Sensory Perceptual Issues in Autism and Asperger Syndrome

Sensory Perceptual Issues in Autism and Asperger Syndrome

of related interest
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Sensory Perceptual Issues in Autism
and Asperger Syndrome
Different Sensory Experiences
– Different Perceptual Worlds
Olga Bogdashina
Forewords by Wendy Lawson and Theo Peeters
Jessica Kingsley Publishers
London and New York
All rights reserved. No part of this publication may be reproduced in any material form
(including photocopying or storing it in any medium by electronic means and whether
or not transiently or incidentally to some other use of this publication) without the
written permission of the copyright owner except in accordance with the provisions of
the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by
the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England
W1P 9HE. Applications for the copyright owner’s written permission to reproduce any
part of this publication should be addressed to the publisher.
Warning: The doing of an unauthorised act in relation to a copyright work may result
in both a civil claim for damages and criminal prosecution.
The right of Olga Bogdashina to be identified as author of this work has been asserted
by her in accordance with the Copyright, Designs and Patents Act 1988.
First published in the United Kingdom in 2003
by Jessica Kingsley Publishers Ltd
116 Pentonville Road
London N1 9JB, England
29 West 35th Street, 10th fl.
New York, NY 10001–2299, USA
Copyright © 2003 Olga Bogdashina
Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 1 84310 166 1
Printed and Bound in Great Britain by
Athenaeum Press, Gateshead, Tyne and Wear
I dedicate this book to my dearest children,
Alyosha and Olesya.
Being their mum is the best experience I’ve ever had.
My warmest thanks to

  • all the autistic individuals who are willing to share their insights
    in order to help us understand this fascinating world of autism
  • the parents who gave me their permission to use their children’s
    drawings in this book
  • the autistic children and teenagers I have had the privilege to
    work with for trying really hard to teach me to communicate
    with them
  • my husband, Nigel Bath, for tolerating my ‘absence’ from his
    life during my ‘writing hours’
  • my beautiful children, Alyosha and Olesya, for their
    unconditional love, support and understanding.
    Wendy Lawson
    Theo Peeters
    Introduction to the Problem 19
    1 Sensory Dysfunction or Different Sensory Experiences? 25
    2 Perception 30
    Sensory systems
    What is perception?
    Sensory perceptual development
    3 Possible Sensory Experiences in Autism 44
    What is the autistic way to perceive the world?
    ‘Literal perception’
    Inability to distinguish between foreground and background information
    (‘Gestalt perception’)
    Hypersensitivity and/or hyposensitivity
    Inconsistency of perception (fluctuation)
    Fragmented perception (perception ‘in bits’, stimulus overselectivity)
    Distorted perception
    Sensory agnosia (difficulty interpreting a sense)
    Delayed perception (delayed processing)
    Vulnerability to sensory overload
    4 Perceptual Styles 83
    Peripheral perception (avoidance of direct perception)
    Systems shutdowns
    Compensating for unreliable sense by other senses
    5 Cognitive Styles 98
    Subconscious, unconscious and preconscious cognitive processes
    Preconscious (indirect) style versus conscious (direct) style
    Attention in autism
    Memory in autism
    Concept formation. Categorization. Generalization
    Perceptual thinking
    ‘Inertia’ (executive function deficit)
    6 Other Sensory Conditions 119
    Prosopagnosia (‘face-blindness’)
    Central auditory processing disorder (CAPD)
    Scotopic Sensitivity/Irlen Syndrome (SS/IS)
    Sensory integration dysfunction
    7 Treatments 143
    Auditory Integration Training (AIT)
    Irlen method
    Behavioural optometry
    Holding therapy
    ‘Hug machine’
    Sensory integration therapy
    8 Sensory Perceptual Profile 160
    9 Recommendations: Rainbows and Umbrellas 170
    Conclusion 181

When I was asked to write a foreword to this book I felt excited and
honoured. To read a book that puts forward ‘our case’ as autistic individuals is still a rarity. Although there is a wealth of books about ‘autism’ there
is still so little that discusses our ‘sensory issues’ and their associations with
cognitive style. This book is an important resource for both professionals
and families relating to and living with autistic individuals. It is only in
understanding that our knowledge can make sense of the world we all live
in. Knowledge that is only ‘academic’ fails to move us along in any practical sense of the word and will fall short of imparting confidence to those
who need it. This book aims to present a balanced view of how an autistic
individual might be experiencing life, what his or her experience may be
and how this experience may change over time. It is frank, to the point and
paves the way to a fuller picture of ‘personal autism’.
Many a time autistic individuals have been ‘pushed’ beyond their
limits of sensory endurance. Often this is due to those relating to them not
having understood how ‘painful’ it is to be overloaded by too much sound;
visual stimulation; emotional or/and physical demand and environmental
expectation. Those who read this book will now be able to access further
the understanding necessary to prepare sensible and thoughtful
programmes for any intended intervention or timetable. No longer will
there exist any excuse for those who are involved in the daily activities of
relating to an autistic individual to be ill prepared.
This book explores the outcomes of monotropic or single channelling:
a constant state of being that is at the very core of what it means to be
autistic; a state of being that non-autistic individuals can experience on
occasion when they are focused to the max or perhaps taken up with an
overwhelming thought or feeling, such as pain. The book considers the
impact literality might have upon cognition. What if you couldn’t separate
an idiom from its literal translation? Might you feel terrified if someone
said he had ‘laughed his head off ’? It demonstrates the extremes of
emotion an autistic individual might travel through. Even today there is
still literature that will tell you autistic individuals lack ‘feeling’! This idea
has been responsible for much of the abuse and misunderstanding that we
have encountered as autistic people.
I still come across the thinking that allows an individual to say ‘Oh she
is doing that for attention’ or ‘He does understand what I’m saying, he is
just too lazy to co-operate’. As autistic individuals we might not have the
luxury of choosing to shift our attention. We might not even know what
‘lazy’ means. Such concepts are exploited more often by non-autistic
individuals who know how to forward think, plot, plan and deliver! At
times our very state as autistic individuals seems to threaten the
neuro-typical (non-autistic) world because we show you up for who you
are. Please don’t be part of the ‘us’ and ‘them’ syndrome. Don’t succumb to
ignorance and typical thinking. Take the time to get to know ‘autism’.
Take the time to get to know us.
In a world that promotes inclusion and equal rights for all, what has
happened to our ‘right’ to be autistic? What has happened to our ‘right’ to
be heard? I think it has been buried under fear and ignorance for far too
long. This book adds to the growing collection of works that is helping to
address the ignorance behind the inappropriate dealings of others, i.e.
those individuals who have not considered what it might mean to be an
autistic individual. For those of you who have instinctively ‘known us’ this
book will confirm your knowing and increase your confidence. To all who
choose to relate to us using the knowledge outlined within the pages of
this book, thank you. You are the individuals who will make a constructive
difference to the quality of both of our lives.
Wendy Lawson
Counsellor, autism consultant and author
12 Sensory Perceptual Issues in Autism and Asperger Syndrome
My hearing is like having a hearing aid with the volume control
stuck on ‘super loud’. It is like an open microphone that picks up
everything. I have two choices: turn the mike on and get deluged
with sound, or shut it off. (Temple Grandin)
His mother says that he has to vomit whenever he smells
cheese…And he says that his teacher stinks.
In my total horror of sounds, the sound of metal was an exception. I
really like it. Unfortunately for my mother, the doorbell fell within
this category and I spent my time obsessively ringing it. (Donna
It hurts if he touches buttons, zippers or anything in metal, but he
may lay his hand upon a hot stove without feeling pain.
I was hypersensitive to the texture of food, and I had to touch everything with my fingers to see how it felt before I could put it in my
mouth. I really hated it when food had things mixed with it, like
noodles with vegetables or bread with fillings to make sandwiches. I
could NEVER, NEVER put any of it into my mouth. I knew if I did I
would get violently sick. (Sean Barron)
He says it hurts when he has a haircut, he refuses to take a shower,
because it hurts, but he has a bath without problems.
Always the same problem: these kids have no education…
They really need to learn to be like everyone else…
Only give them to me for a week and I’ll show them…
Thirty years ago, when I became more and more interested in autism, I
started (as everyone, I think) reading the scientific literature and learned a
lot, in a rational way.
But when I listened to the stories parents told I learned about aspects of
autism that were more or less neglected by the official literature. Whereas
the first type of information hit my brain, the second hit my heart. And I
think that real understanding should include heart and brain together.
In recent years I have a similar feeling when I read books written by
high functioning people with autism. Their understanding of autism is
from within and they treat themes that are less well documented in the
scientific literature. We can learn a lot from them (as they can learn a lot
from us), about autism and sensory problems.
When, for example, I invited Gunilla Gerland (‘A real person’) a few
years ago for conferences to the Opleidingscentrum Autisme (Centre for
Training on Autism) in Antwerp and when I asked her about the themes
she preferred to talk about, she answered that she certainly wanted to have
a conference about sensory problems. Professionals in autism, she said,
seem to focus too much on the triad.
What professionals see as ‘autistic’ usually is – for natural reasons –
what they can see, not what the autistic persons experience. Many
people with Asperger syndrome/high functioning autism define
their sensory processing problems as more disabling than the deficits
in communication/social behaviour.
For our audience her conference on sensory problems really was an
In that period I also read Autism: An Inside – Out Approach by Donna
Williams, who wrote that her problem in infancy was not so much that she
did not understand the world, but that she could not stand it, because she
was so often bombarded with an overload of sensory information.
Then I thought: if people with autism find this so important and if we
understand these problems so little, then I have to study sensory aspects in
autism more and write about it. And then came along this book written by
14 Sensory Perceptual Issues in Autism and Asperger Syndrome
Olga Bogdashina (I do not have to write it anymore) and I like it so much
that I’m a little bit jealous of not having written it myself.
Without mentioning the name ‘Iceberg approach’ she uses the same
ethical approach towards autism as we do (I learned it at the TEACCH state
program during my internship in North Carolina in l979–l980). Basically
it means: if you deal with ‘challenging behaviours’ in autism, do not focus
too much on the behaviours themselves, they are just like the tip of the
iceberg (the biggest part of the iceberg is invisible); do understand the
underlying causes of the behaviours and try to develop an approach not
based on symptoms but on prevention. Challenging behaviours are caused
by problems of communication, social understanding, by different
imagination, by sensory problems… Therefore try to understand autism
‘from within’. It is easier said than done, because it requires an enormous
effort of imagination: we need to learn to put ourselves in the brains of
autistic people and then we will understand better through their eyes the
obstacles in their attempts to survive among us.
This is also the basic orientation in Olga Bogdashina’s book: she gives
a lot of scientific information, but she also gives the word to the ‘natives’,
the ‘born experts’ and all this with an attitude of enormous respect. For a
better future cohabitation with people with autism we will indeed need to
learn to look at life through ‘the Asperger lens’.
My teachers think they know more about autism than me because
they have been on a course. But I have been autistic all my life!
(Mathew Stanton)
‘Trying to understand autism from within’ is the first axis of our approach
to understanding autism. In the first instance you need to try to share the
mind of someone who is different.
I read Olga Bogdashina’s manuscript when I was writing an article on
‘Autism and the search for meaning’. I tried to explain how beyond
behaviours that many people would call bizarre we may find a desperate
search for meaning (e.g. beyond ‘mindblindness’, echolalia, echobehaviour, detail thinking, repetitive and stereotyped behaviours, etc.). If
you try to understand these ‘odd behaviours’ from within then you see that
they may also have important functions for the people with autism
themselves and that they are much less ‘bizarre’ than what people without
Foreword 15
the ‘Asperger lens’ would think. It makes me happy when I read Olga’s
analyses of so many sensory problems and how she shows (with the help
of ‘the native experts’) how many behaviours have a protective function.
Parents often say that the hardest thing to bear is that so many behaviours
seem to have no meaning or function. Once they understand the cause of
the behaviours they are less difficult to accept.
Donna Williams says about sensory issues of autism that they are like a
private heaven under her own responsibility, but like a hell under the
responsibility of others.
When I was a small child my threshold for processing blah-blah was
only a few seconds. When I was about ten or so, my threshold for
processing blah-blah was about five to ten minutes.
It is in these circumstances of extreme stress that people with autism start
humming, rocking, looking at turning objects, flapping hands and arms
(‘sensorisms’, Olga calls them): ‘self stimulatory behaviours’, involuntary
strategies the child has learned to cope with difficult situations (hypersensitivity) or lack of stimulation (hyposensitivity). Olga Bogdashina writes
that it is unwise to stop these behaviours, however irritating and meaningless they seem. First we have to try to find out which functions these
behaviours serve, so that we can replace them with experiences with the
same function.
The second axis of our approach to understanding autism is ‘the
adaptation of the environment’.
We might also define it as ‘trying to get people who live in chaos out of
the chaos, so that they find some meaning and/or order. We have also
called it ‘pre-education’ or ‘creating circumstances where learning
becomes possible’. As the quotes by Gunilla Gerland and Donna Williams
(and so many other ones in this book) suggest: adapting to the sensory
environment (and developing ‘a sensory diet’) is one of the essential
elements of this ‘pre-educational approach’. If people with autism have to
live continuously in an environment that does not take into account their
sensory sensitivity then they live in an atmosphere that makes me think of
‘posttraumatic situations’. In such situations neuro-typical people also
develop acute sensory problems. Information overload may lead to sensory
and emotional hypersensibility and therefore to a situation of chronic
16 Sensory Perceptual Issues in Autism and Asperger Syndrome
stress ‘…it was not so much that I did not understand the world, I could
not stand it…’. People who are not protected enough and who
permanently have to fear that their central nervous system might crash are
not in a position to learn difficult things and to face extra challenges.
I have selected a few fragments from Autism: An Inside – Out Approach
when Donna Williams talks about an ideal educational environment:
My ideal educational environment would be one where the room
had verylittle echo or reflective light, where the lighting was soft
and glowingwith upward projecting rather then downward projecting lighting… It would be an environment where the educator’s
volume was soft, so that youhad to choose to tune in rather than
being bombarded…
It would be an environment that took account of mono and
sensory hypersensitivity and information overload and didn’t
assume that the educator’s perceptual, sensory, cognitive, emotional
or social reality was the only one…
There are many things that people with autism often seek to
avoid: external control, disorder, chaos, noise, bright light, touch, involvement, being affected emotionally, being looked at or made to
look. Unfortunately most educational environments are all about the
very things that are the strongest sources of aversion.
There’s still a lot of work ahead, don’t you think?
Though this book is not the first to be published on sensory issues, I
consider Olga Bogdashina a pioneer. With a monk’s patience she has
puzzled together so many testimonies of high functioning people with
autism, she gives so many deep insights… Some people may say that some
of the information may not be scientifically validated yet, but do you blame
Icarus for flying too high? And isn’t it extremely important that someone
brings together all of this information and intuition to be researched later
on? If the need of this type for information is so urgent, then there is no
time to lose, no time to wait until every little detail has been scientifically
One does not blame a blind child for not being able to name colours.
And yet, youngsters with autism continue to be blamed despite their
distorted, slower, faster perceptions… Many professionals, despite the
evidence, continue to believe that many of these problems are of
Foreword 17
psychological, not of physiological origin. An educational approach,
supplemented with sensory ‘treatment’, is not a question of how many
hours, but of ‘which perceptual world’ we inhabit.
Learning how the senses of each individual with autism function is a
crucial key towards understanding this person. (O’Neill)
I agree completely with Olga Bogdashina when she says at the end:
Stop trying to change them into ‘normals’. Help them to cope with
their problems and how to survive within the community.
Theo Peeters
Director of Centre for Training on Autism, Belgium
18 Sensory Perceptual Issues in Autism and Asperger Syndrome
Introduction to the Problem
Since the first identification of autism in 1943 (Kanner), a lot of research
has been carried out to study this condition from different perspectives.
What has not been taken into account by the experts in the field, however,
is the opinion of the ‘native experts’ – autistic individuals themselves.
Despite the fact that many people with autism have tried to communicate
their views and insights, these attempts have mostly passed without much
professional notice, one of the reasons being that their views and insights
seem unconventional to the majority of people (so-called ‘normal’ people).
In this book I try to show that ‘different’ does not mean ‘abnormal’ or
‘defective’. ‘Normalcy’ is a very relative term, as the ‘norm’ is often applied
to the performance of majority, and it is more justifiable to term it ‘typical’.
To avoid having to use the term ‘normal’, autistic people at Autism
Network International, founded by Jim Sinclair and Donna Williams in
1992, have introduced a new term – ‘Neurologically Typical’ (NT) to
describe non-autistic people.
Here I deliberately use the term ‘autistic people’ rather than ‘people
with autism’ because autism is not something that is just attached to them
and cannot be easily removed. I am aware of the ‘people first, then
disability’ approach. However, without autism they would be different
people, as being autistic means being different. If people with autism
prefer to name themselves autistic why should we be shy to call them that?
Just to show them our respect? There are other ways to do it. Autism is not
something to be ashamed of. To draw a parallel, should we call Russian
people as ‘people from Russia’ to show that we respect them despite the
fact that under the communist party regime the policy of that country was,
to put it mildly, incorrect.
For autistic people, autism is a way of being. It is pervasive, it colours
every experience, every sensation, perception, thought, emotion – in
short, every aspect of existence (Sinclair 1993). They do not respond in the
way we expect them to, because they have different systems of perception
and communication. Bob Morris (1999) calls it a different set of SPATS –
Senses, Perceptions, Abilities and Thinking Systems – that are not in the
same spectral range as NT individuals. Of course, it is very difficult to
communicate with someone who uses a different ‘language’ (and autistic
people are ‘foreigners’ in any culture). But it is wrong to use non-autistic
methods to teach and treat autistic children. It is sure to fail and may
sometimes even damage their lives.
We have to give up our conventional non-autistic assumptions and let
them teach us about their communication systems in order to build bridges
between the two worlds. We follow Donna Williams’s recommendation of
the way to help people with autism: ‘If you have a camel which is finding it
hard to walk under the weight of all the straws on its back, the easiest way
to make it easier for the camel to walk is to take as many straws off its back
as possible’, and not to train ‘…the camel to walk or appear to walk whilst
carrying the straws. To take the straws off the camel’s back, you have to do
two things. One is to identify them and second is to know how to remove
them’ (Williams 1996, p.87).
At present, as there are no known medical tests to indicate autism, the
diagnosis is based on the presence of the specific behaviours (DSM-IV,
ICD-10), namely impairments of social interaction, communication and
imagination, known collectively as the Triad of Impairments (Wing
1992). However, these behaviours are seen as a cluster of purposeful
compensatory reactions caused by some fundamental impairment(s) and
cannot be considered as primary features. These behavioural characteristics, though very useful for diagnosis, do not tell us much about why
autistic people exhibit them and how they experience the world. That is
why it is no use trying to eliminate these behaviours without identifying
underlying causes, no matter how much these ‘bizarre reactions’ interfere
with teaching or treatment of autistic children.
20 Sensory Perceptual Issues in Autism and Asperger Syndrome
Since Kanner’s identification of autism (1943) different theories of the
probable deficits in autism have emerged. Since the 1970s the main
emphasis has been on the cognitive development of autistic children and
different theories of cognitive deficits have been originated: ‘theory of
mind’ (Baron-Cohen, Leslie and Frith 1985); central coherence theory
(Frith 1989); executive functioning deficit theory (Ozonoff 1995) and
some others. All these theories suggest that low-level perceptual processes
are intact in autism and information processing up to the point of
interpretation by a central system can be assumed to be normal in autism
(Frith 1989).
At present it is commonly recognized that there are many possible
causes of autism and some researchers distinguish several types of autism
(‘autisms’), all of which result in the same behavioural patterns
(impairments of social interaction, communication and imagination).
Though many different problems can produce similar symptoms, what
defines autism is a specific combination of these problems reflected in the
Triad of Impairments. There is scientific evidence that deficits in
information processing, both perceptive and executive, is found in all
persons within the autistic spectrum, though the role of sensory perceptual
problems is still very controversial.
Although in the 1960s–70s the idea of possible sensory perceptual
abnormalities as one of the core features of the disorder was put forward
(Rimland 1964) and the theory of sensory dysfunction formulated
(Delacato 1974), till recently it has been ignored by the researchers. What
makes one wonder, is that, though unusual sensory experiences have been
observed in autistic people for many years and are confirmed by autistic
individuals themselves, they are still listed as an associated (and not
essential) feature of autism in the main diagnostic classifications.
Although a number of works have appeared recently highlighting
perceptual abnormalities in autism, to date these possible abnormalities
and their role in causing autistic behaviours have not been systematically
investigated. More research work is needed to find out whether perceptual
problems are core features in the fundamental impairment(s) in the autistic
condition, which senses are affected, the intensity with which the senses
work, etc.
Introduction to the Problem 21
This book attempts to reconstruct the sensory world of autism in order
to help understand the way autistic people experience the world, because
very well-meaning specialists are often ‘failing people with autism…[and]
most [autistic people] have not been helped at all, many have felt degraded
and some have been harmed’ (Gerland 1998), due to misunderstanding
and misinterpretation of the condition. This is the attempt to describe
possible sensory experiences (not always necessarily abnormalities) based
on the personal accounts of autistic people. If we can understand the causes
of certain behaviours, we can accept these behaviours. If we know what to
look for, it will be easier for us to understand the person’s problems and
abilities and to find appropriate methods to identify and remove the
‘straws’ from the camel. Moreover, understanding of the way autistic
people experience the world will bring respect to people with autism in
their attempts to survive and live a productive life in our world instead of
the lack of acceptance often exhibited by the public.
What is lacking in most studies on the sensory dysfunction in autism is
the opinion and views on the problem of the autistic people themselves.
Bob Morris (1999) calls it ‘the original error’ of the investigations, i.e.
trying to reconstruct the ‘autistic world’ using the methods and
perceptions of non-autistics. To avoid this error the personal accounts and
communications should be seen as the main source of information about
this condition. Our approach is to listen to autistic individuals who are
willing to communicate and explain how they experience the world and
not to assume that only our views are right because we are specialists/
parents. It is the same as if I said to you, ‘Sorry, but you speak English with
an accent. Let me teach you English pronunciation. It doesn’t matter that I
am Russian. I am a linguist so I know better than you how to speak your
language properly.’
In this book the term ‘types of sensory dysfunction’ is replaced by the
term ‘types of sensory experiences’, as not all the experiences turn out to be
‘dysfunctional’ or ‘defective’ but rather ‘different’ or ‘showing superability’ (for example, synaesthesia, ‘resonance’, ‘daydreaming’, ‘acute
vision/hearing’ etc.) and might be considered as strengths rather than
Before we discuss the possible patterns of sensory perceptual
experiences in autism it is necessary to give a brief explanation of why the
22 Sensory Perceptual Issues in Autism and Asperger Syndrome
role of these differences should not be ignored (Chapter 1) and to consider
briefly the general concepts and issues, such as sensory systems and
perception in general (Chapter 2). In Chapters 3 and 4 the possible sensory
experiences and perceptual styles in autism are discussed. As sensory
perceptual differences affect cognitive processes, we will further
investigate how these perceptual differences are reflected in the differences
of thinking (Chapter 5). Each descriptor is followed by a ‘what to look for’
section, to help with the identification of this particular characteristic with
the ‘behaviours on the surface’. Sometimes we cannot explain the
behaviour because we do not know what might cause it. I hope the
descriptions of the behaviours will help find the answers to some ‘why
does he do this’ questions. While reading the descriptions and especially
explanations and experiences given by the autistic authors, I would advise
the reader to do two things: first, try to simulate these autistic sensory
experiences in order to imagine at least what it could be like for them, and
second, think of any autistic person you know. Is it about him or her? Does
his or her behaviour make sense now?
Other sensory conditions, which are quite common in autism, are
described in Chapter 6. The possible sensory experiences and perceptual
styles are classified into 20 categories. These are by no means a complete
set of the descriptors. Further research (and co-operation with autistic
individuals) is needed. However, I feel, it would be a good start to
achieving an understanding of a sensory world of autism.
After ‘exploration’ of the sensory world we move to the consideration
of different treatments to eliminate sensory perceptual problems,
supplemented by discussion of the limitations and strengths of different
approaches and techniques addressing sensory perceptual difficulties
experienced by people with autism (Chapter 7) and then to the ‘rainbows’
– special graphs that will help identify possible different experiences of
each child in order to work with him ‘on his territory’ (Chapter 8). (The
Sensory Profile Checklist is included at Appendix 1; it is designed to
identify areas of strengths and challenge for autistic individuals.) The
Sensory Perceptual Profile suggested in the book is aimed to assess the
impact of these difficulties on each individual and to initiate relevant
strategies and environmental changes to facilitate more effective
functioning. In Chapter 9 are some ideas to help interpret the behaviours
Introduction to the Problem 23
caused by sensory perceptual differences and identify the sensory
perceptual difficulties of autistic individuals.
Throughout the book, examples are offered to illustrate different
24 Sensory Perceptual Issues in Autism and Asperger Syndrome
Chapter 1
Sensory Dysfunction or Different
Sensory Experiences?
In recent decades, different conceptions of autism have appeared, which
highlight sensory perceptual abnormalities as the basis of core features of
the disorder. Some researchers describe autism as a disorder of the senses
rather than a social dysfunction, where each sense operates in isolation and
the brain is unable to organize the stimuli in any meaningful way
(Hatch-Rasmussen 1995). It has been hypothesized that all symptoms of
autism are simply a consequence of the brain injury that makes brains of
autistic children perceive inputs from the world differently from
non-autistic brains. Autism is sometimes defined as sensory dysfunction
(Delacato 1974), a sensory integrative disorder in which the brain is not
able to attach meaning to sensations and organize them into percepts and
finally into concepts (Ayres 1979), etc. Unusual sensory experience is
claimed by some authors to be a primary characteristic feature able to
account for the basic symptoms of autism, considered to be essential
according to DSM-IV and ICD-10. Thus, abnormal perceptions might
give rise to high levels of anxiety, this in turn results in obsessive or compulsive behaviours, thus making the more commonly accepted criteria, in
fact, secondary developmental problems (Delacato 1974).
Though, it is not as simple as that and the syndrome of autism is far too
complex a phenomenon to be explained by differences in sensory
experiences, sensory perceptual problems do play an important role in
autism. The indirect evidence comes from the research in the fields of
sensory deprivation and visual and/or auditory impairments. Sensory
deprivation studies (Doman 1984) show that sudden and nearly complete
deprivation of stimulation through the five senses can lead to autistic-like
behaviours (withdrawal, stereotyped movements, etc.). The symptoms of
sensory deprivation in animals and many autistic symptoms are similar as
well: animals confined to a barren environment are excitable and engage in
stereotyped behaviours and self-injury (Grandin 1996b).
The research in the field of visual impairments (Cass 1996) has shown
that some similar patterns of behaviour occur in children who are blind
and in those who are autistic: impairments in social interaction,
communication, stereotyped movements. Gense and Gense (1994) have
shown the many ways in which the behaviours of children with autism and
those with visual impairments are similar. For example, such behaviours as
rocking and rhythmic head banging, spinning objects, or perimeter
hugging (especially in large places) and the need to touch everything in a
room before settling down, are typical for both autistic and visually
impaired children. In autism, this is often considered as obsessional ritual
behaviour without explaining the function it serves. Autistic people argue
that the original cause is of a perceptual nature. Donna Williams, a
high-functioning autistic woman, for example, when asked why she does
this, explained that she had difficulty perceiving herself in relation to her
environment until she had done this; it gave her security by helping
interpret her environment.
Common features have been also observed in the language
development of children with autism and those with visual impairments,
for example, echolalia and pronoun reversal – distinctive features of
‘autistic language’ – are also observed in the language of children with
visual impairments (Fay and Schuler 1980). It is recognized that there is a
critical role for visual stimulation for the development of communication.
Similar ‘autistic’ characteristics are observed in deaf children, though in a
lesser degree.
A possible explanation for this lies in the fact that around 75–80 per
cent of the information about the world comes through vision, so a blind
child has to make sense of or process a very different set of sensory
information, which may develop emotional and psychological problems
and result in ‘autistic’ behaviour. The researchers (Cass 1996) assume that
the autistic-like picture observed in a proportion of blind children arises
26 Sensory Perceptual Issues in Autism and Asperger Syndrome
from the same core deficit as that in sighted autistic children. Thus, the
following characteristics (Cass 1996) might be ‘normal’ for blind children:
absence of eye contact; referential eye gaze and pointing; repetitive
behaviours; language abnormalities; orienting behaviours (for instance,
smelling, touching objects, etc.). There arises a question: Are autistic
children ‘blind’ in a way, i.e. is their perception distorted?
Though blindness means there is an absence of visual information
about the world, it affects all levels of functioning. To draw a parallel, one
might assume autism means there are distortions of visual/auditory/
gustatory/olfactory/tactile information about the world. Whereas the
blind/the deaf/the deaf-blind have other senses (that work properly) to
compensate their lack of vision or hearing, and ‘see’ through their ears,
nose and hands, or ‘hear’ through their hands and eyes, autistic people
often cannot rely on their senses as all of them might be affected in some
It is worth learning how autistic individuals themselves consider the
role of sensory perceptual difficulties they experience. The personal
accounts of autistic individuals reveal that one of the main problems they
experience is their abnormal perception, and many autistic authors
consider autism as largely a condition relating to sensory processing
(Gerland 1997; Grandin 1996a, b; Grandin and Scariano 1986; Lawson
1998; O’Neill 1999; Willey 1999; Williams 1992; and others). For
example, J. G. T. VanDalen (1995) believes that the true invisible
deep-rooted cause of all social and emotional problems is of a perceptual
nature, and autism, to be really understood, has to be seen above all as a
perceptual deficit. For Donna Williams (1992; 1996; 1998), her
expressive difficulties were secondary and sprang from the primary
inconsistencies in her perception of the world around her. Temple Grandin
(1996a, b), one of the most famous autistic individuals, states that some
episodes of difficult behaviour were directly caused by sensory difficulties
and hypothesizes that there is a continuum of sensory processing problems
for most autistic people, which goes from fractured disjointed images at
one end to a slight abnormality at the other.
In the Geneva Centre for Autism (Walker and Cantello 1994) a survey
was conducted to gain more insights into sensory experiences of autistic
people: autistic people were asked to complete the survey anonymously
Sensory Dysfunction or Different Sensory Experiences? 27
through the Internet. According to the data obtained, 81 per cent of
respondents reported differences in visual perception, 87 per cent in
hearing, 77 per cent in tactile perception, 30 per cent in taste and 56 per
cent in smell. All these data give some evidence of the possible role of
distorted sensory perception in autism.
Autistic people understand that they are different in early life, but they
do not know why. It is no wonder that they are often unaware that they
perceive the world differently because they have nothing else to compare
their perception with. Bob Morris (1999) explains: ‘if you are born with
different perceptions, you have no way of knowing your individual
perceptions are not the same as the other 99% of the population, until your
differences are called to your attention’. The first realization of the nature
of their differences comes in late teens or even later. For example, it took
Liane Willey, a woman with Asperger syndrome, many years before she
realized that she did and thought many things that others did not, then she
saw how peculiar her world was – not wrong or embarrassing or
unessential – just different.
To illustrate the idea of misidentification and misunderstanding of
autistic people by non-autistic individuals Bob Morris (1999) uses Hans
Andersen’s story ‘The Ugly Duckling’. A swan egg became misplaced into
a duck’s nest. As it grew, it was seen as a poor performing odd duck. But in
time, and after correct identification, the swan was shown to be physically
more stately, majestic and powerful than any duck could even hope to be.
The author concludes that if we recognize that we all have complementary,
weak and strong capability patterns in our respective SPATS, the autistic
person can have life, not life-support, for life. Morris’s advice to
professionals is to include SPATS in the diagnosis check-off and to teach
the all-wise ducks how to recognize, handle and develop a swan, instead of
trying to mould the swan into a defective duck. Many autistic authors
emphasize that there are beneficial ‘side-effects’ of autism that could far
outweigh the negatives (Kochmeister 1995; Grandin 1996a, 1999;
O’Neill 1999; Sinclair 1992; Williams 1994).
The fact that autistic people share common systems of perception and
thinking is confirmed by many autistic individuals: they report that they
have very few problems communicating with and understanding people
‘of their own kind’ (Dekker 1999; Williams 1994). Though there are
28 Sensory Perceptual Issues in Autism and Asperger Syndrome
plenty of varieties in their perception, in general autistic people are no
more all different than non-autistics when SPATS are considered as a
whole (Morris, 1999). As the systems work differently their responses to
sensory stimuli are ‘normal’ (from the autistic point of view), though
different and unconventional, and not abnormal or defective.
It seems wrong to use non-autistic methods to treat autistic individuals.
There are always two ways to look at things: the non-autistic way and the
autistic way (Bovee). Our task should be to understand the second way.
In the next chapter, we briefly discuss the general concepts we will use
throughout the book, namely sensory systems and perception, and
compare the sensory perceptual development of autistic and non-autistic
Sensory Dysfunction or Different Sensory Experiences? 29
Chapter 2
Sensory systems
The importance of sensory experiences is undeniable. The French philosopher, Etienne Bonnet Condillac (1715–1780) claimed that judgement,
reflection and understanding originated in sensations. To illustrate the role
of the senses in the shaping of the mind he described a marble statue that
was given first the sense of smell, then taste, then tactility and finally
hearing and vision; and the statue came to life. She generated ideas, exhibited feelings and made judgements.
To begin to understand how we sense and perceive the world, we must
know how sensory mechanisms are constructed and how they operate to
convey sensations, i.e. experiences caused by stimuli in the environment.
The senses operate through specialized sensory organs.
Sensory organs, or receptors (organs or cells able to respond to an
external stimulus such as light, heat, etc. and transmit signal to a sensory
nerve), can be classified into exteroceptive (relating to stimuli produced
outside an organism) and interoceptive (relating to stimuli produced
within the organism) receptors. Exteroceptive sense organs are divided
into distance (or far) senses (vision, hearing, olfaction) and contact (or
near) senses (gustation and tactility). Interoceptive cells operate within the
body, for example, proprioceptors (relating to the position and movements
of the body).
Traditionally we distinguish the following sensory systems:

