Pathological Demand Avoidance: what is it and what strategies can help?

A lot of our children with additional needs struggles with everyday ‘demands’- requests, expectations, questions, commitments. But for some, even the most routine of expectations cause great anxiety; that’s when we see Pathological Demand Avoidance (PDA) or extreme demand avoidance.

What is PDA?

Pathological Demand Avoidance (PDA) is a condition which is part of the autism spectrum, and is characterised by an overwhelming need to avoid or resist demands.
This information sheet provides some behavioural strategies to support a person with PDA.
Key characteristics of PDA
Along with other characteristics seen on the autism spectrum, a person with PDA may show the following features:
• An obsessive resistance to ordinary demands and requests
• Use of socially manipulative or outrageous behaviour to avoid demands
• Sudden changes in mood apparently associated with a need to control
• ‘Surface’ sociability, reflected in social peculiarity, difficulties with peers and lack of social constraint
• Comfortable in role play and pretending.
Like many other people on the autism spectrum, people with PDA experience high anxiety levels and can feel that they are not in control. This leads people with PDA to avoid and refuse any requests that are made too assertively. Sometimes this is due to how the person with PDA interprets the question or instruction. This can lead them to avoid tasks and activities that they would otherwise enjoy, which can be upsetting for the person with PDA.

Core features of PDA are:

  • A need to resist normal, everyday demands made by others
  • This resistance appears to be a way of managing acute anxiety
  • Unlike those with autism, learners with PDA may use social skills to manipulate; these skills are, however, at a functional and logical level rather than at a deeper emotional level.

What are the differences between learners with PDA and autistic spectrum disorder (ASD)?

  • Passive early history in the first year

Young people with PDA tend to sit on the side lines just watching what is going on. They can be described as ‘actively passive’, letting things drop to the floor from their hands. They develop strong objections to normal requests. This is unlike young people with ASD who tend to lack social response and empathy, and tend to have poor body language and stereotypical behaviour.

  • Continues to resist and avoid ordinary demands of life

Young people with PDA devote themselves to resisting ordinary demands, and as their language develops this can become worse. They may well acknowledge the demand but then can come up with a myriad of excuses as to why they cannot comply such as, “my legs won’t work”, “the teddy told me not to do that,” etc. They may crawl underneath furniture and say that they cannot do something because they are ‘stuck’ and often use fantasy to withdraw, pretending to be a cat or a super hero. This is unlike young people with ASD who may be reluctant to follow a demand, but this tends to be by ignoring or shutting out pressure in a non-social way with few direct strategies for avoidance. Their approach is more direct than devious.

  • Surface sociability, but apparent lack of sense of social identity, pride or shame

Young people with PDA look more sociable but this is without depth. They have few boundaries and can display uninhibited behaviour that can be shocking. Praise, reward and punishment are likely to be ineffective. Young people with ASD are not inclined to use manipulation because of a lack of social empathy and often there is no impression of sociability.

  • Lability of mood, impulsive, led by need to control

Young people with PDA can switch from passive to aggressive very quickly. They may apologise yet do the same thing again straight away, whereas young people with ASD are seldom impulsive, tending more to work to their own rules and not put an act on for anyone.

  • Comfortable in role play and pretending

Young people with PDA can behave to other learners like the teacher. Some lose touch with reality, adopting a ‘video’ character. Young people with ASD tend to be inflexible with a lack of symbolic or imaginative play due to a lack of social empathy.

  • Language delay, seems result of passivity

Young people with PDA tend to have an early language delay and often a sudden catch up. Their social use of language can appear normal although content may be odd. Social mimicry is more common than video mimicry. Young people with ASD have language which is both delayed and deviant. Their social language skills are poor.

  • Obsessive behaviour

Young people with PDA have obsessions which tend to be social in nature. They can be over-powering in their liking for certain others. Most behaviour is obsessive, especially the demand avoidance, and can lead to low levels of achievement. Young people with ASD have obsessions which are rarely social and not focused on demand avoidance. Their obsessions are not used for manipulative purposes.

Young people with PDA are less likely to:

  • have caused anxiety to their parents before 18 months of age
  • show stereotypical motor mannerisms
  • show echolalia or pronoun reversal
  • show speech abnormalities in terms of pragmatics
  • show tiptoe walking
  • show compulsive adherence to routines

Young people with PDA are more likely to:

  • resist demands obsessively (100%)
  • be socially manipulative (100% by age of 5)
  • show normal eye contact
  • show excessive lability of mood and impulsivity
  • show social mimicry (including gesture)
  • show role play (more extended and complete than mimicry)
  • show other types of symbolic play
  • be female (50%)

Which strategies may help?

