This month I am speaking to Dr Amanda Ludlow, who is a researcher at Anglia Ruskin University in the UK and who is conducting research into autism and sensory related issues.
The environment within which a person with autism presides within can have a profound effect from a sensory perspective. For a manager with Asperger syndrome (AS) it can have a significant impact on their performance.
1) MJ: Amanda, thank you for your time. Firstly, could you explain a little more about your research and how it relates to autism/asperger syndrome and how you became interested in it please?
AL: To date my research has mainly looked at sensory processing in children with ASD and Asperger syndrome. However, we believe that a lot of our findings could be applied to an adult population.
Sensory dysfunctions are frequently reported in individuals with autism spectrum disorders (ASD). It has been suggested that these symptoms are associated with their difficulties processing language as well as with social isolation observed in people with autism. However, there is a distinct lack (commented on by families and charities) of research into interventions for the common and disabling sensory difficulties seen in Autism Spectrum Disorders. Sensory defensiveness or over-sensitivity to sensations (touch, sound, visual information or movement) is common in these individuals and can result in problems with focusing on tasks, participating in everyday activities in busy environments, maintaining work and social relationships, or experiencing physical contact with others.
I became interested in sensory abnormalities when working with a high functioning 11 year old child with Autism whose sensory problems affected every aspect of his life, including leaving the house and engaging in social activities. I have been particularly interested in the “sensory behaviours” which suggest the possibility of heightened sensory sensitivity reminiscent of that characterised in other literature as visual stress. This includes perceptual distortions such as distortions in text and asthenopia (eye strain). I have been looking mainly at the use of colour overlays and coloured glasses as one treatment strategy. We have been the first to highlight some of the remarkable differences it can have in alleviating sensory symptoms. So far, colour overlays have been shown to improve performance on a reading and visual search task in a large proportion of children with ASD (approx 80%)(high and low functioning) (Ludlow et al., 2006; 2008). However it is also possible that wearing of coloured filters might improve visual perceptual and reduce distortion to the extent of improving face perception: particularly given that one of the consequences of wearing coloured filters can be an improvement in socialisation (Ludlow & Wilkins, 2009). We are also been looking at the effect of lighting. Fluorescent lighting is thought to increase visual stress (Winterbottom & Wilkins, 2009) and therefore likely to exuberate sensory behaviours.
2) MJ: as a manager with Asperger syndrome I have become increasingly aware of how sensory factors such as noise, bright light and touch related factors such as clothing that is irritable or uncomfortable on the skin can affect me personally. Can you say why this is please?
AL: There are many types of sensory behaviours. Brown & Dunn (2002) in their adolescent and adult sensory profile, designed to measure behavioural responses to every day sensory experiences, have tried to characterise them in to 4 main types (Low registration, sensation seeking, sensory sensitivity & sensory avoiding). People can show these behaviours to various degrees and can show different patterns from one another. For example, some people may only score highly for low registration, another person may not show any of these behaviours, or another person may score highly in several of the behaviour types.
Low Registration measures passive behavioural responses such as missing stimuli or responding slowly. Sensation seeking measures active behavioural responses such as seeking items to identify responses and characteristics such as enjoyment, creativity, and the pursuit of sensory stimuli. Sensory Sensitivity measures passive behavioural responses such as noticing behaviours, distractibility and discomfort with sensory stimuli. Sensation Avoiding identify responses and behaviours such as deliberate acts to reduce or prevent exposure to sensory stimuli and efforts to make exposure more predictable (I only eat familiar foods). Thus if behaviours become irritating you are likely to be showing more sensory seeking and/or sensory avoiding behaviours.
3) MJ: according to Professor Tony Attwood there are several different (hyper/hypo-sensitive) sensory systems and the most common sensitivity is to specific sounds. Can you shed any light on this observation, especially from a work environment perspective?
AL: In serious cases, individuals with auditory sensitivity can develop phobic conditions, such that the mere possibility of hearing a painful sound can cause fear and anxiety. To cope, these individuals develop strict routines to safeguard themselves from challenging acoustic environments.
