Autism and Sensory Sensitivities: Tips for Management

More than one in 100 people are on the autism spectrum and there are around 700,000 autistic adults and children in the UK, and the most up-to-date statistics reveal that autism is three times more prevalent in boys than in girls. According to a study of more than seven million children carried out by researchers from the University of Cambridge’s Department of Psychiatry, in collaboration with researchers from Newcastle University and Maastricht University, around one in 57 (1.76%) children in the UK is on the autistic spectrum, significantly higher than previously reported.

Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviours or interests. They may also have different ways of learning, moving or paying attention. Autism is a spectrum; this means everybody with autism is different. Some people have average or above average intelligence, whilst others may have a learning disability, meaning that they may find it hard to look after themselves and need help with daily life. Sensory issues are common in people with autism and are included in the diagnostic criteria for autism spectrum disorder.

In this informative article, we will explore the unique sensory sensitivities experienced by individuals with autism spectrum disorder (ASD) and provide practical tips and strategies for managing and accommodating these sensitivities. Understanding and addressing sensory challenges is crucial for improving the quality of life for individuals with autism.

Understanding Sensory Sensitivities

Sensory processing refers to how the nervous system receives and interprets messages through the various senses and turns them into motor and behavioural responses. Nerves relay the signals such as noises, textures, flavours, scents, light, colours, temperatures or pain to the brain, which interprets them as sight (vision), sound (hearing), smell (olfaction), taste (gustation), and touch (tactile perception) – our senses. People with autism might also have sensitivities to balance (vestibular), awareness of body position and movement (proprioception) and/or awareness of internal body cues and sensations (interoception).

We learn to take in the right amount of sensory information to allow us to successfully engage with our environment. For example, when concentrating on a task, we will shut out background noises and ignore other visual stimuli. However, for people with sensory processing difficulties, they may have problems modulating sensory information, as the central nervous system does not organise sensory information into appropriate responses. Studies suggest that there is a prevalence of sensory sensitivities in between 69% to 90% of autistic people.

As autism spectrum disorder (ASD) is unique to each person, not all autistic people experience sensory processing difficulties in the same way; they may experience sensory differences. A person with autism can experience sensory hyper-sensitivity (over-responsiveness) or hypo-sensitivity (under-responsiveness) in one area only, or across several senses, and can have mixed sensitivity to a wide range of stimuli, i.e. sights, sounds, smells, tastes or textures. Most people with autism have a combination of both hyper-sensitivity and hypo-sensitivity. This can be a positive thing, for example heightening the senses to potential threats or dangers, but it can also cause the person distress or discomfort, and can produce anxiety, or even physical pain.

Processing everyday sensory information can be difficult for autistic people. For those who are over-responsive a smaller number of stimuli is needed to reach the threshold of the brain processing an incoming message. Whereas it takes a larger stimulus for those who are under-responsive to input. Having unique sensitivities to certain types of sensory input can create challenges in everyday situations such as at school/college, at work or in community settings. Many autistic people will avoid everyday situations because of their sensitivity issues. Schools/colleges, workplaces and shopping centres can be particularly overwhelming, and can cause sensory overload for some autistic people. For example, in a noisy workplace or smelly café there may suddenly be too much information coming in through the senses for the brain to process which can trigger a response which may include:

• Withdrawing
• Anxious or distressed behaviour
• Shutting down
• Having meltdowns

This fight, flight or freeze response happens when the brain doesn’t know what to make of the stimuli in the environment and it goes into survival mode. This often happens when someone is overstimulated and has too much information to process.

Common Sensory Challenges

When someone struggles to process and act upon information received through their senses, challenges may arise in performing everyday tasks. As we have noted, autistic people are in themselves unique, and will experience sensory sensitivities and challenges differently from each other. However, it is possible to identify some of the most common challenges and reactions to these challenges:

Hearing

For someone who has highly sensitive hearing (hyper-sensitivity):

• • Noise levels may feel magnified
  • They may dislike loud noises
  • They are easily startled by unexpected sounds, for example sirens etc.
  • They may start to “chew” to damp down noises
  • They may be anxious before expected noise such as alarms, school bell etc.
  • They may talk loudly
  • They are easily distracted by background noises such as a lawn mower outside, an air conditioner, a refrigerator or buzz from fluorescent lights

When there is hyper-sensitivity to sounds the child or adult may have constant overreactions, or bigger reactions, to everyday sounds in the environment. This distracts the child or adult from what they need to be listening to. It may mean they avoid certain places, for example, avoiding the toilets because they don’t like the sound of the hand dryer, or avoiding large, crowded places such as shopping centres or supermarkets.

