Sensory Processing & Autism

Join Lynette and Rich as they explore an intervention model for Autism called The S.U.C.C.E.S.S. Approach (SM). The model is designed to help you understand, respond, and help those in your world who live a life with Autism. Our goal is to help expand your thinking to better serve these amazing people, and to support you in your daily struggles and celebrations.  In this episode guest Occupational Therapist, Ellen Winney, joins Lynette and Rich as they discuss the many sensory processing challenges in autism. Conditions like sensory “over responsivity” and “under responsivity” are explained, and examples shared as to how these conditions can impact the day to day functioning of individuals on the spectrum. Examples of occupational therapy methods used to address these conditions are shared by Ellen and Lynette who have successfully treated sensory processing problems for over 45 years collectively.     

As Heard on the Show:
Sicile-Kira, C. (2 March 2010). What is Sensory Processing Disorder and how Is It

Related to Autism. Retrieved from http://www.psychologytoday.com/blog/theautism-advocate/201003/what-is-sensory-processing-disorder-and-how-is-itrelated-autism

If you or someone you know could benefit from the full training for The S.U.C.C.E.S.S. Approach (SM), you can take the course online.  Just go to https://www.thesuccessapproach.org/online-course for registration and other details.

The S.U.C.C.E.S.S. Approach is a registered Service Mark protected under intellectual property law unless otherwise specified, all music, audio visual, and proprietary content shared in this podcast is property of AWEtism Productions, LLC and it’s sister agency Integrations Treatment Center. The use of this content is unlawful without the expressed written consent the proprietor.  

For more information about The S.U.C.C.E.S.S. Approach(sm), please go to our website at www.thesuccessapproach.org.

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Transcript

Connect with Success Podcast - Episode 4, Launch Date: April 28, 2021

With Dr. Rich Smith and Dr. Lynette Scotese-Wojtila
Guest: Ellen Winney   Subject: Sensory Processing

Welcome to Connect with Success with Dr. Lynette Scotese-Wojtila where we help connect you with knowledge. Our mission is to lead you to a new and exciting way of understanding, responding to and helping all those with autism. We hope to expand your thinking about how to best serve these amazing people and how to support you in your daily struggles and celebrations.

Dr. Richard Smith

Welcome everyone to episode four of our Connect with Success podcast built around The SUCCESS ApproachSM, the person who coined it Dr Lynette Scotese-Wojtila and the people who use it and benefit from it every day. In today's episode Dr Lynette is going to discuss another one of the common ideas when it comes to understanding and helping a child or adult with autism. She's going to give it a name that you may or may not have heard before in the field of autism. 

My name is Dr. Richard Smith and I'll be facilitating our discussion about this idea that we should understand and support all those who live and work with autism. So Lynette, what is our term that you're going to share with us in this episode?

Dr. Lynette Scotese-Wojtila

Today’s term is sensory processing. Sensory processing is basically a brain process, and we use it often and address it often in occupational therapy, by definition, is the process through which we register, process, and interpret sensory information so we can organize it and use it for function. Kind of a simple idea, but it's very, very complex and it occurs at the most primitive parts of the brain.

Dr. Richard Smith

Okay well I'm excited because we have to we actually have our first guest on the show today and it is someone that we both know very well, and we're excited to have her and honestly kind of having a fanboy moment because I've got the two best angels on earth here with me because they helped me to reach out to my daughter, who's on the spectrum, and was like a life saving moment for us all, so I'm excited for you guys to meet them because we know Dr. Lynette, but to have Ellen with us too is just having a complete dynamic in the room that I wish you guys could be here to see so welcome to the show, Ellen, tell us a little bit about yourself.

Ellen Winney

My name is Ellen. And, like Dr. Lynette, I am therapist with close to 20 years of experience, 15 of those have been specifically with Autism and Related Disorders and sensory integration has been a huge part of my treatment and one of the main theories that I operate from as an occupational therapist specifically with autism, but as we'll delve into, it's not just kids with autism who need their sensory systems addressed.

Dr. Richard Smith

It's amazing to me as we're in our household very aware that we're more aware now of that is a sensory issue for us, like I'm sitting there and Christy, for example, My wife she'll talk about different packaging, something Styrofoam, packaging like coming out of the box, just like nails on a chalkboard to her. And so the kids will just open up a package and Christy like can you do that in the other room? You know, like it's so you're right I mean it's really for anybody really it's going to be process and intake, some of the things going on around this. 

