Sensory Processing

Learning Disability and Sensory Processing

Unusual responses to sensory information are often associated with autism (APA, 2013).  However, children and young people with SLD have additional social communication, learning or even physical differences which make it harder for them to recognise, communicate or appropriately meet their sensory needs. The way in which a child or young person with SLD reacts to sensory input can be observed in their behavioural responses.  Some of these behaviours may seem unexpected or extreme, and the sensory triggers may not be immediately obvious. This makes it vitally important for the adults supporting or teaching the child/young person to carefully observe and appropriately analyse the behaviours to understand their root cause. To do this effectively, it is essential to understand more about sensory processing.

What is Sensory Processing?

Sensory processing is the way people learn to make sense of the world and respond appropriately. Sensory messages are received through eight systems:

  • Visual, detected by the eyes (sight)
  • Auditory, detected by the ears (hearing)
  • Gustatory, detected by the tastebuds (taste)
  • Olfactory, detected by the nose (smell)
  • Tactile, detected by the skin (touch)
  • Vestibular, detected by receptors in the inner ear (awareness of movement and balance)
  • Proprioception, detected by the muscles and joints (body awareness and its relationship to the environment around it)
  • Interoception, detected by the body-brain connection (awareness of internal needs such as hunger, thirst, toilet etc. These body-based sensations get translated by the brain into feelings)

The information received through these sensory systems tells us about what is going on in the surrounding environment and within our own bodies, allowing us to then respond appropriately. 

Link here to Sensory Processing Resource

Sensory Regulation

The eight sensory systems provide a huge number of sensory messages for the brain to sort out, so from birth, it learns to filter information. Children and young people typically learn to respond to certain information (such as someone speaking their name) and ignore other information (such as the rain on the window as they are listening to a story). This filtering process is constantly monitored by the brain so that each child or young person has just the right amount and combination of information to keep them interested and alert, but not so much that they become overloaded and distracted. 

Balancing sensory needs in this way is called sensory regulation. Self-regulation is the term used to describe children and young people who can independently recognise and respond to their own sensory needs, for example a young person who requests a calm break when feeling overwhelmed.

The brain tells the body what it needs to maintain sensory regulation. However, some children and young people with autism notice every small detail and others appear not to notice the most obvious of signals. Sometimes their filters can let in too much information, or the filters do not let enough information through. 

Over-responsiveness

Over-responsiveness, or hyperreactivity, to sensory information is the term used when children and young people appear to overreact to a situations or stimuli. They may over-respond to specific stimuli (e.g., their hands becoming messy, or the noise of a lawnmower outside) or they may become overwhelmed in busy environments (e.g., the dining hall, walking down a corridor or street). This can happen when their filter lets in too much information, or input is perceived at a greater intensity or because they notice every small detail. Their brain becomes full of sensory signals which make it difficult for them to know what to focus on, and what to disregard. 

With their brain already struggling to process all the sensory signals, even just a little more sensory information can overwhelm their ability to cope. This can happen more quickly when there is a reduced ability to cope, for example through illness or tiredness, or an elevated level of anxiety due to changes.

Over-responsiveness can lead to ‘fight, flight or freeze’ responses which are all ways of managing sensory overload. 

  • Fight
    Some children and young people might shout, swear, hit/push or throw and break objects.  This is their way of reacting to overwhelming sensory input.  In some cases, they may engage in these actions as a way of communicating that they are overwhelmed and need a break.
  • Flight
    Some children and young people may run from the classroom or other environment which is too overwhelming for them. Flight responses can also include an avoidance of transitioning to new places or engaging in activities which they perceive as uncomfortable, threatening, or even painful.  Strict adherence to rigid routines is also an indicator that the child or young person may be trying to avoid some sensory experiences.
  • Freeze
    Some children and young people may ‘shutdown’, entirely blocking out everything around them as a self-protective measure.

Some children and young people might suddenly cry or complain once they feel overwhelmed while others create routines, so they know what to expect. 

Link here for strategies to address over-responsiveness.

Under-responsiveness

Under-responsiveness, or hypo-reactivity, to sensory information is the term used when children and young people appear to under-react to situations or stimuli. This can happen when their filter blocks out too much information and they do not notice the sensory stimuli around them. Their brain does not receive enough sensory signals to keep them alert and engaged, so they appear lethargic and disengaged. Children and young people who are under-responsive to sensory information need additional sensory stimulation to increase awareness of sensory information, allowing them to respond.  Providing more sensory input will improve engagement in all daily activities. 

Some respond by seeking the sensations themselves – these are the children and young people who are always ‘on the go’.  They might frequently run, bounce, spin, rock, or pace.  They may also like to always hold a fidget object, touch others round them, smell different objects or make repetitive noise.  

