ASSIST: Autism Sensory Strategies, Information, and Toolkit

Hyper-reactive

• May cover/close eyes to avoid bright lights and colors.¹
• May dislike flashing lights and bold colors.¹

Hypo-reactive

• May seem unaware of the visual environment.¹
• May have difficulty finding things in a visually busy environment.¹

Sensory Integration

• Directions may require individuals to follow sight and sound can be a challenge.4
• May experience dizziness trying to follow visual cues while moving.5

Police Car/Ambulance:

• Strong, bold colors can be overwhelming (color lights, clothing, walls).²‚³
• Patterns on walls, clothing, furniture can be distracting and disorienting.²,³
• Sudden changes in light can be alarming; provide a warning before turning on bright lighting (patrol car and ambulance sirens).¹
• If using an unmarked car with a sunroof, keep shade closed.²
• For sunlight from windows, if available, can use window shades or covers.²
• Filling out paperwork can be a stressful task due to the small text; provide opportunities to or the option to fill out the paperwork with larger text or help to write the information for the individual.

Crowds/Shelters

• Patterns on walls, clothing, furniture can be distracting and disorienting.²‚³
• Individuals may need extra time to acclimate to changes in light intensity (turning lights on/off, natural light to artificial light).²‚³
• Adjust room lighting to be darker or dim the lighting.3,6
• If available, use shades to dim overhead fluorescent lighting.6
• Be mindful of light glare reflecting off of flooring, TVs, computers, tablets, phones, and other reflective surfaces.²‚³
• Filling out paperwork can be a stressful task due to the small font and dense text; provide movement breaks or the option to fill out the paperwork with larger and concise text.

• Use a phone to show pictures and create a sequence of steps for what the individual should expect to happen.³
• Sunglasses to alleviate brightness.
• Lava lamps and slow-moving videos or projections can reduce stress.6

1. Smith-Roley, S., Imperatore-Blanche, E., & Schaaf, R. (2001). Understanding sensory integration with diverse populations. New York: Therapy Skill Builders.
2. Robertson, A. E., & Simmons, D. R. (2015). The sensory experiences of adults with autism spectrum disorder: a qualitative analysis. Perception, 44(5), 569-586. https://doi.org/10.1068/p7833
3. Piller, A., & Pfeiffer, B. (2016). The sensory environment and participation of preschool children with autism spectrum disorder. OTJR: occupation, participation and health, 36(3), 103-111. https://doi.org/10.1177/1539449216665116
4. Iarocci, G. & McDonald, J. (2006). Sensory integration and the perceptual experience of persons with autism. Journal of Autism and Developmental Disorders, 36(1), 77-90. https://doi.org/10.1007/s10803- 005-0044-3
5. Carson, T.B., Wilkes, B.J., Patel, K., Pineda, J.L., Ko, J.H., Newell, K.M., Bodfish, J.W., Schubert, M.C., Radonovich, K., White, K.D., & Lewis, M.H. (2017). Vestibulo-ocular reflex function in children with high-functioning autism spectrum disorders. Autism Research, 10(2),
251–266. https://doi.org/10.1002/aur.1642
6. Lytle, R. & Todd, T. (2009). Stress and the student with autism spectrum disorders strategies for stress reduction and enhanced learning. Teaching Exceptional Children, 41(4), 36-42. https://doi. org/10.1177/004005990904100404
7. Ashburner, J., Bennett, L., Rodger, S., & Ziviani, J. (2013). Understanding the sensory experiences of children with autism spectrum disorder: A preliminary investigation. Australian Occupational Therapy Journal, 60(30), 171-180. https://doi.org/10.1111/1440-1630.12025

Hyper-reactive

• May only eat certain foods, show discomfort or fear of foods due to the smell.¹
• May be aware of smells others do not notice.²
• May experience physical discomfort or nausea from certain smells.³

Hypo-reactive

• May be unaffected by strong smells.²
• May not notice unpleasant smells.²
• May seek to smell items or fixate on objects with certain smells.6

Sensory Integration

• Closely related to taste system which can impact consumptions of meals.5

Police Car/Ambulance:

• Be aware of strong smells and take steps to limit them.4
  • Limit presence of strong-smelling food or drink, including gum or mints, in the car.4
  • Can cut side of air freshener bag instead of fully opening it, or choose air fresheners with a more neutral or mild scent.4
  • Be aware after getting gas for a vehicle that scent could be too strong.
  • Scent from alcohol wipes, disinfecting sprays, or hand sanitizer could be overwhelming.
  • Avoid using strong smelling lotion, perfume, or cologne.³,4
• Time the consumption of food or coffee to avoid odor on clothes.³
• Social story of potential experiences prior to entering a car or ambulance.¹
• Allow opportunities to open windows if scents are too strong inside, or to close
  windows if in traffic near areas with stronger scents (i.e. gas stations, other cars, food stops, cigarette smoke nearby, etc.)