Ellen Winney

Absolutely, and once you become aware of it, it's fascinating. Like you said, everybody has certain sensory preferences, certain sounds, certain meals, certain things, that maybe just sort of like kind of like, oh, that's, that's not right. That's all. But it comes a problem when those sensory preferences are stronger than just preferences, and impact function, and that's where usually we need the help of your OT, who are specially trained in sensory processing to kind of see what's going on in the brain and how we can help those sensory processes. be better facilitated and interpreted.

Dr. Richard Smith

That would be an amazing episode. Make sure you guys stick around for it, but first tell us a little bit about yourself. Tell us about your family, what things you like to do, what are some of your favorite places to be.

Ellen Winney

Well, these days anywhere with real people is great! So I am a mom of five, I have three boys and two girls 14 down to four. When I am not working in the field of autism. I'm also a homeschooling mom, so that takes up quite a bit of my time, but when I have free time, I love to read. I'm pretty active in our church, and just love, lately, being outside and enjoying beautiful weather -- and sunshine is high on the list sunshine!

Dr. Richard Smith
Definitely, I can't wait for the sunshine! 

Alright. Well now we got to know a little bit about Ellen, and I'm really excited about jumping into this next segment where we can talk more about sensory processes so we've got some of the best experts in the room in my opinion that we can possibly talk about this so Lynette gave us a definition cursory definition of what sensory processing was when we first started, Ellen, can you tell us a little bit more about it?

Ellen Winney

So, if you think about it, we are bombarded with sensory information constantly.  The people listening to this podcast obviously are hearing the sound, the auditory input of our voices, but they also are seeing whatever's in front of them, they're feeling their clothing on their body. If maybe they're out listening to this while they're jogging, then they're feeling the movement of their body. So there's lots of sensory input coming at us both internally and externally. 

And so sensory processing is that ability where our body first of all registers that input, the input that is coming in, and then sends it up through the brainstem, to the parts of the brain where it's going to be recognized and processed, and then send input back to the body of what to do, based on that input. And so it's something we all have as we referenced earlier. Some of us have certain sensory preferences. But what we find in the field of autism, but other issues with sensory processing is sometimes the body doesn't register that information properly. And we can see very obvious aspect of that would be if somebody was blind, they're not even going to register the visual input, but sometimes those sensory functions that take in the sensory input are working fine, but there's a problem in processing it, and then interpreting that information and that's where, occupational therapists tend to come in to help that process and facilitate the normalization of sensory processing and interpretation.

Dr. Richard Smith

So what does sensory processing have to do with childhood development, Lynette?

Dr. Lynette Scotese-Wojtila

Well as Ellen said, if we're going to be taking in information about our world and acting on it. Then, the role of sensory processing and childhood development is to support proper learning and proper engagement with the world. And we see that at a very, very young age. A good example that Ellen and I will often give in the class that we teach is the rooting response when we have a newborn. Most mommies, most babysitters, most daddies, anybody that has experience with newborns can sort of picture this, but they may not tie it to the sensory stimulus I'm about to identify, but when a newborn is in contact with the tip of a bottle, and uses the nipple of a bottle to stroke or to touch the side of baby's mouth. That baby will automatically route, turn the head to the source of the nutrient. And that's a very primitive, very understandable, very black and white response. The baby is designed to thrive, based on a food source. And so, that can't happen if the sensory system isn't intact, because the stimulus may not be perceived and then we're therefore the motor response that Ellen referred to earlier, can't kick it. So there's this beautiful symbiotic, you know codependent if you will, co related relationship between inflammation coming into our body and processing and then having an output usually a motor output. 

Dr. Richard Smith

And so that's how it normally works for folks

Dr. Lynette Scotese-Wojtila

That is how it normally works for folks and in childhood development, there's various stages where we start off pretty reflexive, like we're a little bundle of reflexes when we're first born. That's a normal, spontaneous, subconscious we would say, autonomic (it happens spontaneously without us thinking about it) very low in the brain, like Ellen mentioned, in the brainstem, very naturally. And it is dependent on good neurology.

Ellen Winney

And I would like to point out that so much of early childhood -- the whole job of being a child really -- is to allow this to mature and develop. And if you think of a typical two year old, to really picture a two year old little boy, what are they doing all day long? They're running, and they're jumping in, they're jumping off the furniture, they're crashing into the couch cushions and they're climbing and they're going down the slides and they're very physical and very active and that is the natural normal way, in somebody who's neurotypical that those sensory systems develop appropriately, and the body learns to register that information and then to process it properly so that is a big part of toddlerhood is really this process of integrating and maturing, the sensory systems, because that becomes the foundation for everything else.