  • vision – the faculty of seeing
  • hearing – the faculty of perceiving sounds
  • vestibular system – refers to structures within the inner ear that
    detect movement and changes in the position of the head
  • olfaction (the sense of smell) – the faculty of perceiving odours
    or scents
  • gustation (the sense of taste) – the faculty of perceiving the
    sensation of a soluble substance caused in the mouth and throat
    by contact with that substance
  • tactile system – the faculty of perceiving touch, pressure, pain,
  • proprioceptive system – the faculty of perceiving stimuli
    produced within an organism, especially relating to the
    position and movement of the body.
    Sense organs transform sensory stimuli, such as light, sounds, odours,
    flavours, touch, into electrical/chemical nerve signals, which are identified, put together and interpreted in the brain. The signals from each
    sensory organ are processed in specialized areas of the brain. Most of the
    sensory information (except smell) passes through the thalamus and then
    to the opposite hemisphere of the cortex for further processing.
    Olfaction (the sense of smell)
    The olfactory system is the primary sensory channel in infancy. Olfactory
    receptors are located in the nostrils on the olfactory epithelium and deal
    with odour molecules in the air. There are about 10 million smell receptors
    in the nose, of at least 20 different types. Each type detects a different
    range of smell molecules. The receptors respond quickly to minute chemicals in the air, but they also adapt to them in a very short time so that the
    intensity of the smell is lost very quickly. The nerve signals pass along the
    olfactory nerve to the smell centre in the brain that processes the electrochemical signal pattern and identifies the smell.
    Smell differs from other senses in two ways. First, it is the only sense
    that goes straight to the amygdala (limbic system) and then to the cortex,
    without ‘visiting’ the thalamus – the central relay station from which
    sensory signals are transferred to regions of the cortex specialized for each
    Perception 31
    sense. Second, unlike other senses, it does not go from each nostril to the
    opposite hemisphere but passes uncrossed to the same hemisphere.
    Smell plays an important role in the way we taste.
    Gustation (the sense of taste)
    The receptors of taste are taste buds (taste receptors) on the tongue, inside
    the cheeks, on the roof of the mouth and in the throat. We have between
    2000 and 5000 taste buds which are subdivided into several categories of
    the primary tastes: sweet (near the tip of the tongue), salty and sour (on the
    sides of the tongue), bitter (on the back of the tongue) and spicy. The
    middle of the tongue, sometimes called the tongue’s blind spot, has no
    taste buds. The tongue can also sense temperature and texture.
    The sense of taste is not very strong without the sense of smell. That is
    why we do not seem to feel any taste when we have a cold and our sense of
    smell is blocked. The senses of smell and taste are often called chemosenses
    because they operate in very similar ways: the sense of taste deals with
    chemicals in liquids and the sense of smell with chemicals in the air.
    The sense organs of vision are the eyes. The function of the eyes is to
    receive light and let it in to the nerve endings (the sight receptors) at the
    back of the eyes (the retina).
    The place on the retina where the nerve endings of the rods and cones
    form the optic nerve and its blood vessels join the retina is called the blind
    spot because there are no light-sensitive cells on that part of the retina and
    the eye does not receive light here. To find the blind spot look at one of the
    crosses (Figure 2.1) with one eye only. Slowly move the book towards your
    face. At some point, one of the crosses will seem to disappear. It is when the
    image falls on the blind spot.
    32 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 2.1 Blind spot
    Perception 33
    Box 2.1 The eye
    There are three layers of the eyeball:
  • The sclera is the outer layer (the ‘white’) of the eye
    that protects the eyeball. The cornea is the
    transparent horny part of the anterior covering of the
  • The choroid is the middle layer of the eyeball, which
    has blood vessels and brings oxygen to the eye.
  • The retina is the inner layer of the eye, made up of
    light receptors. These light receptors are of two types:
    rods and cones. Rods are sensitive to dim light.
    Cones are sensitive to bright lights and colours.
    Light enters the eye through the pupil. The iris (the coloured
    area around the pupil) controls the amount of light entering the
    Directly behind the pupil is the lens. The eye’s lens, like any
    other lens, inverts the visual image upside-down. Thus, we
    receive ‘upside-down pictures’ on the retina. It is the brain that
    turns them the ‘right way up’.
    The function of the lens is to focus the light rays. The ability
    of the eyes to adjust the focus by thickening or flattening of the
    lens is called accommodation. In normal sight, the light rays are
    focused on the retina. However, sometimes the cornea and lens
    do not focus correctly. In myopia (short-sightedness) light from
    distant objects focuses in front of the retina and images on the
    retina are blurred. In hypermetropia (long-sightedness) light
    from nearby objects focuses behind the retina and images are
    Between the cornea and the lens is a jelly-like liquid called
    the aqueous humour that helps to keep the eyeball firm.
    Directly behind the pupil and lens there is the yellow spot
    on the retina, where the most cones are located.
    The brain learns to compensate and fill in missing parts of the image
    using information from the colours and shapes around it.
    Each eye’s visual field covers a slightly different area and each eye sees
    an object from a slightly different angle. The brain combines these
    different views of an object into one image. Seeing with two eyes is called
    binocular or stereoscopic vision.
    Electrical signals are carried along the optic nerve from each eye and
    cross over at the optic chiasma, so that the signals from the right side of the
    left eye and the right side of the right eye go to the right hemisphere and
    the signals from the left side of each eye go to the left hemisphere.
    The visual cortex of the brain consists of many areas, each processing
    different aspects of sight, such as colour, shape, size, motion, depth,
    distance, etc. Thus, each visual element is processed by a different brain
    The sense organs of hearing are the ears.
    The sound information from each ear goes to the auditory cortex of the
    opposite hemisphere.
    Vestibular system
    The sense organs of balance and gravity (vestibular system) are located in
    the inner ear. These are three semicircular canals, covered with
    endolymph. These organs pass messages to the brain about movement and
    changes in the position of the head: when we move our head, spin, lie
    down, etc. the endolymph presses on the nerve endings behind the wall of
    each canal and sends the message to the brain.
    The sense of balance is backed up by our vision and by the
    proprioceptors. It is much more difficult to balance on one foot with the
    eyes closed. When we spin, we often feel dizzy because the brain receives
    confusing messages about the position of the body. It takes time for babies
    to develop coordination between the sense of balance, sight and
    34 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Perception 35
    Box 2.2 The ear
    The ear consists of three parts – the outer ear, the middle ear and
    the inner ear.
    The outer ear
    The pinnae (broad upper part of external ear) is used for catching
    and directing sound waves into the ear. The auditory canal is a
    short tube leading from the pinnae to the eardrum (a tightly
    stretched membrane closing off the outer ear). When sound
    waves travel down the auditory canal they make the drum vibrate.
    The vibrations pass along to the middle ear cavity.
    The middle ear
    There are three little bones – the hammer, the anvil and the
    stirrup – that form a chain across the middle ear. The vibration of
    the eardrum causes the vibration of these three little bones which,
    in turn, causes the oval window (another membrane in the inner
    ear at the opposite side from the eardrum) to vibrate.
    The Eustachian tube is a passage communicating between
    the middle ear and the back of the throat (larynx), and serving to
    equalize air-pressure on both sides of the eardrum.
    The inner ear
    The vibration of the oval window causes the perilymph (a fluid
    in the inner ear) to vibrate and to produce the vibration in the
    endolymph (a fluid surrounding auditory nerve endings) and
    send electrochemical information along the auditory receptors to
    the brainstem and through the thalamus to the auditory cortex of
    the temporal lobe for further processing.
    The proprioceptive system (kinaesthetic sense) receives the information
    from contracting and stretching muscles, bending and compression of
    joints, and provides awareness of body position. Receptors in muscles,
    tendons and joints inform the brain about the position and posture of the
    body. Proprioceptors also identify the right amount of pressure to pick up
    something light or heavy.
    Proprioceptive information is processed in many different brain areas.
    The sense of touch is one of the first senses to develop; it develops in the
    uterus. The sense of tactility plays an important role in receiving information about the environment and in exhibiting protective reactions.
    The sense organ of tactility is skin. There are five different types of
    tactile receptors in the different skin layers: for light touch, for pressure, for
    pain, for heat and for cold.
    Different types of touch receptors respond to different kinds of stimuli.
    For example, Pacini’s endings respond mainly to pressure; Merkel’s and
    Meissner’s endings react to touch and small, fast vibrations; Ruffini’s
    endings detect changes in temperature and pressure; nociceptors are
    primary receptors of pain caused by extreme temperature, pressure and so
    Millions of tactile receptors are scattered all over the skin, more highly
    packed in some places, for example, the fingertips, making them very
    sensitive, and with less density in others, for instance, the back. When
    tactile receptors are stimulated by touch, heat, cold or vibration they send
    the signals to the special areas in the brain.
    When we get dressed we can feel our clothes on the skin, but then the
    feeling fades. This fading of sensation is called habituation. It is the same
    with smell and taste. If the senses are exposed to a continuing stimulus,
    habituation soon occurs. When the stimulus changes, the feeling returns.
    Like with smell and taste, tactile receptors display habituation to a
    continuous stimulus. That is why we do not feel the clothes we are wearing
    and become aware of them only if we change or adjust them.
    36 Sensory Perceptual Issues in Autism and Asperger Syndrome
    What is perception?
    Everything we know about the world and ourselves has come through our
    senses. All our knowledge therefore is the product of what we have seen,
    heard, smelt, etc. The process by which an organism collects, interprets and
    comprehends information from the outside world by means of senses is
    called perception. The process of perception has several stages. It starts
    with sensation. This is an elementary process incapable of analysis; it takes
    no account of any external object, being simply feeling. Sensations possess
    quality, intensity and duration. They may be broadly divided into affective
    (pleasure, pain) and representative (taste, touch, smell, heat). At the level of
    the perceptual (literal and objective), there is no understanding that things
    can have meaning beyond what is perceptually available (Powell 2000).
    Once the incoming information has passed through special areas in the
    brain the sensory perceptions are joined with appropriate cognitive
    associations and are bound to general types of things in memory
    (concepts). For example, the perception of a pen is joined with the concept
    of writing:
    Sensory perceptual development
    A baby is not born with knowledge and strategies ready-made for perceiving the complexities of environmental stimuli. This ability develops with
    age. After birth, the baby’s interaction with the environment immediately
    becomes a source of knowledge. Infants acquire information about the
    world and constantly check the validity of that information; the process
    defines perception: extracting information from stimulation (Gibson
    Perception depends on both learning and maturation. Babies are not
    given the perceptual world with all its categories at birth. They actively
    create it through their experiences, memories and cognitive processes. For
    Perception 37
    Stimulus Sensation Interpretation
    A pen
    (an object)
    A long thin
    plastic thing
    A pen I can write with it
    babies, even their own body does not exist as a whole, rather as ‘separate
    organs such as hands, mouth, arms and belly’ and they know ‘nothing of
    the various parts being related together’ (Tustin 1974, p.60). Gradually
    babies learn to ‘feel self ’ and control their body parts to produce
    meaningful movements.
    The baby has to learn how to see, to hear, etc. Thus, vision or hearing
    means the ability to receive sights or sounds, but this ability does not
    include comprehending visual images and sounds. We have to learn how to
    see and hear with meaning. We develop our visual and auditory processing
    skills and achieve the comprehension through interaction with the
    environment. Babies are learning how to discriminate different stimuli
    from a chaos of sounds, shapes, patterns, movements, and in the first
    months of their lives infants achieve the ability to make fine
    discriminations between the slightest variations in colour, form, sound, etc.
    Babies also have to learn how to get and store the information from their
    senses. They actually learn how to use their sensory organs and connect
    sensory images with meanings.
    If the perceptual processes are functioning appropriately, the infant is
    able to ‘make sense’ out of the environment. On the other hand, distorted
    sensory input becomes distorted information (Ornitz 1983; 1985). If one
    (or several) of the senses is lost (for example, sight or hearing), the other
    senses develop to compensate and create the balance. However, the
    sensory perceptual worlds of blind or deaf people are very different from
    the sensory perceptual world of people without these disabilities. It is not
    enough to shut the eyes or ears to imagine how they experience life. Here
    we can talk about different perceptions, different languages, and even
    different cultures.
    For example, the blind live in a tactile/auditory/olfactory/gustatory
    world without any visual perceptions. Their experiences are based on their
    interaction with the world through the senses available to them. This is by
    no means a dysfunctional world. It is rather a completely different world.
    Instead of visual images, they have tactile-motor concepts. Their
    perception of space and time is different. They perceive distance by time –
    by how long it has taken to reach or pass objects. The blind compensate the
    lack of vision by other senses (often very acute) and reconstruct their
    38 Sensory Perceptual Issues in Autism and Asperger Syndrome
    ‘visionless’ world rich in sound images, tactile and olfactory ‘pictures’ that
    is very difficult for sighted people even to imagine.
    In his book An Anthropologist on Mars, Oliver Sacks writes about a man
    named Virgil who had been blind for 45 years. When his sight was
    restored, the results were very surprising (and in many ways
    disappointing). Virgil could see but he could not interpret what he saw. He
    was still ‘blind’ to the meaning of visual stimuli. He could reach the ‘visual
    meaning’ if he touched the objects, i.e. using his tactile system. He could
    ‘see’ with his ears, nose or hands much better than with his eyes. He had to
    learn to connect visual experiences with meaning. As his world had been
    built up with other senses, Virgil had great difficulty in learning how to use
    his eyes – he would attend visually only if he was asked to. Without visual
    experience and visual memory, he had problems recognizing objects,
    animals or people. He could not even distinguish between a circle and a
    square if he was not allowed to touch them. Virgil was ‘mentally blind’ –
    able to see but not to decipher what he was seeing (Sacks 1995).
    Extraneous information that came through his eyes that was not backed up
    with visual experiences and visual memories brought only confusion into
    his perception. This ‘foreign’ information interfered with his ability to
    interpret the environment. He could ‘see’ better without his eyes!
    Problems similar to Virgil’s may be experienced by congenitally deaf
    people whose hearing is restored later in life. Initially they find themselves
    in the world of chaotic sounds, which they are unable to interpret
    (‘mentally deaf ’). It takes them a long time to learn to use their ears and
    attach meaning to auditory images. They have to learn to ‘translate’
    auditory stimuli into visual/olfactory ones in order to learn their meaning.
    Those whose vision or hearing is restored at a younger age, have fewer
    problems with adjustment to their new perceptual world. Thus, the timing
    when perceptual problems are handled is very important.
    Some autistic children may require to be taught how to see using their
    eyes, how to hear using their ears, how to eat and how to move. Jim Sinclair
    (1992), a high-functioning person with autism, emphasizes that simple,
    basic skills such as recognizing people and things presuppose even
    simpler, more basic skills such as knowing how to attach meaning to visual
    stimuli. Understanding speech requires knowing how to process sounds,
    that, in turn first requires recognizing sounds as things that can be
    Perception 39
    processed, and recognizing processing as a way to extract order from
    chaos. Autistic individuals may experience problems acquiring these skills.
    More complex functions such as speech (or any kind of motor behaviour)
    require the ability to keep track of all the body parts involved, and to
    coordinate all their movements. Producing any behaviour in response to
    any perception requires monitoring and coordinating all the inputs and
    outputs at once, and doing it fast enough to keep up with changing inputs
    that may call for changing outputs (Sinclair 1992). Autistic children do not
    seem to possess these basic, taken for granted by us, abilities.
    So how do we learn to use our senses in order to make sense of the world
    around us? Eleanor Gibson (1969) identifies three trends in perceptual
  1. Increasing specificity of discrimination. Maturing organisms restrict
    their reactions to a stimulus, i.e. they respond only to the true
    stimulus or a close approximation. Youngsters show a steady
    increase in the precision and consistency of their
    discriminations and they also manifest a constant reduction in
    the time needed to discriminate.
  2. The optimization of attention. Perception is an active process that
    changes developmentally. Children of the early childhood age
    are vigorously active, and their perceptual processes are now
    more searching than the passive perceptual responses of
    infancy: their eye movements, for example, no longer fixate on
    a single spot of an object but follow its contour seeking
    distinctive features. They select needed information from
    complex stimuli, thus demonstrating attention to relevant and
    disregarding irrelevant stimuli. Changes in ability to attend to
    wanted information and ignore the irrelevant occur with age.
  3. Increasing economy in information pickup. Combining the first two
    of these developmental trends helps to explain growing
    perceptual sophistication. Youngsters learn to discriminate an
    object by focusing on the fewest possible features that
    distinguish it. If they can isolate some invariant, i.e. a feature
    that remains constant over time, they have drastically improved
    their perception of an object. They thus increase their ability to
    40 Sensory Perceptual Issues in Autism and Asperger Syndrome
    process several objects or events simultaneously because they
    see relationships and can form structures, which facilitates
    retention and economical recall.
    The real world and the perceived world (i.e. our mental image of the world)
    differ. All the information we receive from our senses is constructed (pieced
    together) in our brain. Our brain cannot process all the stimuli present;
    therefore, it selects the key aspects of the scene while the rest of the world
    falls into the background. That is, the process of perception is an active
    process, guided by the brain. Moreover, it is a two-way process: information from the sense organs (relatively raw material) is influenced by the
    ‘inside information’ (the information we have stored and adjusted to our
    earlier experiences).
    What is more, with age we often tend to ‘distort’ what we perceive even
    more because we often add to our perception by ‘seeing’, ‘hearing’, etc.
    what we expect to see, hear, etc. in certain situations. These expectations are
    based on our experience and knowledge. We do not have to examine the
    flat vertical surface with a handle every time we see it, to know that this is a
    door and we can open it to get into the house. A lot of ‘perceptual
    constancies’ stored in our brain help us to move in our world with
    confidence and certainty and ‘save the time’ for other cognitive processes
    (solving problems, planning activities, etc.).
    Our interpretation (‘seeing’) of the world is based on our imagination,
    memory and experience. For instance, we know from our past experience
    the size of objects and people. We use this knowledge to ‘see’ and interpret
    things and people we are confronted with at present. As a result, the final
    picture (multi-sensory: visual, auditory, olfactory, etc.) is inevitably
    distorted, without our even realizing that our ‘perceived world’ is not a
    true copy of the real one. Looking at the three people in the picture (Figure
    2.2), we know that the person who is farthest away should look smaller. If
    this person looks of the same height, we interpret it as if he or she is the
    tallest even though the three of them are exactly the same. This is an
    example of visual illusion. However, we may experience illusions in any
    sensory modality.
    Illusion is defined as erroneous interpretation of something really
    existent and actually perceived by the senses. Some illusions arise from
    imperfect knowledge or perception, others from a disordered condition of
    Perception 41
    42 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 2.3 A vase or two faces?
    Figure 2.2 Which person is the tallest?
    the senses, as when someone sees two objects where one exists. In contrast
    to hallucinations, illusions are errors of perception and/or construction,
    rather than false constructions (Carter 1998).
    We may distinguish several types of illusions:
  4. Illusions caused by some physiological and/or mechanical
    processes, for example, blind spot; the halo effect (when
    brightness persists after bright light has been switched off due
    to residual firing of the light receptors in the retina).
  5. Illusions caused by ‘filtering foreground and background
    information’, when our perception depends on what we have
    picked as a foreground image, for example, a vase or two faces
    (see Figure 2.3).
  6. Cognitive illusions – caused by cognitive interpretation of the
    perceived stimuli, for example, when we ‘see’ what we expect to
    ‘Seeing’ or ‘not seeing’ visual illusions provides an objective and replicable
    way of examining visual-constructive capacities of the brain (Sacks 1995).
    Oliver Sacks quotes the case of S.B., a blind person whose vision was
    restored when he was in his fifties. S.B.’s responses to visual illusions were
    very peculiar. ‘Physiological illusions’, such as parallel lines that seem to
    diverge because of the effect of diverging lines on them, were seen as
    parallel by him. Reversing figures (‘filtering illusions’), such as cubes and
    staircases drawn in perspective or ambiguous figures, did not reverse for
    S.B. and were not seen in depth. He had no ‘figure-ground fluctuation’ and
    saw one ‘image’ without changing from foreground to background perspective. Sacks interprets S.B.’s failure to ‘see’ the illusion as evidence of
    rudimentary visual constructions and absence of early visual experience.
    Thus, there is always something of us in our interpretation of stimuli.
    Our response is not objective. It depends on our previous experiences,
    interests, motivation, etc. Besides, our perception is also influenced by our
    culture. And though every brain constructs the world in a slightly different
    way from any other because every brain is different, the ways it operates
    are similar for non-disabled people. Even with perceptual differences, we
    see sufficient similarity to agree that a book is a book, a cat is a cat, etc.
    Perception 43
    Chapter 3
    Possible Sensory Experiences in Autism
    What is the autistic way to perceive the world?
    Learning how each individual autistic person’s senses function is
    one crucial key to understanding that person. (O’Neill 1999, p.31)
    Though autistic people live in the same physical world and deal with the
    same ‘raw material’, their perceptual world turns out to be strikingly different from that of non-autistic people. It is widely reported that autistic
    people have unusual (from a non-autistic point of view) sensory perceptual
    experiences. These experiences may involve hyper- or hyposensitivity,
    fluctuation between different ‘volumes’ of perception, difficulty interpreting a sense, etc. All these experiences are based on real experiences, like
    those of non-autistic people, but these experiences may look/sound/feel,
    etc. different, or they may be interpreted differently. We think about the
    world in a way we experience it and perceive it to be. Different experience
    brings a different stock of knowledge about the world. So can we be sure
    that we are moving in the same perceptual/social, etc. world if our reconstructions of it are so different? Can we be sure that we see, hear, feel, etc.
    exactly the same things? How can we know that only our ‘perceptual
    version’ of the world is correct and theirs is wrong? Whatever the answer
    to these questions it is worth remembering that autistic people cannot help
    seeing and hearing the ‘wrong thing’, and they do not even know that they
    see or hear the wrong thing (Rand). ‘Normal’ connections between things
    and events do not make sense for them, but may be overwhelming, confusing and scary.
    What makes the matter even more complicated is that no two autistic
    people appear to have the exactly same patterns of sensory perceptual
    We can distinguish some features of ‘autistic perception’ of the world,
    based on the testimonies of high-functioning autistic individuals and close
    observation of autistic children. Below we will discuss the most commonly
    reported perceptual phenomena.
    These experiences are not unique. We all may ‘feel strange’ sometimes
    and have similar experiences now and then, especially when tired or
    drugged. What is unique about these experiences in autism is their
    intensity and continuity: these experiences are ‘normal’ for them.
    ‘Literal perception’
    Most things I take at face value, without judging or interpreting
    them. I look at them in a concrete, literal, and very individual way. I
    do not normally integrate things or see them as connected unless I
    actively look for a connection. I do not ‘draw’ connections, I assign
    them consciously, based on reasoning and usefulness. All my associations are consciously formed, and may be consciously severed.
    (Blackburn 1999, p.10)
    Autistic people seem to perceive everything as it is. It is sort of ‘literal perception’, for example, they may see things without interpretation and
    understanding (literal vision). Professor Snyder, who studies the phenomenon of autistic savants, suggests that autistic people look at the world the
    way it actually is.
    A very good example of our inability to actually see the world the way
    it is without the brain’s interference with the process is the way we
    interpret so-called impossible objects. Looking at the top part of the figure
    (Figure 3.1), we interpret it as a construction with two columns. However,
    if we change the perspective and look at the bottom, we ‘change our mind’
    and conclude that there are three columns. As we know that this is
    impossible (though our eyes tell us the opposite), we arrive at the
    conclusion that this is an impossible object.
    Possible Sensory Experiences in Autism 45
    Inability to distinguish between foreground and background
    information (‘Gestalt perception’)
    It was like having a brain with no sieve… (Williams 1994, p.42)
    There is much evidence that one of the problems many autistic people
    experience is their inability to distinguish between foreground and background stimuli (inability to filter foreground and background information). They often are unable to discriminate relevant and irrelevant stimuli
    (Gibson’s first two stages of perceptual development). What is background
    to others may be equally foreground to them; they perceive everything
    without filtration or selection. It is often hard for the autistic person to
    integrate what they are experiencing into separate and unique entities
    (Joan and Rich 1999), to ‘break’ the whole picture into meaningful parts.
    Delacato (1974) discovered that some autistic children (‘hypervisual’
    in his classification) are not fooled by optical illusions and identified it as
    one on the visual ‘isms’. Several theories have appeared trying to explain
    the phenomenon of ‘optical disillusions’ in autism: the theory of ‘probable
    46 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 3.1 Impossible object
    prediction’ (Feigenberg 1986) and the modification of the ‘weak central
    coherence theory’ (Frith 1989) to low levels (Happe 1996).
    Feigenberg (1986) suggests that what we see (hear, feel, etc.) is mostly
    something we are expecting to see (hear, feel, etc.). The brain does not need
    to process all the stimuli; it just ‘fills in the gaps’ and ‘predicts’ the final
    picture. That is why we are prone to illusions. This ability of the brain to
    ‘see’ before actually seeing is not restricted to vision. The same can be
    observed with other senses, for example, we can ‘hear’ or ‘feel’ what we are
    expecting to hear or feel.
    Happe (1996) interprets low susceptibility to illusions in autistic
    individuals as evidence of weak central coherence, as visual illusions
    require processing of information in context, i.e. holistically. If autistic
    people perceive everything in fragments and focus on these fragments
    without integrating them with the surrounding illusion-inducing context,
    one might expect them to succumb less to the typical misperceptions
    (Happe 1996). A recent study (Garner and Hamilton 2001), however, has
    questioned the proposition of universal weak central coherence in autistic
    people. Garner and Hamilton (2001) demonstrated that some autistic
    individuals (all nine autistic participants in their study) are able to
    experience visual illusions and implement central coherence, and some of
    the participants experienced it even before the non-autistic ones. The
    researchers conclude that the idea that weak central coherence dominates
    all perceptual experience of autistic individuals is incorrect.
    The results of the study of Ozonoff et al. (1994) have also questioned
    the weak central coherence in autism. They reveal that the autistic group
    demonstrated no particular difficulty processing global features of a
    stimulus, nor did they exhibit superiority in processing local features,
    relative to the two matched control groups, one with Tourette syndrome
    and the other developmentally normal. Ozonoff et al. (1994) hypothesize
    that autistic individuals do indeed focus on details at the expense of seeing
    the big picture, but do this at a conceptual, rather than a perceptual level.
    That is, they may have no trouble visually processing the whole picture;
    difficulty may only be apparent when the individual elements are
    meaningful pieces of information that must be integrated to form a general
    idea or understanding at a higher-order conceptual level.
    Possible Sensory Experiences in Autism 47
    The inability to filter foreground and background information can
    account for both strengths and weaknesses of autistic perception. On the
    one hand, they seem to perceive more accurate information and a larger
    amount of it. On the other hand, this amount of unselected information
    cannot be processed simultaneously and may lead to information overload.
    As Donna Williams describes it, they seem to have no sieves in their brains
    to select the information that is worth being attended to. This results in a
    paradoxical phenomenon: sensory information is received in infinite detail
    and holistically at the same time. It can be described as ‘gestalt
    , i.e. perception of the whole scene as a single entity with all
    the details perceived (not processed!) simultaneously. They may be aware
    of the information others miss, but the processing of ‘holistic situations’
    can be overwhelming.
    The phenomenon of autistic savants can contribute a lot to the
    explanation of ‘autistic perception’. Steven Wiltshire, a well-known
    autistic artist, for example, draws pictures of architectural buildings with
    minute detail. It has been suggested that this ability is the result of
    photographic memory that helps hold the whole scene together. Another
    interesting feature of his drawings is that he could start the picture from
    any (often insignificant) detail and complete it with ease. Could it be that
    for him all these details are one entity? If you want to draw a circle, you can
    start from any point and complete it. For people like Steven, who perceive
    the gestalt, the starting point does not matter, as for us it does not matter
    from what point we start to draw a circle.
    Louis, an autistic boy (aged nine at the time) completed his picture of
    Humpty Dumpty in ten minutes after having watched a cartoon (Figure
    Many autistic children, whose drawings though are not so spectacular,
    exhibit the same technique of creating a picture. They may start to draw a
    car with a wheel, a man with a foot, etc. Gestalt perception may account for
    their ‘superability’ to see simultaneously two pictures in one (for example,
    well-known ‘vase-faces’ picture). Other ‘disillusions’ (for example, Titcher
    circles, etc.) can be accounted for by ‘probable prediction’ deficit
    (Feigenberg 1986).
    Gestalt perception is often overwhelming and may lead to all sorts of
    distortions during the processing of information, such as fragmented
    48 Sensory Perceptual Issues in Autism and Asperger Syndrome
    perception, hypersensitivity, fluctuation between hyper- and hyposensitivity, delayed processing, etc.
    It is common knowledge that autistic people do not like changes and
    like routines. If a slightest detail is changed (for example, a picture on the
    wall is not straight, or a piece of furniture has been moved a few inches to
    the side), the whole scene (gestalt) is different, i.e. unfamiliar. For them to
    recognize things, things must be exactly the same as they have already
    experienced. Only then will they know what to do with them (Williams
    1996). The same is true about routines: if something goes differently, they
    do not know what to do. The gestalt of the situation is different.
    All this results in fear, stress and frustration.
    Paradoxically, autistic people have much more trouble with slight
    changes than with big ones. For instance, they can cope with going
    somewhere unfamiliar much better than with changes in the arrangement
    of the furniture in their room. The explanation of this phenomenon lies in
    the gestalt perception. Their encounter with new information is a new
    gestalt, which will be stored, while any changes in the ‘familiar gestalt’
    Possible Sensory Experiences in Autism 49
    Figure 3.2 ‘Humpty Dumpty’. Drawing by Louis, aged nine years old
    bring confusion: on the one hand, it becomes a complete ‘new picture’, on
    the other hand, in the familiar situation they are confronted with an
    unfamiliar environment.
    Autistic people may experience gestalt perception in any sensory
    modality. A person who experiences visual gestalt has a great difficulty
    focusing on a single detail of the scene and finds it almost impossible to
    separate it from the whole picture. People with auditory gestalt perception
    have a great difficulty to concentrating on one auditory stimulus, for
    example, someone’s voice as it goes as a package with all the
    environmental noises: fans working, doors opening, somebody coughing,
    cars passing, etc. Their ears seem to pick up all sounds with equal intensity.
    If they try to screen out the background noise (separate it from the voice
    they want to attend to), they also screen out the voice they are trying to
    attend. The same problem occurs when several people are talking at once:
    it is difficult for them to listen to one voice and screen out the others
    (Grandin 1996b). They often feel ‘drowned’ in the ‘sea of background
    noise’ and cannot isolate the words of the person they are talking to from
    those talking within the room, in the next room, outside, etc. In crowded
    places, their brains seem to try to process all the stimuli around them –
    what every other person is saying, and what other noises and sounds
    coming from all directions mean.
    What to look for:
    1 Is not fooled by optical illusions
    2 Notices every tiny change in the environment
    3 Does not recognize a familiar environment if approached from
    a different direction
    4 Gets easily frustrated when trying to do something in a noisy,
    crowded room
    5 Does not seem to understand the instructions if more than one
    person is talking
    6 Is unable to distinguish between tactile stimuli of different
    intensity (e.g. light and rough touch)
    50 Sensory Perceptual Issues in Autism and Asperger Syndrome
    7 Is unable to distinguish between strong and weak odours/tastes
    8 Clumsy; moves stiffly
    9 Resists change to head position/movement
    Alex notices every tiny change in the environment (‘The rubber is
    under the table’ ‘The picture is not straight’, etc.). I should be very
    careful about these changes, as the boy would not do anything unless he
    ‘puts everything right’; i.e. the way it used to be.
    Brad Rand, a high-functioning person with autism gives very good
    examples to illustrate this phenomenon:
    You seem to learn general things, like shirts hanging in a closet, then
    you can process little changes about those things easily and quickly,
    like the shirts are still shirts hanging in a closet no matter what order
    they’re in, or if one has fallen off its hanger a little, or if pants have
    accidentally got mixed into the shirts.
    But some people who are different learn specific things, like
    when they learn about shirts hanging in a closet, they learn those
    exact shirts in that exact order. Anything different that they see next
    time is not what they learned. Maybe it is like kids who learn to read
    by memorizing the shapes of letters, instead of by phonics. They can
    read Sat because they learned s and a and t equal Sat. But they can’t
    read Cat, because the c changes everything. (Rand, pp.12–13)
    As there is too much information coming in, it is hard to know which
    stimuli to attend to. As the stock of knowledge accumulated by autistic
    individuals is different, then their attention would also be different.
    Here arises the question: Does the explanation of ‘gestalt perception’
    contradict the ‘weak central coherence theory’ (Frith 1989) in autism? No,
    it does not. The theory of weak central coherence ‘starts working’ at the
    next stage of the process of perception when gestalt perception inevitably
    leads to distortions and fragmentation, in order to limit the amount of
    information to be processed.
    Different stages (and styles) of perception can account for the
    controversial findings of the studies investigating weak central coherence
    and global processing in autism. On the one hand, Embedded Figures
    Possible Sensory Experiences in Autism 51
    Tests have been considered as the strongest area where autistic individuals
    perform better than non-autistic ones (Joliffe and Baron-Cohen 1997;
    Shah and Frith 1993) and the results have been interpreted as an
    illustration of weak central coherence in autism. On the other hand, the
    recent study (Garner and Hamilton 2001) has challenged this idea and
    shown that autistic individuals can see optical illusions, i.e. have the ability
    to cohere. The authors interpret these findings as the confirmation of
    Happe’s (1999) notion about coherence being a continuum and
    representing a cognitive style. Whether it is a cognitive style or a
    perceptual style, we cannot talk about a continuum here, as one and the
    same person seems to be able to display both styles at different times. Thus
    the overflow of sensory information that cannot be filtered and/or
    processed simultaneously may cause distortions in perception.
    Gestalt perception may result in different sensory experiences and
    compensatory strategies (voluntary and involuntary) the person acquires in
    order to cope with sensory information overload.
    Most commonly reported sensory experiences in autism are:
  • hypersensitivity and/or hyposensitivity
  • disturbance by certain stimuli and/or fascination by certain
  • inconsistency of perception (fluctuation between hyper- and
  • fragmented perception
  • distorted perception
  • sensory agnosia (difficulty interpreting a sense)
  • delayed perception
  • sensory overload.
    Hypersensitivity and/or hyposensitivity
    In his book The Ultimate Stranger: The Autistic Child, describing possible
    sensory problems in autism, Carl Delacato (1974) classified each sensory
    channel as being:
    52 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • hyper-: the channel is too open, as a result too much stimulation
    gets in for the brain to handle
  • hypo-: the channel is not open enough, as a result too little of
    the stimulation gets in and the brain is deprived
  • ‘white noise’: the channel creates its own stimulus because of its
    faulty operation and, as a result the message from the outside
    world is overcome by the noise within the system.
    Delacato stated that each sensory channel could be affected in a different
    way, for example, a child could be hypovisual, ‘white noise’ auditory,
    hypo- to tastes and smells and hypertactile.
    While recognizing the revolutionary contribution to the understanding of autism made by Delacato, it seems necessary to argue one point
    in his theory. Delacato considered that a channel could be either hyper- or
    hypo- or ‘white noise’. However, it turns out that often one and the same
    person can experience sensory inputs of one and the same channel at
    different times from all three of Delacato’s categories – hyper-, hypo-,
    ‘white noise’ – because the intensity (the volume) with which the channels
    work often fluctuates. For example, an autistic boy in my group can watch
    ‘spots’ and ‘moths’ (small particles in the air), shows great discomfort at
    bright lights (Delacato’s characteristics of being hypervisual), while he
    often inspects objects by hand, likes mirrors (hypovisual) and has large
    pupils, often looks through people and things, dislikes eye contact and has
    distorted visual experience (‘white noise’).
    While describing their unusual sensory experiences autistic
    individuals prefer the term ‘hypersensitivity’. This term is very broad. In
    this book ‘hypersensitivity’ means acute or heightened, or excessive
    sensitivity; ‘hyposensitivity’ stands for below normal sensitivity. Here the
    terms are deliberately narrowed, as it seems more justifiable to distinguish
    between different sensory experiences, often conventionally covered by
    one term. Below are some examples of hyper- and hyposensitivities of all
    the channels experienced by autistic individuals.
    Possible Sensory Experiences in Autism 53
    Hypervision (seeing ‘invisible’) means that they can see more than other
    people, i.e. their vision is too acute. For example, Alex, an autistic child,
    often complains ‘Moths [air particles] are flying.’ His vision is so hypersensitive that ‘moths’ often become a background with the rest of his environment fading away. Annabel Stehli (1991, p.186) described her autistic
    daughter Georgiana who saw ‘too well’ and everything she saw was magnified; ‘she saw like an eagle’; she saw, for example, every strand of hair
    ‘like spaghetti…[that] must have been why she’d been so fascinated by
    people’s hair’. Jasmine O’Neill (1999) describes an autistic person as the
    person who sees what is around him with extra-acute sight.
    Hyperhearing (hearing ‘inaudible’) is widely reported. Temple Grandin
    (1996b) describes her hearing as having a sound amplifier set on
    maximum loudness, and she compares her ears with a microphone that
    picks up and amplifies sounds. They might be able to hear some
    frequencies that only animals normally hear (Williams 1992). Alex, an
    autistic boy, seems to hear noises before other people. He can announce his
    dad coming home before anybody else can hear the car turning to the
    porch. As noises seem so much louder to him, Alex usually moves away
    from conversations and avoids crowded places.
    Children with hyperhearing often cover their ears when the noise is
    painful for them, though others in the same room may be unaware of any
    disturbing sounds at all.
    Hypertaste/Hypersmell: Some autistic individuals have olfactory
    sensitivities comparable to canines (Morris 1999). For them, ‘almost all
    types of food smell too sharp’ and they ‘cannot tolerate’ how people smell,
    even if they are very clean. They do not like some food because ‘the smell
    or taste’ might be intolerable (Rand). Hypersensitivity to certain stimuli
    experienced by autistic people can be compared with allergies (O’Neill
    1999). Donna Williams’s allergic reaction to some perfumes made the
    inside of her nose feel like it had been walled up with clay up to her
    eyebrows, some perfumes ‘burned her lungs’ (Williams 1996).
    Some food problems, however, may be caused not by taste or smell but
    by intolerance of textures of certain food, sounds it produces or even its
    colour. Alex, for example, would never eat any red vegetables or fruit. He
    would accept a green apple but never a red one!
    54 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Hypertactility is very common among the autistic population. Some
    autistic children pull away when people try to hug them, because they fear
    being touched. Many children refuse to wear certain clothes, as they
    cannot tolerate the texture on their skin. Because their hypertactility
    results in overwhelming sensations, even the slightest touch can send them
    to a panic attack. Small scratches that most people ignore can be very
    painful to them. Parents often report that washing their child’s hair or
    cutting nails turns into an ordeal demanding several people to complete it.
    Luke Jackson (2002), a teenager with Asperger syndrome, describes his
    autistic brother Ben who has real problems with clothes. Ben will now
    wear his clothes to go out to school, but as soon as he comes home he
    cannot help stripping them off – ‘Hurts!’
    For some people it takes many days to stop feeling their clothes on
    their body. And unfortunately, when this comfortable feeling (or
    ‘non-feeling’) has been achieved it is time to wear clean ones, so the
    process of getting used to it starts again.
    Gillingham (1991) states that this ‘superability’ of autistic people,
    when the senses are so finely tuned that they make them acutely aware of
    things the ‘normal’ person would not notice, sometimes causes extreme
    pain. The researcher hypothesizes that to block this pain the body
    produces endomorphins that, in turn, may suppress further sensory
    Temple Grandin (2000) suggests that a partial explanation for the lack
    of empathy in autism may be due to an oversensitive nervous system that
    prevents an autistic child from receiving comforting tactile stimulation
    from being hugged.
    Vestibular hypersensitivity is reflected in a low tolerance for any activity
    that involves movement or quick change in the position of the body.
    People with vestibular hypersensitivity experience difficulty changing
    direction and are poor at sports. They feel disoriented after spinning,
    jumping or running. They often express fear and anxiety of having their
    feet leave the ground. Ayres (1979) termed them ‘gravitationally insecure’.
    Proprioceptive hypersensitivity is reflected in odd body posturing,
    difficulty manipulating small objects, etc.
    Possible Sensory Experiences in Autism 55
    There might be times when they are not getting enough information, then
    their brain can feel empty and stop processing and they do not really see
    anything or hear anything. They are just there. Then they might get the
    information going again in their brain and nervous system by waving their
    hands around or rocking back and forth or making strange sounds or
    hitting their head with their hand (Rand).
    Hypovision: Some autistic people may experience trouble figuring out
    where objects are, as they see just outlines, and even bright lights are not
    ‘bright enough’ for them. They may stare at the sun for a long time, or walk
    around something, running their hand around the edges so they can
    understand what it is (Rand).
    Hypohearing: We often see children who ‘seek sounds’ (leaning their ear
    against electric equipment or enjoying crowds, sirens). They often create
    sounds themselves to stimulate their hearing – banging doors, tapping
    things, vocalizing.
    Hypotaste/Hyposmell: Children with hypotaste/hyposmell chew and
    smell everything they can get – grass, play dough, perfume.
    Hypotactility: Those with hypotactility seem not to feel pain or
    temperature. They may not notice a wound caused by a sharp object or
    may seem unaware of a broken bone.
    Vestibular hyposensitivity: They enjoy and seek all sorts of movement and
    can spin or swing for a long time without being dizzy or nauseated.
    Autistic people with vestibular hyposensitivity often rock forth and back
    or move in circles while rocking their body.
    Proprioceptive hyposensitivity: They have difficulty knowing where their
    bodies are in space; are often unaware of their own body sensations (for
    instance, they do not feel hunger). Children with hypoproprioceptive
    systems appear floppy, often lean against people, furniture and walls.
    Delacato (1974) was one of the first researchers to suggest that hyperand hyposensitivity experienced by autistic children caused all autistic
    behaviours, namely withdrawal from social interaction and
    communication, stereotypic behaviours (or stims, or self-stimulations). He
    called these behaviours sensoryisms (sensorisms: blindisms – visual ‘isms’,
    deafisms – auditory ‘isms’, etc.) and considered them as the child’s attempts
    56 Sensory Perceptual Issues in Autism and Asperger Syndrome
    to treat himself and either normalize his sensory channels or communicate
    his problems.
    Autistic individuals often describe their stims as defensive mechanisms
    from hyper- or hyposensitivity. Sometimes they engage in these
    behaviours to suppress the pain or calm themselves down (in the case of
    hypersensitivity), sometimes to arouse the nervous system and get sensory
    stimulation from the outside (in the case of hyposensitivity), and
    sometimes to provide themselves with internal pleasure. Very often,
    therefore, these self-stimulatory behaviours (‘sensorisms’), which are
    defined by non-autistic people as ‘bizarre behaviours’ (such as rocking,
    spinning, flapping their hands, tapping fingers, watching things spin), can
    be viewed as involuntary strategies the child has acquired to cope with
    ‘unwelcome stimulation’ (hypersensitivity) or lack of it (hyposensitivity).
    That is why, no matter how irritating and meaningless these behaviours
    may seem to us, it is unwise to stop them without learning the function
    they serve and introducing experiences with the same function. The
    stereotypies caused by sensory hyper- or hyposensitivity can involve one
    or all senses. If we interpret these behaviours, we will be able to imagine (if
    not fully comprehend) how the child perceives the world and help the
    child develop strategies to cope with these (often painful) sensitivities.
    In order to recognise the presence of hyper- or hyposensitivities, one
    should know what signs to look for. Below are some common signs
    indicating the sensitivities in each sensory channel that can be helpful in
    compiling a child’s sensory perceptual profile and choosing the methods
    and environments suitable for each child.
    Possible Sensory Experiences in Autism 57
    58 Sensory Perceptual Issues in Autism and Asperger Syndrome
    What to look for:
    Hyper- HypoVision
  • constantly looks at minute
    particles, picks up smallest
    pieces of dust
  • dislikes dark and bright lights
  • is frightened by sharp flashes
    of light, lightning, etc.
  • looks down most of the time
  • covers or closes eyes at bright
  • is attracted to light
  • looks intensely at objects or
  • moves fingers or objects in front
    of the eyes
  • is fascinated with reflections,
    bright coloured objects
  • runs a hand around the edge of
    the object
  • perimeter hugging
  • covers ears
  • is a very light sleeper
  • is frightened by animals
  • dislikes thunderstorm, sea,
    crowds, etc.
  • dislikes haircut
  • avoids sounds and noises
  • makes repetitive noises to
    block out other sounds
  • bangs objects, doors
  • likes vibration
  • likes kitchen, bathroom
  • likes crowds, traffic, etc.
  • tears paper, crumples paper in
    his hand
  • is attracted by sounds, noises
  • makes loud rhythmic noises
    Possible Sensory Experiences in Autism 59
    Hyper- HypoTactility
  • resists being touched
  • cannot tolerate new clothes;
    avoids wearing shoes
  • overreacts to heat/cold/pain
  • avoids getting ‘messy’
  • dislikes food of certain texture
  • avoids people
  • likes pressure, tight clothes
  • seeks pressure by crawling
    under heavy objects
  • hugs tightly
  • enjoys rough and tumble play
  • prone to self-injuries
  • low reaction to pain and
  • toileting problems
  • runs from smells
  • wears the same clothes
  • moves away from people
  • smells self, people and objects
  • smears (plays with) faeces
  • seeks strong odours
  • bedwetting
  • poor eater
  • uses tip of tongue for tasting
  • gags/vomits easily
  • craves certain foods
  • eats anything (pica)
  • mouths and licks objects
  • eats mixed food (e.g. sweet and
  • regurgitates
    60 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Hyper- HypoProprioception
  • places body in strange
  • difficulty manipulating small
    objects (e.g. buttons)
  • turns the whole body to look
    at something
  • low muscle tone
  • has a weak grasp; drops things
  • a lack of awareness of body
    position in space
  • unaware of their own body
    sensations (e.g. does not feel
    hunger, etc.)
  • bumps into objects, people
  • appears floppy, often leans
    against people, furniture, walls
  • stumbles frequently; has
    tendency to fall
  • rocks back and forth
  • fearful reactions to ordinary
    movement activities (e.g.
    swings, slides, merry-go-round
    round, etc.)
  • difficulty with walking or
    crawling on uneven or
    unstable surfaces
  • dislikes head upside down
  • Becomes anxious or distressed
    when feet leave the ground
  • enjoys swings, merry-go-round
  • spins, runs round and round
  • rocks back and forth
    In my class there are four children suffering from hyper- or
    Alex’s vision is very acute (hyper-): he can see the tiniest particles in the
    air, the smallest pieces of fluff on the carpet. These experiences distract
    his attention from whatever he is supposed to do. He hates bright lights
    and fluorescent light gives him headaches. What makes things even
    more complicated is that Alex’s hearing is also very acute. He can hear
    what is going on in the next room but one and always keeps me
    informed about it – ‘The chair is being moved. The ruler has been
    dropped. The bus is coming’, etc.
    Helen’s vision is hypo-: she is attracted by any shining object, looks
    intensely at people (that irritates Alex, who cannot tolerate any direct
    look at him), is fascinated with mirrors. At the lessons she can move her
    fingers in front of her face for hours. It seems she cannot get enough
    visual stimulation and always switches on all the lights as soon as she
    enters the classroom. (This is usually followed by a fight with Alex
    who throws a tantrum every time the light is on.) Helen’s hearing is
    also hypo-: she cannot tolerate silence, and if there is not enough noise
    for her, she would produce sounds herself – banging doors, tapping
    things, shouting.
    John (hypoauditory) always joins in Helen’s ‘noise making’. However,
    his hypersensitivity to smells prevents him coming too close to anybody
    and makes any activities in the kitchen intolerable.
    Vicky is hypersensitive to sounds, touch and smell. If she is being
    touched by somebody, she immediately smells the place of touch, and
    more often than not she takes off her jacket or dress with this ‘spoilt
    spot’ and refuses to wear it again unless it is washed.
    Hypersensitivity can also lead to two different experiences: disturbance by
    certain sensory stimuli and its opposite – fascination with certain stimuli.
    These experiences are very individual. The kinds of stimuli that are disPossible Sensory Experiences in Autism 61
    turbing or fascinating vary from person to person. A sight/sound/smell
    that causes one child pain may be pleasurable to another.
    All senses can be affected. Some people might find many noises and
    bright lights nearly impossible to bear; for others certain noises (children’s
    voices, car horns, a kettle whistling) and the pitch of some sounds might
    cause a lot of discomfort. A woman with Asperger syndrome cannot
    tolerate somebody whistling. She describes it as a ‘physical abuse’ because
    whistling causes her body to tremble and even ache. Besides, not only
    certain sounds but also any sudden unpredictable sounds can be painful.
    The fear of noise that hurts the ears is often the cause of many bad
    behaviours and tantrums. Some autistic children, for instance, can break
    the telephone because they are afraid it will ring (Grandin 1996b).
    Consider the following example given by Marc Fleisher, a person with
    Asperger syndrome, and try to imagine the ‘perceptual world’ of this
    student at the moment of ‘ruler-danger’. No wonder, the possible
    challenging behaviours of the person would seem as ‘coming out of the
    blue’ and the ABC (Antecedent – Behaviour – Consequence) principles of
    Applied Behaviour Analysis (when we look for triggers of challenging
    behaviours) are useless in this case, as we should deal with ‘probable future
    antecedent’ triggering the behaviour at present.
    You are in a room with an autistic individual and you are trying to
    give a math lesson. On the table, and among other items, you have a
    wooden ruler. At one particular instant, you unintentionally brush
    your arm against the ruler so that it now is only just balancing on the
    table edge with almost half its length in the air with no support.
    Provided there is no draught the ruler will probably still remain, but
    shove it any more, and it certainly fall, making a loud clatter on the
    stone floor…
    …you probably would not even have been aware that you had
    moved the ruler. Many autistic people are very susceptible to noise.
    Suddenly their whole world is focusing on that ruler – all other
    objects in the room seem to dim. The ruler! The ruler! That’s all that
    matters. If it falls it will make a loud clatter on the floor. (Fleisher
    2001, pp.323–4)
    Some autistic people often find it impossible to touch some objects. Donna
    Williams calls one of her particular texture problems ‘wool on wool’, i.e.
    62 Sensory Perceptual Issues in Autism and Asperger Syndrome
    intolerance of hair rubbing against hair or cloth against cloth. It means that
    it is difficult to her to tolerate people’s hair rubbing on her or their clothes