For someone who has low sensitivity hearing (hypo-sensitivity):

• They enjoy really loud noise such as loud music, high volume on the TV etc.
• They fail to pick up expected cues such as alarms etc.
• They may not respond when their name is called
• They may make more noise themselves or deliberately move closer to sounds
• They enjoy noisy environments such as sports arenas, shopping centres, and the cinema

Some children and adults with hypo-sensitivity are slower to respond to sounds. They may need more time before they respond to the noise or to be closer to the noise before they notice it. They may seek out more noises and sound, or will sometimes make their own sounds to drown out other sounds in the environment.

A person with either hyper-sensitivity or hypo-sensitivity to sounds may experience poor auditory discrimination, which relates to the qualities of the sounds. For example:

• How loud was the sound?
• What pitch was the sound?
• Was it a familiar noise or a new one?
• Was it a female voice or a male voice?
• Was it the voice of someone known or a stranger?
• Was there any rhythm to it?

A person with poor auditory discrimination skills can find processing all of these sounds more challenging.

Sight

For someone who has highly sensitive vision (hyper-sensitivity):

• • They dislike bright lighting
  • They prefer dark environments
  • They are distracted by visual information
  • They may appear distracted and/or non-functional in an environment with visual stimulation or when doing visual tasks especially tasks such as reading
  • They may react strongly to colourful or complex images; they find them confusing
  • They find messy desks, rooms etc. stressful due to visual clutter
  • They can be sensitive to direct eye contact
  • They tire easily, or might get irritable when attending to visually complex tasks

Some children and adults may squint, rub their eyes or get headaches after reading, having to complete close work or using a computer screen but they do not require glasses. They may have difficulties appropriately filtering visual input and therefore become easily overwhelmed. It may mean they avoid certain places such as the cinema, or shops as they are inundated by too much visual stimulation.

For someone who has low sensitivity vision (hypo-sensitivity):

• • They touch everything in order to make up for lack of visual input
  • They have trouble with finding objects in cluttered spaces
  • They have difficulty with puzzles such as jigsaws or following visual instructions
  • They have a preference for brightly lit rooms or well-lit areas
  • They have difficulties reading, because they lose their place
  • They might require more visual information to react
  • They may not attend to visual cues or information because they cannot register it
  • They may have a preference for visually stimulating body language such as facial expressions, hand gestures etc. although some may not be able to read more subtle body language

Sometimes for a person with visual hypo-sensitivity objects can appear quite dark, or lose some of their features. For some, their central vision is blurred but their peripheral vision is quite sharp, whilst for others, a central object is magnified but things on the periphery are blurred. A person may also have poor depth perception, and experience difficulties with throwing and catching. They can also be seen as being clumsy.

Taste and/or Smell

For someone who is highly sensitive to taste and/or smells (hyper-sensitivity):

• • They dislike strong tastes and like only bland tastes
  • They taste or smell objects, clothes etc. often as opposed to looking at or touching them
  • They are sensitive to the smells of people
  • They like a consistent temperature of food, sometimes really cold or really hot
  • They over-react to new smells
  • They can gag easily
  • They only eat familiar foods
  • They dislike fragrances from perfume, scented candles or bath products

Someone who has high sensitivity to taste and/or smells may demonstrate excessive caution or fear when trying, for example, new foods or drinks, or meeting new people or trying out new places, as the tastes and/or smells may be totally unfamiliar to them. This can lead to a restricted diet. Some people may avoid changing jobs, or going on holiday, for example; they may also form a dislike of people with distinctive perfumes, shampoos, etc. They may also shut down when there is too much sensory input or avoid places with a lot of sensory information such as the laundry aisle in supermarkets, perfumery departments, restaurants or kitchens.

