Demystifying Sensory Approaches to Intervention for Children with Autism Spectrum Disorder
Brittany Koenke, OTD, OTR/L, SWC; Emily Campi, MA, OTR/L; Allison Q. Phillips, OTD, OTR/L; Emily Sopkin, OTD, OTR/L;
and Grace T. Baranek, PhD, OTR/L, FAOTA, Associate Dean and Chair
Calvin (pseudonym) is a 7-year-old boy who enjoys spending time with his friends and playing tag. His story will help to demystify sensory approaches to intervention. Calvin sees his friends and family riding bikes and wants to join them, but he cannot get his body to move in the right way at the right time to ride like everyone else. His parents hate to see him feeling so left out, so they seek an occupational therapy evaluation to better understand Calvin’s difficulties. The occupational therapist (OT) immediately recognizes that some of Calvin’s difficulties may be related to “sensory integration,” which is the neural process of taking in sensations from our environment, filtering them, and responding with an appropriate action. The OT explains to Calvin’s parents that the development of sensory integration occurs prenatally and throughout childhood, and sensations include sights, tastes, smells, touch, sounds, movement, positions in space, and information from our internal organs. She also lets them know that, after completing an evaluation to determine Calvin’s specific strengths and needs, she will likely use many interventions, or “sensory approaches,” which provide specialized sensory information to support children with sensory challenges, including those with autism.
The OT evaluation showed that Calvin’s sensory challenges stretched beyond riding a bike to difficulties with bilateral coordination (using both sides of his body together), postural control (keeping his body upright and centered), safety awareness, maintenance of attention, and diminished pain sensation. Calvin’s parents and the OT worked together to select appropriate goals and plan ways to support Calvin’s progress.
Calvin’s OT sessions often consisted of sensory integration therapy, or Ayres Sensory Integration (ASI®), a specific play-based therapeutic intervention developed by Dr. Jean Ayres. Calvin’s OT has specialized training so that she can use the core principles of ASI® as a treatment approach. Calvin loves participating in ASI®, because the specialized therapy room has swings, climbing equipment, and crash mats where Calvin can take the lead and choose to experience many safe, manageable, and challenging tactile, proprioceptive (position sense), and vestibular (movement sense) sensations. The OT is always monitoring Calvin’s responses to these experiences and adjusts activities accordingly. He and his OT often pretend to be in the jungle or on a quest to find the treasure when they encounter obstacles they need to climb over, jump off, and more. Little does Calvin know, his OT carefully curates activities to create the “just right challenge:” not too easy, but not too hard. Over time, Calvin is able to take on increasingly difficult challenges as his ability to locate his body in space and use both sides of his body together improves. Eventually, these new skills will help him learn to ride his bike.
Calvin’s OT also uses sensory-based interventions (SBIs). Since Calvin can take the lead on many activities, his OT recommended primarily active SBIs, meaning that Calvin can choose what he needs to increase or decrease his level of alertness and attention. The OT also suggested that Calvin participate in “heavy work” (proprioception), such as emptying the dryer or bringing clean laundry in a basket to his room. These activities provide him with the sensory input he needs to become aware of where his body is in space. Calvin’s mom, during one of her weekly conversations with his OT notes that after “heavy work” activities Calvin seems more aware of his body and less likely to bump into furniture and get hurt. Also, his OT recommended that his mom can help him when he is slouching during mealtime by giving him a textured, inflated cushion for additional sensory input to assist with his sitting posture and engagement during seated activities. Since this is a seating arrangement that is done without Calvin’s help, the wiggle cushion is considered a passive SBI.
Lastly, Calvin’s OT recommends a few sensory environmental modifications to make the physical environment more conducive to Calvin’s sensory needs. He uses alternative seating at home, such as a bouncy ball to sit on during homework time. This helps to increase his alertness and attention so he is just right for learning. His home environment now includes a quiet space where he can do his homework with headphones to limit auditory input and soft lighting to reduce distractions from potential buzzing lights. Calvin and his family also enjoy attending sensory friendly events, such as movie night at the park with many seating options and space to move if needed.
Since every child is unique and so are their sensory needs, it is important for a child to receive a thorough evaluation with tailored treatment with an OT knowledgeable in sensory integration theory, assessment, and intervention. Communication with all members of the interdisciplinary team, including parents, is key to best support children with sensory challenges to participate fully in their daily lives.