Sensory Issues
Many people with autism struggle with sensory issues. These vary from person to person and can have a significant impact on a person’s day to day life. For instance, attending school, using public transport and partaking in enjoyable activities, these simple activities can be far more difficult for someone with sensory issues.
What are sensory issues?
The sensory system includes; touch, taste, smell, sound, sight, proprioception and the vestibular system. Sensory issues are caused by the disorganised way the brain processes information from the senses. If there is a sensory issue, the sensory system is either over-sensitive or under-sensitive. However, this can be different for each sense. For example, someone can be under-sensitive to touch, but over-sensitive to sound.
What does over-sensitive mean?
Over-sensitive means that senses are heightened. For example, a person may hear noises from far away or lights may be seen much brighter.
What does under-sensitive mean?
Under-sensitive means that the senses are under developed and a person receives less stimuli. For example, a person may not notice extreme odours, or have a very high pain threshold.
What are common sensory issues for people with autism?
Sight
Fluorescent lights can seem overly bright to someone who is over-sensitive.
Lights in bedroom or on street can make it more difficult to sleep.
Under-sensitivity can cause poor depth perception resulting in clumsiness.
How to help
Over-sensitive: Don’t use fluorescent lights, use blackout blinds or curtains in bedrooms, wear sunglasses.
Under-sensitive: Make a high walled desk in school work or home for studying or working to reduce visual distractions.
Sound
Loud and sudden noises can become very distressing to a person who is over-sensitive.
Over-sensitivity can make it difficult to filter out background noise.
If someone is under-sensitive to sound they may only hear in one ear. they may also enjoy loud noises and loud environments.
How to help
Over-sensitive: use earplugs or noise cancelling headphones, practice fire drills and smoke alarms, closing doors and windows to limit outdoor noise.
Under-sensitive: use visual supports to support verbal information.
Touch
Over-sensitivity: To touch can result in not enjoying hugs, shaking hands or being in close proximity to people. For instance on public transport.
The feel of certain fabrics against skin can cause huge levels of discomfort for some over-sensitive people.
Under-sensitive: People enjoy weighted blankets and can have a high pain threshold.
How to help
Over-sensitive: Removing tags from clothing, investing in sensory supports for brushing hair and teeth, slowly introduce new textures in objects and foods.
Under-sensitive: Use weighted blankets to provide stimulation.
Taste
The texture of certain foods may cause discomfort to someone who is over-sensitive. For instance, only smooth foods like mashed potato or yogurt is eaten.
A person who is under-sensitive may prefer very spicy foods or may eat non edible objects. This is called Pica.
How to help
Over-sensitive: Slowly introduce different food textures, ensure there are no nutritional deficits due to restricted diet.
Under-sensitive: Try to make sure food is not served too hot as an under-sensitive person may not notice and burn themselves.
Smell
People who are under-sensitive may not notice extreme smells, like bad body odour or the smell of rubbish.
Oversensitive people often get overwhelmed by smells, like shampoos, perfumes and food.
How to help
Over-sensitive: Try to make the environment as fragrance free as possible. Use low fragrance detergent, shampoo and cleaning products.
Under-sensitive: Establish a personal hygiene routine, a routine for getting rid of rubbish and cleaning room/home.
Vestibular (balance)
Under-sensitive can result in a need for sensory input, like rocking, jumping, or spinning.
Over-sensitive people can have difficulty in sport and can experience travel sickness.
How to help
Over-sensitive: Breaking tasks activities into smaller steps and using visual cues can make them more manageable.
Under-sensitive: Encourage activities that activate the vestibular system, like jumping and walking.
Proprioception (body awareness)
Under-sensitive people may stand too close to people or objects and often have difficulty navigating through rooms.
Over-sensitive people may have difficulty with tying shoe laces and doing up buttons.
How to help
Over-sensitive: Fine motor skills activities can help like making pasta necklaces or learning how to crochet.
Under-sensitive: Establish a rule for personal space, use weighted blankets to help ground the person.
A visual representation of sensory sensitivity
This is a video created by Aspire Productions documenting the experience of asperger syndrome and sensory sensitivity. Watch the short clip to see the world from her perspective.
Special Interests
Many people with autism /asperger syndrome have a special interest. These vary from person to person and are unique to each individual on the spectrum. These tend to start from a young age and can change over time.
Why special interests are so important to people with autism
Provide a time to relax and destress.
Makes initiating conversations easier.
Can provide structure and predictability to the person’s day.
Friendships can develop through a shared interest.