Dr. Richard Smith

So, and how does this differ in autism?

Ellen Winney

Well for children in autism, the wiring of the brain is different. And so the pathways that would take in that sensory information, and then send it to the higher centers of the brain are wired differently, and so the child doesn't necessarily experience sensory processing the same way that somebody neuro typically would. And so we see things both ways, where they might be under responsive or hypo responsive, we call it, to sensory input where they're not registering, Where somebody at a neurotypical level would. So for example, if somebody is under responsive to movement, especially like spinning, we call that the vestibular input, they might spin and spin and spin and spin and spin and spin and spin and spin and spin -- and get off the swing, and walk in a straight line! Their body didn't even register all that rotation, where some of us who are neurotypical, with just watching that movement without experiencing it, we would be sick, if not extremely dizzy. 

Children on the autism spectrum, and adults as well, can also be over or hyper responsive to sensory input and so we see that a lot of times that auditory input were something that would, you know, barely register for us they're, you know, holding their hands over their ears are very sensitive to it; or to the sense of smell, where they can smell somebody's perfume two miles away at Target and have a hard time focusing on anything else because that's just really overwhelming to them. So those are just some, some typical examples, and again every child on the spectrum is different and the variations in their sensory system might be different, but those are some of the typical ways we see things profile out.

Dr. Lynette Scotese-Wojtila

Another way that the brain of a child with autism differs from those without autism has to do with the brain's capacity to slow or altogether stop or inhibit. And we have nerves and neurons that allow us to amplify sensory stimulation, if we need to do that. And there are certain nerve cells that actually dampen or quell the energy or the action potential we'd say in science, to make that impulse not so intense; and we take that for granted in neuro typical development. But people listening to my voice right now are naturally inhibiting everything else going on around them auditorily. However, If a siren went flying by, or came close to the house and pulled them to their driveway that siren would become salient for them versus my voice, and it should, because it signals something. But our bodies know enough, subconscious, sub brainstem sort of way -  a subcortical kind of way -- to not pay attention to everything, because we wouldn't function if we did. So we have this gift of inhibition. And so, Ellen pointed out very eloquently that sometimes adults with autism or children with autism are too sensitive or not sensitive enough. But part of the underscoring problem to that is that they can't inhibit well, and that poses problems that show up in what we might consider behavior. 

Ellen Winney

Exactly, so we hear parents say, “My child can't concentrate because of the hum of the refrigerator.” So something that we normally just inhibit or tune out, don't even pay attention unless someone draws our attention to it can impair that from functioning; and we see this in classrooms where there is so much stimulation in a typical classroom with the other child rustling papers, or the lawn mower going outside, or the bell is going; and there's just so much input, not to mention the visual input of lots of different people moving about things they have the feeling that the child cannot possibly tune into the teachers voice saying, “Okay, children open your math books to page 35.”  Because there's just so much other input that they're not able to inhibit, to be able to focus on what should be salient.

Dr. Richard Smith

To a degree where they're almost overstimulated and they're having trouble processing everything around them. And that's really what this is right? So to go back to your point, I was going to actually jump in with the same example. I had a student who was listening to the air conditioning run, and wasn't realizing that was what was holding them back, like they were trying to figure out what that noise was. What clicked, what their click was what their running was in the room, and they were trying to figure out if they were okay, versus me just thinking they just weren't paying attention to what I was saying in the classroom, right. So, why, why else is it important for parents or teachers and or those with autism themselves to understand what sensory processing is. 

Dr. Lynette Scotese-Wojtila

Well I think for teachers, it's important, especially because of what you just said, Rich, we misinterpret what the child's attention is on, or the reasons a child attention or not, maybe on us. So your excellent example of the air conditioner that child can't inhibit that stimulus, and so they're forced to attend to it, a teacher looking at that might come up with adjectives in their head, it's natural, it's normal we do this as human beings we interpret what we see and we put names to it. And so it might be “disengaged”. My personal favorite, not really, is “aloof.” That's a real interesting adjective and quite sad when people use that term especially to identify or label a child with autism is behavior or response or “disinterested” “disengaged” “acting out”, you know “disrespectful”. How about that one. They don't even realize that there's another stimulus to attend to. So one of the reasons it's important to know and understand sensory processing is because it impacts what we talked about in our second podcast, which was readiness. If a child is unready to attend to Dr. Smith's voice. Then he's not ready, period. And it might be a sensory reason why he's not ready, and not a behavioral reason.

