2016/2017

An Introduction to Autism
Spectrum Disorder and Sensory
Sensitivity
Sian Williams
CONTENTS

Introduction.2

What is Autism?..2

Diagnosing Autism..3

The Effects of Autism: Social Communication...4

The Effects of Autism: Social Interaction....4

The Effects of Autism: Repetitive Behaviour and Routines....5

The Effects of Autism: Highly Focused Interests.............6

The Effects of Autism: Genetic Disorders........6

The Effects of Autism: Seizure Disorders........6

Sensory Sensitivity: Introduction..........7

Sensory Sensitivity: Light.............8

Sensory Sensitivity: Sound.............8

Sensory Sensitivity: Smell.............9

Sensory Sensitivity: Taste..............9

Sensory Sensitivity: Touch.......,........9

Sensory Sensitivity: Balance...............10

Sensory Sensitivity: Body Awareness.............10

Sensory Sensitivity: Synaesthesia............11

Sensory Sensitivity: Help and Support............11

Sensory Sensitivity: Voluntary Experience ................11

Conclusion............................................13

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An Introduction to Autism Spectrum Disorder and Sensory Sensitivity

Introduction

Within this research paper, I will outline what Autism Spectrum Disorder is, and how individuals with this
developmental disability are affected by their sensory sensitivity, whilst outlining how individuals tend to
get diagnosed. I will describe the effects of autism in terms of social behaviours, repetitive behaviours,
interests and also the link of autism with other disorders such as genetic and seizure disorders. When
discussing sensory sensitivity, I will focus on light, sound, smell, taste, touch, balance, body awareness and
synaesthesia, before discussing treatment for these individuals and describing my own voluntary experience
with working with adults with severe autism.

I was inspired to write this paper because of a keen interest in the disability for a variety of reasons,
including that I have various family members who have autism and also because of my work experience
further enhancing my interest.

What is Autism?

Autism is a lifelong developmental disability that affects how people perceive the world and interact with
others, [1] affecting the way they see, hear and feel things, compared to others. Although autism cannot be
cured [2] and is a condition someone can have for life, they can improve their standard of living, but often
see their autism as a large aspect of their identity. Autism spectrum disorder (ASD) and autism are broad
terms to describe a collection of complex disorders of brain development which are categorized judging by
their degrees of difficulties within issues such as social interaction, verbal and nonverbal communication
and repetitive behaviours.

Autism has been called a range of different diagnostic labels, over time. These include: autism spectrum
disorder (ASD), autism spectrum condition (ASC), classic autism, Kanner autism, pervasive developmental
disorder (PDD), high-functioning autism (HFA), Asperger syndrome and Pathological Demand
Avoidance (PDA) [3]. Due to changes to the main diagnostic manuals, ASD (Autism Spectrum Disorder) is
the most used diagnostic term when diagnosing this disorder. Following a publication of the DSM-5
diagnostic manual in May 2013, all the Autism disorders were combined into the overall diagnosis of ASD
(Autism Spectrum Disorder) whereas before they were considered as various subtypes such as autistic
disorder, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified and
(PDD-NOS) and Asperger syndrome [4].

As autism is a spectrum condition, each person with autism is different and is affected in ways that may
differ from another, but many of these individuals do share similar and the same difficulties. They may also
suffer with issues such as learning disabilities, mental health problems [5], or various other issues which
affects the type and level of support they will receive. Every person with autism is able to learn and develop;
especially with the support they receive which improve their quality of life.

Autism is a condition which is more common than people tend to realise, with 1 in 100 people living with
the condition, with around 700,000 people in the UK alone [6] with the condition. The disorder is believed
to affect 1 in 68 children within the USA [7] and it is believed there are 48 million people with autism in the
world currently [8]. It has been to shown to affect more men than women, with the disorder being five times
more common for boys than girls; this is backed up with the statistic that an estimated 1 out of 42 boys and 1
in 189 girls are diagnosed with autism in the United States [9], According to statistics from the U.S. Centers
for Disease Control and Prevention (CDC). No matter your nationality, cultural, religious and social
backgrounds, anyone can have autism.