Special interest can also be a great way for someone with autism to study in the area they are interested in and gain employment in this field.
Can special interests affect someone with autism negatively?
While special interests are important to people with autism, they can sometimes cause friction in households or between peers and colleagues.
How to help if a special interest affects someone negatively
Understand why your family member enjoys focusing on their special interest Could the increased amount of time spent on the special interest be due to anxiety or boredom?
Increase structure into the day. This can reduce anxiety and boredom levels, which may reduce the negative impact of the special interest.
Help reduce anxiety. This can be with mental health professionals, or home supports like mindfulness and meditation.
Set boundaries. It can be important to set limits on special interests. This can gradually happen over a number of weeks or months.
Example of how to set boundaries
Ben’s special interest is history and he loves talking about the new books he is reading and new facts he has learned. However, Ben is unable to concentrate in school or communicate with his peers because he only wants to talk about history. After addressing his anxiety levels and need for structure, Bens parents set boundaries on how often Ben can talk about history. For example;
1. Ben is allowed to talk about history as he usually does, but is introduced to the idea of this time being limited to allow him to make friends and enjoy other activities.
2. Create a plan with Ben, with visual supports if he would prefer, so that he can see the changes that will happen each week.
3. Decide with Ben if he would prefer to talk about history in smaller chunks throughout the day, or larger chunks but less often.
4. Week 1, Ben is now allowed to talk about history every hour, for 15 minutes.
5. For week 2, Ben is now allowed to talk about history for ten minutes every hour.
6. For week 3, Ben is now able to talk about history for 10 minutes every 1.5 hours.
7. In the fourth week, Ben will now talk about history for 10 minutes every 2 hours.
This process will provide Ben with the skills to be able to concentrate in school, and socialise with his peers and focus his attention to other important aspects of his life. Please remember that it is really important to not prevent someone from spending time on their special interest. This is something which is very important for people with autism and should never be eliminated from their lives.
When a special interests becomes problematic
Some people with autism may struggle with setting aside the special interest to complete tasks during the day. This is when a special interest becomes an obsession and is heavily motivated by anxiety. This can have an impact on the persons health and wellbeing. If any of the following issues arise, it may help to seek support from a mental health professional:
The person is not enjoying the special interests but are unable to stop.
There is a significant impact on other people, like family members and carers.
It is preventing them from concentrating in school, college or work.
Forming or maintaining friendships being negatively impacted.
Routine and Structure
Routine and structure can be very soothing to autistic people. When the world is confusing it can be helpful to have some sense of predictability. The need for routine and structure can increase during times of high stress.
Examples of routine and structure:
Eating the exact same food each day
Walking the exact same route to work
Having a specific routine for when you come home from school
Only wearing specific clothing
Changes in routine that can cause stress
Moving house
Changing schools
The change in routine during summer holidays
Physical changes to an environment, such as a new layout in your house or office
How to prepare for changes to routine and structure
Find out about changes in advance. For example, if you know that there will be timetable changes in school, get in touch with the school to find out the exact changes.
Prepare for changes. If you are coming up to the summer holidays or easter break and you know there will be a change in routine, discuss the upcoming change in routine well in advance.
Use visual supports. These can be pictures of a new teacher, or a timetable of the new routine for summer holidays.
Be prepared for anxiety to increase. Change in routine and structure will increase stress levels. Have a plan in place for when this happens. It can be helpful to create a sensory box to help. This can include anything the person likes which relaxes them. IT can include a favourite book, fidget toys and art supplies.
A visual representation of routine and structure
Aspire Productions documentary about asperger syndrome has a character called Billy. Billy has a very similar routine in place most days and struggles if this changes. Watch the short clip to see the world from his perspective
Repetitive Behaviour
What are repetitive behaviours?
Repetitive behaviours are not unique to the autism community. Examples of repetitive behaviours include: feet tapping, cracking knuckles and listening to the same song on repeat.
Repetitive behaviours can be repetitive motions, repetition of words (echolalia), vocalizations and repetitive movement of objects. These behaviours are also known as stimming and self-stimulating behaviours. While most people can control when they exhibit repetitive behaviours, they are often involuntary for people with autism.
What repetitive behaviours can be common in autistic people?
