Monday, April 22, 2013

Don't Obsess with Behavior, Consider Stimuli too

Here's an article that is helpful...

~ Shien

Hyper- and Hypo-sensitivity in Children with Asperger’s and High-Functioning Autism

Children with Asperger’s (AS) and High-Functioning Autism (HFA) often fluctuate between hyper-sensitivity (i.e., being overly sensitive) and hypo-sensitivity (i.e., a lack of sensitivity) to unexpected stimuli in the environment. For example, at one moment a touch or noise may make the child jump or scream, while at another moment she may not respond when parents call her name – or she may act as if the rest of the world doesn’t exist.

For neurotypical children (i.e., those without a spectrum disorder), unexpected stimuli is relatively predictable and anticipated. For example, they expect a loud noise when seeing someone using a hammer, but not when a pillow falls on the floor. They anticipate a hug or a kiss when a grandparent is approaching them with open arms. Even when they don’t notice someone walking up to their front door, the first knock may startle them, but the subsequent knocks don’t, because they anticipate more than one knock. When their mother starts the vacuum cleaner, the noise may surprise them, but they quickly predict that the noise will persist for a while, and they adapt to it. If it is not raining now, they don’t expect rain soon. Thus, for neurotypical children, the world is reasonably predictable – particularly in the near future punctuated only by brief surprises.

In contrast, many children with AS and HFA have difficulty with prediction and anticipation. To these young people, a loving hug by grandma may feel like a shocking squeeze, and noise from otherwise routine events may be largely unexpected and frightening. As a result, they are frequently startled by stimuli in the environment and they overreact. The AS/HFA child’s weak predictive ability makes many daily events very stressful, which contributes to his or her high level of social anxiety. This explains hyper-sensitivity.

As a defense against constant surprises from the world, as well as against overwhelming sensory stimulation and the inability to (a) employ “selective attention” (i.e., focusing on one thing at a time) and (b) “filtering” (i.e., ignoring certain environmental stimuli), AS and HFA children may “suppress” stimuli for long periods of time (i.e., they shut it out and retreat into a world of their own, unaffected by all that goes on around them). This explains hypo-sensitivity.

Hyper-sensitivity primarily occurs due to poor prediction. The AS and HFA child often over-reacts to unexpected loud noises or moving objects. But, it is not the noise or motion itself that is frightening. The youngster himself can happily make as great a noise as any that he is afraid of, and he can move objects about to his heart's desire. He may not want his grandmother to touch him, but he will go and touch her. This is because “self-generated” noise and “self-initiated” touch are relatively more predictable and thus less surprising.

In additional to unwanted surprises, “poor adaptive adjustment” also contributes to the AS and HFA child’s hyper-sensitivity to constant(non-surprising) stimuli (e.g., background noise in an airplane, florescent lighting in the classroom, skin pressure from clothes, etc.). Neurotypical children adapt to such stimuli because they can predict their persistence, and as a result they are able to ignore the stimuli. This “adapting and ignoring” skill helps neurotypical children to label background stimulations as “unimportant.”

When a youngster receives a diagnosed of AS or HFA, educational priorities often focus on behavioral interventions aimed at development of social and communicative skills, while the youngster’s sensory needs are often ignored. As paradoxical as it seems, sometimes AS and HFA kids benefit from being misdiagnosed as having visual and/or auditory impairments. Being placed into an environment where their sensory difficulties are addressed may help these young people to respond to social and communication interventions better than if they were placed into a typical environment where the main emphasis is only on training in social/communicative skills.

AS and HFA children should be protected from painful environmental stimuli. For example, in the case of visual/auditory hyper-sensitivity, visual and auditory distractions should be kept to a minimum. Tactile hyper-sensitivities should be addressed by choosing the clothes and fabrics the youngster can tolerate. If parents or teachers can’t hear, see or smell some stimuli, it doesn’t mean that the AS/HFA youngster is being “ridiculous” if distressed by “nothing at sight.” 

Parents and teachers need to consider the level of “sensory pollution” in the child’s environment. If there are several conversations in the same room, ceiling fans blowing, florescent lights buzzing, and people moving around, the AS/HFA youngster with sensory hyper-sensitivities is sure to be overwhelmed.  However, if the youngster is hypo-sensitive, extra stimulation through the senses that don’t get enough information from the environment should be provided.

Understanding the way children with AS and HFA experience the world will help parents and teachers to respect them in their attempts to survive and live a productive life in a “sensory-unfriendly” world. If we understand how the AS and HFA youngster experiences the world and how she interprets what she sees, hears, feels, etc., we can design treatment programs in accordance with her perceptual abilities and deficits. Understanding each particular child’s specific difficulties and how they may affect her functioning is vital in order to adopt methods and strategies to help her function at home, school and in the community.


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