Crowds/Shelters:

• Wear odor-neutral deodorant, avoid strong smelling lotion, perfume, or cologne.4
• Social story of potential experiences prior to entering shelter or crowded space.¹
• Able to move into a room or area further away from eating spaces like cafeterias.
• If possible, offer a shelter room/space with a window that can be opened/closed as needed.
• Scent from alcohol wipes, disinfecting sprays, bleach, or hand sanitizer could be overwhelming – give a warning if possible prior to cleaning a room/space or post a sign on the door outside of the room to indicate when it was cleaned.
• Be mindful of trash areas with some scented garbage bags being overly scented/ fragranced.

• Essential oils or other pleasant smelling items (also have an item to put the scent on as appropriate including cotton ball, perfume strip, or other items).7
• Calming music.³
• Notepad and pen to ask and record the individual’s preferred calming smells and any overwhelming scents/smells.
• Have unscented soap options and unscented garbage/trash bags in car or center available.8,9
• Offer a variety of scented hand sanitizers.9

1. . Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory
   sensitivity in children with autism spectrum disorders. Journal of the American Dietetic
   Association, 110(2), 238-246. https://doi.org/10.1016/j.jada.2009.10.032
2.  Wicker, B., Monfardini, E. & Royet, J. (2016). Olfactory processing in adults with autism
   spectrum disorders. Molecular Autism, 7(4). https://doi.org/10.1186/s13229-016-
   0070-3
3. Robertson, A. E., & Simmons, D. R. (2015). The sensory experiences of adults with
   autism spectrum disorder: a qualitative analysis. Perception, 44(5), 569-586. https://
   doi.org/10.1068/p7833
4. Srivastava, A. (2016). Sensory integration strategies for handwriting among autistic
   children. Academic Journal of Pediatrics and Neonatology, 2(1). https://doi.
   org/10.19080/AJPN.2016.02.555579
5. Lane, A.E., Geraghty, M.E., Young, G.S., & Rostorfer, J.L. (2014). Problem eating
   behaviors in autism spectrum disorder are associated with suboptimal daily nutrient
   intake and taste/smell sensitivity. ICAN: Infant, Child, and Adolescent Nutrition, 6(3),
   172-180. https://doi.org/10.1177/1941406414523981
6. Mays, N. M., Beal-Alvarez, J., & Jolivette, K. (2011). Using movement-based sensory
   interventions to address self-stimulatory behaviors in students with autism. Teaching
   Exceptional Children, 43(6), 46-52. https://doi.org/10.1177/004005991104300605
7. Lytle, R., & Todd, T. (2009). Stress and the student with autism spectrum disorders:
   Strategies for stress reduction and enhanced learning. Teaching Exceptional Children,
   41(4), 36-42. https://doi.org/10.1177/004005990904100404
8. Kuhaneck, H. M., & Chisholm, E. C. (2012). Improving dental visits for individuals with
   autism spectrum disorders through an understanding of sensory processing. Special
   Care in Dentistry, 32(6), 229-233. https://doi.org/10.1111/j.1754-4505.2012.00283.x
9. Dunn, W. (2007) Supporting Children to Participate Successfully in Everyday Life
   by Using Sensory Processing Knowledge. Infants & Young Children, 20(2), 84-101.
   https://doi.org/10.1097/01.IYC.0000264477.05076.5d

Hyper-active:

• May be sensitive or respond negatively (cry, flee, etc.) towards loud or unexpected sounds.1,2
• May be bothered by sounds that others do not notice, such as buzzing lights or crinkling paper.
• May cover their ears or physically avoid the sound.¹,²

Hypo-reactive

• May appear unaffected or unresponsive to sounds.²
• May not respond to their name, or to other auditory cues.
• May enjoy making repetitive sounds.3
• May create loud sounds through banging or clapping.