    rubbing her clothes, and it is hard to tolerate putting a woollen jumper over
    her head or walking on some carpets with certain types of socks (Williams
    The most often reported visual sensitivities are sensitivity to bright
    light, fluorescent light, colours and certain patterns (especially stripes).
    The light sensitivity in autism coincides with the symptoms of Scotopic
    Sensitivity/Irlen Syndrome (SS/IS) identified by Helen Irlen (1991) (see
    Chapter 6). Many autistic people confirm that bright lights and sunshine
    disturb them and often cause distortions. For example, as a child, Nony
    (1993) found it difficult to walk in town on a sunny day. Her eyes would
    close and she would have to turn into a darker doorway or cover her eyes to
    get them open enough to see; the glare of sidewalks and shop windows
    was too much for her. Some people report that on bright days their sight
    blurs (White and White 1987).
    Alex, an autistic boy, cannot tolerate contrasts: it is impossible for him
    to walk along the street in the dark with cars with bright lights passing by.
    Even his tinted (very dark) glasses do not help much.
    Fluorescent light has been reported by many autistic individuals to be
    very difficult to tolerate, because they can see a 60-cycle flicker. Problems
    with flickering can range from excessive eyestrain to seeing a room pulsate
    on and off (Grandin 1996a). Some people report that they feel sleepy
    when the fluorescent lights are on.
    Sensitivity to colours and colour contrast is another visual problem for
    some autistic people. For example, Liane Willey, a woman with Asperger
    syndrome, finds it difficult to look at pastels as they make her feel icky,
    queasy and uneven. They drown her (Willey 1999).
    Some autistic individuals cannot tolerate food of some particular taste,
    smell, texture or appearance (certain colours, for example), or even the
    sound it produces when they chew it.
    What to look for:
  1. Squints or closes eyes in bright light
  2. Gets easily frustrated/tired under fluorescent lights
    Possible Sensory Experiences in Autism 63
  3. Gets frustrated with certain colours
  4. Gets frustrated with certain sounds
  5. Tries to destroy/break objects producing sounds (clock,
    telephone, toy, etc.)
  6. Cannot tolerate certain textures
  7. Cannot tolerate some smells/tastes
  8. Cannot tolerate certain movements/body postures
  9. Fears falling or height
    Fascination with certain stimuli is an opposite of disturbance by certain
    stimuli, caused also by hypersensitivity. These two features are like two
    sides of one and the same coin. The only difference is, while disturbance
    causes pain, fascination gives pleasant experiences and brings calm and
    peace to autistic people (although at the cost of their withdrawal).
    Sometimes people with autism, when they have given up fighting in an
    incomprehensible world, rescue themselves from overload to an
    entertaining, secure and hypnotic level of hyper-: watching the reflection
    of every element of light and colour, tracing every patterned shape and
    vibration of noise as it bounces off the walls (Williams 1994). Donna
    Williams names it as the beautiful side of autism, sanctuary of the prison.
    Autistic people can be fascinated with different sensory stimuli, such as the
    smell of melting candles, rice cooking, the feel of velvet and marble, the
    taste of smooth, satiny wood, the pit-pat of bare feet on tiles, the look of
    clouds gliding high, the feel of a horse’s nose, the chalky taste of seashells
    (O’Neill 1999).
    The sources of fascinations are very individual. For example, to Liane
    Willey (1999) such visual elements as linear lines, symmetry, balance,
    straightness, perfect alignments, squares and triangles were appealing.
    Wendy Lawson (1998) finds certain colours fascinating. Her favourite
    colours are rich emerald green, royal blue, purple, and turquoise. A typical
    picture of an individual with autism is when he is sitting staring transfixed
    at the crystal, turning it around and around in front of his eyes, catching
    rainbows (Oliver in Williams 1994).
    64 Sensory Perceptual Issues in Autism and Asperger Syndrome
    One and the same stimulus can cause disturbance and fascination to
    different children.
    What to look for:
  10. Is fascinated with coloured and shining objects
  11. Is fascinated with certain sounds
  12. Is fascinated with certain textures
  13. Is fascinated with certain smells/tastes
  14. Is often engaged in complex ritualistic body movements,
    especially when frustrated or bored
  15. Spins, jumps, rocks, etc. especially when frustrated or bored
    Vicky hates the sound of running water, whereas John is fascinated with
    it. Alex is disturbed by bright lights, whereas Helen enjoys looking at
    Inconsistency of perception (fluctuation)
    One of the baffling features of autistic people is their inconsistent perception of sensory stimuli. Two types of this inconsistency can be distinguished: fluctuation between hyper- and hypo-; and fluctuation between
    hyper-/hypo- and normal (‘in’ and ‘out’).
    Fluctuation between hyper- and hyposensitivity is quite common. A
    child who appears to be deaf on one occasion may react to an everyday
    sound on another occasion as if it is causing acute pain; visual stimuli that
    may appear so bright on one occasion will on another occasion appear
    very dim. Similarly, reaction to pain may vary from complete insensitivity
    to apparent ‘over-reaction’ to the slightest knock (Jordan and Powell
    1990). Sometimes a particular food, which is one of the favourites, will be
    rejected for no particular reason (Legge 2002).
    Ornitz and Ritvo (1968) suggest that autism is characterized by
    fluctuation between states of over- and underarousal resulting in a failure
    to modulate sensory intake adequately and an unstable perceptual
    Possible Sensory Experiences in Autism 65
    experience. The authors argue that the individual’s sensitivity to stimuli
    fluctuates and depends on whether the person is in a state of over- or
    underarousal. Ornitz (1989) states that the disturbance of sensory
    modulation involves all sensory modalities and is manifested as both
    under- and overreactivity to sensory stimuli and as self-stimulation. Ornitz
    suggests that optimal levels of stimulation will vary across autistic persons
    as a function of developmental level, degree of familiarity with the
    situation, and biologically based individual differences, including the
    severity of autistic disorder. This model assumes that the disturbances of
    sensory modulation are the primary symptoms and the impairments of
    social interaction, communication, language and bizarre behaviour are
    consequences of a dysmodulation of sensory input.
    In personal accounts people with autism describe their experience of
    ‘unreliable’ perception, for example:
    Sometimes when other kids spoke to me I would scarcely hear, then
    sometimes they sounded like bullets. (White and White 1987)
    It [hearing] gets louder sometimes… Things seem suddenly closer
    sometimes. Sometimes things get suddenly brighter. (Oliver in
    Williams 1994, p.189)
    Fluctuation between hyper-/hypo- and normal (‘in’ and ‘out’). Dr
    Freeman (1993, p.5) describes perception of the world by people with
    autism ‘like an FM radio that is not exactly tuned on the station when you
    are driving down the freeway. Sometimes the world comes in clearly and at
    other times it does not.’
    People with autism contribute to the explanation of this phenomenon.
    Donna Williams (1994) compares autism with a seesaw: when it is up or
    down she cannot see a whole life; when it is passing through in the middle
    she gets to see a glimpse of the life she would have if she were not autistic.
    J.G.T. VanDalen terms it as ‘suddenly falling out of autism’ and describes
    his personal experience of this process as follows: ‘the stay in the
    non-autistic condition lasts only a few minutes…the exit-procedure
    occurs instantaneously, the return is gradual’ (1995, pp.13, 14).
    Interestingly, it is these experiences that have brought VanDalen to the
    conclusions that:
    66 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • Autism is primarily a perceptual deficit, as during these short
    periods when his ‘perception was normalized’ he ‘noticed
    above all the diffused fear (he constantly experienced) was
    completely vanished…the habitual occupation with inanimate
    physical objects disappeared in favour of all the (warm) feelings
    that belonged to normal relationships’ (p.13).
  • ‘The degree of autism within an individual can vary
    considerably even to the point of ‘suddenly falling out of it’
    What to look for:
  1. Responds differently (pleasure – indifference – distress) to the
    same visual/auditory/olfactory/gustatory/tactile stimuli,
    movement activities (swings, slides, spinning, etc.)
  2. May have different muscle tone (low – high)
  3. Pencil lines, letters, words, etc. are uneven (e.g. sometimes too
    tight, sometimes too faint)
    Vicky can eat everything she is given one day, and refuses to eat even
    her favourite food (sausage) on the other. Alex can respond differently
    to the same visual (colours, patterns) or auditory stimuli (the sound of
    heating system, fan) depending on his physical state and the value of
    his ‘cup’.
    (See Vulnerability to sensory overload below.)
    Fragmented perception (perception ‘in bits’, stimulus
    Because of gestalt perception, when too much information needs to be
    processed simultaneously, very often people with autism are not able to
    ‘break’ the whole picture into meaningful units and to interpret objects,
    people and surroundings as constituents of a whole situation. Instead they
    process ‘bits’ that happen to get their attention.
    Possible Sensory Experiences in Autism 67
    This fragmented perception can affect all the senses:
    I had always known that the world was fragmented. My mother was
    a smell and a texture, my father was a tone, and my older brother was
    something, which was moving about. (Williams 1992, p.11)
    I remember being attracted to pieces of people’s faces. I might have
    liked the color of the eyes, the texture of the hair or the straightness
    of the teeth. (Willey 1999, p.23)
    Sometimes people would have to repeat a particular sentence several
    times for me as I would hear it in bits and the way in which my mind
    had segmented their sentence into words left me with a strange and
    sometimes unintelligible message. It was a bit like when someone
    plays around with the volume switch on TV. (Williams 1992, p.61)
    The perception of parts instead of wholes and utilizing only a very limited
    amount of available information is known as stimulus overselectivity
    (Lovaas et al. 1971). The result is that autistic people often react upon parts
    of objects or people as being complete entities:
    Where someone else may have seen ‘crowd’, I saw arm, person,
    mouth, face, hand, seat, person, eye… I was seeing ten thousand
    pictures to someone else’s one. (Williams 1998, p.21)
    I did not see whole. I saw hair, I saw eyes, nose, mouth, chin, …not
    face. (Alex in Williams 1999, p.180)
    One of the theories attempting to explain this phenomenon is the central
    coherence theory (Frith 1989; Happe 1994): people with autism lack the
    ‘built-in form of coherence’ and, as a result, they see the world as less integrated, i.e. analytically rather than holistically.
    In contrast to weak central coherence hypothesis in autism, one may
    hypothesize that people with autism possess a very strong drive for
    coherence (i.e. holistic perception of the world) with the main difficulty
    being to break the gestalt into meaningful units in order to analyse them
    separately. Without perceiving separate units as integrated parts of a
    whole, it is impossible to interpret the situation. Brad Rand, a person with
    autism, suggests that one of possible causes for seeing things as
    disconnected might be lacking the resource(s) to process all relevant parts
    of a stimulus at once. This, in turn, could result in either overly narrow
    68 Sensory Perceptual Issues in Autism and Asperger Syndrome
    attentional focus or insufficient memory resources to handle the task. In
    this case, the relatedness of things disappears. Everything seems to be
    conceptually a separate and unrelated entity; ‘on’ and ‘next’ and ‘in front
    of ’ do not mean much anymore, because whatever something is ‘on’, ‘next
    to’ or ‘in front of ’ no longer has a reality until it itself is focused upon
    directly (Williams 1999).
    Fragmented perception caused by inability to ‘break gestalt’ into
    integrated and meaningful parts fits into the definition of weak central
    coherence. Thus, we may conclude that weak central coherence theory
    may be applied at later stages of sensory perceptual processing.
    The perception ‘in bits’ can be clearly seen in drawings by some autistic
    children. A 13-year-old verbal autistic boy was drawing a church (Figure
    3.3). He was commenting while drawing: ‘I’m going to draw a church. A
    flag on the church. A clock – twenty past two. And then I’m going to draw
    a big window at the church. A bell – goes ding-ding. Done it!’
    Possible Sensory Experiences in Autism 69
    Figure 3.3 ‘Church’. Drawing by D., 13 years old
    In the state of fragmented perception, the person has great difficulty in
    dealing with people as they seem not only to consist of many unconnected
    pieces but also the movements of these ‘bits of people’ are unpredictable.
    The strategy to cope with the problem is to avoid people and never look at
    them. It does not mean that they cannot see an entire person (perceptual
    level). They seem to be unable to process the meaning of an entire person
    but process them bit by bit instead. As a result the mental image of a ‘collection of bits’ is often meaningless and often frightening. Fragmentation
    complicates the interpretation of facial expressions and body language and
    thus hinders or even blocks the development of non-verbal communication.
    Let us have a look at the children’s drawings again. Two autistic boys
    drew ‘portraits’ of their mothers (Figures 3.4 and 3.5). It is no wonder that
    these children find social interaction very difficult, if not impossible. We
    often describe them as ‘aliens’, but don’t we look aliens to them?
    70 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 3.4 ‘Mother’s portrait’, by D.
    This category also includes a sort of ‘tunnel vision’ experienced by some
    people with autism:
    I picked up his hand and looked at it closely. I traced it with my eyes
    from the fingers to the shoulder, from the shoulder to the eyes, down
    to the nose and mouth. Ian was a jigsaw of bits that my mind was in
    no state to make sense of as a whole. (Williams 1999, p.21)
    Fragmentation may be felt in all sensory modalities. For example, Alex is
    sure that he (like everybody else) has two foreheads and always asks his
    mother to kiss ‘both’ – ‘this one and that one’.
    As some individuals with autism perceive everything in pieces they
    need time to adjust to different surroundings. As the number of objects
    seen by them is greater (because they see different images of one and the
    Possible Sensory Experiences in Autism 71
    Figure 3.5 ‘Mother’s portrait’, by Alex
    same object from different angles – VanDalen 1995) – they do not feel safe
    in this chaos of things and people. As a consequence of this fragmented
    perception autistic individuals exhibit maintenance of sameness, resistance
    to change, anxiety in unfamiliar places.
    Perception ‘in bits’ means that autistic individuals define people and
    places and things by these bits. They can suddenly find once familiar
    things to be strikingly unfamiliar if slight components are changed, such
    as when the furniture has been moved or someone does not wear the same
    coat as usual (Williams 1996). As they process what they perceive piece by
    piece and not as a whole, they recognize things and people by the ‘sensory
    pieces’ they store as their definitions. For instance, they may ‘recognize’
    their mother by the colour of her dress and may not ‘recognize’ her if she
    wears a dress of different colour, or they may know people and objects by
    smell, sound, intonation, the way they move, etc.
    People with Asperger syndrome (especially women) are reported to
    have a very poor sense of direction. When they approach even a familiar
    street from an unusual direction, they do not immediately recognize it.
    Another ‘side-effect’ of perception in bits is ‘a sense of fear that is not
    specifically related to certain objects but is originated in the fact that [the]
    first encounter with a physical object is a partial one’ (VanDalen 1995,
    p.12). VanDalen compares this experience with a confrontation with a
    silhouette in the dark: one knows that something is there but it is not
    altogether immediately clear what it is.
    It is difficult to identify the ‘sensory concepts’ the child has stored in
    his memory. However, some parents intuitively ‘know’ what might upset
    their child.
    What to look for:
  4. Resists any change
  5. Selects for attention minor aspects of objects in the
    environment instead of the whole scene
  6. Gets lost easily
  7. Does not recognize people in unfamiliar clothes, on
    72 Sensory Perceptual Issues in Autism and Asperger Syndrome
  8. Hears a few words instead of the whole sentence
  9. Complains about some parts of the clothes, smells of some
    pieces of food, etc.
  10. Is confused with the food he used to like
  11. Complains about limbs, part of the body
  12. Resists new motor activities
    Vicky often has problems with parts of her clothes – ‘It hurts here’
    (trying to tear off her right sleeve while feeling comfortable with her
    left one).
    Alex ‘sees in bits’: ‘Her leg disturbs me’. ‘Dasha’s [the cat] head has
    turned round.’
    Distorted perception
    Although fragmented perception can be also termed distorted, in this
    book distorted perception means not fragmentation but rather change
    (distortion) in the perception of the form, space, sound, etc. Distortions are
    reported to become worse in the state of nervous overarousal and information overload.
    In the field of vision the most common distortions reported by the
    individuals with autism are poor/distorted depth and space perception,
    seeing a 2D world, ‘double vision’, distortions of shape, size and
    movement. Because of these distortions, their perception of space may be
    different; space may seem to be expanded, or, on the contrary, look smaller.
    Problems with proprioceptors may bring trouble with understanding
    boundaries and relationships between objects in space and their own
    bodies; sometimes they are confused about the parts of their bodies. For
    example, Oliver (in Williams 1994, p.191) describes his experiences of
    ‘losing his legs’: ‘I had no sense of my body from my waist down. I feel like
    I was flying.’ As a teenager, Donna Williams spent many hours trying to
    shake a hand off an arm without the perception that both were part of her
    Possible Sensory Experiences in Autism 73
    body (1996, p.14). Some people experience difficulties in perception of
    Occasionally I lost all sense of perspective. Something would seem
    monstrously large if coming towards me at speed, or if I was unprepared. Someone suddenly leaning over me could frighten me enormously. I felt something was falling onto me and that I’d be crushed
    underneath it. (Gerland 1997)
    The bitumen floor of the school playground intrigued me and I
    noticed that as I ran it seemed to run with me. (Lawson 1998, p.29)
    One of the characteristic behaviours of autistic children is to spin themselves and enjoy swings without becoming dizzy. The individuals with
    autism report that these activities help them normalize perception and a
    vestibular system. Many autistic children would climb to great heights and
    jump down in desperate attempt (though not consciously) to normalize a
    vestibular system.
    Russell (1994) suggests that one of the basic deficits in autism might
    be disturbance at the stage of ‘efferent copying’. In normal development
    the ‘efferent copying’ gives the sense of one’s own agency, i.e. the nervous
    system does not only control movements of the head and eyes to scan the
    environment or keep track of moving objects, but also records those
    movements in order to distinguish the case where the movement is in the
    person’s head and eyes, and the world is still. In autism, the researcher
    suggests, the disturbance at the stage of ‘efferent copying’ prevents the
    person having a sense of himself or herself as an agent. In this case the
    person would not get dizzy in the normal way from spinning and,
    moreover, might seek for the kinds of sensations that would give
    movement stimulation free from recording head and eye movements in
    relation to the world.
    What to look for:
  13. Fears heights, stairs, escalators
  14. Has difficulty catching balls
  15. Appears startled when being approached
    74 Sensory Perceptual Issues in Autism and Asperger Syndrome
  16. Compulsive repetitive hand, head or body movements that
    fluctuate between near and far
  17. Pronunciation problems
  18. Unable to distinguish between some sounds
  19. Hits eyes/ears/nose/oneself
  20. Difficulty with hopping, jumping, skipping, riding a
  21. Climbs high into a tree, jumps off tall fences, etc.
    Helen does not seem to feel boundaries of her body and its position in
    the classroom. She often hits herself when confused with the instruction
    to move her body, for example, ‘Don’t lean over the table.’
    Vicky has poor depth and space perception. She is afraid of descending
    the stairs, and when ascending she lifts her feet too high above the stairs.
    Sensory agnosia (difficulty interpreting a sense)
    The consequence of being unable to filter sensory information and being
    flooded with sensory stimuli at the rate the person cannot cope, is being
    able to sense (see, hear, etc.), but unable to attach the meaning to (i.e. to
    interpret) the sensations. The person is ‘blind while seeing’ (VanDalen
    1995), ‘deaf while hearing’, etc. Donna Williams (1994; 1996; 1998;
    1999) calls these experiences ‘meaning-blind/meaning-deaf/touchdead’. She compares this condition with being deaf-blind, the main difference being, the blind get meaning without seeing, while the
    meaning-blind see without meaning. The deaf-blind may have lost their
    sense but the meaning-blind/deaf lost the sense (meaning) (Williams
    1994; 1998).
    In the state of sensory agnosia, interpretation of any sense can be lost;
    they often act as if they were really blind, deaf, numb, sometimes ‘dead’. It
    is a very frightening experience. Each individual develops his/her own
    strategies to cope with it.
    Possible Sensory Experiences in Autism 75
    What to look for:
  22. Feels/acts blind/deaf/etc.
  23. Rituals
  24. Has difficulty in interpreting smells/tastes
  25. Seems not to know what their body is doing
  26. Becomes disoriented after a change in head position
    Helen often behaves as if she were deaf; she does not react to any sound
    at all and does not seem to understand what she is expected to do.
    Delayed perception (delayed processing)
    It is not uncommon for autistic children to exhibit delayed responses to
    As a child…it appeared as though I didn’t feel pain or discomfort,
    didn’t want help, didn’t know what I was saying, didn’t listen or
    didn’t watch. By the time some of these sensations, responses or
    comprehensions were decoded and processed for meaning and
    personal significance, and I’d accessed the means of responding, I
    was fifteen minutes, one day, a week, a month, even a year away from
    the context in which the experiences happened. (Williams 1996,
    A person can be delayed on every sensory channel.
    Concerning vision, VanDalen (1995) attempts to give one of the
    possible explanations of this phenomenon: the acquisition of the full
    meaning requires some observation time from different points of view;
    besides, people with autism must translate perceptual configurations into
    their proper terminology.
    Perception by parts requires a great amount of time and effort to
    interpret the whole. Many autistic individuals emphasize the amount of
    ‘thinking’ necessary to make sense of the world. VanDalen describes the
    process as ‘thinking in the background’ – constructing an object by using
    explicit trains of thought, whereas for non-autistic people this process is
    76 Sensory Perceptual Issues in Autism and Asperger Syndrome
    automatic and effortless. To illustrate the point VanDalen describes how he
    perceives objects:
    When I am confronted with a hammer, I am initially not confronted
    with a hammer at all but solely with a number of unrelated parts: I
    notify a cubical piece of iron within its neighborhood a coincidental
    bar-like piece of wood. After that, I am struck by the coincidental
    nature of the iron and the wooden thing resulting in the unifying
    perception of a hammerlike configuration. The name ‘hammer’ is
    not immediately within reach but appears when the configuration
    has been sufficiently stabilized over time. Finally, the use of a tool
    becomes clear when I realize that this perceptual configuration,
    known as ‘hammer’, can be used to do carpenter’s work. (VanDalen
    1995, p.11)
    The experience of ‘delayed hearing’ is termed by Dr Rimland ‘delayed
    mental audition’: when the question has been sensed and recorded without
    interpretation until the second (internalized) hearing. Rimland describes
    the effect of ‘delayed mental audition’ as an echo; and the sound of the
    echo-like voice is high-pitched, hollow and parrot-like, i.e. the internally
    experienced voice duplicates precisely the classical manner of speech of an
    autistic child. Rimland names it the ‘closed loop’ phenomenon when the
    stimuli enter memory and later emerge unchanged (Rimland 1964,
    In the most extreme cases, it can take years to process what has been
    said. Sometimes it takes days, weeks or months. The words, phrases,
    sentences, sometimes the whole situations, are stored and they can be
    triggered at anytime. In less extreme cases, to process something takes
    seconds or minutes. They may be able to repeat back what has been said
    without comprehension that will come later.
    Due to delayed processing autistic individuals may need some time to
    process the question and their response. (Immediate responses are often
    given on ‘autopilot’, triggered by memories.) Before proper response
    autistic people must go through a number of separate stages in perception,
    and if this long decision-chain is interrupted by the outside world, the
    autistic person must start all over again because overselectivity has
    changed the scene completely (VanDalen 1995). In other words, an
    interruption effectively wipes away any intermediate result, confronting
    Possible Sensory Experiences in Autism 77
    the autistic person literally ‘for the first time’ with the same
    object/event/situation. VanDalen suggests that autism could possibly be
    understood as an extension of the processing time of impressions. This
    definition implies the importance of giving autistic people time to enable
    them to finish their perceptual work successfully and ‘to experience
    meaning that is awaiting on the end of the long road of perception’
    (VanDalen 1995).
    All these ‘continuous obligatory thinking activities connected with
    everyday object-perception’ (VanDalen) require much effort and energy,
    that is another reason for autistic children to resist any changes, and to
    prefer familiar surroundings where it is much easier for them to control
    their perceptual world. Every step of perception they experience explicitly,
    in a non-automatic way with a great mental effort involved. That is why
    they are often unable to start the action immediately.
    There are several consequences of delayed processing. One of them is
    ‘experiencing meaning’ out of the context it should have been
    experienced, i.e. new experiences, no matter how similar to previous ones,
    are perceived as new, unfamiliar and unpredictable, and responses to them
    are poor regardless of the number of times the person has experienced the
    same thing. Another one is that, as the amount of time needed to process
    any experience often remains slow (or delayed), regardless of having had
    similar experiences in the past, things do not get easier with time or
    learning (Williams 1996). They are not able to generalize and apply
    something they have learned in one situation to another.
    Their subjective experience of time is also different from that of
    non-autistics. For them, time might seem faster, whereas non-autistic
    people may think that autistic children are slow in their decision-making.
    What to look for:
  27. Response to visual/auditory/gustatory/olfactory/tactile stimuli
    is delayed
  28. Echolalia in monotonous, high-pitched, parrot-like voice
    78 Sensory Perceptual Issues in Autism and Asperger Syndrome
  29. Any experiences are perceived as new and unfamiliar, regardless
    of the number of times the person has experienced the same
  30. Very poor at sports
  31. Seems oblivious to risks of heights, etc.
  32. Holds head upright, even when leaning or bending over
    All the children in the class display delayed perception to the auditory
    stimuli; John, Helen and Vicky could respond to the question in a few
    minutes; Alex sometimes gives responses even in a few days. It is very
    difficult to connect his ‘announcements’ with the question he was asked
    a few days before. To an outsider, these responses, unconnected to the
    present situation, seem weird.
    Vulnerability to sensory overload
    Many autistic people are very vulnerable to sensory overload. They may
    become overloaded in situations that would not bother other people
    (Blackburn 1997; Lawson 1998; Morris 1999; Willey 1999). The causes
    of information of overload can be:
  • the inability to filter out irrelevant or excessive information
  • delayed processing
  • if the person works in mono but is forced to attend to the
    information from several channels
  • distorted or fragmented perception, resulting in anxiety,
    confusion, frustration and stress that, in turn, may lead to
    Donna Williams (1996) emphasizes that sensory hypersensitivity can
    happen both independently of information overload and as a direct result
    of it. The overload can lead to hypersensitivity (with its resulting physical
    pain, tantrums and difficult behaviour). Sometimes it can result in ‘accumulation of unknown knowing’, i.e. when information gets processed
    outside of conscious awareness so that one is not aware of what one knows
    Possible Sensory Experiences in Autism 79
    nor able consciously or voluntarily to access that knowledge, though
    sometimes it can be triggered or cued by something outside (Williams
    1996); or might go further to ‘total systems shutdowns’ (Blackburn 1997;
    Williams 1996). The process from hypersensitivity to systems shutdowns
    may be fast (i.e. sensory discomfort may be short lasting or not experienced at all) or may be slow (i.e. sensory discomfort may be prolonged).
    The information overload may be dispersed before it leads to systems
    shutdowns or it may not. In the first case, a person may experience severe
    sensory hypersensitivity (colours becoming too intense, light becoming
    too bright, certain pitches becoming intolerable, certain patterns
    becoming obtrusively distinct, touch may feel ‘prickly’ or ‘ticklish’, or
    provoke ‘shock’) yet continue to process information. If information
    overload is not diffused in time, it can result in temporal sensory agnosia –
    a temporary inability to process touch, sound or visual information
    (Williams 1996). For example:
    Overload had set in. Explanations were just blah-blah-blah… My
    vision started to climb… The lights became brighter. I was tickled
    by the effect on my senses and began to giggle. The hypersensitivity…climbed even higher…I squinted and grinned, the strain and
    the confusion of the sudden change from happy to excited to
    tortured took place within the space of fifteen minutes with no cues
    to tell me why or what I was feeling and no time to reflect. My ship
    was sinking and no one knew. (Williams 1994, p.106)
    Together, the sharp sounds and the bright lights were more than
    enough to overload my senses. My head would feel tight, my
    stomach would churn, and my pulse would run my heart ragged
    until I found a safety zone. (Willey 1999, p.22)
    The causes of information overload on auditory level are reported not to
    do with the perception of pitch and volume but rather with the number of
    simultaneous sound sources, the duration of these stimuli and the rate of
    the bombardment relative to process capacity. Then hearing becomes
    acute, sounds that are normally inaudible can be as audible as usual sounds,
    the perception of these additional sounds can make them intensely
    unbearable (Williams 1996). Donna Williams considers this reverberation
    of sound as one of the biggest contributors to sound information overload.
    80 Sensory Perceptual Issues in Autism and Asperger Syndrome
    The visual equivalent of sound reverberation, according to Donna
    Williams, is light refraction (or ‘shine’) that can cause a visual effect of
    shooting out streams or ‘sparks’ of light and ‘visually cutting up’ people
    and objects. The same can happen with touch: when too much of visual
    and auditory information has been taken in, the sense of touch can be
    oversensitive, ‘sharp as a pin’, and to be touched can be ‘shocking’
    (Williams 1996).
    The threshold for processing sensory stimuli varies among autistic
    persons, at different ages and in different environments. For example:
    When I was a small child, my threshold for processing blah-blah was
    only a few seconds. When I was about ten or so, my threshold…was
    about five to ten minutes. When I was a teenager and up to my
    twenties, this threshold was about fifteen minutes to half an hour.
    Now it is about twenty to forty-five minutes. In a more accommodating environment…these thresholds could have been much higher
    than they were. (Williams 1996, p.204)
    Dena Gitlitz (cited in Donnelly 1999) names it Eight Ball Theory: Eight
    Ball is similar to a juggler that can successfully juggle seven pins or balls
    but if you throw in one more they will drop them all. Dena has a limited
    capacity for ‘how many balls she can juggle’ successfully. This phenomenon could be called the ‘rule of the last drop’: if the child’s inner ‘cup’ is full
    already (whatever the reasons for this may be) the slightest trigger (which
    on the days when the ‘cup’ is empty would not be noticed by the child)
    might produce an overload.
    Each individual may cope with overwhelming stimuli in different
    ways: mono-processing, avoidance of direct perception, withdrawal,
    What to look for:
  1. Sudden outbursts of self-abuse/tantrums/difficult behaviours
  2. Withdrawal
  3. Tires very easily, especially when in noisy/bright places, or
    when standing
    Possible Sensory Experiences in Autism 81
  4. Gets nauseated or vomits from excessive movements (swings,
    merry-go-rounds, cars, etc.)
    Alex is very vulnerable to sensory overload. The speed with which his
    ‘cup has been filled’ depends on the number and intensity of the stimuli.
    For example, if there are two or more people talking at once, he is sure
    to be overwhelmed; bright lights (especially fluorescent lights) and lots
    of movement around him will cause his outburst in a few minutes.
  5. Gestalt is a shape, pattern, or structure, which as an object of
    perception forms a specific whole and has properties, which cannot
    be completely deduced from a knowledge of the properties of its
    parts. The term was originally used by a ‘school’ of psychology –
    Gestalt psychology, which emphasizes the relational aspects,
    especially of perceiving, in strong opposition to atomistic concepts.
    82 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Chapter 4
    Perceptual Styles
    Autistic children seem to develop (voluntarily or involuntarily) the ability
    to control their awareness of incoming sensory stimuli in order to survive
    in a world bombarding them with extraneous information. These compensatory or defensive strategies are reflected in acquired perceptual styles.
    Most commonly reported perceptual styles are:
  • mono-processing
  • peripheral perception (avoidance of direct perception)
  • systems shutdowns
  • compensating for unreliable sense by other senses
  • resonance
  • daydreaming.
    To avoid overload of sensory information, only one modality is processed
    consciously by the brain (though subconsciously a great amount of information may get in – ‘accumulation of unknown knowing’ – Williams
    1994). The person might focus on one sense, for example, sight, and
    might see every minute detail of the object. However, while his vision is
    on, the person might lose awareness of any information coming through
    other senses. Thus, while the person sees something, he does not hear
    anything, and does not feel touch, etc. When the visual stimulus fades out,
    the sound could be processed, but then the sound is the only information
    the person is dealing with (i.e. disconnected from sight). As the person
    focuses on only one modality at a time, the sound may be experienced
    louder because it is all the person focuses on (hypersensitivity).
    According to the number of senses working at a time the person can be
    classified into ‘multi-track’ versus mono-processing (Williams 1996) or
    ‘being singly channelled’ (Lawson 1999). The ability to receive and
    process information via multiple sources can also be referred to as
    ‘polytropism’, in contrast to ‘monotropism’ (using one channel at a time)
    (Lawson 2001; Murray 1992).
    Wendy Lawson believes that central coherence (the ability to draw
    connections together from the ‘big picture’) can only occur with least
    effort, when one has access to the big picture via many different channels
    (polytropism). Wendy argues that in monotropism, where all the attention
    is gathered into one place, there is an extreme central coherence but of
    different type. ‘Monotropic central coherence’ excludes information from
    outside the attention channel (Lawson 2001).
    Most people use their senses simultaneously. When they are hearing
    something, they are still aware of what they see and feel emotionally and
    physically, because they are ‘multi-tracked’. For people who work in mono
    to process the meaning of what they are listening to while being touched
    may be to have no idea where they were being touched or what they
    thought or felt about it. To process the location or special significance of
    being touched while someone is showing them something means that they
    see nothing but meaningless colour and form and movement (Williams
    1996). For example, Donna Williams’s inner-body sense, like everything
    else, was mostly in mono: if she touched her leg she would feel it on her
    hand or on her leg but not both at the same time (Williams 1994). She had
    big restrictions in being able to process information from the outside and
    inside at the same time, for example, touching the furniture she could feel
    the texture of the wood but would have no sense of her own hand. She
    could also switch channels and feel her own hand but would lose sensation
    of what her hand was in contact with. Without being able to process her
    own body sensations in relations to textures it was, perceptually, as though
    either she did not exist and other things did or she existed and they did
    not. She was either in a constant state of jolting perceptual shifts or
    remained on one sensory channel or the other (Williams 1998).
    84 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Actually, this type of processing is taken advantage of by the parents of
    some autistic children who are ‘picky eaters’. Children with very restricted
    diets (hypersensitive to taste/smell, texture of the food) will eat better if
    they are watching a video, listening to music or talking to someone.
    Jared Blackburn (1999) describes the trouble he had processing many
    things at once. For example, he could not take notes at the lecture because
    he could either listen or write, but not both. Many of his teachers thought
    he was being lazy or inattentive because he did not take notes and did not
    look at them and had a blank look on his face, but he was actually almost
    hypnotically focused on what they were saying. It is a matter of taking one
    thing at a time (Kathy French cited in Donnelly 1999).
    Individuals with autism define this mono-processing (monotropism)
    as one of their involuntary adaptations to avoid sensory overload or
    If I’m looking at something and listening to something at the same
    time, too much information might come in my eyes and ears at the
    same time, so I might touch something. That gets information going
    in a different sense, through my touch, and it lets my eyes and ears
    have a rest. (Rand, undated)
    It is a mechanism by which the time and energy that goes into processing
    gets spread a little less thinly than it otherwise might: switching between
    different channels gives them an opportunity to keep the remaining ones
    going more efficiently (Williams 1996; 1998). Donna Williams illustrates
    this phenomenon as follows:
    This is like having one employee working in a huge department
    store instead of having a whole staff. If a customer has a demand in
    the shoe department whilst the worker is presently dealing with a
    demand in the toy department, the customer in the shoe department
    wouldn’t find anybody there…and sometimes (this single worker
    closes) the shop in different departments when she can’t cope with
    the demand. (Williams 1996, pp.99, 100)
    We should be aware of this style of perception in order to give the child
    information in a way he will be able to process. The matter is complicated
    by the fact, that they could switch channels and our task is to find out
    which channel ‘is open’ to get the information.
    Perceptual Styles 85
    What to look for:
  1. Does not seem to see if listening/smelling/feeling
    taste/touching, etc.
  2. Does not seem to hear if looking/smelling/feeling
    taste/touching, etc.
  3. Does not seem to feel taste if
    looking/listening/smelling/touching, etc.
  4. Does not seem to smell if seeing/hearing, etc.
  5. Does not seem to feel being touched if looking/listening, etc.
  6. Fails to define the texture or location of touch
  7. Does not seem to know the position of the body in space/what
    the body is doing when looking at/listening to something
  8. Does not seem to mind any movements when looking
    at/listening to something
    The teacher shows a card with number ten. John is looking at it very
    attentively but he ‘loses’ the auditory instruction, ‘Say the previous
    number’, and seems very confused without any understanding of what
    is expected of him.
    Peripheral perception (avoidance of direct perception)
    One of the characteristics of autism is avoidance of eye contact. It is an
    example of peripheral perception, as it turns out that avoidance of direct
    perception is not restricted only to vision but also includes other sensory
    One of the theories to account for this is that people with autism use
    peripheral vision because their central vision is hypo- while their
    peripheral vision is hyper-. However, analysis of the personal accounts of
    individuals with autism shows that often they do not use their
    direct/central perception because ‘it hurts’, i.e. it is hyper-. For instance,
    86 Sensory Perceptual Issues in Autism and Asperger Syndrome
    for Nony eye contact was painful: ‘It was not quite like a broken bone or a
    burn but it can only be described as pain’ (Nony 1993).
    Jean-Paul Bovee describes eye contact as something that he always has
    trouble with, as all of the stress that is put on doing it makes him more
    nervous, tense, and scared. Jasmine O’Neill reports that ‘gazing directly at
    people or animals is many times too overwhelming… Some autistic people
    don’t even look at the eyes of actors or news reporters on television’
    (O’Neill 1999, p.26).
    Some of the problems autistic people have with making eye contact
    may be nothing more than intolerance for the movement of the other
    person’s eyes. Temple Grandin writes about an autistic person for whom
    looking at other people’s eyes was difficult because the eyes did not stay
    still (Grandin 1996a).
    Direct perception in autism is often hyper. It can cause sensory
    overload resulting in switching to mono:
    I actually hear you better when I am not looking at you…eye contact
    is…uncomfortable…[people] will never understand the battle I
    have gone through to be able to do this. (Lawson 1998, p.11)
    Perceiving sound, visual stimuli, etc. directly and consciously may often
    result in fragmentation: the person can interpret the part but lose the
    whole, and incoming information is interpreted piece by piece. Donna
    Williams (1998) explains that when taking things indirectly, peripherally,
    the fragmentation did not happen; things were more cohesive, they
    retained context, whereas the mind-jolting senses of direct vision and
    direct hearing could not be consistently relied upon as meaningful primary
    Some autistic people seem to be hypersensitive when they are
    approached directly by other people:
    Dr Marek was ‘touching’ me with his eyes… I was afraid… I was
    being hurt. (Williams 1994, p.121)
    It can feel creepy to be searched with the eyes. (O’Neill 1999, p.26)
    Someone looking directly into my eyes felt like an attack. (Nony
    Perceptual Styles 87
    When I look someone straight in the eye, particularly someone I am
    not familiar with…I feel as if their eyes are burning me and I really
    feel as if I am looking into the face of an alien. (Jackson 2002, pp.70,
    For some, if they are looked at directly (even if they do not ‘return the
    gaze’), they may feel it as ‘a touch’ – sort of ‘distance touching’ with actual
    tactile experience that can be painful. Avoidance of direct perception for
    autistic people is another involuntary adaptation that helps them to survive
    in a sensory distorted world by avoiding (or decreasing) information
    Autistic children often seem to look past things and are completely
    ‘absent’ from the scene. However, it could be their attempt to avoid
    experiencing a visual/auditory stimulus directly. This strategy gives them
    the ability to take in sensory information with meaning.
    They can often understand things better by attending to them
    indirectly, for example, by looking or listening peripherally (such as out of
    the corner of one’s eye or by looking at or listening to something else). In
    this case it is a kind of indirectly confrontational approach in contrast to
    the ‘normal’ directly confrontational one (Williams 1998). The same is
    true for other senses if they are hypersensitive: indirect perception of smell
    or ‘instrumental touch’ (Williams 1994) are often defensive mechanisms to
    avoid overload.
    What to look for:
  9. Avoids direct eye contact
  10. Reacts to the instructions better when they are ‘addressed to the
  11. Can tolerate only ‘instrumental’ (not ‘social’) touch
  12. Avoids direct smell/taste
  13. A very careful eater
  14. Has difficulty in imitating/copying movements
  15. Avoids balancing activities
    88 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Alex, John and Vicky ‘hear better’ (i.e. react to the instructions) if the
    instructions are ‘addressed to the wall’. Alex and Helen often use their
    peripheral vision and seem to see what is going on without directly
    looking at it. Alex cannot tolerate it when someone is looking at him
    directly and makes them turn away (‘Don’t look!’ ‘Turn away!’). He
    even complains if the cat is looking at him.
    Systems shutdowns
    Too much sensory overload may result in systems shutdowns, in which the
    person loses some or all of the normal functioning. Shutdown may feel different to different people, but is extremely unpleasant (Blackburn 1997).
    When the person cannot cope with sensory information, he may shut
    down some or all sensory channels. Many autistic children are suspected to
    be deaf, as they sometimes do not react to sounds. Their hearing, however,
    is often even more acute than average, but they learn to ‘switch it off ’ when
    they experience information overload. A child with sensory overload
    learns to avoid overwhelming sensory bombardment early in life. When
    sensory input becomes too intense and often painful a child learns to shut
    off his sensory channels and withdraw into his own world. Temple
    Grandin (1996b; 2000) hypothesizes that by doing this the autistic child
    creates his or her own self-imposed sensory deprivation that leads to
    secondary central nervous system (CNS) abnormalities that happen as a
    result of the autistic child’s avoidance of input. To back up her argument
    Grandin (1996b) cited animal and human studies that show that
    restriction of sensory input causes the CNS to become overly sensitive to
    stimulation (Aftanas and Zubeck 1964; Melzack and Burns 1965; Simon
    and Land 1987). The effects of early sensory restriction are often long
    lasting. The brainwaves of autistic children also show signs of high arousal
    (Hutt et al. 1964). The hypersensitivity caused by sensory deprivation
    seems to be relatively permanent. Autopsy studies indicate that cerebellar
    abnormalities occur before birth (Bauman 1991). However, the limbic
    system, which also has abnormalities, is not mature until the child is two
    years old. Temple Grandin argues that the possibility of secondary damage
    of the nervous system may explain why young children receiving early
    Perceptual Styles 89
    intervention have a better prognosis than children who do not receive
    special treatment do.
    The research on primates has shown that early social isolation may
    result in deficiencies in social behaviours among primates (‘primate
    isolation syndrome’). Isolation early in life results in significant changes in
    early experiences. These differences in experience may result in central
    nervous system modifications related to social deprivation. ‘By the time
    significant psychopathological systems demand intervention later in life,
    some aspects of the disorder may be attributable to the primary process,
    but others may reflect behavioural and neurobiological aspects of the
    primate isolation syndrome’ (Kraemer 1985, p.154). This argument was
    put forward by Kraemer in the context of schizophrenia. However, it could
    be applied to autism as well.
    Systems shutdowns may be considered as an involuntary adaptation
    (compensation) when the brain shuts certain systems off to improve the
    level of functioning in others (Williams 1996). Donna Williams
    distinguishes three basic forms of systems shutdowns:
  16. Shutdown in the ability to simultaneously process sensory
    information and thought, feeling, body sensation or the
    monitoring of intentional and voluntary expression: all
    processing capacity may be diverted to processing incoming
    sensory information and no connections may be made to
    responding to that information. Donna Williams calls this state
    ‘all other, no self ’. For example, Temple Grandin (1996a)
    remembers how at the age of three she was frustrated because
    although she could understand what people said to her, she
    could not get her words out. On the other hand, incoming
    information, which has previously been processed, may be
    responded to at the expense of being able to further process
    any more information (‘all self, no other’).
  17. Shutdown in the ability to simultaneously process sensory
    information on several channels at once: Donna Williams
    subdivides it into temporary partial and extended systems
    shutdowns. Temporary systems shutdowns work by shutting
    down the ability to process information on a number of
    channels so that information can be efficiently processed on
    90 Sensory Perceptual Issues in Autism and Asperger Syndrome
    whatever channel or channels are remaining. Temporary
    systems shutdowns can affect the processing of body awareness,
    touch, taste, smell, vision or hearing. They can be partial or
    almost total for any one sense. Partial shutdown means that
    only a part of processing may fall out of a particular sense
    (partial meaning deafness, partial meaning blindness, partial
    touch deadness, etc.). For example, a high-functioning person
    with autism could work with overload and shutdown in a way
    that never left him with any one system shutdown permanently
    but his systems in a constant state of shift (Jim in Williams
    1994). Total shutdowns mean that though, for instance, eyes
    continue to see and ears to hear, the brain does not process any
    meaning of what is being seen or heard. Temple Grandin
    (1996a) calls these states visual/auditory tuneouts or whiteouts.
    Extended systems shutdowns are where a particular systems
    shutdown is a compensation to handle information overload
    over an extended amount of time: days, weeks and, very
    occasionally, a few months and even years.
  18. Temporary or extended shutdown in the ability to maintain
    conscious and voluntary processing leads to the accumulation
    of the ‘unknown knowing’, i.e. the information is being
    perceived unconsciously, without the person’s awareness of
    receiving it.
    What to look for:
  19. Appears to be a mindless follower
  20. Surprises with knowing ‘unknown’ information
  21. Sometimes does not react to any tactile
  22. Seems not to know how to move his body (unable to change
    body position to accommodate task)
    Perceptual Styles 91
  23. Becomes disoriented in noisy/bright places
  24. Rocks unconsciously during other activities (e.g. watching a
    There are times when John and Helen seem to be mindless followers
    without any awareness of what is going on around them.
    Compensating for unreliable sense by other senses
    Because of hypersensitivity, fragmented, distorted perception, delayed
    processing or sensory agnosia, one sense is never enough for autistic
    people to make sense of their environment. Thus, in the case of visual distortions and meaning-blindness, they use their ears, nose, tongue or hand
    to ‘see’, i.e. they compensate their temporary ‘blindness’ through other
    senses. For example, a child can tap objects to produce the sound in order
    to recognize what it is, because visual recognition can be fragmented and
    meaningless. Some children smell people and objects to identify them. To
    many autistic people the senses of touch and smell are reported to be more
    reliable. Many autistic children touch and smell things, some constantly
    tap everything to figure out where the boundaries are in their environment, like a blind person tapping with a cane. Their eyes and ears function,
    but they are not able to process incoming visual and auditory information
    (Grandin 1996a). Those who experience visual and auditory distortions
    prefer using touch to learn about their environment – they ‘see’ the world
    mostly through their fingers.
    What to look for:
    Tests visual/auditory/gustatory/olfactory/tactile information by other
  25. Smells, licks, touches, or taps objects
  26. Looks for the source of the sound
  27. Inspects food before eating
  28. Watches their feet while walking
    92 Sensory Perceptual Issues in Autism and Asperger Syndrome
  29. Watches their hands while doing something
  30. Avoids climbing, jumping, walking on uneven ground
    John and Alex smell, touch or tap objects to check their visual
    perception of them. Vicky always inspects her food (smells it) before
    eating it.
    Fascination with certain stimuli may culminate with ‘losing oneself ’ in
    these stimuli to the extent that one can become ‘resonant’ with them.
    These terms were introduced by Donna Williams (1994; 1996; 1998;
    1999) to define a state when one ‘loses oneself in’/’becomes resonant’
    with something else. Here they are used to denote the higher degrees of
    fascination with sensory stimuli. The person can merge with (lose oneself
    in) different sensory stimuli as if the person became a part of the stimulus
    itself. These are very real experiences.
    Wendy Lawson describes her experience when the colours and
    fragrance were so vibrant to her senses that she could ‘feel’ them. While
    watching some shiny things she felt a sense of connection, she felt safe, as
    if she were part of them: ‘It was so intoxicating and I felt so alive’ (Lawson
    1998, p.2).
    Donna Williams describes how she could ‘feel’ colours:
    These streetlights were yellow with a hint of pink but in a buzz state
    they were an intoxicating iridescent-like pink-yellow. My mind
    dived deeper and deeper into the colour, trying to feel its nature and
    become it as I progressively lost sense of self in its overwhelming
    presence. Each of the colours resonated different feelings within me
    and it was like they played me as a chord, where other colours played
    one note at a time.
    It had been the same as long as I had known…some things
    hadn’t changed…since I was an infant swept up in the perception of
    swirling air particles, a child lost in the repetition of a pattern of
    sound, or a teenager staring for hours at coloured billiard balls,
    trying to grasp the experience of the particular colour I was climbing
    into. (Williams 1999, p.19)
    Perceptual Styles 93
    Willey (1999) loved the sensation that came from floating with water: she
    felt as if she was liquid, tranquil, smooth.
    In the state of ‘resonance’ one can sense the surface, texture and
    density of material without looking at it with physical eyes or touching it
    with physical hands or tasting it with a physical tongue or tapping it to
    hear how it sounds, i.e. sensing it with non-physical senses (the so-called
    ‘shadow senses’) (Williams 1999). Those who experience this condition
    can be ‘in resonance’ with colours, sounds, objects, places, plants, animals,
    people. For example:
    I could resonate with the cat and spent hours lying in front of it,
    making no physical contact with it. I could resonate with the tree in
    the park and feel myself merge with its size, its stability, its calm and
    its flow. (Williams 1998, p.44)
    ‘In resonance’ with people they can sense (‘see’, ‘hear’ etc.) thoughts,
    emotions, pain, etc. of other people, for example:
    It is rare that I know what anyone is actually thinking, but concurrent emotions are very common. (McKean 1994)
    When I was younger I heard a lot of noises in my head, spoken
    things and unspoken things. Tell me you can hear people think. I
    wish I didn’t. If there is a medication that will kill people’s thoughts
    I like (sic) to try it. (Walker and Cantello 1994)
    I physically felt the pain when someone banged themselves. Around
    someone with a broken leg, I felt their pain in my leg. (Williams
    1998, p.59)
    I…remember responding to people’s call by coming into the room,
    sometimes answering their request by going and getting what they’d
    wanted. People had seemed surprised at these behaviours because
    they hadn’t been verbally called or asked or that I was busy with
    things of my own at the time. (Williams 1998, p.27)
    A woman with Asperger syndrome describes how she ‘feels’ people: ‘I
    know when people do not like me, or find me strange and scary, no matter
    how polite and friendly they try to look. I just physically feel their attitude
    to me.’ Similar experiences have been reported by few other autistic indi94 Sensory Perceptual Issues in Autism and Asperger Syndrome
    viduals. Probably, some people are reluctant to share these experiences
    because there is always a fear to be considered ‘psychic’.
    Interestingly, cats and dogs seem to possess the similar sort of
    ‘telepathic’ ability. Sheldrake (1999) suggests it could be caused by some
    force field (‘morphic field’) that is not yet fully understood. Donna
    Williams (1998) offers her explanation of the phenomenon: the body is
    more than a physical form. It is also an energy form. Some people’s energy
    boundaries are more ‘open’ than for most people. These are the people
    most prone to a wider range of ‘psychic’ experiences and ‘déjà vu’. This
    state is involuntary, beyond their control. They can either give in to it or try
    to fight it.
    What to look for:
    These experiences are very difficult for ‘outsiders’ to identify. There are
    several reasons:
  • Even high-functional verbal autistic children often see no need
    to describe these experiences as they assume that others
    experience the same.
  • Autistic adults are often very unwilling to talk about these in
    order not to sound crazy or psychic.
    However, many parents do feel that their children are able to ‘read their
    minds’ (not to be confused with the ‘Theory of Mind’), but they are afraid
    to articulate their suspicions. Indeed, I have met two mothers who
    confided in me about their feelings. Other indicators can be:

