remember that I’m still me with my abilities and difficulties, regardless of the outcome of testing. However, this is hard to remember.

I hope that the testing experience will be as stress-free as possibe. Thank you for any help you may be able to provide.

Kind regards,

Astrid

I went to the country’s top notch autism center, which happens to be in my town, yesterday. They thankfully believe I’m on the spectrum and don’t see a need to re-evaluate me. They however recommended intelligence and neuropsychologcal testing to find out why I function at a much lower level than my verbal ability would suggest.

They also recommended a sensory processing evaluation. I have suspected I have sensory processing issues for a long while, but now that I think on it, I may ask specifically about auditory processing. I used to be seen as an auditory learner (probably because my tactile skills were worse), but I still have a lot of difficulty understanding speech when there’s background noise. I also tend to process speech with some delay it seems. For example, I’ll say “What?” and then realize I did hear what was being said. Some people in the sensory processing disorder community said that auditory procesisng is different from sensory integration, so I’ll have to ask specifically about this.

Lastly, they recommended a support worker come to visit me at home and in the institution to establish my independence and support needs. Then, they could help me develop greater independence skills.

Dear So and So at Mummy from the Heart

Sensory Processing Difficulties in Autism #AtoZChallenge

Welcome to another day in the A to Z Challenge, in which I write about autims. Today, I write about an important aspect of difficulty in autistic people: sensory processing. Sensory processing disorder (SPD) is sometimes also diagnosed in non-autistic children. Therefore, this piece may be useful for both people interested in autism and those dealing with SPD kids.

Sensory processing refers to the way the nervous system receives and interprets messages from the senses and turns them into appropirate motor or behavioral reactions. There are many different ways in which sensory processing difficulties can manifest themselves in people with SPD or autistic people.

The most common type of sensory processing disorder is sensory modulation disorder, which means an affected person over-responds or under-responds to sensory stimuli or seeks sensory stimulation. In autistic people, the stereotypcal (self-stimulatory) movements that are a core symptom of autism, are usually interpreted as a sensory modulaton issue. In fact, unusual sensory responses are a core symptom of autism in DSM-5. Some people are mostly sensory seekers, sensory over- or under-responders, while others exhibit mixed features.

In addition to sensory modulation disorders, sensory-based motor disorders (eg. dyspraxia) and sensory discrimination disorders are other subtypes of SPD. The symptoms of these disorders are not autism core symptoms but they are common in autistic people too.

I myself have many different symptoms of sensory processing difficulties. For example, I avoid certain textures. I wouldn’t wear jeans until age twelve, still hate the feel of brushing my teeth and dislike getting my hands dirty sometimes. These are symptoms of sensory over-responsiveness. So are being a picky eater and sleep problems, both of which are common among autistic people.

Symptoms of sensory under-responsiveness include appearing unreactive and slow, having extreme difficulty waking up, lacking awareness of pain and difficulty with toilet-learning (because of not feeling the urge to go). I myself do not have most of these symptoms.

Sensory seekers might appear impulsive. They often fidget excessively, climb or jump when it’s not appropriate, bite or suck on clothes, pencils, etc. I did/do many of these things.

I also have many symptoms of sensory-based motor disorder (dyspraxia), such as being uncoordinated and clumsy. Lastly, people with sensory discrimination disorder often have difficulty with tasks such as dressing and eating, have poor handwriting and will drop objects constantly.

How to tell if your child with sensory processing difficulties has SPD or autism? Since many of the sensory processing difficulties listed above are common in autistic people too, this may be hard. Sometimes, getting an autism diagnosis might be beneficial for the sake of treatment, because many health care systems do not fund therapy for sensory processign disorder. There are, however, difficulties in autistic people that those with “pure” SPD do not have. For example, autistic people often have difficulties with theory of mind (the ability to understand and respond to others’ motives and feelings) and executive functioning (organizational skills). If, in addition to sensory processign problems, your child particularly has social communicative problems, it may be advisable to have them evaluated for autism.

Motor Deficits: Dyspraxia

I have had mild motor deficits all my life. Since I don’t know whether they have ever been diagnosed and if so, as what, I try to learn about conditions such as developmental coordination disorder, and strategies that work for people with similar problems.

Dyspraxia is similar to developmental coordination disorder (DCD). DCD is a somewhat misleading name for the whole construct of dyspraxia, as dyspraxia can, besides fine and gross motor skills, also affect speech as well as sensory processing. Dyspraxia is seen as a subtype of sensory processing disorder (sensory integration dysfunction) where the brain has trouble interpreting and responding to the body’s movements..

According to the National Center for Learning Disabilities (NCLD), there are several different types of dyspraxia. These are:


  • Ideomotor dyspraxia: where a person has trouble executing single-step motor tasks such as waving goodbye.

  • Ideational dyspraxia: problems occur with multi-step tasks, such as brushing teeth, making a bed or putting on clothes in the right order.

  • Constructional dyspraxia: affects ability to establish spatial relationships, for example, moving an object from one place to another correctly.