Sensory Integration

• Closely related to vestibular system; loud sound can impact movement.12
• Difficulty following directions requiring sound and sight.¹³
• Individual may turn head away while listening.
• May have challenges listening to directions when being touched.¹¹
• May cover their eyes as a means of blocking out the sound due to sensory disintegration.

Police Car/Ambulance:

• Reduce loud or piercing sounds1:
  • Turn down radios/intercom and handheld radios to a minimal
    volume.
• Turn cell phone alarms and ringtones to silent or vibrate.
• Provide warnings of potential loud noises, such as sirens or alarms, before they occur.
• If police or service animals are present, provide warning about potential noises such as barking and be aware it could be overwhelming for an individual.
• Provide fidget toys (stress ball, putty, etc.)8 or have a preferred object for comfort available.
• Play music that the individual or caretaker notes is calming for them. 4,5,6
• Ask caregiver what words or visuals can help explain that sounds are “safe” or “okay”.5
• Be mindful that talking too much can be frustrating and overwhelming. If direction is needed, it should only be provided by one person at a time.7
• Use a gentle tone and use direct questions at a slow pace.8
• Ask individual or caregiver what is comforting for the individual and what would help them relax.8
• Have a notepad available so that individual can write responses instead of talking.8

Crowds/Shelters:

• Competing sounds can be an issue (i.e., multiple radios/songs on, people talking, etc.).6.7
• Low intensity or common sounds can be frustrating (i.e., people crunching food, sniffling, whistling, computer sounds, fluorescent light buzzing). 5,6,7
• Give time to acclimate to sounds first by separating with distance or a door/another space first. 5
• Provide fidget toys (stress ball, putty, etc.)8 or have a preferred object for comfort.¹
• Ask individual or caregiver what is comforting to him/her and what would help them relax.8
• Ask caregiver what words or visuals can help explain that sounds are “safe” or “okay”.5

• Noise-cancelling headphones (short-term strategy, long-term use can increase sound. ¹,5 sensitivity).
• Fidget toys (stress ball, putty, etc.) or have a preferred object for comfort.¹
• Visual supports or index cards with simple images to explain directions.¹
• Phone to play a preferred song or music on repeat for comfort.4,5,6,8
• Social Story of potential experiences prior to entering police car/ambulance (https://paautism.org/resource/what-are-social-stories/). 9,10
• Remember to speak slowly and give time for a response to questions. You may have to repeat yourself.
• No more than one person should be talking at a time.

1. Stiegler, L. N., & Davis, R. (2010). Understanding sound sensitivity in individuals with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 25(2), 67-75. https://doi.org/10.1177/1088357610364530
2 .Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: a comparative study using the short sensory profile. American Journal of Occupational Therapy, 61(2), 190-200. https://doi.org/10.5014/ajot.61.2.190
3. Weitlauf, A. S., Sathe, N., McPheeters, M. L., & Warren, Z. E. (2017). Interventions targeting sensory challenges in autism spectrum disorder: a systematic review. Pediatrics,
139(6), e20170347. https://doi.org/10.1542/peds.2017-0347
4. Porges, S. W., Bazhenova, O. V., Bal, E., Carlson, N., Sorokin, Y., Heilman, K. J., Cook, E. H., & Lewis, G. F. (2014). Reducing auditory hypersensitivities in autistic spectrum disorder: preliminary findings evaluating the listening project protocol. Frontiers in pediatrics, 2, 80. https://doi.org/10.3389/fped.2014.00080
5. Stiegler, L., & Davis, R. (2011). Managing sound sensitivity in individuals with ASDs. The ASHA Leader, 16(1), 5-7. https://doi.org/10.1044/leader.FTR3.16012011.5
6. Robertson, A. E., & Simmons, D. R. (2015). The sensory experiences of adults with autism spectrum disorder: a qualitative analysis. Perception, 44(5), 569-586. https://doi.
org/10.1068/p7833
7. Landon, J., Shepherd, D., & Lodhia, V. (2016). A qualitative study of the noise sensitivity in adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 32,
43-52. http://doi.org/10.1016/j.rasd.2016.08.005
8. Railey, K. S., Bowers-Campbell, J., Love, A. M., & Campbell, J.M. (2020). An exploration of law enforcement officers’ training needs and interactions with individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(1), 101-117. https://doi.org/10.1007/s10803-019-04227-2
9. Soares, N., White, K.E., Christensen, R.T., Christiansen, A.,& Apple, R. (2019). Collaborating with families and law enforcement agencies to improve outcomes for individuals with autism spectrum disorder. Journal of Developmental & Behavioral Pediatrics, 40(9), 659-668. https://doi.org/10.1097/DBP.0000000000000741
10. Edmonds, C. O. (2017). Designing emergency preparedness resources for children with autism. International Journal of Disability, Development & Education, 64(4), 404–419.
https://doi.org/10.1080/1034912X.2016.1264577
11. Mikkelsen, M., Wodka, E.L., Mostofsky, M.H., Puts, N.A. (2018). Autism spectrum disorder in the scope of tactile processing. Developmental Cognitive Neuroscience, 29, 140-150. https://doi.org/10.1016/j.dcn.2016.12.005
12. Baum, S.H., Stevenson, R.A., & Wallace, R.T. (2015). Behavioral, perceptual, and neural alterations in sensory and multi-sensory function in autism spectrum disorder. Progress in Neurobiology, 134, 140-160. https://doi.org/10.1016/j.pneurobio.2015.09.007
13. Iarocci, G. & McDonald, J. (2006). Sensory integration and the perceptual experience of persons with autism. Journal of Autism and Developmental Disorders, 36(1), 77-90.
https://doi.org/10.1007/s10803-005-0044-3