Ellen Winney

Another thing that's really important to know is that there was research done in 2010 by Phil Keera that said that adults and teens with autism identify sensory processing challenges as their number one area of difficulty. This disordered sensory processing has been associated with impaired daily living skills, poor social participation, anxiety and depressive symptoms. 

So it's critical that we truly understand the role that sensory processing plays, not only in children, but if it's not addressed in children, how it can linger into young adulthood and adulthood and continue to cause issues. And when you look at sensory processing it really is the foundation for every other skill. You cannot have good attention skills, if you don't have good sensory processing. You don't have good eye hand coordination, if you don't have sensory processing good sensory processing. 

And it goes further down. If the child doesn't have good set high hand coordination, they don't have good attention skills, then they are going to have poor social outcomes. Think about it. Even a child that is high functioning, you know, when they're picking teams for kickball, no one's going to want the kid that doesn't have good eye hand or foot coordination or can't pay attention to the game! And so, it affects their self esteem and self confidence. 

So it's really this whole spiraling effect that we can trace all the way back to core sensory processing, so that's why it's so critical to understand it, to acknowledge it and to address it. 

Dr. Lynette Scotese-Wojtila

And I want to have Ellen repeat those areas that were identified in the study. We know that these teens and adults identified sensory processing as their number one challenge. Out of the mouth of babes, that's so important. But let's go over again, Ellen, you said I'm going to count the areas that you identify. So what is affected by poor sensory processing?

Ellen Winney

Impaired daily living skills, so that's a pretty broad category that can go into a lot of things in and of itself, but 1) daily living skills, 2) poor social participation, 3) anxiety and 4) depressive symptoms. 

Dr. Lynette Scotese-Wojtila

Four major things impacted or the result of word processing, and some of them not so fun, anxiety, depression. These are heavy things that our kids and adults deal with -- and their families. And, again, sometimes we're not really in tune to the difficulty. And so if we're missing the sensory processing problems, we're not understanding the behavior. And then the person experiencing the issue doesn't have the support. And so not only that, they're likely to maybe have those kinds of outcomes with anxiety or depressive disorders, they don't have a sense that there's any other way to be.

Dr. Richard Smith 

Right, or I'm listening to you say this and that's such a broad stroke of some of the symptoms that can be categorized as something else so it really could be something that goes missed -- the sensory processing issues for our students as well.

Ellen Winney

Absolutely and I think, unfortunately the way they're often labeled is “behavioral problems” and they're the child is labeled as being manipulative, because, you know, they will, won't wear jeans, anywhere. And so, you know, that runs into a problem and a power struggle sometimes when it's time to get dressed and they get labeled as being difficult or stubborn or manipulative because they know that you know this, we give way too much credit. I think sometimes to kids on the spectrum that they that they know that what they're going to do is impact me and I'm going to react this way and then they're going to react this way like the meta metacognition is not really where they're at as a four year old refusing to put on jeans, it's usually something you know much more basic like a sensory process issue but we interpret it differently, if we don't we don't have that knowledge and these parents are trying the best they can, but you know they need to do they need to be empowered to know what the underlying causes because that changes completely how we approach the situation.

Dr. Lynette Scotese-Wojtila

And I think that parents miss it because they themselves have effective sensory processing, right. They're clipping along at the speed of light, they can tolerate their clothes, they can tolerate the smell of cupcakes, or the liver and onions, whatever we're making in the kitchen -- it all makes sense to them, literally and figuratively, because their senses, process it, and interpret and allow them to function through those sensory experiences, whereas the child with autism or other neurological disorders, don't.

It halts them, or changes their capacity to do something, so we want to understand it, because it's so foreign to us that if we don't, we're going to accidentally not support our young adults or children or older adults for that matter as much as we could and we all want to help as much as we can so significantly important to understand it, address it and respect it, like this is their body. This is their brain. This is how they're wired, and they're not having fun, living in this existence, necessarily, they need our help, and they don't always have the words to ask for it, it will come out in behavior, posture, seeking certain parts of a room or avoiding certain stimuli, if you really work with your occupational therapists in the school setting and or private setting, particularly private setting because a lot of times in the school based model. The children's needs tend to manifest in kind in a motor way, a fine motor sort of way, where we know that really there's a lot of underscoring sensory issues. So sometimes those private-based therapists can delve a little deeper into those needs and train a parent, to help them and understand it, and treat it sort of as an extension of their own service that may be in the home setting.