Seems to be absorbed with lights, colours, sounds, smells, etc.

Seems to feel pain of others

Seems to be absorbed with body movements

Appears to be in constant motion


It is not uncommon among autistic people to experience so-called ‘daydreams’. Whether this phenomenon is the sixth sense, clairvoyance, precognition or another form of extra-sensory perception and whether we can explain it or not, it does exist. Personal accounts of autistic individuals contain quite a number of these experiences, for example:

At school strange things were happening. I would have daydreams inwhich I was watching children I knew. I would see them doing the trivialest of things: peeling potatoes over the sink, getting themselves a peanut butter sandwich before going to bed. Such daydreams were like films in which I’d see a sequence of everyday events, which really didn’t relate in any way to myself. I began to test the truth of these daydreams; approaching the friends I’d seen inthem and asking them to give me a step-by-step detailed picture of
what they were doing at the time I had the daydream. Amazingly, to the finest detail, I had been right. This was nothing I had controlled, it simply came into my head, but it frightened me. (Williams 1992,

There were odd occasions at school when I seemed to know things about people before they did. One day when two children were skipping rope and the game was getting intense, I knew that one child would fall down – I had hardly seen the thought when it happened. I know this could easily be coincidence, but it happened many times. Sometimes I would dream of a place, in great detail, and then experience that very same place at some future time. (Lawson 1998, p.30)

Donna Williams emphasizes that these are not fantasies, these are real experiences, which she calls ‘unintentional out-of-body experiences’:

In my teens I lived in quite a dangerous and lonely state a lot of the time and this caused me to ‘visit’ non-physically people and places where I felt safe. I didn’t fantasize what I’d like to say or do. I simply
found myself feeling physically in these places or with these people… Yet I did feel myself moving up the stairs to my friend’s flat, through the front door and into the kitchen. I could sense the
smell of the room and the noises in the room. I could ‘hear’ and ‘see’ as my friends moved about and went on with things. (Williams 1998, p.34)

What to look for:

There are no general indications to this phenomenon. However, bearing in mind that it is possible, one might find that some behaviours or attempts to explain something ‘just fit’.
As the expressive language of the children is limited, it is difficult to say whether they experience this. Though, sometimes, Vicky’s mother ‘feels’ that her daughter ‘reads’ her emotions, no matter how hard she
tries to hide them.

Chapter 5 Cognitive Styles

I struggled to use ‘the world’ language to describe a way of thinking
and being and experiencing for which this world gives you no words
or concepts… (Williams 1994, p.84)
As the way a person perceives the world affects the way he stores and
utilizes information, we will discuss information processing problems and
differences in autism considering different cognitive styles; analysing
discrete functions specific to autism, such as attention, memory, concept
formation, categorizing/generalizing, types of thinking, imagination.
Subconscious, unconscious and preconscious cognitive