A common issue with those with Autism is that the world appears to be overwhelming and therefore have a
heightened sense of anxiety. This enhances their issues with understanding/relating to others, no matter who
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they are, and can have a large impact of activities which occur in everyday life such as family, school, work
and social issues. Many people find difficulty in socialising and interacting with autistic people, which adds
to the feelings that many autistic people feel that they are different and misunderstood, which can cause a
great deal of sadness. Intellectual disability, motor coordination related difficulties and physical health
issues [10] (e.g. sleep and gastrointestinal disturbances [11]) are associated with Autism. Approximately one
third of people with Autism are nonverbal [12], but often learn communication skills with other methods,
such as sign language. Some autistic individuals have large interest and passion for visual skills, music,
math and art and can use these skills as an outlet or even as a career choice for adults. Approximately 40
percent of autistic individuals have average to above average intellectual abilities [13].

Autism, in the U.S, is one of the fastest-growing developmental disorders, and it is believed that it costs on
average $60,000 to support an individual with the disability [14]. The 2012 National Institutes of Health
Funds Allocation Total budget for Autism was $30.86 billion with $169 million going directly into autism
research [15]. This figure represents 0.55% of total NIH funding [16].

Diagnosing Autism

The first diagnosis of Autism was in the 1940s [17]. The diagnosing process of autism to declare formal
identification of the disorder is usually done by a multi-disciplinary diagnostic team, usually including a
speech and language therapist, paediatrician, psychiatrist and/or psychologist [18]. Benefits of a diagnosis
including the help of autistic people (also their families, partners, employers, colleagues, teachers and
friends) of being able to understand the reason they potentially experience difficulties and how they can help
themselves and the autistic person and it also makes support services more easily accessible. For a diagnosis
to identity autism, the individual is likely to be showing persistent difficulties with social communication
and social interaction and restricted and repetitive patterns of behaviours, activities or interests since early
childhood, to the extent that these "limit and impair everyday functioning", [19] although characteristics of
each autistic person usually differ greatly.

Autism cannot be officially diagnosed until the age of approximately 18 to 24 months although early signs
tend to appear at 8 to 12 [20], with these signs including no back-and-forth sharing of sounds, smiles and
other facial expressions by 9 months; no babbling or back-and-forth gestures (for example pointing) by 12
months; or any loss of babbling, speech or social skills at any age [21]. Red flags for Autism include: No
big smiles or other warm, joyful expressions by six months or thereafter, No back-and-forth sharing of
sounds, smiles or other facial expressions by nine months, no babbling by 12 months, no back-and-forth
gestures such as pointing, showing, reaching or waving by 12 months, no words by 16 months, no
meaningful, two-word phrases (not including imitating or repeating) by 24 months and any loss of speech,
babbling or social skills at any age[22]. There are online resources for parents regarding autism, such as the
M-CHAT (Modified Checklist for Autism in Toddlers) which can help determine whether to consider a
professional evaluating their child, with answers suggesting their childs risk for autism [23]. Research
proves early diagnosis and intervention provides a positive chance for improving and maximising an
Autistic childs progress and outcomes [24].

The Effects of Autism

Social Communication

Those with autism tend to have difficulty interpreting language, both verbal and non-verbal [25]. For some
autistic people, everything they say or hear is taken very literally and mean exactly what they say [26]. This
can cause great difficulty understanding, interpreting and using language features such as facial expressions,
tone of voice, jokes and sarcasm [27]. Depending on their severity of language barriers, some will have
limited or no use of speech [28] but can clearly understand what is being expressed them to them. Many

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autistic people suffer with struggling both understanding others and also expressing their own thoughts and
feelings, alongside struggling with abstract concepts. Alternative forms of communication tend to be
favourable and manage to communicate effectively without using speech. For example, the use of sign
language and visual symbols can be quite beneficial for an autistic person [29]. Although some autistic
people do have good language skills and can communicate effectively in many situations, understanding the
expectations of others in conversation can be difficulty. They may focus on their own interests and talk for a
long time about this topic or engaging in echolalia, which is where someone repeats what the other person
within the conversation has just said [30]. This usually helps for autistic people to ensure clear, consistent
speech and helps with allowing them to process what is being said, as they are allowed time to do this
processing.