  • Oromotor dyspraxia: affecting the ability to control the muscle movements necessary for pronouncing words.

Dyspraxia can cause many different problems at various stages in development. The NCLD lists these difficulties by age. Young children may have trouble learning to crawl, roll over, walk, jump or skip. In adition, they may have trouble in the following areas:


  • Prnouncing words and being understood.

  • Developing hand preference.

  • Sensitivity to touch, such as clothes touching the skin, hair-combing or tooth-brushing.

  • They may bump into things frequently>./LI>

As children age, the following difficulties may emerge:


  • Poor pencil grip and handwriting.

  • Difficulty with fine motor tasks such as buttoning clothing and cutting with scissors.

  • Problems in playing sports.

  • Difficulty sensing direction.

  • Difficulty speaking at a normal rate or volume.


Additionally, children with dyspraxia may have trouble with social skills and have phobias or obsessions.

Teens and adults with dyspraxia may have problems in the following areas:


  • Speech control, such as volume, pitch, articulation.

  • Writing and typing.

  • Over- or undersensitivity to touch, light, smell, taste, etc.

  • Personal grooming and other self-help tasks.

  • Cooking and other household tasks.

  • Driving

The Dyspraxia Foundation lists many other symptoms of dyspraxia, such as motor overactivity, excitability, messy eating, lack of sense of danger (probably due to sensory seeking behaviors, as an example the Foundation lists is jumping from heights).

I do not have all symptoms of dyspraxia. For example, I am very much right-handed, though an old educational psychologist’s report says my lateralization was poor (at age eight). Some symptoms can also be explained by my blindness (such as my bumping into objects). I am, however, told that my messy eating, oromotor difficulties, difficulties with complex tasks such as making a bed, balance problems, and sensory over- and underresponsivity, are not normal for a blind person. I do not truly want a label for these, but I am finding that it is extremely hard for me to explain these problems to my treatment team, and they affect me to a great extent.

“Autistic Traits”

A few days ago, Jessi over at Deciphering Morgan wrote a post on autistic traits vs. autism. I came across it through a response by Stacey of We Are the Brothers B. Stacey”s son Thomas has “autistic traits”.

What annoys me about the “autistic traits” thingy, is that it often connotes that 1. everyone who is a little socially awkward, has them, and 2. having autistic traits means you’re not as severely disabled as someone with full-blown ASD.

To start off with the first, I am aware that there is something called the broader autism phenotype, which includes people who are socially awkward and a little routine-oriented, but not enough to meet the criteria for an autism spectrum disorder. The important thing is that people on the broader autism phenotype usually do not have disabling symptoms. In both DSM-IV and DSM-5, it is a requirement for an autism diagnosis that your daily functioning is impaired to some degree. In my opinion, just being somewhat of a loner with a couple of friends, is not an impairment. Saying you have “autistic traits” when you’re truly just an introvert, trivializes the impairmetns of those with actual autism or significant autistic traits.

Then on to the second idea, which is pretty much the polar opposite of the first: people who just have “autistic traits”, are not severely disabled. Please realize that you cannot be diagnosed with autisms pectrum disorder in DSM-5 unless you meet all three social/communicative impairment symptoms. Autism is still seen as a social cognitive disorder, and I’m not sure that I think of this, but people who are pretty sociable, cannot be diagnosed with autis under DSM-5. Social development, however, is just one area impaired by autism. I for one am relatively sociable, but I still have severe difficulties in sensory processing and executive functioning, leading to quite severe impairments in self-help skills, significant behavior problems, etc.

Both my former nd current therapist trivialized my autistic impairments by referring to me as having “autistic traits”. I do have a formal diagnosis of an autism spectrum disorder, but havin this diagnosis constantlydownplayed, confuses and irritates me. Sensory processing disorder is not as much of a recognized disorder here as it is in other countries, but even if it were, the connotation is still that SPD is less severe than ASD. Executive functioning disorder is not recognized by most clinicians at all. This leaves a lot of children and adults with severe sensory processing or executive functioning difficulties either getting the wrong diagnosis, or getting less suppor than they need. I am not sure whether I believe adding more labels to the diagnostic manuals, is the solution to this. However, I do believe that children and adults who are having a lot of difficulty functioning in life, should get the support they need.

What Is a Sensory Diet?

Sensory processig disorder (SPD) refers to a group of disorders that cause problems regulating and processing sensory input. Sensory issues can also be prevalent in autistic individuals. I for one have strong sensry needs, and have lately considered creating my own sensory diet.

What is a sensory diet? It involves all sensory input we deliberately create to meet a person’s sensory needs. I reckon it can also be sensory input we remove, because some people actually get overloaded by certain stimuli. In sensory integration dysfunction, a particular type of SPD, people roughly fall into two types or a combination of both: sensory seeking and sensory avoidant. I for one avoid certain stimuli and crave others, which both can be addressed in a sensory diet.

