Sensory Overload.

 

Sensory overload.

Many people, including neurotypical individuals, struggle with sensory overload. Some individuals can tolerate this sensory overload. They will develop strategies to help them tolerate these sensory overload.

Autism and sensory processing difficulties often go hand in hand.

We're often told, "oh yes the lights are quite bright, I'll turn them down/off."

But sensory overload is not just bright lights. If an environment is too busy - lots of people or even lots of information/colours/posters/decorations on walls/ceiling and so on, this can cause sensory overload. Big smells from food and drinks. The texture of clothing or other items. There are many sensory inputs that can cause sensory overload.

For those individuals who have sensory processing difficulties, turning the lights off, turning music down, isn't the solution.

What does sensory processing difficulties feel like? It differs from individual to individual. O has always been, and still is, very articulate in describing how she feels. L is now much the same.

O .... "If your skin feels like it is crawling when you hear someone crunching on ice cubes, you might be able to imagine how sensory overload feels. But now add in that the constant continuing overwhelming sensory input that makes your skin feel like it is literally crawling and itching all the time. Your brain hurts like you have a migraine, to the point that you feel like your head is going to explode. Sounds feel like they're echoing around your head with a constant ringing in your ears. And nothing you do, can ease these sensations. The sensory overload may cause your brain to shut down, and cause the flight fight freeze response to take over. Once these feelings take hold, there is nothing you can do except escape from that environment. And it's not just sounds that cause sensory overload. Bright lights, clothing textures, places that are busy with people. Any sensory input collides with every other sensory input causing a tsunami of sensory overload."

I always thought that I was being overly dramatic with sensory inputs. I'd tell myself that I was fine and had to tolerate the sensory inputs. Now I know that I'm not being dramatic. I have sensory processing difficulties and I allow myself to react and respond to the overload.

So next time an Autistic individual tells you that they feel like they are becoming overwhelmed by the sensory input, ask, what you can do to help them.

The Hidden Sense of Interoception

One of the things that I have learnt on our Autism journey thus far is that you never stop learning. Never!

Since O started her therapy sessions we have begun yet another learning journey.

But before I get onto the topic of this post, there is some background information that you need to know about first, otherwise you may become slightly confused.

Ever since O started Kindy, we have always struggled to get her to drink water regularly, eat her recess and lunch at school and go to the bathroom on a more regular basis.

I am sure that she has a hidden camel hump somewhere, as on some days she will rarely drink water during the day but then she loads up in the afternoon and evening. I also wonder if she has a bladder of steel as this little superhero can hold on for a very, very long time!

We've always put these struggles that we have down to O just simply being too busy at school or simply forgetting. Now the issue with not drinking enough water or eating enough food throughout the day leads to other more serious complications. On more occasions than I would like, we have ended up in the emergency department of our local hospital with a very dehydrated child.

It was only in talking to O's key therapist and the school age services coordinator that we realised that perhaps, just perhaps, O's sense of interoception hasn't fully developed.

I can now hear you asking, what on earth is interoception?

I have talked briefly about interoception in a previous post, but let's go into a little more detail.

First we need to go back to basics. We all know about the five senses - hearing, sight, smell, touch and taste. But there are three others that are considered our hidden senses. Senses that we don't consciously think about or are aware of on a daily basis.

The sixth sense is our vestibular sense - this sense provides our bodies with information as to where our head and body are in space. It helps us to keep our balance as we move about.

Then we have the seventh sense which is proprioception. This is our body sense that tells us where our body is in relation to the rest of us. It also tells us how much force to exert when performing different activities like hugging someone, shaking hands, cracking an egg open and so on.

Then we have an eighth sense - our interoception sense. This is a relatively unheard of internal part of the sensory system and consists of all of the internal sensations that we may feel on a daily basis when we're hungry, thirsty, anxious, nervous or when we need to go to the bathroom. Any sensations that originate from within our bodies all stem from the sense of interoception. Receptors in our body organs and skin, are constantly sending information about the inside of our bodies to our brain.

Our sense of interoception is always there in the background and it isn't something that we are generally consciously aware of.

In some individuals, particularly those who have sensory processing difficulties, this hidden sense may still be developing. And as with sensory processing difficulties, individuals may be under-responsive, over-responsive or a combination of both.

Some specialists consider that individuals with sensory processing difficulties may not know how to verbally label the data that their brains receive from the interoceptive sense. If they are not receiving enough data, the sensations that they receive may be confusing. And likewise if their brains are receiving too much data from the interoceptive sense, the sensations may become very overwhelming.

In O not feeling the need to drink water regularly in essence means that this part of her interoception sense is under-responsive - she simply isn't receiving enough data to register that she is thirsty.