For someone who has low sensitivity to taste and/or smells (hypo-sensitivity):

• They may eat non-food items
• They have lots of hard, crunchy food in their diet
• They crave strong tastes and may add salt and spice to their food
• They don’t notice or care whether food is spicy or bland
• They may under-react to strong, bad or good smells
• They struggle to distinguish between different smells

Someone who has low sensitivity to taste and/or smells may lick things to get a better sense of what they are. Some people have no sense of smell and fail to notice extreme odours; this can include their own body odour.

Touch

For someone who is highly sensitive to touch (hyper-sensitivity):

• • They may dislike having anything on their hands or feet, for example they have difficulty with wearing shoes, socks or gloves
  • They may find many food textures uncomfortable, including avoiding mixed textures such as pasta dishes or foods with some lumps such as yoghurt with fruit pieces
  • They dislike having messy hands or avoid getting their hands dirty in any way, for example when cooking, gardening etc.
  • They can either love or hate being hugged, or may avoid shaking hands and can react aggressively to another’s touch
  • They only like certain textures, clothes etc. and may be bothered by the feeling of clothing labels
  • They can feel very sensitive to pain and can be very sensitive to temperature, either hot or cold
  • They may have difficulties brushing and washing their hair because their head is sensitive
  • They may struggle with toe and fingernail cutting or with haircuts
  • They may have difficulty with teeth brushing
  • They will avoid messy textures such as finger paint, glue and dough, and sometimes dry textures such as sand

Tactile defensiveness is a term used to describe the reaction that occurs when someone is very sensitive to touch. Individuals who are highly sensitive to touch may respond by avoiding sensations, or by having a bigger reaction than would be expected by others. This may include touching or being touched. For some people, their skin is more sensitive to everyday things and often touch can be painful and uncomfortable, which can affect all kinds of relationships.

For someone who has low sensitivity to touch (hypo-sensitivity):

• • They may hold others tightly as they need to do so before there is a sensation of having applied any pressure
  • They may be unable to feel food in their mouth
  • They enjoy having heavy objects such as weighted blankets or bedclothes on top of them
  • They may chew on anything and everything, including clothing and inedible objects
  • They have a high pain threshold or may have difficulty responding to pain or high or low temperatures
  • There are risks that they may self-harm
  • They can sometimes be heavy-handed or may over-grip objects
  • They enjoy the feelings of textures and feel the need to touch anything and everything
  • They can “play rough” without realising

People who are touch hypo-sensitive may engage in sensory seeking to get more sensory input from the environment. This might lead to taking unnecessary risks.

Balance / movement

For someone who is highly sensitive to balance (hyper-sensitivity):

• They may have difficulties with activities where the head is not upright or feet are off the ground
• They may experience car and travel sickness
• They may have difficulties stopping quickly or during an activity such as sport, where they need to control their movements
• They may hate spinning or jumping and become dizzy easily
• They dislike a busy place full of movement

For someone who has low sensitivity to balance (hypo-sensitivity):

• They may have difficulty sitting still
• They can be fast but not always well co-ordinated and often run rather than walk
• They can often be constantly fidgeting or tapping
• They often take risks

For someone who is highly sensitive to body awareness (hyper-sensitivity):

• They don’t like others being too close to them
• They often create their own boundaries, sometimes inappropriately such as insisting on being at the start or end of a queue
• They remove themselves from crowds, for example crowded shops, busy queues, crowded public transport
• They have difficulties with fine motor skills, for example when manipulating small objects such as buttons or shoelaces
• They often move their whole body to look at something

For someone who has low sensitivity to body awareness (hypo-sensitivity):

• They often stand too close to others, because they cannot measure their proximity to other people and judge personal space
• They find it hard to navigate rooms and avoid obstructions
• They may bump into people or trip over objects
• They might put themselves in too small spaces or push against corners of the room
• They often look at their feet when going down the stairs.