Mixed and Fluctuating Responses

Most children and young people will present with a combination of both over-responsiveness and under-responsiveness to sensory input.  They may respond differently to different types of input e.g., a child may be overresponsive to noise, smells and light touch, but seek out increased movement and proprioceptive (deep pressure input).  Sensory needs can also fluctuate throughout the day and change over the course of a lifetime. 

A Note on Interoception

Increasing attention has been given to the interoceptive system in recent years, and it is now referred to as the ‘8th Sensory System’.  The interoceptive system receives messages from within the body about internal body states, including:

  • Hunger and feeling full
  • Thirst
  • Needing to go to the toilet
  • Temperature regulation- feeling too hot or too cold
  • Emotional states e.g. anxiety, happiness
  • Tiredness
  • Sex drive

Efficient interoceptive processing relies on the individual recognising these internal body states, and then knowing how to meet these needs e.g. sensing that the stomach is empty and then eating, or sensing that the bladder is full and then going to the toilet.

A child or young person who is hyper-reactive to interoceptive information will register even mild signals and may process them as urgent needs.  This can then lead to eating too often or going to the toilet with urgency and frequency.

A child or young person who is hypo-reactive to interoceptive information will not register internal body messages, and will therefore not recognise when they are thirsty, or need the toilet, or feel too hot or too cold.  This can then lead to not drinking enough, difficulties in toileting or not wearing clothing appropriate to the weather.

Link here for strategies to support improved interoceptive awareness

These strategies encourage the child or young person to become more aware of body sensations.  They start externally on the hands, feet etc, and then move to awareness of internal body states, before linking this to the actions required to meet needs e.g. if my throat feels dry and scratchy, I will drink some water.

Some children and young people will not yet be ready to register and interpret body messages and will therefore need the use of visual supports and schedules.

For example:

  • A child or young person who is having frequent toileting accidents may benefit from a visual system which prompts them to go to the toilet at regular intervals, or which prompts the supporting adult to take them to the toilet
  • A child or young person who is eating too frequently, because they do not register feeling full, may benefit from snack and mealtimes on a visual schedule to show them when to eat

Sensory Dysregulation 

When the child or young person who is over- or under-responsive to sensory information is unable to adequately reduce or increase their sensory input (perhaps due to lack of opportunity, or limited learning, communication, or mobility) it can be difficult for them to self-regulate. This causes dysregulation and, in the extreme, results in emotional and behavioural reactions. When children and young people have difficulty self-regulating, it becomes very important for the adults who support them to notice their dysregulated state and prompt or assist with regulating activities. This is part of mutual regulation which you can read more about here. 

The most obvious signs of sensory dysregulation are behavioural – changes in the way the child or young person behaves in response to a particular situation or stimulus. Behaviour changes can include increased stimming, loud vocalisations, hitting out at others, increased movement, and increased seeking of deep pressure input. There may also be more extreme behaviours such as biting, self-injury (e.g., picking at skin or banging head), pica (eating non-food substances), or smearing faeces. Other children and young people react by becoming excessively lethargic or having complete shutdowns.

These behaviours may occur when a child or young person finds it very difficult to cope with sensory input around them (e.g. someone standing too close) or can occur if they are not able to access the sensory input they need to regulate themselves (e.g. movement or deep pressure activities). There may be an increase in dysregulated behaviours because of the anxiety this causes the young person.  They may rock back and forth, spin themselves or pace up and down, and may become increasingly agitated. Similarly, when a child or young person is over-responsive, they may use behaviours to block out an external stimulus they wish to avoid.

The importance of skilled observation, appropriate analysis, and mutual regulation by caregivers and educators cannot be overstated!

Read how Middletown Centre for Autism helped GH, a young boy with behavioural signs of dysregulation

Less obvious signs of dysregulation are physiological – the changes in the way a child or young person’s body functions. Physiological changes can include sweating, changes in pallor (becoming flushed or pale), dilated pupils, increased or shallow breathing, shaking, nausea or vomiting, changes in appetite, or changes in toileting habits. 

It is important to remember that dysregulation can build up over time, so it may not necessarily just be the ‘final straw’ event or situation which causes the dysregulation. 

Link here for Positive Behaviour examples

Stimming

Stimming is the term used to describe self-stimulatory behaviours, which usually provide increased amounts of sensory input, such as visual stimulation, movement, proprioception, tactile input or noise.  The behaviours are repetitive (or stereotypic) motor actions which are used by the child or young person to help keep themselves regulated.  Many autistic people say that they stim because it simply makes them ‘feel good’.

