Signs to look For

I received an email with a question regarding someone who believed a family member might have a child with autism. She was interested in learning more about autism and things you could look for to see if the issues that were being observed could be related to autism. So, I thought I'd take a portion of the email I wrote to her and discuss some of the signs or red flags one might notice in a child as he/she are developing.

Some signs to look for (every autistic kid does not have every one of these -- the severity of the autism has to do with how much, how often and how many of them):

Age Appropriate Toys -- does the child play with age appropriate toys or still hold on to baby toys or cause and effect toys (by 3, children should move on to more imaginary play toys like cars, dolls, action figures, drawing, etc)
Tip toe walking --- some do, some don't, but it is a sign of autism
Hand flapping --- some do, some don't, but another sign of autism (often referred to as "self stimulating behavior" -- if over stimulated, the child may wave his hands up by his face to show excitement or nervousness)
Eye Contact --- many children with autism have no eye contact issues with family and close friends/relatives, but can't look strangers or acquaintances in the eyes -- they may glance, but nothing sustained
Joint attention -- does the child point to objects when asked (whether in a book or out on a walk, like point to the tree, or fire hydrant or stop sign) they look for finger pointing -- actual single finger pointing to an object - autistic children often do not point out things and have "poor joint attention", only picking and choosing what to draw their attention to
Interest in things that spin --- many children will spin themselves (another form of self stimulating behavior, but do not get dizzy); others like objects that spin and will stare at it for unusually long periods of time
Appropriate use of everyday objects -- does the child know how to use a hair brush on a doll or self, or know that a spoon is used to stir, -- autistic kids often need to be taught about what an object is used for and these kids do not learn by imitation; how do they play with cars -- line them up & stare at the pattern or spinning the tires are 2 signs that they look for
Interest in shiny objects --- many kids will stare for unusually long periods to shiny objects
Attention span- many autistic kids have a very short attention span; many can't sit through the reading of a book or show no interest in books as infants/toddlers
Chewing/Mouthing objects -- many autistic kids chew or mouth objects as tiny babies without teeth would do; these kids have shirt collars constantly in their mouths, seatbelt straps, toys, etc.
Interest in new toys - does the child have a hard time wanting or knowing what to do with a new toy; does the child show interest in the new toy or pick it up and then move on
Attention to task - this one has to do with two extremes --- either the child bounces from one task to another without long attention or the child is sooo attentive to the task that they can't move away from it or won't do anything else -- both extremes are signs of autism like behavior
Response to own name - a majority of the time will ignore their own name when called
Speech/Language - Most autistic kids have some sort of language or speech delay; extreme cases never gain speech; some have cognitive/receptive issues; others have pronunciation; many/most have both; almost all are late talkers
Dietary Concerns - many kids are "sickly"; have food allergies, bowel issues, stomach problems; weight loss/weight gain; picky eaters; many hate textured foods; many need food purified -- each need is different but there is usually some sort of "feeding" issue one way or another; some are messy eaters and don't know how to use utensils correctly, others can, but prefer to use hands,
**Sensory Issues - Most kids have some sort of Sensory Integration issues which is the source of the manifestation of some of the above listed behaviors -- the brain processing the sensory information received through the senses incorrectly -- some are "sensory seekers", constantly looking for sensory input -- these kids are "crashing into" things like furniture and people's legs; they might spin and not get dizzy; they love "messy" play like paint and glue and might put it all over their hands and arms -- others "avoid" all the sensory input -- they might hate touching certain textures, glue, sand, etc. --- then on the auditory side, they may fear loud noises, including hair dryers or toilets flushing, while the other extreme is that they don't even notice sound and seem like they might have 'hearing' issues, but test within range for hearing (hence not reacting to own name);
on the sensory issues -- there are a ton -- other issues may be poor gross motor skills -- may walk unstably, may have a hard time avoiding obstacles, may avoid or seek swinging for long periods of time, may feel more "grounded" with feet always touching the floor, so can't sit still at a chair with feet up or on a toilet without feet touching a stool

I have a good book that talks about sensory issues that is a good introduction into children that just seem to be a bit different -- not necessarily autistic, but have Sensory Processing Disorder. It's called The Out of Sync Child by Carol Stock Kranowitz. She also wrote a companion book called The Out of Sync Child has fun, which is a workbook that teaches parents tips to practice in the home to help your child overcome the sensory issues. The good news is that if it's Sensory Processing Disorder by itself, then there are things that you can do that helps the child and makes it go away. Many kids with autism have Sensory Processing Disorder, but not every child with it has Autism. It is a good resource for a parent to read who has just begun to understood their child is a bit "different".