Sensory Triggers

Sensory triggers are stimulants that appear in the environment and are sensed by one of our five primary senses. As we have seen, a person with autism may experience any number of sensory difficulties with a variety of stimuli. Some of the most common sensory triggers for someone with autism might include, but are limited to:

• Bathing
• Bright or flickering lights
• Change
• Crowds
• Fabrics
• Fatigue
• Food textures
• Hair washing / touching / cutting
• Long events
• Movements
• Smells
• Socialising / people talking
• Sounds
• Teeth brushing
• Temperature changes
• Touch / hugs
• Transitions
• Waiting
• Water on the face / in the ears

Individual Variability

We have seen above that people with autism can experience sensory sensitivities in many different ways. There are also variables in particular sensitivities, for example one person may not like the smoothness of steel or other metals, whilst another is drawn to them. Particular fabrics may be a problem for some, but not for others. Many sensitive people complain of stiffness of new clothes or of clothes labels. Food textures may also vary, with one person particularly sensitive to lumpy food whilst another may hate smooth or pureed foods.

It is similar with noises; sudden sounds can be a trigger for some, whilst constant loud noises prove to be a challenge for others. For others, they may be the ones making the noise as they are insensitive to sound.

The mere presence of lots of people may overwhelm the senses of some people, whereas it may be the smells, noise or unexpectedness of crowds that may be a trigger for others.

Sensory preferences and experiences vary for every individual. We all have sensory preferences whether we notice these or not, for example we may prefer wearing natural fabrics rather than synthetic. However, most of the time our sensory preferences do not present as challenging.

By recognising and understanding the individual sensory preferences of someone who is autistic we can help the individual to find strategies that support them to overcome their challenges.

Tips for Managing Sensory Sensitivities

Sensory insufficiency or overload can be momentary or something that happens repeatedly or for a sustained period of time and can really disrupt what a person is trying to do. Some people experience one or more symptoms every day whilst others experience symptoms only in certain circumstances or certain places. Creating a sensory-friendly toolkit with things to help reduce the sensory experience is helpful for most people. Strategies may change depending on the individual, location and environment; however, here are some things to consider trying.

Create a Sensory-Friendly Environment

A sensory-friendly workplace is a workspace where strong external stimuli such as scents, visuals, light or sounds are reduced or controlled. This prevents the environment from becoming overwhelming, distracting or uncomfortable for people with sensory sensitivities.

Eliminate harsh or fluorescent overhead lighting. Those with light sensitivity may experience headaches, anxiety and other unpleasant feelings, especially early in the morning. Look for sensory-friendly alternatives, such as floor lamps, sunny windows, and incandescent bulbs that produce a soft, warm glow.  

If the workplace is open-concept, provide access to quiet spaces, as for those with sensitivity to sound, it can significantly affect performance, especially when they have a challenging task requiring deep focus. Providing access to quiet spaces and breakout rooms is incredibly helpful for employees who are sensitive to loud environments. If providing access to quiet spaces isn’t feasible in the workplace, then providing noise-cancelling, over-ear headphones can be helpful. 

Review dress code policies. Uncomfortable, restrictive clothing can cause significant physical distress for people with sensory processing differences. It is fine to have standards of professionalism for workplace attire, but if the workplace dress requirements are physically restrictive, it could put some employees at a disadvantage.

Perfumes or aftershave can trigger bad headaches, nausea, or even allergic reactions for people with scent sensitivities, as too can highly scented cleaning products. Certain food smells can also be a trigger for people with odour sensitivities. Enacting a scent- and odour-free workspace policy for employees can help.

Allow for hybrid work models. A hybrid working model can have a profoundly positive impact on people with sensory processing differences. Offering the option to work from the comfort of home makes it easier for employees to be productive without having to navigate such things as crowded commuting, busy workplaces and sensory-unfriendly environments.

In the home, lighting and colours can easily overwhelm an individual with autism, so take measures to reduce visual stimuli in order to lessen this effect. Choose lighting that is as close to natural light as possible and avoid lights that flicker. Have dimmable lights to make it easier to control the level of light in the home. Lighting can also make a very low sound, which most people do not hear, but the buzz of a light can be painful to someone with autism.

Glare from outdoor sunlight, glare on computer screens, and even glare from reflective, hard surfaces, such as hardwood flooring, can also be problematic, so look for ways to reduce this. Window tinting, anti-glare coatings or blinds might help.

Avoid decorating with bright colours. Many individuals with autism see colours with greater intensity than neurotypical people. Too many bright colours, and red in particular, can be overstimulating for someone with autism.

Keep the home organised and free from clutter. The chaos created by clutter makes it difficult to function with sensory sensitivities. People with autism generally thrive when they have routines in place. To make life easier for them, keep the home organised. Establish distinct places where objects belong and put them back immediately after use. Having a place for everything is key to reducing visual stimuli in the form of clutter.