An early form of communication is babbling and eventually by their first birthday have usually learnt to say
a couple of words, whilst understanding that pointing to objects that they want/want to show someone is a
useful skill and by this point they can usually show their answers, such as yes or no through sound or
expression. However, young individuals with the disorder may have delayed development in terms of
babbling [31], speaking and the use of gestures even if within the first few months they babble but they
usually lose these communicative behaviours but others dont speak or communicate at all even much later
on. Most eventually learn to speak and communicate. Ways of communicating for non-verbal individuals,
both children and adults, can include the use of pictures, sign language, electronic word processors or even
speech-generating devices [32].

Social interaction

'Reading' other people is a problem quite often for autistic people as they may experience difficulties within
recognising/understanding the feelings and intentions of others within the conversation; they may also
experience unease when expressing their own emotions. This may decrease their quality of life and social
relations as many can appear to lack sensitivity, which can affect how someone emotionally perceives them
as most seek out emotional understanding within friendships and any sort of relationship; autistic people do
not tend to seek comfort from other people and instead deal with things on their own [33]. When overloaded
with other people, they may want to spend time alone which could be considered rude and can cause
problems in settings such as school and the workplace where being in big groups is often necessary for
success. Autistic people may seem to act strangely and act in ways that could be perceived as socially
inappropriate, which effects their potential desire to make friends and interact with others but they do not
know how to achieve this.

On the other hand, some individuals with autism are more than able to maintain eye contact and show
affection by smiling and laughing and explore and engage with their emotions. Many go on to build positive
careers and relationships and may even marry a loved one and raise children. They tend to be honest and as
long as they can develop communication skills, they have the potential of reporting things accurately and
openly. Autistic people usually successfully respond to environments with a positive or negative mind-set
and view and tend to change their maturity levels over time.

By 2 to 3 months of age, typically children will have begun to gaze at faces, turn toward voices, grasp a
finger and even smile [34] whereas the majority of children who develop autism will find they have issues
with general human interactions, both giving and receiving. Many Autistic infants who develop autism show
symptoms including the failure to respond to their names, reduced interest in people and delayed babbling,
by 8 to 10 months of age and in toddlerhood struggle with engaging in social games, fail to imitate the
actions of others and prefer to play alone and independently, whilst failing to seek comfort or respond to
anger or affection displayed by their parents [35]. Research and studies prove that autistic children are
attached to their parents; however their behaviour can show disconnection from their parents due to their
difficulty interpreting what others are thinking, feeling and trying to convey. Without the ability to interpret
gestures and facial expressions, social interactions such as smiling, waving and grimacing has the potential
of having little meaning to the individual. A common factor of autism is a difficulty controlling emotions,

4
which can lead to crying, outbursts when inappropriate, disruptive and physically aggressive behaviour [36],
with the tendency to lose control/break down. This can lead to self-destructive behaviours including head
banging, hair pulling or self-biting.

Once their language develops, autistic individuals may not have a typical, generic way of interacting with
others, with many struggling to combine words into sentences which make sense [37] and convey meaning
often only speaking single words or using echolalia. Some with autism have exceedingly large vocabularies
[38] yet still struggle to form sentences whereas others will talk endlessly about one topic not allowing
others to make comments during the conversation [39]. Matching speech to body language can also be a
difficult task as body language features such as facial expressions, movements and gestures may lack any
link and reflection to what they are saying, with their tone of voice not reflecting this either. This can link to
a failure of understanding needs and wants, frustration and inappropriate behaviour, causing discomfort to
all involved. These are issues which form a part of methods used to help autistic individuals.

Repetitive behaviour and Routines

Many autistic people require a daily routine [40] so they can be assured of what is happening every day,
which could include activities such as travelling the exact same way to and from school/work or eating the
exact same breakfast every morning. If an autistic person has been taught rules and procedures, the idea of
doing something a different way and not the right way can concern and overwhelm them [41]. Change is
often a difficult concept for those with autism but preparation for change can often help them adapt. Autistic
children may, instead of playing with their toys, spend a lot of time organising the items into a specific set-
up and often have to have certain household objects in a fixed order and any disruption to this can lead to the
individual being very upset due to the inconsistency they desire within their environment and daily routine
[42].

