Sensory Approaches for Autism Notes

Clive Smith is a regular trainer with Hirstwood Training and his notes make compelling reading.


 A recent study has identified that synaptic pruning is not as efficient in people on the autistic spectrum have a read why this may be important for children on the spectrum
Many of the challenging behaviours that we have to deal with are the individuals response to pressures around them creating powerful anxiety. Have a read about how this impacts on the children that we work with
Many individuals find great benefits in deep pressure. Two articles here explaining the therapeutic benefits. One rather long and detailed from Temple Grandin well known author who was diagnosed with autism in the early 1950’s
The other is a shorter article but take note it is on the web site of a company selling weighted jackets and associated equipment.
A youtube video looking at sensory integration approaches. Take in the subtitles which link children having great fun whilst learning some important life skills.
Hormones affecting behaviour – Clive Smith

In a previous section discussing how the brain has developed it was identified that with the limbic system a structure called the amygdala was responsible for responding to sensory stimuli. Most notably we are interested in the brains response to stimuli that threaten the individual. The amygdala prepares the body to respond by releasing certain chemicals or hormones into the body. To understand the impact of these changes we need to understand what the various hormones do.

In terms of behaviour adrenaline is most significant in respect of the fight or flight. The structures in the limbic system when faced with what is perceived as a dangerous situation sends a message to the adrenal glands to release adrenaline, known as epinephrine in the United States, into the bloodstream. Adrenaline has several effects, it allows the blood to flow more easily around the body getting it to the heart and back to the muscles where it is needed faster. This means that your muscles can work better and longer. Not just content with making the blood easier to flow it increases the heart rate pushing the blood around even faster. It causes the air passages in the lungs to increase getting more oxygen to the blood stream. Adrenalin also helps the body convert its inherent energy source glycogen into a fuel, glucose, that it can use. The body is now ready for sustained fight or sustained flight.

Some people enjoy the chemical high that a burst of adrenaline provides so much that they actively seek it and become almost addicted to adrenaline. The term coined to describe people who actively seek an adrenaline high is “adrenaline junkies” making the link between the addictive element of the hormone. Such people actively seek the release of adrenaline through the stress caused by high risk activities. Sky diving, bungee jumping, high speed skiing, with an almost endless list. People undertaking such activities talk of an almost euphoric high, a very clear and highly focussed view. This aspect is raised because a certain category of student or individual may begin to actively seek the adrenaline that stems from confrontation and challenge with other individuals.

So adrenaline prepares us for fight or flight but once the body is flooded with adrenaline the only way for it to dissipate is by the reuptake of the hormones into nerve receptors and metabolism by different enzymes. This requires either the strenuous activity it is designed to provide or a significant amount of time to reabsorb the excess adrenaline back within the the body.

In behavioural terms this means that individuals are in a ‘fight or flight’ state until the adrenaline is dissipated, generally considered to be around forty minutes. Why is this important? Because any intervention from others during this period is very likely to ‘spike’ the adrenaline levels again, keeping the fight or flight situation at a critical level.
The only truly effective intervention during this period is to allow the individual the opportunity to calm down. Providing space and safety from anything they are likely to perceive as a threat.

Consider then the very typical scenario where staff endeavour to remove a student from the classroom or playground, or an adult from an activity or an individual from some public location, to a place of safety for his or her own good. To allow them the opportunity to calm down in a quiet and secure environment. This physical intervention will be seen by the individual as yet another threat thus prompting the release of further adrenaline. To actually make the move will often result in physical handling making the whole situation even worse. In such fraught situations it can take several adults to physically move one child or individual to a safe location causing much anguish in the process.

Strategies to manage such responses will be discussed elsewhere in this material both under the ‘Safe Spaces’ section and the ‘Management of Physical Behaviour’

