Sensory Processing and Autism Now days our society is seeing a high increase in the diagnosis of Autism.

In the United States the prevalence is 1 in 150 births. According to the Centers for Disease Control and Prevention, boys are affected more than girls. Autism is a neurodevelopmental disorder characterized by impairments in social skills, nonverbal and verbal communication. It involves repetitive behaviors and unusual interests (American Psychiatric Association, 2000). There is another area that has received great consideration lately, because there are many children with autism that have unusual ways of learning, attending and responding to sensory experiences. People with autism have reported (Shoener, Kinnealey, & Koenig, 2008) that self-stimulatory behaviors often serve as a regulatory function, allowing them to process sensory information from the world around them and attend without the alternative, which is sensory overload. Sensory Integration Dysfunction (SID, also called sensory processing disorder) is a neurological disorder causing difficulties with processing information from the five classic senses (vision, auditory, touch, olfaction, and taste), the sense of movement (vestibular system), and/or the positional sense (proprioception). For those with SID, sensory information is sensed normally, but perceived abnormally. This is not the same as blindness or deafness, because, unlike those disorders, sensory information is sensed by people with SID, but the information tends to be analyzed by the brain in an unusual way that may cause distress or confusion reduction of autistic mannerisms or self-regulatory behaviors may be indicative of a better ability to process sensory stimuli in the environment without the need for regulatory strategies. Jean Ayres developed the theory that is known today as the Sensory Integration Theory. Later on, the Model of Sensory Processing was developed by Karin Dunn. This model was based

in knowledge from neuroscience and behavioral science. The model conceptualizes sensory processings contribution to a childs behavior. Dunns model hypothesizes that an interaction between neurological thresholds and behavioral responses exists (Dunn, 1997). This model illustrate that the neurological thresholds indicate the amount of stimuli needed for a child to notice or react to it. The behavioral responses indicate the manner in which a child responds to stimuli. According to this model, neurological thresholds and behavioral responses fall on a continuum and interact with each other. This is how the four sensory processing patterns that include registration, seeking, sensitivity, and avoiding evolved giving an insight to possible interpretations of a childs behavior. The interaction of neurological thresholds and behavioral responses provides a method for explaining how children process sensory information and guidance for intervention planning (Dunn, 1999). Children with autism have difficulties responding to sensory experiences. They may react in unusual ways. These kids show an apparent inability of the autistic brain properly to encode, decode, integrate and coordinate simultaneously. Humans have interactive sensory systems that include the tactile, vestibular, proprioceptive, visual and auditory information processing. Children with autism may be sensitive and overreact to the different stimulation people encounter in a day. A good example of this could be if a child with autism is overreacting to auditory stimulation and this child could try to escape this stimulation by withdrawing. Other children with autism may exhibit self-stimulatory, and repetitive behaviors such as rocking, spinning, or flapping their hands, these children may be seeking vestibular input. Children with autism often dont recognize the sensory input that it is important; at other times, they are overly sensitive to sensory input and withdraw from stimuli (Ermer & Dunn, 1998). Children with autism dont recognize the pattern of responding to the sensory processing and this makes it

difficult for a child to learn because that student is missing the important information from instruction. It is also very important to keep in mind that the brain only deals with information it receives and is equipped to interpret. It does not know what it does not have. It does not that it is supposed to have or do something, nor how its body is supposed to act in certain circumstances that appear alien to the brain. The brain is concerned with the survival of the body. It will call any response that directly addresses physiologic safety and comfort ( ). Unfortunately for autistic and other atypical persons, those responses do not always correspond with socially approved behaviors. The brain may not be able to redirect nervous energy away from hand flapping or any other self-stimulatory behaviors. The brain may not be able to decipher the meaning and organization of fragmented visual and auditory information it receives in order to tell the eyes to gaze directly into someones face, or the ears to focus on verbal language while tuning out unrelated sounds. In fact, autistic behavior is normal for that system and atypical for people. SID can be a disorder on its own, but it can also be a characteristic of other neurological conditions, including Autism Spectrum Disorders, dyslexia, developmental dyspraxia, Tourette syndrome, multiple sclerosis, and speech delays, among many others. Unlike many other neurological problems that require validation by a licensed psychiatrist or physician, this condition is most often diagnosed by an occupational therapist. Developmental pediatricians, pediatric neurologists, and child psychologists are increasingly diagnosing it. While it has not yet been included in the American Psychiatric Association's Diagnostic and Statistical Manual as a discrete diagnosis, Regulatory-Sensory Processing Disorder is an accepted diagnosis in Stanley Greenspans Diagnostic Manual for Infancy and Early Childhood and the Zero to Threes Diagnostic Classification. There are now 3 types of Sensory Processing Disorders, as classified