In O being in a constant state of anxiety at times in essence means that this part of her interoception sense is over-responsive. Her brain is receiving too much information and the data becomes a distraction so she is unable to focus on anything else and enters into an anxious state.

The tricky thing about our sense of interoception is that the data that it sends to our brain, is required for a range of basic and advanced functions. These functions range from breathing, being hungry or bring full, needing to go to the bathroom, being aware of our own emotions, being able to manage our own emotions and everything else in between.

So it makes sense then that if a child's sense of interoception is still developing, then they may struggle with recognising and responding appropriately to their own emotions and to those of others.

If an individuals brain has difficulties in making sense of the information that it receives, then the individual may not be tuned into their internal body cues that assist others to interpret emotions. They may have difficulty "feeling" the different emotions that they experience. If an individual is not able to interpret their own different body sensations, then they may have difficulty in identifying their own and others emotions.

So how can we help children whose sense of interoception may still be developing?

One of the activities that O's key therapist has been working on with O is labelling different emotions and talking about what some of the external AND internal feelings that she may feel that are associated with these emotions. We have quite a number of body outlines with different sensations written around them - anger, nervous, happy, sad, you get the picture. This has been incredibly beneficial and very effective as O is now starting to recognise the early warning signs of her different emotions and can now verbally tell us how she is starting to feel.

Earlier this year, I developed a social story called "My Book About My Feelings" to assist O in labelling her own emotions. The story started to assist O to identify how she felt inside when she was sad or anxious.

We regularly read books and talk about how the characters might be feeling in particular situations.

When we see the little superheroes experiencing different emotions, we will verbally assist them to label their emotions - "Oh you look very excited....." or "I can see that you are becoming angry/frustrated by ..............." This not only assists them to label their own emotions but it also provides them with the appropriate language so that the next time, they may be able to verbally express themselves.

We also verbally label our own emotions and our internal sensations to the little superheroes. If they recognise that they too experience these internal sensations then they will begin to connect the dots!

Interoception issues are not as well known as other sensory processing difficulties and as such, medical professionals are still developing strategies to further develop this sense in those who need it.

The great thing about being on a learning journey with the little superheroes is that as we have an awareness of and basic understanding of the possible causes behind the little superheroes behaviour and/or functional limitations, means that we are helping the little superheroes. Just having an awareness of the sense of interoception and implications of this sense still developing means that we are able to trial different strategies to see what works best for them. It means that we are more understanding when we see them struggle with skills that everyone seems to take for granted.

So the next time you see a child who can't seem to get the hang of toilet training, or they never seem hungry or thirsty, or they fly off the handle at the drop of a hat, keep in mind that perhaps their sense of interoception is still developing.

What is Sensory Proprioception?

If you’re like me and new to this Autism journey, you probably read the title of this blog and thought “what the hell is that?”

Let me explain, but you’ll have to bear with me as I will have to go back to the beginning.

From a very early age L used to love engaging in rough play. When I say rough play, I don’t just mean rolling around on the floor bumping into the occasional object. He would go up to O and other children and start hitting them for no reason. L would seek out rough and tumble play but take it one step too far and would often hurt himself or others. He would engage in rough play with myself and Daddy superhero and start head butting us or squeezing our arms and legs to the point that it would really hurt.

L is and always has been a sensory seeker. He is constantly moving, jumping, bouncing, spinning, pushing things, pulling things and running. He’s an insatiable bundle of energy. He often uses way too much force when doing simple day to day tasks, opening and closing doors, moving toys around and hugging us. He’s always been loud, he loves crashing into objects and people.

L has always chewed on and mouthed objects, he still does occasionally. He is constantly bumping into or pushing people, including when he is asleep. He constantly seeks out physical touch in the form of hugs and standing or sitting super close to people. L loves tight hugs and heavy blankets.

He would never hurt us and other children on purpose, but he could never understand why O, his peers and us would be upset with him. He never understood why he had to say sorry. And when he did say sorry, it was just a word, there really wasn't any empathy behind it.

We always thought that L just didn’t know his own strength. We immediately started teaching L the “right” way to play. We started teaching him who he could play really rough with (Daddy superhero) and who he couldn’t (everyone else!)

From the age of 18 months until very recently he would constantly and randomly fall to his right, whether he was sitting or standing. This was of a major concern to both us and his pediatrician to the point that we had appointments lined up with a neurologist to try and determine the cause. And then he stopped falling to the right as quickly as it started.

It wasn’t until this year when we were talking with one of his therapists at the early intervention centre and we mentioned his apparent lack of knowing his own strength and what we thought was the relation to his extremely high pain threshold.