The PDA society provides many helpful suggestions, along with its useful PANDA mnemonic

PDA Society: helpful strategies

The website goes on to explain further:

Understanding behaviours

  • Anxiety – the most important starting point is to understand and accept that a PDA child’s behaviours are underpinned by anxiety and a need to feel in control. Anxiety can be expressed in many different ways including avoidance, anger, shouting, crying, restlessness, boredom, fidgeting, rocking, ticks, repetitive actions, obsessing, skin picking, swearing, hiding, running off, withdrawing, throwing things and lashing out at others. The anxiety curve model is a really helpful way to understand anxiety and echoes the hierarchy of demand avoidance approaches seen in a PDA profile of autism. All the helpful approaches explained below are designed to help our children remain on the ‘lower slopes’ of the anxiety curve and avoid escalation where possible.

In addition, any or all of the following may be underlying …

  • Difficulties in processing language – our children may have good expressive language but may not be able to process verbal communication quickly enough to keep up during a conversation and may be confused by non-specific questions or instructions (please listen to our webinar about PDA and speech & language for more detail).
  • Difficulties with social interaction – our children may not always understand the ‘unwritten rules’ of social interaction or non-verbal communication including body language and tone of voice.
  • Confusion about emotions – our children may not be able to understand or accurately ‘label’ emotions in themselves or other people, or may feel overwhelmed by their own and others’ emotions.
  • Intolerance of uncertainty – our children may struggle with all the ‘what ifs’ of life, not knowing how things might ‘pan out’, what might be expected of them, where a situation might lead, when a situation might end and whether they will be able to cope with whatever may come along.
  • Sensory overload – our children’s heightened sensory perception can also contribute to anxiety, overload and avoidance (please listen to our webinar about PDA & sensory processing for more detail).

Adjusting your mindset

A repeated theme in our case studies is that PDA turns “parenting norms” upside down, so our own mindset and mood are key factors in developing a toolkit of helpful approaches. Please listen to our webinar for more detail on this, but some key pointers are:

  • Look beyond surface behaviours – outward behaviours are just the tip of the iceberg with many contributory factors lying below the surface as explained above.
  • Re-balance your relationship – a more equal relationship between child and adult, based on collaboration and respect, builds trust. Try to aim for win:win solutions.
  • Keep calm and carry on – try not to take things personally; model desired behaviours; pick your battles; treat every day as a fresh start.
  • Focus on the long term objective of building a child’s ability to cope rather than short term compliance.
  • Be flexible – helpful approaches require creativity and adaptability.
  • See the positives – whilst supporting our children’s challenges, try not to lose sight of their many positive qualities.
  • Support and self-care for you – being in touch with others who are having similar experiences can be enormously helpful and local families may have invaluable tips relevant to your area (please search our resources directory for support groups near you). It’s also important to ensure you are caring for yourself as well as possible.

Optimising the environment

Just like giant pandas, our children can thrive in the right environment – in place of firm boundaries and the use of rewards, consequences and praise, an approach based on negotiation, collaboration and flexibility tends to work better in PDA households. Top tips include:

  • Balancing tolerance and demands – a child’s ability to cope with demands will vary from day to day and from hour to hour, so try to control the ‘input’ of demands accordingly (remembering that demands are many and varied) and build in plenty of ‘downtime’ to give space for anxiety to lessen and tolerance levels to replenish.
  • Agreeing non-negotiable boundaries – these will vary from household to household and from child to child. For some, the barest minimum of non-negotiable boundaries (such as basic health and safety requirements or those relating to their siblings) may be needed when anxiety is very high, but they may be increased over time. Sharing clear reasons for these boundaries, and agreeing on them together as a family, can help our children to adhere to them. Enforcing these boundaries without exacerbating things may require the use of other helpful approaches (please see next section on reducing the perception of demands).
  • Allowing plenty of time – time is an additional demand, so it’s helpful to build in plenty of time (for instance, setting alarms earlier on a school morning). Always try to plan ahead, anticipate potential challenges and allow some flexibility to accommodate fluctuating anxiety levels.
  • Having an exit strategy – knowing how to extract yourself from a situation can help with reducing anxiety (for instance, you might agree a quiet zone where a child can retreat to or provide reassurance that if something can’t be done today it can be tried again tomorrow).