Hyper-reactive

• May avoid certain foods.¹,²
• May have restrictive diets that require accommodations.²

Hypo-reactive

• May be less aware of bitter or sour tastes.²

Sensory Integration

• Taste system works closely with smell system.²
• Texture of food can impact satisfaction and enjoyment of food.5
• Individuals with known sensory challenges with smell, taste, and proprioception are more likely to refuse food.³

Police Car/Ambulance

• Be aware that an individual may be lethargic if he/she avoids foods and has not eaten or had a drink recently.³
• Be mindful of the foods or drinks that you may have had in your car that could cause an aversive/upset response from an individual.²
• Speak with individual or parent/ caregiver about normal meal/snack time and routine, food sensitivities, and food/drink preferences if individual will need food (i.e., if individual had blood loss from injury, or will require blood drawn and will need
  nourishment).¹
  • If someone has any health conditions (e.g.: dietary restrictions, allergies, diabetes, etc.), make sure to be aware of what foods an individual may need, or what foods to avoid.
  • Be mindful if an individual needs to eat and drink with medication and possible taste/flavor interactions with the medication and the food/drink.
  • It may be challenging for an individual to have his/her meal time/snack routine or preferred brand of snacks changed or interrupted.¹
• Allow for increased time during meal times or snack breaks as the individual adjusts to the new environment.¹

Crowds/Shelters

• Be mindful that areas with a variety of foods and scents could be overwhelming for an individual – consider offering a spot further away from strongly scented foods
  and drinks.²
• Identify when a person’s typical meal times or snack times are, and be mindful that interruptions or changes to that routine can be challenging or upsetting for an individual.¹
• Consider providing snacks that an individual can store in his/her room in case public eating areas are too overwhelming.²,³
• If in a shelter, consider the available foods and what an individual will be able to eat and drink on a daily basis due to sensitivities (ask individual or caregiver/parent about preferred and non-preferred foods and drinks).²,³
• Consider having options for toothpaste flavors as some of the mint-based flavors can be too overwhelming (i.e., consider sweet-based flavors like vanilla or chocolate as options).7
• Have a variety of cups and straws available for individuals who may have difficulties with drinking or with maintaining grips on cups.
• Allow for increased time during meal times or snack breaks as the individual adjusts to the new environment.¹

• Have some snacks available (i.e., bread-based, starchy, or salty snacks).7
• Notepad and pencil to record individual’s preferred/non-preferred foods and scents, and normal meal/snack time and routine.
• Have cup and straw options available.