Repetitive behaviours vary from person to person. Each individual with autism has a unique self-stimulating behaviour. These behaviours can be consistent throughout a person’s life, but can often change over time. For example, one person may flap their hands as a child, use a fidget toy as a teenager and paint as an adult. Here are some other common repetitive behaviours for different senses;
Visual: finger flicking
Auditory: making vocal sounds
Tactile: hair twirling
Taste: licking objects
Smell: smelling objects
Vestibular: rocking front to back
Proprioception: jumping
Why do autistic people have repetitive behaviours?
To reduce sensory input
Many autistic people will stim to reduce the level of sensory input experienced. It is also a way to reduce the likelihood of experiencing a meltdown or shutdown.
To gain sensory input
Some individuals may seek sensory stimulation. For example, jumping on a trampoline or lifting something heavy this is a way to regulate emotional and behavioural responses to sensory stimulation.
To reduce anxiety and stress
Many self-regulatory behaviours are used to reduce stress and anxiety. Focusing your attention on stimming rather than what is causing anxiety can be calming for many people.
For enjoyment
Stimming is not always about avoiding a meltdown. Many people with autism will exhibit repetitive behaviours when they are excited or happy like echolalia or jumping up and down.
Is stimming necessary?
Yes. It is very important for people with autism to be able to use repetitive behaviours. These behaviours are a way to regulate emotions and behaviour. If these are stopped, it would cause a great deal of distress to the person.
However, there are some repetitive behaviours which may put someone with autism at risk. These include head banging, hair pulling and self-harming.
It is important to keep someone safe if exhibiting self-harming behaviours. For example, providing alternatives or increasing structure could help reduce self-harming behaviours.
Provide an alternative:
Head banging could be replaced using a swing. This will provide a similar sensory experience.
A sensory bag, of carrots or chewing gum could be a safe alternative to nail and finger biting.
Increase structure and routine
This may help reduce anxiety and increase the predictability of the day which may reduce self-harming behaviours.
Seek professional help
If the behaviour is driven by anxiety, seeing a mental health professional would be beneficial.
Executive Functioning
What is executive functioning?
Executive functioning is a set of cognitive skills that include working memory, self-control and flexible thinking processes.
What does executive functioning control?
Executive functioning controls a wide variety of skills. Therefore, it is hugely important for living and learning. It is difficult to fully understand executive functioning without listing the different areas of difficulty.
Emotional control
The ability to control escalating emotions in order to complete a task and keeping emotions to an appropriate level. Having emotional control can keep disruptive emotions in check and prevent negative emotions from ruining your day.
Inhibition
Inhibition is the ability to complete a task in sequence and stay focused. This also includes problem solving, staying on topic and avoiding going off on tangents.
Initiating
This involves several other executive functioning skills. Getting started on a task requires planning, prioritisation time management, organisation, impulse control, attention, and working memory. The biggest issue is often getting started and what to do next.
Multitasking
The ability to carry out more than one cognitive process at a time. For example, being able to perform a task while talking.
Planning and organising
The ability to plan and organise time, information and procedures efficiently. For instance, carrying out instructions accurately and completing tasks on time.
Self-monitoring
Self-monitoring is a way to monitor actions, behaviours and thoughts. For example, staying on topic when talking, answering questions accurately and noticing changes of topics in groups. Additionally, noticing when you have made a mistake and being relatively accurate in your judgment of your own and others’ behaviour is also considered within self-monitoring.
Shifting focus
This is the ability to shift attention if something changes. Additionally, being able to change how something is being done when asked and being able to see multiple possible solutions to a problem are examples of this behaviour.
Working Memory
The ability to hold onto information in order to process it. This can include; the ability to identify the main point, take all information into account, tell a cohesive story in a logical sequence, reading comprehension, and following instructions.
Anxiety
Anxiety is how your body and mind react to stressful, dangerous and unfamiliar situations. Anxiety is not always considered a bad thing as it helps us stay away from danger and makes us more alert. However, it becomes a bigger issue when it impacts on your ability to live life as full as you would like. Furthermore, when anxiety impacts on your day to day life, it can lead to an anxiety disorder.
Physical symptoms of anxiety
Racing heart beat
Sweating more than normal
Trembling
Rapid breathing, which is often shallow
Tense muscles
Headaches
Feeling of panic and panic attacks
Dry mouth and/or difficulty swallowing
Nightmares
Difficulty getting to and staying asleep
Poor concentration
Upset tummy
Other health issue or illness flaring up, like asthma or dermatitis.
No interest in sex or low libido
Behavioural symptoms of anxiety
Feeling irritable
Always being in a bad mood
Avoiding situations or experiences that can trigger anxious feelings
Difficulty controlling worry
Feeling of impending doom, danger or panic
Needing constant reassurance
Being a perfectionist
Focusing on what can go wrong in any situation and being pessimistic
What causes anxiety?
