The DSM-V defines Autism Spectrum Disorderadmin / February 20, 2019
The DSM-V defines Autism Spectrum Disorder (ASD) as “A. Persistent deficits in social communication and social integration across multiple contexts. B. Restricted, repetitive patterns of behavior, interests or activities. C. Symptoms presents in early developmental period. D. Symptoms limit/impair everyday functioning. E. Symptoms not better explained by ID or GDD.” The DSM-V further explains within the broader domain of “B. Restricted, repetitive patterns of behavior, interests or activities,” students with ASD may present with hyper or hyproactivity to sensory input. While this is not a main characteristic of ASD, many children with ASD can present with sensory abnormalities which can cause difficulties with sensory modulation; the ability to maintain homeostasis and the ability to give sensory input relevance.
A sensory diet is a carefully designed series of physical activities, accommodations, and assistive technologies specifically scheduled into a child’s day, to provide a child with the sensory input he/she needs. A sensory diet allows a child “ample opportunities to receive beneficial sensory input at frequent intervals, thereby enabling him or her to participate more fully in the activities that comprise his or her daily schedule.” The goal of a sensory diet is to get the child into their “just right” state. A sensory diet provides a child with varying levels and types of input and this helps the child’s brain regulate and have a more appropriate reaction to different stimuli.
A sensory diet is created by an Occupational Therapist (OT) or a Certified Occupational Therapy Assistant (COTA) based on the specific child’s needs. They create this diet with the support of the child’s teacher and/or the child’s parents. A sensory diet should be carried out, as per its schedule, by an OT/COTA or by a person trained by an OT/COTA.
When creating a sensory diet, the OT or the COTA analyzes the child’s processing of vestibular, proprioceptive, and tactile sensations. Based on these results, the OT/COTA creates a sensory diet that is unique to the child. Many forms of Assistive Technology can be used when implementing a sensory diet. It is the OT’s responsibility to find the perfect combination of tools to provide the child with the necessary sensory input. Some examples of Assistive Technology used in sensory diets are, weighted/deep pressure vests, seat disks/move and sit cushions, therabands chew tubes, noise canceling headphones/ear defenders, and therapeutic brushing. Depending on the child’s needs, the OT can use these Assistive Technologies in conjunction with other movement activities to help provide the child with appropriate sensory input.
Weighted and Deep Pressure vests are used to provide a child with deep proprioceptive input. They are assistive technology tools used to provide deep touch pressure interventions. Pressure vests allow proper functioning of a child’s sensation of gravity and body movement; which are essential for accurate and appropriate movements. Similarly, weighted vests offer the the same pressure input with the addition of removable weights which provide added proprioceptive input. When using a weighted vest with a child it is important to note that weights should be no more than five percent more than the child’s body weight and it is not recommended that the child wear the vest for more than thirty minutes, unless otherwise instructed by the OT or COTA. Using weighted vests in the classroom is simple. First, it is important to identify what stimulus causes discomfort or anxiety in the child. Once identified, the pressure/weighted vest is put on the child to provide proprioceptive support. The vest can be applied during any heightened stimulus reactions from the child, during academic instruction, play, and extracurricular activities.
It is important to note that little research has been conducted on the effectiveness of pressure vests/weighted vests for students with ASD. However, the few studies that have been researched, indicate weighted/pressure vests are ineffective in solving the problem of students with inattentiveness, hyperactivity, clumsiness, and other stereotypical problem behaviors with children of ASD. “Research suggests that intervention targeting stereotyped behaviors is more likely to be effective if these behaviors are replaced with a more functional behavior of the same type (sensory specific) rather than the use of a weighted vest to decrease the behavior.” If a child is struggling with inattentiveness, than a more appropriate use of assistive technologies, such as a seat cushion or a theraband.
Seat cushions, as described by Schilling and Schwartz (2004), are a dynamic seating tool that provides children with ASD an opportunity to both actively move and maintain an optimal arousal level while maintaining a healthy, safe, and productive posture. The seat cushion is placed on the child’s chair and can be maneuvered by the child. The cushion is slightly inflated to allow the child the to move freely around in their seat until they are in a comfortable position. By moving around, the child’s brain begins to handle sensory information that enables engagement of the activity at hand. Seat cushions are found in multiple forms and sizes that are accommodated to the need of the child. In the classroom, seat cushion are versatile. Due to the nature of seat cushions, they can easily be relocated. A child can have it on their seat and freely move around without making noise or getting up from their seat. Additionally, children can move their cushion to other classroom locations, if instruction is given in other areas of the classroom. Seat cushions come with a rough and bumpy side and a smooth side. A child who requires more deep pressure and tactile input can use the bump side and a child who needs less input will use the smooth side. The versatility of the seat cushion/move and sit cushion allows the child to be more in control of their therapy/sensory diet.