These repetitive behaviours can include obsessions and extreme interests including unusual items to have a
large interest in, such as fans, vacuums, cleaners or toilets [43] or having a depth of knowledge which may
seem unusual for one specific topic [44], for example exceptionally detailed information about a cartoon
character, as older individuals with autism sometimes have very large interest in numbers, symbols, dates or
science topics.Many autistic individuals show engagement in seemingly unusual activities such as repetitive
behaviours including hand-flapping, rocking, jumping and twirling, arranging and rearranging objects [45],
and repeating sounds, words, or phrases, with some of these activities being is self-stimulating [46], for
example wiggling fingers in front of the eyes.

Highly-Focused Interests

From an early age, it is likely those with Autism will have very high-focused interests which they are very
dedicated to; these interests may stay with them for the rest of their lives or they may change over time. A
common interest is computers but can range from activities such as music or trains.

Many autistic people have intense and highly-focused interests, often from a fairly young age. These can
change over time or be a part of them for the rest of their life, and can be anything from art or music, to
trains or computers [47]. Especially in adult life, some autistic people manage to use this interest to have a
positive impact on their wellbeing and happiness but engaging this interest into studying, paid work or
volunteering etc. Those with autism may be likely to pay close attention to detail and can have high levels of
concentration, especially on topics that they hold interest in; this can lead to high skill level in an area. This
is helped by them usually having skill in learning facts and maintaining skills and talents.

Genetic Disorders

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Some individuals with Autism have a genetic condition affecting brain development. These genetic
disorders including Fragile X syndrome, Angelman syndrome, tuberous sclerosis and chromosome 15
duplication syndrome and other single-gene and chromosomal disorders [48]. Gastrointestinal (GI)
Disorders are common with those with autism, with 85 percent of autistic children having this disorder [49].
Ways this disorder can affect the individual is by chronic constipation/diarrhoea and inflammatory bowel
disease [50], causing a large deal of pain which can lead to self-soothing (rocking, head banging, etc) or
aggression or self-injury. This disorder can be provided with treatment as a way of improving standard of
living and their behaviour.

Seizure Disorders

39 percent of autism individuals suffer from seizure disorders [51] such epilepsy, especially those also with
an intellectual disability. These type of seizures include the tonic-clonic seizure, petit mal seizures
(resulting in the individual temporarily appearing absent) and subclinical seizures, only apparent with
electroencephalogram (EEG) testing [52]. These individuals can experience one or more types of seizures.
Typically, seizures which are linked to autism usually occur in early childhood or adolescence although they
can occur at any time.

Sensory Sensitivity

Introduction
Over or under-sensitivity to their senses (sounds, touch, tastes, smells, light, colours, temperatures or pain) is
common and may cause anxiety or physical pain and can often lead to being fascinated by lights or spinning
objects.

The company I volunteer for is a community multi-sensory room available for anyone despite age or ability,
providing services for babies to adults, some of which have learning disorders, developmental disabilities
such as autism or congenital disorders such as Down syndrome. Individuals, families and groups in 1 or 2
hour time slots book out this room regularly but there is also the option drop in Pay & Play sessions, which
are most used by children whereas a certain lodge book weekly sessions.

This lodge is a transition service which provides accommodation and services for 18+ year olds on the
autism spectrum. This particular lodge puts focus on developing skills such as vocational, intellectual and
general life skills which support positive and effective transition into adult life, whilst providing a
comfortable, homely atmosphere with safety measures such as perimeter fencing. The lodge provides their
own sensory rooms alongside clinical teams providing a multi-disciplinary input, including speech and
language therapy, occupational therapy, behavioural therapy, psychology, psychiatry and vocational
training. All staff keeps the approach of meeting specific individual needs whilst maintaining the use of non-
aversive positive intervention and a calming, consistent atmosphere, which is essential for the volunteers and
workers at the sensory room to be aware of and also follow as a way of ensuring consistency and comfort for
the adults.