The second of the hormones that links with sensory approaches to challenging behaviour is Cortisol. Cortisol is often known as “the stress hormone” because it is secreted in higher levels during the body’s ‘fight or flight’ response to stress, and is responsible for several stress-related changes in the body. Cortisol links in with adrenalin in that it is released in response to stress by ensuring that there is sufficient glucose in the body to meet the demands of fight or flight. Cortisol releases extra glucose from stored reserves ensuring initially that there is essential energy for the brain to function clearly. It also diverts energy from low-priority activities such as the immune system or the digestive system to ensure that the body survives immediate threats.
This process is highly efficient in situations where occasional stress occurs by providing increased energy for survival reasons, it helps the brain focus and decreases sensitivity to pain. However, in a society where individuals face constant ongoing exposure to stress the prolonged cortisol secretion results in significant and potentially harmful physiological changes. The most common being the increase in gastric-acid secretion with its obvious link to stomach ulcers. Other know effects of long term exposure to stress and thus elevated cortisol levels include, raised blood pressure levels, impaired cognitive performance. Long-term exposure to cortisol has a significant effect upon the area of the brain called the hippocampus and this can initiate longer term mental health issues.
It is not just the life threatening instances that create stress. The most common cause of stress in all individual is uncertainty followed by fear. Uncertainty comes from not knowing what is expected or what is going to happen to us in situations where we do not have personal control over our life. The exact scenario for children in schools, adults in care situations and also employees in work situations! Another surprising stress factor is clutter, Visual clutter creates stress, it bombards the sensory system with too many opposing signals. The brain struggles to prioritise and then loses focus. Consider the typical classroom setting with its emphasis on bright colourful varied wall displays. What may appear to many to be a brightly coloured attractive wall display of children’s work, informative posters, pictures ornaments or artefacts can to many be a sensory overload.

Cortisol whilst having a positive function in many scenarios can when individuals are exposed to too much stress have serious negative effects. It can create a predisposition to stress causing some individuals to react far more easily in a negative manner than others to sensory input.

For cortisol to return to healthy levels after stressful situations the body’s relaxation response needs to be stimulated by using stress management techniques, providing safe environments and removing the causes of the stress. All of which will be discussed further in the safe spaces and relaxation sections.

Dopamine plays a complex role in the body chemistry and is an important element when considering behaviour. It is both a hormone and a neurotransmitter. In the brain it functions as a neuro-transmitter ensuring that signals between neurons in the brain are sent efficiently and effectively ensuring the correct connections. Where there is a breakdown in dopamine function say too little or too much the physical results are apparent.

Dopamine is a significant factor in:
Movement – Parkinson’s disease, characterised by tremors and motor impairment, is caused by loss of dopamine-secreting neurons in the brain. Conversely, however, too much dopamine can also lead to high levels of motor activity and “impulsive” behaviour.

Reward driven activities – Dopamine is also strongly connected to reward driven activities, that is those activities that we enjoy and want to repeat, eating food, exercise and sex. When you look at it that the way the body has developed a unique way to ensure that we eat enough and exercise enough to stay fit and healthy and that procreation and the maintenance of the human race is an enjoyable activity and one that we want to repeat, often! When we indulge in any of these activities or many others, too many to name, the body releases more of its stored dopamine. Increased dopamine in the brain stimulates a feel good factor thus reinforcing or motivating us to continue doing something. Without sufficient dopamine in the brain, people feel the opposite of enjoyment and motivation tired, depressed they lack motivation or drive.

Memory Dopamine may be responsible for determining what stays in the short term memory
Behaviour and cognition and learning – In very simple terms the right level of dopamine is essential to ensure that the braincells make the right connections. On those days when we struggle to think clearly, see our way to solutions to simple problems or manage simple tasks that we commonly achieve it is often because our dopamine levels are low.
Attention – There is evidence that Attention deficit hyperactivity disorder (ADHD) is associated with decreased dopamine activity. Dopamine helps in focus and attention. Vision helps a dopamine response in the brain and this in turn helps one to focus and direct their attention.

There is a rather interesting website giving detailed information about dopamine

To aid the body in making Dopamine, the person can use what dopamine they DO have left as often as possible. This tells the body that they need more of it. While you sleep, you use very little dopamine. Exercising, even just a walk around the block will use dopamine (remember, it controls movement). So setting a reasonable sleep schedule, and trying to get some exercise will help speed up recovery

Dopamine in attention
You pay attention best when you are doing something that you like, the structure of dopamine means that it increases when you are doing something that you like. When dopamine levels rise you feel good, everything seems clear and so you are driven to continue with that activity, so there is a link that actively increases attention. Conversely reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder.

Dopamine in cognition
Dopamine in the frontal lobes of the brain controls the flow of information from other areas of the brain. Disorders of dopamine in this region lead to decline in neuro-cognitive functions, especially memory, attention, and problem-solving.
Particular dopamine receptors are responsible for the cognitive-enhancing effects of dopamine.

Low serotonin levels are linked to depression and in fact most antidepressant medications come from a family known as SSRI’s selective serotonin reuptake inhibitors. That simply put means they stop the body from reabsorbing serotonin back into itself from the stomach where it is generally found. Increased serotonin means individuals feel more positive about themselves and others around them. Serotonin is generally lower in winter months particularly for this in the northern hemisphere, hence a link between serotonin and sunshine. Also the basis behind Seasonal Affective Disorder, a seasonal form of depression occurring in the winter months.
It is also a fact that present lifestyles of children and particularly those with the widest range of special needs means that they are being exposed less and less to natural light.
So low serotonin levels can cause a predisposition to depression and thus anxiety.

