Some of my neurodivergent patients avoid or react to being touched or hugged. Some avoid or react to being in crowds or a part of an audience – too much to hear and see. Some have trouble knowing when they are hungry – and thus why they are irritable. Some struggle to identify what they are feeling in a quick and automatic way.
Others rock or talk to themselves repetitively and thus violate classroom or workplace rules and norms. Some melt down when routines or plans change, or when transitioning. Some seem to be in their own world while focusing on their special interests.
In my experience, these types of issues and concerns can often best be understood as stemming from atypical sensory profiles that manifest as sensory over- or under-responsiveness, sensory craving, and sensory defensiveness.
Everyone’s Sensory Profile Is Unique
Each and every one of us, every moment of our lives, takes in, processes, and responds to sensory information from our external and internal worlds.
Most people think in terms of, five sensory systems (vision, hearing, touch, smell, and taste) but it is more accurate to think in terms of eight sensory systems including, in addition to the more familiar five:
- Proprioception: information about our body’s posture, position in space, and movements via sensations from our muscles, bones, and joints.
- Vestibular: located in the inner ear, coordinates with vision and proprioception to provide information about the position of our head and neck, stabilizes gaze, and helps us maintain head position and body posture.
- Interoception: takes in information about body sensations such as hunger, thirst, heartbeat, breathing, and muscle tension and helps us maintain homeostasis and identify emotions.
Our sensory systems do not function in isolation from each other. Our brain and nervous system constantly integrate and act on information from multiple sensory systems at once. Occupational therapists in particular use terms like sensory integration.
Everybody, neurotypical and neurodivergent, can be viewed as having their own, unique sensory profile. Each person’s sensory profile fits better in some environments than others.
When our sensory profile is not a good fit for an environment we sense/perceive/respond more slowly and deliberately (which is exhausting) and less accurately and adaptively. Some people may even withdraw, melt down, or seek sensory soothing to cope.
Sensory Profiles and Autism
Some neurodivergent people, perhaps especially adults who are or could be diagnosed with autism, may experience sensory over-responsivity, under-responsivity, sensory seeking, and/or sensory defensiveness but mask or camouflage so well that there are few or low-intensity observable behavioral manifestations.
Boys and men may be more likely to show behavioral manifestations and be identified earlier and more often than girls and women because, in general, males tend to externalize more while females tend to internalize more and girls and women may do more to mask or camouflage.
Social interactions may be avoided, or the person with sensory differences may be avoided by others. Sensory differences during social interactions can be distracting and cognitively depleting.
Sensory issues may explain autistic peoples’ struggles with change and transitions and hyper-focus on narrow interests. Staying with what’s predictable or familiar may be a way to cope with sensory issues.
These behaviors may indicate sensory issues (and neurodivergence): meltdowns, avoidance-withdrawal, cognitive depletion-exhaustion, overwhelm in crowds; aversions to specific sounds, lights, textures, touch, smells; restricted food choice; seeming lack of awareness of hunger or thirst, fascination with visual repetitive movement (e.g., fans, doors), strong attraction to a particular texture or other tactile input. This is not a complete list.
Two Illustrative Sensory Challenges
Misophonia is an extreme reaction to common sounds that most people don’t even notice. The most frequent triggers are noises related to eating and breathing. Reactions can include aggression or an intense need to escape.
Alexithymia is a neurological phenomenon in which people struggle to identify, label (and, thus, communicate) their emotions. This may be connected to proprioceptive sensory system issues. Imagine how hard it is to learn emotional self-regulation strategies and techniques when one struggles to identify one’s own emotions.
Perceptions of Sensory Challenges
When law enforcement officers interact with neurodivergent people (e.g., at a traffic stop) they may misinterpret atypical sensory system related behaviors (e.g., lack of eye contact, avoidance behaviors, reaction to flashing lights and sirens, repetitive behaviors, reaction to touch) as intoxication or delirium or as disrespect, defiance, even as threats – and respond physically, with handcuffs, with guns drawn, or worse. This is more likely for neurodivergent Black Americans as many in law enforcement are already primed to anticipate that Black Americans will be disrespectful or threatening.
Accommodations and Adaptations
- Frequent breaks and/or sensory breaks (physical activity or deep pressure) and/or allowing movement.
- Limiting auditory or visual stimuli. For example, taking a test in a quiet room or placing dividers between desks. Alternatively, for some, working with music or a radio on.
- A fidget toy, squishy ball, piece of cloth with a preferred texture, a stuffed animal with a preferred feel or smell.
- Allowing stimming or repetitive vocalizations or behaviors, such as rocking back and forth or flapping hands while standing or walking around.
Note that this focus on accommodations fits well with a social model of disability: ‘disability’ is about person-environment fit, not just the individual, and focusing on changing the environment is often better than focusing on changing the person.
Next Steps: Experiment
I invite you to experiment with these accommodations and strategies, or encourage your child, partner, relative, or friend with sensory issues to experiment with them. See what happens.
Or pay attention to what you, or your child, partner, relative, or friend with sensory issues is already doing, at least at times, that is working, at least partially. These are what solution-focused therapists call exceptions to the problem. Perhaps do more of it.