by Stanley I. Greenspan as supported by the research of Lucy, J. Miller, Ph.D., and OTR. These new terms are meant to increase understanding between Occupational Therapists and other professionals who frequently encounter SPD and physicians and other health professionals who approach sensory integration from a more neurobiological vantage. This understanding is critical as physicians are responsible for diagnosing SPD, which is a necessary step in accessing reimbursement (eventually from insurance companies) for professional services to treat SPD. Sensory Processing Disorder is being used as a global umbrella term that includes all forms of this disorder, including three primary diagnostic groups: Type I- Sensory Modulation Disorder Type II- Sensory Based Motor Disorder Type III- Sensory Discrimination Disorder Type I- Sensory Modulation Disorder (SMD)- Over- or under responding to sensory stimuli or seeking sensory stimulation. This group may include a fearful and/or anxious pattern, negative and/or stubborn behaviors, self-absorbed behaviors that are difficult to engage or creative or actively seeking sensation. Type II- Sensory Based Motor Disorder (SBMD)- Shows motor output that is disorganized as a result of incorrect processing of sensory information. Type IIISensory Discrimination Disorder (SDD)- Sensory discrimination or postural control challenges and/or dyspraxia seen in inattentiveness, disorganization, poor school performance. There is no known cure; however, there are many treatments available. Sensory integration needs therapy, and there are many therapies available out there. The most common known is a type of occupational therapy. Sensory integration therapy is essentially a form of occupational therapy, and it is generally offered by specially trained occupational therapists. It involves specific sensory activities (swinging, bouncing, brushing, and more) that are intended to help the patient regulate his or her sensory response. The outcome of these activities may be better focus, improved behavior, and even lowered anxiety. Therapists work on

normalizing patients' reactions to touch, help patients become better aware of their body in space, and help patients work on their ability to manage their bodies more appropriately (run and jump when it's time to run and jump, sit and focus when it's time to sit and focus, etc.). Sensory Integration therapy is driven by four key principles. 1. The child must be able to successfully meet the challenges that are presented through playful activities and just the right challenge. 2. The child adapts the behavior with new and useful strategies in response to the challenges presented. 3. The child will want to participate because the activities are fun and the childs preferences are used to initiate therapeutic experiences within the season. Ultimately, the goal for any sensory integration therapy is to help the child to use appropriate behaviors by providing instructions at the same time to improve the ability of the brain to process sensory information to function better in their daily activities. The effectiveness of sensory integration therapy is controversial, even though there are few well designed studies to be able to base a clear assessment of whether this therapy works or not. Even though almost half of the reports in scientific literature show some type of effectiveness with sensory integration therapy there are other researchers that suggest that sensory integration therapy works better for younger children than for older children. It is also possible that it might work for some children and may not be effective for others.

Although sensory processing differences in individuals with ASD have been widely described, the effectiveness of sensory processing interventions is questionable. Some intervention strategies have been helpful to specific individuals with autism; yet, successes have not yet been reproduced in studies of groups of individuals with autism. There are different interventions out there, some of them were popular, but faded away and others still out there, but their results still questionable up to now. Here are some examples of these interventions.

Auditory Integration Training (AIT): Berard Auditory Integration Training or Berard AIT was developed by Dr. Guy Berard, an otolaryngologist (Ear, Nose and Throat or ENT physician) in Annecy, France. Dr. Guy Berard originally invented AIT to rehabilitate disorders of the auditory system, such as hearing loss or hearing distortion. Dr. Berard determined that, in many cases, distortions in hearing or auditory processing contribute to behavioral or learning disorders. In the large majority of Dr. Berard's cases, AIT significantly reduced some or many of the handicaps associated with autism spectrum disorders, central auditory processing disorders (CAPD), speech and language disorders, sensory issues including auditory, tactile or other sensory sensitivities (hyper or hypo), dyslexia, pervasive developmental disorder (PDD), attention deficit disorder with or without hyperactivity, anxiety, and depression. Berard Auditory Integration Training was designed to normalize hearing and the ways in which the brain processes auditory information. The evidence suggests no benefit to at best a slight decrease in sound sensitivity and slight behavioral improvement. Self-regulation (The Alert Program): The Alert Program (also known as the How Does your Engine Run? Alert Program for SelfRegulation) was created by occupational therapists, Mary Sue Williams and Sherry Shellenberger. By using an engine analogy, children learn if your body is like a car engine, sometimes it runs on high, sometimes it runs on low, and sometimes it runs just right. The ALERT Program for SelfRegulation is designed to help students with autism and related disabilities choose appropriate strategies to change or maintain their levels of alertness. Based on the theory of sensory integration, this program consists of activities that teach sensory self awareness and empowers students to select interventions to ensure that their alertness matches environmental demands. The program was developed to teach children how to

change how alert they feel and to teach adults how to support learning, attending, and positive behaviors. Thus, students learn selfregulation (Williams & Shellenberger,

1996). Studies describing the self-regulation skills of children with ASD were found, no articles about The Alert Program or other self-regulation interventions were found.