1. Schaaf, R. C., Toth-Cohen, S., Johnson, S. L., Outten, G., & Benevides, T. W. (2011). The everyday routines of families of children with autism: Examining the impact of sensory processing difficulties on the family. Autism, 15(3), 373-389. https://doi.org/10.1177/1362361310386505
2. Lane, A. E., Young, R. L., Baker, A. E., & Angley, M. T. (2010). Sensory processing subtypes in autism: Association with adaptive behavior. Journal of autism and developmental disorders, 40(1), 112-122. https://doi.org/10.1007/s10803-009-0840-2
3. Lane, A. E., Geraghty, M. E., Young, G. S., & Rostorfer, J. L. (2014). Problem eating behaviors in autism spectrum disorder are associated with suboptimal daily nutrient intake and taste/smell sensitivity. ICAN: Infant, Child, & Adolescent Nutrition, 6(3), 172-180. https://doi.
org/10.1177/1941406414523981
4. Wallen, E.F., Ljunggren, G., Carlsson, A.C., Pettersson, D. & Wandell, P. (2018). High prevalence of diabetes mellitus, hypertension and obesity among persons with recorded
diagnosis of intellectual disability and autism spectrum disorder. Journal of Intellectual Disability Research, 62(4), 269-280. https://doi.org/10.1111/jir.12462
5. Robertson, A. E., & Simmons, D. R. (2015). The sensory experiences of adults with autism spectrum disorder: a qualitative analysis. Perception, 44(5), 569-586. https://doi.org/10.1068/p7833
6. Du, R.Y., Yiu, C.K.Y. & King, N.M. (2019). Oral health behaviours of preschool children with autism spectrum disorders and their barriers to dental care. Journal of Autism Developmental Disorder, 49(2), 453–459. https://doi.org/10.1007/s10803-018-3708-5
7. Smith, B., Rogers, S.L., Blissett, J., & Ludlow, A.K. (2020). The relationship between sensory sensitivity, food fussiness and food preferences in children with neurodevelopmental disorders. Appetite, 150(1), 1-8. https://doi.org/10.1016/j.appet.2020.104643

Hyper-reactive

• May be sensitive to touch, avoid certain clothing, avoids touching tactile substance
  (e.g. peanut butter).¹ ²
• May dislike crowded areas due to risk of being accidentally touched.¹ ²
• May have an intense reaction to light touch.¹ ²

Hypo-reactive

• May not seem to notice touch, pain, or temperature.¹ ²
• May enjoy rough deep pressure on the skin (hugs, pressure).¹ ²

Sensory Integration

• May not be aware or notice light touch; sense of sight helps notice touch sensation. 5
• May have difficulty holding and grasping items; challenges related to integrating touch and proprioception.5
• May have difficulty concentrating and listening to instructions when being touched due to discomfort.8
• The touch system works closely with vision and movement to help guide and direct the body.

Police Car/Ambulance:

• Physical touch can feel painful and uncomfortable; provide a warning before initiating procedures requiring physical touch.¹
• If physical touch is necessary, demonstrate that touch on a partner if possible.
• Various textures (clothing and bedding fabric, medical gloves, furniture) may cause discomfort/pain and lead to avoiding/pulling away from textures.¹ ³
• If police dogs are present, reassure the individual that the dog will not bite them.
• Individuals may react strongly to being touched on or near cuts, bruises, or injuries, or they may seem not to notice such injuries.
• Individuals may try to avoid or remove unfamiliar textures (face mask, gowns, gloves, bandages). Allow individuals to touch materials or instruments with their hands before using elsewhere on the body.³

Crowds/Shelters:

• Inadvertent physical touch in crowded spaces (bumping into, brushing up against people) can cause physical pain and distress.¹
• Individuals may have different preferences for texture of foods and may express dissatisfaction with food that is unrelated to taste and due to texture.¹
• Individuals may react strongly to being touched on or near cuts, bruises, or injuries, or they may seem not to notice such injuries.
• Various textures (clothing and bedding fabric, medical gloves, furniture) may cause discomfort/pain and lead to avoiding/pulling away from textures.¹ ³

• Provide options for fidget toys with different textures such as rubbery, stretchy, smooth, plastic, beaded, etc.7
• Visual cues during dressing, such as a mirror, can help visualize touch sensation. 6
• Social story for putting on hospital attire and wearing a facemask; a social story provides information in simple language and pictures to inform the individual about different processes and what to expect (https://paautism.org/resource/what-are-social-stories/).4