Reducing the perception of demands

Re-framing demands to make them feel less ‘demandy’ is a key technique. There are lots of ways to do this – you will probably find that a ‘mix and match’ approach works best:

  • Phraseology and tone: subtle adaptations to our language and tone can benefit our children greatly. Using declarative language (like a ‘commentary’) or rephrasing things to talk about an object rather than a person and even simple things like starting rather than ending requests with the word ‘please’ can all make a big difference. For instance, when getting ready for school you might say “The clothes are on the bed. I’m happy to help.” and then walk away, rather than “You need to get dressed now” or if your child hasn’t had a drink all day you might just place the drink alongside them and say “Here’s a drink”. Similarly phrases such as “I wonder whether …” and “Let’s see if …” reduce the perception of demands. Likewise it’s helpful to avoid trigger words like “no”, “don’t” or “can’t” – you can convey the same message using different terminology (e.g. “I’m afraid it’s not possible right now”) and if you can also explain the reason and offer alternatives whilst delivering the message (e.g. “I’m afraid it’s not possible to go to the park right now because there’s a storm, but we can try this afternoon when the forecast is better and in the meantime would you like to bake a cake or watch a film?”) this can help avoid escalation.
  • Indirect communication: indirect communication includes physical prompts (e.g. tapping shoes instead of saying “please put your shoes on”); visual prompts (pictures or checklists (ensuring our children have an element of choice and control, for instance in the order that things are done rather than a more formal ‘first this … then that …’ approach), post-it notes or communicating via instant messenger apps can work well); telling someone else to do something whilst in our child’s earshot (e.g. telling another child or adult “Please remember the rules about not running at the side of the pool” when you know that they know the rules already); leaving leaflets/books ‘lying around’ for our children to pick up out of natural curiosity; communicating using role play or via a third party (e.g. communicate through a favourite toy or by adopting the persona of a favourite character).
  • De-personalising: explain that the requirement is made by some other, higher authority than you – for instance that “the pool manager is shutting the pool at 3pm” or that a certain law dictates certain rules.
  • Distracting/turning things into a game: the idea here is to focus on something else other than the demand, so you might say “let’s see who can pull the silliest face between each item of clothing” when getting dressed or “let’s list the top 10 dinosaurs” whilst getting into the bath for instance.
  • Using humour/novelty: humour  is a great way to make everyone feel more relaxed and to help reduce the perception of demands; and novelty (provided the change in direction feels like a bonus/benefit for the child) can also work well.
  • Asking for help: saying that you don’t know or can’t remember how to do something can be a great way of making a demand more indirect.
  • Offering choices: the idea here is to give a child some control without losing all control as the adult, by offering limited choices (and being willing to accept a different choice of their own that still achieves the aim) or by offering free choice within certain parameters. For instance, you might ask “would you prefer to have a bath at 6 or 7 this evening” (and accept their negotiated answer of “6.30”) or you might stock a cupboard or shelf in the fridge with a range of healthy options and allow your child free choice of any items from there.
  • Model behaviours or apply demands to yourself (with no expectation that your child will follow suit) – for instance, you might say “I’m feeling really stressed right now so I’m going to lie down in a quiet room and listen to some whale songs to help me to calm down”.

Being cautious with rewards/praise/sanctions

It can be helpful to understand why more traditional parenting approaches – such as rewards/praise/sanctions – don’t tend to be effective in PDA households.

Rewards create an additional demand on top of the demand itself; they magnify the problem if something isn’t achieved because not only is the ‘thing’ not achieved the reward isn’t earned either; and they don’t address the underlying difficulties or lacking skills which may have prevented achievement in the first place. What can work well are surprise rewards, rewards that are bestowed immediately (rather than waiting until the end of the day/week) and rewards that are tangible (rather than stickers or tokens) or matter to the child (they may be things that are linked to their special interests or involve free time to pursue an activity of their choice).

Praise may be perceived as a demand to repeat or improve on previous performance, and encouragement can feel like a demand as it increases the sense of expectation. It can be helpful to praise indirectly – for example praising the results rather than the person (e.g. “what a wonderfully tidy room” rather than “well done for tidying your room”) or praising your child to a third party in your child’s earshot. When offering encouragement, providing choices and exit strategies can be effective (e.g. “It would be great for you to go to the cinema with your friends, but don’t worry if it feels too much once you’re there, you can call me and I’ll come and pick you up”).