Those on the autism spectrum have the difficulty of processing commonplace, general sensory information,
which most would not struggle with to such an extent. These issues could involve being over- or under-
sensitive or even both at dissimilar times. This lack of processing this sensory information [53] can lead to
an effect on behaviour and therefore impact their lives on a daily basis. According to a study published in
the American Journal of Occupational Therapy, created in 2007, 95% of autistic children have had issues
struggling with processing sensory information [54], (also known as sensory integration disorder or sensory
processing disorder).

When overloaded with too much information, a person with Autism, no matter the age, can have induced
stress, anxiety or physical pain. Negative impacts of this can include withdrawal, challenging behaviour or
meltdown. Many people with learning disorders or difficulties, such as Autism, or psychiatric disorders,
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such as ADHD, often describe their thoughts as being on 40 different TV channels because they believe
their brain is so hectic and difficult it keep up with, causing stress in their everyday life. Ways that this can
be helped is making small and slight environmental changes to create a more calming atmosphere which is
easier to cope with. A way of ensuring the correct environment is created is to be aware. For example, if the
environment is creating difficulties, is there anything that can be changed? Another way to help is to
consider creativity to ensure positive sensory experiences, which will help the person with Autism to grasp
the idea of different senses and therefore improve their education. Preparation is another important factor. It
is very helpful for the person to be aware of possible sensory stimuli they may experience in a range of
environments, so they know what to expect which can avoid some risk of difficulty processing the sensory
information, reducing the risk of the effects of this.

Many can experience effects of hypersensitivity or hyposensitivity to sights, sounds, smells, tastes,
touch, balance and body awareness.

Light

Those who are under-sensitive to light may have certain effects which may take place. For example, for
some objects may appear fairly dark or lose some features which could result in a distorted view of certain
objects. For some, central vision can be blurred but having sharp peripheral vision but for others a central
object may be magnified but periphery vision can be blurred, or neither of these results could take place
[55]. Another effect could a reduced depth perception, problems with throwing and catching and the risk of
clumsiness [56], interfering with activities such as sport, especially for school pupils going through the
school system which includes subjects such as physical education.

Carers, workers, family and others can help with these issues by including the use of visual supports or
coloured lenses. However, there is very inadequate research evidence on how this has an effect.

Being over-sensitive to light may lead to issues such as distorted vision where objects and bright lights may
appear to be jumping around [57], causing discomfort and increased confusion for the person with autism,
decreasing life style quality or they may have fragmented images appear. They are more likely to be able to
focus on detail which could be a positive as they could potentially be more artistic, but this is not always the
case. A large effect from light sensitivity could be the effect on sleep, decreasing the ease of sleep which
reduces life quality as they could result in problems such as insomnia.

Reducing fluorescent lighting, providing sunglasses, the use of blackout curtains, using divides on desks to
avoid visual distractions and using blackout curtains can all help with this issue [58].

Sound
Being under-sensitive to sound can lead to hearing sounds in only one ear, with the other ear having only
partial or no hearing [58], which could cause potential discomfort and annoyance. Another issue could be
not acknowledging particular sounds. However, enjoyment can arise as they may enjoy crowded, noisy
places which could have a helpful effect on their social side of autism [59] however they may also enjoy
banging doors and objects which could cause discomfort for those around them, especially those who do not
understand the issue that autistic person has. On the other hand, they could hate these situations and feel
over whelmed when within them.

A way to help the people with autism could be by providing equipment such as visual supports which back
up verbal information, and also by ensuring that other people have knowledge of their under-sensitivity to
ensure effective communicate. A way of ensuring this sensory need is met is by ensuring enjoyable
experiences are included in their daily timetable.

