Sensory modulation is the most behaviorally problematic area of sensory processing for youth with Autism Spectrum Disorder. Sensory modulation involves the graded adaptive regulation of sensations. Sensory modulation disorder includes at least one significant difference in sensory: over-responsivity/hyper, under-responsivity/hypo, seeking, or avoiding. Sensory modulation disorders occur significantly more frequently in children and adolescents with Autism Spectrum Disorder and/or a history of Post-Traumatic Stress Disorder. Over half of youth with Autism had significant sensory modulation differences that explained their behavioral problems, with sensory seeking found most related to maladaptive behaviors (Dellapiazza et al., 2019).
Sensory over-responsivity disorder in youth with Autism Spectrum Disorders involves over attention to functionally irrelevant stimuli reflecting neurologically based disruption of habituation (accommodation to prolonged harmless stimulation) by the Central Nervous System. Basic sensory information is neurologically over salient in youth with Autism Spectrum Disorder and sensory over-responsivity causing them to attend to irrelevant stimuli and give inadequate attention to functionally relevant and social cues (Christensen et al., 2020; Green et al., 2016).
The goal of sensory processing intervention is to help youth more adaptively interact with their environment (Camarata et al., 2020). The first step in promoting improved behavior is to help youth recognize their early signs of dysregulation and apply sensory coping strategies to achieve a calm alert state. Specific environmental coping strategies to help students with Autism could include: seating students further away from peers so they are less likely to experience touch that interrupts their attention (Green et al., 2016), using earmuffs to significantly improve learning by reducing distractions (Ikuta et al., 2016), or using a study carol to focus visual attention on learning materials.
If initially lowering the stimulation alone does not result in a calm alert state, the next step is to increase sensory stimulation in a graded manner that add salience to learning materials until a calm alert state is achieved. Individualized examples could include: adding color lined paper to increase conformity of writing to the baseline of the paper, increasing the expressiveness of the teacher’s voice, highlighter use to add salience to relevant teaching cues (critical written information or the plus sign in math), and using a personal AV system improving learning of students with Autism Spectrum Disorder by making the teachers voice louder than the background sounds (van der Kruk et al., 2017).
A simple procedure is presented in the chart above for addressing sensory modulation disorders that are negatively impacting behavior in youth with Autism Spectrum Disorders. The first step is to notice dysregulation from a calm alert state and initially lower environmental sensory distractions. If this intervention alone does not achieve a calm alertness the next step is to incrementally increase functionally salient sensory input until a calm alert state is attained. Achieving a calm alert state is the first intervention to apply for improving behavior in youth who have Autism, behavioral, and sensory modulation challenges.
References
Camarata S, Miller LJ, Wallace MT. Evaluating Sensory Integration/Sensory Processing Treatment: Issues and Analysis. Frontiers in integrative neuroscience. 2020 Nov 26;14:55.
Christensen JS, Wild H, Kenzie ES, Wakeland W, Budding D, Lillas C. Diverse autonomic nervous system stress response patterns in childhood sensory modulation. Frontiers in integrative neuroscience. 2020 Feb 18;14:6.
Dellapiazza F, Michelon C, Oreve MJ, Robel L, Schoenberger M, Chatel C, Vesperini S, Maffre T, Schmidt R, Blanc N, Vernhet C. The impact of atypical sensory processing on adaptive functioning and maladaptive behaviors in autism spectrum disorder during childhood: Results from the ELENA cohort. Journal of Autism and Developmental Disorders. 2019 Mar 13:1-1.
Green SA, Hernandez L, Bookheimer SY, Dapretto M. Salience network connectivity in autism is related to brain and behavioral markers of sensory overresponsivity. Journal of the American Academy of Child & Adolescent Psychiatry. 2016 Jul 1;55(7):618-26.
Ikuta N, Iwanaga R, Tokunaga A, Nakane H, Tanaka K, Tanaka G. Effectiveness of earmuffs and noise-cancelling headphones for coping with hyper-reactivity to auditory stimuli in children with Autism Spectrum Disorder: a preliminary study. Hong Kong Journal of Occupational Therapy. 2016 Dec;28(1):24-32.
van der Kruk Y, Wilson WJ, Palghat K, Downing C, Harper-Hill K, Ashburner J. Improved signal-to-noise ratio and classroom performance in children with autism spectrum disorder: A systematic review. Review Journal of Autism and Developmental Disorders. 2017 Sep;4(3):243-53.
