Sensory Perception in

Autism
Olga Bogdashina

The diagnosis of autism is based on

behaviours

Impairments in social
interaction
Impairments in
communication
Rigidity of thoughts
and activities

Triad
of
Impairments

What role do sensory perceptual issues play in

autism?
- Secondary characteristics, which are common
but not essential for diagnosis?

So many professionals and nonprofessionals

have ignored sensory issues because some
people just cant imagine that an alternate
sensory reality exists if they have not
experienced it personally That type of
narrow perception, however, does nothing to
help individuals who do have these very real
issues in their lives. Even if they dont
understand it on a personal level, its time
they put aside their personal ideas (Grandin)

At present, when sensory perceptual issues in

autism are recognised
they are often
oversimplified -

Hypersensitivities

Hypersensitivities
If we identify hypersensitivities of each
individual and adjust the environment
to his needs, does it mean all the
problems will be solved?

To me, the outside world is a confusing mass

of sights and sounds. It is totally baffling
and incomprehensible (Ros Blackburn)
I believe sensory anomalies may be at the
root of many if not all behaviours that seem
inappropriate and bizarre (McKean)

There is some evidence

from recent research
that does indicate that
sensory perceptual
differences may be
among the first signs of
autism in young
children:

Problems in
attention and
arousal;
They orient less to
visual information;
(Baranek 1999)

Put objects in their

mouths more often;
Need more cues
before they look
when someone calls
their names; (Baranek
1999)

Pull away from

social touch
(Baranek, 1999);

Lack of responsiveness to certain sounds;

hypersensitivity to certain foods;
insensitivities to pain (Hoshino et al. 1982);
Atypical interest in visual stimuli,
overexcitement when tickled, play limited to
hard objects (Gillberg et al. 1990)

Hand-finger
mannerisms, whole
body mannerisms,
unusual sensory
interests (Le Couteur et
al. 1989; Lord et al.
1994)

Unusual reactions to vestibular tasks

(Gepner et al. 1995; Kohen-Raz et al. 1992);

Stereotyped behaviours, under- and

overreaction to auditory stimuli, unusual
postures and unstable visual attention

Watching hands and

fingers, and arm
flapping (Volkmar et al.
1986);

The autistic sensory symptoms observed

during the first year seem to persist into
the second year of life (Adrien et al. 1992;
1993).

Autistic toddlers and pre-school children

display atypical sensorimotor
behaviours at some point of their
development (Ermer & Dunn, 1998; Kientz &
Dunn, 1997; Rapin, 1996).

The Triad of
Impairments

Lack of ToM,
WCC, etc.
Systems of
Thinking
Abilities
Perceptions

Senses

???????

Perception

Stimulus Sensation Interpretation

Comprehension

Vision
Hearing
Tactility
Olfaction
Gustation
Proprioception
Vestibular
system

Senses
deliver the information about the environment
and inner feelings to the brain where this
raw information is processed, interpreted
(and stored for a future reference), and our
perceptual world is created, interpreted and
comprehended, that, in turn, provides us with
ways to act.
This process is very complicated and differs
greatly from species to species.

That is why:

The real world and our mental image of the

world differ
Information from the senses is influenced by
the inside information
Our interpretation of the world is based on our
memory and experience

Perception
Perception is much more than simply
sensing stimuli from the outside world
The plain fact is that the way
information enters the brain affects the
final state as much as any other step in
cognition (Ratey 2001)

Stimulus Sensation Interpretation Comprehension

(Percept)
(Concept)

Blindness:

Recognition through touch a book can read it in

Braille

Autism:

When I pick up a book, I might turn the pages and

sniff each page first before looking at the pictures
in it Someone else with autism may tear a page or
two Another person with autism may totally
ignore [it] because his perception would be
directed towards some other aspect of
environment (Tito)

Two ways to experience the world:

The non-autistic way
The autistic way

The problem for many autistic individuals is that

they do not realize that their sensory perceptual
processing is different.
A typical thought they might have is:
There is something wrong with me. I cant do
things right. Everyone is mad at me. No matter
how hard I try, something goes wrong. Other
people can do things I cant. It must be my fault
that Im having so much trouble (Spicer)

Instructions are printed in red against a green

background but you are colour-blind and
cannot distinguish between red and green.
Would you know what to do?