  • Conscious mind implies the mental faculties are awake and
  • Subconscious mind can be defined as part of the mental field
    outside the range of attention, and therefore outside
  • Unconscious mind comprises those mental processes whose
    existence is inferred from their effects.
  • Preconscious mind contains ideas or memories that can be
    readily be made conscious.
    The conscious mind is not the only way of receiving information about the
    world. Even without conscious awareness we still continue to experience
    things and accumulate information. Thus, even unconscious people (for
    example, patients under anaesthesia) can hear conversations around them,
    remember them and even repeat them later on (Ratey 2001). Research on
    blindsight has established that unconscious processing can occur in the
    absence of conscious realization of visual images (Cowey and Stoerig
    1991; Weiskrantz 1986).
    We are limited in our ability to process information consciously.
    However, subconsciously and/or preconsciously it is possible to take an
    infinite amount of information as we do not have to filter and interpret it.
    Donna Williams (1994; 1998) describes the process of receiving
    knowledge from subconscious to preconscious to conscious, where the
    subconscious mind is a storeroom containing uninterpreted information
    that is still accumulated within preconsciousness where it can be processed
    later removed from its context, and becomes triggered voluntarily or
    involuntarily and is perceived consciously after it has been expressed –
    ‘sort of listening in on oneself ’ (Williams 1998).
    Preconscious (indirect) style versus conscious (direct) style
    There seem to be two distinct styles of accumulating information, which
    differ in ways of perceiving, storing and retrieving information. The first
    one is a preconscious style (‘a waking subconscious mind’ – Williams
    1998) receiving an infinite amount of unprocessed information which is
    literal and objective, indirectly, without conscious interpretation. The
    storing capacity is also unlimited. However, the access and retrieval of this
    information is difficult: it can be triggered but not accessed voluntarily
    (Williams 1998). Research (Farah and Feinberg 1997; Gazzaniga 1988)
    has shown that different neural mechanisms appear to be involved in conscious and unconscious processing.
    Some autistic people use the preconscious system to take in
    information. They use their senses peripherally. It allows them to take in a
    great amount of information though they themselves are ‘absent’ from the
    process. That is, they do not know what information they have
    accumulated, though it may be triggered from the outside and they
    surprise us (and often themselves) with their knowledge we have never
    thought they have. It is sort of ‘unknown knowing’ (Williams 1996). They
    Cognitive Styles 99
    might accumulate as much as 95 per cent of information preconsciously,
    without learning (Williams 1994).
    Dr Robyn Young, a psychologist at Finders University in Adelaide,
    conducted very interesting experiments. Using a technique called
    transcranial magnetic stimulation to switch off the frontal temporal lobe
    (the thinking part of the brain), the researcher tested the savant skills in
    volunteers. Five out of seventeen volunteers showed improvements in
    memory, calendar calculating and drawing abilities. Young hypothesizes
    that we all have the potential to develop skills that we did not know we
    had. By shutting off the conscious part of the brain we can enter the
    unconscious domain. However, there were serious side-effects. It appears
    that those who undergo such a brain bombardment lose many abilities as
    well as gaining some, for example, one person got lost on his way to work
    the day after the experiment.
    Nadia could draw as a professional artist at the age of three. But she
    was autistic and could not communicate. The more she learned how to
    communicate and the more ‘normal’ her functioning became, the more
    ‘ordinary’ became her drawing. She developed language but lost her ‘gift’.
    However, some autistic individuals do not ‘lose’ their gift with their social
    development (for instance, Stephen Wiltshire) but use it as a ‘key’ to open
    the door to the social world around it.
    Some autistic people take in information consciously and directly but
    at the cost of its coherence, because they have to narrow their attention and
    shut down any background information in order to cope with conscious
    processing of whatever is in the focus of their attention. Some autistic
    people seem to fluctuate between these two styles.
    By distinguishing between preconscious and conscious perceptual
    processing, we can distinguish between different types of intelligence –
    conscious and preconscious, the latter with little conscious awareness
    (‘unknown knowing’).
    Attention in autism
    Sensory issues and attentional issues are most likely both real and
    both primary; in some cases one may help cause the other, but I
    suspect that they are usually related only through similar
    100 Sensory Perceptual Issues in Autism and Asperger Syndrome
    neurobiodevelopmental causes. Both attentional and sensory
    problems may have developmental consequences that help to create
    the full autistic syndrome. (Blackburn 1999, p.7)
    The ability to attend selectively to meaningful stimuli while ignoring irrelevant ones is essential to cognitive functioning (Lane and Pearson 1982).
    As we have discussed earlier, filtering of an infinite amount of information
    is necessary to make processing of information effective and conscious.
    Consciously we can process only a limited amount of stimuli, and the
    decision on which stimuli are to be processed in each situation is of paramount importance. Impaired selective attention results in increased distraction and diminished cognitive functioning, because responses to irrelevant stimuli interfere with the processing of targeted information (Douglas
    and Peters 1979; Lane and Pearson 1982).
    Some researchers define selective attention as a component of directed
    attention (Davies 1983; Posner 1975). According to their model, directed
    attention includes:
  • a selective process for distinguishing the relevant from the
  • an intensive process for the distribution of different amounts of
    attention across a set of stimuli, depending on their value
  • an alerting and sustaining process that involves vigilance, i.e.
    the energy to sustain attention.
    Ornitz (1989) adds a motor component to these perceptual processes,
    enabling and modulating perceptual activity (for example, visual
    scanning). Impairments or distortions of any of these components may
    result in neglect. Ornitz hypothesizes that autistic behaviour can be better
    understood as a disorder of directed attention involving neurophysiological mechanisms primarily, though not necessarily exclusively, in
    the right hemisphere.
    It is widely reported that autistic children appear to ignore relevant
    stimuli in favour of apparently meaningless stimuli in their environment.
    But we should remember that the decision which stimuli are relevant and
    which are meaningless depends on the common stock of experiences and
    knowledge. Autistic people might attend to what theythink important, but
    Cognitive Styles 101
    usually it turns out to be different from what non-autistic people think is
    important (Rand), and described as ‘idiosyncratic focus of attention’.
    Uta Frith (1989) applies the theory of weak central coherence in
    autism to account for this idiosyncratic attentional focus. A good decision
    about what to attend to would be based on large amounts of pooled
    information, and if coherence at this central decision-making point is
    weak, the direction of attention would be quite haphazard.
    Blamires (1999) offers an alternative explanation to ‘central
    coherence’. He suggests that people with autism attribute different
    meaning to stimuli or ignore them as meaningless because they possess a
    different stock of knowledge about the world from non-autistic people. It
    is the stock of knowledge that dictates what aspects of the environment are
    important. This view coincides with relevance theory introduced by
    Sperber and Wilson (1986): our attention automatically turns to what
    seems relevant in the environment.
    Brad Rand, an autistic person, confirms this view, as he picks what he
    thinks important, but usually it turns out to be different from what
    non-autistic people focus on in the situation. As he has tunnel vision,
    everything that is not at focus of his attention at the moment fades out. It
    would be helpful for a person with this attention pattern to be told
    explicitly what to look at or what to listen to, to create a shared attentional
    Patterns of attention in autism
    In order to avoid sensory information overload, autistic people acquire voluntary and involuntary strategies and compensations, such as monoprocessing, when they focus their attention to one single channel, or
    so-called ‘tunnel perception’, when they concentrate on a detail instead of
    a whole. They have very narrowly focused attention. Autistic individuals
    often compare this attentional pattern with having ‘a mind like a flashlight’, ‘a laser pointer’ or ‘a laser beam’ that highlights only a single dot (an
    area of high focus) that they see very clearly while everything around it is
    grey and fuzzy (Blackburn 1999; O’Neill 1999; Rand undated). Murray
    (1992) refers to this phenomenon in monotropism as ‘attention tunnelling’.
    102 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Rimland (1978) believes that the various forms of autism represent
    severe disorders of the attentional mechanism. The author assumes that
    autistic savants’ attentional mechanisms are pathologically locked at the
    indistractable, superintense end of the concentration scale. In Rimland’s
    view an autistic savant is endowed with the capacity to deal with minute
    details at the cost of being unaware of the background or context of the
    detail: he is able to apprehend visual or auditory stimuli but not to
    comprehend them.
    We may try to imagine the problems a narrow attention focus might
    create in autism by conducting a simple experiment. Cover a picture (of a
    portrait/an object/a scene, etc.) with a sheet of paper with a small hole in
    the centre. Ask somebody to recognize what is on the picture by moving
    the sheet with a hole in any direction. The difficulty of recognition with a
    narrow focus is obvious.
    Another problem autistic children experience is difficulty in switching
    attention. For many of them shifting attention from one stimulus to the
    other is a relatively slow process that results in a sort of pause or delay of
    reaction. This ‘too slow attention switching’ process may be caused by
    delayed processing of each stimulus. Recent research (Courchesne et al.
    1994) has provided some evidence that a simple delay in attentionswitching might account for many behaviours associated with autism.
    In contrast to Attention Deficit Hyperactivity Disorder (ADHD),
    which is characterized by short attention span, autism exhibits other
    deviant attentional patterns such as problems in selectivity, too narrow
    focus and slow shifting speed. One of the consequences of this is that
    autistic people often see things in fragments, disconnected. However,
    autism and ADHD can often overlap: people with autism may be very
    hyper and have a short attention span, while individuals with ADHD can
    exhibit autistic traits (Blakemore-Brown 2001).
    There is some evidence that lack of Theory of Mind in many autistic
    people is probably the result of their problems with attention-shifting,
    their inability to attend to multiple cues.
    The most common attentional problem in autism is the failure of
    autistic people to establish and maintain joint attention, i.e. the ability to
    attend to the same stimuli as the other person. That leads to the failure to
    share experiences. As a joint attention task involves a divided attention
    Cognitive Styles 103
    task when a person should attend to both the object of the joint attention
    and the person with whom the experience should be shared, an autistic
    person often fails to monitor both of these (if he works in ‘mono’ or has
    ‘tunnel vision’) and either fails to attend to the object of joint attention or
    to the other person’s shifts of attention. This results in the failure to
    comprehend the meaning of the interaction and hinders social and cultural
    For learning language, joint attention is essential. A child connects a
    new word with the object of joint attention. A deficit in joint attention
    affects the way autistic children learn new concepts. They may hear the
    word and remember it in connection with either a part of the object they
    are attending to at the moment, or the whole object (different from the
    object of joint attention but at their ‘flashlight’), or even the whole scene
    (gestalt perception), or sensation they are experiencing at the moment.
    Kanner (1946) describes the case of a child who always associated the
    phrase ‘Peter eater’ with saucepans. The explanation lies in the way the boy
    ‘learned’ the phrase: his mother was saying this nursery rhyme in the
    kitchen when she accidentally dropped a saucepan. The boy connected the
    phrase with a saucepan and ‘learned’ it.
    The main thing is not to assume that autistic children will always pick
    the same thing as we might do. For example, a teacher shows a picture of a
    car: ‘This is a car’, but a child might focus on the reflection of light on the
    teacher’s earring and ‘learns’ the word with his private meaning; another
    child might feel itchy and refer the teacher’s comment ‘this is a car’ to the
    sensation he is feeling at the moment. In this case, all instructions should
    be explicit (‘Look at what I am looking/what I am holding’, etc.); the child
    should be given enough time to switch attention from what he was doing
    to you, and then to the object you are talking about. If he looks in the same
    direction as you do, do not assume he sees the same thing. Always try to
    ‘see’ from the child’s perspective (his perceptual and cognitive patterns).
    Autistic people are reported often not to notice other people because
    for them, people seem no more important (or even less) than objects. If
    they have perceptual problems, people ‘look like shapes, like furniture and
    trees are shapes’ and are not different ‘from any other sight or sound’
    (Rand, undated, p.9). Autistic children appear to ignore people or use them
    as ‘tools’ to get what they want. The explanation for this can be that
    104 Sensory Perceptual Issues in Autism and Asperger Syndrome
    because of attentional and perceptual problems autistic children are unable
    to divide their attention between the object they want and the person ‘on
    their way’ and process separate ‘pieces of information’ (the person and the
    object, or even parts of them) simultaneously. In this case they do not
    ‘perceive’ the person as a person or notice the presence of the person at all.
    It is a typical description of autistic children that they are asking for
    something (the phrases they have been taught to use) in an empty room, i.e.
    addressing nobody. The child might concentrate all his attention and
    energy on the learned phrase and performing it, and he cannot simultaneously appreciate that there should be someone to whom he is
    supposed to address the request.
    Memory in autism
    The main characteristics of ‘autistic memory’ are gestalt and literalness.
    Oliver Sacks notes that in such a memory there tends to be an immovable
    connection of scene and time, of content and context (a so-called concrete
    situational or episodic memory) that results in the astounding powers of
    literal recall so common in autistic savants, along with difficulty extracting
    the salient features from these particular memories, in order to build a
    general sense and memory. The author describes this type of memory as
    quasi-mechanical – ‘like a vast store, or library, or archive – not even
    indexed or categorized, or held together by association, yet where
    anything might be accessed in an instant, as in the random-access memory
    of a computer’ (Sacks 1995, p.208).
    Many people with autism do not remember verbally but while remembering they actually see, hear, feel, smell or taste the items (in their mind).
    The thought about something produces real experiences they had when
    encountering this thing or event for the first time. They store their visual,
    auditory, olfactory, gustatory and tactile memories, which are very real. For
    instance, the thought of textures they hate might cause goose bumps and
    chills and a general sense of unease would follow (Willey 1999).
    Most commonly reported are the feats of visual and auditory memory.
    Well-known pictures by Stephen Wiltshire, an autistic savant, of
    architectural buildings, contain the smallest details such as style and size of
    windows, and this is despite the fact that he saw the original buildings
    Cognitive Styles 105
    only once for a few minutes and did not begin his drawings immediately. It
    is so-called eidetic or photographic memory, which allows these people to
    create visualizations that are as intense as those brought about by the
    original stimuli (Carter 1998).
    Some researchers (Rose 1993) suggest that up to 50 per cent of
    five-year-olds have the ability to ‘see’ an imagined image as though it was
    really there. Some adults are reported to retain this ability (see, for
    example, Schatzman 1980). Clara Park (1967) says that her autistic
    daughter’s eye is like a camera: she draws pictures of houses very
    accurately, with finest detail. Temple Grandin (1996a) writes about
    Barbara, a woman with autism, whose ability to recognize pattern has
    made her one of the best technicians in the laboratory identifying cancer
    cells. Her visual abilities enable her to spot abnormal cells instantly,
    because they ‘just jump out at her’.
    Some autistic individuals are reported to be able to spell excellently
    thanks to their visual/photographic memory: as they read they quickly
    memorize the spellings of words; when they misspell a word they can refer
    to their mental catalogue of data to recall which spelling looks more
    accurate (O’Neill 1999). Temple Grandin (1996a, p.24) compares her
    process of remembering things with a computer: ‘I store information in my
    head as if it were on a CD-ROM disc. When I recall something I have
    learned, I replay the video in my imagination.’ Her memory patterns are
    similar to those described by A. R. Luria (1987) who studied a man with
    amazing feats of memory: when the man heard or read a word, it was at
    once converted into a visual image corresponding with the object the word
    signified for him.
    Some autistic people, while having excellent memory, have problems
    with recognition memory; for example, Jared Blackburn has trouble
    recognizing faces, letters and objects without actively visualizing them
    (Blackburn 1999).
    Some have a very good auditory memory (‘sound memory’,
    ‘audiographic memory’ – Williams 1996), that enables them to repeat
    (‘replay’) long strings of things they have heard. Some can record musical
    pieces in their minds, then hum or play them flawlessly on an instrument
    later on (O’Neill 1999). Some can ‘hear’ conversations in their memory
    (Willey 1999) or even whole ‘sound situations’. ‘It is like replaying a tape
    106 Sensory Perceptual Issues in Autism and Asperger Syndrome
    recording of conversations, songs heard and so on’ (Williams 1998). They
    seem to have ‘audio tapes’ in their memory with detailed ‘sound pictures’
    of objects, people, events.
    Some autistic people store ‘smell images’ in their memory.
    Despite their excellent rote memory many autistic people are very
    forgetful. This is another paradox out of many in autism: on the one hand,
    they have an inability to forget (Luria 1987), on the other hand they may
    be very forgetful. For instance, they may forget what they need to buy at
    the shop, but they are unable to forget the clothes someone was wearing or
    the arrangement of the furniture in the house they moved from many years
    Jordan and Powell (1995) consider the main memory difficulty in
    autism as the failure to develop a personal memory for episodes, i.e. the
    failure to experience self as a part of events that leads to a difficulty in
    developing personal memories. They can remember things but they may
    fail to remember these things happening to them. In order to recall they
    need to be prompted with specific cues.
    Ways to access memory (types of memory retrievals)
    Many autistic people are unable to recall memories unless they are triggered. They often cannot voluntarily ‘get access’ to their stored information. However, if cued or prompted with particular words, intonation,
    gestures, or surroundings they may astonish their parents (and even themselves) with the knowledge they have accumulated. They seem to have no
    conscious control on their ‘database’ and are dependent on the ‘right triggers’.
    Snyder and Mitchell (1999) hypothesize that in contrast to
    low-functioning autistic people, autistic savants may have ‘privileged
    access’ to their memory which allows them to produce outstanding results
    in art, music, calculation. They are able to create their works by directly
    accessing ‘primary memory areas’ at lower levels of information.
    Cognitive Styles 107
    Associative memory
    Autistic memory is often described as associative memory (or ‘serial
    memory’ – Williams 1996). It differs from ‘ordinary’ (verbal memory) in
    the way it unfolds: verbal memory is linear, associative memory is
    non-linear (Grandin 1996a), multi-dimensional, sort of ‘spatial’, and can
    be triggered by sensory stimuli, such as smells, certain colours or patterns,
    touch, physical movement, combination of sounds or words. For example,
    the word ‘under’ triggered Temple Grandin to picture herself getting
    under the cafeteria tables at school during an air-raid drill. Then she continued to ‘play video’ of the teacher scolding her after she hit Alfred for
    putting dirt on her shoe, and then ‘saw’ submarines under the Antarctic
    and the Beatles song ‘Yellow Submarine’. If she let her mind pause on the
    picture of the yellow submarine, she then heard the song; then she would
    start humming the song. When she got to the part about people coming on
    board, her association would switch to the gangway of a ship she had seen
    in Australia, etc. (Grandin 1996a). Seeing the black and white stripes on a
    toy plane can trigger the memory of eating humbugs in a classroom many
    years before and might run into who was in the class on that day and what
    was being taught and the noise that the book made when snapped closed
    and the exact path the teacher travelled across the room at a particular
    point, etc. (Williams 1996). Touching the doorway to a room may trigger
    the serial memory of touching the same door of the same room another
    time and the events that happened after this (Williams 1996). Temple
    Grandin (2000) compares this type of memory with a Web browser: a Web
    browser finds specific words; by analogy, autistic people look for
    memories (pictural, auditory, etc.) that are associated with the words they
    hear or say.
    Many autistic children use this serial/associative memory as a
    compensation for their inability to process information quickly (delayed
    processing): they do not process information at the time it happens, they
    respond to the situation ‘from memory’ when something remembered in a
    serial way is triggered. They often cannot keep track of conversation as in
    the short break between two halves of a sentence, there may have been
    triggered a huge number of tracks, leading to tracks, leading to tracks
    (Williams 1996). They just cannot stop endless associations (Grandin
    108 Sensory Perceptual Issues in Autism and Asperger Syndrome
    1996a) and often use songs, commercials, etc. to respond, or use
    idiosyncratic routinized responses.
    ‘Alex, do you want broccoli?’ (The boy hates it.)
    ‘Yes, please.’
    Mother puts the plate with broccoli on the table in front of him.
    Alex screams and with a very loud ‘No!’ rushes out of the kitchen.
    Concept formation. Categorization. Generalization
    Before language, the symbol (concept) formation process operates in
    sensory modalities. The aspects of perceived experience are stored in
    long-term memory and form sort of ‘perceptual symbols’ files, to be used
    later for reference. From vision, visual images are acquired. From hearing,
    auditory perceptual symbols are stored. From olfaction, ‘smell pictures’ are
    received. From gustation, a file of ‘tastes’ is filled in. From touch perceptual
    symbols for textures, pressure and temperatures are formed. And from
    proprioception, perceptual symbols for limb movements and body positions are mapped. The neuroscience research indicates that each type of
    perceptual symbol is accomplished and stored in its respective brain areas.
    If some areas are damaged, conceptualization of this particular modality
    becomes disrupted (Damasio and Damasio 1994; Gainotti et al. 1995). By
    the pre-verbal stage of concept formation, autistic children exhibit differences. As sensory dysfunction is present (whatever form it may take), perceptual symbols in autism will differ from non-autistic ones. The symbol
    formation process in autism often depends on the channel(s) the person
    uses, or which particular channel is ‘on-line’ at the moment. As a result of
    differences in perception (such as described in Chapters 3 and 4) the information about objects, people and events is not organized into a coherent
    picture. That is why perceptual images (of any modality) are not established into categories and remain as separate entities. Thus, different perceptual systems develop different conceptual systems and result in different intelligence systems.
    With the appearance of language, the concept formation system
    changes. Any word generalizes. ‘Labels’ enable us to categorize and
    generalize. We may ‘file’ our mind with representations of the outside
    world, and easily operate with them creating new ideas. The content of a
    Cognitive Styles 109
    linguistic symbol (a word) does not resemble its referent. In contrast
    perceptual ‘words’ refer clearly to specific objects, states, events. Because
    autistic ‘words’ contain different perceptual content, they are not
    functionally equivalent to non-autistic concepts. Autistic ‘words’ are very
    concrete and specific. Instead of storing general meanings of things and
    events (which is a prerogative of a verbal language) they construct sensory
    perceptual mental images. They store the experiences (sensory
    impressions/templates). Once a perceptual image is stored in long-term
    memory, it becomes a representation of physical input. It becomes a
    symbol for a certain referent and can represent the object in its absence. It
    means that if a person has stored ‘a ball’ by smell, then if it does not have
    the same smell as the one he stored for the first time, it cannot be identified
    as ‘a ball’, even if it looks like a ball, sounds like a ball, etc. To be identified,
    the thing should ‘feel right’, i.e. be exactly the same as in the first
    experience. Thus, autistic people store sensory impressions (taste, smell,
    colour, shape, feel, etc.) which they use later for reference and
    Tito, an autistic boy, could not find any association between things that
    change places. He could identify a picture of a dog on the book as a dog,
    but a dog in the park could not be identified. It took years, and a lot of
    practice by him and the patience of his mother who kept asking him
    questions, comparing pictures of a dog and a cow with the living animals
    on the road (Mukhopadhyay 1999).
    This phenomenon is brilliantly described by Donna Williams:
    I would learn how to tackle a given situation in one context but be
    lost when confronted by the same situation in another context.
    Things just didn’t translate. If I learned something while I was
    standing with a woman in a kitchen and it was summer and it was
    daytime, the lesson wouldn’t be triggered in a similar situation if I
    was standing with a man in another room and it was winter and it
    was nighttime. Things were stored but the compulsive
    overcategorization of them was so refined that events had to be
    closed to identical to be considered comparable. (Williams 1994,
    Paradoxically, sometimes different stimuli may ‘feel’ the same and become
    ‘unconventional personal synonyms’. For example, to Donna Williams
    110 Sensory Perceptual Issues in Autism and Asperger Syndrome
    some words have a similar shape, pattern or rhythms without being similar
    in meaning, e.g. ‘Margaret’ and ‘Elizabeth’ have the same feel and seem
    similar to her (Williams 1996). To Alex, an autistic boy, the words ‘Oliver’
    and ‘cinema’ are the same.
    What to look for:
  1. Displays a good
  2. Reactions are triggered by some stimuli (lights, colours, sounds,
    words, textures, smells, movements, etc.)
  3. Uses songs, commercials, etc. to respond
  4. Uses idiosyncratic routinized responses
  5. Cannot keep track of conversation
    Alex displays a very good visual and auditory memory. John is good at
    recognizing ‘smell messages’. Vicky can distinguish the slightest
    difference between very similar textures.
    Helen can start reciting poems, triggered by one word, then ‘jumps’ to
    the recollection of her visit to her grandma, triggered by the word in the
    poem, etc. It is very difficult to keep her ‘on track’.
    Perceptual thinking
    There appear to be two basic types of thinking in autistic people: totally
    perceptual (usually visual) thinkers and the music, math and memory
    thinkers (Grandin 1999). Research findings (Farah 1989; Zeki 1992)
    show that verbal and visual thinking work via different brain systems.
    These studies reveal that in brain-damaged patients one system can be
    damaged, while another system may be normal. In autism, the systems that
    process visual-spatial information are intact (Grandin 1996b). The
    research on frontal temporal lobe dementia has provided scientific
    Cognitive Styles 111
    evidence for the idea of hidden visual thinking under a layer of verbal
    thinking (Grandin 2000).
    One of the characteristics of autism is the remarkable ability of most
    autistic people to excel at visual-spatial skills while performing very poorly
    at verbal skills. For those who have visual thinking (‘thinking in pictures’ –
    Grandin 1996a), words are like a second language; their thought processes
    are different from language-based thinkers. Temple Grandin, for example,
    translates both spoken and written words into full-colour movies,
    complete with sound, which run ‘like a VCR tape’ in her head (Grandin
    1996a). When she lectures, the language is ‘downloaded’ out of memory
    from files that are like tape recordings. To describe the process Temple
    Grandin uses the computer analogy:
    I use slides or notes to trigger opening the different files. When I am
    talking about something for the first time, I look at the visual images
    on the ‘computer monitor’ in my imagination, then the language
    part of me describes those images. After I have given the lecture
    several times, the new material in language is switched over into
    ‘audio tape-recording files’. (Grandin 2000)
    The ideas are expressed as images for visual thinkers. They can take things
    apart and put them together in different designs completely in their imagination. They can manipulate images to solve most problems. Jared
    Blackburn, for instance, can often measure objects by visualizing a ruler
    moving along the object (Blackburn 1999). ‘Visual thinkers’ actually see
    their thoughts. Things happen like a movie in their minds, to provide a
    concrete basis for understanding what is going on around them (O’Neill
    1999). Jasmine O’Neill, a non-verbal woman with autism who has established herself as a talented writer, musician and illustrator, can see the
    colour and feel the texture of her emotions against her ‘mind’s eye like a
    projector’ (O’Neill 2000).
    ‘Visual thinkers’ often have difficulty with long verbal information,
    and prefer written texts:
    When I read, I translate written words into color movies or simply
    store a photo of the written page to be read later. When I retrieve the
    material I see a photocopy of the page in my imagination. (Grandin
    1996a, p.31)
    112 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Visual thinking is very fast, and not sequential. Very often autistic people
    have poor auditory short-term memory. They have difficulty in remembering auditory instructions consisting of three or more steps. However, when
    these instructions are presented in ‘visual steps’ – pictures, photographs,
    etc. it is much easier for them, as it helps them to ‘translate’ from ‘auditory’
    into their internal visual mode.
    Autistic children usually learn nouns first, as nouns are easily
    associated with pictures in their minds. Words that have no concrete visual
    meaning, such as ‘put’, or ‘on’, or ‘over’, have no meaning for them until
    they have a visual image to fix them in the memory (Grandin 1996a, b;
    Park 1967). For example, Donna Williams became frustrated when she
    could not find an ‘of ’ button on her calculator to calculate percentages. To
    understand verbs and adverbs Temple Grandin has learned to visualize
    The word ‘jumping’ triggered a memory of jumping hurdles at the
    mock Olympics held at my elementary school. Adverbs often trigger
    inappropriate images – ‘quickly’ reminds me of Nestle’s Quik –
    unless they are paired with a verb, which modifies my visual
    image… As a child, I left out words such as ‘is’, ‘the’, and ‘it’, because
    they had no meaning by themselves. Similarly, words like ‘of ’ and
    ‘an’ made no sense… To this day certain verb conjugations, such as
    ‘to be’, are absolutely meaningless to me. (Grandin 1996a, pp.30,
    Autistic people have trouble with words that cannot be constructed into a
    mental picture. Ron Davis has identified ‘trigger words’ which cannot be
    mentally ‘seen’, such as ‘the’, ‘of ’, ‘for’ (Davis 1997).
    To get the idea of how they might hear (create mental understanding
    through producing mental images), read the passage below in which all
    unimaginable (i.e. incomprehensible for them) words are omitted, and try
    to imagine how confusing it might be for an autistic child:
    Alex…tidy…room Look…sister’s room…see…nice girl…people
    say…want…say…lazy boy…go…room…help…tidy…
    [Alex, why don’t you tidy up your room? Look at your sister’s room.
    Everything is in order. Everybody can see what a nice girl she is. And
    Cognitive Styles 113
    what would people say about you? You don’t want them to say that you
    are a lazy boy, do you? Let’s go to your room and I will help you to
    tidy it up.]
    However, visualization thinking patterns are different from one person to
    the other. Some ‘visualizers’ can search the memory pictures like searching
    slides and can stop on any picture to study. They are able to control the rate
    at which pictures ‘flash’ through their imagination. Some people are
    unable to control the rate and end up with overloaded images coming all at
    once. Still others are slow to interpret the information. Thus, for a ‘visual
    thinker’, not being able to visualize quickly what is said, or mentally hold
    visual images together, means that verbal messages are not translated and
    remained meaningless. That is why autistic people often have problems
    learning abstract things that cannot be thought about in pictures. To
    understand abstract concepts they use visual images. For example, to
    understand personal relationships some autistic individuals used the image
    of sliding doors (Grandin 1996a, b; Park and Youderian 1974).
    Besides, the ‘quality’ of visual thinking may depend on the state the
    person is in, and even the time of the day. For instance, for Temple Grandin
    (2000) pictures are clearer and with the most detailed images when she is
    drifting off to sleep; her language part of the brain is completely shut off at
    Visual thinkers, as a rule, can pass simple ‘Theory of Mind’
    (understanding other people’s thoughts and intentions) tests as they can
    visualize what the other person would see. As for more complex ‘Theory of
    Mind’ tasks, the problem is often with the short-term working memory
    and not with their lack of ‘Theory of Mind’. For example, Temple Grandin
    can solve these tests if she is allowed to write down the sequence of events
    (Grandin 1999).
    Not all people with autism are highly visual thinkers. They appear to
    be on a continuum of visualization skills ranging from next to none, to
    seeing vague generalized pictures, to seeing semi-specific pictures, to
    seeing, as in the case of Temple Grandin, in very specific pictures (Grandin
    1996a). Unlike most people who think from general to specific, ‘visual
    thinkers’ move from video-like, specific images to generalization and
    concepts, for example:
    114 Sensory Perceptual Issues in Autism and Asperger Syndrome
    …my concept of dogs is inextricably linked to every dog I’ve ever
    known. It’s as if I have a card catalogue of dogs I have seen, complete
    with pictures which continually grows as I add more examples to my
    video library. (Grandin 1996a, p.28)
    ‘Perceptual thinkers’ can experience thought as reality. It means that when
    they think about something, they relive it visually, auditorily, etc. and emotionally. O’Neill (1999) compares it with ‘watching a movie: a
    mind-movie’ – the pictures of thoughts in this movie ‘transport you and
    create emotions as you view scenes’. It is not uncommon to see an autistic
    child giggling to himself. One of the reasons might be that the child relives
    some funny moment, using recorded, stored sensory images. What is very
    difficult for the parents to comprehend (and accept) is that a child might
    laugh or giggle non-stop when someone is crying. It might be one of the
    defensive strategies used by the child – when he is sad he tries to lessen it
    by ‘feeling the cheerful emotions of a happy mind-movie’ (O’Neill 1999).
    Perceptual thinking can account for some language idiosyncrasies,
    observed by Frith (1989), such as that an autistic child may say ‘French
    toast’ when he is happy, etc.
    Some autistic people who are not visual thinkers may think in ‘audio
    tape clips’: instead of using visual images, they operate with specific audio
    clips (Grandin 2000). They ‘see’ better with their ears as they store ‘audio
    pictures’ with detailed sound information, and ‘read’ these audio texts. For
    ‘auditory thinkers’ sound signals are much easier to understand than any
    visual ones, such as body postures, facial expressions and gestures.
    The examples of gustatory and olfactory images can be ‘gustatory/
    olfactory hallucinations’, reported by some autistic people.
    In all the cases, a whole or gestalt is visualized/heard, etc. and the
    details are added in a non-sequential manner. For example, when Temple
    Grandin designs equipment, she often has a general outline of the system,
    and then each section of it becomes clear as she adds details (Grandin,
    Perceptual thinking may be a slow method of thinking as it takes time
    to ‘play the video/listen to the tape’, etc.
    Cognitive Styles 115
    What to look for:
  6. Easily solves jigsaw puzzles
  7. Remembers routes and places
  8. Memorizes enormous amounts of information at a glance
  9. Poor at mathematics
  10. Learns nouns first
  11. Has difficulties with adverbs and prepositions
  12. Idiosyncratic patterns in language development, e.g. names one
    thing to denote the other, etc.
  13. Composes musical pieces, songs, ‘sound pictures’
  14. Complains about being touched/wearing certain
    clothes/heat/cold when the stimuli are not present
  15. Complains about smells/tastes in the absence of the stimuli
  16. Mimics actions when instructions are being given
  17. Experiences movement while being still (e.g. ‘I am flying’ while
    being in bed)
    John and Helen are very good at jigsaw puzzles. Helen can easily solve
    a jigsaw puzzle of 120 pieces even if the picture is upside-down. Alex,
    Helen and Vicky easily memorize enormous amounts of information at
    a glance (though its reproduction should be properly triggered, e.g.
    instructions given by the same person with the same intonation, etc.).
    ‘Inertia’ (executive function deficit)
    Another problem autistic people are reported to experience is ‘inertia’
    (Dekker 1999) – difficulty in starting and planning the task. But once they
    start, they find it hard to stop until they finish.
    Autistic people tend to be rigid and inflexible, perserverative, narrowly
    focused on details and deficient in the ability to inhibit familiar or
    116 Sensory Perceptual Issues in Autism and Asperger Syndrome
    overlearned responses (Ozonoff et al. 1994). For example, Alex cannot
    stop doing something until he has finished the task, no matter how tired
    he is. He will cry and exhibit some destructive behaviours (kicking the
    chair, throwing things from the table) but continue with the task until he
    completes it.
    Alternatively, some autistic children may have difficulty persisting at
    the task and move quickly to something else and something else and
    something else. Deficits in planning, inhibition of prepotent responses,
    flexibility, and working memory are known as deficits in executive
    functioning. Executive functioning impairment has been proposed as a
    potential underlying deficit of autism because the symptoms demonstrated
    by patients with prefrontal cortical dysfunction are similar to autistic
    behaviours (Ozonoff, Roger and Pennington 1991). One difficulty with
    this hypothesis is that autism is not the only disorder with potential
    executive function impairment and further research is needed to find out
    how executive function deficits in autism differ from those of other
    Deficits in executive function are reflected in speech and language
    impairments. For non-autistic people this process seems to be almost
    automatic. However, for a person with executive function deficit it is a
    difficult process including many stages to come through. Thus a thought
    has to be held in working memory while the response is being organized
    and produced. Autistic children may have something to say, but they have
    difficulty in finding the words they want, getting them formed and
    produced. Generally they have less difficulty in familiar environments,
    with familiar persons, in familiar situations, but they may not be able to do
    it in other environments, with unfamiliar people or situations, though they
    know how to do it.
    One of the diagnostic characteristics of autism is a lack or impairment of
    imagination. Yet autistic individuals do not agree with this description.
    There are many examples of ‘unimpaired imagination’ to be found in beautifully written prose or poetry full of poetic images, drawings, painings,
    equipment created by people who are supposed to lack imagination.
    Cognitive Styles 117
    Imagination is defined as a mental faculty forming images of external
    objects not present to the senses; creative faculty of the mind. The
    differences in perception and memorizing information inevitably bring
    differences in imagination.
    The quality of memory influences our ability to imagine. We do not
    remember things in detail; we fill in the blanks by imagining the details.
    The better the memory, the poorer the imagination. This paradox has
    attracted attention of many researchers. Langdon Down (1887) noted that
    extraordinary memory is often combined with great impairments in
    reasoning power. Sir Francis Galton, one of the founders of the field
    psychology stated that scientists in general have poor imagery. He
    specifically highlighted the antagonism between sharp mental imagery
    and abstract thought. The memory of autistic people is too good.
    However, they do possess imaginative abilities. Oliver Sacks (1995)
    noticed that Stephen Wiltshire’s drawings, though accurate in some ways,
    contained additions, subtractions, revisions, etc. They by no means
    resembled copies or photographs, and always showed Stephen’s peculiar
    style. A more precise definition of impairments in imagination, therefore,
    would be that imagination in autism is qualitatively different from
    non-autistic imagination. Autistic people find it difficult to invent stories
    or conversations (non-autistic characteristic of creativity) but they may be
    very creative in ‘solving better defined problems’ (Blackburn 1999). They
    can write poetry and prose filled with graphic images ‘inside’ their head
    and then type, speak, sing or play it (Kochmeister 1995).
    We cannot deny the imaginative powers and creativity that enables
    them to write poetry and prose, to invent equipment, compose music, etc.
    And another proof of imagination in autism is that many autistic
    individuals try really hard to imagine how non-autistic people experience
    the world, think and feel. (Why don’t we use our imagination in order to
    understand these people?)
    118 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Chapter 6
    Other Sensory Conditions
    There are other sensory related conditions which appear to be quite
    common in autism:
  • synaesthesia
  • prosopagnosia
  • central auditory processing disorder
  • Scotopic Sensitivity Syndrome
  • sensory integration dysfunction/disorder.
    Synaesthesia (Greek syn – ‘together’ and aesthesis – ‘perception’) or ‘joint
    sensation’ or ‘cross-sensory perception’ is an involuntary physical experience of a cross-modal association, i.e. the stimulation of one sensory
    modality triggers a perception in one or more different senses.
    Synaesthesia can be of two types:
  1. Two-sensory synaesthesia, when stimulation of one modality
    triggers the perception in a second modality, in the absence of
    direct stimulation of this second modality. The examples of this
    type are:
  • coloured-hearing or chromaesthesia: when a sound
    triggers the perception of a colour
  • coloured-olfaction: when a smell triggers the perception
    of a colour
  • coloured-tactility: when a touch triggers a colour
  • coloured-gustation: when a taste triggers the perception
    of a colour
  • tactile-hearing: when a sound triggers tactile sensation
  • tactile-vision: when a sight triggers feeling shapes and
    textures pressing the skin
  • tactile-gustation: when a taste is experienced as a shape
  • audiomotor: when the sounds of different words trigger
    different postures or movements of the body etc.
  1. Multiple sensory synaesthesia:
  • coloured-numbers: when numbers are heard or read they
    are experienced as colours
  • coloured-letters: when letters are heard or read they are
    experienced as colours
  • coloured-graphemes: when words are heard or read they
    are experienced as colours
  • shaped-numbers: when numbers are heard or read they
    are experienced as shapes, etc.
    In synaesthesia there can be thirty possibilities of different combinations
    of senses, but usually two senses are involved. Some synaesthetes smell
    sights or taste shapes, others see sounds. Practically every combination has
    been reported.
    More often synaesthesia is unidirectional, i.e. for example, sight may
    be experienced as touch but touch does not trigger visual perceptions.
    One in every 25,000 people is reported to have synaesthesia (Cytowic
    1989), but this estimate might be far too low. Simon Baron-Cohen (1996),
    an experimental psychologist at Cambridge University, suggests that
    perhaps one in 2000 people is synaesthetic. Women synaesthetes
    predominate: a ratio is reported from 3:1 (Cytowic 1989) to 8:1
    120 Sensory Perceptual Issues in Autism and Asperger Syndrome
    (Baron-Cohen et al. 1993). Synaesthesia appears more frequently among
    left-handed people and is believed to be genetic. Fifteen per cent of people
    with synaesthesia are reported to have a history of one of their first-degree
    relatives having dyslexia, autism or ADD (Cytowic 1995). Synaesthetic
    experience is very individual, for example, among people who see
    coloured sounds there is no specific colour for each sound from person to
    person. Learning disabilities seem more common in synaesthetes, however,
    the actual incidence of autism among synaesthetes is not known at present.
    Cytowic (1995) defines the following five diagnostic features of
  1. Synaesthesia is involuntary. It is a passive experience that
    happens to someone. The sensations cannot be suppressed or
    incurred, though the intensity is influenced by the situation
    they occur in.
  2. Synaesthesia is projected into the environment: it is not just in
    the head but the individual actually sees a sound, hears a sight,
    etc.; it is perceived externally in peri-personal space, the
    limb-axis space immediately surrounding the body.
  3. Synaesthetic perceptions are durable and generic, i.e. they do
    not change over time or situation and they are always
    experienced with the stimulus.
  4. Synaesthesia is memorable: the synaesthetic sensations are
    remembered best.
  5. Synaesthesia is emotional: having this experience causes ecstasy.
    One of the most common features of synaesthetes is their superior memory
    (due to their parallel sensations). They remember conversations, verbal
    instructions and spatial location of objects in every detail. They usually
    perform in the superior range of the Wechsler Memory Scale (Cytowic