Remove barriers that can break up the line of sight where possible. This allows the individual with autism to preview a space before entering it, which can improve the individual’s comfort in the home. Arrange furniture so that the person can easily transition from one activity to the next without a visual or physical barrier.

Auditory stimuli can be just as distressing as visual stimuli to people with autism, so the home should be a tranquil retreat. Devices such as noise-cancelling headphones can help and insulated windows are good at blocking noise. Some individuals with autism will ignore sounds and this presents challenges of its own, because alarms in the home, such as smoke detectors or carbon monoxide alarms, may be ignored. Consider investing in visual alarms if this is the case.

An autistic individual’s sense of smell can be stronger than that of a neurotypical individual. Sometimes, scents and odours can trigger meltdowns or distress, even when they seem mild to other members of the family. Scented cleaning products, air fresheners and scented candles can add more confusion to an autistic person’s sensory input, so try to avoid adding them to the home environment. Kitchen and cooking smells can also cause issues. Invest in certified HEPA filters for air purifiers, extractor fans and vacuum cleaners to further remove and neutralise odours.

Add a variety of textures into the home and remove and replace textures the individual finds upsetting. 

The traditional bathroom creates many challenges such as cold toilet seats, harsh cleaning chemicals, slippery floors and poor ventilation which can make bathrooms challenging areas for someone with autism. When individuals with autism struggle with balance and the vestibular system, slippery floors are dangerous. Add non-slip surfaces to slippery bathroom and shower/bath floors.

Develop Sensory Calming Strategies

Integrating sensory calming activities has a proven track record of success. There is a form of therapy known as the deep pressure technique that can be applied in many different ways. The deep pressure technique is a therapy where touch or weight is used to help people who have sensory sensitivity. It uses pressure via touch to help someone who may need an intervention if they are feeling stressed, anxious or overloaded. The therapy can be used on its own or as part of a wider range of therapies. 

One of the simplest ways of applying deep pressure therapy is by giving the person a hug. It doesn’t have to be too tight, but exerting a little pressure when embracing them can make a big difference when they are feeling overwhelmed. Another, less challenging means of applying deep pressure is by placing your hands on the person’s shoulders. This can be done with even a feather-light touch, but is ideal if the person isn’t too fond of being hugged or squeezed. One of the most intense ways of using deep pressure via touch is massage. This can be done in many different ways, using techniques such as Reiki. 

For those autistic people who don’t like to be touched, there are other ways of using deep pressure therapy. One of them is to use weighted items of clothing, such as vests and jackets, or through the person wrapping themselves in a weighted blanket.

The effects of deep pressure may not appear straight away. To apply it, through touch or otherwise, it can take a while, from a few minutes to a few hours.

In general, any activity or action which stimulates or removes sensory input from a sensory system is a sensory break. For a person who is sensory avoidant, perhaps a quiet environment or least sensory-triggering environment is the type of sensory break they need. Sensory seekers may benefit from activity opportunities, or environments, that have high sensory input which support their specific needs.

Sensory toys and games are useful when introducing different textures, shapes and visual experiences. Fidget toys, sensory balls and outdoor sensory games and equipment keep busy hands happy, help to develop fine and gross motor skills and help with concentration.

Apps such as Calm and Headspace are making major waves with wound-up, stressed-out, overstimulated individuals. 

Some autistic people stim as a coping strategy. Stimming or self-stimulating behaviour can include arm- or hand-flapping, finger-flicking, rocking, jumping, spinning or twirling, head-banging and complex body movements. Although stimming varies from person to person, some use it as an attempt to reduce sensory input, and to deal with stress and anxiety, for example, focusing on one particular sound may reduce the impact of a loud, distressing environment; this may particularly be seen in social situations.

Sensory Diet

This is an individualised plan of physical activities and provisions to help a person meet their sensory needs. This is a powerful tool that can allow an autistic person to manage in environments that are often distressing by identifying what might help them regulate in that moment or by giving certain stimulation in advance to allow someone to feel less anxiety throughout the day so they can deal with stressful stimulation better later on. It typically includes a combination of activities that provide sensory input to reduce anxiety, improve behaviour and focus, and promote positive social interaction. Activities can include things such as playing with various textures, calm breathing exercises, massage, deep pressure, and sensory integration activities.