How the Brain Develops – Clive Smith

The growth of the human brain occurs from the inside out and the bottom up.
You are born with 100 billion brain cells, neurons, give or take a few thousands! but these initially are largely unconnected. The neurons when they connect with other neurons do so through synapses and their can be about 15,000 synaptic connections for each cell, so do the maths! When passing information through these neurons the neurons can wire up at the rate of 1.8 million per second!

The brain itself consists of a multitude of different parts but for the purpose of understanding behaviour we can break the brain in reality is divided into four separate zones with different functions. The Brainstem, Diencephalon, Limbic system and Neocortex.

At the core is the brainstem and cerebellum , which deals with the autonomic actions. This section of the brain is also known as “the Reptilian Brain”. The reptilian brain first appeared in fish, nearly 500 million years ago. It continued to develop in amphibians and reached its most advanced stage in reptiles, roughly 250 million years ago.
This is the oldest part of the brain controlling many essential functions such as breathing, heart rate, blood pressures. It is also the gateway to the majority of sensory input that our body receives. It is connect via the spinal column to all the distant nerve cells. How does this link to behaviour? Well the purpose of this part of the brain is survival. This part of the brain controls those bodily actions that to keep the body alive and safe, it controls all those actions that are autonomic
and need to be carried out as a reflex action without thought. These include the beating of the heart to pump blood around the body, breathing to provide oxygen but it also includes reflex actions to danger. These are often known as escape reflexes and include, pulling your hand away from something hot, shutting your eyes when something gets close to the eyeball or ducking or jumping at unexpected sounds. To work so quickly they react to sensory input with a direct link to the motor nerves without signals going via the brain.

This sits atop the brain stem and is responsible for dealing with the incoming signals. It takes sense messages from the eyes, nose, mouth, limbs and so on and then redirects the sensory responses to the appropriate parts of the brain. The hypothalamus is responsible for regulating many of your bodies functions, hunger, thirst, response to pain, enjoyment, anger and aggressive behaviour. It also responsible for regulating bodily functions blood pressure, breathing and reaction to emotional circumstances. The hypothalamus, manages the bodily states by releasing hormones in response to sensory inputs, more of hormones later on. Sensory input therefore allows us to to identify experiences that may threaten our well being. Visual clues to something threatening, crashing sounds that indicate danger, particular smells all these sensory inputs are sent via the brain stem to the diencephalon for a decision to be made on how to respond.

If the appropriate parts of the brain identify these stimuli as dangerous the brain sets in motion a series of chemical actions, which prepare us to deal with the danger in the most appropriate way. Information is then passed to the the third part of the four sections of the brain, the “Limbic System”.
Limbic system
The limbic system first appeared in small mammals, about 150 million years ago. It has the ability to record memories of incidents and behaviours and to categorise them, those that produced agreeable or disagreeable experiences or effectively, safe, unsafe experiences. It is the part of the brain responsible for developing emotions in human beings, creating good or bad experiences.

The limbic system is not just one part of the brain but a collection of different structures and as such supports a variety of functions. For our purposes the most interesting aspect is that the limbic system is responsible for managing aspects of emotion, behaviour and motivation. One structure in the limbic system is the hippocampus, and this is responsible for managing long term memories and retrieving them for use in short term memory. To understand its importance in behaviour issues we need to examine its role further. Our emotions, those of fear, happiness, anger, contentment and so on need to be attached to memories associated with those emotions. We have to have experienced happiness, contentment etc and this memory must be stored before we can experience a situation and respond to it with an appropriate emotion. Some of these experiences can be learnt and not actually experienced to still create an experience such as the know ledge that fire is hot. We do not have to experience being burnt to be afraid of fire but simply have constantly been told it it dangerous. So with these memories laid down sensory input will trigger the hippocampus to respond with an appropriate emotion.

Within the limbic system is another structure, the amygdala, a little almond shaped structure. The amygdala is the most import section of the limbic system from the behaviour viewpoint. Its role is to link strong sensory stimulus with memory to allow us to respond appropriately to sensory input. It seems to be most strongly linked to danger and thus fear, possibly because dangerous situations have to be reacted to instantaneously. Thus early scary experiences remain fixed in the memory via the amygdala. If sensations that link to danger are passed to the amygdala, it gives rise to feelings of fear and anxiety and prepares the body to cope with these dangers. amygdala

So with this link to sensory inputs and fixing these to our memories the limbic brain is the seat of the value judgments that we make, often unconsciously, that exert such a strong influence on our behaviour.