Sanctions or consequences may feel unjust when behaviours are a question of “can’t” not “won’t”, and may appear controlling and arbitrary when not directly related to the behaviours in question (e.g. what connection is there between not being allowed on electronics and being mean to a friend?) – they tend to lead to confrontation and escalation. Natural consequences which flow from behaviours (e.g. a friend not wanting to play or not being able to watch TV if it got broken during a meltdown) enable lessons to be learned in a more realistic way. When everyone is calm, discussing ways to avoid difficult situations from arising in future is another way for natural consequences to unfold.

Supporting sensory needs

Our children may be hyper-sensitive (seeking to avoid the sense) or hypo-sensitive (seeking out more of the sense) to any of the senses listed below:

  • Auditory
  • Visual
  • Oral
  • Smell
  • Tactile
  • Vestibular (the sense of movement and balance)
  • Proprioceptive (the sense of ‘position’ of your body in space and the input from muscles and joints to the brain)
  • Interoception (internal senses from your body, such as hunger, thirst, pain and needing to use the toilet)

It’s possible to be both hyper and hypo sensitive to the same sense (for instance, someone may enjoy their own noise (e.g. their voice or choice of music) but find others’ or background noises intolerable) and it’s important to remember that sensory perception and sensitivity can also vary depending on levels of anxiety, illness, the type of surroundings and so on.

Falkirk Council’s helpful guide “Making sense of sensory behaviour“, the Sensory Processing Checklist and resources on Sensational Brain are useful places to start, along with our helpful webinar on this topic. The Greater Glasgow & Clyde NHS website also has useful sensory resources and the South Australia Department for Education has resources about Ineroception. An Occupational Therapist trained in sensory integration can assess a child’s sensory needs in full and may suggest a ‘sensory diet’. There are a few suggestions to try below:

  • Chewy toys for those who seek oral sensory input
  • Headphones playing a child’s favourite music or audio book for those who become easily overstimulated by noise and crowded places
  • Carrying an object with a favoured scent (eg. candle, soap, pillow or spraying a sleeve or handkerchief) for those who become distressed by unfamiliar or unpleasant smells
  • Seamless socks, wide fitting shoes and cutting labels out of clothes for those who are hyper sensitive to touch
  • Asking before touching/hugging your child as some children are sensitive to touch – or equally some children may like the comfort of deep pressure and may feel well regulated using weighted blankets or similar.
  • Wearing tinted or sunglasses for those who are over sensitive to light
  • Taking packed lunches with preferred food/drinks for those who are avoidant of certain foods/textures.
  • Access to messy play or a fidget toy for those who seek tactile input
  • Plenty of opportunity for movement e.g. scooter, trampoline, running and bike rides for those who seek plenty of movement
  • Rough and tumble play, playing in ball pits and sensory toys (such as a body sock) can be helpful for those with proprioception needs.

Supporting social communication & interaction

Our children often need support in relation to processing language and social interaction. A speech and language therapist can assess a child’s communication and interaction skills and make detailed recommendations. Our helpful webinar on this topic is useful place to start – a few top tips are shared below:

Communication

  • Allow extra processing time so that your child can make sense of what you have said and have time to think about how to respond – it can be helpful to count to 5 in your head following a statement or request.
  • Chunk questions or requests (space them out one at a time) rather than saying or asking many things in one go. Allow time for your child to answer your first question or respond to your first request before adding any follow-ups.
  • Be clear and precise whilst being indirect – for example “I wonder if you could help me. I need four blue cups, from that cupboard, to be put on the table in the kitchen”.

Social Interaction

  • Role play can help our children understand other people’s perspectives, how someone’s actions can make another person feel  and how this can affect relationships.
  • TV/books can be a good way to learn about emotions, relationships and social dynamics, and enable our children to develop understanding and skills, in a more indirect way.
  • Be inventive by linking activities to your child’s special interests or by using role play (e.g. your child could be the teacher for the day and teach her/his toys a social story or how to act in certain social situations) or by making a poster together that will tell other children how to behave.

Approaching behaviour that challenges

The helpful approaches outlined above are often very effective, and the frequency or intensity of meltdowns usually subside. However, meltdowns (best seen as panic attacks) are still likely to occur – please see our detailed page on meltdowns for more on this. It’s really useful to understand the triggers and/or possible purpose behind any behaviour that challenges – please see understanding behaviours for a structured approach to building up a picture of what can lead to these episodes that also points us towards the approaches that may be helpful.