Communication and Advocacy

Self-advocacy is the ability of a person with autism to communicate and stand up for their needs, interests, desires and rights. Being able to advocate for themselves can increase a person’s confidence and autonomy, help them to navigate challenging situations, and improve their wellbeing by having their needs met. 

Schools, employers and organisations providing services have a legal obligation under the Equality Act 2010 to support people with a disability with reasonable adjustments, making sure they can benefit in the same way as a person who isn’t disabled. In order to be able to do this, a person with autism, or their advocate, will need to make the organisation aware of what reasonable adjustment(s) is needed. When communicating your needs, or communicating on behalf of someone with autism, it might be helpful to make a written list of the things that you need, such as your sensory needs, breaks, rest, downtime etc. It is important to do this and not to rely on generic adjustments, as this list of needs will be unique to the individual.

There are times when someone feels that they cannot comfortably communicate their needs and wants. Professional advocates can be a great support tool for adults with autism by ensuring their needs and wishes are respected and their voices heard. Organisations such as Liaise offer a comprehensive range of specialist support services including advocacy.

Gradual Exposure

Gradually exposing a person with autism to the sensations they are hyper-sensitive or hypo-sensitive to, in a controlled and supportive environment, can help them build tolerance and decrease their reactions over time. When facilitating desensitisation, it may be useful to use resources such as ear defenders or tinted glasses and to gradually withdraw such resources as the individual builds their tolerance to the relevant sensory stimuli. More generally, gradual exposure to sensory stimuli is important when facilitating desensitisation.

Occupational Therapy

Occupational therapy has proven to be highly beneficial for people with autism. The individual assessment of the person with autism is a crucial aspect of the occupational therapy process as everyone’s experience will be unique. Occupational therapists first evaluate the person’s sensory, motor and cognitive processing, and then identify the areas of difficulties and then plan approaches that target that person’s sensory, motor, cognitive and social abilities, to help to improve their quality of life.

Support Systems

Living with autism can present unique challenges, but having a strong support network can significantly improve the quality of life for people on the autism spectrum. One of the biggest barriers that autistic people face is that most people have little or no understanding of autism. One of the best ways to support an autistic person is to develop a good understanding of autism and this includes family, friends, schools, employers etc. Telling people close to you about your or a child’s autism diagnosis can help them to understand how to support you. Other support that is available to people with autism includes, but is not limited to:

A needs assessment from the local council, which can include an occupational therapist’s assessment. A needs assessment can be made online.

The National Autistic Society provides a services directory to help autistic people, their families and the professionals who work with them to find local and national services.

The Autism Alliance is a national partnership of not-for-profit organisations that support autistic people and their families.

Autism Central hubs offer guidance to families, carers and personal assistants of autistic people.

Beyond Autism’s directory is designed to help you find local and national services.

Respect and Acceptance

According to the National Autistic Society, only 26% of autistic pupils feel happy at school, and only 29% of autistic people are in any form of employment. A possible reason for this may be a lack of understanding about the condition. There are lots of myths and stereotypes about autism and these can be very unhelpful in promoting respect and acceptance of people with the condition. Autism lasts a lifetime and there is no cure. Autistic people face discrimination and barriers across all sectors of society, in the health and social care systems, in education, in employment, and everywhere in between. Greater understanding and acceptance of autistic people by society would reduce some of the challenges that they face.

Being autistic is an intrinsic part of who someone is and makes them who they are. Autistic people have a unique perspective on the world that we should champion. Autistic people need to be respected and accepted for who they are and to get the support and adjustments they need in order to live fulfilling lives. To gain a better understanding, get involved with World Autism Awareness Day on Tuesday, 2nd April 2024.

Conclusion

Being autistic means that a person’s brain works in a different way from other people, not better or worse, just differently. Like everyone else, autistic people have things that they are good at as well as things that they struggle with. In this article we have highlighted some of these differences and the challenges that they can pose, but these are not insurmountable with the right understanding and support. Understanding autistic people and their very unique individual needs will not only enrich their lives, but it can also enrich the lives of others who they are involved with too.