Examples of stimming:

  • Pacing
  • Clapping hands
  • Flicking fingers or waving hands in front of eyes
  • Spinning or flicking on object close to the eyes
  • Jumping and bouncing
  • Rocking
  • Making repetitive noises or repeating a familiar phrase
  • Tapping

There are of course, many other examples, and stimming can be unique to the individual.  Some autistic people describe a specific interest as their ‘stim’ e.g. drawing, building with Lego.

Stimming can help the child or young person to stay regulated in the following ways:

Hyper-reactivity:
if the person feels anxious or overloaded by sensory input, stimming helps them to feel calm.  It is predictable input, which is in their control, and is therefore comforting when the environment around them may seem unpredictable and chaotic.  It gives them something to focus on, helping them to filter out surrounding input.

Hypo-reactivity
if the person is expected to engage in a quiet, sedentary activity (e.g. tabletop work, Assembly), the stimming behaviour provides increased stimulation to help them stay alert, and in this way, facilitates attention.

As stimming is important in maintaining sensory regulation, it should be allowed to continue.  It is likely to be helping the child or young person to achieve a calm and alert state, and therefore facilitates attention, learning and interaction.  

However, if the stimming behaviour is harmful to the person (e.g. hitting or banging their head), or if it escalates in intensity, this is an indicator that they are dysregulated and becoming increasingly anxious.  In these instances, the supporting adult needs to intervene by removing any trigger which may be causing distress or re-directing the child or young person to a calm space/activity.

Sometimes there may also be an increase in stimming when the child or young person is not adequately engaged in activities.  Visual schedules and structured activities should then be used to support purposeful engagement.

Top Tips for Introducing New Sensory Activities

When considering any new sensory activity for children and young people with autism and additional learning needs, there are some key principles to consider:

  1. Be clear about the aim of the sensory activity
    It is important to carefully observe and analyse a child or young person’s behaviours so that you can identify their sensory needs, and then develop activities around these. When you develop a sensory activity, carefully consider the aim of the activity. What system or systems is it addressing? Is the goal to calm or to alert the child or young person? Do others understand the aim? Remember to always monitor and adapt if the activity is not achieving the intended aim.
  2. Ensure the activity has a clear end goal
    Children with autism and additional learning needs are unlikely to understand that they are engaging in a sensory activity because it is calming, alerting, or regulating. They therefore need a tangible end goal to increase motivation and participation in the activity. An end goal makes it purposeful and playful.
  3. Break the activity into short, sequential steps
    Keep it simple – start with two or three steps. Present the steps visually, with a clear beginning and end.
  4. Consider the context – when, where and how?
    Having identified the steps required, it is important to consider when, where and how to initiate the sensory activity. Choose a situation to introduce it and allow learning to embed before attempting to transfer the skill to other situations. Consider how long to spend on the sensory activity and how you will manage the transitions. A child or young person may not be able to tolerate much at first, for example, when trying to reduce sensitivity to touch. A timer or alarm may be helpful for gradually increasing sensory exposure, building up a few seconds at a time. Conversely, a child or young person may not wish to leave something they are really enjoying, for example, a sensory room. A traffic light visual support may be helpful as a countdown for specific activities, and you can schedule ‘little and often’ sensory activities throughout the day.
  5. Structure the activity
    Use visual supports which are most meaningful to the child or young person, e.g., objects or photographs. These should be consistent with the type of supports they use on their schedules and in other activities. You can read more about the use of social communication supports here.
  6. Incorporate specific interests or favourite items
    Using the child or young person’s specific interests or favourite items can provide added incentive at various stages of sensory activities, for example, hiding favourite dinosaurs in cooked pasta may increase sensory tolerance for touch, as the ‘high value’ reward of finding the dinosaurs outweighs the sensory discomfort. Similarly, a follow-up activity featuring a specific interest may provide the extra value required to transition from an enjoyable sensory activity.

For example, in case study 4, GH became distressed in noisy or busy environments and communicated this by banging his head, biting and hitting himself and others. Reducing GH’s distress and his subsequent behaviours was the goal of introducing a communication board with appropriate calm choices. When staff noticed that GH was becoming distressed, they (a) directed him to the board; (b) he chose a photograph; and (c) swapped it for a calm activity – three short, sequential steps, offered initially during the context of group activities before being transferred to assembly and PE. There were three calm options on the board, each visually supported by photographs, and calm activities were favourites of GH, increasing the value of the activities to him. 

Strategies for managing sensory dysregulation in children and young people with learning difficulties

Managing dysregulation most effectively means understanding which sensory systems are affected by over- or under-responsiveness and reducing or increasing the stimuli accordingly before the child or young person becomes overwhelmed. It is rare for only one sensory system to be affected, or for behavioural changes to be identical in frequency or severity – it depends on the environment, energy levels, wellbeing, and the range of sensory challenges faced throughout the day. 