Here are some examples of sensory activities and input you can use in a sensory diet:


  • Fidgeting. This is perhaps the easiest to incorporate, as anyone can be fidgeting. It may be necessary to teach yourself or the sensory person in your life to fidget in a non-obvious way as to minimize social stigma. Then again, consider also educating the people aroudn the sensory person about toleracnce of varying sensory needs.

  • Weighted blankets or vests. I have not found a weighted blanket in the Netherlands, but honestly have not been looing yet. A weighted blanket, as the term says, is a blanket with extra weight added to it to provide deep pressure. Even people who may be sensory avoidant towards the slightest stimuli, may like this. A weighted vest should not be worn all day. I don’t know about a weighted blanket for sleep.

  • Play dough or clay. Use play dough for a younger child and perhaps some type of clay for an older child or adult. I prefer polymer clay to earth clay because it gets less messy.

  • Swinging, jumping, running, exercise. This seems more appropriate for a child, but then again sensory needs don’t cease to exist when a child grows up. Adults might like to swing too. As an alternative if no swings are available, consider certain types of exercise.


These are all activities for the sensory seeker. For the sensory avoidant person, you may need to eliminate certain stimuli. For example, a person might want to choose dim lighting in their house (I realize this is not an option in schools or public places). There are lamps that shine upward to provide a more even lighting experience.

Most SPD people have trouble integrating multiple stimuli. Avoid having the radio or TV on when talking to them for this reason. It may seem like an inconvenience, but please realize most SPD people are already overwhelmed by the lighting in a room and ordinary sunds that cannot be eliminated. Note please that thoughtless exposure may ultimately teach a sensory person to avoid meltdown, but will not get them to avoid overload.

This Is Autism

Last week, Autism Speaks told the world that autism is a number of bad things, including fear of the future, life in despair, a burden, etc. As a response, there’s a flashblog going on today where autistics and allies submit their art, videos and blog posts on what autism really is. Here’s my contribution.

Let’s start with the facts. Autism is a developmental disability that causes problems in information and sensory processing. This leads to behaviors such as repetititiveness, withdrawal and different ways of communicating and relating to others.

Autism for me has both positive and negative consequences. One of the phrases that Autism Speaks likes to associate with autism, is in fact correct for me: fear of the future. This, however, is a pretty common fear in today’s society. We’re (here in the Netherlands) still in economically hard times, and I personally witness people worrying about whether they’ll get a job, sell their house, etc. These are fears for the future. They may not be the same as mine – I worry about health care cuts -, but it’s not like my worries are unique to autistics and their families.

Autism sometimes makes it harder for autistics to participate in society – or is it society’s unwillingness to adapt to autistics’ differences? These differences, in my case, include inabiity to handle intense, unexpected stimuli and/or multiple stimuli at once. I know that not all these can be prevented, but it’s people having a mindset that autism is ultimately something that needs to be eradicated at least on the surface, that makes it worse. This attitude leads to people seemingly deliberately ignoring my sensory needs for the sake of treatment. And no, this is not a consequence of autism, this is a consequence of intolerance.

I will not go so far as to say all autistic experiences are due to discrimination. As I said, not all difficulties can be avoided. Yet neither can all difficulties for a neurotypical. Some autistics, including myself, have it harder than most neurotypicals. I won’t deny this, and I won’t deny that autism sucks sometimes, but so do a host of other experiences that we don’t give nearly as much attention to eradicating as Autism Speaks does with autism.

Autism and Justified Anger

On my autism treatment and acceptance, Autisticook commented by saying that anger in an autistic is often justified. She compared it to the situation where a wheelchiar user gets angry because they are faced with yet another two-step staircase that wasn’t necessary and where nobody thought of installing a ramp. This made me think: are we overpathologizing anger in people with developmental disabilities (and mental illness)? Are we incorrectly assuming that anger is part of the disorder, while it’s just a response to a lack of accommodations? This is obviously not a scientific discussion, as what is a reasonable accommodation depends on your perspective.

I just a few days ago heard about cognitive accessibility, where people accommodate their language, for exxample, for understanding by people with learning difficulties. I’m trying to find an accessible and understandable explanation of this, but can’t seem to find one. What I understan dit to mean, includes for example using simple, straightfoward language. With autistic people, you may need to refrain from using figures of speech, for example.

What if you were dropped in a country where you didn’t speak the language and everyone refused to speak English? Would you get angry? Quite likely you would. Now understand autism as communicating in a different language, too. Is it strange then that the autistic gets angry when you routinely refuse to make an effort to speak their language?

Autism is not just a communication disability. It’s in a way a sensory disability, too. Imagine, again, being in that foreign country and everyone shouting at you for whatever reason. They also randomly shine a flashlight at your eyes for whatever reason. In addition, this country is rich on insects, and they crawl over your body all the time. Would you get frustrated? Sure you would!

We do not medicate wheelchair users for getting frustrated at the umpteenth staircase. You would not want to be put on medication if you were in the aforementioed country. So why do we medicate autistics who are irritable? It’s probably because accommodating them requires a radical paradigm shift in what we always thought access was all about. Is it a more radical shift than the shift towards wheelchiar accessibility? I am not sure.