I dont think that what I see is what you see.

That is unless what you see are vague clouds
and shadows of substance (McKean)
Unbelievably I live in a world where the
environment of our Earth, with its consistent
gravity, sound waves and refracted light, [is]
but an invention of fiction writers (Blackman)

As people began to explain how other people

experienced my behaviour, I came to learn
that all behaviour had two definitions:
theirs and mine. These helpful people
were trying to help me to overcome my
ignorance yet they never tried to
understand the way I saw the world. (Donna
Williams)

Sensory dysfunction or different sensory

experiences?

Not all the differences in perception are

dysfunctional and sensory differences are not
necessarily problems/difficulties.
Some difficulties may be caused by
environmental factors. If they are
accommodated, this particular dysfunction
would disappear.

Learning how each individual

autistic persons senses function is
one crucial key to understanding that
person (ONeill)

Qualitative differences in experiencing

sensations/receiving information

Possible sensory experiences in ASD

Literal perception
Gestalt perception

Gestalt perception Sensory gating

deficit

The inability to
distinguish between
foreground and
background
information
It was like having a
brain with no sieve
(Donna Williams)

Neuropathology of cortical
inhibitory interneurons
(Casanova 2002)

An imbalance of cortical
excitation and inhibition
(Rubenstein & Merzenich)

The intense world

syndrome (Markram et al.
2007)

Gestalt perception/ Sensory gating

deficit:
Every corner demanded my attention Voices
competed with voices. The colors of the
clothes and dresses worn by people competed
with each other. Even the pictures on the
walls seemed to compete with each other for
my attention. What do I hear and where do I
look? (Tito)

Gestalt perception
perception of
the whole scene as
a single entity with
all the details
perceived (but not
processed!)
simultaneously

Kanner (1943):

The inability to experience wholes

without full attention to the constituent
parts:

a situation, a sentence is not regarded as

complete if it is not made up of exactly the
same elements that were present at the time
the child was confronted with it.

Kanner (1943): The insistence on sameness:

This insistence on sameness led several of

the children to become greatly disturbed
upon the sight of anything broken or
incomplete.
Every activity had to be completed from
beginning to end in the manner in which it
had been started originally. It was
impossible to return from a walk without
having covered the same ground as had
been covered before.

Gestalt perception

Every situation is unique:

Moments with their own uniqueness
challenged me so much that I began to fear all
those unknown paths, clothes, food, shoes,
chairs and strange human voices. Each one
challenged me by putting in front of me a new
situation for me to face and understand (Tito)

Any change destroys Gestalt and brings

confusion and fear

Gestalt perception Resistance to change/ Insistence

on sameness

I cannot tolerate any kind of [change] If a chair

or a table was out of place, I would immediately
place it where it is supposed to be It would
distress me to find someone had picked up a
magazine from the coffee table because I had
arranged them in a certain way. So guests would
be very surprised to find me taking the
magazines from their hands and putting them
back where I thought they should be. (Tito)

Any difference?

Mental map (Tito, 2008)

A mental map is a mental picture I form,
which I expect to face in the process of
events, so that I am not surprised or
shocked by any sudden situation
I have a mental map of how things should
happen around me. When they do not take
place as expected, the anxiety is no less
than any physical pain. It produces an
amplified sensation throughout my gut.

Every experience settled in my mind as a

natural phenomenon, which laid down the
rules of the world. E.g., if I saw a bird on a
tree, and, at that very moment, I saw someone
walking across the street in front of our gate, I
concluded that every time a bird sits on a tree,
someone needs to walk across the street.
[If this didnt happen] I would panic and get so
anxious that I would scream. (Tito)

They make their own connections and

create new Gestalts
Gestalt behaviours rituals and routines

Gestalt lack of generalisation

I would learn how to tackle a given situation in one
context but be lost when confronted by the same
situation in another context. Things just didnt translate.
If I learned something while I was standing with a
woman in a kitchen and it was summer and it was
daytime, the lesson wouldnt be triggered in a similar
situation if I was standing with a man in another room
and it was winter and it was night-time. Things were
stored but the compulsive overcategorisation of them
was so refined that events had to be close to identical to
be considered comparable (Williams)

What we can do to help (Gestalt perception):

We should find out which modality does

not filter information and make the
environment visually/auditorily, etc.
simple.

