Frequently Asked Questions
Written by Temple Grandin, Ph.D.
1. How do I know if my child has problems with sensory over sensitivity?
Sounds or visual stimuli that are tolerated by normal children may cause pain, confusion and/or fear in some autistic children. Sensory over sensitivity can vary from very slight to severe. If your child frequently puts his hands over his ears, this is an indicator of sensitivity to noise. Children who flick their fingers in front of their eyes are likely to have visual sensitivity problems. Children who enjoy a trip to a large super-market or a shopping mall usually have relatively mild sensory sensitivities. Autistic children with severe sensory sensitivities will often have tantrums and other bad behavior in a shopping mall due to sensory overload. These children are the ones who will most likely need environmental modifications in the classroom. Older children and adults, who remain nonverbal and have very little language, often have more severe sensitivities than individuals with good language. Children with auditory or visual sensitivity will often have normal hearing and visual acuity tests. The problem is in the brain, whereas the ears and eyes are normal.
2. What sights and sounds are most likely to cause sensory overload or confusion in the classroom?
Every autistic child or adult is different. A sound or sight, which is painful to one autistic child, may be attractive to another. The flicker of fluorescent lighting can be seen by some children with autism and may be distracting to them. It is mostly likely to cause sensory overload in children who flick their fingers in front of their eyes. Replacing fluorescents with incandescent bulbs will be helpful for some children. Many children with autism are scared of the public address system, the school bells or the fire alarms, because the sound hurts their ears. Screeching electronic feedback from public address systems or the sound of fire alarms are the worst sounds because the onset of the sound canNOT be predicted. Children with milder hearing sensitivity can sometimes learn to tolerate hurtful sounds when they know when they will occur. However, they may NEVER learn to tolerate UNexpected loud noise. Autistic children with severe hearing sensitivity should be removed from the classroom prior to a fire drill. The fear of a hurtful sound may make an autistic child fearful of a certain classroom. He may become afraid to go into the room because he fears that the fire alarm or the public address systems may make a hurtful sound. If possible, the buzzes or bell should be modified to reduce the sound. Sometimes only a slight reduction in sound is required to make a buzzer or bell tolerable. Duct tape can be applied to bells to soften the sounds. If the public address system has frequent feedback problems, it should be disconnected. Echoes and noise can be reduced by installing carpeting -- carpet remnants can sometimes be obtained from a carpet store at a low cost. Scraping of chair legs on the floor can be muffled by placing cut tennis balls on the chair legs.
3. Why does my child avoid certain foods or always want to eat the same thing?
Certain foods may be avoided due to sensory over sensitivity. Crunchy foods such as potato chips may be too loud and sound like a raging forest fire to children with over sensitive hearing. Certain odors may be overpowering. When I was a child I gagged when I had to eat slimy foods like jello. However, some limited food preferences may be bad habits and are not due to sensory problems. One has to be a careful observer to figure out which foods cause sensory pain. For example, if a child has extreme sound sensitivity, he should not be required to eat loud, crunchy foods; but he should be encouraged to eat a variety of softer foods. When I was a child my parents made me eat everything except the two things which really made me gag. They were under-cooked slimy egg whites and jello. I was allowed to have a grilled cheese sandwich everyday for lunch, but at dinnertime I was expected to eat everything that was not slimy. To motivate a child to eat something he does not like, it is recommended to have a food he really likes such as pizza right in front of him along with the food he dislikes. He is then told that he can have the pizza after he eats a few bites of peas. It is important to have the pizza right there in front of him to motivate eating something he does not like.
4. How do I toilet train my autistic child?
There are two major causes of toilet training problems in children with autism. They are either afraid of the toilet or they do not know what they are supposed to do. Children with severe hearing sensitivity may be terrified of the toilet flushing. The sound may hurt their ears. Sometimes these children can learn if they use a potty chair which is located away from the frightening toilet. Due to the great variability of sensory problems, some children may like to repeatedly flush the toilet but they are still not trained. The thinking of some autistic children is so concrete that the only way they can learn is to have an adult demonstrate to them how to use the toilet. They have to see someone else do it in order to learn. Some children with very severe sensory processing problems are not able to accurately sense when they need to use the bathroom. If they are calm they may be able to feel the sensation that they need to urinate or defecate, but if they experience sensory overload they cannot feel it. This may explain why a child will sometimes use the toilet correctly, and other times he will not.
5. Why do some autistic children repeat back what an adult has said or sing TV commercials?
Repeating back what has been said, or being able to sing an entire TV commercial or children’s video is called ‘echolalia.’ Echolalia is actually a good sign because it indicates that the child’s brain is processing language even though he may not be understanding the meaning of the words. These children need to learn that words are used for communication. If a child says the word ‘apple,’ immediately give him an apple. This will enable the child to associate the word ‘apple’ with getting a real apple. Some autistic children use phrases from TV commercials or children’s videos in an appropriate manner in other situations. This is how they learn language. For example, if a child says part of a breakfast cereal slogan at breakfast, give him the cereal. Autistic children also use echolalia to verify what has been said. Some children have difficulty hearing hard consonant sounds such as “d” in dog or “b” in boy. Repeating the phrase helps them to hear it. Children who pass a pure tone hearing test can still have difficulty hearing complex speech sounds. Children with this difficulty may learn to read and speak by using flash cards that have both a printed word and a picture of an object. By using these cards they learn to associate the spoken word with the printed word and a picture. My speech therapist helped me to learn to hear speech by lengthening hard consonant sounds. She would hold up a ball and say “bbbb all.” The hard consonant sound of “b” was lengthened. Some autistic children learn vowel sounds more easily than consonants.