1. Robertson, A. E., & Simmons, D. R. (2015). The sensory experiences of adults with autism spectrum disorder: a qualitative analysis. Perception, 44(5), 569-586. https://doi.org/10.1068/p7833
2. Mikkelsen, M., Wodka, E.L., Mostofsky, M.H., Puts, N.A. (2018). Autism spectrum disorder in the scope of tactile processing. Developmental Cognitive Neuroscience, 29, 140-150. https://doi.org/10.1016/j.dcn.2016.12.005
3. Crane, L., Goddard, L., & Pring, L. (2009). Sensory processing in adults with autism spectrum disorders. Autism, 13(3), 215-228. https://doi.org/10.1177/1362361309103794
4. ASERT.(2020).Wearing a mask social story. PA Autism. Retrieved from: https://
paautism.org/resource/wearing-mask-social-story/
5. Allely, C.S. (2013). Pain sensitivity and observer perception of pain in individuals
with autistic spectrum disorder. Scientific World Journal, 2013, 916178. https://
doi.org/10.1155/2013/916178
6. Howe, M.B., Brittain, L.A., & McCathren, R.B. (2004). Meeting the sensory
needs of young children in classrooms. Sensory Needs, 8(1), 11-19. https://doi.org/10.1177/109625060400800102
7. Ashburner, J., Bennett, L., Rodger, S., & Ziviani, J. (2013). Understanding the sensory experiences of children with autism spectrum disorder: A preliminary investigation. Australian Occupational Therapy Journal, 60(3), 171-180. https://doi.org/10.1111/1440-1630.12025
8. Hilton, C.L., Harper, J.D., Holmes Kueker, R., Runzi Lang, A., Abbacchi, A.M., Todorov, A., LaVesser, P.D. (2010). Sensory responsiveness as a predictor of social severity in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(8), 937-945. https://doi.org/10.1007/s10803-010-0944-8

Hyper-reactive

• Generally not observed.

Hypo-reactive

• Movements may appear clumsy or awkward.¹
• May bump into objects while moving.¹,5
• May have difficulty holding small objects, or applying correct pressure when holding items like a pencil.5
• May play or interact too roughly with peers.5

Sensory Integration

• May have poor postural control.²

Police Car/Ambulance:

• May have difficulty with signing documents due to too much/too little force when holding the pen/pencil and when writing on the paper.³
• Before getting in the car, provide time to do wall pushups or jumping activity.6
• Provide a weighted blanket or other weighted item to place on lap while seated.
• Make sure to keep space clear of any fall/trip hazards.
• If filling out paperwork, provide movement breaks or breaks to relax hands and posture.

Crowds/Shelters:

• Provide an arm’s length distance of personal space.9
• Have heavy work options between activities or tasks (options can include helping to set up chairs6 or carrying a heavy item4.)
• Provide a weighted blanket or other weighted item to place on lap while seated.
• Make sure to keep space clear of any fall/trip hazards.
• Schedule movement breaks (examples: wall push-ups, jumping activities, or yoga) if doing a task that requires sitting for an extended period.³ 10

• Weighted blanket, lap pad, or wrist/ankle weights. 7,8
• Stretch bands (i.e., can be used as fidgets to pull with hands in opposition or can be placed around chair legs to push against, can wrap around door handle for pulling/stretches, etc.).6
• Box with sand for increasing weight against hand muscles.6
• Fidget toys or stress balls.³
• Soft lead 2B pencils (if individual is writing too hard and creating holes in paper).³
  https://www.amazon.com/Tombow-Drawing-Pencil-Graphite-12-Pack/dp/B00AQENMQ 4
• HB pencil (if individual is writing too lightly and handwriting is illegible).³
  https://www.amazon.com/AmazonBasics-Pre-sharpened-Wood-Cased-Pencils/dp/B071JM699P?ref_=fsclp_pl_dp_³