Ctd.

Structure and routine make understanding of

everyday activities easier and provide feeling
of safety and trust.
Always communicate to the person
beforehand, in a way he can understand (e.g.,
using verbal, visual or tactile means) what
will be changed and why. Changes should be
gradual, with his active participation.

Let them have a safety object (a toy, a piece of

string, etc.) when they go to unfamiliar places or
face an unfamiliar situation

Another reason to insist on

sameness
the inability/difficulty to
stop feeling the change,
leading, in turn, to overload
and/or hypersensitivity

Rubenstein, J.L.R. &

Merzenich, M.M.
(2003): Increased
ratio of excitation/
inhibition in key
neural systems
Casanova, M. (2002;
2005): Minicolumns
in autism

Gestalt perception may result in different experiences,

compensatory strategies and perceptual styles:

Fragmented perception
Distorted perception
Delayed processing
Hyper-/hyposensitivity
Mono-processing
Peripheral perception

Fragmented perception
I had always known that the world was
fragmented. My mother was a smell, my
father was a tone, and my older brother
was something which was moving
about
(Donna Williams)

Fragmented perception
I had a fragmented perception of
things at the best of times, seeing
eyes or a nose or whiskers or a
mouth but mostly putting the bits
together in my head. (Williams)

Proprioceptive and tactile fragmentation

My perception of a whole body was in

bits. I was an arm or a leg or a nose.
Sometimes one part would be very
much there but the bit it was jointed to
felt as wooden as a table leg and just as
dead (Williams)

You may observe the autistic person rubbing

sandpaper on his bare arm, or banging his
knuckles sharply into a solid wooden
dresser, then peering at them as if to say,
Oh, hello, hand. So you do belong to me,
then. Sometimes, the body feels
fragmented, so it appears to be suspended
or floating in pieces. (ONeill)

Distorted perception
E.g., in the field of vision:
Poor/distorted depth and space perception
Seeing 2D world
Double vision
Distortions of shape, size, movement, etc.

Distorted perception
To some [autistic] individuals the world looks
like it is viewed through a kaleidoscope: flat,
without depth perception, and broken into
pieces (Grandin)
I sometimes was seeing my hands and the
things I was touching as if they were
multiples The image was either multiplied,
or overlaid by similar reproductions of itself
in duplicate (Blackman)

Distortions
My enchanted world of light and sudden
gaps into which people and objects moved,
affected the way that I processed my fellow
human beings I basically emphasised
folds and depths So I perceived people
as slightly distorted. This was not only in
shape, but also in the composition of the
components of their bodies in my visual
imagination (Blackman)

Auditory distortions

A child with poor auditory perception may hear

sound like a bad mobile phone connection, where the
voice fades in and out or entire parts of the
communication are missing. (Grandin 2008)
My brain had processed the sound so differently
that the human voice was continually distorted I
had heard in surges and troughs, which were further
distorted by the intrusion of background noise
(Blackman 1999)

Delayed perception

Do we live in the same time zone?

Delayed perception
As a child,.. it appeared as though I didnt feel
pain or discomfort, didnt want help, didnt listen
or didnt watch. By the time some of these
sensations, responses or comprehensions were
decoded and processed for meaning and personal
significance, and Id accessed the means of
responding, I was fifteen minutes, one day, a
week, a month, even a year away from the context
in which the experience happened (Donna Williams)

Delayed perception
Some people think I am not paying attention
when am asked a question, because of the
pause I often need to process the question and
my response, and the blank look I often have
when concentrating on such processing. When
people try to get my attention, they actually
just distract me, slow me down, and annoy me
horribly with their impatience.
(Jared
Blackburn)

What we can do to help:

Give them time to take in your question/
instruction and to work out their response.
Be aware that autistic individuals often
require more time than others to shift their
attention between stimuli of different
modalities and they find it extremely
difficult to follow rapidly changing social
interactions

Intensity with which the senses work

Hypersensitivity
Hyposensitivity
Fluctuation (Inconsistency of perception)