Anxiety can be caused by a number of factors and differ for each individual. However, common causes include trauma, illness and work.
Family history
Research has shown that if you have a close family member with anxiety you may be at a higher risk of developing anxiety. However, this is not specific to genetics and is about learned behaviours.
Trauma
Difficulties which occur during childhood, adolescence and adulthood can trigger anxiety. For example, experiencing neglect as a child, bullying or losing a family member are all examples of possible anxiety triggers.
Work
Work or being out of work can cause anxiety. For instance, financial worries, work place bullying or a lack of a work-life balance can all trigger or exacerbate anxiety.
Illness
Having a serious, long term or life threatening illness can cause or increase anxiety. Mental health conditions like depression can also increase anxiety levels.
Alcohol and drugs
Alcohol and drugs can increase anxiety levels. Both the misuse and withdrawal of drugs and alcohol can trigger and worsen anxiety.
When anxiety becomes a concern
Many people experience anxiety. However, there are many symptoms that can tell you that anxiety is becoming difficult to handle and support may be needed:
Feelings of anxiety are very strong and last a long time
Worries and fears are out of proportion with the situation
Worries are hard to control
Symptoms are experienced regularly
Enjoying life becomes challenging
Engaging in activities you like becomes difficult
Depression
What is depression?
Depression can be described as a low mood which lasts for a long time and affects everyday life. At its lowest form, depression can make everything which you are doing more difficult and seem less worth while. However, in its most extreme, depression can be life threatening.
There are many symptoms of depression which vary from person to person. Although it is unlikely to experience all symptoms of depression, it is important to be aware them. Below are the psychological, social and physical symptoms of depression.
Psychological symptoms of depression
Feeling down, upset or tearful
Restlessness, irritability and feeling agitated
Feeling empty or numb
No self-confidence or self esteem
Despair and the feeling of hopelessness
Suicidal thoughts an or suicidal ideation
Concentration difficulties
Difficulty remembering things
Social symptoms of depression
Avoiding social interaction or events which are usually enjoyed
Difficulty at work, at home and or with family life
Neglecting hobbies and interests
Physical symptoms of depression
Difficulty sleeping, sleeping too much or feeling tired all of the time
Weight gain due to over eating
Weight loss due to under eating from of lack of appetite
Aches and pains without any physical cause
Low sex drive or libido
Changes to menstrual cycle
Difficulty speaking or thinking clearly
Self-harming or suicidal behaviour
What causes depression?
Depression can be caused by a number of factors including faulty mood regulation by the brain, genetic vulnerability, and stressful life events. It’s believed that several of these forces interact to bring on depression.
Family history
If there is a family history of depression, there may be a greater chance of developing depression.
Giving birth
Postnatal depression affects women after childbirth. This can be due to physical and hormonal changes in the body and the stress of the experience. Additionally, the added stress and responsibility of caring for a new born can increase stress levels and result in postnatal depression.
Trauma
A traumatic or stressful life event can cause depression. This can include a bereavement, job loss, divorce or financial worries.
Illness
Having a life threatening or a long term illness can be a risk factor for depression. This can include stroke, cancer or other ongoing health issues.
Isolation
Having a lack of connection with friends and family can leave a person feeling lonely. As a result of feeling lonely and isolated, there is an increased risk of developing depression.
Personality
Certain people may be at a higher risk of depression due to their personality. An individual’s personality is a mix of genetic make-up and life experiences. Some people with anxiety or low self-esteem may be at a great risk of depression along with those who are overly self-critical.
Alcohol and drugs
Drugs and alcohol are often used as coping mechanisms for people. Although they can make you feel better, these feelings are often temporary, with low moods being experienced after use. Consequently, alcohol and drugs can increase a person’s risk of developing depression. They can also exacerbate depressive symptoms in individual’s with depression.
Selfcare
What is selfcare?
Selfcare is the deliberate way in which we take the time to take care of our mental, emotional and physical health. Selfcare is completely individual and changes with each person. One person’s needs differ from another’s, selfcare is completely individual to you.
Why is selfcare important?
Selfcare reduces stress, improves emotional stability and promotes good sleep patterns.
It supports us during times of loss and change.
It helps us to heal and recover from challenging times.
It prevents burnout, which leads to a feeling of both physical and emotional exhaustion.
What are the barriers to selfcare?
Feeling like you are being selfish by taking time for yourself.