Dr. Richard Smith

I think that's one of the beautiful things of the success approach is the fact that it really does encourage you to build that team, that collaborative team of people who might be responsible for caring for your child, so it can be not just the parents but the teachers and other caretakers in their lives, to help them to understand, overcoming some of these barriers.

Dr. Lynette Scotese-Wojtila

That's right. It reminds me, Rich, of podcast number one, where I introduced the term transdisciplinary. And one thing we know about sensory processing problems is that it's going to show no matter who's around. So if you have a good transdisciplinary team: if it's a mom, working with a bus driver or bus driver working with a therapist or the therapist working with a doctor -- whoever's on that team, the understanding and respect for that processing problem can be shared and supported so that the child can resolve as fast as possible by everybody understanding and doing the same thing.

Dr. Richard Smith

So who can diagnose sensory processing problems?

Ellen Winney

So typically it might come up as part of the autism diagnosis, it's now a DSM five, one of the diagnostic criteria that can be considered as differences in responding to sensory stimulation, but most often the occupational therapist on your team is the one who's going to be trained to diagnose and to address those, differences and usually it's not just your occupational therapist off the street, occupational therapy is a very broad field, some specialize in hand therapies some are specialized in unit neurological rehabilitation, like stroke and spinal cord; so you really want to look for an occupational therapist that has had additional training in sensory processing and sensory integration. 

Dr. Lynette Scotese-Wojtila

And there is a whole certification track called Sensory Integration and Praxis testing. It's si PT sub tests, and it's very intensive training, intensive neuroanatomy, and neuro phys, followed by mastery level implementation of the 17 sub tests that together comprise the SI pt. And there are great therapists who are certified in sensory integration are not trained in SI PT to actually render si are supposed to call sensory integration treatment. But if you do get a certified therapist, you know they have the training. So it is important to seek that out because Ellen's right, occupational therapy is incredibly broad and even within pediatrics, not everybody specializes in sensory and within that, there's a sub specialty of autism because their particular processing is really unique. 

There's a phenomenon, a condition, I would call it, called Mosaic processing, and it is kind of just like what it sounds. I like to always tell parents about it because it just points out how different their brains process. But a couple of people with it, who have written about it, and were adults that can articulate their thoughts and perceptions, describe it as mosaic processing and it's basically little tiny snippets of auditory and/or visual stimuli, and it doesn't come all at once; it comes in chunks. And one of the women with it, is this amazing, a woman named Donna Williams and Donna has written a book about it, and in one of the chapters of the book she talks about walking into a room, or no, sorry not walking into a room, she's seated in a room, and all of a sudden, she notices the sound of a door ajar. And then a few milliseconds later, she gets the flash of a paw. And then a few milliseconds later, she gets the swish of a tail. And then she hears, maybe a little pur. And then next she gets like a green eye. And she puts all this together very quickly and realizes that her cat came in the room. But by the time she gets those four or five mosaic tiny pieces of information the cats on her lap. 

Right, so apply that to function, you know, how do you cross the street with mosaic perception? Probably not very safely. Right. And so we can't take for granted our own sensory systems, but we do; and again, it's by design. The brain wants it to be automatic and subconscious, because if we paid attention to everything, we wouldn't function, we would be too preoccupied. 

But these people are stuck, in that, sometimes uni-system -- only one system working, just sound, and the others, turn off or just smell and the other is turned off. It's very interesting the  differences, but something like mosaic perception is probably one of the most complex and not so common problems, but it could be something like that, compared to something like hypersensitivity to touch, which shows up in things like children or adults not wanting to wear mittens or hats or not tolerating tooth brushing. Parents talk about not tolerating hair brushing. I often go to the dentist with my patients, with my children. I've gone into the OR before, because the anesthesiologist has to touch the child to get them to have anesthesia put into their veins, and I'm there to help dampen the child, not only am I familiar, but I have the therapy touch and the therapy technique to dampen that child and the part of the skin where that shots going to go in, and or over their face, which is more common, to tolerate the mask where they can go out, be out and have surgery go under. So think about it, our sensory systems are at play all day long, and these kids need help to get theirs to integrate.

Dr. Richard Smith

I'm extremely ego phobic so I may have to borrow you the next time I go in for bloodwork or something like that. Well it sounds, it sounds so relaxing like that might be a pleasant experience, you know at that point, perhaps the. 