1. Imperatore Blanche, E., Reinoso, G., Chang, M.C., & Bodison, S. (2012). Proprioceptive processing difficulties among children with autism spectrum disorders and developmental disabilities. American Journal of Occupational Therapy, 66(5), 621–624. https://doi.org/10.5014/ajot.2012.004234
2. Doumas, M., McKenna, R. & Murphy, B. (2016). Postural control deficits in autism spectrum disorder: The role of sensory integration. Journal of Autism and Developmental Disorders, 46(3), 853–861. https://doi.org/10.1007/s10803-015-2621-4
3. Srivastava, A. (2016). Sensory integration strategies for handwriting among autistic
children. Academic Journal of Pediatrics and Neonatology, 2(1). https://doi.org/10.19080/AJPN.2016.02.555579
4. Schaaf, R. C., Toth-Cohen, S., Johnson, S. L., Outten, G., & Benevides, T. W. (2011). The everyday routines of families of children with autism: Examining the impact of sensory processing difficulties on the family. Autism, 15(3), 373-389. https://doi.org/10.1177/1362361310386505

5. Chu, V. W. T. (2017). Assessing proprioception in children: a review. Journal of Motor
Behavior, 49(4), 458-466. https://doi.org/10.1080/00222895.2016.1241744
6. Schaaf, R. C., & Smith Roley, S. (2006). Chapter 13: Sensational ways to play. In Sensory integration: applying clinical reasoning to practice with diverse populations (pp. 195-242). Austin, TX. Pro-Ed, Inc.

7. Eron, K., Kohnert, L., Watters, A., Logan, C., Weisner-Rose, M., & Mehler, P. S. (2020).
Weighted blanket use: A systematic review. The American Journal of Occupational Therapy, 74(2), 1–14. https://doi.org/10.5014/ajot.2020.037358
8. Gee, B., McOmber, T., Sutton, J., & Lloyd, K. (2017). Efficacy of weighted blankets
for children with autism spectrum disorder, sensory overresponsivity, and sleep disturbance. American Journal of Occupational Therapy, 71(4). https://doi.org/10.5014/ajot.2017.71S1-PO4116
9. Candini, M., Giuberti, V., Manattini, A., Grittani, S., di Pellegrino, G., & Frassinetti, F. (2017). Personal space regulation in childhood autism: Effects of social interaction and person’s perspective. Autism Research: Official Journal of the International Society for Autism Research, 10(1), 144–154. https://doi.org/10.1002/aur.1637
10. Rivest-Gadbois, E., & Boudrias, M. H. (2019). What are the known effects of yoga on
the brain in relation to motor performances, body awareness and pain? A narrative
review. Complementary Therapies in Medicine, 44, 129–142. https://doi.org/10.1016/j.
ctim.2019.03.021

Hyper-reactive

• May fear of leaving the ground easily susceptible to motion sickness.¹
• May avoid actions requiring movement or appear clumsy¹ during movement.
• Difficulty changing directions while moving.¹ ² ³

Hypo-reactive

• May not be aware of their own movement such as rocking.¹ 5
• Enjoy intense movement such as rocking or spinning without getting dizzy.¹ ³

Sensory Integration

• Vestibular system is closely related to the auditory system; loud noises may cause vestibular dysfunction such as dizziness.4
• Vestibular system also related to visual system; can experience dizziness while tracking or scanning.7
• The vestibular system works closely with the visual and proprioceptive (body sense) systems for balance. It is also important for keeping the body upright in sitting or standing.

Police Car/Ambulance

• Provide warning before starting to move the vehicle or initiating sudden turns.
• Avoid routes with road work or construction to avoid frequent stop and go movements or bumpy roads. ¹ ³ 4
• May not sustain eye contact during verbal directions or conversation.¹ ³ 7
• Individual may lose balance or become dizzy while the vehicle is moving; take extra precaution when starting, stopping/ braking, or turning the vehicle.³
• Provide extra time or be prepared for a delay in response with following directions requiring body movements.4
• Getting into and out of vehicles may cause loss of balance or clumsiness during movement.¹ ² ³
• Allow the opportunity to sit in passenger seat instead of backseat; or to have access to a window for air.10
• Being placed on a stretcher and then moved backwards into an ambulance may be challenging.9,10
• Making sure the person has a seat belt on for more stability while seated.9,10
• Consideration of balance needs: if individual is handcuffed, perhaps an officer could provide walking support or have the individual’s hands in front of his/her body instead of behind his/her back.²
• Consideration that clumsiness/stumbling or ability to follow finger-eye movements during tests may be due to vestibular difficulties, not drunkenness or due to concussion.² 6
• Communication may be impacted; individual may have difficulty concentrating or responding when experiencing motion sickness. 8