    1995). Synaesthetes often remember the secondary perception better than
    the primary one. A typical complaint is ‘I can’t remember his name, but I
    know it’s purple’ (Lemley 1999). The most famous Russian synaesthete,
    referred to as S., described by Luria in his book The Mind of a Mnemonist
    (1987), accounts for his ability to remember words:
    Other Sensory Conditions 121
    …I recognize a word not only by the images it evokes but by a whole
    complex of feelings that image arouses. It’s hard to express…it’s not
    a matter of vision or hearing but some over-all sense I get. Usually I
    experience a word’s taste and weight, and I don’t have to make an
    effort to remember it – the word seems to remember itself.
    However, this phenomenal experience, though very useful in remembering things, could lead to complications. S.’s understanding of spoken or
    written speech was literal. Each word evoked images that distracted him
    from the meaning of the sentence as a whole. He could only understand
    what he could visualize (Luria 1987).
    Synaesthetes are observed to have uneven cognitive skills. They are
    reported to prefer order, neatness, symmetry and balance. They are more
    prone to unusual experiences such as déjà vu, clairvoyance, etc. (Cytowic
    1995). Among their deficiencies the most commonly reported are
    right-left confusion (allochiria), poor math skills and a poor sense of
    direction. Here we can see some similarity between the synaesthetic and
    autistic features. In some autistic individuals their resistance to changes,
    insistence on order and routine, echolalia (triggered by some stimuli), an
    exceptional memory for details, a poor sense of direction, etc. might be
    caused by synaesthesia.
    There are several theories concerning the origin of synaesthesia. The
    most recent one is the Neonatal Synaesthesia (NS) hypothesis proposed by
    Maurer (1993). The author states that all human babies (neonates) have
    synaesthesia, i.e. experience undifferentiated sensory input, probably up to
    about four–six months of age. This hypothesis refutes Piaget’s
    developmental theory that the different sensory systems are independent
    at birth and only gradually become integrated with one another. Maurer’s
    hypothesis needs more evidence to be proven, however, there are some
    indirect data that support his idea, for example, neonates of other species
    (kittens, hamsters, etc.) have similar transient connections between visual,
    auditory, somatosensory and motorcortex (Dehay, Bullier and Kennedy
    1984). Maurer (1993) suggests the same could be true of human babies.
    Some autistic people also believe that synaesthesia is an earlier phase of
    sensory systems development: it ‘comes from a time before fixed sensory
    integration, before taste was taste and smell was smell, sound was sound,
    touch was touch and vision was vision’ (Williams 1998, p.127).
    122 Sensory Perceptual Issues in Autism and Asperger Syndrome
    If, according to the NS theory, synaesthesia is a normal phase of
    development, then adult synaesthesia, as was suggested by Baron-Cohen et
    al. (1993), might represent a breakdown in the process of modularization.
    Thus, following an early initial phase of normal synaesthesia, a different
    (adult-like) pattern of the differentiation of the perceptual system is
    developed because of the development of more rapid and efficient
    information processing and adult synaesthesia, therefore, represents a
    failure to develop differentiation of the senses.
    We can draw a parallel. In autism there are some phases of
    development that do not follow a common path. For example, infantile
    reflexes that are meant to become inhibited naturally in early infancy
    through feedback to the brain regarding changes in growth and
    adaptations to the environment, sometimes fail to be replaced by more
    functional ones and are still present in autistic adults (Williams 1996).
    Probably, synaesthesia in autism is another ‘remnant’ that fails to become
    Most people with synaesthesia do not complain of their condition
    because for them it is their normal perception of the world and they are not
    aware of it causing any disadvantages. Moreover, they often enjoy it and
    think that losing their unique perception would be upsetting, ‘just like
    losing one of your senses’ (Duffy cited in Lemley 1999). This leads to the
    paradoxical conclusion that dysmodularity is not always maladaptive
    (Baron-Cohen 1996). Though it is true only if synaesthesia is
    unidirectional, whereas in case of ‘two-ways’ synaesthesia (when, for
    example, a synaesthete not only sees colours when he hears sounds, but
    also hears sounds whenever he sees colours) the individual really suffers
    from the condition. Baron-Cohen (1996) enumerates possible ill-effects of
    this type of synaesthesia: stress, dizziness, information overload, avoidance
    of noisy or colourful places, that lead to social withdrawal and interference
    with ordinary life.
    Sometimes synaesthetic experiences can hinder understanding of the
    situation. For example, S. reported: ‘If, say, a person says something I see
    the word; but should another person’s voice break in, blurs appear. These
    creep into the syllables of the words and I can’t make out what is being
    said’ (Luria 1987).
    Other Sensory Conditions 123
    Though the fact that synaesthesia does occur in autism is recognized, it
    is considered to be rare (Cesaroni and Garber 1991). Probably, the
    reported low incidence of synaesthesia in autism can be accounted for by
    the fact that it is not easily detected in the autistic population. There are
    several reasons for this:
  • Communication problems: even verbal individuals have
    difficulties in expressing their experiences.
  • Even non-autistic synaesthetes find it difficult to realize that
    they experience the world differently and it might be hard for
    them to imagine that others cannot, say, hear sounds while
    seeing colours. It is we who must find out whether they
    experience synaesthesia.
    The analysis of the personal accounts of autistic individuals shows that
    synaesthesia is not rare in this population and practically all combinations
    of senses have been found. Such senses as sight, sound and touch are
    involved more often than smell and taste. Below are descriptions of experiences that can be defined as synaesthetic.
    I loved the way most words play on my tongue…[some words] hurt
    my ears. (Willey 1999, p.20)
    …words that tickled, words that warmed when I spoke
    them…(some voices, especially with heavy nasal or high shrill qualities, or extreme eastern or southern accents) sting my ears like a wet
    towel slapped against my eardrum would. (Willey 1999, p.31)
    I would refuse words that looked ugly by virtue of being too
    lopsided or too cumbersome or too unusual in their phonetics.
    (Willey 1999, p.20)
    I knew I had written something great when I found words that
    looked, sounded or felt good. (Willey 1999, p.31)
    124 Sensory Perceptual Issues in Autism and Asperger Syndrome
    It is possible…not only to see colours, but almost to smell them, too.
    (O’Neill 1999, p.29)
    [As a reaction to the perfume] my mouth tasted like I had eaten a
    bunch of sickly smelling flowers. (Williams 1999, p.57)
    One individual with autism (cited in Cesaroni and Garber 1991) describes
    the experience of sounds as ‘vague sensations of colour, shape, texture,
    movement, scent or flavour. It is as if information was received in several
    modes even though the signal comes from one source.’ Jim Sinclair (1998)
    speaks about the colours of voices and the tactility of music. Donna
    Williams (1996) experiences some people (‘fluffy people’) ‘causing her
    lemons’ because ‘it triggers a sensation that feels exactly how eating
    lemons’ makes her feel:
    Though the taste isn’t there, the response in my mouth and neck and
    muscles is the same. These people cause a ‘sour taste’ that is as
    extreme and of the same type that lemons cause me when eaten.
    (Williams 1996, p. 90)
    What to look for:
  1. Covers/rubs/hits/blinks eyes in response to a
  2. Complains about (is frustrated with) the ‘wrong’ colours of
    letters/numbers, etc. written on coloured blocks, etc.
  3. Covers/hits ears in response to a visual
  4. Complains about (is frustrated with) a sound in response to
    Other Sensory Conditions 125
  5. Makes swallow movements in response to a visual/auditory
  6. Complains about (is frustrated with) taste in response to a
    visual/auditory stimulus/smell touch
    Covers/rubs/hits, etc. the nose in response to a visual/auditory
  7. Complains about (is frustrated with) feeling colours/sounds,
    etc. while being touched
  8. Complains about (is frustrated with) feeling being touched
    when being looked at
  9. Complains about (is frustrated with) backache, etc./heat/cold
    in colourful/crowded, etc. places with lots of movement
    Involuntary movements/postures of the body in response to a
    visual/ auditory stimulus/smell/taste
    Helen and Alex seem to ‘see’ sounds. Alex even tries to describe this
    experience: ‘I was scared. I saw a yellow “z-z-z” sound’, ‘The eyes saw
    the wrong word’ (in response to a verbal instruction). When Alex is in
    a state of sensory overload his synaesthetic experiences aggravate his
    condition and can lead to ‘panic attacks’ and aggression. After one of
    these ‘incidents’ Alex tried to give his explanations of what had
    happened: ‘In the shop I heard black then the word broke down into
    pieces and they entered my eyes. I became blind because everything was
    John displays involuntary movements of the body in response to some
    auditory stimuli (vacuum cleaners, lawn mowers).
    126 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Prosopagnosia (‘face-blindness’)
    Some autistic people are reported to be prosopagnostic (Blackburn 1999;
    Grandin 1996a), i.e. they have trouble recognizing people’s faces. This
    condition makes them blind to all but the most familiar faces.
    Prosopagnosia may be genetic and runs in families, or may be caused by
    strokes, head injuries or severe illnesses. Face-blindness may co-occur with
    autistic spectrum disorders. Hans Asperger reported the example of an
    astronomer with Asperger syndrome who could not recognize his friends
    and relatives. Some researchers (Kracke 1994) even suggest that
    prosopagnosia may be an essential symptom in autistic spectrum disorder,
    perhaps a specific subgroup of Asperger syndrome.
    The exact effects and severity may vary between people. Temple
    Grandin (1996a), for example, often got into embarrassing situations
    because she did not remember faces unless she had seen the people many
    times or they had a very distinct facial feature, such as a big beard, thick
    glasses or a strange hairstyle.
    Some experimental studies of autistic people’s capacity to process faces
    suggest that they use abnormal processing strategies and experience less
    difficulties when faces are presented to them upside-down. Whether it is
    true for their perception of the whole environment needs further
    Non-autistic prosopagnostics state that face-blindness tends to isolate
    them from people in general, as being unable to recognize others interferes
    with making and maintaining relationships (Bill 1997). They work out
    their own recognition system. Most common features that seem to work
    best for face-blind people are casual clothes, long hair and facial hair, and
    movement. Bill, who is face-blind, describes his method of recognizing
    people by their jeans, gait, movements and hair (as the inability to
    recognize faces does not extend to hair, particularly if it is long enough to
    extend out of the face area). He can see a pattern in hair texture and process
    hairlines. Interestingly, many autistic people are reported to be fascinated
    by people’s hair, and many do not recognize their relatives if they wear
    unfamiliar clothes. A prosopagnostic autistic boy, despite knowing the
    names of his classmates, more often calls them ‘a boy’ or ‘a girl’.
    Interestingly, when one of the girls had her hair cut short, he ‘moved’ her
    to the ‘boy’ category.
    Other Sensory Conditions 127
    Another problem prosopagnostic people experience is difficulty in
    understanding and expressing emotions. The main ‘tools’ to express
    emotions are not words but facial expressions, gestures and tone of voice.
    For people who cannot ‘read’ faces because of face-blindness or cannot
    ‘hear’ emotions in voices because of their central auditory processing
    disorder (see below) it is extremely difficult not only to understand
    emotions in others but also to express emotions themselves otherwise than
    using words. Bill (1997) calls it ‘emotion blindness’. Being prosopagnostic
    Bill was struck by the similarity of emotional expressions of blind people
    and prosopagnostics. He assumes that not seeing what emotions are
    supposed to look like when coming in, both the blind and prosopagnostics
    never acquired a large repertoire of emotions to send out. It is no wonder,
    therefore, that autistic people experiencing all sorts of sensory processing
    problems find it most difficult to understand the emotional states of other
    people and their own.
    In addition to their difficulties in ‘reading’ facial expressions, some
    prosopagnostic people have problems with understanding gestures and
    sign language, which involves a lot of facial expression (Bill 1997).
    Central auditory processing disorder (CAPD)
    Autism is often associated with auditory processing disorders (problems).
    Auditory problems in autism investigated in the literature include hypersensitivity (Delacato 1974; Grandin 1996a, b; 1999; Grandin and
    Scariano 1986); hyposensitivity/unresponsiveness to certain sounds
    (Kanner 1943; Koegel and Schreibman 1976); inability to modulate
    certain sounds (Ornitz 1974); delays in auditory processing (Condon
    1975; Rimland 1964) and others. These problems may be covered by a
    single definition – auditory dysfunction.
    This dysfunction is often undetected, as a conventional hearing test
    may not show any problems, especially in older children and adults who
    have acquired strategies to cope with their difficulties, such as blocking out
    Recently a subtype of auditory dysfunction has been singled out and
    described as central auditory processing disorder (CAPD). CAPD is
    defined as a neurological dysfunction responsible for impairments of
    128 Sensory Perceptual Issues in Autism and Asperger Syndrome
    neural pathways of the brain that link the ear with the central auditory
    system when the ear works properly but the parts of the brain that interpret
    and analyse the auditory information do not. The child can hear but has
    problems with listening. The causes of CAPD are unknown.
    French otolaryngologist and psychologist A. A. Tomatis has developed
    Audio-Psycho-Phonology as a multi-disciplinary science (hearing,
    speech/language development and psychological attitudes) and the
    Tomatis Method to affect speech, language, learning and social
    interaction. Dr Tomatis conducted research in the ability to hear in two
    groups of people: factory workers in war plants daily subjected to auditory
    overload, and professional opera singers who had lost the ability to sing.
    Paradoxically, audiometric testing showed that both groups displayed
    similar patterns: hearing loss in the same frequencies. Tomatis formulated
    his theory – the Tomatis Effect – ‘a person can only reproduce vocally
    what he is capable of hearing’, i.e. auditory and vocal organs are part of the
    same neurological loop and changes in the auditory system will
    immediately bring changes in the voice, and vice versa. Tomatis
    hypothesized that the ear can be ‘retuned’ to hearing faulty frequencies
    and that, in turn, can alter one’s self-listening and production of sounds.
    Tomatis developed the Tomatis Method to use sound stimulation in order
    to provide corrective auditory opportunities.
    Tomatis distinguished between hearing (the ability to perceive the
    sound) and listening (the ability to filter irrelevant sounds and focus on
    sounds we are listening). According to Tomatis, listening problems (if they
    are not physiological) are psychological. Listening abilities are vital for the
    development of communication. The researcher thought that
    psychological problems such as difficult birth, disruptive home
    environment, physical and emotional abuse could cause shutting out
    auditory stimuli and thus, create a relaxation of the muscles of the middle
    ear. If the muscles of the ear are inactive for too long, they lose their
    tonicity. As a result, the sounds are distorted and incorrectly analysed
    (Tomatis 1991).
    Tomatis worked out the Tomatis Listening Test aimed to find out the
    person’s level of good listening criteria:
    Other Sensory Conditions 129
  • hearing within normal range
  • absence of auditory distortions
  • the ability to analyse and compare sounds of different
    frequencies (‘auditory selectivity’)
  • the ability to identify the source of the sound; a right-sided
    auditory dominance, etc.
    The failure of one or several of these characteristics results in impaired listening. Tomatis developed special techniques to restore ‘good listening’,
    i.e. functional effectiveness of the ear. (See the Tomatis Method in Chapter
    7 below.)
    Guy Berard, a French otolaryngologist, originally trained by Tomatis,
    disagreed with his teacher on a number of points and developed his own
    approach to the problem. In contrast to Tomatis, who assumed
    psychological causes of the disorder, Berard suggested biological causes.
    According to Dr Berard, processing problems may occur if a person hears
    some frequencies better than the others and develops ‘auditory peaks’
    (frequencies to which a person is hypersensitive).
    Some indicators of CAPD (from different sources) are:
  • may seem deaf at some occasions but hears the slightest sounds
    at other occasions
  • covers ears even if there are no loud sounds (seems to hear
    sounds which other people do not hear)
  • a very light sleeper
  • produces sounds (banging doors, tapping things, making
    vocalizations, etc.)
  • cannot concentrate in noisy environments
  • speech problems.
    Scotopic Sensitivity/Irlen Syndrome (SS/IS)
    The idea that vision must have something to do with difficulty in reading
    and spelling has been highlighted from the earliest times. The first neurologist who investigated this problem was Samuel Orton. He called this phe130 Sensory Perceptual Issues in Autism and Asperger Syndrome
    nomenon ‘strephosymbolia’ (i.e. ‘twisted symbols’), applying it to people
    without identified visual impairments who, nevertheless, saw a printed text
    in a distorted way (Orton 1928).
    In the 1970s–1980s the idea that visual perception might influence
    the reading performance was investigated again. The visual perception of
    dyslexics was stated to be different from that of normal readers (Jordan
    1972). Distortions of print when reading were reported by Meares (1980).
    The researchers found out that visual acuity did not necessarily correlate
    with reading performance. In the following decades there have appeared
    some studies that identified particular types of visual abnormalities as
    possible factors in reading difficulties. Wilkins (1995) investigated the
    effects of visual stimuli on epilepsy. The researcher suggested that
    fluorescent lights and certain patterns (especially stripes) might cause
    problems for people with epilepsy.
    In 1983, perceptual problems caused by light sensitivity were
    identified by Helen Irlen, an educational psychologist, who worked with
    adults with dyslexia. She discovered that a visual perceptual dysfunction,
    unrelated to visual skills normally assessed by ophthalmic examination,
    may cause distortions with print and environment. Helen Irlen suggests
    that there are people whose problem is not in the processing of
    information but in the inability to get it through one of the channels,
    namely vision. She states that these individuals are highly sensitive to
    particularwavelengths and frequencies of the white light spectrum leading
    to rapid fatigue after only short periods of reading, thus giving rise to a
    reading disability, headaches and stress. Irlen called the cluster of
    symptoms of this dysfunction Scotopic Sensitivity Syndrome (now known
    as Scotopic Sensitivity/Irlen Syndrome – SS/IS). SS/IS is a visualperceptual problem that occurs in some people with learning/reading
    disorders, autism, and other developmental disorders. The symptoms
    include (Irlen 1989; 1991; 1997):
  1. Light sensitivity: difficulty concentrating or discomfort in
    fluorescent lighting, bright sunlight, glare or lights at night.
  2. Contrast and colour sensitivity: problems with high contrast
    such as black on white, bright colours and busy patterns such as
    stripes and polka dots.
    Other Sensory Conditions 131
  3. Poor print resolution: difficulty reading print, numbers or
    musical notes. Problems may include print that shifts, shakes,
    blurs, moves, doubles, swirls, sparkles, shimmers or disappears.
  4. Restricted span of recognition: inability to read letters, numbers,
    musical notes or words in groups, or to see objects in the
    environment together. This results in problems tracking,
    correctly identifying words, or the ability to skim or speed read.
  5. Attention deficit: problems concentrating while doing tasks
    such as reading, writing, computer use, looking and even
  6. Poor depth perception: inability to judge distances or spatial
    relationships affecting small and gross motor coordination. May
    be unsure or have difficulty with such things as escalators,
    stairs, ball sports or driving.
  7. Strain and fatigue: physical symptoms are varied and include,
    but are not limited to, fatigue, tiredness, headaches, fidgetiness,
    distractibility and hyperactivity.
    Irlen (1991) identified a variety of ways in which a printed page might be
    perceived by a person with SS/IS, such as the rivers effect, the washout
    effect, the swirl effect, the blurry effect, the halo effect, etc.
    The symptoms described by Irlen were not identified in the previous
    investigations because questions were not asked about how reading
    disabled people see the print. It has appeared that they are usually not
    aware that what they are seeing is abnormal (Irlen 1991; Jordan 1972).
    Optical professionals failed to identify this dysfunction as they had never
    directed their questioning to how a child sees print (Meares 1980). A
    number of probable causal mechanisms have been suggested: the transient
    system deficit, magnocellular/central processing deficit theory, the retinal
    sensitivity theory, the biochemical anomalies theory (for a review see
    Robinson 1998).
    Originally, SS/IS was considered a visual-spatial subtype of reading
    disability. Recent research (Riley 1999) has shown that SS/IS (in a milder
    degree) affects about 20 per cent of the general population as well. They
    experience difficulties with a normal working environment, particularly
    132 Sensory Perceptual Issues in Autism and Asperger Syndrome
    fluorescent lighting and computer screens, resulting in fatigue, eyestrain,
    headaches, poor concentration, inefficiency and stress. SS/IS can be
    associated with other disorders. Most research has been devoted to SS/IS
    in people with dyslexia. However, in the 1990s there arose an interest in
    SS/IS in autism.
    In 1993 Donna Williams and her husband were screened for SS/IS
    and got the Irlen lenses. Although Donna was aware of the fact that she
    saw differently from other people, for the first time was she able to
    experience how great this difference was: for the first time she could see
    other people’s faces and the world around her clearly and as a whole
    (Williams 1999).
    It was these changes in the visual perception of individuals with autism
    by means of the coloured lenses that highlighted new perspectives in the
    research of SS/IS. After several years experience of working with autistic
    individuals Helen Irlen has come to the conclusion that though the
    symptoms displayed by people with autism are not any different from
    those of individuals with learning and reading problems, autistic people
    experience more severe perceptual difficulties. The sensory overload
    caused by bright lights, fluorescent lights, colours and patterns makes the
    body react as if it is being attacked or bombarded, resulting in negative
    biochemical changes. This may result in such physical symptoms as
    headaches, anxiety, panic attacks or aggression. In order to lessen the stress
    caused by ‘sensory bombardment’, individuals use their ‘defensive visual
    behaviours’ – looking away, looking in short glances, looking through
    fingers, looking down, or shut down their visual channel altogether.
    Sensory integration dysfunction
    About 10 per cent of people are estimated to have sensory integration dysfunction. Sensory integrative problems are found in up to 70 per cent of
    children with learning difficulties. Sensory integrative difficulties have
    been identified in people with autism and other developmental disabilities.
    But what exactly is sensory integration dysfunction?
    The theory of sensory integration dysfunction (SID) was formulated
    by A. Jane Ayres (1979), an occupational therapist, to describe a variety of
    neurological disorders. It attempts to account for the relationship between
    Other Sensory Conditions 133
    sensory processing and behavioural deficits, and is known as a ‘theory of
    brain-behaviour relationships’ (Fisher and Murray 1991). At present SID
    still remains a theory and has little recognition and support from the fields
    outside occupational therapy (OT). There is still much scepticism and
    criticism of SID. Below we will try to answer the ‘why is it so’ question and
    see whether scepticism is justifiable or not. There seem to be several
    reasons to account for the criticism received by the theory of SID.
    To start with, the choice of the term ‘sensory integration dysfunction/
    disorder’ was very unfortunate. On the one hand, SID allows a very broad
    interpretation as it was introduced to cover a variety of neurological
    disorders. On the other hand, it effectively narrows the investigation, as it
    excludes any other disorder labelled by a different term, for example,
    sensory processing disorders. As a result, despite the theory having been
    actively developed within the field of OT, it has inevitably ignored a great
    amount of research in the field of sensory and information processing as
    being outside the scope of OT interests. It is no wonder, therefore, to find
    such statements as ‘the state of knowledge regarding modulation of
    sensation was in its infancy during the 1980s’ in a review of OT literature
    (Wilbarger and Stackhouse 1998). On the contrary, quite a lot of research
    was being carried out in the field of sensory dysfunction, including
    sensory modulation problems, in the 1960s–80s.
    In the 1960s, Bernard Rimland (1964) wrote about impairments in
    perceptual abilities of autistic children. Edward Ornitz (1969) described
    disorders of perception in autism. In the early 1970s, Carl Delacato (1974)
    put forward the theory of sensory dysfunction in autism, and proposed a
    classification of abnormal sensory experiences of autistic children.
    Delacato also pioneered the treatment of sensory abnormalities by
    ‘normalizing’ sensory processing. Though his book was published more
    than three decades ago, his basic ideas about sensory dysfunction are still
    relevant today. Actually, these ideas have ‘re-appeared’ in many works of
    OT research in the 1980s–90s as ‘new discoveries’.
    In 1989, Ornitz extended the notion of a disorder of sensory
    processing to the notion of disorders of sensory and information
    processing. This approach allowed him to clarify and identify separate
    stages and functions of sensory perception and consider information
    134 Sensory Perceptual Issues in Autism and Asperger Syndrome
    processing in terms of more discrete functions, such as attention, memory
    and learning.
    Another drawback of the SID theory was that it was presented to
    describe a new phenomenon that had not been investigated before.
    Consequently, it ignored much of the previous research in the field of
    sensory processing, and limited itself to the field of OT.
    It is important to remember that the SID theory was not new, but its
    name was. Before SID, the same concepts were described under the names
    of ‘sensory perceptual impairments’, ‘sensory processing disorders/
    problems’, ‘sensory dysfunction’, ‘disturbances of sensory modulation/
    information processing’, etc. Even now, after several decades of intensive
    research in the field of OT, there is great confusion about definitions,
    concepts and notions related to SI and SID.
    In the OT literature I have been unable to find a single, commonly
    accepted definition of SI(D). Different people either use different
    terminology to discuss identical phenomenon, or apply one and the same
    term to cover different meanings, depending on the views, expertise and
    research interests of the person who uses it. Current works are based on the
    writings of A. Jane Ayres but the concepts of the theory have been further
    developed by OT researchers.
    In order to trace the development of the concept and define the current
    understanding of SI(D), we shall briefly discuss the definitions presented
    in the OT literature. They can be roughly divided into broad and narrow.
    The broad definitions
    Ayres (1989) defined SI as ‘the neurological process that organizes sensation from one’s own body and from the environment and makes it possible
    to use the body effectively within the environment. The spatial and
    temporal aspects of inputs from different sensory modalities are interpreted, associated and united’ (Ayres 1989, p.11). In accordance with this
    broad definition, some authors describe SI as the process by which the
    nervous system receives, organizes, files and integrates sensory information in order to make an appropriate response (Herron 1993); the ability to
    take in information through senses, to put it together with prior informaOther Sensory Conditions 135
    tion, memories, and knowledge stored in the brain, and to make a meaningful response (Stephens 1997).
    And now let us compare these definitions with those of perception and
    sensory processing: perception is the process by which an organism
    collects, interprets and comprehends information from the outside world
    by means of senses. Sensory processing is the ability of the brain to process
    all sensations so we can interact adequately with our environment.
    Confusing? You bet!
    This broad interpretation of SI leads to broad interpretation of SID,
    such as the ineffective neurological processing of information received
    through the senses. (Though some occupational therapists do distinguish
    between sensory processing dysfunction and SID, where sensory
    processing is the way the body takes in ‘raw data’ of sensations from the
    environment through all of the sense organs, and sensory integration refers
    to the way the brain combines and utilizes that raw information in order to
    provide useful information with which we can make a decision.)
    The narrow definitions
    Below are just few examples of narrower interpretations of SI(D). SI is distinguishing between sensory experiences, such as touch, movement, body
    awareness, sight, sound, smell, taste and the pull of gravity (Kapes 2001).
    SID is a disruption in the process of intake, organization and output of
    sensory information. Inefficient sensory intake is taking in too much or too
    little information. With too much information, the brain is on overload and
    causes an individual to avoid sensory stimuli. With too little information,
    the brain seeks more sensory stimuli (Kranowitz 1998, p.55). This latter
    explanation coincides completely with Delacato’s classification of hyperand hyposensitivities (however, Delacato distinguished a third possibility
    – ‘white noise’, as well).
    In a narrow sense, SID is nowadays often used interchangeably with
    sensory modulation disorder/disruption. This brings even more
    confusion, as this ‘interchange’ is not accepted by all the researchers, and
    some authors interpret ‘modulation’ as a separate process.
    Similarly, we find broad and narrow meanings of ‘modulation’ in the OT
    literature. Ayres defined modulation as the ‘brain’s regulation of its own
    136 Sensory Perceptual Issues in Autism and Asperger Syndrome
    activity’ (1979, p.182), and placed the role of vestibular system in a key
    position in modulation.
    Other examples of the understanding of the notion of sensory
    modulation and sensory modulation disorder/problems include the
    following ideas.
    Sensory modulation is ‘a tendency to generate responses that are
    appropriately graded in relation to incoming sensory stimuli rather than
    underreacting or overreacting to them’ (Parham and Mailloux 1996).
    Modulation is the critical balance or regulation of facilitating and
    inhibiting effects (Myles et al. 2001). ‘When an individual overresponds,
    underresponds or fluctuates in response to sensory input in a manner
    disproportional to that input, we say that the individual has a sensory
    modulation disorder’ (Koomar and Bundy 1991, p.268). Wilbarger and
    Stackhouse (1998), having failed to discover a satisfying definition of
    sensory modulation, propose their own conceptualization of it: sensory
    modulation is the intake of sensation via typical sensory processing
    mechanisms so that the degree, intensity and quality of response is graded
    to match environmental demand and so that a range of optimal
    performance/adaptation is maintained. In their review of OT literature on
    sensory modulation they regret that there is limited information written
    about sensory modulation, and emphasize the necessity to update ‘our
    theories to incorporate the new findings in order to facilitate acceptance of
    our unique perspective on central nervous system functioning as it relates
    to human occupation’. One should add, it is equally important to
    incorporate the ‘old findings’ from the outside of OT, such as, for example,
    those described by Ornitz (1983; 1985; 1989) – the disturbances of
    sensory modulation manifested as both underreactivity and overreactivity
    to sensory stimuli.
    As we will see further, all these different interpretations of SID allow
    for highlighting different characteristics and categories. As any aspect of
    sensory processing and information processing can be covered by the term
    of SID, it gives a researcher a free hand to choose whatever they want to
    study, describing it as SID. Stephens (1997), for instance, discusses various
    characteristics of SID under four categories: attention and regularity
    problems, sensory defensiveness, activity patterns and behaviour. Herron
    (1993) includes in the end products of SI such characteristics as the ability
    Other Sensory Conditions 137
    to register and modulate stimuli, motor coordination, attention, motor
    planning ability, balance, eye control, emotional stability, behavioural
    control, body scheme and self-esteem. Kranowitz, the author of The
    Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction
    (1998) describes modulation, inhibition, habituation and facilitation.
    Myles and colleagues distinguish five stages of the SI process: registration,
    orientation, interpretation, organization and execution of a response. They
    also suggest that sensory modulation (not included by them in the five
    stages of the SI process) supports the effective performance by further
    integrating the information to result in a behaviour or action that matches
    our intent (Myles et al. 2001, p.13). Still others enumerate such ‘common
    sensory-processing problems’ as registration, modulation, defensiveness
    and integration.
    Originally, Ayres limited her investigation with three senses – tactile,
    vestibular, and proprioceptive – defined as the basic ones. Later OT
    researchers included all the senses in the theory.
    Ayres introduced the concepts of tactile defensiveness (for tactile
    sense), gravitational insecurity (vestibular system) and postural insecurity
    (proprioception). She defined tactile defensiveness as avoiding or negative
    reactions to non-noxious tactile stimuli (Ayres 1964) and as an imbalance
    between discriminative and protective sensory processing. Tactile
    defensiveness is manifested in ‘fright, flight, or fight’ response or reaction.
    However, the concept of defensiveness in the context of SID seems to be
    misleading as it implies the reaction (i.e. the behaviour caused by
    something) rather than the cause of this reaction.
    This concept has been expanded and developed into a broader
    category by numerous OT researchers and placed on all sorts of continua.
    To name just a few:
  • sensory defensiveness (= an imbalance of inhibitory and
    excitatory forces) as opposed to sensory dormancy (‘too
    much…inhibition of incoming sensory stimuli’ (Knickerbocker
    1980, p.32))
  • tactile defensiveness – registration problems continuum (Fisher
    and Dunn 1983)
    138 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • sensory defensiveness and sensory dormancy (as sensory
    modulation disorders) as opposing ends of a sensory
    responsivity/registration continuum with overorientation at
    one end and a failure to orient on the other (Royeen 1989)
  • sensory defensiveness on a continuum of approach and
    avoidance behaviours (Wilbarger and Wilbarger 1991)
  • registration problems – sensory defensiveness (Parham and
    Mailloux 1996).
    Gradually, the shift from sensory defensiveness to sensory modulation
    problems (a person’s threshold for sensory events and responsiveness to
    sensation) was made. It seems quite logical, as hypersensitivity
    (overarousal, overreactivity) experienced by the individual causes defensiveness (reaction/behaviour). This turn of attention from behaviours to
    experiences probably prevented such terms as ‘visual defensiveness’/’auditory defensiveness’/’vestibular defensiveness’, etc. from being spread in
    the research literature. That is why, though OT researchers still write about
    tactile defensiveness, while describing problems in other sensory modalities they prefer to use ‘hyper-/hyposensitivities’, ‘registration/modulation/integration’ problems, i.e. the concepts of sensory dysfunction and
    sensory modulation disturbances introduced by the researchers in the field
    of sensory and information processing.
    The better prognosis for children ‘who register sensory input but failed
    to modulate it’ than for children who fail to register sensory input,
    suggested by Ayres and Tickle (1980, p.375) also coincides completely
    with the prognosis by Delacato (1974) for children with hypersensitivities
    as opposed to those with hyposensitivities.
    Common classifications of ‘original’ SIDs include:
  • Decreased discrimination of vestibular and proprioceptive information:
    poor posture, frequent falling, clumsiness, poor balance,
    constant moving and fidgeting, poor attention. Treatment
    generally focuses on providing intense vestibular and
    proprioceptive stimulation and improving postural responses
    (Koomar and Bundy 1991).
  • Decreased discrimination of tactile information: a poor body scheme,
    difficulty with praxis and poor hand skill development.
    Other Sensory Conditions 139
    Treatment generally focuses on providing a variety of deepand light-touch experiences (Koomar and Bundy 1991).
  • Somatodyspraxia: poor tactile and proprioceptive processing,
    clumsiness, frequent tripping, falling and bumping into objects,
    difficulty with motor and manipulation skills, poor
    organization (Cermak 1991).
  • Impaired bilateral motor coordination: difficulty with bilateral
    activities such as clapping, hopping, skipping, keyboarding;
    difficulty developing a hand preference. Treatment generally
    focuses on providing vestibular and proprioceptive experiences
    and graded bilateral activities (Koomar and Bundy 1991).
  • Tactile defensiveness: an aversive response to a variety of tactile
  • Gravitational insecurity: limited participation in gross motor play;
    avoidance or fear of escalators, elevators, cars or planes;
    resistance of being off the ground. Treatment focuses on
    providing proprioceptive input and graded vestibular input
    (Koomar and Bundy 1991).
  • Projected action sequences: inability to plan and initiate movement
    in response to changing environmental stimuli. These
    difficulties are thought to be connected with inefficiencies in
    processing vestibular and proprioceptive input (Koomar and
    Bundy 1991).
    Nowadays, the OT researchers extend SID to the problems in all senses.
    According to Sensory Integration International, the following are some
    signs of SID:
  • oversensitivity to touch, movement, sights, or sounds
  • underreactivity to touch, movement, sights, or sounds
  • tendency to be easily distracted
  • social and/or emotional problems
  • activity level that is unusually high or unusually low
  • physical clumsiness or apparent carelessness
    140 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • impulsive, lacking in self-control
  • difficulty making transitions from one situation to another
  • inability to unwind or calm self
  • poor self concept
  • delays in speech, language, or motor skills
  • delays in academic achievement.
    These signs are often complemented by more specific symptoms from all
    sensory modalities and often coincide with the symptoms of CAPD or
    SS/IS described above.
    At present there are two distinct views on the ‘status’ of SID. Some
    authors argue that numerous psychological, psychiatric and neurological
    disorders such as schizophrenia, depression, ADHD, ADD, autism, PDD,
    Tourette syndrome, etc. appear the same as SID, and that many symptoms
    of SID look like symptoms of other common disabilities, making it
    difficult to differentiate one difficulty from another (Nelson undated). The
    others (Wilbarger and Stackhouse 1998) think that referring to the cluster
    of SI problems as a disorder may be premature as SID has not been
    identified as having universal and persistent features that are distinct from
    other established disorders.
    One can make some suggestions. Instead of trying to embrace all
    sensory processing and information processing disorders under one
    umbrella term, wouldn’t it better to investigate specific patterns of sensory
    perceptual problems in different ‘established disorders’? For example,
    though sensory perceptual problems have not been incorporated into
    diagnostic classifications, very specific and easy-to-describe unusual
    responses to sensory stimuli have been reported in most autistic children
    when they are observed prior to six years of age or when their parents are
    questioned about specific behaviours (Ornitz 1969; 1974; 1983; 1985).
    Before the age of six, specific behaviours caused by sensory perceptual
    problems were observed with almost the same frequencies as behaviours
    related to social and communicative impairments (Ornitz, Guthrie and
    Farley 1977; 1978; Volkmar, Cohen and Paul 1986). It would be useful to
    compile specific patterns of sensory perceptual problems for different
    Other Sensory Conditions 141
    developmental disorders in order to find out whether there are differences
    in their manifestations.
    To make the process easier, one could clearly specify and define
    separate sensory processing and information processing phenomena. For
    instance, sensory integration dysfunction can be defined as difficulty
    processing and interpreting information from more than one sensory
    channel at a time; sensory modulation disturbances – the difficulties to
    modulate optimal arousal, that is manifested as both under- and
    overreactivity (hyper- and hyposensitivities) to sensory stimuli, or
    fluctuation between the two; etc.
    Then probably SID, sensory modulation problems, as well as CAPD,
    SS/IS and similar conditions, will fit perfectly into the theory of sensory
    perceptual disorders/problems/difficulties.
    142 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Chapter 7
    When a child is diagnosed autistic, educational priorities focus on behavioural interventions aimed at development of social and communicative
    skills, while the child’s ‘sensory needs’ are often ignored. Paradoxical as it
    may seem, sometimes autistic children benefit from being misdiagnosed as
    having visual and/or auditory impairments. It especially applies to the
    so-called low-functioning (or ‘severely autistic’) children whose sensory
    perceptual problems are usually very severe. Being placed in an environment where their sensory difficulties are addressed these children might
    respond to social and communication interventions better than if they
    were placed in autistic units/schools where the main emphasis is only on
    training in social/communicative behaviours.
    In the case of such disabilities as blindness/deafness the main
    emphasis is on providing sensory substitution in order to replace one
    sensory input the person lacks (vision/hearing) by another (for example,
    tactile aids: Braille alphabet) and adjusting the environment to facilitate
    functioning of people with visual/auditory impairments. The problem
    with autism specific sensory perceptual difficulties is that they are often
    ‘invisible’ and undetected. The first step to make in the direction of
    addressing these problems is to recognize that they do exist. The matter is
    complicated by the fact that autistic individuals are very different in their
    sensory perceptual profile. Treatment programmes that are appropriate
    and beneficial for one child may be painful and harmful for another. Thus,
    if the ‘right problem’ is addressed, the child gets more chances to benefit
    from the treatment. A widely known example of this is described by
    Annabel Stehli (1991) concerning her daughter Georgiana who suffered
    from extremely acute hearing. After the Auditory Integration Treatment
    her hypersensitivity to sound diminished and this enabled her to cope with
    other perceptual problems to such an extent that she is no longer
    considered autistic.
    The sensory perceptual profile of a child could be a starting point for
    selection of methods and, probably, working out new ones, in order to
    address the individual needs of each particular child.
    Without treatment children learn to compensate, and use systems and
    methods available to them, such as stereotyped behaviours, self-injury,
    aggression, tantrums and withdrawal.
    There are different treatments available to address sensory problems.
    These do not offer a ‘cure’ for autism and do not have 100 per cent success
    for all who undergo them. In this chapter the basic principles of
    interventions addressing sensory perceptual problems in autism are
    Auditory Integration Training (AIT)
    Auditory Integration Training (AIT) was developed by French otolaryngologist Guy Berard. It is based on the work of Berard’s supervisor and
    colleague Alfred Tomatis but differs from it at some very important points.
    Both methods – the Tomatis Method and Berard’s AIT – are used at
    present. They have been reported to be beneficial in hypersensitive
    hearing, dyslexia, ADHD and autism, though there is still some controversy in the reports.
    The Tomatis Method
    The Tomatis Method works at three levels: functional, emotional and relational.
    First, the initial assessment is conducted to evaluate the ability to listen,
    listening strengths and weaknesses. This assessment consists of a battery of
    tests, which are administered using electronic equipment. The ability to
    hear specific sound scale frequencies (from 125 to 8000 Hz) is tested and a
    curve is derived for each ear (threshold evaluation). The curves are
    examined in three ranges: bass (125–800 Hz), middle (800–3000 Hz),
    and treble (3000–8000 Hz). In the normal condition, the curves rise at a
    144 Sensory Perceptual Issues in Autism and Asperger Syndrome
    specific rate between specific frequencies. Disturbances in the curves can
    be caused by different problems. Then the ability to recognize pitch
    differences between frequencies is tested for each ear (selectivity
    evaluation) by using a sound input of about 45–50 db. This ability should
    be developed by the time a child is eight–ten years of age. In order to
    discover problems with orientation within one’s environment, the ability
    to orient spatially is tested (spatialization evaluation). Leading ear
    evaluation is conducted to determine the dominant ear.
    Additional tests include examination of lateral dominance, figure
    drawing (the tree test, family test, human figure test).
    After analysis of the test results and a detailed developmental history, a
    specific individual listening programme using the Electronic Ear (the
    apparatus developed by Tomatis in 1953) is implemented. The Electronic
    Ear consists of four mechanisms: filters, electronic gate, balance control,
    and bone and air conduction reception. It is used to retrain the ear.
    The programme consists of two stages: auditory (i.e. receptive, when
    the person is trained to develop better listening skills) and audio-vocal (i.e.
    expressive, when the person is trained to develop a voice of good quality
    and tone to maintain listening skills). The person listens to the sounds of
    music and voice through the Electronic Ear. Electronically modulated
    music is administered through earphones. This ‘auditory input’ is filtered
