Maybe we all just need a bear hug

After giving the presentation on Autism, I realized that while I knew a little about sensory integration from working with kids with autism, I did not know exactly how important it was as a symptom of autism.  If it is as common a symptom as people believe who are working in with kids with autism why isn’t it included in the DSM as a symptom?  Just how common is it for children with autism to have deficits in sensory integration? How important is it in the treatment of autistic symptoms? Also how important is it in the treatment and understanding of symptoms of autism?

While working at an inclusion program for kids with special needs at a summer camp I worked with Olivia, a ten-year old with a seizure disorder and autistic symptoms.  While working with her I found that giving bear hugs and rubbing her arms often helped her to calm down after stressful situations.  She also was very sensitive to loud noises and sensation on her skin, so being in the outdoors at camp was sometimes difficult (the bugs on her skin were a nightmare!).  My boss told me about treatment for kids using sensory diets that tried to regulate the input that these children had, and how it could help them with their daily symptoms.  Things like swinging for 20 minutes a day could have such a great impact.

I found a paper that describes just how important sensory integration seems to be for understanding autism.  I found one statistic that said that 42-88% of kids with autism also have difficulties with sensory integration.  One study also found that all children with autism show deficits in sensory integration even if they are not low enough to be classified as having disordered functioning.   Some studies suggest that children with autism show deficits in auditory processing—either hypersensitivity or underresponsivity—which could relate to the communication deficits.  In addition some studies suggest that eye contact avoidance could be a self-regulatory method used by children to modulate visual input.  It makes sense that if children are overly responsive to visual input they may have difficulties in these areas.

Sensory integration seems to be a key to understanding some aspects of autism and I find it really odd that the DSM does not include this as one of the symptoms. Why could this be?

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5 thoughts on “Maybe we all just need a bear hug

  1. That is interesting Hannah! I had no idea that there were sensory symptoms associated with autism! I wonder why they are associated and why they are not included in the DSM. I feel like the DSM includes too much rather than excluding things.

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  2. A question I had after reading this concerned the possibility for a variety of symptoms and characteristics associated with hypersensitivity and hyposensitivity to visual and auditory stimuli. Are there a particular behavioral presentations idiosyncratic to autistic patients with defects in sensory integration? Eye contact certainly strikes me as a possibility, but being hypersensitive and avoiding eye-contact could be merely correlative. It would be interesting to know which systems are particularly involved in producing the behavioral effects of hyper/hyposensitivity. Perhaps the DSM has not included this as a symptom because of the plethora of environmental triggers that could be associated with a defect in sensory processing. Those being prior experiences which condition a reaction, (i.e. a doctor’s white coat causing a fear of needles.) Is it really because autistic patients are hypersensitive to pain or, rather, are they unable to understand the purpose of a needle prick? Perhaps the biological mechanisms are not that well understood and diagnosing a defect in sensory integration is difficult. I would really like to read more research done in this field.

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  3. Hey Hannah,
    This was a really interesting topic that I related to my own experiences working with children with autism! I’ve worked in a preschool class for children with autism since high school and they use many similar methods that you wrote about. The classroom had six children in it, with an individual paraprofessional for each child. As you wrote, the kids were very sensitive to loud noises and so each child had their own cubby to play / learn in with their para. Most of the children were non-verbal and the teachers used “discrete trial” intervention. This included stacking blocks in order of size and putting different shaped objects into those open balls with holes in them for the 3D triangle, circle, oval, square, etc. Like you mentioned, sensory integration was used all the time. There was a sand box that the kids were encouraged to play in, although some were much more in-tuned to it than others. Additionally, one little boy had a licking problem, in which he licked anything that was in front of him… instead of fleece. His mother and the teachers wrapped everything in fleece, even his shoes, so he wouldn’t lick them. One question I have is that for one little boy who was very fussy, the teachers used a weighted vest, suggesting that it “grounded him” and in fact, if he was crying, the vest would calm him. Why would this be? As you said, when the kids were restless at circle time we would rub / massage their arms… do you think the vest has a similar effect?

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  4. Hannah, this is a very interesting post. My mom is an occupational therapist who works with autistic children and I worked at her school with some autistic children last summer. I have always heard my mom talking about sensory integration issues associated with this disorder, so I was surprised to hear that this was not an official symptom. I think this definitely warrants further investigation, because if it is a symptom, official recognition could lead to better treatment of it. As for the hugs, arm-rubs, and, as Chelsea mentioned, weighted vests, it is my understanding that these do all work the same way. I too have seen this “deep pressure” have a calming effect on overstimulated autistic children, though I am not sure of the mechanism for it. These children often seem to implicitly know their need for it, however. They often seek out bear hugs, jump up and down hard, or play with toys that provide the desired pressure. Last summer, one of the children I worked with would frequently become overstimulated by the noisy classroom environment, but he was learning to ask for “O.T. breaks” where he could go to the occupational therapy room and use whatever toys he wanted. He knew what toys would help him and I didn’t have to do much to facilitate his play. After ten or fifteen minutes he was ready to go back to the classroom and was calm enough to do his work.

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  5. Maybe the confusion about including sensory integration lies in the fact that it varies so much- some people get over stimulated very easily and react strongly to the mild sensations such as having wet clothes, while others are constantly understimulated and don’t ever react to even strong pain. I was reading up on sensory integration therapy for a paper I just wrote, and found a cool example of a “sensory diet”:

    CALMING ACTIVITIES

    8:30AM Bath, Brushing, Deep Pressure

    3:15PM Child’s choice (e.g., biking)

    6:30PM Supper, Bath, Deep Pressure, Free Play, Stories, Bed

    And- EVERY HALF HOUR AND ANYTIME

    Other Sensory Stimulation

    Everything on the other list plus:

    * Smelling Scents Game
    * Rubbing/Brushing (brush firmly and consistently–avoid stomach)
    * Rolling Up In Blanket
    * Crawling through a “caterpillar” (long tube of stretchy fabric)
    * Dragging/Sliding Around Room
    * Silly Walks (e.g., crab walk)
    * Ball and Bat
    * Imitating Songs
    * Hand Games
    * Stilts/Roller Skates
    * Jump Rope

    That’s a lot of activity! I think children with ADHD would greatly benefit from a lot of these things, too.

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