Hypersensitivity
I appear to have very sensitive ears, eyes and skin.
Certain noises very definitely hurt my ears and
certain lights hurt my eyes. (Wendy Lawson)
My hearing is like having a sound amplifier set on a
maximum loudness. My ears are like a microphone
that picks up and amplifies sound (Temple Grandin)
I have an acute sense of color. I see rainbows in a piece
of ice, some colors and lights have sent me into manic
and euphoric episodes and giggle fits. (Donna Williams)
Fluorescent light bulbs have such a high degree of
flicker that some people on the spectrum feel like
they are standing in the middle of a disco nightclub
(Temple Grandin)

Hyposensitivity
My senses would sometimes become dull to
the point that I could not clearly see or hear,
and the world around me would seemingly
cease to exist (Hawthorne)
I had no concept of my body and I never
experienced it My body was a mere
reflection in front of the mirror I never
felt any pain (Tito)

What we can do to help:

Hypersensitivities:
Identify which stimuli the person finds disturbing and either
eliminate them (e.g., use natural lighting instead of
fluorescent lights) or, if impossible, provide the person with
sensory aids (tinted glasses, earplugs, etc.)
Desensitize the person to tolerate the stimuli via sensory diet
Monitor a number of simultaneous stimuli; reduce irrelevant
stimuli
If possible, warn the person about fire alarms, bells, etc.

Hyposensitivities:
Provide extra stimulation through the channels that work in
hypo

Hypersensitivity

Disturbance by
Fascination by
certain sensory stimuli

Sensitivity to (disturbance by) certain

stimuli
The buzzer on the microwave oven,
childrens voices, car horns, the bus bell
people activate to tell the driver they want
to get off, a kettle whistling these are just
some of the sounds I find unbearable (Wendy
Lawson)

Sudden loud noises hurt my ears like a

dentists drill hitting a nerve (Temple Grandin)

Disturbance by
Certain stimuli
Too many stimuli
Any sudden unpredictable stimuli
________________________
Challenging behaviours caused by either
present but invisible antecedent, or
past antecedent, or
probable future antecedents
last straw antecedents

What we can do to help:

Remember, what we think is enjoyable

(e.g., fireworks) may be fearful or
overwhelming to an autistic individual.
Be aware of the colours and patterns of the
clothes you are wearing and of your
perfume.
Always warn a person about the possibility
of the stimulus he is fearful of and show
the source of it

Strategies to cope with light sensitivity are

turning off any unnecessary lighting (esp.
fluorescent lighting), using lamps rather
than overhead lights, low wattage bulbs
and tinted lenses.

As each individual is unique in their sensory

profile, it is very difficult to adapt the
environment for each individuals
sensitivities. Often it is not the stimulus
itself that can trigger what we call difficult
behaviours, but rather the inability to
control or predict it. The understanding of
each individuals sensitivities is vital, or any
intervention becomes a nightmare for both
the person and those who work with him.

Inconsistency of perception
Fluctuation
Skin sensation was so unbearable one minute and yet
completely unfelt next (Blackman)
It is well documented that there are certain textures and
patterns that are painful or displeasing to the touch of the
person with autism. This is true from my own experience,
but I am not able to tell you what they are because they
are always changing. Day to day, hour to hour,
sometimes even minute to minute. This can be very
frustrating (McKean)

What we can do to help:

It is important to recognize the first signs of sensory

overload. It is better to prevent it than to deal with
the consequences
As soon as you notice early signs of coming sensory
overload (which are different for different
individuals), stop the activity and provide time and
space to recover
Teach the individual how to recognize the internal
signs and ask for help or use different strategies
(e.g., relaxation) to prevent the problem
First Aid Kit should be always at hand (sunglasses,
ear plugs, squeezy toys, favourite objects, I need
help card, etc.)

