Autism and tactile defensiveness

Tactile defensiveness is the most common sensory modulation deficit of tactile system and it is predominantly found in children with autism. Children with tactile defensiveness tend to react negatively to touch sensation that is considered otherwise non-noxious by most typical children. Most commonly it is the hyper-responsiveness to light or unexpected touch.

A child with tactile defensiveness may

·        Dislike changes in temperature such as going in or out of bathing

·        Dislike going barefoot or taking his/her shoes off

·        Pull away from light touch

·        Dislike eating messy foods with his/her hands

·        Avoid getting his/her hands in finger paint, sand, paste, clay, etc

·        Dislike having hair washed, teeth brushed or face washed

·        Prefer to touch rather than be touched

·        Seem irritated by fuzzy clothing

·        Have tendency to walk on his/her toes

·        Choose to weight bear on tip of the fingers

·        Get irritated when handled by others especially strangers

·        Resist wearing new clothes

·        Get irritated by tags on clothing

·        Prefer to stand at the end of the line to avoid contact with others

·        Prefers solitary play

Note:  Child should be observed for cluster of behaviors to be identified as having tactile defensiveness. These behaviors alone do not constitute to tactile defensiveness.  Detailed assessments using sensory profiles are important to arrive into a confirmation.

Tactile defensiveness is a problem, in large part, because of the inappropriate behaviors that accompany it. Defensiveness to touch potentially interferes with all occupations and roles. Basic self-care is affected when a child resists to food, clothes, washing hair, cutting nails, etc. Avoiding sand, refusing to walk barefoot on grass and sand affects play and aversive reactions to different textures or touch of other children disrupts class room behaviors in large which would in turn make learning difficult. 

Targets for intervention

•            Increase ability to maintain optimal level of arousal in the presence of tactile (or any over arousing) input
•               Decrease over reaction to tactile input
•               Improve emotional and organizational skills
•               Help the child cope with specific environments
•              Address fine motor skills

Intervention

          Sensory experiences can be started in each session with vestibular and proprioceptive input which will help the child calm down and feel a sense of control over the environment. It can be continued with deep pressure and gradual exposure to touch, if tolerated, can be given at the end.

Activities that provide the above mentioned sensory experiences include

•            Swing that can be used to provide slow and rhythmic movements
•            Hanging on to suspended equipments for proprioceptive input
•            Enable jumping, bouncing or pulling while on swing
•            Burrowing in large pillows and mats for deep pressure
•           Rolling large therapy balls over child’s back or legs for providing deep pressure
•           Activities that involve pulling or pushing heavy objects that would help in enhanced proprioceptive input
•        Pool of balls, beads or beans where the child can submerge and move around to bet enhanced touch input (allow touch input only until it is tolerated)
•         Playing with shaving cream, powder, lotion, paint, sand, water, glue, clay etc after providing vestibular,Proprioceptive and deep pressure input will help to decrease over reaction to touch
•         Chewy tubes, chewy snacks blowing activities, deep breathing can be encouraged throughout the day.

Guidelines for providing the above mentioned sensory experiences

·   Allow children to provide these inputs by themselves so that they have a control over input.

·     It is important to experiment different types of input which would be more effective in each child. Few children might enjoy and prefer deep pressure to heavy joint compression.

·   Children find tactile input more tolerable of they are applied in the direction of hair growth.

·        Proprioception is generally the most organizing type of sensation. When a child appears to be bothered by tactile sensation substituting proprioception or combining deep pressure with proprioception is often successful.

Modifying the physical and social environment

·       Reduce sensory over load in the environment

·       Avoid light touch

·       Avoid tight clothing

·        Lower voice, use natural light

·        Respect child’s personal space

·        Do not impose

·        Allow the child to have a control over the sense he/she receives and expect a response