November 27, 2006

Vol. 22 •Issue 24 • Page 9
Sensory Scene

By Susan N. Schriber Orloff, OTR/L

Autism as a sensory issue is very tricky—so many things over lap and
intertwine. The classic indicators seem to almost be the same.

In fact, I really hold to the opinion that the two diagnoses are
irrevocably meshed.

Having said that, however, there nonetheless remains a need to
differentiate between these two distinct issues.

The two lists offered here are to help illustrate just how careful we
need to be in suggesting that parents further investigate clinically
observed behaviors. Items in each list were compiled from various
sources. I also suggest that clinicians use these lists as informal
checklists as part of their parent intake process or in the course of
therapy as needed. I advise making this into one list but keeping the
items separated, and then note which items from the two categories are
most noted.

Sensory integrative issues may be characterized by:

# constant motion or easy fatigue, or going back and forth between the two;

# withdrawal when being touched;

# refusal to eat certain foods because of how the foods feel when chewed;

# oversensitivity to odors;

# hypersensitivity to certain fabricswill only wear clothes that are soft
or those that are pleasing;

# dislike of getting the hands dirty;

# uncomfortable with some movements, such as swinging, sliding or going
down ramps or other inclines. Your young child may have trouble learning
to climb, go down stairs or ride an escalator;

# difficulty calming him after exercise or after becoming upset;

# jumping, swinging and spinning excessively;

# appearing clumsy, tripping easily or having poor balance;

# social-skill issues/authority issues;

# tantrums;

# over-sensitivity to criticism;

# memory difficulties and/or problems following directions;

# difficulty handling small objects such as buttons or snaps;

# over-sensitivity to sound. Vacuum cleaners, lawn mowers, hair dryers,
leaf blowers or sirens may upset your child; and

# lack of creativity and variety in play. For instance, your child may
play with the same toys in the same manner over and over or prefer only
to watch TV or videos.

Autism and or PDD issues may be characterized by:

# insistence on "sameness"; resistance to change;

# difficulty in expressing needs; use of gestures or pointing instead of
words;

# repetition of words or phrases in place of normal, responsive language;

# laughing, crying or showing distress for reasons not apparent to others;

# preference for being alone; aloof manner;

# tantrums;

# difficulty in mixing with others;

# lack of desire to cuddle or be cuddled;

# little or no eye contact;

# unresponsiveness to normal teaching methods;

# sustained odd play;

# spinning of objects;

# inappropriate attachments to objects;

# apparent over-sensitivity or under-sensitivity to pain;

# no real fears of danger;

# noticeable physical over-activity or extreme under-activity;

# uneven gross/fine motor skills; and

# non-responsiveness to verbal cues; acts as if deaf although hearing
tests in normal range.

As illustrated here, it is easy to see, especially in a very young child
(ages 2-6), how these behaviors can be dismissed as, "they're young,
they'll grow out of it." And making broad statements, suggestions of
referrals to other sources, etc., may be very frightening to parents,
especially if they have been trying to tell themselves that the nagging
feelings they have been experiencing is due to being "over-protective."

A psychologist who refers to my practice once counseled me about
informing parents of issues with their children. She said, "the first
person to tell them gets shot, the second shoved and the third listened
to. Try to be number three."

In our position as occupational therapists, however, we are often put in
the role of being "number one." Being the resource person in the
schools, the first referral source of pediatricians, the person known in
the community for what we do, etc., puts us in the precarious position
of being the first to say to a parent, "There is something that needs to
be investigated." I hope that the use of these lists will help guide
both our families and us in the quest to provide empathic, quality care.

/Susan N. Schriber Orloff, OTR/L, is the author of the book, Learning
RE-Enabled, a guide for parents, teachers and therapists (a National
Education Association featured book), as well as the CEO/exec. director
of Children's Special Services, LLC, an occupational therapy service for
children with developmental and learning delays in Atlanta, GA. She can
be reached through her website at /www.childrens-services.com
or at sorloffotr@aol.com

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