The court part of the brain is the neo-cortex, the newest part of the brain in evolutionary terms, which began in primates, some 2 or 3 million years ago and has developed exponentially since. It is involved in higher functions such as sensory perception, generation of motor commands, spatial reasoning, conscious thought, and in humans, language. It has an infinite capacity for developing these skills allowing humans to employ language, abstract thought, imagination, and consciousness and thus is essentially the reason why humans have been able to develop such a wide range of cultures. In behavioural terms it is important because of its role in reasoning and problem solving.
When the body is preparing for fight, flight or freeze the ability to rationalise the threat and to examine options to avoid the perceived danger is the individuals greatest tool to avoid responding with behaviour that is dangerous to either themselves or others.

Safe Spaces

Problems arise for everyone when trying to learn anything we all know that but just why do we struggle. Generally one of the obvious problems is the brain needs to prioritise all the aspects of the new tasks and we tend to learn in complex and busy environments. Remember the classroom where you were taught, all those bright wall displays, around thirty or more other children, talking whispering moving. How did we manage? Well for most of us it is because our brains have a very good system of ignoring unnecessary stimuli, the ability to self regulate. This means the brain can ignore sensory stimuli that is unimportant. That is how we can listen to people in busy locations like cafes restaurants and focus just upon what they say.
However, many of the children and adults who have a range of special needs also have specific issues with with sensory processing and sensory regulation.

These problems are further compounded when the individual has actual poor sensory skills in other areas, such as vision or hearing or has physical and mobility issues. For these individuals making sense of their environment is difficult enough but if there is an overload of sensory information they may become over anxious setting in chain the whole sequences of hormonal changes that are discussed in detail in the section on hormones and their effect on behaviour. If nothing is done to reduce these anxieties the individual will be unable to focus upon the activities in hand. The anxiety may be even severe enough to provoke a fight, flight or freeze response. See the section on fight, flight or freeze. We all know about fight or flight and will deal with its consequences often in our working lives but freeze is as important. It often doesn’t impact upon us, causes no management problems, doesn’t upset the rest of the class or people we are caring for. If you replace the word freeze with ‘give up’ which is what the individual is doing when they freeze you can see how detrimental this action is for those who need to learn such basic skills. Consider how often individuals with profound and complex needs often appear to have switched off, gone to sleep and consider that just maybe they have chosen to opt out of an activity that creates anxiety for them.

Teachers have always prided themselves on the quality of their classroom displays and often feel that their teaching skills are directly reflected by the quality of their wall displays. In our homes we use pictures and ornaments to create an atmosphere and in community settings rooms are humanised with the same collection of pictures but generally not ornaments! Whilst not suggesting that properly considered displays that enrich an individuals environment should be removed be aware that there is a point where that enrichment just becomes a confusion, jostling for prominence. The brain struggles to decide which stimuli is important and which can be ignored. Anxiety increases and stress hormones start to be released. Examine the environment for excess visual clutter and make a decision about what should remain and what should be removed. It may be possible to restructure and keep the majority of the material but present in a less confusing way. Try and maintain a distraction free area so that individuals can focus upon the learning activity or the individual they are communicating with.
You may want to keep the wall display but can use material to temporarily cover the distraction. Any colour will do but black has the added advantage of absorbing light so making all objects stand out.

Sheets are just one fantastic way to create a back drop, or draped over stands can create a sensory space; just laid on the floor they provide an instant contrast for lighter objects. Fibre optics on a black sheet will show up even in a brightly lit room. We can’t always black out our classrooms or living spaces. A black sheet over a table will even help with normal curriculum or life skill sessions. It makes the individuals focus totally upon the materials that they should be using.

Use coloured sheets to create a theme for sensory storytelling, blue sheets for water based stories, such as ‘The Rainbow Fish’. Back project appropriate digital images to enhance the story telling. Fibre optics draped over the blue sheet creates a shimmering waterfall or river.

Green sheets, provide a back drop to jungle or forest tales, add some bird sounds or leaves rustling from sound files, maybe off your iPad to enhance the moods or to help the individuals’ imagination along. A fan placed behind the sheet adds movement and atmosphere to the scene by blowing the sheets.

Of course white sheets become multi coloured with appropriate back projection, and not just using rotary or pico projectors. There are now available, for around £40, 12v LED lighting strips with remote controls enabling you to select any colour. Placed behind a white sheet they are safe and allow the story teller to select from white to green to red to blue at the press of a button.