The overload can lead to several different routes

they can (are forced) to take and may result in:

If they continue to try to process all the

information coming in, despite their inability
to keep up with it, it may result in
hypersensitivity and/or fragmentation, that
eventually bring anxiety, confusion,
frustration and stress, that, in turn, leads to
tantrums and difficult behaviours

Sensory agnosia (difficulty interpreting a

sense):

I looked at the beige-colored blob in front of

me. Meaning had shut down not only
through my ears but now through my eyes,
too. I could see it but I had absolutely no
idea what it was any more (Williams)

Adaptations and compensations

Perceptual Styles:
Systems shutdowns
Mono-processing
Peripheral perception
Compensating for unreliable sense with other
senses

Adaptations and compensations:

System shutdown

If early in life self-imposed

sensory deprivation:
When sensory stimulation
became too intense, I was
able to shut off my hearing
and retreat into my own
world In pulling away, I
may not have received
stimulation that was
required for normal
development (Grandin)

Adaptations and compensations:

Perceptual Styles

Mono-processing:

- using one sense at a time

I have noticed that when I
am using a particular
channel to address a
task, if I attempt to
introduce another
channel, then I lose my
place in the completion
of the task and need to
begin again (Lawson)

Perceptual Styles

Peripheral perception

Peripheral perception
Autistic people often glance out of the sides
of their eyes at objects or other people. They
have very acute peripheral vision and a
memory for details that others miss. Gazing
directly at people or animals is many times
too overwhelming for the autistic one It
can feel creepy to be searched with the
eyes (ONeill)

What we can do to help:

Never force eye contact

Do not approach the person directly
in his hypersensitive modalities.
When hypersensitivity of the
affected sensory channel is
addressed and lessened, the direct
perception becomes easier

Compensating for unreliable sense by

other senses

One sense is never enough

What we can do to help:

It is important to let the individuals use the

sensory modality they prefer to check
their perception.
With appropriate treatment and
environmental adjustments to decrease
hypersensitivities they gradually learn to
use their sense organs properly eyes to
see, ears to listen, etc.

Are unusual responses to sensory

stimuli bizarre and abnormal?

Bizarre behaviours as compensatory strategies

to regulate their systems and cope with
information overload
These self-stimulatory behaviours may serve
several purposes and one and the same behaviour
may have different underlying causes

A lot of self-stimulation, including rocking the body,

swaying, flapping the hands, rubbing the skin and
countless others, are pleasurable, soothing connections
with the senses (ONeill)

Before we try to address these bizarre and

abnormal behaviours, lets find out their
functions.
Sensorisms behaviours caused by
differences in sensory perception.
Are all challenging behaviours really
challenging?

Functions of stimming:

Defensive: (to reduce pain or

discomfort caused by
hypersensitivity, fragmentation,
overload, etc.)
to eliminate sensory assault that
interferes with functioning
(Shore)

Self-stimulatory: (to improve

the input in case of
hyposensitivity, e.g.)

Compensatory: (to interpret the environment in the

case of unreliable sensory information)

I was coping in a world where other people

effectively realised nothing of that. I reacted to
all this bombardment and confusion with those
physical movements, silence and strange sounds
which are generally lumped together as autistic
behaviours (Blackman)

Out of frustration:

Sometimes head banging and knuckle nibbling, tantrums, or

outbursts happen as a way of letting someone know
enough is enough! (Lawson)

Just pleasurable experiences (that help to withdraw from

a confusing environment)

Rocking and spinning were other ways to shut out the world
when I became overloaded with too much noise. Rocking
made me feel calm. It was like taking an addictive drug.
The more I did it the more I wanted to do it (Grandin)

Autism Spectrum
Temple Grandin:
There is a continuum of
sensory processing
problems for most
autistic people, which
goes from fractured,
disjointed images at
one end to a slight
abnormality at the
other.

SPP

No two autistic people appear to

have the exactly same patterns of
sensory perceptual experiences

Rainbows and Umbrellas

No two autistic individuals have exactly the same patterns of

sensory perceptual experiences

The timing of the advent of sensory processing problems:

Temple Grandin, 1996:

The exact timing of sensory problems may

determine whether the child has [HFA] or is a
nonverbal, [LF] autistic
Oversensitivity to touch and auditory scrambling
prior to the age of two may cause the rigidity
of thinking and lack of emotional
development found in [LFA]. These children
partially recover the ability to understand
speech between the ages of 2 and a half and 3.

[Those] who develop normally up to 2 years of

age, may be more emotionally normal
because emotional centres in the brain have
had an opportunity to develop before the onset
of sensory processing problems. It may be
that a simple difference in timing determines
which type of autism develops.

Differences in perception lead to development

of different abilities, thinking styles and
communication

Learning how
each individual
autistic persons
senses function is
one crucial key to
understanding
that person
(ONeill)