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Being very-sensitive to sound can lead to noise being magnified and sounds become distorted and muddled
[60], confusing the person. They may be able to hear conversations in the distance which also adds to their
inability to cut out sounds, especially background noise, leading to difficulties concentrating, which is
especially inconvenient for those in an import environment such as a school where they are learning crucial
information [61].
Activities to help could include shutting doors/windows, reducing external sounds as a result to aid
concentration. Preparing the person before going to noisy or crowded places is an important factor in
ensuring positivity for the person as they can prepare themselves and consider any triggers and coping
strategies for if they are struggling. Providing ear plugs and music [62] as a distraction is a good idea as they
can channel their sensory based energy into something positive instead of getting worked up, improving
their life style. A good idea especially based in work or school environments is creating screened
workstations in the classroom or office to avoid visual distractions and by avoiding close proximity to doors
and windows to ensure maximum concentration.

Smell
Being under-sensitive to smell could result in no sense of smell and fail to notice extreme odours [63],
which could lead to issues regarding personal hygiene and they may feel the need to lick things [64] to get a
better sense of what they are, which could lead to embarrassment in judgemental environments from people
who do not understand.

Ways of helping could be by creating a routine around consistent washing. Another way of helping is by the
use of strong-smelling products as a distraction from inappropriate strong-smelling stimuli [65], for example
faeces. Being over-sensitive to smell could result in smells being intense and overpowering [66], which
could result in toileting problems and disliking people with distinctive perfumes, shampoos, etc., threatening
maintaining social relationships with certain people. Ways people could help is by using unscented
detergents or shampoos, avoiding wearing perfume, and making the environment as fragrance-free as
possible [67]. Although not everyone could do this as they would be unaware, carers and workers could
consider this when working with the people.

Taste
Being under-sensitive to taste could lead to liking very spicy foods which could result in a limited diet. They
could also eat or mouth non-edible items such as stones, dirt, soil, grass, metal, faeces. This is known as
pica. Pica is a tendency to eat things that are not food, [68]. They may do this to relieve stress and anxiety
and to understand the sensory information. To help manage this situation parents and carers could replace
the item that is being eaten or mouthed with another object, preferably of a similar texture [69].

An individual who is over-sensitive to taste may have a restricted diet as a result of some flavours and foods
being too strong for them, and this could overwhelm them because of having sensitive taste buds. They may
also only eat smooth foods, for instance mashed potatoes and ice cream, to avoid discomfort as a result of
eating foods with unfamiliar and uncomfortable textures [55]. People with autism may have a limited diet
including bland foods or they may having cravings for very strong-tasting food, which shouldnt cause a
major problem providing that there is dietary variety and have a nutritious diet, otherwise they may become
malnourished and so may be at risk for related illnesses.

Touch

Being under-sensitive to touch lead to having to hold others tightly to feel the sensation of pressure [70], this
may cause confusion to the person being interacted with and therefore negative confrontation which could
intimidate the person with autism. They may have a high pain threshold which could increase the risk of
self-harm, especially with this ongoing issue which they may feel disappointed and ashamed about, knowing
they are not living their life to the highest possible standard. They may have the inability to feel food in the
8
mouth [55] or could involve in persistent chewing, including clothing and inedible objects. They could also
enjoy heavy objects (eg. weighted blankets) on top of them [55].

Ways to help could include: the use of weighted blankets or sleeping bags [71]. To reduce smearing a
strategy could be to provide alternatives to hold with similar textures e.g. jelly or cornflour. For chewing,
providing latex-free tubes, straws or hard sweets could be beneficial for a safer option. Being over-
sensitive to touch may lead to touch being painful and uncomfortable so they may not like to be touched
potentially affecting relationships with others. They may dislike any object on hands or feet and there is the
potential for difficulties brushing/washing hair due to a sensitive head, meaning personal hygiene could be
an issue as a result of this. Another result could be finding many particular food textures uncomfortable to
hold or eat which has a knock on effect to their diet which could lead to malnutrition or similar issues. They
may only tolerate certain types of clothing or textures.

Ways people can help is by warning the person if you are about to touch them and by always approaching
them from the front, to avoid shock or discomfort due to a threat to their personal space, including the idea
that a hug may be painful rather than comforting. Changing the texture of food (e.g. to pure it) could help
avoid issues regarding diet as they will be more likely to consume a food where they dont feel a high level
of discomfort. Slowly introducing different textures around the person's mouth, such as a flannel, a
toothbrush and some different foods could help with their development and education. This idea could also
be reciprocated with textures by gradually introducing different textures to touch, e.g. having a box of
materials available. Allowing a person to complete activities themselves (e.g. hair brushing and washing) is
important so that they can do ensure their own comfort whereas someone else doing it for them may cause
the autistic person to become upset. Parents especially can help by turning clothes inside out to reduce the
risk of a seam and they could remove tags and labels, and only provide clothes they feel comfort in.

