Responsive Communication

Responsive Communication: using body language to communicate, with attention to sensory processing difficulties.

For the last few years, we have been aware that, while Intensive Interaction is extremely successful when practised with some children and adults on the spectrum, there are other individuals, whose attention it is difficult to engage. For example, it is counterproductive to work with a child who has visual hypersensitivity if you are wearing a jazzy Tshirt, which triggers visual processing difficulties. Spurred on by the new diagnostic tool, DSM 5, which includes sensory deficits in its criteria for autism, we have been combining Intensive Interaction with paying Attention to Sensory Deficits, addressing the hypo and hypersensitivities that were triggering behavioural distress. We encourage practitioners to be on the lookout for visual, auditory, proprioceptive and emotional hypersensitivity problems and to take steps to meet the distress they are triggering.

For example, a child may be sensitive to bright light, certain colours or patterns. These cause distortions that make incoming visual information difficult to process, which may not only affect vision but also mood, balance and on occasion, sleep disturbance. ‘Irlen Syndrome’, as it is known, can be painful. It can be alleviated by using tinted lenses or coloured lighting, cutting out the frequency that is triggering distress. Similarly, Auditory processing difficulties, (certain frequencies, loud noises, overlapping speech, even dogs barking), can be addressed by using Acoustic Noise Reduction Headphones (not the same as ear-muffs). Proprioceptive processing problems (indicated by jumping, running, banging self, climbing) can be helped by increasing physical input. Particularly helpful is a trampoline. Input needs to be regular, 3 or 4 times a day.

Each child has different sensitivities, depending where the nerves in the brain are failing to link up in the usual fashion during development.

3. Sensory Deficits:

In order to reduce overloading the processing system and consequent sensory chaos, we need to scale down those inputs to which the individual's brain is hyper (over)sensitive and increase those to which it is hypo(under)sensitive, as well as communicating through non-verbal signals that the brain can easily recognise. Stress levels are reduced and the brain starts to function more effectively. Although not every child will be able to respond positively, it is always worth exploring these options. We cannot assess how able a child is until we have addressed their sensory processing problems.

( ‘Autism – Respecting Difference’, published by Pavilion, illustrates the link between how a child or adult with ASD feels and the behaviours their feelings triggers and how we can help by modifying the environment).

Vision: If the individual screws up their eyes in bright light, shows preference or dislike for certain colours, reacts badly to, or fixates on bold patterns they almost certainly have Irlen syndrome. Wear plain muted block colours. Paint walls and ceiling calm colours. Do not clutter walls with pictures/ornaments. Explore use of Coloured light bulbs, Dimmer switches, Peaked caps, Grey Sunglasses (where the problem is caused by intensity of light rather than colour or pattern.)

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Sound: Many children on the spectrum have problems with sound - loud sound, particular sounds, sudden sounds, certain frequencies in certain voices, complex sounds (especially overlapping speech.) Where speech is used, speak quietly. For many it helps to support speech with simple gesture or mime. Designed for helicopter pilots so they can hear each other over the engine noise, BOSE Quiet Comfort 15 Acoustic Noise Reduction Headphones (Amazon) cut down on distant sound while allowing close up conversation. They can be very effective helping children to cope and attend in noisy environments such as school, mealtimes, supermarkets, etc.

Boundaries, Interoceptive and Proprioceptive Distortions:

A common problem is under-sensitivity to messages from the body's muscles and joints to the brain telling it what the body is doing. In an effort to overcome this, children and adults will give themselves strong physical inputs (rocking, jumping, running, bouncing, climbing, hitting themselves) so that at least they have some idea of what they are doing. We can help by also giving strong physical inputs. Explore use of: Trampoline, Pogo Stick, Swing, Space Hopper, Climbing frame, Wall or Bars, Ridged Insoles, Astroturf, Weights, Weighted clothes, Carrying rucksack or shopping bags with books or drink cans in them, Weighted blankets, Compression vests/stockings, Vibration and firm Massage, Manual pressure. (Inputs need to be frequent, topping up with short sessions several times a day to make any real difference.) Boundary Problems are allied to Proprioceptive difficulties, the person finds it hard to know where they stop and the outside world starts. Click this link to view Tight and weighted vests made to order in the material of the individual’s choice.

Some people, not all, but especially those who are under sensitive to proprioception, scrunching toes, banging feet, banging body, slamming feet on the ground, benefit from textured insoles which increases the feedback they are giving themselves and tells them what they are doing.

Texture Insoles (Enhancing Feedback for Symptom Management)

Recent studies suggest that some people on the autistic spectrum have damage to, or a break, in the neural pathway which conducts proprioceptive signals from the body to the brain. Scrunching up my own toes, I wondered how one might enhance the feedback from the body to the brain. It occurred to me that it might be helpful to use insoles with some sort of texture to stimulate the soles of the feet. ‘Reflexology Insoles’, have nodules on them, which enhance proprioceptive feedback from the body to the brain. The following notes are replies from the people who tried out the insoles. The following feedback is from individuals on the spectrum who were experiencing proprioceptive processing difficulties, seeking sensory feedback, such as foot rubbing, scratching or slamming feet on the floor, removing shoes and walking on rough surfaces, or running. From the beginning, I am anxious to point out that no claim is being made that textured insoles are a cure for autism, but it does seem possible that they may alleviate some of the more distressing sensory overload characteristic of the condition. Some people report a reduction in anxiety levels as well as physical symptoms. The feedback includes both positive and negative comments. I would suggest that there is already enough evidence to make this simple (and relatively cheap) approach worth trying.

The insoles need to be cut down to size. Ordinary scissors will do this. The insoles can take getting used to. Try just placing them under the feet first. It is recommended that they are worn for an hour or so to begin with, working towards full time use over a period of up to three weeks. If the high arch is still felt uncomfortable it can easily be filed down with gentle pressure from a power sander. Contact: Revs Reflexology Massage Insoles

Feedback from users:

Hope was one of two people who I noticed was scrunching up her toes when she started to feel anxious. She told me that a lot of the time she felt like a balloon floating round, unattached to the ground. When she first put the insoles in her trainers she said, ‘Before, I knew I was walking but could not feel it, but now I can feel I am walking‘. The ridged insoles are incredibly helpful. They help to ground me. I can actually feel my feet for once in my shoes. The only time I used to be able to feel my feet was when I was in pain with them. Or if I was wearing new (or uncomfortable), shoes which sometimes meant I would purposely wear these uncomfortable shoes just to get that pressure on my feet. Just so I could feel my feet. I now don’t feel like a floating head like I normally do. When I’m getting overwhelmed or overloaded I normally scrunch up my feet but now it helps to stop or lessen overload as when I now scrunch up my toes I now feel the bumps on the reflexology insoles which is stress relieving and calming. ‘The textured rubber material for insoles in my shoes has made a massive difference to my twitchy toes and nerves. I was very surprised for something so simple to work’. And a month later: it took me a while to get use to them and see the difference they made, but I can now safely say I wouldn't go back to wearing shoes without them.’

Paul is an autistic trainer, speaker, consultant and blogger. He has co-authored several books including ‘Life through a Kaleidoscope’. This is what I have noticed.

A better sense of body connectivity. My posture improved. Feet placement less, softer not slamming my feet on the ground trying to get input. My hemiplegia has greatly benefited (my right side),

Richard ‘Autism Live Training, Author of, ‘I Dream in Autism’.

I was not expecting the effect they give. Through giving greater proprioceptive input on my feet I am walking with a smoother gate and not striking my feet on the ground so hard. I have noticed less ankle and knee discomfort as a result.