We also found auditory responsiveness to the most frequent and pervasive form of sensory behaviour in a group of children with ASD. Using Electroencephalography (EEG), a technique which measures brain activity, we have shown differences in how children with autism process language. The children with ASD showed evidence of reduced attentional orienting to sound changes involving frequency and loudness. It is likely that the individuals with ASD deliberately avoid or prevent exposure to sensory stimuli (sensory avoidant) and the preventative strategies which they use may be related to impairments in language processing. It is possible that the expression of sensory behaviours such as actively withdrawing from environment may modulate the degree to which sounds are detected and missed in the environment. This demonstrates how deliberating noise can be for those with ASD.
5) MJ: I would like to investigate the subject of sensory overload or, in particular, a “meltdown”. Do you have any observations to make in this area, especially with regard to prevention and control?
AL: We all experience the world through our senses and our brains interpret the sensations for us so that we can make sense of our experiences and take appropriate action e.g. we feel cold so we put on a jumper. Because we are experiencing countless sensations at any one time, our brains have a filter system that enables us to pay attention only to what is most important and relevant at the time. People with ASD do not seem to have this filter system, so all their sensations may be experienced at the same intensity all at once, which can lead to sensory overload in some environments. It is important to try and regulate the amount of sensory stimuli a person with ASD copes with at any one time and to monitor those that cause unnecessary distress.
6) MJ: There are times when a manager with AS is going to be subjected to such conditions; sometimes unavoidably so. Again, I would be interested in hearing your views as to how these scenarios can be managed?
AL: It is important for any work place to consider the needs of its workers and thus considering the work environment setting is a critical factor in helping those with AS cope in a work setting. Managers need to be aware of sensory problems experienced by adults with AS and to understand the consequences they have for those is a work environment and to accommodate it accordingly. Due to the variance of sensory problems that any one individual with ASD may suffer from it would not be possible to accommodate for all. However, one simple way to manage this is being aware of the difficulties and changing approaches to people with autism accordingly. It is important to keep things fairly simple to avoid over-stimulation of activity.
By creating more routine and providing structure and boundaries in their daily lives and giving advance warning of change, to bring predictability and minimise stress, is also thought to people with ASD cope better in sensory situations.
Modifying the environment to minimise sensory overload can also be very helpful. This can include avoiding fluorescent lighting, replacing it with subdued lighting, introducing carpets, curtains and soft furnishings to large rooms, to muffle the harsh sounds and echoes more and improve acoustics; using screens or partitions to divide up large rooms and by providing a quiet corner in a noisy office will all reduce stress and enable the person with ASD to cope better in their environment.
7) MJ: I would now like to investigate a little further the subject of sound. One of the most difficult things that I have had to deal with as a person with AS is interacting and communicating with someone who shouts! As well as practical methods like removing ones’ self from the noise (if possible) how effective are techniques like Sensory Integration Therapy?
AL: I have had less experience with this aspect. I know that Sensory Integration refers to the skills & performance in developing & coordinating sensory input, motor control & sensory feedback in a smooth process. Through sensory integration, the many parts of the brain work together so that a person can interact with the environment effectively & experience appropriate achievement in daily activities. Normally good sensory integration is developed in the early years as the child explores his body and environment, learning about the way they work together. Many accounts in the literature from adults with ASD have suggested that is equally as effective in adults.
8) MJ: coming now to tactile sensitivity. Touch and uncomfortable clothing are an issue for me as a manager. I don’t really enjoy wearing suits or enduring issues that are associated with them: a tightly fitted tie for example. Have you come across any specific interventions that can alleviate things in this area?
AL: Many people with ASD are tactile defensive to the point they cannot bear to be touched. Often, light touch is harder to tolerate than firm touch. The feel of shoes, clothing and clothes labels may be unbearable, so they take them off at every opportunity. Sensations such as heat, cold, hunger, thirst and pain may not be experienced in the usual way. Essential daily activities such as dressing and having hair cut may be problematic because they are felt to be invasive. In a work environment where individuals with ASD often have to adhere to a strict dress code, this sensory aspect can be very challenging. Many of the interventions involve avoiding items that cause distress or introducing them in to contexts which have reduced sensory stimuli so the person feels more able to cope.
MJ: Amanda, thank you very much.