    and modified according to the specific auditory problems of each
    individual. The Listening Training Programme is aimed to simulate five
    stages of listening development with special attention to the stages where
    the person displays difficulties. These five stages are: filtered high
    frequency listening (prenatal listening); integration of low frequencies
    (sonic birth); humming (prelanguage); repeating words and phrases
    (language); reading aloud. The first two phases (prenatal listening and
    sonic birth) are passive, where the child listens to filtered music (usually
    Mozart) and their mother’s voice while they are engaged in some activity
    (painting, doing puzzles, talking or even sleeping) for two hours a day. The
    last three phases are active, where the child has to repeat filtered sounds
    modified by the Electronic Ear. The whole programme usually lasts for 30
    days (2 hours a day).
    The Tomatis Method is claimed to be beneficial for a number of
    ‘psychological disorders’, including autism.
    Treatments 145
    The Berard method of AIT
    The AIT method was developed by Guy Berard, who was originally
    trained by Alfred Tomatis. The publication of Stehli’s book The Sound of a
    Miracle, A Child’s Triumph over Autism (1991) brought AIT a great attention
    and interest. Annabel Stehli described the remarkable results of AIT on her
    daughter Georgiana who had been diagnosed autistic and spent the first
    11 years of her life in special residential schools and institutions. The treatment was so effective for Georgie that she could live independently, graduated from the college with a degree and got married.
    AIT is based on two theories:
  • Behaviour is a direct result of how well a person hears.
  • The hearing mechanism can be retrained. As a result, improved
    hearing leads to improved behaviour.
    The principle of AIT originated from the concept of possibility of cure by
    mechanical needs. For example, if the movement of a limb is restricted, it
    can be cured (trained) by special physical exercises to increase mobility.
    This ‘mechanical’ treatment influences not only the related muscles but
    also the related area of the brain. Berard implies this principle in his ‘ear
    training’: if one of the areas of the auditory system is stimulated (trained)
    by certain sound training (with frequencies causing hypersensitivity
    having been filtered out) hearing is normalized. Research has shown that
    in order for the nervous system to develop normally, it must receive
    adequate sensory input that stimulates the development of corresponding
    areas in the brain.
    Berard developed an AIT device – Audiokinetron Ears Education and
    Retraining System. It selects on random high and low frequencies from
    music and sends the sounds via headphones.
    The AIT procedure involves:
  • Audiometric testing to find out whether the person has
    ‘auditory peaks’. According to Berard, these auditory peaks can
    be reduced or eliminated by AIT.
  • The filtering out of sounds at certain selected frequencies in
    accordance with the individual audiogram. Where an accurate
    audiogram cannot be obtained, the basic modulation system
    without specific filters is used.
    146 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • The modulation of the music by alternatively dampening and
    enhancing, on a random basis, the bass and treble musical
    output. Each session lasts for 30 minutes, 2 sessions a day for
    10 days.
  • After five days, another assessment of the person’s hearing to
    find out whether the auditory peaks are still present and
    whether there is a need to readjust the filters. If the person has
    speech and/or language problems, after half the sessions the
    volume level for the left ear is reduced to stimulate the
    language development in the left hemisphere.
    After AIT, the person should perceive all the frequencies equally well and
    have no auditory peaks.
    During the treatment and for some time after it some people exhibit
    temporary behavioural problems, such as hyperactivity, rapid mood swings
    and even aggression. It seems that the more severe the side-effects, the
    more beneficial the treatment is for the person. Typically, these behaviours
    do not last long (from two days to two months). Dr Berard explains AIT
    and summarizes case histories of some of his patients, with copies of their
    hearing tests before and after the treatment, in his book Hearing Equals
    Behavior (published in France in 1982; the English translation, 1993).
    Numerous pilot studies of the method demonstrated significant
    results: a reduction in self-stimulatory behaviours, hyperactivity, anxiety,
    social withdrawal, distractibility and echolalia, and an increase in
    attention, comprehension, articulation and auditory memory. There are
    very few immediate changes after the treatment. Usually positive changes
    take several months to be noticed. Most common positive changes are in
    the areas of social, emotional and cognitive development. Lower
    functioning individuals typically show greater improvement. It is not
    known yet how AIT affects a person’s behaviours.
    The report on the efficacy of AIT summarizing the results and critiques
    of 28 studies (January, 1993–May, 2001) was prepared by Edelson and
    Rimland (2001). The report covers 28 studies of AIT with 23 concluding
    that AIT benefits various population subgroups, 3 claiming no benefit, and
    2 with contradictory results. Dr Rimland considers that the Berard
    Method is more effective than the Tomatis therapy, which is more likely to
    produce side-effects, and is more expensive and intrusive. Besides,
    Treatments 147
    Tomatis’s emphasis on supposed psychological and/or emotional causes
    of the disorder can be misleading.
    The treatment is used with people with auditory processing problems,
    including those with autism, dyslexia, learning disabilities, PDD, ADHD
    and others. However, some researchers feel strongly against the treatment
    and warn that AIT can be harmful for children as the sound level of the
    processed music used in AIT might well exceed the maximum allowable
    levels as specified by the Occupational Safety and Health Administration
    in the USA.
    So why does the treatment work with some children and harm others?
    As there is no definite answer to this question at present, we may suggest
    the following hypothesis. We know that many people with autism do
    suffer from auditory problems (especially hypersensitivity to certain
    sounds). AIT aims to reduce this hypersensitivity by retraining the ear to
    tolerate certain frequencies and pitches. However, we should always
    address the causes of auditory hypersensitivity and not the symptom per
    se. Very often hypersensitivity is caused not by certain frequencies or
    certain sounds but by the number of auditory stimuli, the rate of auditory
    processing the person has to cope with and even other ‘non-auditory’
    stimuli (lights, movements, etc.) that can contribute to sensory overload
    and result in auditory hypersensitivity. Training the ear to tolerate certain
    frequencies may bring some improvement in the short term but as it does
    not address the improvement of sensory processing of other channels that
    may be the main source of the person’s overload, it is short-lived. AIT
    administered to the person whose main difficulties are rooted in auditory
    problems (i.e. they are the causes and not the symptoms) may produce
    ‘miraculous’ results, as it happened with Georgiana Stehli. When the
    primary problem is addressed and eliminated (or lessened), we can see
    immediate improvements in other systems as well, as they do not need to
    compensate for the impaired auditory channel and may get on with ‘their
    own job’. On the other hand, if auditory problems result from the auditory
    system being compensation for other sensory systems with primary
    impairments, AIT does little to ‘cure’ the condition.
    148 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Irlen method
    Helen Irlen has developed two methods to treat SS/IS: the use of coloured
    overlays to improve reading; and tinted glasses to improve visual perception of the environment.
    Overlays are used to reduce perceptual distortions of printed text, such
    as, for instance, the dominance of the white background when the black
    print may fade into background. The optimal colour of the overlay is very
    individual and depends on each person’s unique visual-perceptual
    Irlen argues that visual-perceptual distortions can be minimized by the
    use of tinted non-optical lenses (Irlen filters) and has developed the Irlen
    Differential Perceptual Schedule to identify symptoms of SS/IS. It is
    believed that the lenses filter out those frequencies of the light spectrum to
    which a person may be uniquely sensitive (Irlen 1997). The use of colour,
    usually worn as tinted glasses (Irlen filters) appears to change the rate at
    which visual information is processed by the brain, thus reducing overload
    and hypersensitivity.
    The Irlen Method consists of two steps:
    Screening: Irlen has designed a special questionnaire, which serves as a
    screening instrument. The questionnaire has to be completed by either the
    individual themselves or a family member. Each questionnaire is evaluated
    to determine whether an individual is a candidate for the Irlen Method.
    Testing: The correct colour is found. Usually it takes one to two sessions
    to determine the right colour. Irlen has designed a standardized set of
    procedures to determine the correct colour prescription for the overlay and
    the tinted lenses.
    A large number of studies have reported positive results in using
    coloured filters (Robinson 1996). However, negative results have been
    reported (Winter 1987) and mixed outcomes (Cotton and Evans 1990) as
    well. At present there is no doubt that using coloured filters reduces print
    distortions experienced by many ‘poor readers’. However, these filters do
    not solve the problem: improved print makes learning more effective but
    will not teach reading skills, and must be accompanied by appropriate
    reading correction methods.
    Recently there have appeared reports about positive changes people
    with autism experience while using Irlen coloured lenses (see, for example,
    Treatments 149
    Bogdashina 2001; Pemberton 1999; Waterhouse 2000) that give
    evidence that there are some visual-perceptual abnormalities in autism.
    The type of visual-perceptual deficits associated with autism is unique, and
    the distortions are varied, unpredictable and constantly changing.
    Quite a few autistic individuals have reported positive changes in their
    visual hypersensitivity brought by the tinted filters (Blackman 2001;
    Sinclair 1998; Williams 1999). The positive changes are: perception with
    depth instead of a two-dimensional world; no fragmentation of visual
    information (coherence); meaning-blindness is rare; improvement in eye
    contact, reduced sensitivity to auditory stimuli; increased ability to
    understand language; the ability to use several channels at the same time
    (for example, to see and to hear). Vision becomes a reliable sense, the other
    senses do not need to compensate any more. As there is no need to
    compensate for visual overload, there is better processing of sound, touch
    or body connectedness. Autistic individuals who have benefited from the
    Irlen Method report seeing better, feeling more relaxed, less sensitive to
    bright lights; having fewer perceptual distortions; better small and gross
    motor coordination.
    The Irlen Method is not a ‘cure’ for autism but rather one of the tools or
    compensatory strategies. It seems to work for those whose visual problems
    are overwhelming and helps slow down visual processing, thus helping to
    filter the information and in turn reducing the overload of other systems
    that compensate for unreliable vision.
    At the age of eight, Alex, a boy with autism, was also diagnosed as
    suffering from SS/IS, and since the age of nine he has been wearing his
    Irlen lenses for six–eight hours a day. He was very hypersensitive to
    bright lights and could not tolerate fireworks, lightning and bright
    sunshine (Figure 7.1). After having worn his Irlen glasses for a few
    months his light sensitivity has considerably decreased and now he
    enjoys watching fireworks and theatrical performances, bright sunshine
    (Figure 7.2) but demands to wear his glasses while watching. However,
    it is still difficult for him to be in places where fluorescent lights are on.
    After 30–40 minutes he exhibits anxiety, aggression or sometimes
    sleepiness, even if he is wearing his glasses. When he is ‘overloaded’ his
    150 Sensory Perceptual Issues in Autism and Asperger Syndrome
    anger is directed at…the glasses. He hits them, complaining ‘The
    glasses are not working.’
    In the case of Alex, the decrease of visual distortions and light sensitivity
    led to the improvement of auditory sensitivities, the increase of an attention span, reading abilities and the improvement in motor coordination. It
    means that all senses are interconnected and one should work at the evaluation of the ‘distortions’ of the sensory system as a whole and find the ways
    to correct possible perceptual abnormalities of all the senses. Only if we
    know what needs correction can we find the ways to correct it.
    Behavioural optometry
    There have been suggested other methods to improve visual processing.
    One of these is behavioural optometry.
    Behavioural optometry or vision therapy (sometimes it is also called
    ‘occupational therapy for the eyes’) is based on the principle that vision is a
    learned process and can be developed or enhanced at any age. Just as motor
    development, vision must follow certain steps of progression that may be
    Treatments 151
    Figure 7.1 Alex could not tolerate bright lights
    hindered, distorted or even stopped due to injury, illness, sensory
    deprivation or other still unknown causes. If any disruption in visual
    development occurs it could be corrected by the use of special lenses,
    prisms, and vision therapy to enhance visual capabilities, reduce visual
    stress, prevent and rehabilitate vision problems. This approach is aimed at
    ‘retraining’ the eyes and the brain so they work together.
    Vision dysfunction is often unrecognized and undiagnosed as the
    individuals may have 20/20 eyesight but distorted visual patterns. What
    makes the matter even more complicated is that many people have
    acquired compensatory strategies to cope with their visual difficulties.
    Specifically trained behavioural optometrists can identify visual
    152 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 7.2 Alex is enjoying his day out in bright sunshine
    dysfunctions, which are not identifiable by conventional eye tests. The
    symptoms of possible visual dysfunction include (from different sources):
  • eyes that cross or turn
  • tilting, turning the head
  • closing or covering one eye in order to use only one eye
  • peripheral vision
  • blinking, grimacing, squinting the eyes
  • finger flicking, spinning things and other visual stimulation
  • short attention span, avoidance of close work
  • headaches, dizziness, car sickness
  • light sensitivity.
    Vision therapy can be done at weekly sessions, with ‘homework’ assignments to train the skills learned during the sessions.
    This approach has its sceptics who say that there is little proof that
    behavioural optometry can accomplish such a difficult task as organizing
    the brain by retraining eyes. However, anecdotal successful cases have been
    Holding therapy
    In the late 1980s holding therapy was popularized and described as a
    ‘miracle cure’ for autism. These two magic words did inspire the parents to
    try it with their children. Though it brought extreme distress and suffering
    to both the child and the parents who had to observe the suffering of the
    child they were trying to help (cure?), the parents were told this was the
    price they had to pay for a ‘miracle’. When the ‘therapy’ did not work, the
    therapist would simply tell the parents that they were not doing it often
    enough or that their hearts were not really in it when they did it (Siegel
    When it works… Is it beneficial for the child? Let us listen to those for
    whom it ‘worked’. Therese Joliffe wrote about her experience of
    ‘successful holding therapy’:
    Treatments 153
    To me the suffering was terrible and it achieved nothing… A claim
    by proponents of this therapy is that the children are much quieter
    and better behaved for a little while afterwards. My quietness was
    due to exhaustion and to my being disturbed so much as a result of
    the experience that I was shocked into a state of terrified quietness,
    where I could not think or do anything much for a while. (Joliffe,
    Lakesdown and Robinson 1992)
    Isn’t the price too high? The same (or even better) beneficial effect can be
    achieved by less stressful methods.
    Claire Sainsbury (2000), a person with Asperger syndrome, believes
    that forced holding is not only not ‘therapy’, it is a form of abuse, a form of
    ‘sensory rape’. Some professionals trying to justify holding therapy
    compare it with Temple Grandin’s squeeze machine or describe it as a form
    of desensitization. It could not be further from the truth. The main
    differences are: the squeeze machine allows the user to control the touch
    and pressure and to be able to stop the stimulation when it becomes too
    overwhelming or intense. It is never forced.
    Many autistic people are hypersensitive to tactile stimuli, especially
    light touch. Both hypersensitive and hyposensitive children benefit from
    deep pressure and often seek it themselves. They might crawl under tables,
    cushions, quilts and prefer tight clothes (Jackson 2002). Desensitization
    technique presupposes gradual exposure to touch and pressure in a way
    which is safe and enjoyable for a child. Forced holding has nothing to do
    with these techniques. It has nothing to do with bonding with mother,
    ‘Hug machine’
    Temple Grandin, who is very hypersensitive to touch, has discovered that
    deep pressure can help her reduce her hypersensitivity and the anxiety it
    causes. When a child, Temple would crave deep pressure, crawling under
    the sofa or wrapping herself in blankets. She could not get the ‘right’
    amount of pressure from people because they were uncontrollable and
    either gave her too much or too little deep pressure.
    The idea to create her ‘hug/squeeze box’ or ‘hug/squeeze machine’
    came from her observation of cattle being branded in a squeeze chute at
    the farm of her relatives. Temple noticed that the cattle calmed down as
    154 Sensory Perceptual Issues in Autism and Asperger Syndrome
    soon as pressure was administered to them in the chute. She then designed
    and built her own device to administer pressure and control the amount
    and duration of it to achieve this calming effect. Gradually she was able to
    tolerate the machine holding her and her hypersensitivity to touch was
    slowly reduced.
    The ‘hug machine’ is a device consisting of two padded side-boards,
    which are hinged near the bottom to form a V-shape. The person crawls
    inside and, by using a lever, provides the deep pressure stimulation. The
    lever operates an air cylinder, which pushes the sides together. The person
    can control the level of pressure he wants to stimulate.
    Studies of the effectiveness of the ‘hug machine’ have produced some
    positive results. The researchers found a reduction of tension and anxiety
    resulted from the ‘hug sessions’; the number of stereotypies decreased,
    more relaxed behaviour followed afterwards. The best candidates to use
    the machine are those with tactile hypersensitivity, hyposensitivity
    (seeking for deep pressure experiences) and those who cannot regulate
    their arousal state.
    Some people need time to desensitize themselves while inside the
    machine (letting the sides touch them). When the nervous system becomes
    desensitized through gradual and slow stimulation, the experience of
    touch becomes pleasurable.
    Sensory integration therapy
    The goal of sensory integration therapy is described as facilitating the
    development of the nervous system’s ability to process sensory input in a
    more normal way. The main principles of sensory integration therapy were
    introduced by Delacato (who called it treatment of sensory dysfunction)
    and Ayres. They were based on the assumption that many autistic children
    could be helped through gently applying sensory stimulation through five
    senses (Delacato 1974) or tactile, proprioceptive and vestibular stimulation (Ayres 1979). At present, some occupational therapists still rigorously
    follow Ayres’s recommendations to work at the ‘three major senses’, while
    there are others who recognize the necessity to involve other senses as
    SI approaches may be of various types:
    Treatments 155
    1 Multi-sensory integration – the use of senses (vision, hearing,
    tactility, smell, taste, proprioception and vestibular system) in an
    integrated way, i.e. the use of several systems at once, for
    example, look and listen, rather than being single-channelled
    (mono-processing). However, it is important to remember that
    mono-processing is a strategy to avoid overload by using one
    channel at a time that is caused by the inability to filter out
    background and foreground information. In this case it is a
    symptom of the overload not the cause of it. That is why the
    original causes of sensory overload (which might be different
    for each individual) should be addressed.
  1. Desensitization, though not a cure, does provide more
    tolerance, increase speech and eye contact and decrease
    stereotypical, self-injurious and aggressive behaviours in some
    children. The sensory activities are aimed to raise the children’s
    threshold for arousal. They are never forced but introduced
    gently in the form of games and pleasurable exercises. The
    therapist typically analyses the child’s processing of vestibular,
    proprioceptive and tactile sensations in relation to the child’s
    ability to learn and move and incorporates meaningful activities
    that provide specific sensory stimuli to elicit an adaptive
    response, thereby assisting the child in overall motor and
    conceptual learning (Fisher and Murray 1991). The change in
    environment is also recommended. To have an optimum effect,
    the sensory diet should be designed for the child’s unique
    sensory processing needs (Wilbarger 1995).
    Sensory diet is defined as a type of therapy that involves a planned and
    scheduled activity programme implemented by an occupational therapist.
    Each diet is designed to meet the needs of each particular child’s nervous
    system. ‘Just as the five main food groups provide daily nutritional requirements, a daily sensory diet fulfils physical and emotional needs’
    (Kranowitz 1998, p.187). A sensory diet stimulates the ‘near’ senses
    (tactile, vestibular and proprioceptive) with a combination of alerting,
    organizing and calming techniques.
    For instance, hypersensitivity to touch is addressed through stroking a
    child with different textures (Ayres 1979). It should be done by an
    156 Sensory Perceptual Issues in Autism and Asperger Syndrome
    experienced therapist. A light touch increases arousal and overstimulation
    of the central nervous system. The pressure should be firm but gentle. Deep
    pressure stimulation is proved to be calming (Ayres 1979; King 1989).
    Different techniques are used to desensitize the child. For example, the
    Wilbarger Brushing Protocol, also known the Deep Pressure
    Proprioceptive Touch Technique, involves the use of a small brush and a
    massage protocol. With a special surgical brush the therapist makes firm,
    brisk movements over the body, especially the arms, hands, legs and feet.
    The brushing is followed by a technique of deep joint compression. As the
    child receives deep touch pressure the tactile receptors that are
    hypersensitive to light touch are depressed. Eventually, the child’s
    tolerance to tactile stimulation increases.
    Other techniques used in sensory integration therapy are tactile play
    (shaving cream and soap foam play, play dough); ‘heavy work’ activities
    (pushing and pulling a heavy box around the room; tug-of-war games;
    ‘sandwiches’ when a child is placed between two couch cushions and
    ‘squished’); vestibular activities (large therapy balls for bouncing, rolling,
    jumping on).
    An occupational therapist teaches the parents to use these techniques
    with a child at home for three to five minutes, six to eight times a day. As
    the child starts responding to touch more normally, the time of the sessions
    is reduced. The therapist should monitor the child’s responsiveness to the
    strategies and, should any adverse reactions occur, the therapist should
    discontinue the activity and modify the treatment approach accordingly
    (Koomar and Bundy 1991).
    Very often tactile stimulation may help different sensory systems work
    together and become more integrated. That can explain the necessity to
    feel the facilitator hand even on the shoulder to be able to communicate via
    facilitated communication. The supporters of SI therapy hypothesize that
    SI treatment can influence brain organization and brain change. As it is
    difficult to observe any changes in the brain, the only means to evaluate the
    effectiveness of the therapy is limited to observable behaviours. To
    complicate the matter, there is still no agreement about what to consider
    ‘truly sensory integrative’ treatments. As there are no clear definitions of SI
    and SID, the principles of the ‘truly SI therapy’seem to change from author
    to author. For example, Cermak and Henderson (1999) exclude any
    Treatments 157
    studies which involve ‘pure sensory stimulation’ from the ‘truly sensory
    integrative’ treatments because they are inconsistent with the principles of
    SI the authors opted to choose as ‘truly sensory integrative’ ones, i.e. the
    characteristics of sensory integration procedures, proposed by Kimbal:
  • active participation
  • child directed
  • individualized treatment
  • purposeful activity
  • need for adaptive response
  • input varies based on child’s response
  • activity rich in proprioceptive, vestibular and tactile input
  • implied or stated goal of improving processing and
    organization of sensation (not the teaching of specific skills)
  • administered by a trained therapist (OT or PT). (Cermak and
    Henderson, 1999)
    These characteristics restrict treatments to the ‘main three senses’ leaving
    vision and hearing out of the ‘truly sensory integrative’ interventions. It is
    necessary to mention, though, that many researchers and occupational
    therapists do include other senses in SI therapy.
    In SI research, factors influencing the effectiveness of SI therapy have
    been identified:
  • the child’s age: children under six were reported to make rapid
    progress in therapy
  • the diagnosis
  • the severity of responsiveness to certain kinds of sensory input.
    (Ayres and Tickle 1980)
    Aromatherapy is a therapeutic treatment using essential oils and massage. It
    stimulates the senses of smell, tactility and proprioception and can often
    bring relaxation. The repeated association of a particular smell with
    158 Sensory Perceptual Issues in Autism and Asperger Syndrome
    feeling calm and relaxed during a sensory-massage session can ‘teach’
    relaxation (Longhorn 1993).
    Autistic individuals who operate with ‘smell pictures’ and define
    objects, places and people by smell can be taught to react to particular
    smells (for example, to relax during sensory overload or anxiety).
    This method is also used with music or ‘cue’ words – the same word or
    phrase repeated softly during relaxation sessions – and can be used at
    ‘difficult times’ when the person is distressed (Ellwood undated).
    Sensory-massage can help to develop tolerance to touch and body
    Treatments 159
    Chapter 8
    Sensory Perceptual Profile
    Differences in perception lead to a different perceptual world that inevitably is interpreted differently. We have to be aware of these differences and
    help autistic people to cope with painful sensitivities and develop their
    strengths (‘perceptual superabilities’) that are often unnoticed or ignored
    by non-autistic people.
    Teachers and other professionals who work with autistic children need
    to recognize sensory differences in autism in order to select appropriate
    methods and plan intervention for these children.
    As all the senses are integrated, deficiency in one may lead to
    disturbances in the other(s). It is, therefore, necessary to find out which
    senses and to which extent are deficient, and which senses can ‘be relied
    In the 1960s–70s the batteries of ‘perceptual tests’ and screening tools
    were developed in order to identify ‘perceptually handicapped’ children.
    These tests were aimed at identifying lack of such skills as ‘laterality’,
    ‘directionality’, ‘visual closure’, ‘ocular pursuit’, ‘temporal-spatial
    relations’ but never addressed such perceptual phenomena as hyper- or
    hyposensitivity, inconsistency of perception, mono-processing, delayed
    perception, etc. The conventional auditory and visual acuity tests do not
    detect these problems.
    There exist several standardized instruments for evaluating sensory
    integrative dysfunction, for example, the Sensory Integration and Praxis
    Tests for children between the ages of four years and eight years eleven
    months (Ayres 1989), the DeGangi-Berk Test of Sensory Integration for
    children aged three to five (Berk and DeGangi 1983), but these tests are
    sort of ‘office tests’. They do not assess the child in natural settings and are
    aimed only at identifying deficits. Besides, the age limit does not allow
    assessment of the trends of sensory development and compensatory
    strategies acquired by the individual.
    As it is difficult for autistic children to tolerate the test situation or
    understand what they are expected to do, these tests are not suitable for
    autistic children.
    Recently quite a few informal assessments have been developed as
    screening tools for SI problems in the form of parent questionnaires that
    are aimed to reveal sensory-related problems.
    The Sensory Profile Checklist-Revised (SPCR, Appendix 1) has been
    organized into a screening tool for compiling a Sensory Profile of an
    autistic child. Its descriptors are based on the information from personal
    accounts of autistic individuals and close observations of autistic children.
    The SPCR includes 20 categories through all 7 sensory systems to cover
    possible patterns of autistic people’s sensory experiences. This ‘inside-out’
    approach to the problem reveals that not all sensory experiences are
    dysfunctional, and some of them might be classified as ‘superabilities’ and
    considered as strengths rather than weaknesses. It has been found very
    useful to ‘narrow’ the terms to describe different sensory perceptions. For
    example, the statement ‘the child is hypersensitive to visual stimuli’ does
    not say much about this particular child’s visual experiences, as the child’s
    vision might be distorted, peripheral, too acute, etc. Distinguishing
    between different ‘hypersensitivities’ allows us to address that particular
    child’s deficits while using his strengths.
    Table 8.1 summarizes possible sensory experiences in autism singled
    out for the Sensory Profile.
    Sensory Perceptual Profile 161
    162 Sensory Perceptual Issues in Autism and Asperger Syndrome Table 8.1 Possible Patterns Of Sensory Experiences In Autism Vision Hearing Tactility Smell Taste Proprioception Vestibular 1. Gestalt perception Inability to filter visual stimuli Inability to screen out background noise Inability to distinguish between tactile stimuli of different intensity Inability to distinguish between strong and weak smells Inability to distinguish between strong and weak tastes Inability to coordinate body position and movements of body parts Inability to distinguish between ‘inner’ and ‘outer’ movements 2. Intensity with which the senses work Hyper-, hypo- Hyper-, hypo- Hyper-, hypo- Hyper-, hypo- Hyper-, hypo- Hyper-, hypo- Hyper-, hypo- 3. Sensitivity to(disturbance by) some stimuli Light/colour sensitivity Disturbance by some patterns Disturbance by some sounds Sensitivity to certain textures Disturbance by some olfactory stimuli Disturbance by some gustatory stimuli Disturbance by some body positions Intolerance of certain movements 4. Fascination with certain stimuli Fascination with patterns, lights, colours Fascination with sounds Fascination with tactile stimuli Fascination with smells Fascination with flavours Fascination with certain body movements Excessive physical movements
    of perception
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    between hyperand hypo-; ‘in’
    – ‘out’
    Sensory Perceptual Profile 163
  1. Fragmented
    Seeing ‘in bits’,
    Hearing ‘in bits’ Feeling touch,
    cold/hot ‘in
    Smelling ‘in
    Tasting ‘in bits’ Feeling only
    some parts of
    the body
  2. Distorted
    depth and space
    seeing 2D
    distortions of
    shape, size
    sounds, etc.
    Distorted tactile
    perception of
    perception of
  3. ‘Sensory
    interpreting a
    ‘deaf ’
    body position,
    body sensations,
  4. Delayed
    processing of
    visual stimuli
    processing of
    auditory stimuli
    processing of
    tactile stimuli
    processing of
    processing of
    processing of
    body postures,
    body sensations
    processing of
    movement of
    to sensory
    Visual overload Sound overload Tactile overload Olfactory
    164 Sensory Perceptual Issues in Autism and Asperger Syndrome 11. Mono- processing (number of channels working at a time) Shutting down other senses while seeing Shutting down other channels while hearing Shutting down other channels while touching or being touched Shutting down other senses while smelling Shutting down other senses while tasting Shutting down other senses while being aware of body position Shutting down other channels while aware of body movements 12. Peripheral perception (avoidance of direct perception) Peripheral vision, avoidance of eye contact Hearing if listening to somebody indirectly Peripheral tactile perception Peripheral olfactory perception Peripheral gustatory perception Peripheral proprioceptive perception Peripheral vestibular perception 13. Systems shutdowns Visual ‘whiteouts’ Auditory ‘tuneouts’ Tactile ‘tuneouts’ Olfactory ‘tuneouts’ Gustatory ‘tuneouts’ Proprioceptive ‘tuneouts’ Vestibular ‘tuneouts’ 14. Compensating for unreliable sense by other senses Checking visual perception by other senses Checking auditory perception by other senses Checking tactile perception by other senses Checking olfactory perception by other senses Checking gustatory perception by other senses Checking proprioceptive perception by other senses Checking vestibular perception by other senses 15. ‘Losing oneself ’ in stimuli. Resonance Merging, getting in resonance with lights, colours,
    getting in
    resonance with
    getting in
    resonance with
    tactile stimuli;
    feeling pain of
    other people
    getting in
    resonance with
    getting in
    resonance with
    getting in
    resonance with
    In constant
    Sensory Perceptual Profile 165
    emotions of
    other people;
    events that do
    not relate to
    thoughts of
    other people;
    ‘Feeling’ events ‘Olfactory
    while being still
    movements of
    while being still
    Seeing sounds,
    temperature, etc.
    Hearing colours,
    flavours, touch,
    Seeing colours,
    hearing sounds
    while being
    sounds, colours,
    Tasting shapes,
    colours, sounds,
    body postures
    in response to
    visual, auditory,
    tactile, etc.
    movements in
    response to
    visual, auditory,
    tactile, etc.
  5. Perceptual
    sound’ memory
    Tactile memory Olfactory
  6. Associative
    Triggered by
    visual stimuli
    Triggered by
    auditory stimuli
    Triggered by
    tactile stimuli
    Triggered by
    Triggered by
    Triggered by
    body positions,
    Triggered by
    motor activities
  7. Perceptual
    Visual thinking
    (‘thinking in
    Thinking in
    Thinking in
    ‘tactile images’
    Thinking in
    Thinking in
    ‘Body positions,
    Relating to
    The SPCR is completed by the parents of the child. However, while the
    input from the parents is very important, particularly regarding the child’s
    sensory history and behaviour at home, it is also necessary to observe the
    child during sessions at school or at the clinic in order to consolidate the
    parental information and check some points marked in the SPCR as ‘not
    sure’. The observation is conducted in the form of ‘incident’ sampling –
    each time the target behaviour occurs a box is ticked. To organize and summarize the observations Observation Checklists prove to be very useful.
    They include a list of behaviours (sensorisms) which should be checked for
    the child. At the stage of interpretations of the findings, the parents and the
    children should be actively involved. The discussions with the parents are
    vital as they help not only to compile the SPCR for their child but also to
    interpret the child’s behaviours. The children should be encouraged to
    analyse their own behaviours and give their own interpretation of them
    through verbal explanation and/or drawings (how they feel and perceive
    the world).
    The Sensory Perceptual Profile compiled for each child helps to:
  • Identify the areas in which the child has (or had) problems but
    has learned to cope with them either by normalizing
    (desensitizing) the channel or by having acquired
    compensatory strategies. Using the data from ‘Was True’
    column we can trace the history of the child’s sensory
    development and identify the acquired strategies to cope with
    certain deficits.
  • Identify domains of strength which will be used both to
    provide compensatory techniques for coping with painful and
    meaningless input paths and to provide ‘communication
    channels’ to bring the information to the child.
  • Identify ‘problem domains’ in order to be desensitized or
  • Identify the preferred sensory modality that will be used as the
    ‘gates’ to bring information to the child. (For the majority of
    autistic children it is vision. However, some children exhibit
    preference for auditory, tactile or olfactory channels.)
    166 Sensory Perceptual Issues in Autism and Asperger Syndrome
  • Select the appropriate intervention strategies in accordance
    with the child’s strengths and weaknesses.
    The data obtained from the SPCR can be presented in the form of specially
    worked out graphs – ‘rainbows’ – with the boxes, representing specific
    features experienced by the individuals, coloured in. The numbers in the
    graph coincide with the characteristics enumerated in the table. Different
    colours can be used for each sensory channel: for example, red for vision,
    orange for hearing, yellow for tactility, green for smell, blue for taste,
    indigo for proprioception, and violet for vestibular sense. The extent to
    which each channel is affected is demonstrated when the ‘rainbows’ are
    coloured in as the number of coloured sections correspond to the number
    of characteristics experienced by the individual. As all the senses are integrated, the deficiency in one may lead to disturbances in the other(s).
    ‘Rainbows’ are supposed to assist in finding out which sense(s) and to what
    extent are deficient and which ones are ‘reliable’ or ‘superior’.
    The reason the symbol of a rainbow was chosen to indicate probable
    sensory experiences was that many autistic people compare autism with a
    rainbow and describe the autistic world as a rainbow prism. Besides, it
    seems appropriate to show the Sensory Profile of an autistic individual in
    the form of curved lines rather than a straight line, as not all sensory
    differences are deficits; some are better described as superabilities (or gifts)
    that could be successfully used in the treatment of autistic people. Figures
    8.1–8.4 show the ‘rainbows’ compiled for four children diagnosed as
    having autism. The graphs reveal the diversity of sensory problems
    experienced by each child, while the symptoms ‘on the surface’ (DSM-IV,
    ICD-10) are the same.
    Treatment programmes that are appropriate and beneficial for one
    child may be painful and harmful for another. Thus, if the ‘right’ problem
    is addressed, the child gets more chances to benefit from the treatment.
    Sensory Perceptual Profile 167
    168 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Figure 8.1 Alex’s Rainbow
    Figure 8.2 Vicky’s Rainbow
    Sensory Perceptual Profile 169
    Figure 8.3 Helen’s Rainbow
    Figure 8.4 John’s Rainbow
    Chapter 9
    Rainbows and Umbrellas
    The role of professionals should be to help people use their natural
    processes to learn and grow. This might mean helping people
    develop strategies for dealing with sensory oversensitivities: using
    earplugs or colored lenses, adapting clothing to accommodate tactile
    sensitivities, providing opportunities for deep pressure or vestibular
    stimulation, etc. It might mean teaching self-monitoring and
    self-management of behavior and emotions. (Jim Sinclair 1998)
    The ability to perceive stimuli in the environment accurately is basic to
    many areas of academic, communicative and social functioning. As autistic
    people do have ‘differences’ in this area, it is important for those who work
    and/or live with autistic children to be able to identify these and to understand how these differences might relate to the problems autistic individuals experience in learning and in general functioning. This will enable the
    provision of more effective programmes of learning and treatment.
    The sensory problems in autism are often overlooked. As children are
    unable to cope with the demands of the world they are not equipped to
    deal with, they are likely to display behavioural problems, such as
    self-stimulation, self-injury, aggression, avoidance, rigidity, high anxiety,
    panic attacks, etc. It is important to remember that these children have no
    control over their problems, as they are caused by neurological differences.
    The so-called low-functioning autistic individuals may have a
    near-normal brain trapped inside a sensory system that does not work
    properly and, as a result, not enough undistorted information gets
    through. It may be that the child’s abnormal sensory functioning leads to
    secondary abnormalities in the brain development because of distorted
    sensory input or lack of sensory input (Grandin 1996a). The more the
    child shuts down the incoming stimuli, the more sensory deprivation he
    creates and the less opportunity he has to learn to interact with the world.
    Because autism is a neurological disorder it causes some behaviours
    that a child cannot change without specific help. This is similar to hearing
    aids for deaf children, glasses for children with vision problems and
    wheelchairs for cerebral palsy children. Just as we never blame a blind child
    when he cannot name the colours of the pictures we show him, or expect a
    deaf child to come when we call him from two rooms away, we should not
    demand from a child whose disability is not straightforwardly visible to
    ‘behave himself ’, but should try to find out the reason for his
    ‘misbehaviour’. We accept that we cannot cure blindness and we do not
    waste time and effort teaching a visually impaired child to recognize
    colours using a bar of chocolate as a reward. We see our task to help a blind
    child function using different ways and compensatory strategies, and
    adjusting the environment to make it easier for him to orient in space. We
    accept and respect his disability, which, if appropriately addressed, does
    not interfere with the quality of life.
    While people with ‘visible’ disabilities, such as, for example, visual
    /hearing impairments or cerebral palsy, are provided with special tools to
    lessen their problems (glasses, hearing aids, wheelchairs) autistic children
    with ‘invisible’ sensory processing problems are often denied any support
    to accommodate their difficulties. Whatever educational approach is
    implemented, sensory interventions are vital in order for the child to
    benefit from it. To effectively teach and treat autistic children it is necessary
    to understand how the qualitative differences of sensory perception
    associated with autism affect each particular child. Often it is not the
    treatment and the number of hours you work with your child, but in ‘what
    perceptual world’ you both are, i.e. whether you are in one and the same
    perceptual world or in two different ones.
    First, we must understand how the child experiences the world
    through each of the channels and how he interprets what he sees, hears
    and feels, in order to design treatment programmes in accordance with his
    perceptual abilities and deficits. Understanding each particular person’s
    specific difficulties and how they may affect this person’s functioning is
    Recommendations: Rainbows and Umbrellas 171
    vital in order to adopt methods and strategies to help the person function
    in the community.
    Analysing the information from the SPCR, along with observations
    and reports from people who know the child will provide an accurate
    picture of each particular child’s strengths and weaknesses. It gives
    information about what the child currently can and cannot do, and allows
    setting priorities in his treatment programme.
    There is a continuum of sensory processing problems in autism. Some
    people have severe sensory distortions while others may experience only
    mild but nevertheless confusing sensory problems. Nonverbal people
    usually have more severe sensitivities. The unique characteristics of each
    child will require unique individual strategies, techniques and
    environmental adjustments to be implemented. There is no single strategy
    for all autistic children as each of them exhibits a very individual sensory
    profile. Moreover, with age the strategy that was very useful for this
    particular child may not work any more and should be replaced by another
    to reflect the changes in the child’s abilities to function.
    There are two major sets of factors which may influence the child’s
    level of functioning: negative factors and positive factors. Each set falls
    into two categories. The first category comprises personal (internal)
    characteristics of the child – both positive (the child’s strengths and
    abilities) and negative (the child’s weaknesses and deficits) characteristics.
    The second category is composed of environmental (external) factors:
    positive factors (resources and conditions helping the child to cope with
    his weaknesses and to develop his strength) and negative ones (interfering
    with the child’s ability to cope). The aim of any intervention programme
    should be to create and/or develop both internal and external positive
    factors in order to counterbalance the negative ones.
    The internal positive factors represent the child’s strengths,
    preferences and interests. The internal negative factors include painful
    hypersensitivities and acquired strategies to cope with them that may lead
    to secondary impairments, for example, shutdowns. The balance between
    positive and negative characteristics may change with age and
    development though some general features are typically found in all
    people with autism (such as perceptual thinking/perceptual memory).
    While developing programmes it is necessary to keep in mind the child’s
    172 Sensory Perceptual Issues in Autism and Asperger Syndrome
    strengths. Building on the child’s natural resources and the strategies he
    has acquired will increase the child’s competence and level of functioning.
    The preferences and interests will serve as motivators, reinforcers and ‘first
    aid’ in the case of sensory overload. Often the behaviours that seem
    challenging may hide the child’s strengths and may be ‘shaped’ into assets
    rather than problems.
    Using the SPCR we may identify the negative factors within and
    outside the child in order to eliminate them and we may explore the ways
    to use positive factors available in order to help the child to learn and
    function in the community. This information will also help parents and
    professionals who work with the child learn how to relate to the child in
    order to avoid undesirable ‘by-products’ of sensory processing difficulties
    – tantrums, aggression, etc.
    We can get a lot of information from watching repetitive behaviours.
    These behaviours are the key to understanding the way the child
    experiences the world, the problems he faces and the strategies he has
    acquired to cope with his difficulties. Consciously or unconsciously the
    child tries to regulate the environment and his responses to it and acquires
    defensive strategies and compensations for his deficits. The child shows us
    his way to cope with his problems.
    However, one of the difficulties in interpreting the child’s behaviour
    caused by sensory processing differences is our own ‘non-autistic’ sensory
    function. We have to train ourselves to perceive and understand the world
    from the individual’s perspective. Only then will we join the person ‘on his
    territory’, in his perceptual world, and will not have to function in two
    parallel ones.
    Repetitive behaviours in autism are multi-functional. They may be:
  • defensive: in order to reduce the pain caused by
  • self-stimulatory: to improve the input in the case of
  • compensatory: to interpret the environment in the case of
    ‘unreliable’ channels