Link here for general strategies on managing dysregulation here

However, for children and young people with learning difficulties, strategies may need to be adapted to consider an individual’s level of understanding, and their communication or mobility skills. We refer to this process as differentiation.  

Differentiating Strategies for Children and Young People with Learning Disability

Link here for visual strategies for all children and young people

In addition to the strategies mentioned, you can differentiate for children and young people with learning disabilities who are over-responsive to visual stimuli by:

  • Using a wooden desk or covering the desk with a plain cloth
  • Using less brightly coloured toys and games
  • Providing a darker area (for example a pop-up tent) as a retreat area

In addition to the strategies mentioned, you can differentiate for children or young people with learning disabilities who are under-responsive to visual stimuli by:

  • Containerising single elements of an activity for individuals who have difficulty selecting objects in competing backgrounds
  • Scheduling time in a sensory room for visual stimulation to increase and maintain alertness
  • Using puppets to enhance visual attention

Link here for auditory strategies for all children and young people

In addition to the strategies mentioned, you can differentiate for children young people with learning disabilities who are over-responsive to sounds by:

  • Teaching an alternative appropriate response to noise-related behaviours (see case study 4)
  • Providing access to a calm space to encourage regulation

In addition to the strategies mentioned, you can differentiate for the child / young person with learning disabilities who are under-responsive to sounds by:

  • Using objects, pictures etc to gain attention.
  • Scheduling time for auditory sensory input, for example music sessions or sensory room to increase and maintain alertness.

Link here for gustatory strategies for all children and young people

Sensory over-responsiveness to taste or texture can present as the child or young person eating a limited range of food. However, there may be non-sensory reasons for this, so if you are concerned about a child or young person who appears underweight or eats a limited range of food, you consider the following: 

  • Liaise with parents and relevant professionals (e.g. GP or psychologist) for information and advice
  • Work in partnership with parents when introducing new foods
  • Increase exposure to food through other senses (e.g. smell and touch) by promoting engagement in food play, food preparation and exploration, outside of mealtimes

Sensory under-responsiveness to taste or texture can present as a need for strong flavours or eating non-food items (pica). Pica is a serious concern, and there may be non-sensory reasons for it, so again, please:

  • Seek advice from relevant professionals (e.g. GP or psychologist)
  • Schedule time for oral motor activities to provide additional sensory input
  • Add stronger flavours to food

Link here for olfactory strategies for all children and young people

Sensory over-responsiveness to smells may present as the child or young person refusing to go into the dining hall or bathroom. You can:

  • Allow them to eat in another room
  • Keep bathrooms well ventilated
  • Reduce fragrances
  • Provide a preferred scent to mask smells they find unpleasant

Children who are under-responsive may smell everything but not recognise bad smells as potential sources of danger. You can:

  • Schedule time for ‘smelly play’, e.g. using scented play-doh
  • Ensure hazardous materials are kept out of reach

Link here for tactile strategies for all children and young people

As the tactile system overlaps with several sensory systems, over-responsiveness to touch may present in a variety of ways. It is vital that appropriate observations and analysis take place. You can help children and young people who are over-responsive to touch by:

  • Giving them their own space, which reduces the chance of them bumping into or brushing against another person
  • Teaching an alternative appropriate response and using deep pressure when they feel overwhelmed
  • Providing access to a calm space to encourage regulation

In addition, children and young people with autism and learning difficulties who are under-responsive to touch may touch their private parts or poke at their bottom. You can help by:

  • Scheduling time for tactile sensory input, for example sand play, fingerpainting, dough etc
  • Providing structure throughout the day to maintain sensory stimulation
  • Adapting tasks to increase tactile experience e.g. finger painting instead of or as well as using brushes
  • See Case Study 1 here

Link here for vestibular strategies for all children and young people

Over-responsiveness to movement can present as fear of sudden, backwards or spinning movements, or fear of being off the ground. You can help by:

  • Avoiding fast, rotational, or unpredictable movement
  • Using floor-based activities which are controlled by the child or young person
  • Using deep pressure (proprioception) activities before and after a movement activity

Under-responsiveness to movement can present as impulsiveness, fidgeting and poor attention. You can help by:

  • Scheduling frequent movement breaks. Remember, to be meaningful to a child with learning difficulties, they should have a clear purpose
  • Keeping activities short and structured
  • Providing fidget toys at listening/waiting times

Link here for proprioception (body awareness and its relationship to the environment) strategies for all children and young people

As proprioceptive activities can be both alerting and calming, they are useful to help the child or young person become or stay regulated. You can help by:

  • Scheduling proprioceptive activities throughout the day
  • Preferably using active rather than passive engagement
  • Providing resistive, weight-bearing, or deep pressure input

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