Dealing with Sensory Overload
It's been a while since my last blog post but this one is going to be about a very common autistic trait, Sensory Processing and Overload, "Over 96% of children with ASD report hyper and hypo-sensitivities in multiple domains."[1] and in one survey of adults with ASD the result was still at 83%. [2] While some coping strategies and masking behaviours can be adopted the issues with sensory processing continue in to an autistic adult's life. As always this post will be about my own personal experiences with sensory processing and I acknowledge that it's a much bigger issue for some people. As with all autistic profiles there are a very wide and diverse spectrum of issues and severities.
What can be said with some certainty is that autistic people process sensory information differently and this can cause issues in a world that has been designed to be comfortable for the senses of neurotypical people. Sensory processing concerns have been a key feature of clinical descriptions of autism since the original reports by Asperger and Kanner. It is so prevalent that sensory issues are used a a key feature of the diagnostic criteria.
Neuroimaging evidence suggests that sensory symptoms originate from
differences in low-level processing in sensory-dedicated regions in the
autistic brain and offer insight into circuit-level alterations. [3]
It seems that all sensory inputs can be affected and there are some of us who have particular issues with taste and smell which can limit what foods we may prefer or avoid. Some of us prefer food that stimulates the senses. Spicy food for example may give us tactile stimulation and I especially love Korean food. We may also love or avoid certain foods because of the way they feel in the mouth (bananas and avocados are my main dislikes here). When we find foods that work we tend to stick with them and repeatedly eat the same thing. Autistic children are often labelled as fussy eaters as they can be very cautious of trying new things.
Tactile processing goes much further than just the feel of food and can create a dislike of; certain fabrics, soaps, or anything that comes into contact with the skin. I really dislike being touched by others, especially strangers. I have had big issues with hairdressers, dentists, doctors, random hugs, handshakes, pat's on the back, even accidental contact by someone brushing past me or just coming too close. As an adult I'm expected to not react when coming into contact with others and that has developed into a form of masking. Avoidance is another strategy that works but there's an obvious downside to avoiding things like the dentist.
Then of course there is visual overstimulation. I have problems with bright lights, reflections of lights, flashing lights, flickering light, certain frequency lighting or refresh rates on LCD and LED screens. I have for years turned the brightness down as far as I can to keep monitors comfortable.
My main sensory issue though is definitely auditory. It is the most common area of sensory processing problems in autism and as such receives the most attention. As I realise what bothers me and I unmask more and more I have greater difficulty just accepting the cacophony of sound that the world provides.
Noise is everywhere and beeps, bells, whistles, alarms, engines, brakes, people, conversations, TV, music, phones can all be heard at once. For me I have great difficulty prioritising one sound source over another and cannot block sounds out. If I'm having a conversation in a pub and there is a quiet yet still audible beep in the pub's kitchen then that may just be the only thing I can hear. Even if nobody else has even noticed it exists. I also struggle greatly if there is more than one conversation at once.
These auditory sensitivities can distract greatly and I cannot read, write or draw at all unless I'm in complete silence. I used to keep headphones handy and when commuting to work I would wear them even if no music was playing just to block the world out. These days I tend to have a set of loops earplugs[4] handy.
So when do these sensitivities become sensory overload? In children there may be a more obvious heightened reaction to what is outwardly a seemingly meaningless stimuli (e.g. screaming and hitting oneself in response to the sound of a vacuum cleaner) but the responses may come from a larger build up of previously unnoticed stimuli. Certainly as an adult I feel a more accumulative effect that reaches a tipping point.
The problem here, for me at least, is due to an inability to filter out the sensory inputs that are not important. If you regard all sensory input as having the same importance then it becomes overwhelming very quickly. When this happens there are a few options, a fight, flight or freeze[5] response.
Fight: You can try to ignore the extra input, distract from it, while this is not usually successful it's sometimes the only option. It's stressful and usually ends up triggering a greater reaction, a meltdown or an increased level of stimming.
Flight: This is my solution where possible I'll just leave, often five minutes in a quiet place will be enough to help me reset. Removing the affected person or the sources of the distraction would work equally well.
Freeze: Here I'll disengage from conversation and just try to shutdown all input. I'll go quiet and not engage with anyone. Often stimming helps here too but if nothing changes flight is still the end result.
One last thing I'd like to mention is that sometimes sensory overload can come purely from within. Yep, I can get overwhelmed by tactile stimulation from the clothes I'm wearing or even my own skin. I can fail to block out the noises I'm making or just have so much racing in my mind that any sensory input makes it impossible to focus. At least then I have more control over the source of the problems but it has taken me years to realise that I can be the source of my own sensory overload.
If I'm stuck in an enclosed space with stimuli outside of my control then I will reach sensory overload fairly quickly. Being on a busy train with people in close proximity, everyone talking at once, screeching brakes, fluorescent lighting, people brushing past, announcements, and no way to escape is sure to break my ability to mask successfully and unfortunately this is how I regularly spent a significant portion of my adult life.
What I've found very helpful is sharing details of my triggers, my wife is aware of and always considers my sensory issues when we arrive at a restaurant. There may be lights, sounds, people approaching that she knows will add to my sensory discomfort and she always asks where is best for me to sit. Sometimes that's all that is needed. Other than that a personal awareness of my triggers allows me to avoid them as much as possible, be equipped with ear plugs, sun-glasses and the knowledge that I don't have to put up with sensory disturbance just to fit in.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086654/
[2] https://www.griffinot.com/asd-and-sensory-processing-disorder
[3] https://www.nature.com/articles/pr9201193/
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