Recognizing Sensory Processing Disorder

I am continuing to read the book, The Out-of-Sync Child, by Carol Stock Kranowitz and am positive that an OT evaluation will reveal that John has Sensory Processing Disorder. (SPD)

According to Carol Stock Kranowitz, SPD is the inability to use information received through the senses in order to function smoothly in daily life.

There are 3 categories within Sensory Processing Disorder and 5 sub-categories under those 3 main ones. The three Disorders are:
1. Sensory Modulation Disorder
2. Sensory Discrimination Disorder
3. Sensory Based Motor Disorder

Under the Sensory Modulation Disorder, the subgroups are :
1. Sensory Over-responsivity
2. Sensory Under-responsivity
3. Sensory Seeking

Under the Sensory-Based Motor Disorder, the subgroups are:
1. Postural Disorder
2. Dyspraxia

John falls under the Sensory Modulation Disorder as a Sensory Seeking Child, based on my own evaluation using Carol Stock Kranowitz' checklists.

This kind of child wants "more" -- wallows in mud, dumps out toys (rummaging through them for the texture), chews on objects and shirt collars, runs and 'crashes' into furniture on purpose, moves constantly, fidgets, loves being upside down, takes bold risks, craves bear hugs, loves being squeezed, seeks heavy work and vigorous playground activities.

With sound, I see John having aspects of all 3 main categories -- he covers his ears to close out normal everyday sounds (microwave and hair dryer) -- overresponsive child
He ignores ordinary sounds and 'turns on" to exagerrated sounds -- underresponsive child
He loves crowds and places with noisy action --- sensory seeking child

I also notices some motor skills issues -- low muscle tone and fine motor planning with his mouth (although with speech therapy, this is getting so much better -- this week, he can now blow bubbles consistently!)

Many issues can arise because of sensory processing issues. Such as:
Self Regulation - inability to adjust mood (calm down once aroused)
Sleep Issues - want or need to sleep with parents, difficult falling asleep, staying asleep, and waking up
Eating Issues - picky eater, texture issues, lack of coordination to chew, swallow, and breathe
High Activity Level
Inattention
Impulsivity
Poor Communication
Other issues like Autism, ADHD, Selective Mutism, Down Syndrome, etc may accompany SPD

So, to sum it up for the day, Sensory Processing Disorder is difficulty in the way the brain takes in, organizes and uses sensory information, causing a person to have problems interacting effectively in the everyday environment. Through OT/SI (Occupational Therapy Sensory Integration), children learn to develop their nervous system. A professional evaluation and diagnosis is necessary to begin OT/SI therapy. John has had a primlimary screening through Casa Colina, in which they determined he needed a full evaluation.

*This information was taken from Carol Stock Kranowitz' book, The Out-of-Sync Child.

Sensory Integration Disorder

Through an Occupation Therapy screening, I have learned John needs an evaluation for Sensory Integration. Sensory integration is an innate neurobiological process and refers to the integration and interpretation of sensory stimulation from the environment by the brain. In contrast, sensory integrative dysfunction is a disorder in which sensory input is not integrated or organized appropriately in the brain and may produce varying degrees of problems in development, information processing, and behavior

I was told to read a book called, "The Out-of-Sync Child" by Carol Stock Kranowitz. I can't put it down. Right now, I'm about 150 pages into the book. I feel like I am reading a book that was written about my son.