  • just pleasurable experiences that help to withdraw from a
    confusing environment.
    Recommendations: Rainbows and Umbrellas 173
    These behaviours will change with the child’s changing abilities. As
    deficits in one area interact and affect other areas, improving functioning
    in one sensory modality may bring improvements in the others. For
    instance, reducing visual hypersensitivities (with the help of tinted glasses,
    for example) may make auditory and tactile stimuli less overwhelming.
    By looking at how the child reacts, it is possible to reconstruct and
    assess the child’s problems in various sensory channels. The child’s
    ‘self-prescribed’ movements (rocking, flapping hands, jumping) give a
    very clear idea of what the child needs.
    For example, if a child frequently covers his ears (even if you do not
    hear any disturbing sounds) it means his hearing is hypersensitive, and it is
    your job to find out which sounds/noises disturb him. If a child flicks his
    fingers in front of his eyes, he might have problems with hypersensitive or
    hyposensitive vision. Children who like crowds and noisy places either
    have mild sensory problems or are hyposensitive. Autistic children are
    often engaged in stereotyped activities. If these activities serve as a
    protective mechanism to shut down the sensory stimuli because they are
    painful or overwhelming, the job of an educator (or a parent) is to decrease
    sensory bombardment.
    Let us look at some possible interpretations of the SPCR.
    Difficulty in filtering background and foreground information caused by
    gestalt perception leads to rigidity of thinking and lack of generalization.
    Autistic people can perform in exactly the same situation with exactly the
    same prompts but fail to apply the skill if anything in the environment,
    routine or prompt has been even slightly changed. For instance, the child
    can perform the task if he is being touched on the shoulder and fails if he
    has not been given the prompt. Alternatively, a familiar room may seem
    different and threatening if the furniture has been slightly rearranged.
    These children need sameness and predictability to feel safe in their environment. If something is not the same, it changes the whole gestalt of the
    situation and they do not know what they are expected to do. It brings
    confusion and frustration. The strategy is to always communicate to the
    child beforehand, in a way he can understand (i.e. visual, tactile, etc.) what
    174 Sensory Perceptual Issues in Autism and Asperger Syndrome
    and why will be changed. Changes should be gradual, with the child’s
    active participation.
    On the perceptual level the inability to filter foreground and
    background information may bring sensory overload. Children are
    bombarded with sensory stimuli. They are ‘drowned’ in them. For
    individuals with ‘auditory gestalt’ perception, for example, a lot of effort
    has to be made to understand what is being said if there is more than one
    conversation going on in the room or more than one person speaking at a
    time. They are bombarded with noises from all directions. If they try to
    screen out the background noise they also screen out the voice of the
    person they try to listen to. The task should be to find out which modality
    does not filter the information and make the environment
    ‘visually/auditorily, etc. simple’. The next step would be to teach the
    person ‘to break the picture (visual/auditory/tactile/olfactory/
    gustatory)’ into meaningful units.
    Each of the senses (vision, hearing, tactility, smell, taste, proprioception,
    vestibular system) should be assessed to determine if the child is hyper- or
    hyposensitive. Depending on the sensitivity, the objectives should be both
    to desensitize the child’s ability to tolerate the stimuli (internal factors) and
    to provide the aids to help him cope with ‘offensive’ stimuli (tinted glasses,
    earplugs, etc.). Desensitization is aimed to increase sensory tolerance very
    gradually through pleasurable activities.
    There are many challenging behaviours (self-injury, tantrums,
    aggression) that can be dealt with effectively by simply changing the
    environment. Consider the level of ‘sensory pollution’. In the case of
    hypersensitivities, even a ‘visually/auditorily’ quiet environment may
    cause overstimulation and challenges for the child. Autistic people must be
    protected from painful stimuli. For example, fluorescent lights might be
    replaced by ordinary bulbs (in the case of visual hypersensitivity); school
    bells might be disconnected until the child’s auditory hypersensitivity is
    reduced, etc. If the child is hypersensitive, it is important to keep visual and
    auditory distraction to a minimum. We should always remember that if we
    Recommendations: Rainbows and Umbrellas 175
    cannot hear/see/smell/feel some stimuli, it does not mean that the child
    ‘is being stupid’ if distressed by ‘nothing at sight’.
    Tactile hypersensitivities should be addressed by choosing clothes and
    fabrics the child can tolerate. Wearing tight clothes that apply pressure
    helps to reduce self-stimulatory behaviours. As hypertactile children are
    frightened by light touch, especially if it is unpredictable, always approach
    the child from the front to prepare him visually for possible touch.
    Always monitor a number of simultaneous stimuli. If there are several
    conversations in the same room, plus fans working, plus people moving
    around, plus a fan working two rooms away…the child with sensory
    hypersensitivities is sure to be overwhelmed.
    If a child is hyposensitive, provide extra stimulation through the
    channels that do not get enough information from the environment.
    Encourage physical exercises (swinging, climbing), pushing/carrying
    heavy objects.
    As each child is unique, we very often find children with hyper- or
    hyposensitivities in one and the same classroom. The knowledge of each
    child’s sensitivities can help the teacher to plan the activities and address
    each child’s particular needs. It is often very difficult to adjust the
    environment to satisfy the needs of several children as the same stimuli may
    cause pain in some children and bring pleasurable experiences in others.
    Sensitivity to (disturbance by) some stimuli
    Identify which sensory stimuli may interfere with the child’s capability to
    cope and either reduce or eliminate them or, if impossible, provide ‘sensory
    aids’ (tinted glasses, earplugs) or protect the child with a ‘sensory umbrella’
    – modifications and adaptations of the environment to meet the child’s
    needs. Remember, what we think is enjoyable (for example, fireworks) may
    be fearful or overwhelming to an autistic child.
    Reported strategies to cope with light sensitivity are turning off any
    unnecessary lighting (especially fluorescent lighting), using lamps rather
    than overhead lights, low wattage light bulbs and tinted lenses.
    Be aware of the colours and patterns of the clothes you are wearing and
    of your perfume.
    176 Sensory Perceptual Issues in Autism and Asperger Syndrome
    The fear of a stimulus that ‘hurts’ is often the cause of many
    challenging behaviours. The antecedents cannot be easily identified.
    Sometimes we cannot see/hear/feel them as our senses are too ‘normal’.
    Sometimes these are ‘possible future antecedents’. Some autistic children
    try to break things (telephone or alarm clock, for example) that can
    produce painful stimuli. They do it as a protective reaction. The staff
    working with the child must consider not only immediate environmental
    threats for the child but also any potential factors that can cause painful
    experiences. It is useful to make a list of possible threatening/painful
    stimuli for each child, no matter how common and unthreatening they
    might seem to us: school bells, fire alarms, fans, dogs barking, babies
    crying, etc. Always warn a child about the possibility of the stimulus he is
    fearful of and show the source of it.
    Joe, an 11-year-old autistic boy, could not tolerate the high-pitched
    voice of one of his classmates. As soon as Mike appeared in the doorway,
    Joe would rush outside covering his ears and screaming. If the door was
    locked he got under the table with his hands over his head. Mike, a
    teenager with AS, was very upset: ‘I didn’t even say anything. Why is he
    afraid of me?’ Very gradually Joe was ‘desensitized’ to Mike’s voice: Joe
    was encouraged to watch Mike’s lips. Though he still found it difficult to
    tolerate the voice, the predictability and watching the source of it made it
    easier for Joe to cope with it.
    Fascination with certain stimuli
    Make a list of pleasant stimuli, to be used in the ‘case of emergency’ – to
    calm down the child after a painful/stressful experience. If you think the
    activities (behaviours) or materials the child uses for ‘self-treatment’ are
    inappropriate, identify their function and replace them with more appropriate ones. Remember that the stimulus that is pleasurable for one child
    may be a cause of distress for the other.
    Inconsistency of perception (fluctuation)
    The impact of environmental factors (both positive and negative) will vary
    with the age and circumstances of each child. At times it may appear that
    Recommendations: Rainbows and Umbrellas 177
    everything goes well, at other times the child may exhibit challenging
    behaviours under similar environmental conditions.
    Fragmented perception
    Routine and rituals help to facilitate understanding of what is going on
    and what is going to happen. Introduce any change very slowly and always
    explain beforehand what and why is happening differently. Structure and
    routines make the environment predictable and easier to control.
    If a person is prosopagnostic, introduce yourself each time you see him.
    Wearing the same clothes and hairstyle facilitates ‘recognition’.
    Sensory agnosia (difficulty interpreting a sense)
    Though they can see adequately, some autistic people may often have
    limited comprehension of what is seen when they are focused on something else. For example, they may be able to recognize the location of
    pieces of furniture in space to avoid bumping into them, but may not be
    able to identify what these objects are unless some cues (verbal or otherwise) are provided. Sometimes they cannot even identify people as people
    and may be startled by unexpected movements of ‘noisy objects’. In the
    state of sensory agnosia they need similar aids as visually/auditory
    impaired people.
    Delayed processing
    Give people time to take in your question/instruction and work out their
    response. Do not interrupt. Be aware that autistic people require more time
    than others to shift their attention between stimuli of different modalities
    and they find it extremely difficult to follow rapidly changing social interactions.
    Vulnerability to sensory overload
    A child vulnerable to sensory overload needs to be in control of his environment. Learning to recognize early signs of coming sensory overload is
    very important. It is better to prevent it than to ‘deal with the conse178 Sensory Perceptual Issues in Autism and Asperger Syndrome
    quences’. A child may need a quiet place (the ‘isle of safety’) to recover,
    where he can go to ‘recharge his batteries’ from time to time.
    Teach the child how to recognize the internal signs of the overload,
    how to control the state of his ‘inner cup’ and how to use strategies (for
    example, relaxation) to prevent the problem. A ‘First Aid Kit’ (for sensory
    overload) should always be at hand. Possible contents might be sunglasses,
    earplugs, squeezy toys, favourite toys, ‘I need help’ card.
    Mono-processing (number of senses working at a time)
    A child with mono-processing may have problems with multiple stimuli.
    Find out which channel ‘is open’ at the moment. Always present information in the child’s preferred modality. If you are not sure what it is or which
    channel ‘is on’ at the moment (in the case of fluctuation), use multi-sensory
    presentation and watch which modality ‘works’. Remember that they
    could switch channels.
    Peripheral perception (avoidance of central/direct perception)
    Never force eye contact. Use an indirectly confrontational approach, especially involving hypersensitive modalities. Indirectly confrontational communication can mean that if something needs explaining or showing, the
    person explaining or showing can do so as if out loud to themselves,
    addressing the wall or the floor, or his shoes, or the objects relating to the
    demonstration. The person with a problem of overload should be allowed,
    similarly, to address and interact with you through speaking out loud with
    you ‘in mind’. Gradually, bridges can be built from indirectly to more
    directly confrontational interaction and communication (Williams 1996).
    When hypersensitivity of the affected sensory channel is addressed
    and lessened, direct perception becomes easier. For example, an autistic
    boy whose visual hypersensitivity was intolerable and often painful was
    prescribed Irlen tinted glasses. After having worn them for a few months
    his eye contact improved from none to several seconds, and his ‘visual
    behaviour’ (using his eyes to look instead of using other senses to
    compensate for painful, and therefore often useless visual perception)
    became apparently better.
    Recommendations: Rainbows and Umbrellas 179
    Systems shutdowns
    If the sensory stimulation is overwhelming autistic people can shut their
    systems off. To avoid painful sounds they shut down hearing. (Though
    certain frequencies cannot be shut down.) Continuous noises (fans, microwave, heating) that do not bother other people may be very annoying. To
    shut down the painful channel they may engage in stereotypic behaviours,
    or deliberately distract themselves through other channels (for example,
    touching objects when hearing is overwhelming) or withdraw altogether.
    Compensating for unreliable sense by other senses
    Let the child use the sensory modality he prefers (for example, smell,
    touch) to ‘check’ his perception. With appropriate treatment and environmental adjustments to decrease hypersensitivities they gradually learn to
    use their sense organs properly – eyes to see, ears to listen, etc.
    ‘Resonance’, synaesthesia
    In many ways ‘autistic perception’ is superior to that of non-autistics.
    Autistic individuals with their heightened senses can often appreciate
    colour, sound, texture, smell, taste to a higher degree than people around
    them. Their gifts and talents should be nurtured and not ridiculed, as is
    often the case. Let them use their ways to explore the world.
    Perceptual memory. Perceptual thinking
    Choose methods of instruction to match the child’s learning style, for
    example, visual aids for ‘visual thinkers’, audiotapes for ‘auditory thinkers’,
    learning through movements, etc. The preferred channel will be our ‘gate’
    to reach the child. Autistic children learn better with concrete information,
    whether it is visual, auditory, tactile, etc.
    180 Sensory Perceptual Issues in Autism and Asperger Syndrome
    As some sensory dysfunction is present in all individuals with autism it
    would benefit parents of autistic children and professionals working with
    them to become more knowledgeable about the sensory perceptual
    problems they experience and possible ways to help them.
    However, we need to stop trying to change them into ‘normals’ and to
    adapt to our world. The aim of any intervention should be to help autistic
    individuals to cope with their problems and to learn to function in the
    community. Whatever treatment programme or therapy is used, it does not
    make them less autistic. However, increased self-knowledge can lead to
    better compensations for one’s difficulties, which in turn may decrease
    symptoms and make the autism less disabling (Gerland 1998). There is
    usually some natural progress in autistic children as they grow (Kanner
    1971). Some of Kanner’s patients became very high-functioning as adults
    even though they were not given any special treatment. These people
    found ways to cope with their problems and could function quite
    The type of intervention should depend on the type and severity of
    sensory problems the child experiences. The intensity of treatment should
    be in direct proportion with the child’s ability to cope with sensory
    As the Sensory Profile of each individual is unique, what works for one
    child may be not only painful but also harmful for another. That is why
    some methods (like, for example, Lovaas’s Applied Behaviour Analysis
    Programme) work for some children and bring no improvement in others.
    Parents often confess that what was intolerable about their child’s
    behaviour was that it seemed meaningless. When they could understand
    the reason for this behaviour it did not seem strange or disturbing any
    more. This brings acceptance and respect for the autistic person’s efforts to
    ‘make sense’ of the world.
    Whatever approach/treatment is chosen, the person working with the
    child should make the environment sensorily safe for the child and try to
    ‘move in the same sensory world’. Many behaviours that interfere with
    learning and social interaction are in fact protective or sensory defensive
    responses of the child to ‘sensory pollution’ in the environment.
    Autistic people are vulnerable to being abused. They have to live in a
    world which is not designed for them, and they have to deal with people
    who, while being aware of the difficulties they experience, often overlook
    the effort they are making trying to survive in the world which is not
    designed for them. If we look at their ‘bizarre’ behaviours and responses
    through their eyes, they make sense. Our behaviours may equally seem
    ‘bizarre’ to autistic persons. For example, how could one enjoy fireworks if
    your eyes are hit with ‘bunches of bright arrows’ and the sound in your ears
    ‘tears them raw’? We often do not understand the ‘autistic perspective’, the
    problems they experience. And sometimes our ‘treatment’ does more harm
    than good. Let us take some examples.
    A family were struggling to find the solution to a challenging
    behaviour of an eight-year-old autistic boy. The boy removed his clothes at
    any opportunity no matter where he was. The mother asked for advice
    from a ‘specialist’. And the advice was to encourage (?) the boy to keep his
    clothes on and reward him (with a chocolate biscuit) when he complies. If
    we look at this situation from the ‘autistic perspective’, tactile processing
    problems are obvious. The boy himself was aware of which fabric would
    ‘hurt’ him and tried to protect himself. His ‘clues’ were not recognized by
    the people involved. We could interpret the intervention as follows: a
    person with broken legs is encouraged to run and promised a reward of a
    chocolate biscuit. Would you run?
    Another situation: at one of the autistic provisions, a teaching support
    assistant is happily whistling and singing. Joe, an 11-year-old autistic boy,
    is rocking back and forth. He covers his ears with his hands, but it does not
    seem to work and he pushes his index fingers inside his ears. No effect.
    182 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Then he pleads with his ‘helper’: ‘Laura, stop singing, please. Stop it!’ The
    reaction of the support worker? ‘Why should I? Don’t be stupid, Joe.’ If we
    look at the same situation from Joe’s perspective, we could interpret it as a
    sensory assault of the child. For this boy the ‘singing’ (whether it was the
    pitch of the voice or the sounds of whistling he could not tolerate)
    physically hurt his ears, as if the helper threw stones or litter at him. So
    why should she stop?
    The sensory environment is very important for autistic people. They
    lack the ability to adjust to sensory assaults other people accept as normal.
    If we accommodate it and try to ‘keep it clean’ in order to meet their very
    special needs, the world could become more comfortable for them. With
    sensory needs met, problem behaviour becomes less of an issue. If there
    were no risk of being attacked, you would not need defence. To make the
    world safer for autistic individuals the price would not be too high – ‘just
    stop singing’ when they ask you to. And if they cannot ask because of their
    communication problems, use your knowledge and imagination to find
    out what they need.
    Some questions remain: How many of the behavioural characteristics
    listed as diagnostic criteria for autism are symptoms of sensory dysfunction? How could children develop if these problems are addressed as early
    as they are labelled autistic? How could we enter their perceptual world
    and bring them into ours?
    This book shows a possible direction to follow in the field of sensory
    perceptual dysfunction in autism. Besides, it could be a starting point for
    selection of methods and, probably, working out new ones, in order to
    address the individual needs of each particular child. And last, but not
    least, I hope this reconstruction of the sensory world of autism will give
    the readers some idea of the way autistic people perceive the world and
    will make non-autistics understand that the way they see the environment
    is not necessarily the only way to see it.
    Conclusion 183
    Appendix 1
    Sensory Profile Checklist
    Revised (SPCR)
    Name of child_______________________Birthdate _
    Diagnosed ________When? __ Where? __
    PURPOSE: This checklist is designed for completion by parents of children
    who have been diagnosed as having Autism Spectrum Disorder (ASD).
    The SPCR is intended to clarify the sensory experiences of such children
    and to draw a sensory profile (’Rainbow’) in order to identify possible
    sensory strengths and weaknesses that would be helpful in selecting
    appropriate methods of teaching and treatment.
    INSTRUCTIONS: Please tick the appropriate answer to indicate the statement described as:
  • WT – was true in any time in the past: in brackets, specify the
    age of the child when the statement was true, e.g. (two–five
  • T – true now (if it was true and is true now, tick both answers)
  • F – false (if the statement is not true)
  • NS – not sure or do not know.
    Additional information is welcome: write it near the question, or copy the question
    number on a blank sheet of paper and add the information there.
    Please try to answer all questions.
    Appendix 1: Sensory Profile Checklist Reviced (SPCR) 185
    No Behaviours WT T F NS
    1 Resists any change
    2 Notices every tiny change in the environment
    3 Does not recognize a familiar environment if
    approaches it from a different direction
    4 Does not recognize people in unfamiliar clothes
    5 Is not fooled by optical illusions
    6 Constantly looks at minute particles, picks up smallest
    pieces of fluff
    7 Dislikes dark and bright lights
    8 Is frightened by sharp flashes of light, lightning, etc.
    9 Looks down most of the time
    10 Covers, closes, or squints eyes at bright light
    11 Is attracted to lights
    12 Looks intensely at objects and people
    13 Moves fingers or objects in front of eyes
    14 Is fascinated with reflections, bright coloured objects
    15 Runs a hand around the edge of the object
    16 Perimeter hugging
    17 Gets easily frustrated/tired under fluorescent lights
    18 Gets frustrated with certain colours (Specify: )
    19 Is fascinated with coloured and shining objects
    (Specify: )
    20 May respond differently (pleasure – indifference –
    distress) to the same visual stimuli (lights, colours,
    visual patterns, etc.)
    21 Selects for attention minor aspects of objects in the
    environment instead of the whole thing (e.g. a wheel
    rather than a whole toy car, etc.)
    22 Gets lost easily
    23 Fears heights, stairs, escalators
    186 Sensory Perceptual Issues in Autism and Asperger Syndrome
    24 Has difficulty catching balls
    25 Appears startled when being approached suddenly
    26 Makes compulsive repetitive hand, head, or body
    movements that fluctuate between near and far
    27 Hits/rubs eyes when distressed
    28 Feels/acts blind
    29 Ritualistic behaviour
    30 Response to visual stimuli is delayed (e.g. fails to close
    eyes when the light is being switched on, etc.)
    31 Any experiences are perceived as new and unfamiliar,
    regardless of the number of times the child has
    experienced the same thing
    32 Sudden outbursts of self-abuse/tantrums or
    withdrawal in response to visual stimuli
    33 Does not seem to see if listening to something
    34 Avoids direct eye contact
    35 Appears to be a mindless follower
    36 Surprises with knowing ‘unknown’ information
    37 Smells, licks, touches, or taps objects
    38 Seems to be absorbed (merged) with lights, colours,
    39 Seems to know what other people (who are not
    present) are doing
    40 Covers/rubs/blinks, etc. eyes in response to a
    41 Complains about (is frustrated with) the ‘wrong’
    colours of letters/numbers, etc. on coloured blocks,
    42 Displays a good visual memory
    43 Reactions are triggered by lights, colours, patterns
    44 Easily solves jigsaw puzzles
    45 Remembers routes and places
    Appendix 1: Sensory Profile Checklist Reviced (SPCR) 187
    46 Memorizes enormous amounts of information at a
    47 Poor at mathematics
    48 Learns nouns first
    49 Has difficulties with adverbs and prepositions
    50 Idiosyncratic patterns in language development (e.g.
    names one thing to denote the other, etc.)
    51 Gets easily frustrated when trying to do something in
    a noisy, crowded room
    52 Does not seem to understand instructions if more
    than one person is talking
    53 Covers ears at many sounds
    54 Is a very light sleeper
    55 Is frightened by animals
    56 Dislikes thunderstorm, sea, crowds
    57 Dislikes haircut
    58 Avoids sounds and noises
    59 Makes repetitive noises to block out other sounds
    60 Bangs objects, doors
    61 Likes vibration
    62 Likes kitchen and bathroom
    63 Likes traffic, crowds
    64 Is attracted by sounds, noises
    65 Tears paper, crumples paper in the hand
    66 Makes loud rhythmic noises
    67 Gets frustrated with certain sounds (Specify: )
    68 Tries to destroy/break objects producing sounds
    (clock, telephone, musical toy, etc.)
    69 Is fascinated with certain sounds (Specify: )
    70 May respond differently (pleasure – indifference –
    distress) to the same auditory stimuli (sounds, noises)
    188 Sensory Perceptual Issues in Autisom and Asperger Syndrome
    71 Hears a few words instead of the whole sentence
    72 Pronunciation problems
    73 Unable to distinguish between some sounds
    74 Hits ears when distressed
    75 Feels/acts deaf
    76 Response to sounds, questions, instructions is delayed
    77 Echolalia in monotonous, high-pitched, parrot-like
    78 Sudden outbursts of self-abuse/tantrums or
    withdrawal in response to auditory stimuli
    79 Does not seem to hear if looking at something
    80 Reacts to instructions better when they are ‘addressed
    to the wall’
    81 Looks for the source of the sound
    82 Seems to be absorbed (merged) with sounds
    83 Seems to be able to ‘read’ thoughts, feelings, etc. of
    84 Complains about ‘non-existent’ conversations, sounds
    85 Covers/hits ears in response to lights, colours/touch,
    86 Complains about (is frustrated with) a sound in
    response to colours/textures/touch/scent/flavour/
    87 Displays a good auditory memory (for nursery
    rhymes, songs, etc.)
    88 Reactions are triggered by sounds/words
    89 Uses idiosyncratic routinized responses
    90 Uses songs, commercials, etc. to respond
    91 Cannot keep track of conversation
    92 Composes musical pieces, songs
    93 Unable to distinguish between tactile stimuli of
    different intensity (e.g. light and rough touch)
    Appendix 1: Sensory Profile Checklist Reviced (SPCR) 189
    94 Resists being touched
    95 Cannot tolerate new clothes; avoids wearing shoes
    96 Overreacts to heat/cold/pain
    97 Avoids getting messy
    98 Dislikes food of certain texture (Specify: )
    99 Moves away from people
    100 Insists on wearing the same clothes
    101 Likes pressure, tight clothing
    102 Seeks pressure by crawling under heavy objects, etc.
    103 Hugs tightly
    104 Enjoys rough and tumble play
    105 Prone to self-injuries
    106 Low reaction to pain, temperature
    107 Cannot tolerate certain textures (Specify: )
    108 Is fascinated with certain textures (Specify: )
    109 May respond differently (pleasure – indifference –
    distress) to the same tactile stimuli (clothes, touch,
    heat, pain, etc.)
    110 Complains about parts of the clothes
    111 Hits/bites themselves when distressed
    112 Feels/acts numb
    113 Sudden outbursts of self-abuse/tantrums or
    withdrawal in response to tactile stimuli
    114 Does not seem to feel being touched if looking
    at/listening to something
    115 Fails to define either texture or location of touch
    116 Can tolerate only ‘instrumental’ (not ‘social’) touch
    117 Sometimes does not react to any tactile stimuli
    118 Seems to be absorbed (merged) with certain textures
    119 Seems to feel pain of others
    190 Sensory Perceptual Issues in Autisom and Asperger Syndrome
    120 Complains about being touched/hot/cold, etc. in the
    absence of the stimuli
    121 Complains about (is frustrated with) feeling colours,
    sound, etc. when being touched
    122 Complains about (is frustrated with) feeling being
    touched when being looked at
    123 Complains about (is frustrated with) backache,
    etc./heat/cold in colourful/noisy/crowded places
    124 Displays a good tactile memory
    125 Reactions are triggered by
    126 Unable to distinguish between strong and weak
    127 Toileting problems
    128 Runs from smells
    129 Smells self, people, objects, etc.
    130 Smears/plays with faeces
    131 Seeks strong odours
    132 Bedwetting
    133 Cannot tolerate certain smells (Specify: )
    134 Is fascinated with some smells (Specify: )
    135 May respond differently (pleasure – indifference –
    distress) to the same smells
    136 Complains about smells of some pieces of food while
    ignoring the rest
    137 Hits nose when distressed
    138 Has difficulty in interpreting smells
    139 Response to smells is delayed
    140 Sudden outbursts of self-abuse/tantrums or
    withdrawal in response to smells
    141 Does not seem to feel smell when looking/listening,
    Appendix 1: Sensory Profile Checklist Reviced (SPCR) 191
    142 Avoids direct smells
    143 Sometimes does not react to any smell
    144 Inspects food before eating
    145 Seems to be absorbed (merged) with smells
    146 Complains/talks about ‘non-existent’ smells
    147 Covers/rubs/hits nose in response to a
    visual/auditory stimulus/touch/taste/movement
    148 Complains about (is frustrated with) the smell in
    response to a visual/auditory stimulus/touch/taste/
    149 Displays a good memory for smells
    150 Reactions are triggered by smells
    151 Unable to distinguish between strong and weak tastes
    152 Poor eater
    153 Uses the tip of the tongue for tasting
    154 Gags/vomits easily
    155 Craves certain (plain) foods
    156 Eats anything (pica)
    157 Mouths and licks objects
    158 Eats mixed food (e.g. sweet and sour)
    159 Regurgitates
    160 Cannot tolerate certain food (Specify: )
    161 Is fascinated with certain tastes (Specify: )
    162 May respond differently (pleasure – indifference –
    distress) to the same food
    163 Is confused with (complains about) the food he used
    to like
    164 Has difficulty in interpreting tastes
    165 Response to tastes is delayed
    166 Sudden outbursts of self-abuse/tantrums or
    withdrawal in response to taste
    192 Sensory Perceptual Issues in Autisom and Asperger Syndrome
    167 Does not feel any taste while eating something and
    looking at/listening to something
    168 A very careful eater
    169 Sometimes does not react to any taste
    170 Seems to be absorbed (merged) with certain food
    171 Complains/talks about ‘non-existent’ taste in mouth
    172 Makes swallowing movements in response to a
    visual/auditory stimulus/touch/smell/movement
    173 Complains about (is frustrated with) some tastes in
    response to a visual/auditory stimulus/touch/smell/
    174 Displays a good memory for tastes
    175 Reactions are triggered by certain food
    176 Clumsy; moves stiffly
    177 Odd body posturing (places the body in strange
    178 Difficulty manipulating small objects (e.g. buttons)
    179 Turns the whole body to look at something
    180 Low muscle tone
    181 Has a weak grasp; drops things
    182 A lack of awareness of body position in space
    183 Unaware of their own body sensations (e.g. does not
    feel hunger)
    184 Bumps into objects, people
    185 Appears floppy; often leans against people, furniture,
    186 Stumbles frequently; has tendency to fall
    187 Rocks back and forth
    188 Cannot tolerate certain movements/body positions
    189 Is often engaged in complex body movements, esp.
    when frustrated or bored
    190 May have different muscle tone (low – high)
    Appendix 1: Sensory Profile Checklist Reviced (SPCR) 193
    191 Pencil lines, letters, words, etc. are uneven (e.g.
    sometimes too tight, sometimes too faint)
    192 Complains about limbs, parts of the body
    193 Difficulty with hopping, jumping, skipping, riding a
    194 Does not seem to know what their body is doing
    195 Very poor at sports
    196 Tires very easily, esp. when in noisy/bright places, or
    when standing
    197 Does not seem to know the position of the body in
    space/what the body is doing, when looking
    at/listening to/talking
    198 Has difficulty imitating/copying movements
    199 Does not seem to know how to move their body
    (unable to change body position to accommodate
    200 Watches their feet while walking
    201 Watches their hands while doing something
    202 Seems to be absorbed with body movements
    203 Complains about ‘non-existent’ physical experiences
    (e.g. ‘I am flying’, etc.)
    204 Involuntary postures of the body in response to a
    visual/auditory stimulus/smell/taste/touch
    205 Displays a very good proprioceptive memory (e.g.
    understands directions better if produces exact
    movements they have to do in order to follow these
    206 Reactions are triggered by body positions/movements
    207 Mimics the actions when instructions are being given
    208 Resists change to head position/movement
    209 Fearful reactions to ordinary movement activities
    (e.g. swings, slides, merry-go-round, etc.)
    210 Has difficulty with walking or crawling on uneven or
    unstable surfaces
    194 Sensory Perceptual Issues in Autism and Asperger Syndrome
    211 Dislikes head upside down
    212 Becomes anxious or distressed when feet leave the
    213 Enjoys swings, merry-go-round
    214 Spins, runs round and round
    215 Fears falling or height
    216 Spins, jumps, rocks, etc. esp. when frustrated or bored
    217 May respond differently (pleasure – indifference –
    distress) to the same movement activities (swings,
    slides, spinning, etc.)
    218 Resists new motor activities
    219 Tiptoeing
    220 Becomes disoriented after a change in head position
    221 Seems oblivious to risks of heights, etc.
    222 Holds head upright, even when leaning or bending
    223 Gets nauseated or vomits from excessive movement
    (swings, merry-go-round, cars, etc.)
    224 Does not seem to mind any movements when looking
    at/listening to something/talking
    225 Avoids balancing activities
    226 Becomes disoriented in noisy/bright places, or after
    physical activities
    227 Rocks unconsciously during other activities (e.g.
    watching a video)
    228 Inspects the surface before walking on it
    229 Appears to be in constant motion
    230 Involuntary movements of the body in response to a
    visual/auditory stimulus/smell/taste/touch
    231 Experiences movement while being still (e.g. ‘I am
    flying’ while being in bed)
    232 Reactions are triggered by motor activities
    Appendix 2
    Key for Decoding the Checklist
    This key will aid you in completing the chart and rainbow.
    If you have ticked the ‘True’ box for a question in the Sensory Profile
    Checklist then you will need to colour in the corresponding box in the
    chart. For example, if you have answered question 15 as ‘True’ then you
    colour in box 2 in the V column. Some questions in the profile relate to the
    same box in the chart. For example, if you have answered ‘True’ to either
    question 76 or 77, colour in the box 9 in the H column.
    Once you have completed the chart, count the number of coloured
    boxes in the corresponding section. Colour in the same number of boxes in
    the corresponding section of the rainbow. For example, if you have
    coloured in ten boxes in the V column, then colour in ten boxes of the V
    section of the rainbow.
    196 Sensory Perceptual Issues in Autism and Asperger Syndrome
    1 V1; V6
    2 V1
    3 V1; V6
    4 V1; V6
    5 V1
    6–9 (hyper-) V2
    10 V2; V3
    11–16 (hypo-) V2
    17–18 V3
    19 V4
    20 V5
    21–22 V6
    23 V7; Vs7
    24 V7; P7
    25–27 V7
    28 V8
    29 V8; H8; Tc8
    30 V9
    31 V9; H9; Tc9
    32 V10
    33 V11
    34 V12
    35–36 V13; H13
    37 V14; Tc14
    38 V15
    39 V16
    40–41 V17
    42 V18
    43 V19
    44–50 V20
    51–52 H1
    53–59 (hyper-) H2
    60–66 (hypo-) H2
    67–68 H3
    69 H4
    70 H5
    71 H6
    72–74 H7
    75 H8
    76–77 H9
    78 H10
    79 H11
    80 H12
    81 H14
    82–83 H15
    84 H16
    V – Vision
    H – Hearing
    Tc – Tactility
    S – Smell
    T – Taste
    P – Proprioception
    Vs – Vestibular
    Appendix 2: Key for Decoding the Checklist 197
    85–86 H17
    87 H18
    88–91 H19
    92 H20
    93 Tc1
    94–98 (hyper-) Tc2
    99–100 (hyper-) Tc2; S2
    101–106 (hypo-) Tc2
    107 Tc3
    108 Tc4
    109 Tc5
    110 Tc6
    111 Tc7
    112 Tc8
    113 Tc10
    114–115 Tc11
    116 Tc12
    117 Tc13
    118–119 Tc15
    120 Tc16; Tc20
    121–123 Tc17
    124 Tc18
    125 Tc19
    126 S1
    127–128 (hyper-) S2
    129–132 (hypo-) S2
    133 S3
    134 S4
    135 S5
    136 S6
    137 S7
    138 S8
    139 S9
    140 S10
    141 S11
    142 S12
    143 S13
    144 S14; T14
    145 S15
    146 S16; S20
    147–148 S17
    149 S18
    150 S19
    151 T1
    152–155 (hyper-) T2
    156–159 (hypo-) T2
    160 T3
    161 T4
    162 T5
    163 T6; T7
    164 T8
    165 T9
    166 T10
    167 T11
    168 T12
    169 T13
    198 Sensory Perceptual Issues in Autism and Asperger Syndrome
    170 T15
    171 T16; T20
    172–173 T17
    174 T18
    175 T19
    176 P1
    177–179 (hyper-) P2
    180–183 (hypo-) P2
    184 (hypo-) P2; Vs2
    185–186 (hypo-) P2
    187 (hypo-) P2; Vs2
    188 P3; Vs3
    189 P4
    190–191 P5
    192 P6
    193 P7
    194 P8
    195 P9
    196 P10
    197 P11
    198 P12
    199 P13
    200–201 P14
    202 P15
    203 P16; Vs16; Vs20
    204 P17
    205 P18
    206 P19
    207 P20
    208 Vs1
    209–212 (hyper-) Vs2
    213–214 (hypo-) Vs2
    215 Vs3
    216 Vs4
    217 Vs5
    218 Vs6
    219 Vs7
    220 Vs8
    221 Vs9
    222 Vs9; Vs13
    223 Vs10
    224 Vs11
    225 Vs12
    226–227 Vs13
    228 Vs14
    229 Vs15
    230 Vs17
    231 Vs18; Vs20
    232 Vs19
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    Developmental Psychologist 5, 7–10.
    Zeki, S. (1992) ‘The visual image in the mind and brain.’ Scientific American 267, 3,
    210 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Subject Index
    ‘accumulation of unknown knowing’ 79,
    83, 91
    Applied Behaviour Analysis 62, 181
    aromatherapy 159
    attention 40, 51, 67, 100, 105
    in autism 100–5
    delay in switching 103
    directed 101
    idiosyncratic focus 102
    joint 103–4
    selective 101
    tunnelling 102 (see also monotropism)
    Attention Deficit Hyperactivity Disorder
    103, 141, 144
    auditory impairments 25, 143 (see also
    Auditory Integration Treatment (AIT) 144
    autism 19–20
    as a way of being 20
    as sensory dysfunction 25
    diagnosis 20
    misunderstanding 22, 28
    theories of 21 (see also theory of mind)
    autistic savant 45, 48, 103, 105, 107 (see
    also Nadia; Wiltshire, Stephen)
    attentional mechanism of 103
    skills 100
    avoidance of direct perception 83, 86,
    88, 179 (see also peripheral
    behavioural optometry 151
    Berard method 146–8
    blind spot 32
    blindness 27, 38, 92, 143, 171 (see also
    visual impairments)
    central auditory processing disorder 119,
    128, 142
    central coherence 21, 47, 84, 102
    monotropic central coherence 84
    weak central coherence, theory of 21,
    47, 51, 68, 69, 102
    cognitive style 52, 98
    concept 37
    formation 98, 109
    tactile-motor 38
    daydreaming 22, 83, 95–6, 165
    deafness 26, 38–9, 143, 171 (see also
    auditory impairments)
    delayed processing 49, 52, 76–9, 92,
    103, 108, 160, 163, 178
    desensitization 154, 156
    ‘distance touching’ 88
    distorted perception 28, 38, 52, 73–4,
    79, 92, 163
    disturbance by stimuli 52, 61–5, 162,
    disturbances of sensory modulation 66,
    137, 139, 142 (see also sensory
    modulation disorder)
    executive function deficit 116–7
    eye contact 87, 156, 179
    avoidance 86, 88, 164
    face-blindness 127–8 (see also
    fascination with stimuli 52, 61, 64–5, 93,
    162, 177
    fluctuation 43–4, 49, 52, 65–6, 142,
    162, 177, 179 (see also inconsistency
    of perception)
    foreground and background information,
    inability to filter 46–8, 79, 156,
    175 (see also perception, gestalt)
    fragmented perception 48–9, 52, 67–73,
    79, 92, 163, 178
    gravitational insecurity 138, 140
    habituation 36, 138
    holding therapy 153–4
    hug machine 154–5
    hypersensitivity 49, 52–5, 57, 61, 64,
    79–80, 84–5, 89, 92, 139, 146,
    hyposensitivity 49, 52–3, 56–7, 128,
    155, 173
    illusions 41–3, 47
    cognitive 43
    physiological 43
    visual 41, 43, 46–7, 52
    imagination 41, 98, 112, 117–8
    inconsistency of perception 52, 65, 160,
    162, 177
    Irlen method 149–150
    light sensitivity 63, 131, 150
    ‘losing oneself ’ in stimuli 93, 164
    memory 41, 98, 100, 105, 118
    auditory 105–6, 111
    in autism 105–8
    characteristics of ‘autistic memory’
    episodic 105
    gustatory 105, 111
    olfactory 105, 111
    photographic 48, 118
    tactile 105, 111
    modulation 66, 136–9
    mono-processing 83–5, 102, 156, 160,
    164, 179
    monotropism 84–5, 102 (see also attention
    Nadia 100
    Neurologically Typical 19
    information 48, 52, 64, 79–80, 83,
    88–9, 91, 102, 123
    sensory 52, 73, 82–3, 85, 87–9, 126,
    133, 148, 156, 159, 173, 175,
    vulnerability to 79–82, 163, 178
    perception 37–41, 43, 109
    gestalt 46–52, 67–8, 104, 174
    literal 45
    perceptual development 37–41
    perceptual style 23, 52, 83
    perceptual tests 160
    perceptual thinking 111, 115, 165, 172,
    auditory 115
    visual 111, 112–4
    peripheral perception 83, 86–8, 164,
    179 (see also avoidance of direct
    polytropism 84
    primate isolation syndrome 90
    probable prediction theory 46–8
    prosopagnosia 119, 127, 163 (see also
    212 Sensory Perceptual Issues in Autism and Asperger Syndrome
    ‘rainbows’ 23, 167–169
    receptors 30 (see also sensory organs)
    auditory 35
    light 33, 43
    proprioceptors 30, 34, 36
    sight 32
    smell 31
    tactile 36, 157
    taste 32
    relevance theory 102
    resonance 22, 83, 93–5, 164, 180
    Scotopic Sensitivity/Irlen Syndrome
    (SS/IS) 63, 119, 142, 150
    in autism 133
    probable causal mechanisms 132
    symptoms 131–2
    self-stimulation 56, 66, 170 (see also
    sensations 20, 25, 30–1, 36–7, 55–6, 60,
    74–6, 84, 90, 104, 119, 120–1,
    sensorisms 56–7, 166 (see also
    sensory agnosia 52, 75, 80, 92, 163, 178
    sensory defensiveness 137–9 (see also
    tactile defensiveness)
    sensory deprivation 25–6, 89, 171
    sensory diet 156
    sensory dysfunction 21–2, 25, 109, 135,
    139, 155, 181, 183
    theory of 21, 134
    sensory modulation disorder 136–7 (see
    also disturbances of sensory
    sensory integration dysfunction 119,
    broad definitions 135–6
    narrow definitions 136
    theory of 133–5
    sensory integration therapy 155–8
    sensory organs 30–1, 38 (see also
    sensory perceptual profile 23, 57, 143–4,
    160–1, 166–7, 181
    ‘sensory pollution’ 175, 182
    sensory systems 30–6
    gustation 31, 32
    hearing 30, 34
    restored 39
    kinaesthetic 36
    olfaction 31
    proprioceptive 31, 36
    tactile 31, 36
    vestibular 31, 34
    vision 30
    restored 39
    SPATS 20, 28–30 (see also systems of
    stimulus overselectivity 67, 77
    synaesthesia 22, 119–25, 165, 180
    diagnostic features 121
    in autism 124–5
    multiple-sensory 120
    theories of origin 122
    two-sensory 119
    ‘two-ways’ 123
    unidirectional 120, 123
    systems of perception 20, 28 (see also
    systems shutdowns 80, 83, 89–91, 164,
    tactile defensiveness 138–140 (see also
    sensory defensiveness)
    tinted glasses 63, 149–50, 174–9
    theory of mind 21, 95, 114, 103
    Tomatis Effect 129
    Tomatis Method 129, 144–5
    transcranial magnetic stimulation 100
    Subject Index 213
    Triad of Impairments 20–1
    tunnel vision 71, 102, 104
    visual impairments 25–6, 131, 143 (see
    also blindness)
    visualization 106, 114
    ‘white noise’ 53, 136
    Wilbarger brushing protocol 157
    Wiltshire, Stephen 48, 100, 105, 118
    214 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Author Index
    Aftanas, E. D. 89
    Ayres, A. J. 25, 55, 133, 135, 136, 138,
    139, 155, 156, 157, 158, 160
    Baron-Cohen, S. 21, 52, 121, 123
    Bauman, M. 89
    Berard, G. 130, 144, 146, 147
    Berk, R. A. 160
    Bill 127, 128
    Blackburn, J. 45, 79, 80, 85, 89, 101,
    102, 106, 112, 118, 127
    Blackman, L. 150
    Blakemore-Brown, L. 103
    Blamires, M. 102
    Bogdashina, O. 150
    Bovee, J. P. 29, 87
    Bundy, A. 137, 139, 140, 157
    Burns, S. K. 89
    Cantello, J. 27, 94
    Carter, R. 43, 106
    Cass, H. 26, 27
    Cermak, S. A. 140, 157, 158
    Cesaroni, L. 124, 125
    Condon, W. S. 128
    Cotton M. M. 149
    Courchesne, E. 103
    Cowey, A. 99
    Cytowic, R. E. 120, 121, 122
    Damasio, A. R. 109
    Damasio, H. 109
    Davies, D. R. 101
    Davis, R. D. 113
    DeGangi, G. A. 160
    Dehay, C. 122
    Dekker, M. 28, 116
    Delacato, C. 21, 25, 46, 52, 53, 56, 128,
    134, 136, 139, 155
    Doman, R. Jr. 26
    Donnelly, J. 81, 85
    Douglas, V. I. 101
    Down, J. L. 118
    Dunn, W. 138
    Edelson, S. M. 147
    Ellwood, J. 159
    Evans, K. M. 149
    Farah, M. J. 99, 111
    Fay, W. 26
    Feigenberg, I. M. 47, 48
    Feinberg, T. E. 99
    Fisher, A. 134, 138, 156
    Fleisher, M. 62
    Freeman, B. J. 66
    Frith, U. 21, 47, 51, 52, 68, 102, 115
    Gainotti, G. 109
    Garber, M. 124, 125
    Garner, I. 47, 52
    Gazzaniga, M. S. 99
    Gense, D. J. 26
    Gense, M. H. 26
    Gerland, G. 22, 27, 74, 181
    Gibson, E. J. 37, 40, 46
    Gillingham, G. 55
    Grandin, T. 26, 27, 28, 50, 54, 55, 62,
    63, 87, 89, 90, 91, 92, 106, 108,
    111, 112, 113, 114, 115, 127, 128,
    154, 171
    Hamilton, D. 47, 52
    Happe, F. 47, 52, 68
    Hatch-Rasmussen, C. 25
    Henderson, A. 157, 158
    Herron, E. 135, 137
    Hutt, S. J. 89
    Irlen, H. 63, 131, 132, 133, 149
    Jackson, L. 55, 88, 154
    Joliffe, T. 52, 153, 154
    Joan 46
    Jordan, D. 131, 132
    Jordan, R. 65, 107
    Kanner, L. 19, 21, 104, 128, 181
    Kapes, B. 136
    King, L. J. 157
    Knickerbocker, B. 138
    Kochmeister, S. 28, 118
    Koegel, R. L. 128
    Koomar, J. 137, 139, 140, 157
    Kracke, I. 127
    Kraemer, G. 90
    Kranowitz, C. 136, 138, 156
    Land, P. 89
    Lane, D. M. 101
    Lawson, W. 11–2, 27, 64, 74, 79, 84,
    87, 93, 96
    Legge, B. 65
    Lemley, B. 121, 123
    Longhorn, F. 159
    Lovaas, O. I. 68, 181
    Luria, A. R. 106, 107, 121, 122, 123
    McKean, T. 94
    Mailloux, Z. 137, 139
    Maurer, D. 122
    Meares, O. 131, 132
    Melzack, R. 89
    Mitchell, J. D. 107
    Morris, B. 20, 22, 28, 29, 54, 79
    Mukhopadhyay, R. (Tito) 110
    Murray, D. K. C. 84, 102
    Murray, E. 134, 156
    Myles, B. S. 137, 138
    Nelson, S. 141
    Nony 63, 87
    O’Neill, J. L. 27, 28, 44, 54, 64, 87, 102,
    106, 112, 115, 125
    Ornitz, E. M. 38, 65, 66, 101, 128, 134,
    137, 141
    Orton, S. T. 130, 131
    Ozonoff, S. 21, 47, 117
    Park, C. C. 106, 113
    Park, D. C. 114
    Parham, L. D. 137, 139
    Pearson, D. A. 101
    Pemberton, A. 150
    Peters, K. G. 101
    Posner, M. 101
    Powell, S. 37, 65, 107
    Rand, B. 44, 51, 54, 56, 68, 85, 102,
    Ratey, J. 99
    Rich 46
    Riley, D. 132
    Rimland, B. 21, 77, 103, 128, 134, 147
    Ritvo, E. R. 65
    Robinson, G. L. 132
    216 Sensory Perceptual Issues in Autism and Asperger Syndrome
    Rose, S. 106
    Royeen, C. 139
    Russell, J. 74
    Sacks, O. 39, 43, 105, 118
    Sainsbury, C. 154
    Scariano, M. 27, 128
    Schatzman, M. 106
    Schreibman, L. 128
    Schuler, A. 26
    Shah, A. 52
    Sheldrake, R. 95
    Siegel, B. 153
    Simon, D. 89
    Sinclair, J. 19, 20, 28, 39, 40, 125, 150,
    Snyder, A. W. 45, 107
    Sperber, D. 102
    Stackhouse, T. M. 134, 137, 141
    Stehli, A. 54, 143, 146
    Stephens, L. C. 136, 137
    Tickle, L. S. 139, 158
    Tomatis, A. A. 129, 130, 144, 145, 146,
    Tustin, F. 38
    VanDalen, J. G. T. 27, 66, 72, 75, 76, 77,
    Volkmar, F. R. 141
    Walker, N. 27, 94
    Waterhouse, S. 150
    Weiskrantz, L. 99
    White, B. B. 63, 66
    White, M. S. 63, 66
    Wilbarger, J. L. 134, 137, 139, 141
    Wilbarger, P. 139, 156
    Wilkins, A. 131
    Willey, L. H. 27, 28, 63, 64, 68, 79, 80,
    94, 105, 106, 124
    Williams, D. 19, 20, 26, 27, 28, 46, 48,
    49, 54, 62, 63, 64, 66, 68, 69, 71,
    72, 73, 75, 76, 78, 79, 80, 81, 83,
    84, 85, 87, 88, 90, 91, 93, 94, 95,
    96, 98, 99, 100, 106, 107, 108,
    110, 111, 113, 122, 123, 125, 133,
    Wilson, D. 102
    Wing, L. 20
    Winter, S. 149
    Yourderian, P. 114
    Zeki, S. 111
    Zubeck, J. P. 89
    Author Index 217