Lightening Round Interview 5: Autism and Sensory Needs

Lightening Round Interview 5: Autism and Sensory Needs

Welcome to another installment of Lightening Round Interviews. For these interviews, I speak with experts in various professions related to speech language pathology and early childhood development.

Today, I’m thrilled to welcome Maria Del Duca, a speech language pathologist certified by the American Speech-Language-Hearing Association (ASHA) with expertise in assessing and treating individuals with Autism Spectrum Disorders. Maria has years of experience treating individuals with autism and has earned a certificate of completion for Greenspan’s Floortime Approach. She is also the author and creator of numerous speech therapy products available through her online store and author of the Kid Confidential monthly column on ASHAsphere. Maria will participate in a lightening round interview of 5 questions on the importance of understanding and tackling the sensory needs of individuals with autism for speech therapy. The first question is always personal and related to how the interviewee became interested in working in a particular area or with a special population. For the last question, I ask for recommended resources.

1. Maria, you specialize in assessing and treating individuals with Autism Spectrum Disorders (ASD). How did you become interested in serving this population?

Answer: My very first client in my CFY was an 18 month old female with what we now would most likely characterize as having “classic autism”.  Firstly, having the diagnosis at such a young age for a female 12 years ago was pretty rare so you can imagine how profoundly delayed she was.  From the moment I met her, I just fell in love with her, her idiosyncrasies and the nonverbal ways she communicated information to me.  It seemed as if I could understand her in a way her wonderful parents just couldn’t.  Then I attended a one day CEU course presented by an OT and SLP discussing sensory processing, sensory processing disorder and how we as SLPs can provide sensory integration activities in speech therapy as a means to stimulate language development.  I, of course being the eager beaver that I was, went right back to speech therapy and trialed these techniques and was amazed at the progress my 18 month old client made in such a short time in social reciprocity, joint and sustained attention as well as the significant reduction in her exhibition of stimulatory behaviors.  So you could say from that moment on I was hooked!  I wanted to read and research everything I could about ASD and sensory processing disorder so I could find a way to help these clients.  Over the years, I have continued to research and have been lucky enough to work closely with an OT who was very knowledgeable in sensory processing, sensory processing disorder, and creating sensory diets.  I have been a sponge soaking up all the wonderful knowledge she has taught me and I have added all to my speech therapy arsenal.

2. Terms that are becoming more and more common when talking about autism are sensory integration difficulties, sensory sensitivities, sensory problems and even sensory integration dysfunction. What are some obvious signs of these difficulties? What are some subtle signs that are important to recognize but often overlooked or missed?

Answer: Sensory integration, also known as sensory processing, is not a new concept.  In fact, in the 1960s, the term sensory integration dysfunction was coined and introduced into occupational therapy literature by Anna Jean Ayers.  Therefore, difficulties in sensory processing have been documented and explored for over 50 years now in the OT field.  We as SLPs, in my opinion, are getting a late jump on this crucial information and just beginning to document the positive effects of supporting a sensory diet or accommodating for sensory differences in our therapy sessions.  Sensory processing difficulties can occur in any or multiple areas of sensory integration and can be manifested in very overt or subtle behaviors in our children with ASD (and some research is suggesting a percentage of children with ADHD may also present with sensory dysfunction as well).  Here are some examples of overt signs of sensory processing issues we may have seen in children with ASD: constant humming/noise making, rocking back and forth, jumping around in circles, hand flapping, mouthing non-food objects (which may or may not actually be PICA, as PICA is defined as an appetite for various non-food items, whereas some children with ASD mouth non-food items for sensory input rather than actually craving the taste of certain non-food objects), etc.  A few less obvious signs may be children who require the use of hats/hoods/sunglasses indoors due to visual sensitivities, noise canceling headphones due to auditory sensitivities, intently driving cars on floor/table/windowsill as a means of filtering light, preoccupation with spinning toys also for the purpose of light filtering, avoidance of food textures, tastes or temperatures, etc.  Behaviors do not have to be disruptive to indicate sensory integration dysfunction.

3. As a fellow speech language pathologist who also works with many children with ASD, it’s important for us know how to appropriately respond to our client’s sensory needs to have successful speech therapy intervention. Some children may be hypersensitive while others may be hyposensitive. Can you please explain how children who are hyposensitive have different sensory needs than those you are hypersensitive?

Answer: I like to think of these extremes of sensitivities as filtering issues.  We have to ask ourselves how well do children filter the sensory information coming into their central nervous system (CNS).  For those who exhibit hypersensitivities in sensory areas, it means they are UNDER-filtering, meaning they are allowing both the important and unimportant sensory information into their CNS, therefore, they tend to be easily overwhelmed by sensory information.  Children who are hypersensitive in various sensory areas will OVER-react to small amounts of sensory information.  For example, a hypersensitive child to auditory stimuli, may struggle to tolerate sounds louder than a whisper or an “indoor voice”, or may become completely overwhelmed when more than one person is talking at a time, etc.  Hypersensitive children, typically exhibit avoidance behaviors related to the sensory area in question.  These children require environmental accommodations in order to successfully reach a state of alertness in order to learn.