Following a situation that has been tricky to handle, it can be helpful to reflect back and think about how a re-occurrence might be avoided in future. Try to approach this with a detective’s hat on, take the learning points on board but try not to dwell too much on things.

Working together with our children collaboratively and proactively to find solutions can also be really beneficial – many families find Dr Ross Greene’s approach  in this area extremely helpful, it is explained in detail on his website and in his books ‘The Explosive Child’ and ‘Lost at School’. Ross Greene’s approach is also particularly useful when there may be doubt or disagreement about diagnosis as his approach is diagnosis ‘agnostic’.

Recognising and regulating emotions is something most of our children find very difficult. Whilst our children are young, the adults around them will need to be very vigilant in spotting the signs that anxiety is escalating. As our children grow older and their emotional intelligence develops, they may be able to recognise their emotions and deploy their own coping skills more effectively. Books can be a good way to learn about emotions, and enable our children to develop understanding and skills, in a more indirect way. There are some general book ideas that may be helpful with this in the resources section.


Supporting emotional well-being

It is important to remember to try and support our children’s emotional well-being by

  • focusing on their many positive qualities as well as trying to support them with areas that they find difficult
  • regularly reminding them that they’re valued for who they are and that it’s ok to be different
  • regularly reminding them that they’re loved through whichever medium works best for them
  • supporting them with the things that they’re interested in rather than trying to impose on them what you feel they should be doing
  • speaking about them in positive terms to other people e.g. “Millie has an amazing imagination, she always thinks of really good games to play” or “Luke really makes me laugh, he’s such good fun to be with.”

Further information

For more information and support, please have a look at these useful resources and websites:

Special Needs Village SEND Video Playlist

The PDA Society

Understanding Pathological Demand Avoidance

Behavioural Strategies for PDA

Information for parents of children with PDA

Creating a sensory diet for your child

It is strongly recommended that you seek the advice of an occupational therapist or other SEN advisor before implementing a sensory diet, but below are some tools to help establish your child’s needs and a variety of safe strategies and materials you can use at home while you are awaiting further assessment.

So first off, we need to establish the area our child is struggling with and which areas they are particularly hyper- or hypo- sensitive to.

Below are two tools, with links, which you can use to establish your child’s preferences.

The first was published in Raising a Sensory Smart Child by Biel & Peske

To download and print a copy please use this link: Sensory Checklist Biel & Peske

Our second resource was published by Robert Cox for Life Recovery Consulting

To view & print please use the following link: Life Recovery Consulting

Once you have established your child’s needs, you can start to implement strategies and establish a sensory diet that works for them.

Understood.org helps to explain how a sensory diet could look throughout the day and what it may involve:

“What might an example sensory diet look like?

A sensory diet is made up of a group of activities specific to your child’s needs. These depend on your child’s sensory issues. Let’s say your child is what OT’s call low arousal (meaning sluggish). Her routine might include:

  • 20 jumping jacks
  • Bouncing on a therapy ball 20 times
  • Holding a Zen bug yoga pose for 10 seconds

Your child will repeat this circuit of activities a set number of times. Each session should last 10 to 15 minutes (the effects can last for hours). Once your child’s routine is set, she’ll do it two or three times throughout the day.

What activities might be included in a sensory diet routine?

Your child’s OT will observe her to see what sensory input she seeks or avoids. The OT takes those preferences into account when coming up with a routine. Here are some standard activities they draw on to create a sensory diet:

  • Jumping jacks or lying on the ground and doing snow angels
  • Somersaults
  • Log rolling (rolling back and forth)
  • Swinging on swings
  • Climbing ladders and sliding down slides at the playground
  • Hopping up and down
  • Push-ups (which can be modified to pushing off the wall or on their knees)
  • Bouncing on a therapy ball with feet on the ground while clapping
  • Rolling on a therapy ball on their belly, forward and backward
  • Rolling a therapy ball on their back while they lie on the ground to “make a sandwich”
  • Yoga poses like downward dog or happy baby (also known as Zen bug), holding a position for at least 10 seconds
  • Facing a wall and pushing as hard as possible (variations include standing sideways and pushing against the wall with a shoulder, or pushing while sitting with the back against the wall, holding positions for at least 10 seconds)
  • Heavy work activities at home with supervision, like sweeping/dry mopping, dusting, vacuuming, lifting and carrying grocery bags from the car into the home
  • Animal walks such as crab walk (on all fours facing sky) or bear walk (on all fours facing ground)

A sensory diet may also include other activities that target specific sensory issues. One technique, the Therapressure Protocol (you may hear it referred to as brushing), can be very helpful to some kids. But it requires specific training from an OT and is not something parents can do without professional guidance.

