Sensory Issues: Seeking and Avoiding

Date Last Revised: October 30, 2008
Date Published: April 2, 2007

We know that individuals with ASDs struggle to navigate the social world with an impaired “social sense.” The way the world is experienced through other senses is also often off kilter. This has been noted since the very earliest descriptions of the disorders,¹  and appears in autobiographical reports of individuals with ASDs, accounts provided by parents of children with ASDs, and in the observations of clinicians working with people “on the spectrum.”

Some individuals with an ASD can be hypersensitive, that is over-sensitive, to stimuli such as sound or touch. For example, a child with an ASD might hold his hands over his ears and crawl under a table in a noisy, crowded room, or panic at another person’s attempt to put their arm around him. Other individuals appear to be hyposensitive, that is under-sensitive, to sensory information coming at them from the environment. For instance, a child may act so unmoved by someone’s voice that she appears deaf even although her hearing is perfectly intact.

What is truly perplexing for those observing from the outside is that a single person with an ASD can be both hypersensitive and hyposensitive, not only to different sensations, but to the same ones.^2,3   Temple Grandin, a well known author and speaker who has an ASD, reported how she would flee from an embrace, and yet seek out “deep pressure” sensations elsewhere:

"From as far back as I can remember, I always hated to be hugged. I wanted to experience the good feeling of being hugged, but it was just too overwhelming. It was like a great, all-engulfing tidal wave of stimulation, and I reacted like a wild animal. Being touched triggered flight; it flipped my circuit breaker. I was overloaded, and would have to escape, often by jerking away suddenly." ⁴

Despite this need to escape a random hug, she craved deep pressure so much that she constructed her own “squeeze machine” – a device she could lie in lengthwise and use to apply pressure to the entire length of her body. The pressure, she found, helped her to combat anxiety and panic attacks.⁵

This issue surrounding pressure shows that more than the usual five senses – sight, hearing, smell, taste, and touch -- are involved. Two additional senses which are often discussed are the propioceptive sense (which involves knowing what your muscles and joints are doing and where you are in space) and the vestibular sense (which is related to the inner-ear and involves your awareness of movement, head position, and balance). “Some individuals,” writes one expert, “seek propioceptive input by crawling under furniture or into small, cramped spaces, or seek vestibular input by spinning, swinging, or bouncing repetitively.” ⁶

It is thought that hyper-responsiveness – that is, being extremely sensitive -- might be connected to flight-or-fight reactions, and that hypo-responsiveness – that is, seeming not to feel or hear something significant -- may be a part of the general tendency of people with ASDs to become over-focused on an object or single aspect of the environment while shutting out the larger world.⁷

Despite the current lack of thorough scientific findings, “clinical and treatment literature treats sensory dysfunction as an established core deficit in autism… Sensory integration theory is widely applied to autism by practitioners.” ⁸

In other words, those who live with or treat individuals with ASDs observe these sensory issues at work daily, adapting the environment and treatments to address them. Occupational therapists (OTs) have become the key providers of "sensory integration" treatments. (In one survey, 99% of OTs were using sensory integration methods with clients “on the spectrum;"⁹  in another, Sensory Integration was shown to be the third most common treatment used by parents of children with ASDs.1⁰)  A number of research projects aimed at finding out whether these treatments are truly effective are underway.

In any case, it is evident that noise, light, and other aspects of the environment that most people filter out and ignore can become like an assault for a person with an ASD. Understanding this can help families and other supporters comprehend how a classroom or a workplace that looks OK to a typical person can seem deafening, blinding, and otherwise nerve-wracking to a person with an ASD.

References: 

1. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.
2. Baranek, G.T., Fabian, J.D., Poe, M.d., Stone, W.L., & Watson, L.R. (2005). Sensory experiences questionnaire: Discriminating sensory features in young children with autism, developmental delays, and typical development. Journal of Child Psychology and Psychiatry, 47(6), 591-601.  Abstract
3. Baranek, G.T., (2002). Efficacy of sensory and motor interventions for children with autism. Journal of Autism and Developmental Disorders, 32(5), 397-422.  Abstract
4. Grandin, T. (2006). Thinking in pictures: My life with autism. (Exp. ed.) New York: Vintage Books. (Page 58)
5. Grandin, T. (2006). Thinking in pictures: My life with autism. (Exp. ed.) New York: Vintage Books. (pp 58-83)
6. Lord, C., & Spence, S. (2006). Autism spectrum disorders: Phenotype and diagnosis. In S. Moldin & J. Rubenstein (Eds.) Understanding autism: From basic neuroscience to treatment. (pp. 1-23). Boca Raton, London, New York: Taylor & Francis.
7. Baranek, G.T., Parham, L.D., Bodfish, J.W. (2005). Sensory and motor features in autism: Assessment and intervention. In F. Volkmar et al. (Eds.), Handbook of Autism and Pervasive Developmental Disorders (pp.831-857). Hoboken, NJ: John Wiley & Sons.
8. Rogers, S.J. , & Ozonoff, S. (2005). Annotation: What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry, 46(12), 1255-1268.  Abstract
9. Watling, R., Deitz, J., Kanny, E.M., McLaughlin, J.F. (1999). Current practice of occupational therapy for children with autism. American Journal of Occupational Therapy, 53(5), 498-505.  Abstract
10. Green, V.A., Pituch, K.A., Itchon, J., Choi, A., O’Reilly, M., Sigafoos, J. (2006). Internet survey of treatments used by parents of children with autism. Research in Developmental Disabilities, 27(1), 70-84.  Abstract