Crowds/Shelters

• May need to provide space to allow movements such as jumping and spinning because a person may need movement to stay calm or to be alert.5
• Steps or uneven ground may be challenging to navigate and cause imbalance.¹ ² ³
• Provide seating options that provide support/stability or opportunities for movement like a rocking chair or cushion.5
• If a shelter has bunk beds, consider the option of the bottom bunk to allow the person to be closer to ground if the person has a fear of gravity. ¹ ³
• Make sure to have railings or have someone walk with them when going up/down stairs to assist with maintaining balance.¹ ³
• Ask the individual or caregiver (if needed) about preference for using stairs, elevator, or escalator.

• Chairs or large exercise balls that rock can be relaxing and calming for hyporeactivity to movement as long as an individual can maintain his or her balance on the chair or ball (some individuals also prefer chairs that spin).¹¹
• Provide stable four-legged seating with back support and limited movement for hypersensitivity.5
• Provide a nausea bag in vehicles for motion sickness.
• Provide a heavy blanket or bean bag chair to provide touch and pressure input to an individual’s body to help calm an overreaction to movement.5
• Provide opportunities to walk around or do light exercise to help support attention and focus.5
• Play preferred music to help soothe and calm.9

1. Kern, J.K., Garver, C.R., Grannemann, B.D., Trivedi, M.H., Carmody, T., Andrews, A.A., & Mehta, J.A. (2007). Response to vestibular sensory events in autism. Research in
Autism Spectrum Disorders, 1(1), 67-74. https://doi.org/10.1016/j.rasd.2006.07.006
2. Siaperas, P., Ring, H.A., McAllister, C.J., Henderson, S., Barnett, A., Watson, P., & Holland, A.J. (2012). Atypical movement performance and sensory integration in asperger’s
syndrome. Journal of autism and developmental disorders, 42(5), 718–725. https://doi.org/10.1007/s10803-011-1301-2
3. Smith-Roley, S., Imperatore-Blanche, E., & Schaaf, R. (2001). Understanding sensory integration with diverse populations.New York: Therapy Skill Builders.
4. Baum, S.H., Stevenson, R.A., & Wallace, R.T. (2015). Behavioral, perceptual, and neural alterations in sensory and multi-sensory function in autism spectrum disorder. Progress in Neurobiology, 134, 140-160. https://doi.org/10.1016/j.pneurobio.2015.09.007
5. Howe, M.B., Brittain, L.A., & McCathren, R.B. (2004). Meeting the sensory needs of young children in classrooms. Sensory Needs, 8(1), 11-19. https://doi. org/10.1177/109625060400800102
6. Railey, K.S., Bowers-Campbell, J., Love, A. M., & Campbell, J.M. (2020). An exploration of law enforcement officers’ training needs and interactions with individuals with autism spectrum disorder. Journal of Autism and Developmental Disorder, 50(1), 101-117. https://doi.org/10.1007/s10803-019-04227-2
7. Carson, T.B., Wilkes, B.J., Patel, K., Pineda, J.L., Ko, J.H., Newell, K.M., Bodfish, J.W., Schubert, M.C., Radonovich, K., White, K.D., & Lewis, M.H. (2017). Vestibulo-ocular reflex function in children with high-functioning autism spectrum disorders. Autism Research, 10(2), 251–266. https://doi.org/10.1002/aur.1642
8. Henriques, I.F.,de Oliveira, D.W.D., Oliveira-Ferreira, F., & Andrade, P. M. O. (2014). Motion sickness prevalence in school children. European Journal of Pediatrics, 173(11), 1473- 1482. https://doi.org/10.1007/s00431-014-2351-1
9. Murdin, L., Golding, J., & Bronstein, A. (2011). Managing motion sickness. BMJ, 343, d7430. https://doi.org/10.1136/bmj.d7430
10.Leung, A.K., & Hon, K. L. (2019). Motion sickness: an overview. Drugs in Context, 8, 2019-9-4. https://doi.org/10.7573/dic.2019-9-4
11.Lytle, R., & Todd, T. (2009). Stress and the student with autism spectrum disorders: Strategies for stress reduction and enhanced learning. Teaching Exceptional Children, 41(4), 36-42. https://doi.org/10.1177/004005990904100404