Balance

Being under-sensitive to balance (vestibular) could result in a need to rock, swing or spin to gain sensory
input [72]. To help, people can inspire activities with the goal of developing the vestibular system. For
example, include using rocking horses, swings, roundabouts, seesaws, catching a ball or practising walking
smoothly up steps or curbs [58]. People over-sensitive to balance may have difficulties with activities like
sport, where there is a need to control personal movements and they may have problems with the quickness
of their stopping during an activity. Car sickness and activities which involves feet off the group and your
head not being upright can also cause difficulties in their lives. To help, people can break down activities
into smaller steps and using visual cues e.g. a finish line.

Body Awareness

Our body awareness (proprioception) system informs humans where our bodies are positioned, and the way
in which different body parts are moving [58]. If under-sensitive to body awareness, some may stand at a too
close proximity to others as they cannot judge personal space due to the unawareness of their own proximity
[58]. They may find it a challenge to navigate rooms and avoid physical obstacles [73] in the way of them,
not helped by the fact they may bump into people which could often cause confrontation, which is
potentially a fear and panic-trigger for some people with autism. Helping factors could include the
positioning of furniture nearer the edge of a room ensuring easier navigation and placing tape, especially
coloured tape [74], on the floor as this could be used to indicate boundaries, ensuring maximum
understanding and knowledge from the autistic person.
If over-sensitive to body awareness, some people with autism may have difficulties with fine motor skills
[55], for example working with small objects like buttons or shoe laces, which could cause frustration and
irritability. They may also have to move their whole body to look at something. This could be helped by the
offer of 'fine motor' activities, for example lacing boards.

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Synaesthesia

Synaesthesia, a rare condition occasionally experienced by some on the autism spectrum, where an
experience goes in through one sensory system and out through another [55]. For example, someone may
hear a sound but experience it as a colour.

Help and Support

There are types of therapies and equipment that can help with autism effecting sensory systems. For
example, music therapy will use instruments or sounds as a way of developing the sensory systems of a
person with autism [75], in order to expand their education on this form of sensory information [55].
Another example is occupational therapists ensuring that the individuals are living independently as much as
they can [76], whereas speech and language therapist may include sensory stimuli within their sessions to
encourage the individuals language growth [77]. These forms of support will help these individuals to build
skills in terms of everyday skills and within their social interactions and understanding.

Voluntary Experience

When volunteering for the sensory room for the first time, I met four individuals, not including the main
worker who organises and runs the sessions. Each autistic adult had a carer each. I will not include names or
personal details so will instead refer to individuals by their role of adult (those with autism) or carer,
alongside a number.