In addition to physical activities, a sensory diet may incorporate other sensory experiences that help your child feel “just right.” These could include using fidget toys or weighted blankets, or chewing crunchy foods throughout her day.”

Here are two more examples provided by Healthline

For a child who seeks out rough play, has trouble calming themselves, and chews on objects

  • 8 a.m.: Have a chewy breakfast or snack, like a bagel or granola bar.
  • 9 a.m.: Carry a crate of books to the school library.
  • 10 a.m.: Hold the heavy library door open for the class.
  • 11 a.m: Squish with a beanbag chair.
  • 12 p.m.: Lunchtime with chewy options and water bottle with bite valve.
  • 1 p.m.: Do wall pushes.
  • 2 p.m.: Play with crash pad.
  • 3 p.m.: Walk with weighted backpack.

For a child who can’t sit still and constantly touches and fidgets with objects

  • 8 a.m.: Use fidget toy on the bus.
  • 9 a.m.: Jump on trampoline.
  • 10 a.m.: Play with tactile sensory bin.
  • 11 a.m.: Sit in rocking chair for reading time.
  • 12 p.m.: Bounce on a yoga ball.
  • 1 p.m.: Swing at recess.
  • 2 p.m.: Play-Doh time.
  • 3 p.m.: Sit on a yoga ball while doing homework.

*Have you had success in implementing a sensory diet for your child? Which strategies did you find particularly effective?

More resources:

Basic sensory diet ideas NHS

Sensory diet treatment, what you need to know

Beginners guide to a sensory diet

OT Sensory Processing Assessment for Caregivers

The impact of sensory processing issues and how to help

Sensory processing issues are a common comorbidity of neurodevelopmental disorders such as autism and ADHD. But what does the term ‘sensory processing’ actually mean and how does it manifest? How can we help our children when they are suffering from sensory overload or sensory-craving to the point of injuring themselves?

Some children receive a diagnosis of Sensory Processing Disorder (SPD). In the UK, this is usually diagnosed after an assessment with Occupational Therapy or Peadiatrics. However, in this article, we will use the more generic term of ‘sensory processing issues’ or ‘sensory processing difficulties’ because many children are affected by sensory dysregulation but don’t have a specific diagnosis of SPD.

What do these terms mean?

Hypersensitive

being overly responsive to sensory input, can lead to sensory-avoiding behaviour (see below).

Hyposensitive

being under responsive to sensory input, can lead to sensory-seeking behaviour (see below).

Sensory craving

is described as when one is “driven to obtain sensory stimulation, but getting the stimulation results in disorganization and does not satisfy the drive for more”. It can become excessive and even dangerous; such as in cases of repeated head-banging.

Hyperarousal

involves heightened baseline levels of autonomic arousal. The child is already in a heightened state of arousal so it doesn’t take much for them to become seriously overwhelmed.

Hypervigilant

involves scanning the environment for threat-relevant stimuli, and preparation for potential threat. In the case of children with sensory processing issues, they may seem to always be on the alert and extremely anxious about the possibility of sudden loud noises.

Sensory overload

this happens when you’re getting more input from your senses than your brain can sort through and process. Multiple conversations going on in one room, flashing overhead lights, or a loud party can all produce the symptoms of sensory overload. But when there’s competing sensory information, your brain can’t interpret it all at the same time. For some people, this feels like getting “stuck”; your brain can’t prioritize what sensory information it needs to focus on. Your brain then sends your body the message that you need to get away from some of the sensory input you’re experiencing. Your brain feels trapped by all the input it’s getting, and your body starts to panic in a chain reaction.

Have a look at these videos by The National Autistic Society to see how sensory overload can feel:

‘Make It Stop’

‘Can You Make It To The End?’

This causes the ‘flight or fight’ response of the sympathetic nervous system to be triggered. Have a look below at the difference between the sympathetic nervous system and the parasympathetic nervous system & the vast array of systems they can affect.

When we experience sensory overload, our sympathetic nervous system is activated. To help calm a child down during sensory overload, we want to reduce the input they are receiving and try to activate the parasympathetic nervous system instead.

These activities stimulate the vagus nerve and encourage the body to calm down. It can be really effective to implement some of these strategies when our children are struggling. Try a few and see which work best for you.