Not setting out a specific time or day for your selfcare routine.
Believing that others needs are more important than yours.
Not developing a routine around your selfcare can sometimes mean it gets moved or forgotten about.
How to introduce selfcare in to your life
Sleep
Sleep is extremely important to your overall health and well-being. Think about your night time routine and how you could change it to encourage a better night’s sleep.
Maintain a routine, try to go to bed and wake up at the same time each day.
Caffeine will keep you awake so should be avoided a few hours before you go to bed.
Avoid eating before going to bed.
Create an environment which promotes a good sleep, a dark room that is quiet and slightly cool.
Avoiding screens an hour before you go to bed.
Food
Healthy eating is a great way to practice more selfcare. Eating more fruit and vegetables in your diet will increase your vitamin and mineral intake and reduce your sugar and starchy snack intake.
Cooking can be very therapeutic and not only increases your interest in food, and independent living skills, but can also provides you with the opportunity to practice some selfcare. Listen to your favourite music or a podcast while cooking and it can make the experience all that more enjoyable.
Cooking also provides the opportunity to spend some time with friends or family.
Exercise
Exercise improves your mood, reduces your anxiety and stress levels and improves your physical health. The HSE recommend 30 minutes of moderate exercise 5 days a week. This could be walking at a brisk pace, gardening, swimming or cycling.
Say no
Sometimes saying no to those around us can protect us from burning out. If you are stressed or anxious, it is important to take time out to recover and recuperate. Some people may feel obligated to say yes to every invitation but protecting yourself is also very important.
Saying no sometimes is a good way to introduce more selfcare.
Take time out
Do something new and out of your normal schedule. Going on an adventure, big or small, can be a great way to reconnect with yourself and practice selfcare. Try sightseeing, the cinema, camping, or something which you wouldn’t get time to do normally.
Go outside
Nature is a great stress reliever. Fatigue, stress and anxiety can be reduced by going outside. It can also help improve your sleep.
Animals
Being around animals and pets can be very beneficial. They can help reduce anxiety and stress levels. If you do not have your own pets, maybe volunteering in an animal sanctuary is something which could interest you and they are always looking for volunteers to help.
Read
Take some time away from your tv and phone to read. Maybe you have a long bus journey, bring a book and read during your commute.
Get organised
Getting organised means that you will be able to practice selfcare.
Make a new routine for yourself, set aside a time in your day for selfcare and stick to it.
Bringing your dog on a walk after dinner, having your lunch in the garden, or listening to your favourite podcast in the morning are all examples of small pockets of selfcare you can fit in to your day.
Establish a new routine
Make a selfcare plan for 2 weeks and see how you feel afterwards.
Introducing something new can take a while to become part of your normal routine. After the 2 weeks you can reassess what you would like to focus on, for example, more time outside or more time with friends.
Seeking Support
When should I seek a therapist?
People engage with mental health professionals for a wide variety of reasons. You could be becoming overwhelmed with stress at work, or having difficulty in your relationships with friends or family. If you feel troubled, grieved or unable to make decisions, a mental health professional can help. If you have experienced a critical event, like a death, accident, change of job or have been the victim of a crime it may be time to seek help and support.
How do I know it’s working?
Things should improve when you link in with a therapist. Recovery is sometimes like a rollercoaster. You can experience moments of feeling down or moments when you feel a lot better. In general, you should feel a change and notice a change within the first 10 sessions with a therapist. If you do not feel things are progressing in the way you feel they should, discuss this with your therapist and they can then try something different to help you. Communicating your worries is important and allows the therapist to understand how you are progressing through your sessions.
How do therapy sessions start?
Therapists, when they first meet you, will go over a contract with you and ask you for emergency contact information and details of your GP. This information is confidential but would be used in the instance where the therapist feels that you are a risk to yourself or to others. The therapist may then tell you about themselves and their background. They will then ask you to discuss why you have decided to link in with the service. It is important to build a relationship with your therapist, this allows for you to feel comfortable enough to discuss personal feelings.
How long will I need to attend therapy?
There is no definitive answer to this question and it will most certainly depend on the reasons for attending a counsellor. Some people can attend counselling for years due to a significant trauma or ongoing difficulties, but some people may only need to attend for a few months before feeling secure and safe enough, with the guidance of a counsellor to take a break or ceasing sessions. A counsellor will not continue seeing you for appointments if they feel that they are no longer necessary and will develop a plan to slowly ease you from sessions over the course of a few weeks or months.