I want to go back to something you guys talked about earlier in terms of reaction to these over stimuli. Right. And the whole idea of what we're perceiving as, as the child doing, which could be this whole avoidance technique; and we see students that stay glued to their headphones because it's their way of escaping the over stimulus that they might be experiencing. So how can I help my child if he or she has sensory processing problems?

Ellen Winney

Well, I think the very first thing is, sensory integration treatment has to be individualized to the specific child. So you need to be working with an occupational therapist for very specific to your child recommendations based on assessment of their sensory systems and how they're processing or not processing things particularly, so that's the number one recommendation is child's an individual and it would be negligent to say here if your child is oversensitive to sound this is what you need to do, you really have to work with your occupational therapist and what the occupational therapists will usually do after a thorough assessment and interview with you and observing the child, and that whole process is write what is called a sensory diet. 

A sensory diet is not what we put into our bodies in terms of food, but of what we do have our bodies experienced in terms of sensory input and so it should be a very collaborative process between the therapist and the parent or the main caregivers; and you're obviously, again, we're talking about this team approach. So if the child's at school full time, it's ideally the teacher or the support personnel at school should be involved. And it's really looking and saying, What does this child's body need to function at an optimal level of readiness throughout the day, and finding regular and predictable intervals where sensory input is going to be provided to allow that body to start the integration process where they're able to that process and utilize and interpret and use an adaptive response to it. 

And so we find in the process of sensory integration that a child who might be under responsive, to say example again, the vestibular input with a spinning that one of the things that an occupational therapist might prescribe is regular intervals of spinning, because if the body is getting it at regular intervals at a certain intensity that the OT would prescribe, the brain starts to register, and it's almost like a switch goes off and that that neuron completion happens connection happens, where all of a sudden their vestibular system gets turned on to a new level and then it starts to normalize and then a less spinning and less and less and then it's to a more normal amount, but again that needs to be accurately diagnosed and prescribed, but that's just one example. 

The other thing that the OT will work with is, while we're getting more integrated helping with just some practical ways to adapt while we're waiting for the sensory systems to catch up and to integrate, so that might be this will sound familiar to you, my child is dumping lotions and lathering it all over the place or powders and all of that, things that sometimes when the parent is in this situation, it's just hard to be objective and be like, well, this is, you know, way to go around that, so it might be, probably my parents are going to walk all of that stuff up, except for the one time a day we're under mom or dad supervision we're giving them that tactile touch input in a way that is therapeutic with parameters around it and boundaries, to allow them to integrate that tactile system, while saving mom and dad’s sanity in the meantime.

Dr. Richard Smith

Okay, so I just have to share this story with everyone who's listening right now So Maddie, you know, had her sensory processing that she was going through, and very, very young at this point we just finished shopping at Costco, the night before, but still hadn't put everything away. And so, I wake up Saturday morning Maddie’s up raring to go and said, well, “We'll let Christy sleep in, so I'm gonna be super dad and I bring Maddie downstairs and I laid down on the couch, and I woke up gasping for air, and our blue couch that once was completely blue was now all white with the exception of the body outline of dad who was laying on the couch because apparently I fell back to sleep. Madison had gotten into the five pound bag of flour that was sitting on the floor, and I woke up to her saying it's snowing and there was flour everywhere. So, Christy comes downstairs and she says, I thought you had it I'm like oh I did that clearly. Dad had to go grab the vacuum and clean up but Maddie was clearly trying to satisfy a need, at some point in time yeah

Dr. Lynette Scotese-Wojtila

And what Maddie wasn't doing particularly before the event is plotting it out. She wasn't saying, I'm gonna make my dad gasp for air, because it's covered in flour and clouding his air supply around him such that is the outline of a body left there, and mom has to come in and break up the party and say “what is going on here?” 

She didn’t plan that. We're drawn, we're moved by our sensory inclinations, if you will, and hers, her threshold, Ellen and I talk about this a lot in my class. The threshold for her to feel or to register or take, in this case the flower, or any other tactile input, it was so high that she had to get a lot of it. And it's unusual the things that they'll seek out sometimes. So Ellen had a great example of how we put the lotions away, she can't access anything for a while, except for one time of day. That's a great approach that's going to help. Sometimes it's not enough. And we actually have to bring other sensations to her skin, like brushing technique the very specialized technique that we use a surgical brush that highly trained, highly qualified therapists can do, or we might suggest a bucket of rice and beans that the child can dig through up to the elbows to find marbles or letters or something else in a transdisciplinary way that maybe they need to work on for school, you know, whether it's identifying academics or numbers or something, but it's strategic by the OT on their part to have her sink into this deep bucket of rice and beans that has temperature value, and tactile value, and gravity and resistance and all sorts of in sound value at sight, I mean there's a lot of multi sensory things we can do. So while flour was her medium, there are other things that, I bet you if we chose to dose Mattie before she got to the flour, she would be more adaptive, and wouldn't have to find it, that's the thing --- it's proactive. 

