TACTILE DIFFERENCES

Tactile symptoms are among the most commonly reported sensory symptoms described by parents of children with autism spectrum disorder (ASD) (Rogers et al.,2003). 

Behaviors that you will see when a child is over responsive includes:

• Avoids messy play or wants hands immediately wiped if they get dirty.
• Avoids touch and moves away from people or withdraws.
• Avoids certain food textures and may become upset if food falls on shirt, gets on hands or face while eating. 
• May also have a very ridged/limited food selection.
• Dislikes wearing clothes, refuses clothes that have tags, certain fasteners or seams. May melt down during dressing routines. Takes clothes off after being dressed or prefers to be naked. 
• Difficulty with staying in line or sitting beside peers in a classroom setting.
• Reacts aggressively when touched OR withdraws quickly.

Try these strategies:

1.  Physical environment manipulation. Give the child a space of their own.

1. When standing in line, put the child at the very beginning or end where an adult would be to ensure reduced contact from peers who are often very poorly aware of where their own bodies are in space.

2. Provide boundaries:  If the child has to participate in "circle time" offer each student a carpet square to help them remain in their "spot" to reduce the likelihood of being bumped or touched. 

3. Pay attention to other factors in the environment that are touch related:  

-Fan or vent blowing directly on the child.

-Desk too small.

2. Make accommodations and honor their sensory preferences. 

1. Try to find what it is about the clothes they dislike so that you can replicate what they do like in their clothing selection. Many manufacturers are supporting sensitivity in this way by removing tags, offering compression lines, making socks without seams etc. 

2. Help family members understand the child's sensitivity so that they aren't pushy about being overly affectionate and touchy with the child who is highly offended by it. 

3. Don't require the child to participate in activities that are messy if it solicits a negative response. Offer another option. Work on desensitization slowly and systematically at the child's own pace. Forcing is never recommended.

4. Allow the child to have time and opportunities to be naked if that's what supports a self-regulated state. Choosing the right places and times that are appropriate. 

5. ASK BEFORE TOUCHING. Get the child's permission to touch them. This gives them the opportunity to decide if they want it or don't want it and they can prepare for the touch. Ask if they want the touch to be firm or light.

6. Ask the school to work with the uniform policy to make accommodations for the child. It may actually make a difference in the child's mood, behavior, and grades. 

7. There are many sensory challenges that may come into play with haircuts, nail trimming and toothbrushing. Tactile over-responsivity is just a part of that. Use more firm touch, minimize the amount of touch, consider letting the child have slightly longer hair so you can go longer between cuts, trim nails but don't file, if you are so inclined bite the child's nails rather than using metal clippers. 

3. Autonomy and Control: 

1. Allow the child to self-select clothing.

2. Allow the child to eat something preferred at mealtimes while working toward increasing food repertoire.

3. Teach self-care skills early on so that the child can perform themselves rather than needing other to touch him to complete the tasks. There are many personal hygiene challenges related to touch including hand washing, nose/face wipes, cleaning bum when diapered or toileting, getting dressed or undressed, washing body at bath time, bath preference of shower v/s tub, textures of cleaning clothes or clothes, food textures and utensils preferences, tooth brushing, hair brushing, haircuts, nail trimming, etc. If you have a child with tactile over-responsiveness, you know the challenge is real. 

4. Use Deep Pressure: 

1.  Over responsiveness to touch is commonly the problem with many of the self-care skills that are so averse to children. Firm touch is typically preferred to light touch. I'm not saying to pull the child's hair or yank their nose off when wiping but be mindful of the pressure you are giving so that it is less averse. Another strategy is to firmly touch one part of the body while offering moving touch to another part as with wiping nose or face. (Example: Firm pressure over top of head while wiping nose)

2. Please give the child warning that you are going to do something before just touching them. (Ex: Show the kleenex (visual cue), model what you will do by gesturing it on yourself (visual cue), offer the kleenex and ask if they want to do it (give them some control), even if they are not very successful it may have been sufficient touch to their own face that the area has been prepped for touch, then say, "let me help". You get once chance here: firm pressure on top of head or behind head to stabilize then wipe (1 time with gentle but firm pressure). Say, "all done". 

3. Some (not all) children like pressure vests and compression clothing. These items will offer a more sustained pressure to help with self-regualtion and it offers a diffuse contact over a large area so that it minimizes the feeling of clothing moving against the body in various places (light moving touch). Some children dislike the way long sleeves feel at their wrist or pants at their ankles, so something with pressure covering that area helps. 

4. Manual deep pressure (proprioceptive input) can be helpful with decreasing tactile sensitivity. Some things I do with clients is to offer deep squeezes along their arms and legs (say, "squeeze" as you are doing it so that the child can put a word with an action and hopefully will begin to request squeezes when needed), whole body hugs, body burritos in a blanket, rough play activities (pillow fights, dodge ball, body slam on soft surfaces like bed or sofa, play with weighted balls or toys, pushing pulling things with extreme effort needed). Therapists often refer to this as "HEAVY WORK" activities. 

5. Utilize Weighted Items: Check out the proprioception differences area of my site and you will find pictures and descriptions of weighted items:  weighted blankets, weighted lap pads, weighted back packs, weighted balls, etc

6. Vibration: 

Tactile symptoms are among the most commonly reported sensory symptoms described by parents of children with autism spectrum disorder (ASD) (Rogers et al.,2003). 

Behaviors that you will see when a child is under responsive includes:

• Difficulty noticing touch
• May not seem to notice being physically attacked
• May not notice extremes in temperature, often dressing inappropriately for the weather
• Don't notice when hands, face, or other body parts get dirty or wet
•  A classic symptom is inadequate body awareness, poor endurance, and movements that are not appropriately graded. 

Try these strategies:

1.   Play with resistive materials that that increase proprioceptive feedback to the hands, eg.  Playdough, pastry, dough.   

2. Vibration – Use toys that vibrate to ‘wake up’ their hands/body before asking them to complete tasks that require fine motor skills.  

3. Jiggle the Extremities- Jiggling is a large vibration of manual shaking of the extremity to offer the joint proprioceptive input. 

4.  Wearing body socks/lycra  tops/shorts/leggings can increase tactile feedback.    Increase proprioceptive feedback to the upper limbs to increase awareness.

5. Compression and Distraction of th bearing by four point crawling, wheel barrow walks, monkey bars to dangle and climbing frames.