Check out your nearest curtain shop who will probably have a range of cotton fabric in all colours and most importantly for school or centre use they can provided as certified flame retardant materials.

Last bit of kit, have a box or bin to keep your sheets and artefacts in so you can catch that moment. Enjoy your sheets!!

We are becoming much more aware of sensory processing disorder and how sensory regulation difficulties can affect the individuals that we work with. In the sensory room we can have a great degree of control of visual, auditory, tactile and the other sensory stimuli. In the classroom, day room or even living room or kitchen we have much less control. This doesn’t mean we can’t work in these areas, we just have to give some thought to the process. Strangely enough we don’t have to cut out the extraneous stimuli it appears from experience to be enough to reduce it. One very easy way to do this in any location is to us umbrellas.
Black or white is ideal but coloured will work. The umbrella provides a good screen that isolates the student from other activities reducing the anxiety caused by other students moving close by. A black ‘brolley’ will provide a good contrast for visual effects. Fibre optics which lose their impact in the classroom will have good visual impact laid underneath a black brolly. Fluorescent objects will light up with just the light from a small UV blacklight torch. Small battery operated lighting effects such as torches, hand held fibre optics, glowballs, will stand out really well under a black ‘brolley’. You can use a white ‘brolley’ for projection effects, whether it be shining coloured torches from outside the ‘brolley’. Placing a rotating projector such as the Solar 250 so that its light shines onto the umbrella allows the student to access a strong colourful and moving image with no worries about shining bright lights directly into their eyes. You can use small data projectors to project any recorded video favourite cartoons, films or incredibly effective video of the student themselves. Most digital compact cameras can record video that can be played through a projector and never underestimate the power of children seeing images of themselves, their family or favourite pets as a sensory stimulus.
This is only a brief taste of how the humble ‘brolley’ can open up visual work with our students for more ideas and some helpful background information look at “Using Umbrellas for Sensory work” on the Hirstwood Training blog site at or for some pictures to start you off visit the Hirstwood Training page on Facebook.

In most establishments the sensory room is timetabled to allow equal access for all students but for your students your allocated time may not be when they are ready to work on a particular sensory issue. Yet your classroom is too bright, to busy for focused work. What you need is a temporary mini sensory room. Well with a bit of ingenuity it is easily achieved. What we need to develop is a small environment with clear boundaries, some sort of screen to cut out the visual background of the classroom and distraction of other students. You can create areas with screens and blackout material that create the right sort of space but a very easy and quickly achieved solution as we have discussed is to use the humble ‘brolley’

Little Room Concept
Lilli Nielsen was a Danish psychologist specialising in working with children with multi-sensory impairment, children both deaf and blind. She was also a strong advocate of ‘Active Learning’. Active learning embraced a widespread notion that the adult’s role in learning is to provide a safe and stimulating environment in which children enjoy exploring. Not an environment in which the adult prompts the child to explore by hand over hand guiding. Obviously for those children with visual and auditory impairments becomes difficult. Combine these impairments with poor movement skills due to weak muscle tone and the ability to relocate objects to allow simple handling and exploring becomes a real challenge. This is a serious issue because handling is an important stage in developing an understanding of objects and the world in which we live. It develops such notions of object permanence an absolute prerequisite of developing preference. Remember those old proper prams. The child lay there with a hood up and some rattles strung across the front. This meant the toys were always there in reach with no other distractions to look at. This concept was utilised by Lilli Nielsen in her ‘Little Room’ structure as part of her ‘Active Learning’ principles. The ‘Little Room’ is a purpose designed box with three wooden sides and a perspex lid allowing the child to be observed. Inside there is provision to attach objects and Lilli was insistent that it was best to use real objects with form and purpose rather than toys. The little room therefore allows freedom and security for the child to explore objects in an environment that is safe and can provide consistent responses. The Little Room is also placed on a resonance board, a large sheet of plywood supported from the ground by wooden battens. This amplifies the sound from any movement and provides a tactile feedback in the form of resonance or vibration. The world famous percussionist Evelyn Glennie who has been deaf since childhood yet performed with a 1000 piece drummer ensemble at the opening ceremony of the London Olympics often played on a resonance board to provide feedback to her percussion works. Have a look at the following video placed on You Tube to see a child, Zoe lying on her resonance board thoroughly enjoying her ‘Little Room’ session.

Whilst Lilli Nielsen was very prescriptive about her ‘Little Rooms’ experience has shown that we can provide a similar degree of security and permanence in our sensory work in many ways by using improvised stands and screens, umbrellas work wonderfully for this and allow the work to continue outside the sensory room. For larger areas, pop up tents or shelters work really well.