Corinna Laurie, Clinical Lead Occupational Therapist National Autistic Society and Director of Evolve Children's Therapy Services Ltd, explains what occupational therapy is and how it can help autistic children. Corinna gives examples of therapeutic interventions to target sensory processing differences.

We combine our senses (sight, sound, smell, touch, taste, balance and the sense of our body in space) in order to make sense of our environment. However, some autistic children and young people may have difficulty filtering sensory information, and it can become overwhelming, uncomfortable and/or painful.

On the flip side, some autistic people actively seek sensory sensations to calm themselves, relieve anxiety and often just for pleasure and relaxation. Experiencing sensory stimuli differently from the neurotypical population is known as sensory processing differences. 

Research, and my own clinical observations over the years, have also highlighted that many autistic children, or those with sensory processing differences, often have co-occurring difficulties with posture, coordination and motor planning.

When we lack the “filters” to screen out irrelevant information, this can cause sensory overload and lead to a meltdown. Each sensory input builds and builds without being filtered out appropriately. As one student said to me, “I cannot keep reading because my eyes are full up at the moment”.

When a person is experiencing sensory overload, it can be incorrectly perceived as distressed behaviour. Sensory overload may also result in a withdrawal or complete shutdown. Making sure a student with sensory processing differences has the right sensory opportunities and environmental adaptations throughout their day, will remove barriers to learning and go some way to improve their wellbeing.

Occupational therapists are key. Providing advice and interventions to target each sense, helps the child’s nervous system become more organised and regulated. This can reduce the child’s anxiety and exhaustion, and improve their attention and performance.

What is occupational therapy (OT)?

Occupational therapists work to promote, maintain, and develop the skills needed by students to be functional in a school setting and beyond.  For example:

• self-care (e.g. dressing, eating a meal, managing toileting needs and managing personal hygiene)
• productivity (e.g. emotional regulation, levels of alertness, participation, hand writing and organisational skills)
• leisure (e.g. socialising with friends, belonging to a group, participating in hobbies/play and motor skills for PE).

Every child will have a unique set of sensory needs and these needs will alter depending on mood, environment and therapeutic intervention. 

For autistic children, an occupational therapist works to develop skills for handwriting, fine motor skills and daily living skills. However, the most essential role is also to assess and target the child’s sensory processing differences. This is beneficial to remove barriers to learning and help the students become calmer and more focused.

What is a sensory diet?

A sensory diet/lifestyle is a specifically designed daily activity plan. It aims to include sensory activities throughout the child’s waking day in order to improve focus, attention and ensure the child is feeling “just right” (regulated) throughout the day. Just as the body needs the correct food evenly spaced throughout the day, so does the body need activities to keep its arousal level optimal.

When arousal levels fall too low, they can be stimulated by activities such as:

• dancing
• singing
• visiting the gym.

If levels get too high and the person becomes overstimulated then a relaxing activity can help, such as:

• going for a walk
• reading
• listening to music.

A qualified occupational therapist can use their advanced training and evaluation skills to develop an effective sensory diet for the student, to implement throughout the course of the day. This aims to improve overall wellbeing and quality of life.

What issues does a sensory diet aim to address?

The effects of a sensory diet can be immediate AND cumulative. They actually help to restructure a student’s nervous system over time so that they are is better equipped tolerate situations and have the skills to take control of their own regulation requirements.

Coaching/mentoring and teaching self-regulation strategies helps everyone recognise behaviours and emotions, and successfully adapt and use strategies to meet the demands of any situation. This in turn can prevent burnout/meltdown and decrease stress, anxiety and fatigue.

This allows the child to focus on the task in hand instead of being distracted by stimuli such as:

• their shirt label rubbing on their neck 
• a noise outside
• being bumped in the corridor. 

Sensory circuits

"Participation in a short sensory motor circuit prepares children to engage effectively with the day ahead. Behavioural clues such as fidgeting, poor concentration, excessive physical contact or lethargy can indicate that a child is finding it difficult to connect with the learning process" Horwood (2009) 

Occupational therapists will often recommend starting the day with a sensory circuit: a sensory–motor activity programme which helps children achieve a “ready to learn” state. Sensory circuits are a series of activities designed specifically to wake up all the senses. They are a great way to energise or settle children into the day.

Each session includes three elements.    

• Alerting activities (for example spinning, bouncing on a gym ball, skipping, star jumps) to stimulate the body's central nervous system in preparation for learning.
• Organising activities (for example balancing on a wobble board, log rolling, juggling) which demand brain and body to work together.
• Calming activities (heavy muscle work and deep pressure for example wall pushes, push ups, using weights) to give an awareness of their body in space and increases the ability to self-regulate sensory input.

Children are more regulated, calmer and focused after these activities, reducing anxiety and increasing opportunities to thrive and achieve in the overwhelming environment in which we now live.
 

Further information

Laurie, C (2022). Ten simple sensory strategies for autistic children

Laurie, C. (2022) Sensory and Motor Strategies (3rd edition)