Hyposensitive children on the other hand, OVER-filter information, meaning they filter both important and unimportant sensory information thus blocking information from entering their CNS.  Children with hyposensitivities, tend to UNDER-react to situations and require sensory information to reach a higher level of threshold for the child to register the sensory input as compared to typically developing peers.  These children may be described as “having no fear”, “having a high pain tolerance”, “highly energetic”, etc.  Therefore, these children exhibit sensory seeking behaviors.  They are searching for and needing sensory input to maintain and sustain an alert state for learning.

This is of course a brief, simplified overview of these terms.  There is much more to understand and learn regarding sensitivities in children with sensory processing issues.

4. Can you share any tips or suggestions on how to treat children who crave sensory input and as a result may spin, flap their hands, or rock during speech therapy sessions? How can speech therapists and occupational therapists work together to target the sensory needs of our clients/children?

Answer: The first thing I would recommend when working with children with sensory needs, is to spend time observing the children, getting a complete background and family history from the child’s parents and completing a sensory processing checklist (there are several free ones online) to determine the types of sensory processing the child exhibits and in what particular areas they seem to have difficulty processing.  You can do this independently if you have experience in this area or in conjunction with an OT that has experience with sensory processing disorder.  Working together with an OT to determine an appropriate sensory diet is a wonderful way to collaborate and share your observations and information regarding your client’s preferred stimulatory behaviors.

However, in many therapy settings and in many regions across the U.S. we as SLPs will not have access to an OT for assistance.  However, the lack of an experienced OT does not also remove the child’s need for sensory input, stimulation or accommodations.  Therefore, my second tip is to read the available research on SIT (sensory integration therapy), participate in CEU programs on the topic, and buy available resources found online.  Knowledge is power and the more you know, the more you will understand and the better you will be at serving your clients.

5. Can you recommend any resources (books, websites, others) to help readers learn more about sensory difficulties that people with ASD may experience?

Answer: There are a number of wonderful resources available to therapists who want to learn more on this subject. I recommend reading:

How Does Your Engine Run? Leader’s Guide to the Alert Program for Self Regulation

Take Five!: Staying Alert at Home and School both by Mary Sue Williams and Sherry Shellenberger 

Other great resources are:

Answers to Questions Teachers Ask about Sensory Integration: Forms, Checklists, and Practical Tools for Teachers and Parents
by Jane Koomar, Carol Kranowitz, Stacey Szklut,  Lynn Balzer-Martin

 The Out-of-Sync Child
by Carol Kranowitz and Lucy Jane Miller.

In addition, I have a number of products available through my online store which are created by an SLP for SLPs and are quite reasonably priced.  Please explore the following:

• Sensory Needs and ASD: What EVERY SLP Should Know!This 24 page PDF file is a basic view of sensory processing needs of children with ASD and what speech-language pathologists must understand so as to meet the sensory needs of their students in order for learning to occur.  This file addresses incidence of sensory processing issues in children with ASD, the implications for speech therapy, definitions of sensory processing and sensory processing disorder, filtering issues and the effects on self-regulation, self-regulation and learning, hyper- and hyposensitivity related to sensory needs, how to work with students with sensory needs, available sensory processing checklists to evaluate sensory needs, and examples of classroom accommodations for children with sensory needs.
• Practical Ways to Meet Sensory Needs of Students in the Speech Therapy Room!  This 45 page PDF file provides an extensive list of ideas, strategies, accommodations, modifications, and activities any speech-language pathologist can implement within the therapy room, before or after therapy, in the classroom setting, private practice, or home-based therapy in order to meet the sensory needs of their students/clients.
• Beyond Eye Contact: Connecting with Young Pre-Verbal Children with ASDThis 47 page PDF explains the 5 main steps to take in order to make an initial connection with the child who seems to be disconnected with the world around him.  It’s a culmination of 12 years of my clinician experience and research of numbers therapy techniques and models

Thank you, Maria for participating in my Lightening Round Interviews! Readers, I hope you have found this Q and A helpful! To learn more about Maria, please visit her blog, Communication Station.

Previous Lightening Round interview topics include:

Oral Motor Development and Pacifiers

Bilingual Language Development

Executive Functions and Speech Therapy

Language and Picky Eating in Internationally Adopted Children

Kimberly Scanlon, M.A. CCC-SLP is a speech language pathologist, an author and a mother. As the owner of Scanlon Speech Therapy, LLC, a unique boutique practice in Bergen County, Kimberly embraces individuality and treats the whole person. Her goal is to spread compassion, hope, and some speech, language and literacy tips one moment, one person at a time.  Her first book, My Toddler Talks: Strategies and Activities to Promote Your Child’s Language Development and her second book, Learning to Read is a Ball are available for purchase at online at Amazon and Barnes and Noble.