Disclaimer: although many autistic children have sensory processing disorder (SPD), not all do; also, not all children with sensory processing disorder (SPD) are autistic. In our son’s case, he has both. Since there is a high coincidence, it is definitely worthwhile to have your child assessed for SPD, since sensory issues will interfere with any other therapies or discipline you may want to use with your child.
The book is no longer in print that first introduced me to sensory integration dysfunction (now often called Sensory Processing Disorder), but it was authored by A. Jean Ayers, who first described the disorder, and developed the therapy for it, called Sensory Integration (SI). Other terms you may hear used: sensory defensiveness, tactile defensiveness, sensory over (or under) stimulation. At the time (mid-1990s), Ayers’ was the only book available, since it was at that point a very controversial diagnosis and therapy. Now there are quite a few resources available, although some (uninformed) physicians still consider it controversial. DO NOT let your doctor brush you off on this, and if your insurance company won’t pay for it, see a licensed physical or occupational therapist anyway, who specializes in diagnosing and treating sensory issues. Fortunately, it is much more commonly recognized and treated by insurance companies now than it was when we pursued it, and even school districts provide some services.—————-
How the diagnosis and treatment of sensory processing disorder helps with discipline:
Children with this disorder often act out or throw tantrums because their brains do not interpret sensory input accurately. In Rob’s case, he was tactilely defensive, had problems with his vestibular and proprioceptive systems, and engaged in sensory seeking behavior. In other words, he could not tell where he was in space, could not accurately tell how hard he was hitting or throwing things (or how hard he was being touched), and was ultra-sensitive to things touching his skin (like clothes). This caused him to have tantrums over the feel of his socks, shoes, and clothes, to be throwing things constantly; and his hitting, jumping, banging, pinching, etc were signs of his brain desperately trying to get some accurate information about his environment. His extremely hyperactive behavior was the main symptom, but there were others: his insisting on the same clothes every day, hating to be touched, throwing tantrums about getting wet or being bathed; wearing rubber bands around his wrists and ankles, a cloth tightly around his head (or a tight hat); cinching his belt or tying a rope extremely tightly around his waist. He was also oversensitive to the textures and smells of food, sensitive to loud noises, etc. These issues often led to tantrums about going places (because we would want him to change his clothes); bedtime (because of bath and brushing teeth); meals (because of sensitivity to food texture and smell); public places (too noisy, too busy, too strange); being with other kids (because he would often throw things, hit and pinch them, or cry when they just touched him).
The treatment consisted of daily exercises designed to normalize his sensory processing. Each child will have different needs, so you need to see a specialist to have him assessed, because the exercises have to be highly specialized to the needs of each child. They will do some of them at a clinic 2-3 times a week with special equipment. Some of the exercises you will have to do at home several times a day. The main thing that helped Rob was deep pressure, either by wrapping him in a blanket and squeezing him, or by brushing his skin with a surgical brush in a very particular way every hour and a half. We also had to compress his joints in a particular pattern. We did this 5-6 times per day, daily, for almost 6 years. So don’t give up or get discouraged. The exercises help the brain re-program itself, which takes time. He also had other exercises that he did once daily, either at school (which was equipped with a sensory room), or at home ( certain swings, playing on a large inflatable ball, etc). He also went to physical therapy 2 times per week – once in group therapy, and once a week in a private session with the occupational therapist.
The improvement in Rob was almost immediate. So long as we did the exercises regularly, he was much calmer, and melted down much less often. He liked the feel of the deep pressure so he did not resist doing it, especially if we worked it into his regular schedule so that he came to expect it. We were fortunate that his school had an occupational therapist on staff that would do the brushing and joint compression. We also taught the school nurse, and he would go to her before lunch and again in mid-afternoon. At home, we did it when he got up, before he left for school, when he got home from school, before dinner, and at bedtime. We got into a routine so that the entire brushing/joint-compression protocol could be done in less than 5 minutes. Then we didn’t make big deal about it; it was just the next thing in his schedule. We also made efforts to cut tags out of clothes for him, and if he found a certain article to be especially comfortable we bought several of those identical items. We instructed friends and family to always touch him slowly and with warning (and never from behind) so that he could have information about how he hard he was being touched.
So the tantrums and hyperactive behavior were happening much less frequently; and when they did happen, we knew to look for a sensory cause first. Sometimes he would be throwing a tantrum about an apparently unrelated issue; but we learned that if his socks were annoying him, he had less patience for waiting in line, for example. I carried a brush in my purse so we could do a quick skin-brushing to help calm him down, which also helped. As he got older we helped him to be able to identify and verbalize what was bothering him, rather than having a tantrum or screaming. A time-out became a useful tool, not as punishment, but as a way for him to figure out what was bothering him, and to allow him to use a self-calming behavior like thumb-sucking, or brushing his own skin, or wrapping up in a blanket, to calm himself. We encouraged him to try to tell us what was bothering him rather than screaming. Sometimes the only thing to do was to leave the situation. This is really frustrating, especially if you are shopping or have other children with you. But if there is something in the situation beyond your control (flickering fluorescent lights, for example) there may not be anything else to do. Sometimes it would help to give him a time frame, for example: “I know the lights are really bothering you, but we will be done in 5 minutes.” But then you needed to make sure you really were done in 5 minutes, so you can’t use it as a stalling tool. The thing to remember is that he isn’t “being picky”; the lights really are bothering him in a way that you cannot perceive. Moreover, he may not realize that the lights do not affect you in the same way. He may assume you already know what is bothering him, and so may not understand why you are not reacting the same way.
This leads to the second issue with disciplining autistic children: lack of comprehension about what you want from him….