We had always assumed that because L’s pain threshold was so high, he therefore didn’t know when he was hurting others because he thought that everyone didn’t feel pain.

And wouldn’t you know it, we were completely wrong!

One of L’s therapists started talking about Sensory Proprioception and the term went straight over our heads. We must have looked like goldfish standing there with our mouths open and a stunned expression on our faces.

The therapist then explained in very simple language that when you or I hit something we can feel the force when we connect with whatever we have hit. We know when we’ve touched or hit something too hard or too soft or just right. L doesn’t. To receive the same sensation that we receive when we touch something lightly, L has to hit the same object a lot harder. It’s not that he doesn’t know his own strength, he doesn’t have the same level of receptors that you or I have.

Before speaking with L’s therapist I had never heard of sensory proprioception. So when I got home I did a little research, and this is what I found out.

You should be familiar with the five senses – sight, hearing, smell, taste and touch (tactile.) Well, our bodies have two additional senses that we receive input through. I knew about these, I just didn’t know that they had names. I mustn’t have been paying attention in Biology and Anatomy classes at University!

The first is the Vestibular Sense, or the movement and balance sense. This sense gives us information as to where our head and body are in space. It allows us to stay up right while we sit, stand and walk. It lets us know which way is the right way up. It helps us to keep our balance as we move.

The second little known sense is the Proprioception Sense, or body awareness and position. Put simply it tells us where our body parts are in relation to each other. It gives us information on how much force we need to exert in certain activities, for example how much force we need to exert when cracking open an egg so that we don’t crush it in our hands, or how much force we should be exerting when hugging someone.

We know that our eyes and ears are constantly sending information to our brain about what we see and hear. Our muscles, joints, ligaments, tendons and connective tissues are also constantly sending information to our brain, but on an unconscious level.

Humour me for a moment. If you close your eyes right now, well perhaps not right now but after you have finished reading, you’d be able to tell exactly how and where your body is positioned. Perhaps your legs are crossed or maybe your hand is supporting your chin as you try to stay awake while reading this! You didn’t have to think about this, you just knew. This is the proprioceptive system in action.

The proprioceptive system is primarily located in the cerebellum and it works closely with the vestibular and tactile systems.

We’d ordinarily gain proprioception input when we engage in resistance type activities like pushing or pulling activities or activities in which we’re actively engaging our muscles like when we're exercising.

When the proprioceptive system doesn’t function correctly it can be extremely difficult for an individual to sit still and stay focused. For a child it can be difficult for them to gauge how hard they can play with other children. It may even make it difficult for the individual to remain calm.

We knew that L was a sensory seeker and we now know that this is because he is under responsive to proprioceptive input. All the things that L loves doing are common indicators to an under responsive proprioceptive input!

All of the activities that L loves to do are assisting him to increase the input in his proprioceptive system. All the input is assisting him to understand just how hard he can play with others, how much force he needs to exert when doing certain activities and tasks.

I'm now starting to realise that some of the activities that O engages in are also because she is seeking proprioceptive input. O is constantly chewing on objects - toys, necklaces, clothes - and she says that she does to help her to concentrate. It's all starting to making a lot of sense!

And one of the many things that we as parents now need to do, is assist O and L to gain proprioceptive input through therapy based activities at home.

We do this by encouraging them to draw and play games while sitting and laying in different positions – sitting up with legs crossed, sitting at a table, sitting upside down on the couch or laying down on their tummies. They can gain input through using different fidget toys and playing with playdoh. We have different types of pillows and blankets that the little superheroes can stack, climb on and hide under.

We actively play rough and tumble games with L and we encourage them both to bounce on the trampoline in the backyard. But at the same time we're reiterating to L who he can and can't play rough with.

When L and O are particularly agitated, we do deep tissue massage by squeezing their legs and arms to try and calm them down.

We get L and O to help with heavy work activities around the house like carrying the shopping in from the car, helping to pack away around the house, lifting the washing into and out of the washing machine, watering the vegetable patch with a full 3L bottle of water, wiping the table after dinner.

It sounds bizarre but all of these activities not only provide proprioceptive input but they also help both O and L to become calm. The activities are giving them extra input to balance out their little systems.

We've always encouraged both O and L to engage in these activities, but now that we know just how much they are helping both the little superheroes, we encourage them even more!

It truly is amazing just how many common every day chores and activities around the house can be turned into therapy activities! I'd never really understood how occupational therapy worked, I do now!

**** If you believe that you or your child may benefit from activities that increase proprioceptive input, please speak to your GP or pediatrician for advice.****

For more information on the Proprioceptive Sense head over to these sites!

SPD Australia
Sensory Smarts