How many senses do we have?

Most people with automatically respond with “Five”, but we actually have at least eight.

Let’s look at each sense in turn. We will see how to spot whether our children are under or overly responsive to various types of stimuli, and also what adjustments we can make to help them.

The Auditory System

A healthy functioning auditory system allows children to respond appropriately to what they hear. For example, they may turn their head when their name is called, or follow verbal directions given by a teacher. They would also be able to filter out irrelevant noises (such as another child tapping their pen, or the buzz of an electric light). Some children however, may be hyper or hyposensitive to the sounds that they hear and this can affect their behaviour.

The Visual System

A healthy visual system allows the child to filter out inconsequential things they can see, and also to pay attention to information that is important. Some children are overly sensitive to visual stimuli; this is particularly true of children on the autism spectrum.

They may benefit from a reduction in visual stimuli, as demonstrated below.

As seen here, the TEACHH workstation method is very effective for children who are hypersensitive to visual stimuli.

Some children are under sensitive to visual stimuli and may need bright colours and visual stimulation to keep them engaged.

The Tactile System

The tactile system is the sense of touch. A healthy tactile system allows us to process temperature, feel pain, differentiate pressure and texture. When the tactile system is well regulated, a child is able to filter out unnecessary tactile input; such as a breeze blowing in their face. They are also able to tolerate a variety of textures, such as different fabrics of clothing.

A child who is overly sensitive to tactile input may present with the following behaviours:

Children who are under responsive to tactile input may benefit from the following strategies:

The Gustatory (Oral) System

The sensory receptors in our mouths allow us to perceive temperature, texture (e.g. smooth like yogurt, hard like a crisp, or a mixture of textures like cereal with milk), and taste (e.g. sweet, salty, bitter, sour).

Our brains also receive lots of proprioceptive information from the joint of the jaw as we bite and chew different foods that provide different types of resistance (e.g. a crunchy carrot, chewing gum)

Children with a healthy oral system are able to eat a variety of foods, including a range of tastes and textures. They would also not need to seek out extra oral sensory input such as chewing on clothes, in order to regulate their behaviour.

A child with dysregulation in the gustatory system may demonstrate some of the symptoms below:

Alerting and calming activities can help to regulate the gustatory sensory system.

The Olfactory System

A child with a healthy olfactory system is able to tolerate smelling foods and other odors in his environment.  He can even tolerate unpleasant odors (within reason) without extreme reactions.  A functioning olfactory system helps a child know the difference between “good” smells – those that are safe, pleasant, or associated with positive emotions – and “bad” smells – those that are dangerous, displeasing, or reminders of negative experiences.

Children who are hypersensitive to smells may demonstrate the behaviours below:

Some children may crave olfactory input and would benefit from trying some of these activities:

The Proprioceptive system

What is the proprioceptive system?

When children move and play, their muscles stretch and contract.  Proprioception refers to the way joints and muscles send messages to the brain to help coordinate movement.

This sense also allows us to grade the force and direction of our movements – our bodies instinctively know to apply more effort when lifting a heavy box and less effort when lifting a piece of paper.  While the vestibular system tells the brain about balance and moving against gravity, the proprioceptive system helps us coordinate the movement of our arms and legs in an efficient manner to play and move without even having to look.

A functioning proprioceptive system allows a child to write with a pencil without pushing so hard that he breaks the tip or take a drink from a paper cup without crushing it in his hand. A functioning proprioceptive system allows children to move, play, and explore in a smoothly coordinated and efficient way – not too gently, not too rough.

To help regulate the proprioceptive system, sensory circuits; a sensory diet and heavy work can be very beneficial.

The Vestibular system

The vestibular system has to do with balance and movement and is centered in the inner ear.  Each of us has vestibular organs located deep inside our ears. When we move our heads, the fluid in these organs moves and shifts, constantly providing us with information about the position of our heads and bodies in space (spatial awareness).

When our vestibular sense is fully functioning, we are secure and organized enough in our bodies to be able to attend and respond to all of the other senses we encounter daily.  A child with a well-developed vestibular sense feels confident and safe during movement activities, even if his feet are off the ground.  He is able to start and stop movement activities calmly and with control.  He is comfortable with climbing, swinging, somersaulting, and jumping – knowing that his body will adapt and that he will be able to maintain his balance and keep himself from falling or getting hurt.

The Interoceptive system

So how can we help our children with sensory processing issues?