And I always use this example in class, and Ellen knows just what I'm going to say, but I equate it to anemia, you know, you don't swallow a bottle of iron when you're on your deathbed, with anemia, you take one every day so you never get anemic. And that's really important for parents to know because they oftentimes, like we talked about in our earlier podcast, they feel hopeless. They don't understand it. They don't know what to do about it, but something as simple as a bucket of beans that a therapist has to prescribe, don't just do it because if you're the kind of kid that doesn't need that or is going to have a negative response, then you've rocked nervous system in ways you don't want to deal with. You don't want to undo that. You have to go under your direction. I'm an occupational therapist, but it's in that it's treatable it's fixable, it's probably an okay word as well as long as that therapist is really in tune to the individual needs has assessed every system there's a lot of sensory systems, we talked about vestibular which is balance and touch, which is tactile, but there's others. And they all need to be evaluated very carefully and beautifully balanced; and a sensory-rich sensory diet should be put in play for a very specific amount of time with regular spot checks, and then weeded out when the child is ready. And one of the number one issues we have in OT is sometimes people who are engaging in the sensory diet process and prescribing this. Don't ever pull it out, and so it kind of gets a bad rap that well didn't work, you know, well it didn't work because you didn't fade it out, it doesn't so that's supposed to be when the child 18 years old still brushing them or prescribing beans and rice. Right. So it's just as important to discharge or discontinue the intervention as it is to assess for it and treat it.

Ellen Winney

Absolutely. And, again, to think about what is going to be age appropriate, you know, we focus a lot on children, but we've had many young adults and adults that come to us and we have to be a little bit more creative on, you know, what are those sensory diet activities and really teaching as the child gets older, teaching them to recognize when they are starting to feel dysregulated. When you know a lot of times the kids as a symptom of the sensory processing difficulties they do a lot of what they do to be able to maintain their state of readiness or to be able to attend so we see you know teachers say, well, he can't do his work and sitting in a seat, but you know if he's standing he can, or bouncing on, you know, a therapy ball, they can attend; and so, helping the child to know what their body needs to function at its best and to advocate for themselves in an appropriate way to get that, that's a lot of the work that we do is the the age of the young adults really teaching that self awareness of self regulation, and how to meet those needs in a way that's going to be socially appropriate.

Dr. Lynette Scotese-Wojtila

And appropriate to even the work setting. We work with some people on the job site, where this is a time of day where the person gets overwhelmed, and we tell them, you have to kind of schedule a walk around the grounds. Get out of the environment -- that's good for everybody. Right, right, but for the strategic purpose again The SUCCESS Approach is a strategic model. It's intentional. So a strategic goal accomplished is to leave the worksite that let's say maybe has a high pitch kind of sound, or fluorescent lights, that's bothering somebody, to go and get some reprieve from that from their nervous system, and come back a little more refreshed, you know.

Dr. Richard Smith

Google has in their campus they have these isolation pods, where you can go and kind of retreat in this area and just kind of pull the shield over and I just think that this is such a genius process that could really help someone with a sensory need.

Dr. Lynette Scotese-Wojtila

Well, Chances are they consulted with an amazing occupational therapist!

Dr. Lynette Scotese-Wojtila
Ellen was it you?

Ellen Winney
I wish!

And the reaction to their reaction to a sensory need that's not being met, is just as important as as a parent, as a teacher, as a caretaker, to understand that sensory diet. I love that term, I'm bringing it back because I totally forgot about the whole idea of the “sensory diet.” I know what it is, and I know how to function within it, but I love the term, just in equating it back to nutrition. 

How can we help someone begin to identify? Because I'm thinking back to Madison in preschool. The way we kind of got tipped off to the class was through her amazing teacher Andrea Brown, who had been through The Success Approach Training with you guys and really kind of spoke to you maybe you want to go and see integrations treatment center or maybe you want to go seek out someone who's an occupational therapist to look into this because we think there's a need or a misfire. How can we get ourselves to that level to identify it? 