Another therapy available is Wilbarger (brushing or deep pressure) protocol: Mention of tactile defensiveness is common in the ASD literature but no studies looking at the efficacy of the Wilbarger or similar protocol were found. There is preliminary evidence suggesting that deep pressure and massage could be helpful. The Wilbarger Protocol (Wilbarger, 1991) is a specific,
professionally guided treatment regime designed to reduce sensory defensiveness. The Wilbarger Protocol has its origins in sensory integration theory, and it has evolved through clinical use. It involves deep-touch pressure throughout the day. Patricia Wilbarger, M.Ed., OTR, FAOTA, an internationally recognized expert who specializes in the assessment and treatment of sensory defensiveness, developed this technique. There currently is a lack of documented research to substantiate this technique. However, the protocol has been used by many occupational therapists that have noted positive results with a variety of populations. Many parents of children with autism have reported that their children have responded positively to this technique, including reduction in sensory defensiveness, as well as improved behavior and interaction. Many adults with autism have also reported reduction in sensory defensiveness, decreased anxiety, and increased comfort in the environment through the use of this technique.

Finalizing with Visual Therapies: There is preliminary finding suggesting that wearing prism lenses may have short-term positive behavioral effect and improve spatial orientation. On this therapy there is not a strong research to back it up, and as well as the other therapies mentioned above. It's important to know that sensory processing disorder is NOT an official diagnosis, and

there is disagreement as to whether sensory integration therapy is actually effective. While there are plenty of anecdotal stories about the success of sensory integration therapy - and research studies that support those stories - there are also plenty of studies that dispute their findings. We can see now that even insurance companies are addressing sensory processing disorders and what they believe its not effective. The Aetna Insurance Corporation has developed a policy relative to sensory integration therapies of various sorts, and summarizes its policy as follows: Aetna considers sensory and auditory integration therapies experimental and investigational for the management of persons with various communication, behavioral, emotional, learning disorders and for all other indicators. The effectiveness of these therapies is unproven. They are basing their statements and policy decisions with few specific studies by major researchers in the field.

As is suggested by the opinions described, research to date has not been conclusive. Studies suggest that, for example, those children are more likely to focus well after exercise than after sitting still. But this kind of finding seems to be a statement of the obvious. Some small studies suggest that sensory integration is extremely helpful, and other equally small studies that suggest the opposite. So far, no one has truly shown that the specific therapeutic tools of sensory integration are more effective than, say, a brisk walk around the block, or a session with a jump rope. Nevertheless, anecdotal findings do seem to suggest that sensory integration therapy (also called sensory dysfunction therapy) can make a significant difference for some people. Available research is limited in its generalizability because of design flaws and weak or ineffective outcome measures that produced mixed results. Research with the ASD population regarding the effectiveness of SI treatment is difficult in general because of childrens varying developmental levels and the interactive nature of the treatment. SI therapy is not "one size fits all." According

to SI theory, children with sensory integration issues have their own unique set of sensory responses that need to be addressed. What is calming and focusing for one child may be over stimulating for another, and vice versa. The child's unique set of sensory responses must be considered.

References 1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington, DC: Author. 2. American Journal of Occupational Therapy January/February 2002 vol. 56 no. 1 97-102 3. 4. Ayres, A. J. (1979). Sensory integration and the child. Austin, TX: PRO-ED. Baranek, T. G. (2002). Efficacy of Sensory and Motor Interventions for children with Autism. Journal of Autism and Developmental Disorders, Vol 32, No. 5. 5. Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9(4), 2335. 6. Dunn, W. (1999). Sensory Profile. San Antonio, TX: Psychological Corporation. 7. Dunn, W., & Brown, C. (1997). Factor analysis on the Sensory Profile from a national sample of children without disabilities. American Journal of Occupational Therapy, 51, 490495 8. Howlin, P.(2006). The effectiveness of interventions for children with autism. Vienna: Springer eBooks.