Apart from using the sense-specific strategies above, children with sensory processing disorders can be really helped by the use of sensory circuits and a specifically-tailored sensory diet.

Both programs take time to organize and implement so we will have a blog post dedicated to each one individually. Subscribe to have them delivered straight to your inbox!

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Helpful links:

Subtypes of SPD

Hypervigilence: symptoms, causes and strategies

Anxiety disorders & sensory over-responsivity in children

OT & self-regulation

Heavy work activities & sensory processing disorder

Introduction to Sensory Processing

Many children with autism struggle with sensory processing. As shown in a previous article, sensory issues are now part of the diagnostic criteria.

Our senses affect how we respond to the world around us. Many children are either over-sensitive (hyper) or under-sensitive (hypo) and it can be tricky for them to cope with their reactions to what is going on around them.

Below are some examples of different issues that our children may have and just a few tips on how to help them. This is an extensive subject with many research projects underway, so there will be more in depth articles to follow.

  • Taste

Some children may need to sniff their food before tasting it, or they may have a preference for very bland flavours. Similarly, they may prefer textures that are only crunchy, dry, or liquid or they might love spicy food. Trying new foods can be really challenging. My son declared that he hates kiwi fruit and it’s the worst thing in the world; he’s never tried it but he wanted to make sure he didn’t have to. When he did try it later, he decided that he loved it. I still can’t persuade him to try anything that looks too wet or ‘slimy’ (as he puts it).

How To Help: Offer the child a small amount, but don’t force it. If your child has a preference for certain textures or flavours, try to introduce similar items to their diet so it is balanced and healthy.

  • Sound

I’ve found that for most children and adults that I’ve worked with noise is a big trigger for negative behaviour. Many autistic people are sensitive to certain noises or pitches. Sudden noises, such as a police car or fire alarm, can be really distressing. In addition, areas with a lot of background noise- such as a busy cafe or supermarket can cause a build up in anxiety.

How To Help: Ear defenders are a good option and available in many colours and sizes. Alternatively, having an iPod or MP3 player handy when out and about can give the child something auditory to focus on and block out the rest of the noise.

  • Touch

This can be pressure on the body, the feel of clothes, physical contact with other people like hugging or holding hands, brushing teeth, getting their face wet, or experiencing pain. Some of our children may be hypo (under) sensitive to pain or temperature, whilst others may really struggle with something as (apparently) simple as a hug.

How To Help: For a child that is over-sensitive to touch, a verbal or visual warning may be needed. Don’t force the child to hug/cuddle/touch something if they find it too distressing as this could only exacerbate the issues.

For a child that is under-sensitive, then they may like a weighted jacket or blanket, or deep pressure massage.

  • Vision

Children with autism are predominantly visual learners. This means that they take in a lot of information through what they can see. Some colours or sights may be distressing or overstimulating. They may struggle with bright sunshine or the flickering of a strobe light.

How To Help: Sunglasses and window shades in the car- these have been a lifesaver for me and avoided many a meltdown due to the sun being “too shiny”. Try to keep bedroom walls clear of clutter and posters, this will help the child to be settled at bedtime rather than visually over-stimulated.

  • Smell

Smell can be a particularly emotive sense for many people and children with autism are no different. Some scents may be preferred and a source of comfort,  whereas a change in washing powder or air freshener can be very upsetting.

How To Help: Introduce new scents slowly. If a change in behaviour is noticed as a response to a certain smell, it may be best to avoid it.

  • Proprioception

This is basically our sense of position and movement. It’s something that many children with autism and ADHD struggle with as their sense of spatial awareness and connection with their own body can be a bit disjointed. This may manifest as clumsiness and issues with personal space.

  • Vestibular

This ties in very closely with proprioception in that it affects spatial awareness but also incorporates balance. Again, it can manifest as clumsiness or a child who spins or swings quite vigorously in order to get some sensory feedback from that sensation.

How To Help: Sensory circuits and physiotherapy exercises can really make a difference with these issues. There will be a guide to sensory circuits on the website in a few weeks, as it is such an effective way to help with behaviour due to sensory imbalances.

Occupational therapy and physiotherapy can help the child to master their fine motor control and strengthen their core. An occupational therapy assessment would be the first port of call to assess which difficulties the child has and how to help them individually. 

As I said before, this is just a brief introduction to sensory issues and there are more in depth articles on the way. In the meantime, please feel free to e-mail me for advice or further information.

© Peta Slaney, 2020, All Rights Reserved.