Ellen Winney

I think for most parents, it's intuitive, a little bit that there's something not quite right because you're comparing it to yourself in a way of saying like that seems like an overreaction or why do I need to say their name five times before they turn towards me and make eye contact? Or whatever the case might be. So some of it is a little bit intuitive, but we don't just know how to name it. 

I do think there are great resources out there to kind of give a cursory view of them, certainly you know, we discuss some of them in the class and get some general information out there, but there are wonderful resources out there. Lucy Jane Miller is a great occupational therapist Winnie Dunn. They all have information on their websites and things like that are friendly, for parents to read, to kind of put it in layman's terms to learn a little bit more so you could identify it so that you go into your consultation with an occupational therapist with maybe a little bit more concrete language around what you're experiencing, and some of it is just observing natural normal childhood development. And so, that's hard to watch if it's your first child or and you didn't grow up around a lot of cousins and all of that but even just going to the playground for a day and watching neurotypical children, you get a really good insight into what is normal, whatever that means behavior, but neurotypical behavior, and you can kind of see you know where is my child? Not that it's a direct comparison, but where is my child maybe doing different but again some of those red flags that we might look for is -- over sensitivity to sound to touch. If you accidentally brush up against them, and they hit you or completely jerk away, that's a red flag. Or that, you know, again, we said it's typical for a two year old to run and crash into things over and over to spin and spin and spin but if the child is getting older and they're six years old it's seven years old and this has never been addressed and they're still constantly on the go, constantly seeking input, it's something to worth looking into. 

Dr. Lynette Scotese-Wojtila

And I would add to that, practical things like mealtime, you know, watch your eaters:  are they picky eaters, not so much because they don't like the taste, but because they can't tolerate the texture. And that usually goes with things like not doing well at the dentist, not tolerating tooth brushing, not tolerating face washing. I mean there's, think about that, there's, there's profiling we kind of do in occupational therapy, where the profiles emerged because they answer questions a certain way or we can observe certain consistency within a tactile system for instance, or things like -- you know, we went to the family reunion, and everybody else took his shoes off ran across the hill, down into the sand and into the water, and my kid froze, wouldn't even put a step of one foot onto the grass. That's probably because they couldn't tolerate it, not because they weren't being social. It has nothing to do with the family, he just didn't tolerate the sensation. So when you understand the diversity among the individuals with autism, the autism population and how they process, you understand that it's usually different. And that difference is okay, we just need to identify because if they want to get better and their family wants them to get better, and it's a dysfunction, like they can't move through space because everything is too hypersensitive, then we need to help that child or adult regulate and integrate the senses so they can function. It is all about function.

Dr. Richard Smith

Well thank you so much for being with us Ellen, for being with us today, and always having Dr Lynette Scotese-Wojtila with us as well. If you want to check out The SUCCESS Approach, they do have the online training so make sure you can go to the integration Treatment Center website. We will put that link in the show notes for you so that you can check out the training. You can do it online self paced. You can get to see the amazing Ellen Winnie, sort of in person on video. Right, so that they can get in on some of this great stuff that's happening with The SUCCESS Approach in helping your individual with autism so thanks again for coming on. We really appreciate it.

Ellen Winney

Thank you so much, I had a blast, I'd love to come back again.

Dr. Richard Smith

Oh, we will have you. Stay tuned for Lynette’s challenge for us. Coming up next.

Dr. Lynette Scotese-Wojtila

So the challenge for today, folks, is to identify in your child, to really look at your child for poor processing. You want to look for signs for poor sensory processing. How do they respond to touch? How do they do with smell? What do they look like when they're done moving? Are they seeking out too much movement?  Look for signs for processing, and if you have a hunch that you found some, consult with an occupational therapist to help identify it, the intensity or extent of it, and the best way to treat it.

Dr. Richard Smith

In our previous episodes we discussed what The SUCCESS Approach is when we defined it. We've talked about observing readiness in the second episode and taking in that information. In the last episode we talked about making sense of it, once we're ready to take in that info information, so it's logical. Then in this episode, we looked at sensory processing, where our body might be having trouble manifesting how to give an output for it, right?

Dr. Lynette Scotese-Wojtila

Yeah, the problems that we see in sensory processing stop us from eventually connecting with and making success of our world. So when we think about sensory processing, we want to understand that we all do it. It's very normal. It's very, very subconscious. It happens at the base of our brain, and we need it to be able to get information from our environment and our body, so we can function.

Dr. Lynette Scotese-Wojtila

We hope that you learned something today to help you on your journey with autism. We'll share more on our next Connect with Success Podcast.

Until then, expect success!

Dr. Richard Smith

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