The book has checklists that parents can use to determine if their child has a Sensory Integration dysfunction and what kind it may be. I have learned that John is a Sensory Seeker. He craves movement, loves being upside down, bumps into couches for sensory stimulation, loves spinning, oftentimes not getting dizzy, can't get enough of tactile stimulation (through the hands), etc.

John has always wanted his hands in my armpits. He would put them there when trying to fall asleep, when I'd carry him in the grocery store, standing in church---everywhere and any time. I thought it was weird and annoying, but didn't think much more of it. He touches to a point of annoyance, even when the touch isn't wanted. He always has his hands on my face or trying to put them in my mouth. If I'm talking to other people and my attention is diverted away from him, he often grabs at the collars of my shirt, trying to put his hands down the front of my blouse or up the sleeves.

John is always mouthing/teething objects. He doesn't put play dough or glue in his mouth, but he does chew on shirt collars, toys, blocks, bottles, the car seatbelt ---anything that can be chewed on. His shirt is often wet and if he can't find anything else, his fingers go in his mouth. He never was a thumb sucker and his pacifier was given up at 6 months old. But, he has always chewed on toys and clothes.

He loves his teeth brushed. He has always been obsessed with toothbrushes and helping my husband and I brush our teeth. We used to joke that he was going to be a dentist. Recently, we bought him an electric toothbrush, which has helped him with his poor muscle tone in his mouth.

Low muscle tone is one of John's problems. I never realized this, as I always thought of him as strong. But, muscle tone is not a measure of strength. It is the amount of tension our muscles have at rest. Normal muscle tone would reflect muscles that are "ready to move" or react when we need them to. Low muscle tone means that they are more at rest than they should be.

John's low muscle tone in his mouth accounts for his speech delay and inability to make his mouth move in certain ways to make certain sounds. It makes it difficult to blow bubbles. Ways of increasing muscle tone of the mouth includes sucking a milkshake through a straw, blowing bubbles, etc.

Low muscle tone would also account for the inability to stack blocks. Stacking blocks in a high tower requires the hand to 'release' the block. The muscle used to release is different than the muscle used to grasp. Ways of increasing muscle tone of the hands is to squeeze a wet sponge and release it. Different size sponges increase the level of difficulty of squeezing to help build the squeeze and release muscles.

John loves tactile sensations. Many kids do, but children who are sensory seekers can't get enough of it. The brain doesn't recognize that it has received enough stimulation because the nervous system is "out of whack". These kind of children want "more more more". The opposite, but still sensory dysfunctional on the other extreme, would be the child who can't stand touch, who withdraws from it (or any other sense for that matter --- covers ears during fireworks, high pitch noises, doesn't like crowds). Each sense has sensory seekers and avoiders, as well as those that don't show one way or another. A "normal" sensory integration child would be able to adapt to the environment as different senses pick up different things. It's what tells us that there is danger or fun in what is around us. Kids with this dysfunction don't know how to interpret this sensory information and it throws their whole day off.

For John, he needs "more more more". His brain is using its energy inefficiently, which accounts for his lack of attention. Everything is full force and outside the level his brain should function at. Calming him down is difficult. When he sleeps, he's not at full rest. He inefficiently does everything around him.

I tested this theory, doing a sensory activity for the tactile sense. I put both my kids in a bathtub with shaving cream. I told them we were going to finger paint in shaving cream. I squirted it all over the bathtub and let them at it. Katie rubbed her hands and arms in it for a few minutes and then washed it off, proceeding to draw letters and pictures around the tub. John, on the other hand, took huge clumps of it, clapped it together, watched it fly around the bathroom and giggled. He then sat in the tub and put his feet up on the sides, rubbing them in the shaving cream, giggling. After that, he stood up and grabbed a bunch and began lathering himself in it. He rubbed it on his stomach and then continued to put more and more on. He then slapped it and watched it float and fly off his body. Once it was gone, he wanted more. I obliged and it started all over again. When it was all over, he transitioned fine to the next activity, but talked about the 'shvn crm' all night long. Now, every time he sees the bathtub, he wants the 'shvn crm'. I'm just happy he's saying "shvn crm"!