I decided to observe their behaviour as way of expanding the knowledge on the topic of autism, to increase
my limited knowledge which I have obtained from having a brother with autism and through a friends
younger brother high on the spectrum. I noticed straight away that adult 1 would explore and show interest
in every section of the room and all the sensory equipment. He would start with the nearest object then move
onto the next and then do a circle of the room trying out everything. He appeared to be able to use all his
senses. However, he may have had problems with balance sensitivity as he would use movement, such as
rocking back and forth. Like discussed earlier, being under-sensitive to balance (vestibular) could lead to the
action of rocking, swinging or spinning to gain sensory input. When playing with throwing and catching
balls with the carer, carer 1, he would then rock back and forth. He was also rather close in terms of
proximity to carer 1; this could suggest he didnt understand the proximity between him and his carer,
suggesting he potentially has issues with understanding his body awareness. His interest in balls and toys
suggests he enjoyed engagement with his hands. He seemed to enjoy it when his carer would drape a fabric
over his head and let it flow down his face and then take it off and repeat this action. He may have enjoyed
the sensation of the soft fabric. He smiled when she did this, which suggests he does not have any major
issues with taste sensory systems. He then started rocking back and forth when she had stopped. He quickly
moved onto the next object. I noticed him liking items a few times, which is considered a self-stimulatory
behaviour. Self-stimulatory behaviours are actions that may help an individual with autism spectrum
disorder (ASD) cope with his or her environment, [78] as a way of providing comfort and understanding.
For autistic people, especially children struggling with sensory issues, an effective way of gaining
information on taste and texture is by licking objects such as toys, clothing and surfaces. This creates a
feeling of familiarity and comfort. This behaviour can become repetitive if it was reassuring, which is why it
often appears in adulthood as well as childhood, which is sometimes a cause for concern. Although I did not
notice adult 1 does this, some individuals with challenges revolving around themselves instead of objects as
this fulfils the same sensation and can create a calming, grounding effect and trigger the wanted emotional
response [64]. This form of self-stimulation (stimming) could lead to issues with hygiene, however. For
example, this action could lead to the spreading of germs, most likely in community based areas, such as
classrooms as illness-causing viruses/bacteria may lead to the spread of illness. Tissue damage is also a
possible issue according to a book named Autism Spectrum Disorders where it discusses that if repetitive

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licking is a regular action and if the licking occurs on the same spot on their skin as the skin may become
cracked and dry. A personal example of a similar event is my brother, who is on the autism spectrum. He
continually bit the middle of his lip when he was younger, due to perhaps his consistent anxious feelings,
and now has a permanent scar now, even though he is now currently 22. This form of self-stimulation could
also lead to social issues as the behaviour could be perceived as odd to others who do not understand and
may interfere with children playing with the autistic child, and effects relationships in adult life too. Autism
already impacts social relationships so this could add to the problem, due to a potential lack of
misunderstanding social interactions and behaviours.

Adult 1 seemed to struggle with his social skills but least struggled with carer 1. He didnt appear to talk, as
he did not talk at all whilst I was in his company. He seemed unaware that I was in his company and only
seemed to focus on the carers and the worker, which is common in autism, perhaps because they feel a
security blanket through familiar people? He seemed to avoid eye contact but maintained eye contact with
carer 1 when they were playing together. I didnt notice any particularly unusual or interesting behaviour
within adult 1s reactions to sound and light. He seemed un-interested by the background music playing
which was a series of instruments with no lyrics, and the only action he seemed to take in terms of light was
changing the bubble tube colour to red. The bubble tube helps to provide a calming, soothing effect for some
and for others it can act as a stimulant. In adult 1s case, he seemed to enjoy the soothing effect and seemed
quite comfortable.Adult 2, on the other hand, was very quiet, reserved and, similarly to adult 1, did not talk.
Instead of engaging with the items and objects around the room, he sat by himself twiddling objects with his
hands, seemingly perfectly content. One of Adult 2s first actions was to sit alone, while supervised from the
outside, appearing to hide, inside a tent with a fabric draping over the door. He also avoided eye contact
when engaging in any sort of interaction with an individual. This lack of eye contact occurs due to avoiding
the tense and unwanted distraction of the stress caused by eye contact and they find it easier to engage in
communication without this added stress [79]. It also means they can focus on the communication. Adult 2
would engage by occasionally laughing and smiling when interacted with. He did not engage with adult 1
but engaged slightly at times with the carers and the main worker. A study from 2005 suggests that autistic
people had a triggered threat response when made eye contact with [80], which completely distracts them
from the communication and causes more problems. Hiding away may have been due to unfamiliarity of a
new stranger in the room, and therefore needed to adjust to his new surroundings? Soon, he moved away
onto the sofa where he remained for the rest of the session. It was explained by his carers this was adult 2s
ideal session as sometimes when they come with other adults from the lodge they are too hyperactive for
adult 2 to keep up with.

Conclusion

Overall, in this paper I have explained what Autism Spectrum Disorder is and how it affects an individuals
everyday life, whilst informing you on facts and figures about the developmental disability. I have discussed
and explained the diagnosis procedure and process and the impact on sensory sensitivity within an autistic
persons life. I have provided my own person experience with volunteering with adults with autism.

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