Therabands are also a proprioceptive sensory input implemented for children who become very fidgety due to excessive stimuli in their environments. This device, and others like it, is used in the classroom at child’s desk. It is either tied at the bottom legs of a desk or the side of the desk. When the Theraband is attached to the side or bottom of the child’s desk/chair, they are able to swing their feet back and forth while pressing against the band. This action triggers a distraction from the stimuli that causes dysfunction. When placed on the sides of the child’s desk/chair, the child can lift the Theraband up. Both of these uses provide the child’s muscles with sensory and proprioceptive input. As a low tech assistive technology tool, Therabands support students with ASD that present troubles with focusing and anxiety.
Similar to Therabands, Chew Tubes provide children with deep proprioceptive input to their mouths and jaws. Chew Tubes and other chewable objects, provide children with a safe object to place in their mouths. Chew Tubes can be a stand alone object that a child can hold or that can be placed on top of a pencil so a child can chew on it while they are working. While Chew Tubes are the most well known there are also other objects that are used. There are necklaces and bracelets that a child can wear that will proved them with similar sensory input when chewed. Chew Tubes are a low tech assistive technology tool that can be used to help a child remain calm and maintain attention, all while allowing them to remain seated.
Children with ASD can presented with hyposensitivity to noise. Noise canceling headphones are a low tech assistive technology tool used to aid children with this issue. These headphones function similarly to other noise canceling headphones. They are made to stop ambient sound. Children who may benefit from these headphones are either highly distracted by noise, highly disturbed by noise, or have a level of heightened concentration with noises. Noise canceling headphones are given to the child as a means to focus on their present activity without getting distracted or flustered by surrounding stimulus. Learning Abled Kids states that, the use of noise canceling headphones is easily implemented in the classroom. A child that has a hypersensitivity to noise can use the noise canceling headphones to concentrate. Furthermore, students who function best with noise, but can be a distraction to other classmates can use the noise canceling headphones as an aid to concentrate through music or white noise background.
Therapeutic brushing is one of the most well known assistive technologies used for tactile defensive children. Children who exhibit tactile defensiveness often dislike being touched, they struggle to transition between activities, and they may appear lethargic. Brushing is used to reduce sensory defensiveness and helps children respond to sensory input more appropriately. Brushing, when implemented within a sensory diet, has been shown to help children feel more calm, maintain attention, transition more effectively, and reduce their tactile defensiveness. When implementing therapeutic brushing it is recommended that you use The Wilbarger Protocol. This protocol was developed by Patricia Wilbarger, MEd, OTR, FAOTA. From start to finish the protocol should take about three minutes to complete. The therapist should use the therapeutic brush provided and provide the appropriate amount of pressure needed by the child. The protocol recommends that the therapist starts at the arms and works down toward the feet. It is very important that the child’s stomach, chest, and head should be avoided as brushing these places can cause adverse reactions. “There is not much documented research on the Wilbarger Protocol. However, many parents of children with autism have reported seeing decreases in sensory defensiveness and anxiety as a result of using this technique.” Just like all assistive technologies discussed in this paper, brushing should not be implemented without a discussion with an OT or a COTA.
A sensory diet combines all of these assistive technologies and many others, with a structured schedule that is unique to the child. The OT/COTA can make the sensory diet as intensive or as sparse as needed for that child. There has been inconsistent research conducted regarding sensory diets as well as the specific use of weighted/pressure vests, seat cushions, therabands, chew tubes, noise canceling headphones, and therapeutic brushing. Due to the limited research many of the findings conflict. For example, researched showed the ineffectiveness of weighted vests on a child’s behavior, but other studies encouraged teachers and therapists to continue to implement them in the classroom. When working with children with ASD it is important to remember that all symptoms present differently and therapies needs to be individualized and unique to the child in order to be effective. If you suspect that a child in your class presents with sensory defensiveness, please consult an Occupational Therapist to see if a sensory diet would benefit that child.